The Case of the Mouth Breathing Mania

In too many people that I meet these days, both young children and older patients, I observe that the lower jaw is set back too far and it looks like they have no chin. It’s almost rampant how many children have this problem and yet so little is being done about it. When that lower jaw is set back then the airway, i.e. breathing, can be adversely affected.  These folks will breathe through their mouth in order to open the breathing passage as much as possible. This is what we call a compensatory effect- the body realizes there is not enough oxygen coming in so the person now breathes in as much air as they can through their mouth, instead of the preferred way through the nose. Here are some of the issues with mouth breathing:

  • Being a mouth breather will affect the person’s health as well. A mouth breather tends to initiate breathing in the upper chest, whereas normal breathing comes from the diaphragm. This means the body has to work harder to breathe and oftentimes the chest breather will take extra breaths or yawn to get in more air.
  • Mouth breathing is often erratic and not very smooth. This keeps the person in high sympathetic nervous system activity-i.e. in constant ‘fight or flight ‘mode – and this disrupts the normal digestion, sleep, hormonal recharging, mood, mental ability, and many other bodily functions.
  • Children who breathe through their mouth tend not to be well oxygenated and this affects their mental development. Many children wake up tired, want to sleep in all the time, and generally feel irritable all day long. For many of them, this lack of restfulness can lead to a diagnosis of ADD/OCD/ADHD. In reality- they are just sleep deprived.
  • Mouth breathing tends to force the body into a forward head posture position which then puts stress on the neck and back. Again- this is a compensatory position as the body tries to open the airway as much as possible. This then leads to long term back and neck pain which can lead to the need for neck/back surgical correction.

The message to parents is that they need to take a moment and just look at their child now and then. Are they breathing through their mouth? Is their head bent into a forward position? Do they snore at night or sleep with difficulty? All these issues can lead to sleep apnea, even in very young children. In turn, sleep apnea is now directly correlated with diabetes, cardiovascular disease, and even cancer.

Nasal breathing mouth breathingSo what can be done about being a mouth breather? First, get a diagnosis of what is going on. In  our office we have an xray that can measure the volume of the airway and this is a good start on the analysis. Also- you might want to have a sleep test done to see how efficiently the child/adult is sleeping. As for actual treatment, most sleep doctors will suggest you wear a CPAP to force the air down the throat and into the lungs. Some people do fine with this, and others not so much. From a dental viewpoint, the use of the ALF appliance has been extremely effective in actually fixing many cases of sleep apnea and sleep disordered breathing. The ALF expands the arches, making more airway space and allows the tongue better roof of the mouth positioning. In addition, it helps to level distorted cranial bones which allows for better flows in the skull- think blood, cerebral spinal fluid, and lymphatic drainage.

If mouth breathing can be identified at an early age, there is really good hope that the person can achieve better breathing, better sleep, higher functioning, and improved quality of life in a short period of time. Early diagnostics are the key to a better life!

The Case of the Concern About Radiation

The Case of the Concern About Radiation sleep and tmj therapy VA

Almost every day someone asks me about the radiation coming from our dental xray system. It is understandable that our patients have this concern, after all, we hear on the news that we need to be careful about sun exposure and the need for sunblock, so be careful about the radiation that you can really control- xrays. First of all, let’s talk about how xray units are measured. I prefer using a term called ‘micro-sieverts’ which is 1/1000 of a milli-sievert as far as dosing is concerned. Example: A normal whole body CT scan when done at your local hospital can expose you to around 10,000 microsieverts. That’s a lot of radiation! However, the radiation output for the 3-D imaging in my own office is more like 400-1000 microsieverts- that is substantially lower than a whole body scan. I am actually being very conservative with my estimate because the manufacturer of my xray unit insists that the radiation output is really more like 200-400 microsieverts.

The funny thing about radiation output is that it all depends on who you talk to. So far, I have not met with any consistency in these estimates. Did you know that you are exposed to around 400 microsieverts EACH and EVERY year just from being in your own home? That’s right- building materials put out radiation to a fairly high level. And if you have granite countertops, these things put out more radiation than a whole year of dental xrays! So when it comes to xrays at my office, I do not worry too much about the patient’s exposure because it is generally very little compared to all the background radiation around them.

By the way, I just read a report by Spring Hatfield, a dental hygienist, who reports that we receive 30,000 microsieverts of radiation yearly just from our food! The radioactive foods and drinks we ingest include Brazil nuts, lima beans, bananas, white potatoes, carrots, red meat, beer, and the annual dose you receive from food is equal to about 60 dental X-rays. So if you want a good snack it might not be so wise to wash down those brazil nuts with a cold beer!

The really important message here is that radiation is cumulative. This means that the more exposure you get, the more likely you will end up with a health problem. Like all things, moderation is the best approach. So when you do need xrays, it is always wisest to work with a doctor who uses digital xrays to keep down the amount of radiation you will be exposed to.

As you can see, the above information is really just a guideline to the amount of radiation you are exposed to on a regular basis. We are all constantly exposed to this radiation and just have to make the most out of our situation by being wise with how many times we get xrays and paying attention to the types of exposure we will be experiencing. Additionally – I personally believe in keeping radiation exposure to the bare minimum with children because their bodies are still developing and I think it is important to not overly dose them with radiation, even though it is so very little. Every person’s body responds differently so keep this in mind.

The Case of Treatment for Tinnitus

As many of you know, tinnitus can come in many forms. A person may experience hissing, buzzing, ringing or generally strange noises in their ears for no apparent reason. Sometimes the tinnitus can be so bad that a person is bed ridden and unable to perform their normal functions like going to work or taking care of their children. Other people find that the tinnitus wakes them up in the middle of the night and they are unable to get back to sleep. In our society, most people are already sleep deprived, so this is a serious threat to their general health.

It is generally recognized that tinnitus can be caused by several factors. One of the first correlations to tinnitus is actually in your neck. That’s right, when C-2 in your neck is out of place, this can often lead to the symptoms of tinnitus. As a TMD practitioner, I am well aware that when C-2 is out of place, this often will lead to displacement of the discs in the jaw joints as well, so perhaps the displacement of C-2 causes disc displacement in the jaw joints, which in turn puts inadvertent pressure on the ear. This might be how it all occurs, but there is no conclusive proof at this time.

The most logical cause of tinnitus, and the one factor that I have seen to be consistent over the years is that when the articular discs in the jaw joints are displaced, quite often this causes pressure on the ear canal and I believe is one of the leading causes of tinnitus. The reason I believe this to be true is that when the displaced jaw joint discs are treated, oftentimes the tinnitus goes away. If you check out the diagram below, you can see that the normal positioning of the articular discs should be just above the top of the jaw bone. Then, when that disc is slipped forward, or anteriorly, it will have the effect of pushing that jaw bone (condyle) much harder toward the ear canal. And since most of the time a disc is displaced anteriorly, I believe this is what puts the pressure on the ear canal and causes the tinnitus. And since I see tinnitus abating over the course of TMD treatment, there seems to be a strong correlation to slipped discs in my opinion. Sure, there could be other factors involved like damage to the ear itself from trauma, but most every time that I order an MRI after trauma and self-reporting of tinnitus, I see anteriorly displaced articular discs.

Normal Jaw Join Placement v Anterio Disc Displacement

So when someone reports tinnitus as a problem, it would probably be logical to check for displaced articular discs in the TM joints. It’s a great place to start.

In the sketch below, it can clearly be seen how many nerves are within and around the jaw joint. So if the jaw is pushed aside by a displaced articular disc, this can cause pain in the nerves and can disturb the surrounding tissue. Unfortunately, such problems are often overlooked by many practitioners. They are more often trained to treat the symptoms rather than delve deeper into the structural problem itself. With all the nerves that traverse through skull, it is important that the structure of the skull be examined carefully and the practitioner needs to look for any imbalances and displacements that might cause pain/tinnitus/twitching/etc.

TMJ Auriculotemporal Nerve diagram

Can Stress Trigger TMJ Disorder?

Sleep and TMJ Therapy Can Stress Trigger TMJ Disorder
You bet it can! When we are stressed, we do not sleep well and this can lead to plenty of clenching and grinding of the teeth. If this goes on long enough, the grinding/clenching can actually damage your jaw joints and displace the discs in the joints that are designed to protect the jaw bones.

In the past few months my office has seen many new patients to the practice and their chief complaint has been pain due to clenching/grinding of the teeth. The stress of dealing with quarantine and the Covid-19 isolation is really getting to people. Many people are worried about their jobs right now and I have met many who have not left their house except to come see me here at the office. They feel like they cannot wait anymore in dealing with the pain.

So why is all this stress so difficult on people? Well, what I personally see is that people are clenching their teeth together more frequently than they normally would. This is actually a fairly normal reaction to stress. It’s just like if we lived 1000 years ago- going into battle we clench our teeth and take a defensive, or offensive, stance in preparation for an attack. Well, stress does the same thing to our body- our sympathetic nervous system is activated- this is the ‘fight or flight’ response as our body prepares to handle an attack (stress). We clench our teeth, our blood pressure goes up, we are unable to sleep, cortisol increases, and we prepare to handle whatever comes our way. Unfortunately, when this happens day after day after day, the body burns out and starts to fall apart. By the time I meet up with this person, he or she is simply frazzled and feels like they have been hit by a train.
The mechanics of this stress is quite interesting. When you clench your teeth, the jawbone or condyle, gets ‘jammed’ high up into the jaw socket and pushes harder on the protective discs that cover the jaw bones. Then you end up with a slipped disc. We all know what a slipped disc in the lower back can do- leg pain, back pain, numbness. In the head, this pain can often be much worse. My new patients are reporting head and neck pain, arm and hand numbness, dizziness, tinnitus (ear ringing), and even various tics. These symptoms are extremely common with TMJ disorder, however, lately they seem to be on the increase.

So what do you do about it? With most of the people that I meet, they want to understand what is really going on and wish to deal with the problem. This is when I order an MRI of the TMJs to figure out if there is any displacement of the little disc in the joint. And in 95% of those cases, the discs are indeed out of place. So basically, what I tell them, is that the discs were probably out of place all this time and the stress kind of pushed them over the edge due to clenching on the joints and more pushing on the discs. For this problem, we have various paths of treatment if they wish to treat the problem. For those people who do not wish to identify or treat the source of the problem, what often can help is a nightly hot bath with Epsom salts and lavender to stimulate the parasympathetic nervous system- i.e. the ‘calming’ nervous system. I personally do a bath like this every night after a long day of seeing patients and hunching over the computer. Another thing that helps a lot of people is to just get out there and walk- every day of the week! Get out in the fresh air and if you have sunshine, well, that’s even better. Sun will help produce Vitamin D on the skin and the Vitamin D will help you sleep better at nighttime. After all, Vit D is not really a vitamin, it is a sleep regulatory hormone. Who knew? Anyway, more on that in a later blog. Another thing that might help is massage therapy and even meditation.

An interesting observation is that the stress is actually helping people to identify an underlying issue that has probably been there for all these years and they really did not know it was there. Perhaps this is a good thing in a way- people are identifying a health problem, due to the reaction to stress, and are dealing with it now rather than waiting until later on when it is more difficult, not to mention more expensive, to treat. So listen to the signs- if your jaw pops and clicks, you have more head and neck pain, then perhaps it is time to figure out what is going on. As I tell all of our patients every day- listen to your body! It knows what is going on. Stay safe. Stay healthy.

The Case of PPE and PSP (Personal Safety Protocol)

The Case of PPE and PSP (Personal Safety Protocol)

Everybody already knows what PPE is don’t they? It’s Personal Protective Equipment in case you are not aware. But today I would like to talk about my own philosophy on PSP- Personal Safety Protocol. Having been a dentist for over 30 years, I am acutely aware of bacteria and viruses in our environment. My own protocol has been like this for many years now. Every morning that I come to the office I will enter the office wearing sweats and a T shirt. In the office I will shower and change into what you see me wearing- pants and a dress shirt. During the course of the day I will wash my hands about 50 times, which leads to dry skin, which then I take care of with lots of Meyer’s clean day lotion- I just love the stuff!

There are a few changes that have been instituted for your own protection when you come to our office. First, we want to make sure you can be nearly ‘contactless’ upon entering the building. The front doors have a button to activate and open them- these are at the handicapped level. Just today, I called the management and asked them to put a foot button at each door as well because I have noticed people actually kicking the button that is at knee level, and the buttons have already been damaged because of that. It will add to our costs, but it also adds to your safety as well. Then, once in the building, you do have to push the elevator buttons to get upstairs- I recommend you use a knuckle to do this, not the fingertip. Knuckles are rarely used to rub eyes and face so I believe this should be safer for you. And when you come to our office, the door is wide open so it is contactless. In addition, we removed the cloth furniture from our waiting room and only have our patients sit in the leather chairs which are disinfected after each visit. We do ask that ONLY the patient or the patient with a parent come into the office. We no longer can have multiple visitors. Another thing that we are doing is we have you wash your hands before and after the appointment and use a pre-procedural rinse that kills bacteria and viruses for the time you are here. It’s a wonderful technique that I believe adds more protection and safety for your visit. And as always, ALL of our operatory chairs are disinfected after every patient and a new plastic disposable head cover is used on the headrest.

At the end of the day, our cleaning crew disinfects our floors. Also, we previously fogged the office every month, but now do this procedure every two weeks. Sure, it’s a bit of a pain, but I sleep well knowing that we do everything we can to protect you. And, just to add more, we are waiting on our UVC light which should be here any day. This will be used to further disinfect masks between patients which is required since our supply chain for masks is still unstable. Once again, we are doing all we can to protect you and your family when you enter our office.

And now back to my day- when I finish here, I change back into my sweat pants and T shirt, drive home after using a wipe to touch the elevator buttons, and leave my shoes in the garage or foyer area. Then I wash my hands and head up to shower and toss the sweats and T shirt into the laundry basket. I have done all of this for many years to protect myself and my family, but since so many of our patients are asking what I do personally, I figured I might as well go through the whole thing.

I am sure some of you will tell me this is a bit too much, a bit of ‘overkill’ as they say- pun intended here folks- ‘overkill’ of the bacteria and viruses. Get it? Good. I, however, feel that I want my office to be as safe as possible for my team and our family of patients who trust me with their health every day. By being perhaps a bit OCD about personal safety and keeping our office as safe as possible, this means there is one less thing you need to worry about during your day. Rest assured that when you enter my office that ALL of us are acutely aware of the struggles and stresses you are all going through and we want to make your visit with us safe and comfortable. Just this week I have had dozens of patients tell me they appreciate all that we are doing and how obvious it is that we are doing so much (Does this mean they think I really am OCD? Hmm…). I may be a little OCD, but at least I admit to being so and I’m darn proud of it these days. So with that I wish you all a safe transition through these difficult times and may you stay healthy and happy. All the best.

What Is An ALF Appliance And What Does It Do

ALF (Advanced Lightwire Functional)

The ALF (Advanced Lightwire Functional) appliance was developed by Dr. Darick Nordstrom about 40 years ago. In working with an osteopath (bone doctor), the ALF was developed with the principles of osteopathy in mind. There principles include promoting movement of the fluids within the skull especially, but these devices also will re-align distorted bones within the skull as well. Our bodies require symmetry and balance in order to work effectively. A good example of this is when your hips are not in alignment- this can cause the legs to be of different lengths which means walking becomes difficult and painful. The same can be said for the bones inside your skull. When the cranial bones are distorted, this can cause nerve impingement which can lead to head and neck pain.

Many of the patients who are treated with the ALF appliances have originally sought treatment for migraines, tremors, vertigo, neck pain, and even seizures. The principle of the ALF is that it will re-align the distorted cranial bones so that the structures within the skull can function more efficiently. Think of it like if your car has been in an accident and the frame has been bent. If you continue driving the car, you notice that the ride is rough- the car vibrates and simply does not run well. This is what happens with distorted bones in the skull- blood does not pump well, cerebral spinal fluid does not move well, and lymph cannot drain as well. And when the cranial bones are distorted, oftentimes the eyes are not level so the patient learns to tilt their head a bit to make their eyes line up with the horizon, and this will have the effect of pulling on their neck. So any distortion to the cranial bones will pull the neck to the side- and this is where dystonia comes from!

With children, the ALF is a valuable tool in preventing many future problems. The research from many years ago confirms that 95% of all children are born with distortions to their skull from birth trauma (that’s right – 95%!). As the years go by, their faces look more uneven – the ears, eyes, eyebrows become uneven. The ALF appliances work to make the bones in the skull more even, more balanced, over time. In addition, most children these days have very narrow dental arches and their teeth are crowded. The ALF can also have the effect of expanding the upper and lower arches to make more room for the teeth, which can prevent the need for extractions! That’s right- instead of pulling teeth out, more room can be gained for the teeth and this will avoid bigger problems later on!

One of the hottest topics these days in dentistry is dental sleep medicine. There is research that now links sleep disordered breathing (waking up a lot at night, snoring, sleep walking, etc) to heart disease, diabetes, and now cancer. There are many dentists who recommend using dental sleep appliances which open the airway and reduce snoring. These appliances to help however, they do not treat the underlying cause. Another issue with these devices is that they tend to create an open bite, i.e. the back teeth no longer touch. This can all be avoided using the ALF appliance. An experienced ALF practitioner can use these appliances to widen the dental arches and make more room for the tongue, which promotes better breathing and will stop snoring in most cases. As you can see, the ALF is an amazing little appliance that is designed for better health- for all ages!

The Case of the Screen Without the Saver

Sleep therapy VA The Case of the Screen Without the Saver

There is now a fair amount of research that indicates children should greatly limit their amount of screen time, hence the title of the blog- more screen time will not save you anything! More screen time means more damage to the body as there is less sleep and less healing. Let me explain. Research is now showing that when exposed to the screen of our TV, phone, and even that little alarm clock, the body does not produce serotonin as well. The light of the screen is telling your body that it is time to wake up, not time to shut down and rest. So here we have countless people who watch TV in their beds at night and wonder why they cannot get to sleep and get a good night’s rest. The screen is not saving them. The screen is not helping them sleep. The screen is actually harming your health!

As many of you already know, much of my training over the years has been in dental sleep medicine. There is now a great body of research in this field and we have learned that sleep is incredibly important to good health. One of the biggest problems we are facing now is that most people seem to have fragmented sleep. What this means is that many of us wake up multiple times each night and this is detrimental to our well being. Our hormones that control the body are not able to recharge like they should and the lack of deep sleep does not allow the body to heal.

So now let’s talk about the average child’s nighttime rituals. Well, mostly it seems to involve a little box with lights and it makes a lot of noise. It seems that many children are on their Android or Apple phones well into the nighttime, talking to their friends, gaming, and reading up on social media. This means that their bodies are being told to wake up. 100 years ago, BC (Before Cells), when the evening came around a child might read a book for a while with gentle light and they would slowly drift off to sleep. Today, that same child might be on their phone up until the time of bed, only to find that they cannot fall asleep. So they toss and turn all night, waking up frequently, and when the morning comes they are too tired to function. Unfortunately, I see this every day.

After enough years of poor sleep, it’s no wonder children are showing more signs of ADD, OCD, and health and behavioral problems. Fragmented sleep is now rampant in our society and there is no sign that it is getting any better. In fact, new research is showing that the current generation of children will not live as long as the previous generation due to the decline in overall health. Could all this be due to poor sleep? Yes- it certainly is contributing to poor health. Every day I counsel my patients to get outdoors and get in the sun and the fresh air. Do they do it? Heck no- they would much rather play games on their phone and log in to social media.

Dear readers – it is time that we re-think our behaviors and make changes that will help us live longer and healthier. Get outdoors! Get some sun on you! All it takes is 20-30 minutes to stimulate Vitamin D production which will help regulate the sleep patterns better. We routinely have our patients check Vitamin D levels and in almost all cases the D is virtually nonexistent. So make sure your ‘D’ is good, get outdoors, and have some fun in the sun!

The Case of the Miraculous MRI…Maybe

The Case of the Miraculous MRI…Maybe TMJ Joint

As you all well know, I like to document our treatment by using an MRI to determine if the discs in the jaw joints are out of place, and to what extent they are out of place. This gives us a great way to track progress and determine if the discs have improved over the course of a year in treatment.

Recently, I had a patient who was one year in treatment and it was time for a new MRI to see if the discs had improved in position to make sure we were on track basically. Her symptoms were most certainly a lot better- i.e. much less pain and better range of motion. Unfortunately, the original MRI showed very prominent displacement of the discs in both joints- i.e. it was bad. The day that we reviewed that MRI I told her that her risk of needing the microsurgery to fix the damaged discs was relatively high, but we needed to ‘work the joints’ as I call it, for about a year to see what can improve.

The original MRI showed the right disc had ‘prominent medial’ displacement which is about as bad as it gets. And the left joint had both ‘prominent anterior’ and ‘prominent lateral’ displacement- again really a lot of displacement. Both discs did not reduce on opening – i.e. they were stuck there and probably had been like that for many years. Another thing that I order on my MRI’s is the angle of the jaw relative to the central axis to determine how out of alignment the jaws were. Those angles came in at 76 degrees on one side and 62 degrees on the other- again, not a good situation but very important information to have to compare for the future.

Back to the story at hand. At one year into treatment, I ordered the new MRI for comparison purposes and told the lady to go back to Novant imaging- the same  people who did the first MRI so that we could get a good comparison done. You already see where this is going: She went to a different imaging center for the new MRI and the report came back stating there was no longer any displacement, nothing was out of place, all was well. Hey folks- I think I am pretty good at this, but not that good!  In all the years I have been doing this work, I have never had such severely displaced discs go back into proper position completely- in other words it’s simply not likely. It’s the same odds as winning the lottery, imho.

This is why good data is so very important. When using an imaging service for the MRI’s, it is really important to maintain consistency and use a company that does these images all day long. Most imaging companies only do MRIs of the TM joints once in a while, whereas I send oftentimes 3-4 patients daily to this one place- and they have become very good at reading and producing good data. So when I got this new report for this woman, I knew right away that the results were nearly impossible and if indeed the report was correct, this classifies as a small miracle! And since I have not seen such a miracle in the past, it was not likely that the discs recovered as much as the report stated- i.e. they did not read it well.

As I sat back and thought about this turn of events, I understood why the lady went to another location for the imaging- it was near her home and they were in network- i.e. insurance paid more. But then as I further reflected on the situation, it made me realize how easy it can be to entirely misdiagnose a TMD case. If the radiologist cannot read an MRI properly, that means there are many cases out there that are being misdiagnosed. So imagine  if this lady had originally gone to a TMD doctor more near her home and if she had the imaging done at the same place as she had done, then it is likely they would have missed the problems and her course of treatment might have gone a lot differently.

This is why TMD treatment seems to be a ‘hit or miss’ kind of thing. Over the past years I have had countless new patients show up here telling me they have been to ‘dozens and dozens’ of specialists- Mayo clinic, Harvard, UCLA, and Hopkins as well. A good MRI proved that the discs were displaced and allowed us to begin proper treatment. Without that MRI to prove what I thought to be true, treatment would never have begun. So therein lies the rub as they say- taking a shortcut on diagnosis does not benefit anyone.

The Case of the Happy New Year

Sleep TMJ Therapy VA The Case of the Happy New Year

Here we are starting a new year folks- it’s 2020! As I look back on what happened in 2019 I realize that our practice has hit some new highs that really need mentioning. My team and I have helped thousands of people over the years to improve their health and well being and I am extremely proud of my team for making this happen. I feel very blessed to have such a group of people that I call friends, and even family. Together, we have made a positive difference in many, many lives and I am truly thankful they are with me.

And now for 2020: we are going to help more people this year than ever before. I am currently heading to another dental sleep medicine program this coming weekend and it is geared up for both myself and my team members. This is one of those ‘few and far between’ programs that is designed to have the doctors train at reading various graphs and sleep studies while team members learn about how the lack of sleep affects a person’s life and how we can really help them get better.

As for me personally, I am in the middle of my studies to become a Diplomate of the American Board of Dental Sleep Medicine. This is quite a large amount of work. I fly to Boston every couple months, study articles and reports, write a synopsis of everything I study, and I just passed my first exam. This program is being done through Tufts University and already has given me new insights into how to better treat our patients.

One interesting thing that I learned from the Tufts program is that more emphasis needs to be placed on the TMJ and how dental appliances might help or hurt the joints. I have already brought this up with the directors of the program and they are considering making a few changes here and there. I personally believe that the ALF appliance that I use every day is the best course of treatment for sleep apnea because it makes very slow, very gradual changes that improve the shape of the jaws for better breathing. These days, when I deal with sleep apnea patients, I offer them the dental sleep appliance if they just want something to get by for now, or, alternatively, I offer them the ALF appliances to actually fix the apnea. That’s right folks- I am talking about really fixing the apnea situation once and for all. What the ALF does is that it widens the upper and lower dental arches which makes  more room for the tongue, and it slowly lowers a high palate which means you can breathe better through your nose. This is really important because nasal breathing promotes the formation of nitric oxide which helps you to heal better.

This year I am planning to teach in a few locations to help spread the word about what our practice does. If all goes well, I will be teaching in Warsaw, Poland, in the fall and plan on showing many of my own cases done in this office. It should be a fun journey and I am quite sure the doctors that I teach will be able to help their patients in a better fashion. Overall, it’s going to be a busy year with much more education and changes in our sleep protocol that will improve more than ever before!

The Case of the Thanksgiving Thoughts

The Case of the Thanksgiving Thoughts

As another year comes to its end, I am just sitting here thinking of how very blessed I have been. I truly am thankful for all the people that have trusted me over these many years and I am thankful that I have been able to contribute to the betterment of their lives. Although what we do is not an easy process- it does take time to unwind the pain that has been there for so many years- we have proven that this process works really well and we have many successes over these past years.

One of the main reasons that I believe we are so successful is because of my team- they are the best!  I am very lucky to work with a team of seven people who run this office like the well oiled machine that it is. These folks are hard working and really understand that our patients need to feel cared for and appreciated at the same time. My team members exude confidence in what they do and the patients really pick up on this. Our patients know that my team knows what they are doing and know that I trust what they do! By having such a highly trained group of people working with me, I am able to focus on taking care of 20 patients each day and never have to rush through our discussions and planning sessions because I know that my assistants are just down the hall taking great care of another patient and I know that my front desk team is handling everything else. This great group of people makes sure that my day is productive and the patients are well handled at all times.

I would like to also point out that I am ever so thankful to the many patients of ours who have referred their friends and family to our office over the years. It is truly remarkable to meet a new patient only to have them tell me they are related to Mary or Sam who I treated years ago! As I look back on just today for example, I can look at the schedule and feel thankful that so many of our patients said “Thank you Dr. Brown” as they report feeling better as each month passes. It is I who is thankful for all those people who have put their trust in me and will give me the time it takes to make them feel better.

And so another year comes to an end, another chapter in the life of ‘Sleep and TMJ Therapy’, and a few more gray hairs show on top of my head!  😊  The journey has been amazing and shows no signs of slowing down anytime soon and I am right there having fun every day of the week! Thank you all for all that you do!

The Case of the Initial Exam and Consultation

TMJ diagnosis The Case of the Initial Exam and Consultation

The purpose of this blog is to inform our potential new patients how we do the initial examination and consultation, so you know what to expect when you come in for your visit. First of all, many of our new patients already know that they have some kind of TMJ problem- i.e. their jaw joints pop and click or get stuck open or closed. Many of them also have pain in their joints as well. This is usually what prompts a person to call and come in to see our office. And so when that first visit happens, it is a screening process to determine whether or not you really do have an underlying TMJ problem and whether or not you are in the right office.

When a patient first comes to our office, they will find the exam a bit interesting because they sit in a bar stool, not a dental chair. After a few minutes to review their symptoms, I will actually ask the patient to sit up straight and look directly at my nose to give them a focal point. I will then look at that person- I look at the eyes/eyebrows/ears/nose/shoulders/neck/etc to determine if there are any imbalances present. And in almost all cases I see that the ears and eyes are not level. This means that the bones inside the skull- the cranial bones- are not level or balanced. After the initial observations, then I will glove up and start pressing on many of the muscle groups that are attached to the TM joints. If these are a bit sore or painful, it leads me to believe that the discs are out of place. If you have popping or clicking in the jaw joints, this also means it is likely that the discs are out of place and further examination is needed to determine the extent to which those discs might be displaced.

If I suspect an underlying jaw joint problem, then I will order an MRI of the TM joints. This means that we are not ‘fixing’ anything on that first visit. Diagnosis is critical! If you follow me on Facebook I am constantly preaching that you MUST take the time to figure out the real problem and document it carefully. So, 95% of the time, I will send you to another location to get an MRI of the jaw joints. This requires that you schedule your MRI with either Novant or Inova Radiology and you will either pay them directly, or your insurance will cover this procedure.
Once the MRI is done, it takes a few days for the radiologist to review it and come up with a report. At that point, you are ready for visit #2 with our office- the next consultation and the MRI review. This is the visit where I will personally review the findings of the MRI and show you what your joints look like on the imaging that we pull up on the computer. I have direct doctor’s access to both Inova and Novant imaging services so I will be able to show you exactly what is going on. It is important that you as the patient understand your situation prior to treatment. At the MRI consultation visit we will discuss the options you have on your course of treatment and I will provide you with the information you need to make an informed decision. At that time, you will understand the appliances that are recommended and what they will do to help your condition. Again- at this appointment we are not actually ‘fixing’- we are talking and planning. If you are ready to begin treatment right away, we will take the actual impressions that day to make the appliance(s), however, most people want to know what insurance will cover. That could take weeks or even a month or so since insurance companies do not react very quickly.

As you can see, this is not simply a process of walking into my office and I get right down to fixing the problem. It takes time to diagnose the problem and to document it carefully. Now we have a baseline to work on getting you better! Ideally, we would like to have a three dimensional x-ray as well, but most patients want insurance to pay for that, so we do not take the x-ray unless they are really ready for treatment.

There you have it- two consultations visits to gather information and formulate a plan and from there we are able to begin the actual treatment.

It’s TMJ Awareness Month!

It’s TMJ Awareness Month!
As November rolls around, I have been made aware that it is officially TMJ awareness month. So, what is this TMJ thing? What does it do? Why is it so important? Well, it all begins with a little piece of tissue that is on top of your jaw bone and is supposed to cushion the jaw as you open and close. It’s sort of like a knee cap on your knee, but it’s on top of your jaw bone. When this little piece of tissue slides off the jaw bone, it can literally wreak havoc with your entire body! Let me explain. First of all, TMJ refers to the Temporo Mandibular Joint. Inside this joint is where the top of the jaw bone (the condyle) resides, and on top of the condyle rests the articular disc. There you have it folks, all the anatomy you need to understand TMJD (temporomandibular joint disorder).

So now let’s talk about displaced or slipped discs. Imagine that your doctor informs you that you have a slipped disc in your lower back. The light bulb goes off in your head and now you understand why you have pain in your legs and/or back. It just makes sense because we have all heard about slipped discs all our lives. Very few people, however, understand that slipped discs in the jaw joints can cause all sorts of health issues like headaches, migraines, neck pain, back pain, and even tics and numbness. Most of the patients who come to my office have already been to ENT’s, neurologists, regular MD’s, dentists, and even psychologists to figure out what is going on.

A really good way to figure out if you have TMJ disorder is to measure how big your mouth opens. Measure from the tip of the upper front teeth to the tip of the lower front teeth at the most you can open your mouth. This should be around 50 mm. If you only open to 35 or 40 mm, the odds are that the articular discs are likely out of place and will block your ability to open your mouth widely. And if those little discs are out of place, they are going to pinch blood vessels and nerves that travel through that joint- and there are so many of them!

So many people suffer needlessly from slipped discs in their jaw joints. It is relatively easy to take the pressure off the joints and promote healing, however, many people do not deal with the problem while it is easier to fix. Many folks wait until it is quite painful and are hoping there is some kind of quick and magical cure for this problem. There really is not- it takes time and patience to give the discs a chance to get back into proper position. Many times, we are able to move the discs into a better position and that is when the patient notices the relief they have been wanting for so very long.

By being aware of the TMJ and the various problems slipped discs can create, you can help yourself and others who are close to you. If you or someone you know has popping or clicking in the jaw joints, this indicates that the discs are out of place and need treatment. In my office, the first thing we do is assess the situation and see if a problem actually exists. If there appears to be a problem with the TMJ, then an MRI of the jaw joints is ordered to determine how displaced the articular discs might be. At the next appointment we review the options and show the patient the MRI findings. From there, a plan for treatment is developed. Generally, we work with our patients for a year or so to help the discs get back into proper position. This is Phase I as we call it and the goal here is to help those discs get back into place if they are able to. From there, we will figure out how to finish up, so you no longer need to keep up with our office on a regular basis. Our success rate is extremely high, and as with all things, the sooner you deal with the problem, the more likely we can get you better. So now you know a little more about TMJ disorders and what to do about it. Schedule a consultation for a screening so we can assess the situation and get to the root of the problem.

Here are some of the symptoms you might want to look for to help you in understanding TMD Disorder:

  • Locking of the jaw and inability to open or close your mouth
  • Pain in and around the ears
  • Jaw pain and tenderness
  • Headaches and/or Migraines
  • Neck/Shoulder/Back pain

Some of the causes of TMJ Disorder include the following:

  • Poor posture- in today’s modern society we are notoriously hunched over a computer all day and this is highly contributory to TMJD
  • In the event of an injury the discs are more likely to be knocked out of proper position
  • A misaligned bite or previous orthodontic treatment that did not pay attention to the articular discs
  • Teeth grinding and/or clenching
  • Bony defects like arthritis

In my office we also coach our patients through the process of treatment and teach many different exercises to alleviate tension through the head/neck region. These exercises ( are posted on our website and include head movements, tongue exercises, and even meditation.

Spread the word about TMJ Awareness Month by sharing this blog!

The Case of the Apnea and the Attack

sleep anpea disorder VA treatment The Case of the Apnea and the Attack

The heart attack, that is. When a person has sleep apnea, their entire body no longer functions the way mother nature intended. The hormones do not recharge properly, the body does not have the ability to heal correctly, and you just plain feel awful most of the time. As someone who has in the past suffered the effects of sleep apnea, I can testify that it really is not much fun waking up tired, waking to a head ache, and feeling like you just cannot get out of bed some days. And now that I treat these cases, I hear these things every day in my new patients. They feel awful and just don’t know what to do about it.

Well folks, at this point I might as well add on another little concern. When a person has sleep apnea, their body is simply not getting enough oxygen for the body to heal. They are in a state called ‘hypoxia’- which simply means the oxygen is too low in the body. There has been a fair amount of research into this area and we have now learned, much to my chagrin, that sleep apnea now directly correlates to cancer risk. OH CRUD! The research indicates that the low oxygen allows the cancer cells to thrive better than they can in a high oxygen environment. So now, let’s review all this. Sleep apnea not only leads to heart disease and high blood pressure, but it also correlates to diabetes, and now to a high risk for cancer.

And now let me add on some other observations that I made recently. Just yesterday I went to the grocery store to buy more organic non dairy creamer for my team (they refuse to put the regular junk into their coffee) and I just started looking at the other shoppers- 90% of their were actually obese. I was thinking- is this the new norm? Is this what people look like now in general? I recall a photo from Facebook a few weeks ago. It showed a picture from the beach at that time. NO ONE was overweight-everyone was generally normal sized if not thin. A few months ago I noticed that more than half of the beach goers were extremely overweight over at Fenwick island- near Ocean City, MD.

As I thought about all this, things started to come together even more. Hmmm- sleep apnea means that your hormones are not able to re-charge properly so the hormones that control eating are out of whack. You can’t control your eating habits very well due to the apnea, this makes you eat more, you feel like crap from over eating and now you can’t even sleep well at night. What a vicious cycle this is! Pretty soon you are on medications to control the high blood pressure and the weight and now you have to worry about cancer as well! It really stinks having sleep apnea, doesn’t it?

So what can you do about it? Well, because I see so many apnea patients each day, I try to have a nice little chat with them about what is going on because I think understanding the problem is the first step toward fixing it. One of the first steps toward a real fix is exercise- simple as that. I now tell, not ask, all my patients to get out there and walk at least 20 minutes each day. This is where they start the process. Of course, we do a sleep study and analysis of their sleep patterns, but this needs to begin with something in which the patient takes charge of their condition, and I think walking is a great start! From there, we have lots of work to do, but let’s keep it simple for now and I’ll see you in the next blog.

The Case of the Xray vs the MRI- Who Wins the Battle?

Sleep TMJ Therapy Xray MRI Falls Church VA

When it comes to TMJ disorder, there really is no contest here. The Xray AND the MRI are critical to a really good diagnosis. First of all, when the jaw joints pop or click upon opening and closing, it is likely that the articular discs are out of place. The discs are made of soft tissue, basically like cartilage, so only an MRI would tell you if they are in the proper position or out of place. Over the years I have learned that the MRI is quite difficult to get done properly unless the MRI center has a lot of experience at doing this. I only allow our patients to go to Novant imaging for that reason. They have a dedicated Tesla coil for this imaging and know what I expect. In addition, I only have my colleague, Dr. Nick Patronas, do the reading. I really do not allow any other radiologist to look at the MRIs because I have found that Dr. Patronas does the best, most concise reading that I have ever seen. And this is what allows me to know the status of the discs in the joints. This is the view of the ‘soft’ tissue.

The view of the ‘hard’ tissue, i.e. the bone, is done through the xray. Xrays are designed to view hard tissue and will not allow you to see the disc tissue. The distinction is quite important. Xrays are indeed radiation so you want to limit how much you allow in exposure to the patient. The MRI, however, is magnetism so really no worries there. When it comes to xrays, you want to be sure you get a lot of bang for your buck here- i.e. minimal radiation exposure but maximal information gain. For this reason, I am luck to have the VA Tech i3D machine. It basically does 3-D imaging of the head/neck region so I can view not only the jaw bones (the condyles) but I can also see the cranial bones and the cervical spine. This is a lot of information that helps in the diagnosis and treatment for our patients.

So as you can see, dear readers, the twain are indeed not at battle with each other, yet they must coexist together on the same plane (wow, that was rather eloquent if I must say!). With both the xray and the MRI, we are able to view both the hard and the soft tissues in the jaw joints and the skull. With this knowledge comes a better understanding of what is happening in the TM joints and then we can better formulate a plan to help you. I often have people ask why they cannot just do an MRI, or just an xray, and this is because the two work together – i.e. no battle!

The Case of Not Knowing What You Don’t Know Until One Day You Find That You Didn’t Know It

TMJ disorder treatment VA The Case of Not Knowing What You Don’t Know Until One Day You Find That You Didn’t Know It

This was sort of a frustrating one that happened the other day. A perfectly lovely woman came in for a consultation for TMJ disorder, because that’s what I do, and her comments were very interesting. She explained that she went to someone else nearby for a TMJ consult and the doctor was bragging that not one of his patients ever needed surgery! She was surprised that I told her that surgery was always a possibility and that is why I do an MRI to understand the status of the jaw bones, the joints, and the discs. She also told me this other doctor never does MRI’s because he does not feel it to be necessary. To me, this was a dangerous position to be in- not being aware of the status of the joints and just assuming all was well. You know what happens when you assume (you make an ass of u and me).

Well, dear readers, as you well know, we ALWAYS do an MRI. And as you already know, the reason for this is that we must establish a good baseline to compare how we are doing during the course of treatment. It is important to document the position of the discs in the joints so that we know if things are improving. In almost all cases, the discs do improve and this is what we want to see.

The problem with not documenting with an MRI is that if the condyles (jaw bones) are eroding away and you do not track the progression of the disease process, you are not doing well by that patient. In so many of our new patients, the MRI shows long standing degenerative arthrosis and condylar erosion. So let’s imagine you go to the dentist who does not do an MRI. Even though the patient might be feeling better over time with the appliance therapy, the erosion continues and gets worse, yet the patient does feel better overall. Without the proper tracking mechanism there could be catastrophic failure one day. What that means is that the eroded jaw bone is so damaged that if the patient fell down on the ice, slipped in the rain, got hit in the head with a soccer ball, well, you get the picture, then that already eroded jaw bone could snap or break. And this means a major surgical procedure to fix it.

It would have been so much, much easier to just do an MRI at the beginning and redo that MRI every year or two to make sure things are ‘holding their own’ and not eroding. As you all know by now, I see about 100 patients each week who have TMJ disorders. Of those, 1 person or 1% will need surgery. That’s a pretty good percentage I believe. But I do have many other patients who I am ‘tracking’ over time. They have some erosion of the condyles due to the displaced discs, yet they do not want to do surgery or simply cannot do surgery for whatever reason. My job is to keep them well informed of their situation by periodically doing the MRI and monitoring the status of the discs, the joints, and the condyles. This way, if and when we see erosion or break down occur, we can discuss the surgery option and let the patient decide what they want to do. That’s all I’m saying folks- track the progression and keep the patient informed. You never want to learn that you did not know something that you should have known.

The Case of the Way We Work and Why it isn’t Working

sleep tmj treatments The Case of the Way We Work and Why it isn’t Working

Every day in my practice I meet new patients who have what is called FHP (Forward Head Posture) and realize this is starting to become the norm, not the exception to the rule. We are all so attached to our little phones and hunch over them all day long that our necks are now out of place all the time. Just yesterday I had spoken to a young lady about her rolled shoulders and head craned forward as she texts her friends and watches videos. She then straightened up nice and tall…for about 30 seconds…and then re-hunched (this should be a real word!).

A few weeks ago I was at Dulles Airport on my way to Toronto and was noticing how most people were hunched over their machines- phone or tablet or computer. I thought gee, maybe I could invent a device that they rest their head into to make the ‘hunch’ more comfortable. Think of something like a chin rest where you lean forward and rest your chin into a cup like device so that the neck does not get too sore for the hours upon hours of doing your work or just surfing on your devices. Would I really make such a device- no! Just kidding folks.

As each day goes by and I meet my usual 3-4 new patients, I am noticing a trend. More and more of them are slouching over at our initial consultation meetings. Most of these folks are on the computer all day long and it just becomes a habit to hang their head forward. This forward posturing will also tend to make your jaws slide forward, which in turn will close down the distance between C-1 and C-2 in your neck, which will adversely affect the TM joints. When I see this happening, I explain to the person how they really need to work on posture and be aware at all times. It’s not easy, and I am the first to admit that it kind of feels good to lean forward while on the computer, but hey, it is not the healthy way to go!

So, dear readers, take a look at yourself in the mirror. That’s right, stand up and take a good look at yourself from a side view. Are you bent over? Do you look like the hunchback of Notre Dame? Maybe you could even take a look at your fellow workers and help them as well. Maybe, just maybe, you all should look at each other and practice good posture and getting that neck more upright. I even have some neck stretching videos on my website that will help- check them out. So take a good look and make yourself better!

The Case of Medicare and the Mathematical Mistake

sleep medicine tmj therapy The Case of Medicare and the Mathematical Mistake VA

The other day I was talking to a patient of ours about the promises of Medicare for all Americans according to the recent political debates. It seems that our politicians, who know nothing about what healthcare is all about, have determined that good health is just a commodity- something that you bargain for to get lowest price. Well, dear readers, this is not the case. When I explained to this patient that what they would end up getting is some poor, overworked doctor who really does not care about their health, and only cares about getting that co-pay or whatever compensation they can get, she did not like to hear my words.

I gave her an example. When I make a sleep appliance for a patient, the cost to that patient is around $5000. Currently, Medicare would only pay me $1100 for that appliance if I was a provider. To be honest, that $1100 does not even cover my costs to make this device. So what happened? What’s wrong with this picture? I called my lab one day and actually asked if I could somehow make a super cheap appliance and was told yes, it can be done. When I saw the device I told the lab guy it looks like a piece of junk and I would never allow a patient of mine to wear such a crappy device. He agreed, but said this is what dentists with Medicare provide- a piece of junk. Our government has boiled health care down to a commodity- i.e. provide the cheapest of the cheap and ignore the quality.

And now, this will reflect with the kind of doctors you see. If I was such a provider of Medicare services, then doing work at nearly a 75% discount would mean I could not provide quality service and high quality treatment- that is just the way it would have to be. My patients know that I travel frequently to train in physical therapy and osteopathy and now sleep medicine training. I am able to help so many, many people get better because I am highly trained in the field of craniofacial pain. If I was to participate in Medicare or other discount plans, then you as the patient would suffer.

Heck, I know everyone wants a good deal, but healthcare is no place to cut corners. The numbers just do not make sense and the politicians who think they can promise free health care to everyone are not making sense either. To have the government tell us what they are willing to pay for a procedure forces the doctors to bid themselves downward to the point where they not only do not make enough money to survive, but now they are forced to cut corners and do the LEAST (Least Expensive Acceptable Standard of Treatment). To me, this really is NOT acceptable in any way at all. This approach demeans the quality of care in this country.

Currently, the US is no longer one of the top 10 for quality healthcare in the world. We are not even in the top 20 any longer. I attribute this to the fact that healthcare has become a low quality business in this country where ‘cheap’ is the ruling factor, not quality. Do you folks remember that East German car- the Yugo? Well, that’s what we now have in the US- it’s still healthcare, well, sort of, but instead of pride, prestige, and quality we are now more like that Yugo. Low quality and run by a bunch of mechanics (politicians) who could care less about value.

The Case of: The Concept of a Commodity Gone Wrong

TMJ braces migraines The Case of The Concept of a Commodity Gone Wrong

The other evening, my wife asked me to meet up with her and the kids at the mall for dinner. My daughter had a bunch of her friends doing the shopping thing and they all had dinner afterward. The other kids were to be picked up by their parents. One of the parents showed up very early to say hello and just catch up. She was concerned her daughter might not be doing so well since she had been hospitalized two days prior with a severe and debilitating migraine. She started getting migraines a few years ago- around the time she started getting braces. You already know where this is going, don’t you, dear readers?

The mother told me and my wife that her daughter had just finished braces phase one, and now was ready for phase two and another two years and thousands of dollars worth of treatment. I looked at her daughter and could not figure out from a cosmetic view point why she needed more time in braces. Then the mom told us she went to a ‘cheaper’ orthodontist who also could not figure out why the girl needed more braces. The mom just wanted to save money, thinking all orthodontists are basically the same. This is where they went wrong- mom thought buying braces was like buying soap or a toothbrush- basically it’s all the same- just a commodity in other words. WRONG!

I have tried for years and years to explain to parents that orthodontic work must be done three dimensionally. It really does a patient no good if you are just making their teeth straight and you ignore the vertical height of the teeth, which are critical to support the TM joints. You ALL know this, don’t you? For all the years I have blogged onward and upward, I have once again encountered a parent who ‘just doesn’t get it’. So as I sat at this restaurant, I looked across at my wife and asked “Should I tell your friend the truth or just shut up while I’m ahead?”. Her friend then piped up and said “Give it to me”, thinking she could handle the truth. So, as you all know dear readers, I told the truth. I explained that when the vertical height of the teeth is ignored, the jaw bones (condyles) jam the sockets and impinge on those little discs that cover the condyles and the discs get pushed out of place and can pinch blood vessels and nerves- VOILA!: Migraines.

And so as I did my thing and explained to the mother that all orthodontic work is simply not the same. Basically, I let her know that she was not buying a product, she was buying a service and with that service comes either very basic knowledge, or a very high level of understanding of the various systems in the human body. I explained that if the cranial bones are distorted, then this is contributory to headaches as well, and most likely we would need an MRI of the TM joints to check for disc displacement. The mother was basically dumbfounded at this point, saying no one told her any of this, and she had no idea all of this was connected. At this point, I told my wife and her friend that I was glad to talk more but we should probably continue this at my office with a real and proper exam for her daughter.

I guess the motto of the story should be you get what you pay for. But that’s not fair since neither the mom nor the orthodontist is trained in this field. I have the same problem with other doctors as well- little to no understanding of TMJ disorders or cranial bone or cervical spine distortions. As time goes by, I am sure the knowledge will spread and I am trying to make it happen one patient at a time.

The Case of Driving Under the Influence

Sleep Apnea oxygen

I’m giving that patient a DUI citation next time he comes in! This is what I am thinking of telling folks who come see me as a new patient and I see them yawning, there are circles under their eyes, and they look like they have not slept in weeks. Well, as it turns out, they probably have not had good, high quality sleep in years. Unfortunately, the effects of sleep apnea and sleep disordered breathing -SDB- tend to catch up with us so slowly, that by the time we ‘get there’ it is often late in the game. What I mean by all this is that SDB problems creep up very slowly on us and we pay a big price later on. At first, it’s just a little trouble falling asleep so we sleep in on the weekends to compensate for this. Then, our spouse notices that we are snoring here and there. Then the restless legs kick in (get the pun?) Then one day the spouse notices the outright gasping for breath or the total stoppage in breathing (this is the real serious stuff folks- being just about dead cannot be very healthy!)

So if you notice in your family members the above symptoms- restless legs, snoring, gasping, trouble sleeping, and outright stoppage of breathing, then DO SOMETHING about it. Get them help. A child who snores is not very cute in my world- this is a dangerous thing. We can help these kids so much with their breathing by wearing ALF appliances. These devices open the airway and give more room for better breathing. With adults, the same appliances are very useful in reducing SDB- they are how I can actually cure sleep apnea.

As it turns out, most cases of Sleep Disordered Breathing are totally ignored. I am not talking just the apnea cases, I am talking about the other symptoms that I mentioned. Since most doctors out there have little to no training in this area, they tend not to address the obvious problems. Then, as the years go by the patient develops cardiac problems – otherwise known as the silent killer. Let me explain. With apnea, the patient gets less oxygen in their system than what their body needs. The heart rate increases to pump more blood to the brain, so blood pressure increases to make that happen. After enough years of this, the heart gets damaged- it just was not designed to work that hard during the nighttime.

In my office, we have just begun a new program to help analyze sleep apnea and what to do about it. I am in the process of setting up a meeting with my friend, an MD who is an internal medicine specialist. The plan is to have his office do the needed bloodwork to analyze Vitamin D-3, B Vitamins, and other indicators that correlate with SDB. The research is so far quite promising since once get the vitamins balanced out, this will help the patient sleep better, not to mention grind their teeth less. Yes indeed, dear readers, SDB directly correlates to clenching and grinding your teeth at night. Go figure!

So now that you know more about SDB, tell your friends, tell your neighbors, tell your family members and get them some help. As always, my team and I are there to help you figure things out.

The Case of the Very LEAST

Least Expensive Acceptable Standard of Treatment

So, what am I talking about here? Well folks, I am doing today’s blog to talk about insurance companies and how they promote the lowest cost options available, and the reason why they would do this. You see, it turns out that most patients dump their insurance and change carriers after just a few years, so from the insurance company’s point of view, it really is not a good idea to pay a lot of money and cover that patient for high quality treatment since they will not likely recuperate that expenditure as the patient will not stay with them long enough and pay enough in premiums to make high quality/higher cost treatment practical.

This is where we talk about LEAST: Least Expensive Acceptable Standard of Treatment. This is a really good acronym that explains how insurance companies operate. You as the patient would like to have high quality care, of course, yet the insurance company just wants to minimize their own out of pocket costs. The two goals are not in synch with each other, quite obviously.  Therefore, when a patient comes to my office they are sometimes in a conundrum. They want the best care possible. They want to actually FIX the problem, not just put a band aid on it. And then when they find out that it will cost a lot of money out of pocket to work with us, they tend to have second thoughts.

And this is where the concept of ‘in network’ kicks in. A ‘participating provider’ is simply a doctor who is willing to work for a lot less money in most cases. And to do this, they make up the difference in volume. They do what I call the Costco approach – pack in as many customers as possible because profits are so low that the only way to make any money is to jam in as many patients as possible. You see this routinely at the dermatology office. A few years ago, I sat in my daughter’s dermatology office for an hour and a half waiting to be seen. When I told the receptionist, we did not have all day, she told me she would still charge for the appointment when I told her we were leaving. I told her the doctor would have to pay me for my down time as well. It was a stand off and I never went back again.

So here I am comparing the concept of selling a product, Costco that is, to the concept of selling a service, and that is where the problem comes in. Insurance companies are trying to commoditize health care and make you think it’s basically all the same, so it does not matter who you go to. Well, dear readers, there is something truly wrong in the state of Denmark if you believe them. This is what my blog is all about. I CHOOSE not to do the lowest standard of care for my patients. I CHOOSE to provide a high-quality service at a reasonable cost. I could easily just write prescriptions all day long for pain killers and drugs that reduce dizziness or drugs that make you sleep better or drugs that do whatever you want done. But I do not do this because drugs do not actually fix anything. They simply mask the problem.

In my practice I have chosen to actually fix problems, not to cover them up. And this costs money. And this is often not well covered by the insurance carriers because it is simply not the LEAST available. This morning alone, I have been told by ALL my patients that their head pain is less, the tinnitus is better, the shoulder pain is gone, the neck pain has lessened, and the dizziness has reduced. Those who were taking drugs are now taking less drugs. This is how it should be. And let’s talk cost. Yes, it is somewhat expensive to have me make these devices, however, it is far less than the cost of not wearing them over the long term. When a patient chooses the insurance company over me, they end up on drugs that they will eventually become intolerant to or they end up with liver and kidney problems from the medications. There are other more numerous side effects to drugs, but we all know that. So, let’s also look at a little thing that I call opportunity cost- the cost of what you missed out on.

For this discussion on opportunity cost I am going to recall a wonderful lady from Florida who I treated for dystonia a while back. She had literally spent over 20 years in bed she told me, due to pain from having her neck pulling all the time. She lost out on life basically. Well, when she met me, she was understandably skeptical that a little device in her mouth would fix most of the dystonia. She took the plunge, paid the cost, and now let me tell you about her. She has two wonderful daughters who she spends every evening and weekend with now, instead of curling up in bed and in pain. She has created priceless memories with her girls. I was able to give her back her life, instead of taking pain meds that were the only things ‘authorized’ by her insurance company. So, she lost a lot of years from being in pain with dystonia, but today she feels great and is living her life to the fullest. There is no price you can put on this.

So here we are folks, the year is 2019, and I get emails almost daily from patients asking me to participate in their so-called network. My response is basically what you have read above but I also add this in as well: How would you like it if next year your employer told you that you are going to work for 40% less pay, take it or leave it? This is the kind of doctor you are dealing with when they participate. You are now going to an office where they need to see you quickly and get you out the door so they can make their money and move on to the next patient. Dear, dear people- that’s just the way it has to be. You are now a participant in the commoditization of health care! All doctors are the same and all treatments are the same!

In reality, that simply is not the case. Like I said, it’s 2019, and it’s also June 19 today. Because I do not believe in the principle of LEAST, I spent last weekend at the ALF Academy/Interface meetings in the exciting town of Columbia, Illinois (let’s just say the most exciting thing I saw there was the local carwash). That weekend was both my birthday and Father’s Day and I spent those days training at the Academy meetings. It was a choice and a choice that I would do again and again. It was all about becoming the best that I can be. And Monday morning when I returned to the office, that training came in very handy once again. It seemed that most of the new patients early this week had already been to many doctors and simply found no relief. It literally took but a moment or so to figure out that they had cranial bone distortions and/or slipped discs in the TM joints. But, in addition to all that, it was painfully obvious that they were not sleeping well and that was highly contributory to their reported symptoms. Because of last weekend, I am now working with an MD who is checking blood panels for Vitamin D-3 discrepancies which we now know are highly contributory to clenching/grinding and sleep disordered breathing. Because we now have neurologist attending the Academy meetings, those of us who train there are now able to help our patients even more. But that is another blog for another day.

To wrap things up, now you all know that I am not a ‘LEAST’ doctor, and now you know why. I sleep well at night because of this, and hopefully this blog will help you sleep better too. Thank you.