The Case of the Parking Lot Prediction

Sleep TMJ Therapy Vienna VA The Case of the Parking Lot Prediction
I knew before he walked in the door who he really was. He had filled out the online form as a new patient- it said he had sleep apnea, teeth pulled out as a kid, and his face was all distorted. As soon as the young man hopped out of that car, I told Meghan our new patient would be walking in the door in about 10 seconds. I was off by only two seconds! These days I have a bit of fun when anticipating that new patient and I see him or her walking up to our building and I try to figure out if they are here for us or one of the other doctors.

So anyway, this young fellow walks in and sure enough, it’s the new kid on the block, so to speak. We had a great talk about the fact that his orthodontist had pulled out several teeth and now he felt like there was no room for his tongue and he really could not breathe well any longer. His tongue looked like it was all dented in along the sides- it’s called scalloped tongue and happens when the tongue shoves its way forward at night in response to a closed airway. The tongue then gets indents from the teeth where it is pushing so hard, trying to open up the airway.

After the preliminary muscle exam/palpation/measurements, I explained that we now would need an MRI to check the discs and the joints. He asked me why I did not look at his occlusion- his bite- and I told him that the pathology of his bite supports the pathology of the joints and cranial bones, so who cares about the bite right now? He sighed and told me had been to three orthodontists recently who only cared about the teeth and all three took photographs to study his bite! My response was that his bite was bad and we first need to work with the cranial bones and the joints to get them level and aligned, and then one day we will get those pretty little white things nice and straight!

It is my goal, one of these years, to change how exams are done. It should be the standard to check a patient for cranial bones distortions, slipped discs, airway issues, and any other obvious distortions long before looking at the teeth. You see folks… unlike they taught me in dental school, the occlusion is NOT where it all begins. Only once the joints and bones and muscles are happy do we look at the teeth and consider doing the braces/Invisalign/whatever. Maybe one day we can turn things around and get it right!

The Case of the Misspent Youth

Vienna VA Orthodontist TMJ Sleep Disorders treatment The Case of the Misspent YouthIn my office we offer no charge screening for children who are considering orthodontics. Just yesterday a new patient came in and mom was interested in getting braces done for her daughter one day. She was 10 years old at the time and they showed up with an x-ray of all the teeth –a Panoramic film for you aficionados of radiography! The mother told me they had already been to three other orthodontists, which is when I stepped in to explain that I’m not a ‘real’ orthodontist, I just have lots of training in orthodontics, and that is a totally different thing. (Look for another blog on a totally different thing coming soon to a website near you) Anyway, the mom told me the real orthodontists had no intention of doing anything for the little girl for at least another year or two, until the adult teeth ‘came in all the way’ they said. As I looked at the x-ray, it was obvious there was not enough room for either the adult canines or the adult bicuspids to come in. Those of you who know me already know what happened- that’s right, I had palpitations, began to sweat profusely, and nearly passed out – just kidding ☺

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As I looked at the x-ray I held my breath while the mother explained all this and I politely explained that the little girl had a distortion to her cranial bone- the sphenoid – on the left side it was quite high. The girl also had big circles under her eyes and admitted to having trouble sleeping. Her palate was also cyanotic meaning her tongue could not reach up to the right height (this means her palatal vault is too high to allow for good nasal breathing too). So why did these so called experts want to wait on treatment? In my mind, I was screaming “She needs ALF appliances, not soon, but years ago”. So I very calmly and politely told the mother it might have been a wee little tiny bit smarter to have started a while ago (like around five years ago) and she told me this went against what the real orthodontists told her. When I showed her the high palate, the circles under the eyes, the very narrow arches, the huge looking tongue, then I think she got the message. She knew something was wrong, knew it a long time ago I think, but it took someone to show her what she already knew. Now I think this mother will go home and look at her other kids and start thinking about how they look and how well they sleep. I asked her to go to my blogs and learn some more before booking any appointments with our office. I think she really needed time to digest all that was said!

The Case of the Insurance Two (or more) Step

Vienna VA TMJ therapy treatment The Case of the Insurance Two or more StepIt was a dark and stormy morning- I knew this because I could hear yelling behind the door to our private office. Barbara was in there, the door was closed, and it was getting loud. Then, she came out and glared at me- you know, dear readers, that look that says I just want to hit something or someone. Well, luckily I gave her a cup of coffee and she calmed down. She had just spent a couple hours on the phone with an insurance company ‘idiots’ as she called them. She was trying to help a potential patient get help with their insurance and already she had been shuffled around (I call this the two step shuffle- they send you on to the next person and the next), hung up on, went on the eternal hold, and now finally got looped back around to the first person who said the claim would be denied.

This all started because a young man had been referred to me because he had headaches, neck and back pain, could not focus, and was just plain feeling awful. When I met him, he proudly showed me his recently completed orthodontic pictures- his teeth were very pretty and very straight. I could care less about that, because as many of you already know, we make the teeth look good ONLY when the jaw joints are happy and comfortable. Anyway – it took about ten seconds to look at a couple pictures to realize what was going on. His left ear and left eye were quite a bit higher on his left than on his right side. This clearly indicates the cranial bones are distorted, hence all the pain and other symptoms. When I did our palpation exam, he was hurting all over the head/neck region. My very technical diagnosis was this: he was a mess.

This young man had had his teeth pushed all over the place while ignoring the jaw joints, so he ended up with slipped discs in his jaw joints. Not a pretty sight when looking at the MRI. So I brought him and his parents in one Saturday to explain all this. I think it went well, but then they said a four letter word that changed everything: Insurance. (Yeah, I know it’s more than four letters, but who’s counting? You get the message) It turns out that the insurance coverage was the most important aspect of the treatment, and as many of you already know, insurance does not cover what we do most of the time. So, Barbara did her very best to battle with the father’s insurance carrier –she put MANY hours into the fight and when she asked the father to call member services (only the subscriber can do this, we are not allowed) he berated her and told her to ‘do your job’. That did not go over very well as you can imagine. Our office just helps people file as a courtesy- we do not participate or work for the insurance companies. In the end, the insurance company won, they did not have to pay, and the family gave up on us. This does not happen too often – many times we can win the battle, but after so many hours of getting shuffled around, you get nowhere and have to end the fight. It’s a shame when we have the answers, yet the insurance company gets in the way of proper treatment.

The Case of the Missing Migraine II

TMJ Treatment Vienna VA The Case of the Missing MigraineIt was Thursday, February 18, 2016 and I dreaded what was going to happen. You see, SHE warned me, SHE told me she was going to be my worst nightmare. That was two weeks ago when I placed the appliances in her mouth. I knew I should have just turned her away, I knew how this was going to go down- she would come in this morning, angry and frustrated because she could not eat or talk with ‘the stupid things’ in her mouth. We both knew this was going to happen and so that is how my day began on February 18, 2016. It was one of those dark and stormy nights, or daytime’s, as so many writers write about.

Anyway, back to my story. So SHE came in, sat down in the dental chair, and demanded to see me right away. I walked out onto the floor, expecting to be berated for putting those ‘stupid plastic things’ in her mouth, but instead I was met with a smile! In two weeks, this lady’s migraines were totally and completely gone! She told me her kids were thrilled their mommy was able to be with them all the time. Then she told me her husband was thrilled to have his wife back! I guess my worries were all a waste of time. You see folks, this lady had terribly slipped discs in her jaw joints, and there just was no other way to deal with this problem – she HAD to wear the ‘stupid things’ in her mouth to decompress the discs, take the pressure off the nerves and get relief from the migraines. I just had no idea it would work so quickly- I was thankful it did because that is the biggest problem with what I do – compliance! It sometimes takes a good bit of time for the discs to ‘unwind’ as we call it and show the patient that this stuff actually works.

I guess I should not be so hard on myself some of these times, but I just want people to get better. I really do worry that the patient may not tolerate the device at times, but I really don’t know any other way to do what we do.

The Case for Natural Healing

Vienn VA TMJ H2O2 Therapy treatments The Case for Natural HealingFor many years now, I have recommended that our patients, friends, and family use Hydrogen Peroxide when they are under the weather. Little did I know that there is so much more to this little substance than I ever thought. If any of you would ever like to do a little research, just type into a Google search for an e-book on hydrogen peroxide therapy/treatment. The book I found was almost 100 pages long and explains how you can very naturally treat many of today’s maladies. The treatment is so very simple, yet what I wonder is this: Why won’t the doctors prescribe such a treatment? The reason is quite simple: There is no money in it for them.

You see, dear readers, hydrogen peroxide occurs as a byproduct in nature, from the process of photosynthesis. It’s hard to charge a lot for something that is so plentiful and so cheap – heck, our government would need to charge for our proximity to trees and plants in order to control our access to the peroxide (let’s not give them any ideas). There is strong evidence that the regular use of hydrogen peroxide may assist in many health functions and in curbing the disease process as well. Take a look at the information and decide for yourself.

So get off that chair, hop on the computer, and do yourself a favor- go find information about hydrogen peroxide therapy and decide if it’s the way to go for you and your family. Wishing you a healthier day!

The Case of the Distraught Dentist and the Displaced Distrust

Sleep Apnea TMJ Therapy Vienna VA The Case of the Distraught Dentist and the Displaced DistrustToday is a Monday morning, around 06:30, and I’m at the office reviewing charts for the day, looking at MRI’s, and generally just getting ready to start things. I am just a little distraught about a few things, and as you know, dear readers, I get these things off my chest. I had to come into the office yesterday and spend about two hours (on a Sunday) writing a letter – for the third or fourth time (I’ve lost count) – to help a patient get insurance approval for their upcoming treatment. Well, it’s been over four months now and my staff has put about 10 hours of their time into this one claim alone and we are getting nowhere! We used a normal billing code that can mean several different things and the insurance carrier manipulated the wording, of course, into something that made absolutely no sense in order that they could deny the claim. What else is new? So we now have this young college man who cannot sleep, has constant pain, cannot focus in school, and yet cannot get the coverage to pay for the treatment. The other problem is that his father has decided that the insurance company knows best and we are supposed to do what they say and “make it work” as he told us. Well, this has now been over four months of us sending in for pre treatment estimates and all we get is a lot of difficulty from the insurance carrier. Bottom line, they just do not want to pay and will do what they can to avoid spitting out a check.

So now, I’m distraught about all this, and the father does not trust us any longer because the insurance company has put a wedge in between all of us- hey, that’s a pretty good technique which will save the insurance carrier thousands of dollars! In the meantime, this young man is hurting and I know I can help him because this is what I do all day- his case is pretty simple and straightforward to me and yet the insurance has created a block to proper treatment- way to go! I am about ready to just call the father and tell them to go elsewhere, but any dentist who knows what to do would just tell the father to pay the bill and deal with insurance on their own. We are really trying to help these folks, but some days you have to wonder if it is worth it.

Dear reader- here is my message today: Don’t let the insurance company control your course of treatment!  I am not able to ‘participate’ because this would mean reducing my fees by about 75%. Would you like to have your pay cut by 75%?  The only way I could ‘participate’ is by running a clinic in which we see hundreds of patients a day and do a huge volume to make it work. You would lose the personalized service and I would not be able to do what I do to get people better. I realize you have insurance and I realize you want to use that insurance, but sometimes it does not help get you better. As an example, insurance will pay for the drugs for pain but likely will not cover a device which could actually fix your problem. In the long run, my treatment is far less expensive for everybody because most of our patients are actually fixed for the long term, not drug dependent, and stay more productive which as we know is better all around.

From your blogger who has had it with insurance companies…

The Case of the Baffling Botox

TMJ Therapy Treatment Vienna VA the case of the baffling botoxJust recently an article came across my desk and it really piqued my interest. I have referenced the article below so you really don’t have to believe what I say- you can draw your own conclusions. But, dear reader, since you know me by now, I am going to tell you what I think anyway! From what I have learned in this article, it does indeed appear that botox has the potential for damaging both the mandible and the condyle which are critical components to TMJ therapy! This is not good because I see classes all over the internet for dentists to learn how to make more money by doing Botox injections on their patients. This concerns me because one day there may be an accounting for those dentists and MD’s who have used Botox for monetary gain when they should have known about the damage Botox might cause!

In the past six months, I have had four patients of record do the surgery to correct the disc in the jaw joint. Each time, the surgery itself went really well, but post-surgery the patients had a lot of complications with pain and spasms. In all four cases, these patients had used Botox and some of them had only used it for a month or so. Well, the article does state that in the test cases there was bone damage in just a month or so. Just imagine that if you have been on botox for years then there could conceivably be so much damage that the jaw bone could erode away in some cases. And, we just had this happen a few months ago- one of our surgical patients had this happen. When the oral surgeon went into the joint to re-position the disc, he discovered that a large portion of her jaw bone had eroded away. Further investigation showed us that she had been on Botox for years to cope with the pain. Luckily, many months later, she is getting better but it is a long, slow process indeed.

For those of you who want papers, case studies, details and more data, don’t ask me!   I am just a TMJ guy who is down in the trenches treating patients and making observations as I go. I learn every day and try to guide people toward a better path whenever possible. I have stated many times that I do not have the time or the resources to run a bunch of studies, although I would really like to! So if any of you have a really rich parent who would fund my research, just let me know! ☺

Referenced Article: Further Evidence that Botox® Injections Cause Bone Loss in the Jaw

The Case for Too Many Little Letters

Vienna VA Orthodontist The Case for too many Little LettersToday is just for fun my dear readers. I was watching the Super Bowl last night and saw an ad for ‘OIC’ and could not help but laugh. OIC stands for opiod induced constipation. Go figure –now they have to abbreviate drug induced constipation. I guess it’s kind of like saying you have a ‘TIA’- if you are Hispanic, that means you have an aunt, but if you are in the hospital it means you are having a transient ischemic attack, or chest pain.  Go figure! And if some of you might remember, I am still being investigated by the CIA. I am not sure where the investigation is going, but such governmental agencies keep a close eye on people who mix too many spices in their chili and do not follow proper protocol- hence the Culinary Institute of America is watching my every move. I promised them never to mix coriander, ginger, chili powder, and garlic – ever again – yet I’m still on their watch list!

The other group, the FBI, has been watching me as well for some time. I knew I was in trouble that day – it all happened at the local pub down near DC – I ordered a ‘French connection’ and it all went sideways from there. The bartender turned his head a bit off to the side and categorically denied any and all knowledge of such a thing. He went across to a quiet side of the bar and made a phone call and came back shortly. He then proceeded to mix Courvoisier with Grand Marnier and as he put it in front of me, he told me how no one asks for such a drink and to ‘never mention it again’ in public because you simply should not mix these things. Anyway, the Food and Beverage Industry, the FBI, has kept an eye on me for the past couple years to make sure I did not slip up again. You see, mixing cognacs is not allowed, especially in France, and it may have created a gastronomical incident.

Too many abbreviations! I am on a mission to eliminate them and will do my best to never, ever, abbreviate again!  TKS, FYI, my MO is to ELIM ABBs ☺

The Case of Disastrous Dental School Dilemma

Sleep TMJ Therapy Vienna VA The Case of Disastrous Dental School DilemmaIn dental school, like all other dentists, I was taught that the ‘occlusion’ or ‘the bite’ was the most important, highest level of achievement that a dentist could acquire. It was considered the holy grail of dental training to get the bite right and make sure all those little teeth occluded correctly. Well, I am here to tell you that this is a load of bunk! Our teeth actually rarely meet during the course of the day, and even when you eat, they really do not touch at all. The reason why we want the bite to be correct is to give the muscles a proper point to remember to ‘stop’ and rest. That’s really about all there is to it. And now the big BUT!  Even more important to proper occlusion is the condition of the joints!

When the discs are slipped out of place in the joints, the bite simply cannot maintain stability. I see so many patients who have had braces and they simply cannot maintain a stable position because there discs are so far out of place. It’s kind of like if your car needs a front end alignment and you never get around to doing it and you wonder why the ride is so rough all the time. Well, that’s what happens when jaw joint discs are all out of place- it’s a rough ride and the teeth will drift and shift because the ride is so unstable.

Another issue that is very important is that we need to address the cranial bones as well, yet NONE of this was ever taught in dental school. Earlier this week I was on Facebook trying to explain this concept on a forum that only dentists are allowed onto and I was thoroughly lambasted by some dentist who said cranial bones do not move and I am crazy for thinking they do!  I tried and tried to explain to him that cerebrospinal fluid must pump regularly through the skull and how at night the glial cells need motion to dump out toxins. He told me I was an idiot for not understanding how the cranial bones are locked and simply do not move. I just figured he had not had any continuing education in a very long time, but it was interesting to deal with his lack of education because I see it every day. The neurologists will not believe that slipped discs can cause such pain – again, it’s because they did not learn this in medical school, so therefore, it does not exist.

This is the dilemma of my day- lack of training and lack of understanding. This is what my predecessor, Dr. Brendan Stack, had to deal with on a daily basis, so I am thankful he paved the way for me to some extent. He did the job of cutting the path through the jungle for me and now I at least have a trail of some kind. Maybe one day I will actually pave the road and get the doctors to accept what we do. Until then, it’s one day at a time and one patient at a time.

The Case for Good Intel

TMJ therapy treatment orthodontics help neck head back pain The Case for Good IntelYesterday I met a most interesting young man. At age 23, he had been in braces for almost the past 10 years – that’s right TEN years. He did 5 years in regular braces, then 5 years in Invisalign. When I met him, he presented with chronic back/neck/head pain.  The pain radiated from his temples and down into the jaw joints and into the neck and trapezius areas. Wow –this guy was in bad shape! Both of his orthodontists told him there was nothing they could do for him. My first glance at him indicated he likely had some cranial bone distortions – palpation confirmed this. The kid was distorted in the jaw joints which therefore twisted him up internally. I basically told him if he never saw me again, at least see an osteopath and a myofunctional therapist to get some relief going! On palpation of his muscles, he lit up like a Christmas tree as we say – everything hurt except for one muscle. That’s a guy who is hurting a lot.

So, dear readers, as you know, I sent him out for the usual MRI. The findings were posted online and conclusively show the discs are slipped inward- medially- on both sides. This would explain a few things. This young fellow also jumped around a lot, shook his head, could not sit still-  in other words he was exhibiting signs of a movement disorder. This had not been yet diagnosed by his MD, but the MRI findings now made more sense. Our plan would have been ALF appliances on the upper and lower jaw if the damage had not been so severe, but it was, so the plan is for him to wear the lower flat planed splint and an upper ALF until such time as the discs are corrected one way or another. And of course, you all already know, this likely means he will need surgery to fix the joints.

As it might seem really obvious by now, it takes good intelligence –good intel –to make a decision on how to treat a patient. The MRI and the proper palpation of the muscles made things fairly easy to identify. I just wish this young man did not have to go through 10 years of braces in order to figure it out.

So What Does the Modified Gelb Appliance Actually Do?

TMJ treatment Vienna VA do not give upI have been asked to explain what the concept is behind our modified gelb appliance. Well, here goes. It is a basically very simple concept – the device decompresses the joints-  that’s it! What I tell our patients is that the jaw bone is set too deeply into the socket, and this tends to push the disc out of position so by making your lower back teeth a little taller, this will effectively allow the jaw bone to come down and out of the joint and take pressure off the little disc in there. Wearing the appliance is not the easiest thing in the world, I definitely admit to that. In fact, I tell many of our patients how much they will likely hate me for the first week or two as they adjust to the appliance! Speaking is not at all easy, and eating is downright difficult, but in a week or two you should be fine.

What happens with this appliance is that by taking pressure off of the joint, the disc that sits above the jaw bone now has a chance to actually go back into place. Will it actually work? I would have to say it’s all a matter of time. I find that this works exceptionally well the younger the patient is. As the years go by, the slipped disc has been too far out of place for too long and is more likely to adhere, or get stuck, in the slipped position. Then surgery would be indicated. The surgery is simple and takes less than one hour to do. For most patients, they are back to work almost right away, but to be fair, the patients who have been on botox, risperidone, Seroquel, and other various drugs do not fare as well post operatively. We are not sure exactly why, but we are working on it.

The plan with the modified gelb is that the patient wears this for about 6-12 months, then we do a new MRI to see if things have gone back into position. If all is well, then it is usually time to do braces and get rid of the appliance(s). In my discussions with our patients, I very clearly do state that there are a number of options and we will discuss them well in advance so they know what they are getting themselves into.

The Case of the Frequent Flyer

TMJ Treatment Vienna VA TMJ Therapy Jo Ellen

By the way, here are Jo’s actual pictures before treatment and now!

In today’s blog I am going to tell you a story about a woman named Jo Ellen, or “Jo” to her friends. For 25 years Jo has suffered the debilitating pain of dystonia. She spent her weekends curled up in bed because of the pain and could not even play with her children in the park. Her neck was so tipped to the side all day and all night that she was constantly exhausted fighting with her own body. Her husband left her a long time ago and she was forced to raise two children by herself. She thought her life was ruined and her children would be growing up without a mom pretty soon. Jo lives in Orlando, Florida, where the sun shines all year round and it never really gets too cold, but that did not matter because she had no life to enjoy.

It was about a year ago that Jo found out about my office – Sleep and TMJ Therapy– and after a lot of deliberation, she decided to fly up to Vienna, Virginia, to meet with me and my team. We discovered she had a serious TMJ problem –the discs in her jaw joint were slipped out of place. I made her a special dental appliance to take the pressure off her jaw joints and within minutes her head went from tilted to straight. This was just the beginning. I explained to Jo that this would be a long process, it would take lots of adjustments, and lots of patience and time. She said she was game for it. Over the next 8 months, Jo flew up to our office about 6 times to have her appliance adjusted accordingly and at every visit she reported how she felt better and better.

Today, Jo goes to the park almost every weekend with her children, takes them out for pizza, and enjoys every minute of her life. Her story is one of devotion to family and commitment to better health. Jo recently met the man of her dreams and thanks God every day for her new life. At our office, this is a typical story of what happens every day- we meet people who have almost given up and give them back their lives!

The Case of the Misleading Medication

TMJ therapy Vienna VA dangers of exposure to botulinum toxin botoxIn the past six months, we have had 3 or 4 people have serious difficulty with healing after their TMJ surgery. I have been debating this with our surgeon, Dr. Eugene Gregory, for some time now and we have finally started to see a common theme here. Each and every one of these difficult patients has taken Botox in the past year or so! Here is their situation: they all have had seriously slipped discs in their jaw joints and after conservative therapy wearing the TMJ splint, they all felt better that first year. However, as my readers well know, I am not convinced they are finished until and unless the MRI looks good. In these cases, the follow up MRI obviously did not look good so the patients elected to have the surgery and fix the joints once and for all. In each case, the surgery went quite well and the patient started along the road to recovery.

In one case, the patient called me two weeks post operative to tell me she was having spasms of the head and neck region. In another two cases, the pain in their head and neck was getting worse and worse by the day. In all of these cases, the patients had a fairly easy surgery but the healing was going way too slowly and the pain was subsiding every so little at a time. And now the fourth patient was in this morning – she told me she has trouble sleeping and the pain is going down, but it has been months since the surgery. Her jaw joints are fine, but the rest of the body is settling down ever so slowly.

The surgeon and I are in the process of determining how much botox was used, frequency of use, etc. and should be able to figure out more of this puzzle shortly , but what we are seeing is that even three injections of botox may have made these people unstable and now they are not healing very well. The way the botox works is that it locks up the muscle fibers very tightly and after the surgical intervention the body does not respond well as things reset. This is all just conjecture at this point, of course, but since people come to us for answers, we are looking at how botox might play into what we do. I will keep you all posted if we find something interesting.

The Case for Why I Have a Migraine

TMJ Therapy Treament Pain Migraines Spasms Vienna VA Tysons Corner MRI displaced disc

Just the other day I met another new patient who had been to multiple places like the Mayo Clinic, Hopkins, and other university hospitals. Her situation was that she suffered debilitating pain/migraines/spasms and onward down the long list. I did my usual muscle exam and discovered that almost every muscle I palpated was in spasm- i.e. lots of pain everywhere. For a 30 year old woman, this is not a good thing. So I did my usual thing – I ordered an MRI of the jaw joints.

Early this morning I came into the office with our little emotional support animal- Coco- and we read the MRI that had been posted online last night. The findings were awful- medial displacement of the jaw joint discs on both sides with cortical (bony) erosions of the jaw bones themselves. In other words, her joints were a total mess, a nightmare to deal with. This is a patient who will definitely need surgery to fix her problems.  That is when the migraine kicked in because I knew that I had to explain to this patient that she had needlessly suffered for years and years because no one could spot what looked obvious to me. If any of you have followed my blog these past couple years, then you might have an inkling of what I am about to tell this young lady. She will need the surgery for sure, and if she is like most of the patients who present to me with this MRI report, then it will take many months to heal and lots of pain/discomfort on the journey. She will have to take corticosteroids to reduce all the inflammation before and after the surgery to help things heal. She will need us to use the laser on a regular basis to promote good healing. She will need to work with her osteopath doctor to help re-align her body as she adjusts to having the discs in proper position for the first time in years. She will no doubt regret that she came to see me until one day the pain settles down and she realizes she had no other choice. She will be told that leaving the damaged discs in place will likely cause further degeneration and delays in surgery will lead to more damage to the joints.

And this is why I have a migraine today.

The Case of the Disbelieving Doctor

Vienna VA TMJ Treatment Appliance TMD Therapy Tysons CornerJust this past week we were supposed to deliver a TMJ appliance for one of our now former patients. She could only open her mouth to 22mm so you, dear readers, know she has a real problem that really needs to be fixed. Anyway, her general dentist told her to look into taking muscle relaxants and various drugs instead of actually wearing this thing in her mouth because it will ‘mess up your bite’ too much. Unfortunately, this is just so wrong for so many reasons. Let’s first look at the issue of the medications. Sure, drugs will make you feel better, for a while, but eventually they do not work too well and they most certainly do not fix the problem. Next, leaving the slipped discs in the jaw joints will keep an inflammatory condition going on and on for a long time to come. Chronic inflammation leads to a buildup of histamine and bradykinin which stimulate lipophosphases to enter the joints, and these erode the jaw bone and the disc. (I just had a patient who lost ½ of her jaw bone because she left the slipped discs in place for too many years – the inflammatory chemicals eroded it all away) And let’s not forget, this patient’s dentist was worried about the bite! In dental school, we learned the ‘bite’ was all important. In my world of TMJ treatment, the bite means absolutely nothing at all when a person is suffering chronic pain and can barely open their mouth!

So now, our disbelieving doctor has created a situation in which the now former patient has a chronic inflammatory condition in her body and plans on treating it with drugs instead of actually fixing it. This is like leaving a broken bone just sitting there and taking meds instead of putting it in a cast and allowing it to heal. Would any of you out there allow that to happen? It really made me sad but the doctor, due to her lack of knowledge, has now put this patient in a bad situation which will only get worse over time. I feel sorry for both of them. I truly wish there was more education in the field of TMJ treatment because people need this kind of help and are simply not getting it done the way they should. Too many people come see me when they are hurting badly and it’s too little too late – they are likely going to need surgery and a lot of time to recuperate when a simple device could have so easily fixed them in short order. I’m not discouraged, just more determined than ever to work on getting the word out!

The Case for the Happy New Year

Vienna VA TMJ disorder therapy treatment team

In all things important, one of the most is to have family and friends with you at all times. This past year, I have discovered this to be truer than ever before. I now have a team of people who work with me and they are all totally dedicated to our cause – we are out to make a difference in this world and teach the entire world what TMJ disorders can do to the human body. I can honestly say that 30 years ago in dental school, I never, ever, could even dream that I would be able to make such a difference in peoples’ lives by doing what I do. Heck, thirty years ago my TMJ instructor at Georgetown told us the opposite of what I know to be true now!  And I paid a hundred thousand dollars for that education. Oh well!

Today, many years later, I look back and realize that I really had to take the good with the bad in order to be where I am right now. Just a few months ago a new dentist asked if she could train under my wing and learn what I know. My best advice was to tell her to go learn as much as she can, take all the CE classes you can find, learn how to do it wrong, so that in ten years or so maybe you will be able to see why I had to send you away – sometimes we have to experience all the difficulties, all the frustrations, in order to see a better way to go. I guess that means I had to learn the hard way, but I am so glad I did. Today – the path is clear and as my team and I take on this coming New Year, we are ready to make more of a difference than ever before.

I welcome anyone’s advice and/or guidance on how we can make the journey better and reach more people than ever before. I cannot wait until we have a network of doctors across the globe who really understand TMJ disorder and can help people with the problems that I see every day of the week – it is so sad that so many people need to suffer when the ‘fix’ can be as simple as a thing like a retainer. So as we enter this New Year, let’s go in with a positive attitude and a mindset that says we will reach millions of people this year, not just thousands, and put these people on a better path to better health.

The Case of the More Silent Sleeper

Vienna VA sleep apnea tmj therapy sleep disordersIt was a dark and stormy night, the wind was raging and not a soul could get a good night’s sleep with all that noise out there. Wait a minute, there was no storm at all, it was just the 10 year old boy snoring, kicking, snorting, and waking up every minute of the night. I had a mom in yesterday who told me that in just the past 30 days by wearing the ALF appliances her son was finally sleeping through the night –no more kicking or snoring- and even better, there was no more cessation of breathing, which for a parent is the scariest thing they could ever watch. The young man in question had actually been diagnosed with very mild apnea, which in a child can be extremely dangerous, and even deadly, but we actually are on track to cure his apnea with these ALF appliances.

For those of you who are my regulars on this blog, you already know that I only post about actual cases – it’s kind of hard to make this stuff up anyway. It was such a rewarding feeling for me and my team to know that we may have actually saved this boy’s life – just realizing what we did gives me the shivers at times. How can such a little piece of wire make such a difference in a person’s life? Go figure. Anyway- the logic behind it is solid. The ALF allows the tongue to make the jaws move and grow like they are supposed to. But also – we look at the frenum attachments (those little string like things under the tongue) and we examine the cranial bones for levelness. This young man was both tongue tied and had uneven bones so we sent him to the myofunctional therapist and the osteopath to ‘straighten him out’ as I told the mom (she thought this was kind of funny). So by working as a team with our other doctors, in about a month this fellow went from not breathing at night (and I’m talking about TOTAL stoppage for 20 seconds or more according to mom – she said it was quite scary at times) to normal air flow and no arousals during the night. And, when he came to the office the other day, he could actually sit still in my chair- a month ago he squirmed around incessantly. I forgot to mention he has ADD, OCD, and some other D’s here and there. Is everything fixed? Heck no, but we are on the right path I believe.

The Case of the Frustrated Dentist

TMJ Screening Orthodontist Vienna VA Tysons Corner BracesJust the other day I met a dentist who knew something was rotten in Denmark, and yet here we are in Northern Virginia! You see, dear readers, this guy was all frustrated and just plain upset that people were coming to his office with braces on and they were just plain hurting since the braces were put on. By now, you know this person is yours truly! That’s right – I get frustrated on a daily basis because too many children are having braces put on their teeth just to make things line up really pretty. Unfortunately, they are paying the price – and believe me the price is very high – because the movement of the teeth is forcing the discs in their jaw joints to line up improperly and this can cause pain. That pain can then translate into back and neck pain and can eventually lead to more debilitating problems like dystonia and other movement disorders.

The message that I am trying to ‘put out into the world’ is that BEFORE you consider braces/Invisalign/whatever, you absolutely MUST make sure there is nothing wrong with the jaw joints – and this is such an easy thing to do! In the past week, I saw a patient who came here from Arizona and she had full braces on. She wanted us to see if she was ready to get retainers. She could barely open her mouth and told me all about her head/neck pain. This young lady was in bad shape because she did not have a TMJ screening done before having all that expensive hardware put on her teeth. All I could tell Mom was to go home, think about it, and only come back if she had the braces removed so we could get an MRI. I actually told Mom that if it was me, hearing these words for the first time, I would likely run for the hills! Yes, I actually told the mother that. Well, it’s been several weeks and I have not heard from them. I guess it was not worth having the braces removed to figure out the problem. Welcome to my world! Some days the best I can do is to tell a parent their kid’s braces need to come off so we can start them all over again. I wish I could change the world, but the best I can do is just one person at a time.

More About the Misunderstood Alien

Sleep and TMJ Therapy ALF Appliance Vienna VAOK folks- more on the ALF appliance. Gotcha again, didn’t I? The ALF has very little to do with aliens, but a lot to do with life in general. In many of our younger patients, including my own children, we use the ALF appliance to help our patients breathe better. The ALF actually expands the upper and lower jaw so that there is more space for the tongue. In addition, it will gradually lower the roof of the mouth – this is called the palatal vault – which means you will breathe better through your nose over time. And for those of you who read my blog each week, you already know that better nasal breathing means you will make more nitric oxide which means your body will be healthier in general!

The concept behind the ALF is that it gently expands the upper and lower jaw, but ever so slowly so that there is no ‘cracking open’ of the roof of the mouth, like there is with heavy duty appliances. We hardly ever use the old fashioned RPE- Rapid Palatal Expander for this reason. It has been found that when using ever-so-gentle forces that the body responds better and the reaction is more long term. This is the key to what we do- gentle, slow, careful. The way to think of the ALF appliance is that it stimulates the tongue to do what it is supposed to do and develop the arches more. The benefits are clear: better airway, more tongue space.