This morning I am doing my usual prepping for the day- reviewing patient records, reading MRI’s, and seeing if the schedule is looking good. As I do my review, I notice there is a note on one patient- she is very upset she could not get in sooner! As I look into her notes, turns out she cancelled her regular appointment a month ago (at the last moment) and said she would call back when she is ready. And in the meantime, she broke her appliance and now demands to come in on an emergency basis! Well folks, this is what happens when you don’t keep up with the program- the appliance wears down or grooves get beaten into it from clenching/grinding and just plain normal use. This is why it is so important to keep up with regular appointments. This way we can make sure the device is smooth, properly structured, and easy to wear so that emergencies do not often happen.
The other problem with cancelling at the last minute is that we saved that slot on our schedule just for you, and when you cancel at the last minute, it is not usually possible to replace you with someone else at the last minute. Now we have to use more time later on to accommodate you which blocks up time for someone else who could have used that time slot. You see folks, I do not do what the airlines do- I do NOT overbook and bump people off my flights! I honor their time and I would hope it is not too much to ask that they respect our time as well. Most of the time it works really well, I must admit, but when these last minute cancellations happen, it means that we have forever lost that time and now must re-create it later on which means more people becoming upset that they cannot get in when they want to. Does that make sense?
For example- yesterday I had 2 people cancel at the last minute, which seems to happen now and then. I get it, people are busy, they sometimes have work emergencies or last minute trips. But we lost that time and now have to make time for those folks in the coming weeks. Their time was NOW, not weeks from now, but they now transfer the problem to my scheduler who is being pressure to ‘make it work’ and somehow create time when there is none. One of the people who cancelled has done this three times already so in this case we cannot give her another appointment. She is welcome to call on a day when she really thinks she will come in, but by now her joints are probably in bad shape due to all the delays and cancellations, and the treatment protocol is disrupted greatly. She already complained to my manager that we are not being very accommodating and demands we see her on another day of her choosing. Well, nice idea, but we already had to reschedule other folks who did the same thing and are now taking time from other people. It’s a conundrum!
As I think about all this, I believe I understand some of what these people are thinking – that I am just like all the other doctors out there who over book, knowing people won’t show or will cancel, so who cares if I don’t show? Well folks, I can tell you that I have never done that and never will- I respect your time and all I ask is that you do the same.
In the past weeks of August in 2017 marks a shift in my education that will forever change how I see things with my patients. I spent five days with Dr. James Bronson at the ALF Educational Institute and then one day later flew to Oslo, Norway, and taught side by side with Dr. Darick Nordstrom, the inventor of the ALF appliance. This past week has now brought me to over 500 hours of actual training with the ALF appliance, and now I am into my fourth teaching trip with the ALF. Now, when I teach, I do NOT do cases like Dr. Nordstrom does- he is doing ALF on patients with severe cleft palates and the required surgery along with it. This, I admit to dear readers, ‘is not my cup of tea’ as they say. He was, however, impressed just a bit that we see many Tourette’s and Parkinsons cases. Dr. Nordstrom is an amazingly brilliant man and lives in a world where he makes his own appliances, by his own hand, and does research on a regular basis. He has even developed an amino acid supplement protocol that I would like to offer to our patients with tremors!
So back to the title of this blog. I have had it further ingrained into my rather thick cranium that a patient often needs a bit more than just what the ALF can do, although, based on this morning’s patients, we are doing pretty darn good just with the appliance therapy alone! So now I must put on my humble hat and admit that we could, and should, be doing even better. What that means is that many of the patients I see could do even better if we use a myofunctional therapist during the course of treatment- referred to as ‘MFN’ therapy. What this entails is exercises to keep your tongue working correctly (and believe me, MOST of us have poor tongue posture and movement). In addition, many people have a forward head posture, twisted neck, etc. so they would also need an osteopath – a ‘D.O.’ to help with distorted cranial bones, uneven leg length, out of place hips, and cervical spine (neck) problems.
In my world, I see people every day who have an amazing variety of ‘whole body’ problems that need to be dealt with. It is simply not enough for them to wear a couple devices in their mouth. Sometimes it will take a lot more effort and time to help them get better. And sometimes, about 10% of them simply do not get better without surgery or similar interventions. Some patients are simply in such bad shape that I cannot help them- they end up getting frustrated and angry because they spent ‘all this money’ and expect results. Unfortunately, sometimes there are just too many ‘imperfections’ in the person to help them get better. I see this when a person has been in an accident or two, was in a bar fight, or was T-boned while on a bicycle and a drunk driver outright nailed them. Yes- these are all my cases folks- and they are all quite difficult to fix due to the extent of damage.
I find it interesting that when people come to me, they expect me to fix all their problems with just an appliance or two. When I explain that they also need body work- i.e. an osteopath or physical therapist – many of them just will not do what needs to be done. This is due to cost or time in most cases. But I can tell you that when I see their xrays and their neck is all twisted up or their cranial bones are completely uneven, then I know they need that bit of ‘extra’ help- it’s as simple as that! And when the patient finally listens and does the required ‘extra’ therapy, that is when they get the results they are looking for – almost every time! So when I ask, request, demand, or simply advise that you also do myofunctional therapy or osteopath or physical therapy work, please take heed and just do it!
This week I had two young women in the office to deliver their ALF appliances. One of them asked me why snoring was so bad since her boyfriend ‘snored like a banchee’. As I explained the problems that are associated with snoring- there might be sleep apnea issues that lead to heart disease and diabetes, I noticed the woman’s father was turning red in the face. His daughter then told me that her Dad snored really bad too. Busted! He then said “I guess I should come see you too” and about all I could do was agree with him.
As many of my dear readers will recall from a previous blog, sleep is absolutely critical to your health! It allows your hormones to recharge at night and allows your body to heal from the stress of the day. And to top it off, if you snore, then you are more likely to have sleep apnea, not to mention there could be damage to the carotid artery from all that vibration. Whew…that’s a lot of stuff going on! The situation with children can be even worse- when a child snores, they are depriving their little body of the oxygen needed for body growth AND neurological development. And if they don’t get that oxygen at the proper time when their brain is developing, there will be a high price to pay as they get older. In other words, deal with the snoring NOW, not later!
When I use the ALF appliance, I find that in almost all cases the child or the adult sleeps better after just a few months. The ALF was invented by Dr. Darick Nordstrom nearly 35 years ago and yet very few doctors have any idea what it can do. Too many people come to see me after they have had nasal surgery- balloon plasty, turbinate reduction, septum straightening – and we could have avoided a lot of these if only we started with the ALF first. I was actually in Norway last week and had the honor of teaching side by side with Dr. Nordstrom and we met about a dozen or so local patients who needed some help. As it turned out, most of them had had some form of surgery and it simply did not help all that much. In all cases, our plan was to get them into ALF’s to ‘unwind’ that which had been done to them. I guess the term ‘unwind’ is something I say frequently, but it is very accurate in explaining what we do – I take people who are all tightened up and get them looser over time – and this gives them better health.
As I start this new day, it looks like I will be meeting around six new patients. This makes me realize that we are indeed getting the word out there- the ALF is working well and we have started to spread the word so to speak. As I lecture more and more each year, I see other doctors are beginning to learn that the ALF is a great concept and now that it has been in use for 35 years or so, it might one day become mainstream. I look forward to being part of this!
Hello dear readers- I knew this title would catch your attention! The blog for today is actually about one of our patients that my osteopath/physical therapist buddy, Dr. Logan Cooper, just saw a short while ago. This is a case of a fellow who came to my practice a few months ago and he had an MRI in hand from a local radiology office. He had gone to some local dentist who said he understood TMJ disorders and could help him with all the neck/back/jaw/shoulder/migraine pain that he had been experiencing for decades. I took a look at the guy’s TMJ MRI and the report said there was nothing of note – i.e. nothing wrong at all. Well, this made no sense to me so I asked the fellow to re-do the MRI up at Novant – the place I had used for many years. As it turns out, the new MRI confirmed blatant medial displacement of the discs on both sides of the jaw joints – i.e. this guy was a mess (sorry for the technical terminology here).
I discussed the MRI findings (the good MRI that is) with our patient, then took a few xrays to see what else we might find. The films showed the cranial bones were all distorted- really bent out of shape. This was when the patient became a little perturbed, so I asked him “What’s wrong?… what is upsetting you?” He explained that the other dentist wanted him to go right into braces, and then later do around $50,000 worth of crowns. He said it was very upsetting to hear such a difference in ideas and on how to treat because my plan only involved a couple appliances and nothing further until and unless the discs are back in place – and by now, dear readers, you have heard this many times- NO CASE FINISHING until and unless the discs are much improved! This patient was basically told to go right into a finished position right away. It would have been a disaster and he knew it now.
Anyway, back to the story. I explained all the distortions and slipped discs problems and he understood very well. Today he began working with Dr. Cooper and at the end of the appointment came over to me and said he was amazed what he learned. Dr. Cooper was able to show him that his leg/foot problems were actually causing his severe neck and back pain! And if I may once again say what I’ve said a million times: “It’s ALL Connected!” Who would’ve thunk it! 😊 Music comes to mind: Da foot bone is connected to da leg bone…da leg bone is connected to the hip bone…and onwards. In other words, what goes on in one part of the body really does affect the rest of the body, which affects your sleep, your healing, your entire well being. Get it? Got it? Good. ‘Nuff said.
And now the dilemma that runs through my mind every day. Why is it that so few doctors out there simply do not understand that the body really is connected? This fellow in the above paragraphs had been told by many doctors that all he could was to take botox and pills for the pain. That is simply not true. What actually works better is being seen by a doctor who understands the human body and strives toward better alignment of the body. When you are lined up properly, the CSF (cerebrospinal fluid) flows better and the lymphatics (crud) drains out better and you are simply healthier!
Since this is my blog, I have every right to get up on the podium and let you folks know how upset the insurance companies make me! Every month I meet many new patients who really need my help, but it is sometimes cost prohibitive. It’s a good and a bad thing really. Let me explain. When insurance does not pay, in some cases this might be good because if the person simply is not motivated to fix their problems, then they will not return because cost is the main driver for them. Yesterday I met a fellow who could only open his mouth to about 29mm, and as you all know, this is not healthy. His comment to me was “What does my insurance pay?” and my response was “I don’t know, but my manager will help you with that” He openly admitted that if the treatment was basically ‘free’ to him, he would try it for a while. I told him it will take at least 18-24 months of appliance therapy to unwind the problems. When I him smirk at that, I told him it would be best not to work with him and he agreed. We parted on good terms.
Last week I met a family, or I should say I met three children and their mother. All three children, and the mother, really could use ALF treatment and right away- they ALL had big circles under their eyes and were breathing through their mouths. When they found out that the cost for each of them would be starting at around $8000, the mother almost cried – she said her insurance does not cover ALF or TMJ treatment. These are folks who I would really like to help, but insurance won’t pay anything at all – that stinks! These are the cases that I can do so much good for, yet without some kind of insurance coverage, they simply cannot do it, or they will make a decision on who gets help and who does not.
Now, some of you on Facebook are wondering why I don’t treat them for free. The answer is that I cannot save them all- it’s as simple as that. Already I do about $10,000 per month in services for free – i.e. I help the people who need appliances that cannot afford our services, or give a big discount to an elderly person, or replace an appliance at no charge when the child leaves it sitting in a napkin in the cafeteria. This all adds up- a lot! Maybe it’s time we all look at the insurance companies and the idiots who are denying services. If you look at the insurance carriers profits, it is interesting how they all turn a nice profit year after year, even when the economy is down. Not a bad deal. They interestingly coerce people into signing up for these plans, and then later turn around and deny services – i.e. the TM joint! It is a joint like any other joint in most cases, and yet for some reason insurance companies exclude it in their plans. What a rip off to the customer!
Maybe it’s time for a little insurrection people! Maybe it’s time to call your legislature reps and tell them what a rip off these insurance companies are! Maybe it’s time to fight back and let your congressman know about the stupidity going on. So I’m sorry for ranting today, but after being on Facebook yesterday I realized how upset all of us really are and it’s because we are all paying piles of money and not getting a good return on our investment with our insurance carriers. Time to do something!
Here is one way to care for your teeth while wearing ALF or Gelb style appliances:
The only problem is that you need to do this outside and it can get a bit messy. Why not make things easier for yourself and try the Waterpik approach instead:
As you can see, it is just a small spray of water that will nicely clean the teeth and also keep your appliances clean as well. All you have to do is plug the pump unit into the electric outlet in your bathroom, fill the water tub, and blast away- it really is quite simple and you can do this right over the sink so it’s neat and clean!
A product that we more recently came upon is even easier to use- you just fill it with water and use it in the shower- there is a pump at the bottom, you just pump up the pressure and clean your teeth in the shower with ease -no batteries, no electricity at all- just hand pumping makes it go. The device is called: FAMI Portable Dental Care Air Pressure Oral Irrigator Water Jet Flosser and you can find it on Amazon for about $13. Not bad.
The reason for all this concern, dear readers, is that I am seeing a few too many people these days who are not brushing and flossing like they should while they wear the appliances. It is really important to keep your teeth clean at all times while you work with the appliances. If you do not, then you could end up with gum disease and even lose teeth! This would not be good for anyone!
So please take the time to clean up your act by cleaning up your teeth and gums!
It was a strange day last week when I met this new patient from about 20 miles away. She came in with a bad attitude -it was obvious what was going on – there was pain in her face and you could see if from 20 feet away! I palpated the muscles of the head/neck region and almost everything was incredibly painful -she just hurt everywhere! I knew for sure that I could help her and told her she came to the right place. The problem came up when I ordered the MRI of the jaw joints. She became very angry that she would have to drive to Tysons Corner to Novant imaging and there was no MRI center down the street from her house. I tried to explain that for us she was considered ‘local’- i.e. one of the neighbors.
The funny thing is that while she was in our office we had a family from Kuwait and New York here at the same time. As it turned out, these families were talking to each other about the difficulties of finding someone who understood TMD and craniofacial issues and neither family seemed to mind traveling as the patients were starting to feel better. It made me wonder if this local person was just in so much pain at all times that she was angry about everything that got in her way- like a little drive to see the TMJ guy!
So here I sit in my little office on a rainy and cold Monday morning. I have already seen seven TMD patients as of 10:30 this morning. They are all feeling a bit better overall, which is pretty darned good considering how they started in so much pain. A couple of them just got their appliances last week and have remarked how things are ‘already changing’ for the better- that makes my day when I hear those words. You never know what to expect in our office. And then there is the one from Colorado who feels better and wants me to finish even though the discs are still not in place. In addition -if I start to lower the appliance there will be postural changes that need to be addressed, yet there is no one near her to help make that happen, so we are not ready to lower the device. If she lived here, I would have Dr. Logan Cooper adjust her accordingly. Again, without the local resources, it is hard to finish treating someone who really does live far away!
For all these reasons, I am trying very hard to increase our network of PT and osteopath doctors all over the country, and indeed the world. More recently, I put the ever so famous Dr. Tony O’Connor from Cork, Ireland, on my list of great people to work with. He has a myofunctional therapist in his office who is doing great work for a couple of my patients who are from Dublin. It saves the patients time and money on the travel. Yet, I am still lacking in such resources in other areas of the world. I guess it’s a matter of time- we will get there one day!
It was a dark and stormy night….don’t you just love it when the story starts that way? Well, with most of the calls that I overhear to an insurance company, this seems to be appropriate. It was a couple weeks ago and I was overhearing one of my team talk to the representative from an insurance company. I will not mention the name of the insurance company since it does not really matter- most of them have the same level of ethics and caring as most hardened criminals. The difference is that this time they did it in writing. The policy states something like ‘We cover TMJ treatment’. The next line, however, states ‘We do not cover non-surgical treatment’ and the next line states ‘We do not cover surgical treatment’. So, in my little mind, the hamster is spinning on his little wheel as I get my head around all this. The little guy is running furiously trying to keep up with what my brain is trying to process. And after a moment I realize that this is more insurance doublespeak! I know I have written a little about this before and I just cannot let this one go for some reason! Was it some MBA who wrote the first line and then decided, “Hmm…these patients are a bunch of idiots…they never read the policy…let’s say we cover the treatment so we can truly say that to our idiot patients…then let’s just negate what we said in the next two lines”. My dear readers- all I can say is that this is brilliant, absolutely and totally brilliant! This MBA guy must think everyone out there in medical and dental world are a bunch of flippin’ idiots! Maybe he is right!
Just imagine if your automobile policy states that they cover you in an accident. Then the next lines state that they do not cover if YOU caused the accident, and the next line says they do not cover you if YOU DID NOT cause the accident. So now, in their advertisements, they can state that they cover you in the event of an accident because it says that in their policy manual. It’s like most deceptive advertising practices – just pick out what you want that suits your purpose and who cares about the rest of the sentences that tell the rest of the picture. I think it’s like those lawyer shows on TV when the lawyer asks a question and the person on the stand starts to tell the story, and the slick lawyer cuts them off and does not allow them to finish the whole story – the lawyer will just use the words they want and the heck with the rest of the truth. It’s deceptive and just downright dishonest and unethical.
So sorry for the deviation to the story, here we go, back to it. Anyway – the lady in my office was in disbelief when she read the policy back to the rep on the phone. She said this is a bunch of doublespeak and you could get in a lot of trouble for this. Eventually, after a short eternity of being bounced from one rep to another, to another, to another, did I say to another? She eventually reached a supervisor after many different transfers. She explained to the supervisor that she had the language in hand and would really enjoy filing with the state insurance commission and explain to them her concerns. Well, lo and behold and maybe even a hallelujah being sung in the background (I’m thinking about Shrek right now), the supervisor gave us approval and agreed to pay for the treatment that was needed! It sounded more like the supervisor was trying to pay off the upset patient more than anything else. As for myself, I just fell apart laughing when I heard that the case was approved, but it took multiple hours and countless transfers to get there. So I am thinking that if this is the level of difficulty it takes to get a case approved, why do we have insurance companies anyway? If you have to fight like a badger to help a patient get their claim approved, where does it all end? Perhaps we could go back to Roman times, have our disputes settled with my team members being gladiators and going against the reps at the insurance companies- let’s see them duke it out, maybe a fight to the death and winner keeps the money?
This is why folks, when you deal with those sons of…excuse me, super nice people, at the insurance company, that you write down their name (even if they won’t give you their real name), and write down the case number so that you can track the conversation. This way, later on when they say they never heard from you, you can refer them to the case number. Then when they say the case number does not exist, then you know for sure the game they are playing. This, my dear readers, is another example of the insurance company two step- a dirty little game they all enjoy playing and it costs you and it costs me dearly!
As many of you know, dear readers, I cannot fix everyone who walks through my doors. So today I am going to make a confession about one of my personal failures. This should provide some really good fodder for my naysayers out there, especially when you read about the outcome. This patient’s story goes as follows: Motor Vehicle accident in 1999- he was rear ended at fairly high speed while stopped as a jaywalker was crossing the street. The next morning, he was unable to move his neck or back due to the injuries sustained. TMJ MRI showed displaced discs. The two neurosurgeons told him the same thing: he needed surgery- rods down the neck and back to get stability. This surgery had nothing to do with the TMJ problem so there would be more work to do is how I figured. Anyway – this patient then told me that one of his surgeons told him he looked like “one of those marines who have jumped out of a helicopter a thousand times over” when it came to how damaged his cervical and lumbar spines were. And just to make it better, one of the surgeons told this guy that even if he did the surgery, he would probably be in a wheelchair within five years.
I knew right then and there I was over my head, but I had to try and help this guy. I made the usual decompression appliance which helped a lot. Then the patient went back and forth to MANY different pain specialists –from acupuncture, to chiropractors, to nerve specialists, and more. This poor guy saw everybody you can imagine and yet never really got a lot better. Fast forward almost twenty years and this patient is still wearing a similar appliance as he had right after the accident. He ‘manages’ the pain. There are lots of heating pads, back massagers, advil, hot soaking tubs, and whatever else he can manage with.
It was quite recently that I coined the term ‘train wreck’ with patients like this. It was also at that time that I openly learned to admit that I most certainly DID NOT have all the answers! And that was when life got just a little bit easier perhaps. I knew I could not fix everybody that walked in our doors because you see, dear readers, that patient is ME! Because of an irresponsible driver nearly 20 years ago, I now suffer daily back and neck pain and have learned how to manage my case very carefully. As I sit here typing, there is a massage device wrapped around my neck and I am wearing my dental appliance to support the TM joints. I simply could not take that risk with the rods going through my back- I did not want to end up in a wheelchair. So I too am seeking answers as I go along the journey. Maybe that is what makes me so passionate about what I do. My own failure with my own case has shown me that sometimes a person has so much damage that all you can do is to manage the pain and learn to keep looking for better answers.
I must admit that one of the ‘better answers’ has been working with the osteopath doctors that I work with. They seem to have a handle on getting things lined up better, longer. It is quite interesting having this type of doctor put their hands on your head, feel the cranial pulses, and tell you that you experienced an accident years ago when you never told them anything about it. So as a patient myself, I will keep you all informed of my own personal progress. My goal is to learn as much as I possibly can about this disorder that affects millions of people and is so poorly understood. I am hoping to educate millions of people in the coming years and to give them hope!
Today is a bit different from my previous blogs. Today I am going to speak about the experiences of my oral surgeon who does the TMJ surgery for my patients when they need the disc repaired or removed in the jaw joint. His name is Dr. Eugene Gregory and he has allowed me to use his name and explain what he does in this blog. Dr. Gregory has been doing TMJ surgery for about 30 years now and he has done thousands of joints- that’s right folks, THOUSANDS. In the past month I have had 4 or 5 of my own patients who needed the surgery try to find a surgeon ‘in their plan’- well that was a disaster of epic proportions. One of them actually called 19 – NINETEEN- surgeons hoping to get a discount on the procedure. As it turns out, not one of the nineteen surgeons really did TMJ surgery, although the insurance carrier said they did. (The patient was terribly misdirected by the insurance reps…but that’s a whole other blog) Anyway, all of these people ended up working with Dr. Gregory because no one else seemed to have the experience that he has.
The problem these people had with the surgeon was that he does not participate with their insurance plan – his fee of $6500 simply is not covered. The patient has to pay him the $6500 for his services and the hospital fees are usually covered by the insurance company. I actually asked Dr. Gregory the other day how he set his fees and why insurance did not cover that fee. He explained to me that 30 years ago, Blue Cross paid him $6000 to do the surgery and they also covered the hospital fees as well. It turns out he set his fee according to what the insurance company would pay and figured that would be fine as the years go by. Well, dear readers, what actually happened was that as the years went by the insurance carriers paid less and less for the TMJ surgery and today they only pay around $1500 or so to the surgeon who participates with their so called ‘plan’. This whole thing smelled kind of fishy to me. Instead of keeping up with inflation, ever increasing fixed costs, and higher malpractice rates the insurance company has undercut the surgeon to the point where there is no logic in participating!
I can see how sensible Dr. Gregory has been about all this, but I am also a bit perplexed. He has barely raised his fee in the past 30 years! To me this is incomprehensible for such a sensible surgeon! And when I asked him why he has barely raised his fees, he responded that he was just trying to keep it as simple as possible and help the patients out. So here I am, a guy who has an MBA and lots of business background, absolutely floored that his fee is that low and yet the insurance company has cut their payment by more than 75% over these past years – and this is based on THEIR original reimbursement plan, not Dr. Gregory’s, he was just following their lead years ago and being cooperative.
The way I look at it, these insurance companies are very readily taking over how we look at health care in this country and quite honestly it makes me sad. Just the other day on Facebook I was lambasted by two people – one said their fees would be set based on insurance company current rate plans (good luck with that) and the other said we had a free market system (that comment made me laugh for a good while). What we really have is insurance companies indoctrinating our people into thinking that the insurance company is doing right by them and the doctor is the real enemy who is ripping them off. Every week I explain to the patient who needs surgery that Dr. Gregory charged $6000 thirty years ago and today insurance would only pay him around $1500 if he participated. They are first a bit shocked, then angry, then really not sure what to do. Just imagine that your salary was cut, year after year, instead of going up. If you are smart, you would go find another job. Well folks, that’s what the good surgeons have done it seems- they do not participate because there is really nothing to participate with. But then, you have to wonder, who is really making the money when insurance rates go up, up, and up every year and benefits go down?
Dear reader – did you know carriers like Delta Dental in the past paid about $1000 per year to each of their dental subscribers for their benefit plan? And today, they pay about $1500 per year on many plans. There’s something quite wrong and really rotten with this. If subscriber fees were let’s say ten dollars a month forty years ago, and today it’s more like fifty dollars per month, then the benefit should be something like five times what it was forty years ago, not just 50% more. Do the math- you are being ripped off people!
So to finish up, my conversation with Dr. Gregory was a real eye opener the other day. He has only raised his fee by less than 10% over the past thirty years. I think if I was a patient, I would be quite grateful for a surgeon like that. If the insurance companies were run by people who could actually appreciate this, they would realize that he is doing remarkable work at a fee that is fair and reasonable, but alas, that is not how they think. I guess the motto of the story is that it might be more sensible to trust your doctor more than you should trust the insurance company!
Last Thursday I spoke to three of the osteopath doctors that I share patients with. The patients had all either been through a year of treatment, had the surgery, or were pretty much done and feeling good overall – that is until I sent them to the osteopath for their final checkups. You see, dear readers, I work with cranial osteopaths every day of the week and we very carefully check to see if my patients are able to go into braces and handle the stress of the braces. Let me explain a bit more. When a patient has an archwire- i.e. the wire attached to the bracket- and it goes across the midline, across the upper front teeth, this will effectively slow down the motion of the skull and may even slow down CSF and lymphatic drainage. And this is not a good thing.
Too many of my new patients come in complaining that their pain started during the braces or shortly after braces were done. I learned a long time ago to pay attention to the patients who tell me these things. The way the skull works is that it really needs to ‘move’ at all times to keep the CSF moving, otherwise things ‘lock up’ and ‘back up’ at the same time. Think of it like this- if the drains in your house are not open and able to drain out all the crud that happens to them, they back up and you end with damage to the house. That’s what happens in your skull too- if the crud produced by the brain is not allowed to drain out, then it backs up and you end up with things like ADD/OCD/autoimmune disorders, and other not so fun things happen. Don’t take my word for it- look up the research done at University of Virginia hospital center regarding the brain and lymphatics. This is going to be huge!
And so I have digressed…apologies. Back to the story at hand. The three osteopath doctors told me that the five (that’s right, five) patients that were supposed to be ready for their braces were not quite there yet- in other words crossing the midline with an archwire would have been too stressful on their bodies. But fear not, dear reader, they would all be in good shape with another month or two of osteo treatment. At that point in time, their cranial bones will be moving quite well and they can handle the small bit of stress caused by doing the braces and we can finish up their cases.
Now is where the ominous music should be placed in the program- the dum dum dum dum with lots of drums and scary sounds because by now, some of you have just realized that maybe, just maybe, they should take a different path other than slapping on braces or those clear aligners you see on TV. Just maybe you should have someone who understands TMJ disorders take a good look at you and figure out if your body can handle doing those braces. Just maybe your body is not ready to have the cranial motion locked up for a while. Just maybe such a screening would help you avoid headaches, neck strains, cranial distortions, etc – all of which are caused by having braces put on too early. Just maybe!
When a patient goes to their TMJ doctor, it is vitally important to make sure that certain technologies are used in order to get a good diagnosis and even greater treatment! In this article we will be looking at the merits of the dedicated Tesla coil, the xrays to look at the jaw joints, the digital impression scanner, and the low level laser therapy.
When it comes to getting a really great MRI of your TM joints, it is really important to be sure that the imaging center has a Tesla coil dedicated for this kind of work because it is so sensitive and can allow us to see the articular discs much better than the old technology. In too many cases, the MRI is done with an inferior machine and the reading is simply not that precise. This will often lead to a misdiagnosis and a path of treatment that costs lots of money, time, and frustration.
Another piece of technology in getting proper TMJ treatment involves the right xray equipment. It is important first of all to go with ‘green’ technology- i.e. low dose radiation and three dimensional imaging. The 3-D imaging comes in really handy when the doctor wants to see what’s going on behind and around the corners of various bones, especially the condyle or jaw bone. This information helps when trying to correlate to the findings of the MRI: Do the slipped discs make sense and is that why the jaw bone has shifted in that direction?
A very fun and very special advancement when it comes to doing braces to finish up a TMJ patient is the digital impression system. What this system does is that it basically uses a camera to videotape the teeth and the computer effectively ‘stitches’ all the videos together to show the lab what the teeth look like, instead of the old fashioned putty and tray method. In addition, the digital impressions are so much more accurate than the putty even could be. Then, the braces manufacturer uses a device to ‘cut’ each bracket to the best fit possible for every individual tooth- this means that each bracket is custom made, by hand (the hand of a computer guided laser that is) to the proper tip and torque needed to achieve the best result in the shortest time possible. Think of it like GPS for your trip up to Canada- the computer will design the least difficult, quickest, and most efficient path to get you there.
Let’s not forget to give mention to our old friend, the computer, which has advanced so much in recent years that we have become used to it running on terabytes, not kilobytes, of storage and how fast the processors have become. Without the computer, we could not show the patient the wonderful world of digital xrays and show them how their progress has changed. The computer and all these other technologies have surely changed our world!
In recent months I have met way too many new patients who were scheduled to have jaw joint or other more extreme types of surgery to handle their pain. This is about as smart as jumping into the path of a moving bus- in other words, it’s NOT smart! I am not sure why the increase in recommended surgeries is happening, but I think it’s important to put a stop to it now. The reason for this is that doing any kind of surgery will leave scar tissue and adhesions that will restrict the motion of the body. In my own practice, doing TMJ surgery is always done as a last resort after a course of careful and thorough appliance therapy. In addition, it is very critical that if the cranial bones are uneven, then there must be a concerted effort to level them out in order that if the surgery is done, it will be so much more successful.
The idea behind waiting on TMJ surgery is actually twofold: 1) The first phase oftentimes involves taking the pressure off the jaw joint discs so that inflammation will reduce, and many times those discs will actually go back into proper place so we can actually avoid the surgery and 2) Leveling the cranial bones, lining up the cervical, lumbar, and thoracic spine are all critical to good health and longevity when it comes to doing the actual surgery.
In other cases that I am currently working on, patients were told they would need one side of their jaw ‘cut and shortened’ to make it even with the other side. Well, that’s another ridiculous approach to a fairly simple problem. You see folks, in most of these cases the jaws are just twisted to the side because the discs are pushing the jaw bones out of the sockets and all we need to do is work on relieving the pressure on those discs and the jaw will actually realign correctly.
The only time that I have ever seen the need to ‘go in’ right away and do surgery is if the patient simply waited way too long to be treated and their jaws are locked shut. This is always a difficult situation. The patient tells me that it all started ‘a long time ago’ when the jaw just started to tighten up, things started to close down, they could no longer eat a hotdog or sandwich and eventually the jaw just locked. Sometimes I can use our low level laser to loosen up the muscles to take an impression and make our appliance but sometimes it’s too little, too late, and surgery is the only way to fix it.
So folks, if you are having head/neck pain, jaw popping/clicking, or even a movement disorder, get it checked out carefully before you become a surgical case!
Let’s start 2017 in a healthy fashion and see if we can all improve ourselves just a little bit more. Did you know that the latest research in sleep medicine is indicating that we are supposed to sleep around nine hours each night?
Yes, that’s correct – nine hours. There are so many reasons for this, but in this short article we can only cover a handful.
A few decades ago researchers did not understand why human beings needed sleep – it seemed to be a leftover from our hunting and fighting period. But now it is quite clear what is going on. The human body needs to “re-charge” at nighttime in order to prepare for the day ahead.
At nighttime, our brains drain out what are called beta amyloid particles in order to stay healthy and this requires us to shut down completely. Researchers at the University of Virginia have confirmed how critical it is that these particles drain out at night, otherwise the ramifications are that we are more likely to experience such maladies as Alzheimer’s, ADD, OCD, and autoimmune problems.
This is pretty scary stuff when you realize that there are millions of Americans who simply do not get anywhere near the amount of sleep they require to stay healthy.
Another massive problem in this country is sleep apnea. Apnea occurs when the body stops breathing a certain number of times per hour and oxygen levels in the blood drop substantially. Sleep apnea is directly correlated to heart disease, diabetes, gastrological problems, and a whole host of other issues.
Just imagine, if you are not getting anywhere near those nine hours of sleep – and let’s face it – most of us do not get anywhere near the sleep their bodies need – this means you are more likely to experience these problems as the years go by.
So what is the solution? Well, first you go see your regular doctor and have the normal blood work and yearly checkup that is needed to monitor any changes that might be happening.
In some cases it is necessary to wear a CPAP device to push air into your lungs. In other cases, simply wearing an intraoral device will prop open your airway enough that you can breathe adequately without the need for the CPAP device.
Either way, it is critical that you breathe properly or else you will one day have problems.
All of this information may sound a bit scary, but it is all true. You must see your doctor on a regular basis in order to monitor your stats – blood pressure, pulse, oxygen levels, bloodwork, etc. in order to keep healthy.
Otherwise you will end up on medications, which can reduce your quality of life. So get out there, call your doctor, and do those checkups!
A number of the parents of our Tourette’s diagnosed patients ask why the TV might be a factor in their child’s disorder. Well, let’s first be clear that I am ONLY treating TMJ disorders, I am NOT treating the actual tics, it just so happens that the tics of Tourette’s are likely a comorbidity of having slipped discs in the jaw joints. What I am seeing is that many of the patients who have these slipped discs- the younger patients- tend to be hunched over their TV or computer screens well into the night, my own kids do this too, and it’s hard to stop it.
When a person is hunched over a lot- leaning into the screen, it makes their jaws come forward and this alone can make the discs in the joints slip forward too. The other issue with lots of screen time is that your body does not produce the proper amounts of melatonin in order to get good sleep and this is highly contributory to not sleeping well, of course! And when the body does not get enough rest, it can go into hyperactivity mode and this is where a lot of the tourette’s kids tend to be- they are running all over the place and simply cannot settle down. This is called sleep deprivation by some doctors that I know.
So, dear readers, think of it like this. Your child is in front of a screen day and night on those long weekends- like mine were last weekend – and by Monday they are dead tired, cannot function, are really irritable and sleep deprived. No wonder they get hyper active, but even more so when they have tourette’s as their MD has diagnosed. As most of you already know, my position on movement disorders is that the discs in their jaw joints are displaced inward- medially- so if you add on the stress of extra screen time and not sleeping well, these kids are even more irritable and cranky than ever, which can exacerbate their tics! So if you have a family member with a movement disorder, think about what they are doing to themselves- is this child ‘on screen’ all day and all night? Are they gaming all night with their best buddies on the weekend? Are they up on Friday until 2:30am Saturday like my boys were last weekend? Hmmm….what a way to make a bad thing become a worse thing!
The area of TMJ (jaw joint) treatment is so little understood that maybe it would be good to explain why there are certain doctors out there who practice in this field. First of all, it would be helpful to understand what TMJ treatment is all about. Here are some of the symptoms that would prompt someone to seek help in this field. If you have chronic headaches, it is very possible, and often likely, that the discs of cartilage that cover the jaw bones are displaced, i.e. “slipped” like a disc in your back can be slipped. As you already likely know, a slipped disc in the lower back can hurt terribly. Well, a slipped disc in your jaw joint can do the same thing.
When the disc in the joint is out of place, this can prevent you from being able to open your mouth all the way. This is a very clear indicator that you might want to talk to someone who has an understanding of this problem. If your jaw joints pop, click, or crunch when you open and close, this is another clear sign that there might be a problem. This is something that should be looked at as well.
A small subset of TMJ disorders is when the discs are tipped “inward” from the jawbone and this can cause a patient to have tremors, tics, spasms, etc. Sometimes this is directly correlated to something called Tourette’s Syndrome – oftentimes something as simple as a specialized dental appliance will take the pressure off the joints and calm down a patient who has these “tics” as they are called. This is also the same concept with Parkinson’s – uncontrollable shaking is sometimes due to those slipped discs pinching the nerves around the joint.
Did you know that a TMJ doctor can help you reduce concussions and help with sports performance? It’s true. A well-constructed and well-fitted device will protect and support the jaw joints so that if you took a hit to the head, the risk of a concussion is greatly reduced. There are a number of mixed martial artists using this new technique very effectively already. They are much more able to handle a direct hit and the device gives them better neurological stability which means better strength all around. It’s a great device that can protect athletes and help them perform better, too.
The TMJ doctor can also help with sleep disorders, as well. The way this works is that a TMJ appliance will help the muscles of the head and neck to relax and this effectively helps the airway to open more. X-rays of the airway clearly show how before treatment the airway is nearly blocked, and how a year later the airway opens tremendously, which means better nighttime breathing.
Fixing TMJ problems is not a cure all for everything, but it is most certainly something that should be looked at when the head/neck/shoulders are involved.
As many of you already know, I see a lot of patients who are afflicted with Tourette’s Syndrome. This is truly an awful disorder- the patient can be blinking their eyes nonstop while their whole body twitches and shakes and the whole thing can be both embarrassing and painful at the same time. Tourette’s is difficult at best to deal with, but I think I have some ideas that might give a little insight into this terrible disorder. In the last two weeks, two of my patients, both adults, have had the micro surgery to put the TMJ discs back into proper position. The results were nothing less than miraculous according to the patients. The first one, we will call him Bill, did not even take the morphine drip that was offered post surgery because he felt no pain at all. But the good thing was that when he came back to my office to be checked, his tics were 60-70% gone (and now they are almost completely gone he told me!). And he then told this other guy (who also had Tourette’s) what he went through these past weeks so the second fellow did the surgery yesterday and came in to see me today. When I saw the young man, he only blinked heavily a couple times compared to constant eye wrenching and twisting- it was amazing to see. But more importantly, the spasms of his chest and stomach were over with.
As it turned out, the second patient had a totally perforated disc on one side! In other words, the surgery was beyond necessary and not just to attempt to repair the discs- there was serious damage in that joint and it needed immediate repair. Just imagine if your knee caps were way off to the side and you wondered why it hurt so bad every time you took a walk- well, this guy’s disc was literally blown apart on that side and it needed to be repaired. No wonder he was hurting so badly!
Now, dear readers, let’s get into something that is beyond coincidental, beyond what any of us has ever believed, understood, or even surmised over the years. In both these Tourette’s cases, the discs in the joints were tipped medially or inward. As a doctor, I am making a fairly bold statement here. I am stating that categorically when you have medially inclined discs, the likelihood of a movement disorder is likely higher…likely that is. (Sorry, like I could not resist that one) So what this means is that I am attracting movement disorder patients who ALL seem to have medially displaced discs! Or is it that patients with movement disorders actually, in reality, have articular discs that are medially displaced? That seems more likely, doesn’t it?
Anyway, I am so excited to bring this concept forward, and at the same time a bit sad too. You see, dear reader, I see so many patients with movement disorders and many of them have been misdiagnosed terribly. You need a great MRI and a great radiologist to see that the discs are tipped medially and I just don’t find too much of that happening in the real world. Because all I do is TMJ work, I am lucky enough to have the best radiologist working with me on reading the MRI’s so I admit that I might have the advantage here. This concept on the medial displacement is holding to be true in ALL cases that I see when there is a movement disorder here. Quite seriously, it is not at all likely that I attract patient with medially displaced discs. However, it is more likely that I attract patients who have movement disorders and I am lucky enough to have the tools in place to identify what is going on with them. As time goes by I hope to write a paper on this concept, but in the meantime I will just keep plugging along taking care of one patient at a time.
In the field of health and medicine, there is a lot of new research that health care practitioners need to pay attention to, especially the research that came out of UVA Hospital last year. This research, according to the reports, is about to change medical textbooks across the globe.
Basically, it confirms that the brain has a lymphatic drainage system. What this means is that for years it was believed that the brain did not have a system in place to drain out the debris, i.e. the ‘crud’, that builds up each and every day from normal use. Now researchers have proven that the brain does indeed have a lymphatic drainage system and that if it does not drain at night, then beta-amyloid particles can build up and lead to such debilitating problems as Alzheimer’s, autoimmune disorders, ADD, and OCD.
As an advanced lightwire functional device (ALF) dentist, the importance of this research is amazing. The ALF appliance is designed to open the airway, properly posture the tongue, and develop the face forward growth required to keep the cranial structures moving properly and in good health. This appliance is the only dental device that promotes good cranial motion, which is required to pump cerebrospinal fluid (CSF) and to keep the lymphatic system draining better at night. All of this is what helps keep the body as a system in good shape. Think of it like a well-tuned automobile – the oil flows well to keep the engine well lubricated and running at peak performance, just like all the fluids in the brain flow better when there are less restrictions.
The ALF appliance is made of a specialty wire from Elgiloy aerospace – the makers of some of the most high-tech wires in the world. The wire is actually activated by the patient’s own body heat and tongue pressure. It is adjusted on a monthly basis in order to be sure that it stays level in all dimensions, which promotes levelness of the cranial bones. In order to achieve the best result with the ALF appliance it is often necessary to work with an osteopath doctor to further assist in the leveling process. The results are often amazing when comparing x-rays only one year after treatment begins.
A good way to tell if you or a loved one is a candidate for the ALF is to simply look at the person. If the eyes/ears/eyebrows are not level, then likely the cranial bones are having some kind of distortion issue and could use the help. The ALF is also an amazing tool in reducing head and neck pain – think of it like this: it promotes better cranial motion, sort of like doing exercise, so it gets things moving and pumping and feeling better overall. It is great for both young and old because it gets things moving like Mother Nature intended all along.
Snoring is to obstructive sleep apnea (OSA) as thunder is to lightning. They may, but not always, appear together. One may be just an annoyance, but the other may be the precursor to serious trouble. The pathology of snoring is the same as for OSA, but not all people who snore have sleep apnea (although it is the most noticeable symptom).
Snoring is associated with an increased risk of hypertension as well as an increased risk of both cardiovascular and cerebrovascular disease. The percentage that a person snores has been directly related to the prevalence of coronary disease. In other words, the more one snores, the greater the risk for stroke.
With OSA, muscles of the soft palate at the base of the tongue and the uvula (the small, conical, fleshy tissue hanging from the soft palate) relax and sag, obstructing the airway, making breathing labored and noisy. Collapse of the airway walls can block breathing entirely.
When breathing periodically stops, a listener hears the snoring broken by pauses. As pressure to breathe builds, muscles of the diaphragm work harder. Sleep is then temporarily interrupted, sometimes only for seconds. This, in turn, activates throat muscles and “un-corks” the airway.
A listener hears deep gasping as breathing starts again. With each gasp, the sleeper awakens, but so briefly and incompletely that he does not remember doing so in the morning. Someone with obstructive sleep apnea may stop breathing for ten seconds or longer – dozens, even hundreds of times each night.
Each time breathing stops, oxygen in the blood stream falls and the heart must work harder to circulate blood. Blood pressure rises and over time may stay elevated after breathing restarts. The heart sometimes beats irregularly and may even pause for several seconds. This may account for some deaths during sleep of people who went to bed in apparent good health.
How Do You Treat Sleep Apnea?
The dental solution to treating obstructive sleep apnea is to utilize a comfortable, removable oral appliance. The oral appliance is an articulated elastomeric mandibular advancement appliance. This dental device is designed to allow the advancement of the mandible through a controlled range of forward movement, while at the same time allowing for a limited amount of vertical and lateral movement of the mandible. This type of appliance has proven extremely effective in treating snoring and sleep apnea.
There are three component materials in this type of sleep appliance. The body of the appliance is constructed of elastomer, a pliable material that offers the patients a much greater degree of comfort than harder acrylic materials. For additional support to the teeth as well as the temporomandibular joint, hard acrylic “bite pads” are placed in the molar regions. A commercially pure titanium articulating component grants the appliance the many adjustment characteristics that make this appliance unique – it is kind to the tissues, the teeth, and the temporomandibular joint.
These unique oral appliances are now a great choice for those who suffer from snoring and/or have mild to moderate OSAs. If you think you suffer from OSA, don’t hesitate to call a dentist specializing in sleep and TMJ therapy to schedule an evaluation. You’ll be glad you did.
Part I: TMJ refers to the temporomandibular joint, which is the joint that your jaw hinges and moves within. On top of the jaw bone is a little piece of cartilage-like tissue called a “disc”. When that disc is out of place, it is not unlike having a slipped disc in your lower back. If you had a slipped disc in your lower back, that would make it very clear as to why you might have back pain, sciatica, or even pain in the lower extremities. Well, a slipped/displaced disc in your jaw joint is exactly the same thing – it can cause headaches, neck/back pain, and even movement disorders like Tourette’s
Unfortunately, the TMJ (jaw joint) is perhaps one of the most misunderstood joints in the human body. In dental school, it is pretty much ignored except for teaching how to make a night guard. In medical school, they tell the students to leave it to the dentist – it’s their territory.
Dealing with the TMJ is quite often a cross disciplinary type of treatment. When the discs within the joints are displaced, patients oftentimes don’t really understand where the source of their pain is coming from. All they know is that their neck and back hurt and do not correlate that to the popping and clicking in their jaw joints. All that popping and clicking, however, is how Mother Nature gives out a warning sign of danger ahead to deal with it before it gets more serious. Once again, unfortunately for us as human beings, we go to the doctor and there is really no standard of care on how to treat this problem that can be very debilitating.
One of the best diagnostic tools to determine if the discs are indeed displaced in the joints is an MRI of the TMJ – a wonderful device that simply uses magnetic imaging to see the discs. The discs in the joints can be slipped in three different directions.
When the disc is slipped forward or anteriorly, it is kind of like if your knee cap was slipped forward of the knee – this can really hurt. With anterior displacement, the disc is actually stuck in that forward position, causing popping/crunching sounds.
When the disc is displaced laterally, or outward, this is more difficult to deal with than the anterior displacement. When the disc is not “reducing” (does not go back into place when you open your mouth), it is quite difficult to fix.
The other type of displacement is medial displacement. This occurs when the disc is squished inward toward the brain. This is the most difficult problem to fix. In many movement disorder patients, medial displacement seems to be the diagnosis.
Dealing with displaced discs requires wearing an oral device in order to decompress the jaw joints, which effectively gives the discs a chance to get back into proper position naturally. In fact, this technique is capable of reducing headaches, migraines, back/neck pain, and even movement disorders when done properly.
To be continued… next edition: Treatment Options.