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

Interests: My family, Dentistry, all sports, Travel
Miami Beach,
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Best Treatment for TMJ

Feb 25, 2009 - 818 comments

For the past few weeks I have been throwing around ideas as to the best way to respond to this matter. You see a recent article ( Feb.3 , 2009 NY times) titled "Best treatment for TMJ May be Nothing" nearly made me clench my jaw to pieces.
While well written, I found that the author, Ms. Brody, relied heavily on out dated and narrow perspective supplied to her by a small group of dentists. The information provided to her would lead one to believe that TMD ( or "TMJ' as it is wrongly called by many) is easy to treat and self-manage or that it may all be in the patient's mind. The sources in the article stated that, "TMJ problems were originally thought to be caused by dental Malocclusion but that this was an infrequent cause of the problem".

The American Academy of General Dentistry (AGD), an organization of some 40,000 of the nation's leading dentist, recognizes the relationship between maloclussion and headaches. Their website states " The average person swallows 2000 times a day, causing the upper and lower teeth to come together and push against the skull. People who have a poorly aligned bite or missing teeth can have related problems, such as frequent headaches or Sleep disorders, because their Jaw muscles must work harder to bring the teeth together, straining the surrounding muscles."

a simple Google search for TMD would have provided this author with a wealth of informative sources regarding her subject.

I, as most responsible medical professionals, believe in using the most conservative successful form of treatment. As one who treats patients with most severe TMD symptoms, I can assure you that my patients are unable to manage the pain associated with these conditions by simply receiving counseling on their habits. What's more is  that I find that dental malocclusion is frequently one of the principle causes of the TMD.

The article went on commenting that MRI and CAT scans are among the biggest advances in diagnosis of TMD, that is just ludicrous.While those are valuable diagnostic tools they do not show what is the underlying cause of the misalignment. I frequently find that to be the malocclusion.

Another statement that I found very irritating was " 80-90 % of the needed information can be obtained just by talking to the patient". Now we all know the importance of a thorough and complete history, it is a vital part of diagnosis. However, when objective evaluation tools such as Electromyography to study the muscle condition, computerized jaw tracking to record and document functional abnormalities, x-rays and MRIs to study the structure are available and yet ignored, it is like saying " lets just do away with the EKG, just ask the patient if they have chest pain".

Dentistry has traditionally been a profession guided largely by mechanical concept. It does not have to that way anymore. It is time for the profession to recognize that occlusion and jaw function are governed by physiological processes and diagnose and treat them accordingly.


Feb 25, 2009 - 13 comments

For many years we have known that heavy snoring causes major increase in risk of carotid Atherosclerosis and stroke. This has been widely established through published research. One such reasearch published in "Sleep" the journal of sleep disorders shows that this risk in independednt of the risk for sleep apnea and nocturnal hypoxia. Carotid Atherosclerosis( hardening or clogging)  is a major cause of storkes.

In a recent published study in Sleep, it was shown that heavy snoring in abscence of sleep apnea also seriously added to the risk for carotid Atherosclerosis and stroke. In this study a group of 110 volunteers were broken down into three groups based on the severity of their snoring. Mild snorers , snored less than 25% of the time, moderates snorers, snored 25-50% of the time and severe snorers snored more than 50% of the time. The prevalence of carotid artery hardening increased along with the severity of the snoring. Non of the volunteers showed oxygen desaturation.

A previously published article in JAMA, reported that snorers have a 300% increase in motor vehicle accidents. Both  snoring and sleep apnea are associated with increased daytime sleepiness and reduced mental abilities in both adults and children. Further more, snoring in children has been associated with poor performance in school and ADHD. Sleep apnea has been shown to permanently affect brain development in children. It is well known that emotional , hormonal, cognitive and autonomic nervous system changes occur in patients with OSA. A recent study in July issue of Sleep, showed that many of these problems remain even after successful treatment of the sleep apnea.

It is estimated that 15-54% of middle aged adults snore. Snoring is a major warning sign for sleep apnea, a much more serious and life treathening  disroder that affects 4% of middle aged males and 2% of middle aged females.
While the gold standard of treatment for this problem is CPAP, or continous Positive Air Pressure machines , it also remains one of traetments with the poorest complaince rates. A properly trained Sleep Apnea dentist who is also trained in the treatment of TMJ can provide these patients with another alternative treatment. Patients generally preferre Oral applainces to CPAP machines.