Frequently Asked Questions

General Q&A About Our Office’s Best Practices and Your Visits

How long does it take to get an appointment?

Typically, the scheduling of a new reservation is three (3) weeks out.  We recommend if this is an adjustment appointment book your next visit while in the office.  In cases where you would like to be seen earlier, we do offer our patients the use of a list called “ASAP LIST”.  This list will reflect your set parameters for an earlier appointment. 

Do I need to arrive early for my first appointment and what should I bring?

We do ask you to arrive ten (10) minutes earlier to review your Welcome Packet: questionnaire submission, medical history submission, general office policies/forms, and ID scanning (medical/dental insurance and driver’s license).

How long is the first appointment and what is done?

The first appointment is about forty (40) minutes. This step in your treatment planning process includes additional data gathering.  The visit is setup to record your vitals, current dental measurements, possibly a few photographs, review your questionnaire, medical history, and a complete head and neck exam.

What should I do if I am required to pre-medicate for dental visits?

There is no need to pre-medicate for your first visit consult.  This visit is strictly data gathering and the exam portion involves measurements with no subgingival exam.   For any other visit, a determination will be made with a phone consultation with your physician. 

What if I need to reschedule an appointment?

We understand in those rare cases of conflict with your reserved time you may need to change your appointment.  We ask to be notified as soon as possible.  Ideally, a forty-eight (48) hour notice or more is preferred.  This will allow us to assist you better with rescheduling your appointment.    Please know, we typically do not charge for broken appointments but will ask to keep a deposit on the account if a problem develops with continual no notification and breaking the appointment. At each broken appointment, the deposit will be forfeited.    

What do I do if I have an emergency?

Typically, we can schedule you within a twenty-four (24) hour period.  We understand you need to get in and the time being offered may not be ideal, but we need to work within the scheduled appointment times.  We want to give you the time you need and thank you for your understanding. 

How safe are digital dental x-rays and what are the benefits?

All x-ray machines involve some dosage of radiation to the patient in order to take an accurate, in-depth picture of your bones.  Digital radiography exposure is perfectly safe and the lead apron you wear helps protect as well.  From a health standpoint, digital radiography uses only a fraction of radiation compared to that of traditional radiographs.  For patients who are monitoring their exposure due to existing health conditions or certain risk factors, our digital radiography is the preferred method.  Aside from less radiation exposure, each image is stored on our server ensuring the image cannot be damaged and sending of additional copies can be completed quickly and easily.

Why do I need an MRI?

An MRI gives the doctor a look inside of your jaw joints.  Un like x-rays, the MRI imaging picks up the soft tissue.  It is critical to know the condition of the jaw joints and the position of the articular discs before starting treatment. We must know what we are working with so we can offer you the most effective treatment.

Why do I need both an MRI and a CBCT dental x-ray?

An MRI shows soft tissue like the articular discs in the jaw joints. A CBCT x-ray shows bone and airway analysis. Both provide completely different information and are very valuable tools when diagnosing and treating TMD or sleep issues.

Do I have to go to Novant or can I bring my MRI reporting from another facility?

We certainly understand going to a facility within of your network is preferred by you.  We are always willing to take a look at the reporting and the CD you will bring to your appointment.  Keep in mind, if the images are not captured correctly or the report from the radiologist is lacking information a re-take may be needed. We recommend Novant since there is a dedicated imaging MRI machine set up specifically for TMJ MRI’s. We work directly with Novant’s fully trained team on capturing the imaging we require. In addition, the lead radiologist has been reading our patient’s MRI’s for years. He is aware of the crucial images needed and why our doctor needs them. The reason we ask you to go to Novant is to ensure that the imagine is taken once and correctly. 

General Q&A About Our Treatment for TMJ Disorders (TMD)

What treatments do you offer for TMD?

With every patient the type of treatment and duration will vary.  In our practice we focus on orthotic oral appliances.  The appliances most used are ALFs and Modified Gelbs.

What is an ALF appliance?

The ALF is a light wire appliance that can be customized for the upper and lower arch. It hides behind the teeth and is removable. The appliance helps to gently expand the palate, level the cranial bones, reduce crowding, provides cranial support, and much more. ALF appliances are manipulated by the doctor to achieve personalized treatment goals.

What is a Modified Splint or Modified Gelb?

It is a custom-made removable appliance that fits over your lower teeth. The goal is to take pressure off of the jaw joints and promote better breathing. When the pressure is taken off of the jaw joints, the discs are able to move freely, cranial nerves start to un-pinch, and a reduction of inflammation is achieved.  All of these benefits help rid symptoms associated with TMD. Splints are manipulated based on your symptoms to achieve personalized treatment goals.

How long is treatment?

Treatment length is on a case by case basis since every person is unique and with different treatment goals. Typically, our treatment plans are one year. At each visit (every 6 weeks) measurements are taken to identify progress.  After six (6) and twelve (12) months in treatment, we will schedule a re-evaluation and see how far you have progressed.

How much does this treatment cost?

After the initial consult and the MRI consult (if needed), the doctor will provide you with a treatment plan that best suits your needs. Our treatment plan costs are varied depending on which appliance or appliances being recommended, the treatment goals, and frequency of adjustment appointments.  Before treatment starts, you will be given a complete treatment plan reflecting all your costs for the appliances and follow-up adjustment appointments.  Our treatment coordinator will sit with you to help you figure out the amount of insurance reimbursement and create a financial payment option to assist you in starting the treatment.   

How does TMJ dysfunction cause migraines or chronic headaches?

When the jaw bone is set back too far in the jaw joint, it ‘pinches’ the nerves in that part of the joint.  The resulting effect causes pain which manifests as headaches or migraines.

What does TMJ dysfunction have to do with my ears ringing?

The jaw bone when set too far back or forward in the joint will pinch and irritate the nerve endings directly in front of the ear.  This effect manifests as pain and possibly ringing in the ears.

What is causing my jaw joints to make clicking/popping sounds?

The sounds the jaw makes is largely caused by the dysfunction of the joint.  The disc is pushed out of place.  The act of overextending the jaw either creates the disc to folds up on itself and makes a ‘popping’ sound when it slides around.  The sound can also be caused by bone to bone contact.  The hinged action is no longer buffered by the disc and the jaw bones rub against the skull’s socket.

What could cause my face to be asymmetrical?

The term ‘asymmetric face’ merely means that a person’s facial features are not 100% aligned: both sides of their face do not look exactly the same. Many people have a slight difference and find no effect from this.   In many TMD cases, the patient may experience facial pain.  Their eyes/ears are not level and this in part may be due to a cranial bone distortion. This can often be felt by the doctor when palpating the bones of the skull and x-rays often confirm this distortion. The causes can include congenital disorders, acquired diseases, a traumatic event or developmental deformities. 

What could have caused my TMJ discs to be slipped in the first place?

The disc may have moved due to a muscle (lateral pterygoid muscle) pulling the articular disk out of place.   The abnormal jaw mechanics could have been due to a congenital or acquired asymmetries, trauma, or arthritis. Most of the time, the cause of disc slippage can be traced back to some past trauma: from birth or a fall.  Even a little bit of trauma can cause the jaw bones to slip and push the discs out of place.

How does the TMD affect other disorders like Dystonia & Tourette’s Syndrome? 

The concept presented is the disc inside the jaw joint puts extraneous pressure on the nerves surrounding the joint causing tics.  The pressure sends a noxious signal resulting in an involuntary repetitive movement or sound response relating to Tourette’s. The tics causing pulling or twisting movements of the muscles produce abnormal postures called Dystonia. 

When do I or my practitioner know it is time for a referral to this office?

The best time to refer to our office is when you first spot the symptoms: inability to open the mouth to 50mm, pain in the joints, clicking or popping in the joints, headaches, tilted head, nervous twitches, neck pain, or uneven eyes and ears. It is better to treat earlier then later.

Is there an age where I can see early symptoms of TMD present in my child?

We see children of all ages from 3 to 93! It all depends on their symptoms. Have yourself or child screened early or as soon as symptoms present themselves. Our office is glad to do a no charge exam to help evaluate young children.

Why wear a splint instead of getting surgery immediately?

A splint must be worn at least 4-6 months before even considering surgery.  The goal of the splint is to reduce the inflammation and allow for an easier surgical procedure with better results. The other possibility, the discs may self-correct thus avoiding the surgical procedure. 

Is the material used with the splints safe for me?

All our acrylic materials used in-house or our out sourced laboratory are FDA approved and safe.  The lab uses surgical grade materials and our acrylics are orthodontic acrylic.

General Q&A About Our Treatment for Obstructive Sleep Apnea (OSA)

What is Sleep Apnea?

This is a condition during sleep in which you have a brief but repetitive interruption in your breathing.  This is referred to as apneic events. There are two most noted types: obstructive sleep apnea (most common) and central sleep apnea. OSA is where your upper airway gets partially or completely blocked while you sleep. During sleep, the tongue falls back against the soft palate, and in turn the soft palate and uvula fall back against the back of the throat effectively closing the airway. This is the collapse of the pharyngeal airway.  Central sleep apnea (CSA) is a cessation of lack of breathing.  This type of apnea is where your brain doesn’t tell your muscles to breath.   

What treatments do you offer for Sleep Apnea?

Two of the most widely used and most effective treatments are continuous positive airway pressure (CPAP) and dental appliances.  With dental appliances, there are a multitude of oral appliances.  Some work by holding your tongue forward, while others reposition the lower jaw, known as the mandible. Our office creates non-invasive mandibular advancement appliance.  There are designed and customized to fit your mouth and needs.  The devices snap over the upper and lower dental arches and make it possible to reposition the lower and correct the position of the tongue.  We have had great success in helping patients using dental sleep appliances as an alternative to the CPAP.

How long is treatment?

Treatment length is on a case by case basis since every person is unique. Some factors include the severity of your problem, the physical structure of your upper airway, other medical problems present, and your personal preference. Typically, our treatment is one (1) month to get you into the sleep appliance from the initial assessment. Thereafter, a quarterly or semi-annual checkup will be done.  This re-evaluation process will ensure the appliance is providing an open airway, symptoms are gone, and the oral appliance is optimized with fewer risks of side effects.  This step includes working closely with your sleep specialist or physician. 

How much does this treatment cost?

After the initial consult and the sleep study consult (if not previously completed), the doctor will provide you with a treatment plan that best suits your needs. Our treatment plan costs are varied depending on which appliance is being recommended, the treatment goals, and frequency of adjustment appointments.  Before treatment starts, you will be given a complete treatment plan reflecting all your sleep appliance and follow-up adjustment appointments.  Our treatment coordinator will sit with you to help you figure out the amount of insurance reimbursement and create a financial payment option to assist you in starting the treatment.   

When do I or my practitioner know it is time for a referral to this office?

The best time to come to our office is when you have been diagnosed with sleep apnea by your physician, sleep specialist, or experiencing symptoms.  Some of the symptoms are waking up with a sore or dry throat, choking or gasping sensation, snoring, lack of energy, headaches, forgetfulness, and with children additional difficulty with learning, poor attention span and poor performance at school.  It is better to treat earlier then later and due to the dangers with sleep apnea it is better to be compliant with treatment to avoid other problems.

Is there an age where I can see early symptoms of TMD present in my child?

Although obstructive sleep apnea can develop in any person at any age, there are certain age groups that are at higher risk for sleep apnea as well as body types.  Have yourself or your child screened if any of the symptoms are being experienced.  Our office will evaluate and get you in touch with a sleep specialist.

General Q&A About Dental Healthcare

Should I still see my general dentist?

Yes.  Every established cycle your dentist has created for you please continue.  Your dentist is focusing on your overall general oral care of your teeth and gums.  These are the foundations for our appliances and need to be kept healthy.

Does my home-care change with treatment?

Yes.  Brushing and flossing more frequently as well as cleaning your appliance(s) may be required.  There may also be food restrictions implemented while in treatment.  This would be to allow for joint healing. A few other good practices are: limiting snacks that are high in sugar, eating a balanced diet of soft fruits and vegetables, avoid hard crunchy nuts, and avoiding tobacco. 

Should I use mouthwash regularly?

This is not a replacement for brushing and flossing but can help while in treatment.  Cosmetic mouthwashes are aimed at freshening breath but may contain fluoride.  This is something to keep in mind if you have a sensitivity.  For more advanced conditions, our doctor can prescribe a mouthwash containing chlorhexidine gluconate to kill the bacteria causing bleeding, inflammation and the formation of plaque.