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Ramin Mehregan, DMD  
Male, 49
Canton, MA

Interests: neuromuscular dentistry, orthodontics

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What cuases a bad bite that leads to TMD

Mar 31, 2009 - 3 comments
Tags:

Bad bite

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Mal-occlusion

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TMD

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TMJ

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development

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newborn

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Orthopedics

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Headaches



What causes a bad bite?
Is your bite the cause of your daily headaches, dizziness, etc……continued
In my last blog I discussed how malocclusion (bad bite) can be the cause of TMD ( temporomandibular dysfunction) such as headaches, dizziness, clicking of the jaw joints, and neck and shoulder aches to name a few. In this article I would like to discuss the causes that lead to malocclusion.
The majority of malocclusions (bad bite) start at infancy, during the development of the cranio-mandibular (head & jaw) bones. During this stage any object placed in the oral cavity on which an infant *****, can act as an orthodontic appliance, depending on the force, intensity, direction, and duration of the sucking. When sucking reflex and/or nutritional needs are not met, an infant will attempt to satisfy those needs by sucking on any object that approximates its oral cavity. To name a few:
• Appendages (fingers, toes, fist)
• Milk bottles fitted with conventional nipples
• Pacifiers (non-orthodontic)
Such harmful habits if continued could cause the oral cavity to grow and conform to the shape of the object. Ultimately causing a constricted upper arch, high palatal vault (roof of the mouth), low external muscle force, open lip posture, a mouth breathing habit, and a tongue trust. Because of continued displacement of the tongue, lips, and cheeks, form and function are affected as a result of intra-oral and extra-oral muscle imbalance. The lips become weak and the tongue looses its normal force, hence, the teeth develop a malocclusion as they grow in and mature.
Besides an abnormal growth malocclusion can also be caused by allergies and mouth breathing. Chronic mouth breathing will result in malocclusion since the tongue is no longer confined in its normal position to offset the constant force of the lip and cheek muscles against the teeth. To demonstrate this, one may hold their nose and breathe through their mouth and observe the tongue position! The primary cause of chronic mouth breathing in children is frequent upper respiratory tract allergies and/or enlarged tonsils and adenoids.
In adults, in addition to enlarged tonsils and adenoids, mouth breathing could also be due to nasal passage obstructions such as a deviated septum. Also, malocclusion in adults can also be seen with loss of teeth and grinding, which will cause a shift in the normal positional anatomy of the dentition. Hence, causing muscular and postural imbalance of the lower jaw in relation to the skull. Which ultimately could lead to TMD symptoms.
The concept of the mandible (lower jaw) being a free floating bony structure and its positional neuromuscular association to the maxilla (upper jaw) and the skull and the whole postural system is still not fully understood. But by observing and following good habits most malocclusion can be avoided in later stages of life.  Preventing most TMD problems in later life should begin immediately after birth. Appendage, object, and conventional pacifier sucking should be controlled in early stages of infancy.
I am always presented with this question by concerned parents: “When should we consider orthodontics for our child?” My answer is very simple: “The day the child was born!”


Neuromuscular Dentistry and MPD

Mar 27, 2009 - 7 comments
Tags:

neuromuscular dentistry

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TMJ disorders

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TMD



                                                                                        
NEUROMUSCULAR DENTISTRY
AND
MYOFASCIAL PAIN DYSFUNCTION

When the harmony of the teeth, the facial muscles, and the Temporomandibular joints no longer exist symptoms of
what has been described as TMJ/MPD arises. Some of the clinical symptoms are:
•  Headaches •  Sensitive and sore teeth •  Facial pain
•  Neck and shoulder aches •  Ringing in the ears •  Jaw pain
•  Ear congestion •  Clicking/ popping of the jaw •  Worn down teeth
•  Clenching/ bruxing •  Limited opening of the mouth •  Cervical/ neck problems
•  Loose teeth •  Tingling in the fingertips •  Dizziness/ vertigo

Patients suffering from these symptoms often have to learn to live with pain. They wander from specialist to specialist, depending on the type of pain and problems they experience. When competent clinicians cannot find an organic basis for these symptoms, they often suggest it might be psychogenic. As the wanderers are told and retold that there seems to be no organic basis for their pain, that the cause is psychogenic, their anxiety mounts. When physical findings remain obstinately in abeyance, patients may begin to suspect a brain tumor, turn to drugs to alleviate their symptoms, or on rare occasions, even contemplate suicide.


“Misdiagnosis is rather the rule than the exception with MPD”




What is the cause?  “You can’t catch it”
It is a chronic degenerative disease which often takes years to develop. There are many contributing factors. Every person has a unique personality; this is why we must consider many different aspects of the individual when discussing the cause. The aspects can be divided into three groups:

                                            "STRUCTURAL-EMOTIONAL-BIOCHEMICAL"


All of these components are disturbed to some extent when a person suffers from MPD, but seldom are they affected to an equal extent. Hence, it is important, when diagnosing MPD, to assess the relative impact of each of these components. Many patients may remain oblivious of any symptoms until one day they wake up with, for example, an excruciating headache. It is like filling a cup with water to the rim and one keeps adding droplets until all of the sudden there is a spill over. Similarly, many different lifestyles can combine which could aggravate MPD – such as structural imbalance, stress, fatigue, certain foods and even a simple routine visit with the hygienist for a cleaning. Any one of these is a single drop in the bucket.

Structural
The one aspect that is always present in MPD is structural imbalance. This structural imbalance in the jaw is also termed “mal-occlusion” (“bad bite”), which means that the upper and lower teeth do not close together in the right way. Just as a chair needs four legs in order for one to sit on without falling over, all teeth need to fit firmly together to support the muscles in the face for chewing and swallowing. Teeth are an extension of the skeletal system. It is held to the skull via the Temporomandibular joints (TMJ) and the muscles. Both the position of the TMJ and the muscles are determined by the way upper and lower teeth fit together. When teeth are together they are in occlusion. The occlusion dictates the relation of the jaw to the skull also known as the cranio-mandibular relationship.

Simply stated mal-occlusion is when the skeletal system is in disharmony with the neuromuscular system. This means that the teeth or occlusion is forcing the TMJ’s and muscles into a strained position. Hence, the natural demand to the muscle and nervous system increases beyond their capacity and places them in a spasm cycle. It is just like walking with a pebble inside your shoe. After a few yards the pain becomes annoying and you will twist and torque your hip into all kind of different positions to avoid walking on the pebble. After a mile the pebble feels like a stone and your foot, leg and body hurts. This is the same thing that happens to the muscles of the face and jaw (oro-facial muscles) when they are forced into an unnatural position because of the bite. Eventually the muscles become strained and painful. This strain on the oro-facial muscles causes an alteration in their shape. To compensate for this the other muscles such as the neck, head and back have to compensate for this unnatural position. This in turn places these muscles into strain and spasm. Muscles that are under constant strain can develop “trigger points”, which feel like knots or nodules, and are painful when pressed on them. Trigger points can be the source of referred pain, which means pain is felt in another part of the body other than where it originated.

To correct this, the jaw must be brought back into a neuro-muscularly balanced position.

“Muscles under constant strain are in pain”

Emotional
For a long time it was believed that MPD was a psychosomatic (psych=mind, soma=body) illness, starting in the mind and manifesting itself in the body. Some examples of psychosomatic illnesses are ulcers and hypertension. It is of significance to realize that even though the problem begins in the mind, the physical symptoms themselves are very real.
It is believed, however, that for most part MPD has its origin from a structural imbalance or somatopsychic. The resulting pain in the muscles (soma) causes a feeling of anxiety, tension and stress (psyche). There have been numerous studies on how the impact of being sick affects us mentally and emotionally. For instance emotional reactions when having a headache could include:
• Inability to perform up to ones personal and public expectations
• Anxiety
• Depression
• Frustration
• Anger
• Fear of the unknown
Thus, it is apparent how coping with a chronically painful condition such as MPD can place someone under tremendous amount of emotional stress. Mind and body is a complex interconnected highway, so that even though the problem may stem from a structural imbalance in the jaw, the resulting discomfort will affect the mind as well.

Biochemical
The human body and mind has certain arsenal to its possession. When in pain and in stress it prepares itself for either “fight or flight”. These are short-term positive coping mechanism in the presence of stress. Unfortunately when in pain and under stress at the same time we tend to add to the problems by adopting less favorable habits such as:
• Over-eating
• Drug and alcohol consumption
• Sleeplessness
• Not exercising
Soon the body adapts itself to long term chronic stress. In this second stage, the body’s defense hormones operate in an above-normal rate. In addition to the aforementioned ill-habits, just like your car would eventually run out of fuel, the body will soon be depleted from its natural fuel supply.
At the third stage, exhaustion sets in and the body breaks down. This is where chronic diseases such as MPD will occur.
With MPD the body is placed in constant stress. The extent and severity differs from individual to individual. Some people may have an occasional click in their temporomandibolar joints and some suffer from constant, severe, daily pain. In either case, the body prepares itself to fight against the stressor. Biochemical changes occur to provide the body with energy to compensate and adapt. This energy is limited however, and eventually will be depleted at a faster rate depending on the ill-habits we take on during that time, thereby adding additional stress, pain and discomfort.

“It is important to know the person who has the disease
as to know the disease the person has.”
                                --- Sir William Osler


Headaches and Dental Health

Mar 26, 2009 - 8 comments
Tags:

Teeth

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Headaches

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TMD

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TMJ

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Muscle imblalance

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Cranio-mandibular dysfunction

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Orthopedics

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Dental

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neuromuscular dentistry

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bite

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occlusion



Headaches and Dental Health

Is it nerves?     Is it muscles?


One in eight Americans suffer from recurring headaches that are so severe they cannot carry out normal living! An estimated 80% of all headaches occur from muscle tension. Did you know that many tension headaches are related to your bite?  Do you usually blame it on stress? Do you blame it on aging? This article explains how headaches can result from dental stress and how using a neuromuscular approach can help many headache sufferers.

Headaches are our number one pain problem in the United States. Approximately 40% of all “healthy” individuals suffer from chronic headaches. Head pain is not new. Early civilizations relied on magical potions and spells to cure headaches. In severe cases, holes were drilled in the skulls of headache sufferers so that the evil spirits, which were believed to be the cause of the pain, could escape. However, over the years we have learned much about what causes headaches and how to treat them. Today, there is a growing realization that a common cause of tension headaches is a bad bite.

Headaches from Dental Stress
How can your bite cause a headache? Tension headaches result from muscle strain, or contraction. When muscles are held tight for long periods of time they begin to ache. Headaches from dental stress are a type of muscle tension headache. A tension headache may be on one or both sides of your head. Or, it may surround your head as if a steel band were wrapped around it. The pain feels like a dull, non-throbbing ache. Aspirin usually relieves tension headaches. Specific signs, which indicate that the headaches may have a dental origin, include:
• Pain or pressure behind the eyes
• Sinus problems
• Tinnitus (ringing in the ears)
• Clogging or stuffiness of the ears, or subjective hearing loss
• Pain and/or sore jaw muscles
• Stiffness or soreness in the neck, shoulders and back
• Vertigo (dizziness)
• Grinding and clenching of teeth
• Sensitive teeth
• Clicking or popping jaw joints

Tired Bite
The muscles, which control your jaw and hold, your head upright is very complex. Many people do not realize that every time they swallow, their upper and lower teeth must come together in a firm way to brace the jaw against the skull. We swallow over 2000 times each day and night! If your bite is unstable, as from poorly aligned teeth or even a missing tooth, the muscles must work harder to bring the teeth together. Most people take a vacation from work when they tire out-but your jaw muscles never get a break! The overworked muscles become strained. When muscles are under constant strain, they eventually become painful.

Muscle Imbalance
Other muscles may also become involved. Your head is delicately balanced on top of your spinal column by muscles in your jaw, neck, shoulders, and back. Your head weighs approximately 15 pounds the weight of an average bowling ball! Imagine your head as a baseball balanced on top of a pencil by a number of rubber bands. When muscles are tense, they shorten. Now imagine shortening just one of these rubber bands. Some rubber bands would stretch, some would shorten, and the baseball would throw off kilter! Similarly, when even a single jaw, neck, or shoulder muscle becomes shortened, all of the other muscles are forced to overwork to keep the head balanced on top of the spinal column. We see then that dental headaches originate from an unstable bite, which cause the muscles of the jaw, head, and neck to overwork and become painful. Once the muscles become painful, a vicious cycle begins. The pain makes you fell tense and uptight. This worsens the muscle spasm, which in turn increases the pain.

Dental Treatment
Neuromuscular dentistry is nothing new. Actually, it has been around for some 30 years, but is not the traditional approach to patient care in dentistry. Neuromuscular Dentistry (NMD) is a term applied to techniques that expand upon the more traditional approach to dentistry that is more mechanically oriented. NMD places the occlusion where the muscles that control jaw position are at their best for optimal function and comfort.
Additionally, NMD techniques are used to treat patients that suffer from TMJ-like symptoms and to aid in establishing the occlusion for dentures. The relaxed jaw position gives an added insight that may allow for faster completion and improve final treatment results.
So, the next time you reach for the Advil for that afternoon headache, think of what it would be like to be headache free.


Orthodontics-Orthopedics

Mar 26, 2009 - 1 comments
Tags:

orthopedic

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neuromusculoskeletal

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neuromuscular orthodontics

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Oral

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Neck

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orthodontics

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muscles

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cervical

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facial

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Teeth

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beauty and cosmetics

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smile



"The Science and Art of Aligning Body Parts"

A balanced cranial-lower jaw and cervical relationship must exist in order to establish acceptable dento-facial beauty, balanced facial muscle forces on the teeth (intra and extra orally) that are positioned within a neutralizing zone of muscle forces that will support long term occlusal stability and good periodontal health.

I take a Cranio-Mandibular Orthopedic  approach to my dentistry.   Cranio-Mandibular Orthopedic Occlusion is a physiologically measured and defined relationship that orthopedically supports an optimal cranium to mandible (lower jaw) as well as the cervical neck relationship of the trigeminal nervous system.  It is an approach that goes beyond traditional orthodontic and classical functional orthodontic techniques.

This approach not only straightens and aligns the teeth, but more importantly it verticalizes orthopedically the posterior teeth and bone to an objectively defined position that enhances retention and bite stability.

This approach does take more time, skill, judgment and knowledge and requires further training than what is typically taught in post graduate specialty orthodontic training.  These techniques are advanced conservative and meets all the requires of comprehensive quality care for our patients.