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Hamidreza Nassery , DMD, FICOI, FAGD  
Male, 48
Miami Beach, FL

Interests: My family, Dentistry, all sports, Travel

Hamid Nassery, DMD, FICOI, FAGD
305.672.4444
Miami Beach, FL
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Jaw like a Plane?

Jun 18, 2013 - 5 comments
Tags:

neuromuscular

,

Headaches

,

Neck pain

,

Migraines

,

TMJ

,

TMD



Jaw like a plane?

Head and neck pain and discomfort can run a wide range, being a simple nag to severe radiating pain. These pains can be different from day to day, side to side, or up and down. These variations can cause much confusion for all as to where they stem from and how to fix them.

In my practice I see many head and neck and myofacial pain patients who had thought that the pain might have been migraines; sinus and or tension headaches and so on. Most of these sufferers have been seeking medical advice for many years, actually decades in most cases. Most often for a large number of them x-rays, MRI’s and CAT Scans report nothing wrong. Since there is no definitive diagnosis, there is no treatment other than medications. As a matter of fact, there is a whole industry banking and betting on these patients accepting that they are going to be miserable all their life and continue to take these meds as their only relief. It is also my observation in meeting with these patients that they feel  they are not being listened to or believed by their families, friends and doctors.

Now here comes the jaw. The jaw is attached to our head by a set of intricate and complex muscles. Under certain conditions, these muscles can cause all the symptoms mentioned earlier. However a properly trained dentist can recognize this and help relieve and dissolve these pains.

To better explain the above, I will use an analogy once used by one of my mentors to describe the action:

The closing of the jaw is much like landing an airplane. When landing a plane, the pilot must control three movements, the angle or the steepness of the approach, the straightness of the approach and the evenness of right to left. So basically if the angle is too steep, the nose will damage, or if it’s too high the tail can drag and break. If the approach is not straight, meaning it’s sideways and the head is one direction and the tail is another, who knows what happens. Finally, if one side hits before another it can also cause much damage and destroy the plane. In pilot lingo these movements are called Pitch, Roll, and Yaw. Luckily there are sophisticated electronic instruments that handle all these today.

The Jaw can also have Pitch, Roll, and Yaw. As the lower jaw moves towards the upper and the teeth proximate for “landing”, the same rules apply. If the brain perceives that there are inaccuracies in the way teeth will come together, it will activate certain muscles to pull the jaw in any which way required to bring the teeth together or “land” them just perfectly. Most of us can accommodate these movements and lord knows we need to. Orthodontic research has shown us that for the past 250-300 years our teeth have not exactly come out in the correct position. Current estimates tell us that less than only 3% of us have our teeth naturally in the correct place. Our muscles and jaw joints have had to make the accommodation for our teeth to come together. Multiply this oral gymnastic by many years and you will have some very over worked and unhappy muscles.  Muscles that can go into spasm and cause many of the symptoms mentioned before.

With the use of specialized technology and proper training, some dentists can accurately measure good or bad activity of major muscles that open and close the mouth. This computerized technology tracks your jaw and muscle activity at the same time. The dentist looks for a jaw position where the muscles are happiest. We can then record and capture the position using specialized materials, and from that fabricate an appliance that fits over the lower teeth. This appliance, or as we call it “orthotic”, will mimic a good bite or if you want to call it a “good landing”. This will allow muscles to stay happy and as we all know happy muscles don’t cause headaches and neck pains.

The modality of treatment described above is called “Neuromuscular Dentistry” and it is fascinating to watch and experience as it helps people have healthier lives and their well-being improve.


Hamid Nassery, DMD, FICOI, FAGD is a practicing dentist at Real Smile Dental Spa located in Miami Beach, Florida. For more information you can call the office at 305.672.4444 or visit our website at www.miamibeachdentistry.com


TMJ/TMD Question Posed

Jul 30, 2012 - 13 comments

TMJ/TMD

During a recent meeting with a new colleague, a question was posed to me: “What makes us choose to dedicate so much of our practice to the treatment of TMD?” In my mind my initial response was “duhh” it’s only the foundation of all we do in the mouth!

This question struck me strange at first, but after some reflection I realized that it is at the very root of our problems in this profession. Thankfully better judgment stopped me from replying impulsively and I decided to write a more intelligent summary of facts that may answer the question better.

According to the American Dental Association, 34% of the population suffers from symptoms of TM Dysfunction. In my 20 yrs experience of practice I have come to the conclusion that a large part of the population shows signs but not symptoms. The number could be well above 90% of the population.

It is also advocated by the ADA that Dentists should have the primary responsibility to diagnose and treat TMD. The problem is that most dental schools do not offer courses to give enough confidence to the students to diagnose and treat this issue (hence the colleagues initial question).

While our profession has done a great job in teaching dentists how to deal with teeth and their support structure, there has been a void in the area of TMJ.

TMD can be a serious and life altering problem for many patients. Symptoms may include headaches, neck pain or stiffness, ear aches, congestion or ringing in the ears, cracking, popping or grating noises in the joint, dizziness and fainting, difficulty swallowing, pain behind the eyes,  limited opening or discomfort on opening,  numbness in the hands, along with shoulder and neck pain.

It seems to me that this should be our moral responsibility to treat these patients.
Most members of the medical community are unprepared to deal with these patients. If the jaw is out of position the disc would be dislocated and only a dentist, one with the proper training, can recapture the disc with a properly designed oral appliance. The medical community is trained to deal with symptoms of TMD with anti-inflammatories, muscle relaxants and even anti-depressants. Indeed many of our patients have become depressed due to the chronic nature of these symptoms, causing some patients to feel helpless in reaching any solution or relief from their pain.

Being that the nature of this paper is not a clinical or scientific one, I will not get into the details of different diagnosis and or categories of this disease. Our patients are confused enough.

The fact that there is no consensus in our profession for the approach to the treatment is a sign of evolution of the field. What is not acceptable is a barrage of pseudo-scientific papers written and published by so called dental experts backed by special interest groups, trying to categorize TMD as a psycho-social disease. The latter has created a large gap between our profession and our medical counterpart. Many physicians that now work and refer to our office have explained that in the past they did not know who or what modality they could trust for their patient’s treatment. Believe me- the pain and suffering of my patients is very real. It is not just in their minds.

What is certain is that we need a greater emphasis in dental schools on this subject and an open and honest discussion for the whole profession.

-Hamid Nassery, DMD, FICOI
www.miamibeachdentistry.com


TMJ, Orthodontics (tooth movement) and dentistry’s Dark Cosmetic Secret

May 31, 2011 - 5 comments

I was reading an email on my Gmail account the other day and one of the corner ads got my attention. A fellow colleague was advertising as a “Holistic Dentist”.  Though I had heard it before, I have never put much thought into what it really means.

I suppose that the most basic tenets of “holistic dentistry” should be to do no harm and for the dentist to look at the mouth , teeth, gums and the jaws as an integral part of a larger, whole body system.  Interestingly, in most countries around the world, medical students recite an oath equivalent to “the oath of Hippocrates”, sadly though no student of our profession undertakes such oath upon graduation. I do however believe that we are implicitly bound to honor the trust placed in us as “medical professionals”.

Considering the above we all should be holistic dentists. The reality is different though.  Case point is the orthodontic profession in that it has veered away from being a health science, and has become more pre-occupied with being purely cosmetic at the expense of our health.  Our orthodontic colleagues have been perfectly positioned to be at the forefront of TMJ/TMD treatments. However, not only there has been a total void of leadership on their part, there have been well orchestrated attempts to stop the progress of science.

An example of this is the prevalence of premolar (bicuspid) extractions in private practice. Data is not clear on this but it is estimated that as much as 25-85% our children get their healthy teeth removed in the name orthodontics.

The rational behind this methodology goes back to a 1954 paper by P.R. Begg, which has been proven wrong soundly many times since. Subsequent studies have shown that these cases have less than 10% stability over a 10 year period. This alone should suffice to explain, never mind that we are encroaching on the tongue space and therefore compromising the patient’s airway, creating persons with great susceptibility to sleep breathing disorders. Talk about “do no harm”.

Here we are in 2011 and biomedical instrumentation is available to dentistry. Rather than subjectively guess the position of jaw and move teeth, we can now objectively and scientifically find the position of the jaw and move the teeth according to the patient’s physiology.  Everything we do in the mouth must reflect a healthy echo to the rest of the body.

Many patients often ask what has caused their particular malocclusion (their incorrect bite), on this matter literature supports muscle function and posture. Regretfully, though there are no active teaching programs connecting the two together. (Mainly due to politics, another sad testament to our profession)

If dentistry aspires to be taken seriously as a medical profession, then it must put aside its antiquated ways of the past and re-orient itself towards more objective and scientific ways that are health oriented and less subjective.


The Truth on Porcelain Veneers

Mar 30, 2011 - 0 comments
Tags:

veneers

,

porcelain

,

Cosmetic dentistry



http://www.bizymoms.com/miami-beach/dentists/miami-beach-porcelain-veneers.php