Hamidreza Nassery , DMD, FICOI, FAGD, FICCMO  
Male, 51
Miami Beach, FL

Interests: My family, Dentistry, all sports, Travel
Miami Beach,
All Journal Entries Journals
Sort By:  

Headaches, Headaches, Everywhere!!!!

Nov 22, 2010 - 6 comments





jaw pain

Headaches are one of the most common symptoms of a TMJ (Tempromandibular joint) problem and the number one reason for patients visiting their primary physicians. Tension headaches are the most common type of headache, and the TMJ headache is a tension type of headache. It is often described as a feeling of wearing a hat two sizes too small, with pain in a ring around the head, or as a migraine headache.

There are a few TMJ-related causes for tension headaches. Constant contraction of muscle fibers within a muscle, create tension, pressure or a tight feeling in the face and head, but constant tight muscle fibers prevent or reduce blood flow to that area. The body sends more blood to the areas and this can result an increase in general blood pressure to the muscles and head, sometimes referred to as vascular headaches. Clenching and grinding the teeth, which are TMJ symptoms, produce pain from the muscles in the head, which is a headache.

Unfortunately, these headaches can be so frequent or severe that they are frequently misdiagnosed and treated as migraine headaches.

The pain from muscle headaches can be blocked with medications, or nerves cut with brain surgery or muscles somewhat relaxed with muscle and psychological therapy, but the cause of the disease and damage from the bad bite, malocclusion, will persist. Side effects with medications, complications from brain surgery, and limited results with muscle or psychological therapy do not correct the source of the problem. Neuromuscular dentistry ensures the muscles are happy because they do not have to work hard positioning the teeth to a strained bite.
Many times these headaches are accompanied with facial pain. The jaw area of the face is a complex network of bones, joints, muscles, and nerves. When the jaw becomes unaligned, the surrounding bones, muscles, and nerves are also affected. This includes the muscles of the face, which experience strain or spasm because the muscles are working extra hard to compensate for the unstable bite.

By putting the Tempromandibular joint back into alignment and placing the jaw into its optimal position, neuromuscular dentistry can alleviate most headache and facial pain problems related to TMJ, muscle, nerve and joint disorders.
For more information in this regard, or to have a free evaluation with Dr. Nassery, call our office at (305) 672-4444 and arrange your appointment with us. Please visit us at our website www.miamibeachdentistry.com

Facial Pain
When a patient’s bite is not properly aligned, TMJ (Tempromandibular joint) dysfunctions and a number of related symptoms can arise. One of these symptoms is facial pain.

A neuromuscular dentist can help facial pain problems by working with the source of the problem, the bite. Your neuromuscular dentist will stabilize and realign your bite so that the teeth, muscles, and joints all work together without strain.

Following are references to a number of studies that illustrate the success of neuromuscular therapy in treatment of tension headaches.

Vargo and Hickman  reported on two classic cases presenting with diagnoses of chronic cluster headache.  Both patients were evaluated neuromuscularly.  This included relaxation of masticatory muscles with low-frequency electrical muscle stimulation and verification with surface electromyography (SEMG).  Patients were then treated initially with a mandibular orthosis, posturing the mandible to the physiologically dictated rest position.  Both patients reported almost immediate relief of headache symptoms.  For longer-term treatment, each patient was provided with an overlay appliance adjusting the occlusion to the neuromuscularly determined position.  Follow-up for periods of 25 and 20 months, respectively, found both patients continuing to be virtually symptom free.

Coy, et.al.  reported on a study designed to document frequency and ranking of various symptoms of head and neck pain and dysfunction.  Sixty-eight (68) case histories of patients who had been treated by dentists for craniomandibular pain or dysfunction were reviewed retrospectively.  Of fourteen signs and symptoms exhibited in the patient group, headache was the most common symptom, being reported by 85% of the patients.  Sixty-three (63) percent also had cervicalgia and fifty-four (54) percent atypical facial pain or neuralgia.  Patients were treated with mandibular repositioning to the neuromuscular rest position as verified with SEMG.  Treatment results, as evaluated by both patients and practitioners, showed ninety-seven (97) percent to be completely or largely asymptomatic following treatment.

Cooper’s article  reported on 1182 patients treated for TMD at the Myofacial Pain/TMJ Clinic of the New York Eye & Ear Infirmary and in private practice.  Of that population of patients, 81.6% subjectively reported headache as a symptom.  After muscle relaxation with low-frequency TENS, electromyographic studies of the group showed an average reduction of tension of the anterior temporalis muscle of 39.3% and of all masticatory muscles of 36.7%.  Following treatment to the neuromuscular mandibular position, patients were asked to complete an in-office, self-evaluation questionnaire.  Sixty-seven (67) percent of patients reported improvement or cure of headaches with treatment after one month and seventy-eight (78) percent after three months.

Garry  reported on a classic case of a patient suffering through nine years of various treatments and misdiagnoses before being correctly diagnosed with temporomandibular disorder resulting from malocclusion.  The patient’s chief complaint was severe pain in the left side of her face.  She also suffered pain in the left and right temporal regions.  Surface electromyographic studies revealed extreme hyperactivity of masticatory muscles.  Muscle stimulation with low frequency TENS reduced muscle tension to within normal limits.  Provisional treatment to the neuromuscular occlusal position was applied for three months, during which the patient was symptom free.  This was followed by permanent crown and bridge treatment to that neuromuscularly determined occlusal position.  Eight years post-reconstruction, the patient remained symptom free.

Lynn, et.al.,  studied 203 consecutive patients referred to Craniofacial Pain Diagnostic Associates of Pennsylvania.  Patients were treated with neuromuscular physiologic orthotics to maintain the neuromuscularly determined position of the mandible.  Mean resting surface electromyography values decreased markedly during a twelve (12) week follow-up period.  Results of a subjective patient self-questionnaire showed a consistent pattern of decreasing craniocervical pain over the same twelve week period, with the most apparent decreases occurring between 2 and 4 weeks following orthosis insertion.  By the end of 12 weeks, all mean pain reports were less than 1 (on a scale of 0 being no pain and 10 being the most severe pain ever experienced).  The authors concluded that, “There is increasing evidence supporting the premise that hypertonicity within facial muscles is an etiologic factor for some chronic headache patients.”

  Vargo, CP, Hickman, DM: Cluster-like Signs and Symptoms Respond to Myofascial/Craniomandibular Treatment:  A Report of Two Cases. J. Craniomand. Practice. 1997;15:19-23
  Coy, RE, Flocken, JE, & Adib, FA: Musculoskeletal Etiology and Therapy of Craniomandibular Pain and Dysfunction.  Cranio Clinics International, 1991;1:163-173
  Cooper, BC. The role of bioelectronic instrumentation in the documentation and management of temporomandibular disorders. Oral Surg., Oral Med., Oral Pathology, 1997;83:91-10
  Garry, JF: Craniomandibular Pain and Dysfunction of Elusive Occlusal Origin, Am. J. Pain Management, 1993;3:175-178
  Lynn, JM, Mazzocco, MW, Miloser, SJ & Zullo, T:  Diagnosis & Treatment of Craniocervical Pain and Headache Based on Neuromuscular Parameters, Am. J. Pain Management, 1992;2:143-151


Nov 18, 2010 - 0 comments







In our last article we recognized the importance of Cleansing, Toning and Moisturizing (& SPF!) twice a day, every day. But how often should we mechanically exfoliate (at home, using your hands) with a non-abrasive scrub cream?

Exfoliating is an important requirement to add to your skin regime. Exfoliating scrubs and sheds the naturally occurring top layer of dead skin off, letting the skin breathe and avoiding build-up of old sebum and dirt; thus allowing for new cells to regenerate which in turn improves the health and circulation of the skin.

On their own, some cells do slough off, but not to the optimum level our skin needs. These backed-up dead cells can end up lingering around and clogging pores, which can lead to breakouts and/or dull looking skin. The best way you can promote the shedding of these dead skin cells is by exfoliating on a regular basis.

Ideally, you should add an at-home exfoliate regime once or twice a week to your routine.
That's it.

For some of you, this doesn't sit well and you feel you want to scrub the heck out of your skin everyday because that "FEELS" clean. But that can be more harmful than good and in acneic or overly oily skin cases this can actually cause an unbalanced amount of oil to be produced thus resulting in more breakouts and reddened, irritated skin. In the case of already Normal, Dry or Combination Skin, excessive exfoliating can leave the skin red, dry and flakey thus loosing it's natural balanced oil production and in the end leaves the skin still looking dull.

So the most balanced routine would be to exfoliate once a week for dry skin and up to twice a week for combination and oily skin.  The outcome of exfoliating should leave your skin feeling smoother, softer with an even color and circulation-not red and irritated or overly dry and flaky.

There are of course other methods of deep exfoliating that under an Estheticians supervision are more results oriented and targeted to your skin type. Mechanical exfoliation uses either non-abrasive scrubs and creams or Microdermabrasion which is machine that is a bit more abrasive and gets deeper (using tiny crystals or diamond bits to exfoliate. Chemical Exfoliantes containing AHA & BHA (known as chemical peels) also work excellent and also reduce fine lines.

Be sure to visit your Esthetician at least once-twice a month to have one of these type of Exfoliant treatments performed professionaly and in a relaxed setting followed by a targeted Treatment Mask that suits your skin's needs.

-Yvonne Schwerdtfeger
Register Esthetician at Real Smile


Sep 30, 2010 - 0 comments





athletic mouthguard


jaw pain

So many of us who workout, exercise or engage in athletics on a regular basis, do it because of the feeling we get from it.  It’s an important part o f our life as it brings added energy, strength, balance and inner peace.   The drive to improve our emotional and physical state is what keeps us motivated and driven.
But then it happens- the Plateau, the ceiling.  We all eventually hit it.  Everyone knows it, the point that you just can’t get past.  It could be during a particular workout, yet for others it’s at that point during a sport that we just can’t move beyond.  You have been working on your golf swing for years, but you still lack precise balance and you can’t drive the ball as far as you know you can.  After with minutes into your boxing routine, you have lost focus, accuracy, and speed.  You get the picture….
But what if we could break through the ceiling?  How would it make you fill?  We all strive for our goals but one extremely important aspect of our routines that is often overlooked is Postural Alignment.  Optimal postural alignment is the key to better balance, strength, coordination, speed, focus, accuracy and precision.  This is the reason when we are learning a new sport, exercise routine, or adding a new element to our work outs, we always start with correct positioning, and technique.  The first step is always correct postural alignment.  Correct postural alignment begins in our heads.  No, not mentally, but physically.  In over 90% of the population, the lower jaw is not in the optimal position.  This incorrect position of the jaw leads to a “domino effect” throughout the body.  Usually, the facial, neck and shoulder muscles become sore and therefore require more energy for their use.   When we require excessive energy input for these muscle activities, it results in inefficiency which leads to quick muscle fatigue, imbalance, and reduced strength out put .,  The most important effect of poor postural alignment is the lack of proper balance.
What is there was a simple way to reposition your jaw into the optimal postural position and give you better balance and improved upper body strength?  Could you reach your goals faster? Could you run that extra mile, swim those extra 5 laps, or increase your seeing speed to drive that ball further down the fairway?
There is such a way and it is called Pure Power Mouth guard (PPM).  This is no ordinary athletic mouth guard that you buy at a sporting goods store.  This specialized mouth guard is extraordinary in purpose, design, and function.  It combines the protective characteristics of traditional athletic mouth guards while maintain your jaw in the optimal physiologic and postural position.  By helping to properly align your jaw and facial muscles, PPM mouth guard will improve muscle recruitment and vertebral adjustment that is the unique edge you may need.
PPM was developed from a very effective and scientifically proven dental treatment for TMJ (tempromandibular joint) Disorder patients.  A neuromuscular repositioning orthotic was originally designed to treat TMJ patients and the pain associated with the syndrome, which includes clenching, headaches, dizziness and earaches.  These patients not only experienced a reduction in their symptoms, but they also experienced increased body strength and improved balance.  It was from there coincidental finding that PPM was adjusted and developed to improve athletic performance.
Professional athletes including the Kansa City Chiefs, New Orleans Saints, Carolina Panthers, Scott McCarron (golf), Shaquille O’Neal, Joe Lowden (marathon runner) have all benefited from the PPM with improved balance, strength, and performance.  Fifteen National hockey teams have ordered the PPM so far.
If you are looking a more powerful golf swing, improved endurance, or general increased physical performance, Pure Power Mouth guard may help you get there.  For more information visit www.miamibeachdentistry.com.  Dr Hamid Nassery is in private dental practice in Miami Beach, FL.  Located at 757 Arthur Godfrey rd.  Emphasizing on esthetic, Implant, and Reconstructive Dentistry
Dr. Nassery is also now the official dentist for 5th Street Gym in south beach, original training facility for Muhammad Ali!!

TMD & SLEEP APNEA - So What's the Connection?

Apr 21, 2009 - 4 comments

After the last two blogs, a number of people had asked me about the connection of TMD and Sleep Apnea, and even the origins of these issues.  I am sure that many more had the same question in mind but did not ask.  After all what is a dentist doing speaking about sleep apnea and snoring.
In my previous blogs, you may have noticed how I have mentioned the fact that our dental arches (Upper and Lower Teeth) have been moving back.  We have obseved this phenomenae now for  the past 250-300 years, and it is well documented in orthodontic research.
Dr. Weston Price, a dentist in the 1930's from Cleveland, Ohio, noticed these issues first, some 70 years ago.  He was a true genius.  You see, unlike most who will immediately go into fixup mode, he asked the question, "What is the underlying cuase of all the malocclusion and dengeneration?"  A question that to this day has not been addressed properly.  Unfortunately, the bulk of his work and research has gone unnoticed for the most part. As a dentist, I can tell you that his work or name were never mentioned at all in dental school.  A true travesty.
Whether it is blaten ignorance or systematic cover up  the results are the same.  We have turned into a culture of quick fixes.  The direction of modern medicine and dentistry has been mostly in dealing and hiding symptoms rather than dealing with the source of ailments.  There is a fill for everything, from blood pressure and cholesterol to headaches.  If we break a tooth we just cover it or if one grinds we make them a nightguard, never asking the right question.  Why things go to where they got??
Dr Price asked the right question.  He set out on a journey that took him to several countries where he studied some fourteen different indigenous populations.  From Africian tribes to Eskimos in Alaska, to Polynesian Islands and Swiss Alps.
The first thing he noticed was that the farther he got from civilization the less decay he encountered.  However, he also observed well developed facial features such as nostrils, straight teeth, well developed wide dental arches, healthy bodies and resistance to diseases.  The depth of his findings are much too deep to be explained in a in a simple blog.  I highly recommend reading his book "Nutrition and Physical Degeneration."  It is Timeless.
So, what is the connection of his findings to our subject specifically?  Well, it turns out that those well developed nostrils he noted in his writings have everything to do with what we see today.  Our bodies reaction what he termed "Western Diet" alongside an arguably good dose of environmental pollution, has made it very difficult for most of us to be nose breathers.  We all have differing degrees of histaminic reactions to these substances, which make us more of a mouth breather.
How does this effect our development??  To properly develop our dental arch form, there must be a balance between muscles. Muscles of facial expression from the outside and our tongue from the inside.  However, when one breathes more from the mouth than nose, we effectively take the tongue out of this equation and create the imbalance during our developmental years between ages 2-9, when most facial development is happening this lack of nasal breathing, or upper airway problem will tip the balance off and the only effective force on one upper dental arch is the external forces of muscles of facial expression which will push the upper arch back and narrows it.    In response to this, our lower arch will have to take a more posteriorized position and match the narrow upper arch.  All of these will result in encroachment on the tongue space, which by now has pushed into our pharyngeal airway, also our muscles of masticiation will end up working a different trajectory of function.  This latter is perhaps responsible for most recurrent headaches and sysmtoms.
So now you should have a picture in your mind of what we are dealing with.  I hope that in some small way I have been able to shed some light on the possible origins of these conditions.  This, by no means, is to indicate that these are the only reasons, as there are several other factors that can be at work concurrently.
What seems to be the constant , is the role of our diet in all these ailments.

To your health.