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

Interests: My family, Dentistry, all sports, Travel
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Hamid Nassery, DMD, FICOI, FAGD, FICCMO
Miami Beach,
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TMJ/TMJ The Connection Between Teeth, Neck, Spine & Skull

Jan 27, 2015 - 291 comments
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TMJ

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TMD

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pain in jaw

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pain relief

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Dentistry

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head neck pain chronic

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jaw clenching

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clenching teeth

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tinnitus

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Neuromuscular disease

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tmj therapy

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TMJ disorders

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Miami Beach Dentist



One of the most difficult concepts to get across to my TMD patients and other doctors is the connectivity of the Jaw and the Neck. In fact, it is my strong belief that TMD/TMJ should really be classified as a Craniocervical Disease and hence fall under the umbrella of medical coverage rather than treated strictly as a dental problem.

To the Neuromuscular-minded dentist, "Occlusion" is an extension of general Postural Consideration. In other words it is a part of a complete system of interrelated bones, muscles and joints that ultimately relate to the Trigeminal System. Dental Occlusion must be synchronized with healthy Mandibular Function as it relates to a healthy head position and by extension a healthy posture.

So why are teeth/occlusion so important for posture? In simple terms incorrect posture is due to a twisted spine, which barring accidents or skeletal abnormalities- like a short leg, is due to an incorrect position of the skull. The position of the skull is influenced by the position of the lower jaw and ultimately the position of the jaw is mandated by the eruption pattern and final position of the teeth. Hence your bite is dictating your posture. Ever wonder why your chiropractic adjustments don't hold for long? Of course we can exercise and be mindful of our posture. However long-term we see that this conflict will have its say.

In my experience, examining both symptomatic and asymptomatic patients of my practice, I have found most often that even in asymptomatic patients the area of conflict lies within the spine; namely the cervical area. So the price for accommodation to the poor bite is most often paid for by our neck. Of course only about 24% of the population formally complain about TMD/TMJD, however if we closely examine all patients I believe we find that the incidence is much higher than that.

My approach today is to start this alignment process from within: from the inside first -with the integrity of the spine in correct position. When this is accomplished we can then bring the optimized position of the jaw and reinforce this correct postural position. Thus the teeth are a visual extension of the spine. This is why it is so important to have the spine in correct position foremost and this will produce a harmonious posture and finalizing with a proper balanced bite. Bringing complete health to the patient.

About the Author:
Hamid Nassery, DMD, FICOI, FAGD  has been practicing dentistry for the past 20 years. His dental practice Real Smile is located in Miami Beach and helps local and national patients.

To explore this further contact Dr. Nassery at 305.672.4444 or at
***@****
www.miamibeachdentistry.com


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Avatar universal
by SBosch, Jan 27, 2015
This is a totally amazing concept that I have been trying to convince my doctor to address. Have recently had a flare up of the cervical spin injury. I also have a scoliosis that curves to the left. The pain that occurred with this flare up has been almost unbearable. Sever headaches, numbness at tip of nose, upper lip, upper gum and front teeth, pain radiating into my left ear along lower left jaw bone, and of course in to the left side of neck, down the left scapula and ending at the top of the thoracic spine area. This same doctor asked me what was wrong with my posture, mind you I have been seeing this same doctor for 5 years. He took a profile picture and I was amazed. My neck was straight, with no natural curve, and my head appeared to be jutting forward, which caused my chin to jut forward. He acted like it was my fault regarding the posture issue. I am 57 years old and look like I am developing kyphosis, which is actually a result of the spasms in my neck. He suggestion was to up straighter. Had talked to him about the pain in my TMJ and he said I needed to see a dentist. I think I should start with the spinal alignment and work my way out as your information suggests. The medical doctors wonder why people in my situation would rather go to a chiropractor than take their half hearted attempts at making me, the patient, feel likes it's my fault.

Dear SBosch,

You are correct. But here is a question, how do you get your adjustments done by your chiro to last?  and the answer is "You get your jaw to support that position"
You see , your whole issue started from the mouth. There is a hallmark study , where they took healthy rats and created malocclusion in them artificially. All the rats ended up with scoliosis in short time. We all have malocclusion, and that has been caused by upper airway obstruction in all of us, to varying degree of course.
So , find your self a GNM trained dentist that can captain the ship and take you to health.

All the best .

H.Nassery, DMD FICOI FAGD
www.miamibeachdentistry.com

Avatar universal
by luckyman316, Jan 30, 2015
This is a great article and really supports my theory that my neck is more messed up after having dental work done (two crowns on tooth number 30 and 31). 3 days after I had my crowns placed, my entire body felt different, especially my neck. I had major symptoms.. dizziness with heights (never did), ears were ringing, balance problems, tons of neck pain, teeth clenching and just my head felt "off" many times. Eventually, I was diagnosed with 2 herniated discs which I did not have before and suffered no injury to the neck. I'm pretty sure the chiropractors made it worse as well!

After many adjustments on the crowns, which made slow improvements, I decided to get my gold crowns replaced completely with porcelin crowns fused to gold. Sure enough, this made a drastic improvement with symptoms. Unfortunately, they still linger now. I've seen 2 dentists, none of which were able to get my "bite" right but one did get me a good night guard for my clenching issue. Other dentists were reluctant to adjust my crowns for fear of breaking through them. I've been told the side with the crowns is hitting first though and this could be throwing my entire system out of whack.

I decided to go to a TMD specialist and he saw it all. Unfortunately, he also wanted me to spend $2900 for a treatment plan which had no guarantee it would work but could potentially help my symptoms. His treatment plan involved a series of visits hooking me up to a TENs unit to relax the jaw in a proper position so he could get the bite right.. it also consisted of making a night guard for my lower teeth. Your thoughts on this? Would this method work? Should I stick with the longer treatment of the night guard? It helps to a degree.

Dear Luckyman,

You are not alone. It sounds like they lost your bite. Here is the long and short of the story. The TMJ guy should be able to take care of your symptoms with a good orthotic made.. However, do not call it a night guard, as it really is a 24/7 appliance that should be worn at all times with detailed anatomic carving on its biting surface.
He should be fairly certain that he will take care of your symptoms, if he is not gently remind him he can visit Dr. Clayton Chan and fine tune his skills. At $2900.00 he is actually on the lower end of the costs, I know it seems high, but these works are very time consuming and the average is actually twice that with some of my colleagues actually charging  three times that. But you( the doc) should be confident of your skills.  What you should also understand is that this treatment has a end point, and that end point maybe more restorative work, braces or both. As a rule, I always explain all this to the patient on the first visit. You should go into such treatment with eyes open.

The night guard on the other hand, is not a treatment, its a band aid. just taking some load off your teeth for a period of time, and usually the palliative effects wear off after a few months.

I hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by luckyman316, Jan 31, 2015
Thanks, this helped A LOT. His endpoint was talking about invisalign after this treatment plan. Not sure if this was part of the plan or a separate expense, and if it is then not even sure on cost. Not sure I can use an appliance 24/7 like this. I have a career which definitely would not allow me to wear it 24/7. I may have to talk to him about this.. again, thanks for the advice it has been helpful.

Avatar universal
by SeanPW_1, Jan 31, 2015
I have had a high pitched ringing in my right ear for over a year now, and it's gotten worse.  In addition, my right ear drum feels like a muscle spasm happening...happens 2-3 times a day lasting for 20-30 minutes.

I do have work related anxiety.

I have on the past woke myself up on occasion having actually bitten the end of my tongue in my sleep and drawn blood once from it.  That happened 2-3 times over a 6 month period.  At the time, I thought nothing of it outside of a bad dream.  

Lately, the ringing has increased.  The spasm went away for a while but recently returned.

I also see a Chiropractor..I have a VERY bad lower back that will go out on me from the dumbest things, like reaching for a toothbrush or bending over slightly to get a glass, etc.  

I went to my dentist (my wife is a hygienist as well) and he fitted me with a night guard as I figured this was the cause from not grinding my teeth but clenching my jaw when I sleep (hence the biting of the tongue).  My dentist said I really don't have the symptoms of teeth grinding and all looked fine but the clenching, well, he was not sure.

When I visit my Chiropractor about 1-2 times each month, he always reports that my jaw keeps getting misaligned.  He puts his fingers on my jaw and tells me to open and close...I can feel is fingers move with my jaw to the side.

When I open my mouth wide, I can feel that it is actually tight to do so...strange.

In addition, I can change the pitch of the ringing by extending my lower jaw forward in an exaggerated motion.  It makes the pitch go much higher for about 1 or 2 seconds.

And finally, on occasion, if I move my jaw side to side it actually makes a large snap or crack sound, which I have never noticed.

I went to my ENT..I have very minimal hearing loss in my right ear..I have had a CT scan done last year and all was clear.  He also did other tests and cannot pinpoint what it is. Said tinnitus and I'd have to "live with it".  I'd agree but it's my right ear only and I've read that tinnitus in 1 ear is much more rare than both.

I'm confused and depressed over this thing. 44 years old...had physical recently and my bloodwork was excellent according to my longtime Doc.  Blood pressure very good as well.

Help?!?!

Avatar universal
by pocketaces, Feb 02, 2015
im probably going to die from gum disease .
ever since losing teeth  and having a tori problem that needs to be removed
nothing but trouble with migraines and my ears .
cant get rid of the fungus
anti biotics make it worse

i have bad facet joints in my neck but keep them adjusted as much as i can ,[i do my own adjustments ]have a mouthfull of toxic  krap! it all needs to come out but i cant wear plates till i remove the tori
sometimes it has sores on it and really hurts

my whole face and body hurt

i wish i could afford this
medicare/ are u kidding me?
im on ssdi income and cant afford much
not even food or rent

im tough but this tmd is ugly!




i

Sean,

I can sit here and tell you how all these things relate, but that would be long. I have explained all these , specially the relation to ear symptoms in my other answers in other blogs, so lease read some of my answers in the "Best treatment" blog.
Your case really sounds straight forward in the sense that all your symptoms and reports point to a misalignment of your jaw. Presently, I am in the middle of a case in which we have successfully treated and fixed these same ear issues on a patient.
Your lower back issues are also very much related to the issues in your neck. again, the question you should ask your Chiro is that why don't your adjustments last, and the answer is that the last piece of the puzzle, " your Jaw" is not in harmony with your spine, and it will never allow for your spine to stay in neutrality.
The great news is that these can all be greatly alleviated with the correct approach.

I hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by SeanPW_1, Feb 02, 2015
Thanks for the reply...Where can I read you Best Treatment Blog?

Sean,

That blog is on this same site;
http://www.medhelp.org/user_journals/show/65715/Best-Treatment-for-TMJ

just make yourself comfortable, and get ready to read, a lot.

Regards,

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by DAZR, Feb 07, 2015
Wow I'm amazed!!!  It was around the time my hip and lower back arthritis and sciatica started getting really bad that I started having severe TMJ problems.  Literally within a couple months of each other.  TMJ is so bad some days I can do nothing but lay in bed with my right eye watering as I pray for death.  This started 4 years ago...after the pregnancy and birth of my youngest made me aware of all my joint and nerve issues.  I'm on SSI so I've got state insurance, so when I told my doctor he sent me to a rather lousy dentist.  Well all of my top teeth and 6 dentists later (they keep insisting my teeth are causing this) I have no top teeth and I'm still getting the blinding TMJ pain.  I can't find help in CT for this...my insurance won't pay for a dentist that actually passed dental school for humans.  So I'm resigned to living the rest of my life like this.
The quacks would always blame another tooth when I would report more TMJ pain.  My teeth weren't pretty...but they were mine.  Now I don't even have a denture, because the last dentist/quack that made mine fitted them for a horse or something....I smile and look like I've got a mouthful of chicklets!!  Seriously I'm donating them to a horse retirement farm.  I certainly can't eat with them.
Anyway I'm amazed because I've asked my doctor about how all this started at the same time and was told it was a coincidence.  My gut instinct told me it wasn't, but the doctor says otherwise.  As usual I know my body better than him.  If doctors had listened to me 4 years ago when this started maybe I'd still have my teeth.  Now because of some bad doctors and dentists, me a 37 year old looks like a 50+ year old because of no teeth and veterinarian made dentures.  The state has denied my application for remakes several times so I'm stuck waiting for six more years for another set that will probably fit about the same as these others.

Avatar universal
by Jawouch, Feb 12, 2015
Dear Doctor  Nassery,
I completely agree with your comments with regard to having TMJ disorders reclassified. I suffer from TMJ and besides the pain it causes I am dumbfounded as to why there seems to be no one physician who takes responsibility for this condition. I suffer from jaw pain, face pain, eye pain, neck pain, ear pain and upper/shoulder back pain. I feel the problem is that typical GP's just pass you round the specialist merry go round with not one of these specialists taking a look at the body as a whole. You can be referred to physio therapists, dentists, ENT specialists, maxillofacial surgeons, pain specialist etc. Your absolutely right in having brought up the fact that this disorder needs reclassification. I also believe in your theory that alignment is the key to eliminating this debilitating disorder. It would be wonderful visit a specialist who could actually provide a cure or management for this type of pain. The experience of head pain every single day of your life is something that is difficult to explain to anybody. Too many times I've been written off as just some anxiety ridden depressed individual when the true fact of the matter is I just haven't been referred to anyone competent enough to solve my pain issues.
Regards,
Allison

Allison,

Thank you for your comments. The synopsis you described is almost universal of all my patients, they have been bouncing around for 15-20 years sometimes before they get to some one like me.. and there so much more to deal with than  just the alignment then,,.years of mental anguish is not easy to over come, and I certainly don't feel like I have all the tools for that part. I know what I have to do as a dentist and how to approach my work. However, the limbic component of this disease is something that not many talk about, and requires further involvement by other professional.
I thank you for sharing your experience, and hope you can find help soon.Let me know if I can be of any help there.

Regards.

H.Nassery, DMD FICOI FAGD
www.miamibeachdentistry.com

Avatar universal
by iearm, Feb 19, 2015
Dear Hamidreza Nassery,

Can you personally recommend any dentists in London who have experience treating TMJ disorder? I have all the usual slew of symptoms (pain, locking, headaches) which range from severe to manageable on a day to day basis. My doctor offered me a mouth guard which has done very little to help. I am really interested in your above discussion of the TMD relating to posture. Do you know if GNM dentists exist in the UK? I cannot find anything online. Your advice would be very appreciated.

Regards,
Imogen

Dear Imogen,

The closest thing I can recommend is
Dr. David Cook
London Holistic Dental Center
39 Harley St.
London, W1G 8QH
020 7323 1363
However, Please know that I have not seen him in person and don't know his exact level of studies with NM. I know for a fact that he has not studied with Dr. Chan, which would be a great way to know if the person has good basic background. I know he did train some in the other training center. This is the best I can recommend. Please use your judgment.

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by OldGirlScout, Mar 02, 2015
I also have TMJ, esp on my right side, and more recently, pain in my left ear, down my left side of neck, and into my left shoulder. I even have a large knot in the top of my shoulder the PT can't get worked out. I'm currently 50, but have been wearing a mouth guard at night for about 10 years that keeps my teeth from clenching--though honestly, I don't believe I clench at night but I DO clench during the day. I've worn braces three times now to align my teeth, and I "feel" like my jaws still don't align naturally. I feel like, to close my mouth and align my teeth, my lower jaw moves back too far. I always thought it was odd that orthos would make you sit back in a chair with your head back/low, which caused the lower jaw to fall back, but when you sat back up and were aligned upright, my jaw no longer wanted to be back so far, but that's always how they "aligned" the teeth, from that laying back position. When I wear the night guard, that is the only time my jaw gets to relax (only my front teeth meet on the hard night guard, and they can slide around until my jaw relaxes. Anyway, since this pain is now worse from my ear down to my shoulder, I would like to find a dentist or other doctor who can treat these symptoms properly. Can you recommend anyone in the Chicago area? Thank you for bringing this to light!

Regards,
Sandy

Hello Sandy,

We have Brad, he’s the closest in Chicago.
Bradley Rule, DDS (Levels 4, 5, 6)
(847) 662-7717
6475 Washington St. suite 101
Gurnee, Illinois 60031
Please let me know about your experience.

HNassery, DMD
www.miamibeachdentistry.com

Avatar universal
by jlmmy, Mar 11, 2015
hello, i have the same thing and been on the merry go round. i really need a competent professional to help with this asap as its destroying my well-being. is there anyone neat the ceredigion/wales area to help?

thanks
james

Sorry to hear that James. I am not sure where that area is that you are referring to. Please clarify .
Thank you.

H.Nassery, DMD

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by Cingram, Mar 12, 2015
Dr  Nassery Hamidreza, Hello I have been reading some of your story's but wanted to tell you mine and see what you think. When I was 19 or 20 I had my bottom wisdom teeth cut out. never got my top ones, thank goodness. A while after that I started having a popping in my jaw when I would eat. allot of people in my family have tmj so I figured that's what it was and didn't really do anything about it. In my early 30's, the popping had the pain had started.I went to my dentist and he had me open my mouth and he felt both sides of my face, he said I did not have tmj and to take ibuprofen and it should go away. Well now I am almost 40 and I have to watch what I do, how I eat ect. My jaw becomes very sore, stiff and sometimes I feel like its gonna lock. Singing, yelling or chewing allot makes it worse. I am pretty sure this is tmj from what I have read but my dentist does not think so. My mother and both aunts also have problems with their jaw. please help.

Cingram,

If you had popping jaws , by definition you have TMD, this basically means your jaw was too far back and up, pushing your disc out off the joint space. I am sad to say that the dentist did not know the first thing about normal anatomy.

What you have to understand that this is a cumulative disease, when we are younger we can accommodate better and as we get older our accomodative abilities lessen. You muscles are too tired to try any hard food. The good news is that with proper treatment you can be much better. check the following link for a qualified dentist to help you;

http://batchgeo.com/map/findinganeuromusculardentist

Regards,

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by hc1, Mar 19, 2015
Hello Doctor.  I have very bad TMD my whole life with my jaw being so loud when I eat others can hear it.  I have had chiropractic massage on it and was told it is the worst they have ever seen.  Anyhow... I recently  have been having problems swallowing.  It is more of a "tongue not moving right with my palate" than a "lump in the throat/choking" problem.  I sometimes push food and liquids up into my sinuses.  This happened out of the blue and has not improved in 5 months.

I was worried about neurological problems, but my testing has been normal.  I even had an EMG of my tongue to rule out ALS.  I am continuing to see an MS specialist for more advanced testing.  

I have noted that I am holding the sides of my tongue between my back teeth a lot lately.  I am not sure if it's a new problem or I am just paying better attention.  My sister is convinced that the TMD is causing my swallowing issues.  Have you heard of anything like that?   On a side note, I do have some stenosis and degeneration in my C-spine.  

Thanks in advance.


Dear HC ,

Aberrant swallow pattern is one of the more typical issues in TMD patients. So, yes, I have heard it and more over , I have seen it. We even have a specific scan in our routine tests for it..

Most TMD patients lack the proper space for their tongue, and therefore the tongue is always posturing in an incorrect position. Your neck issues are also very characteristic of this patient pool. I hope this answers your question.
You can make things better.

Regards.

H.Nassery, DMD FICOI FAGD

Avatar universal
by hc1, Mar 19, 2015
Thank you for the information!  

Avatar universal
by ProteusP, Mar 23, 2015
Hello Dr Nassery Hamidreza,

Would you be able to recommend a neuromuscular dentist in Toronto?
I suffer from TMD issues, I've been dealing with chronic headaches and TMJ issues for the past 10 years now, being bounced from one practitioner to the next with little results..
If things don't pan out..I'm seriously considering flying down to Miami to see you about my TMD and oral health..etc..

Best regards

Paulo.

Dear Paulo,


Here is some one in Toronto,


Tony H. Wan, D.D.S.
9 Penwood Crescent
North York, ON M3B 3B1 Canada Zoom
Phone: (905) 876-1188

But I really recommend : a little farther but worth the drive..and you don't need to fly down here..

Hoa Nguyen, D.D.S.
267 O'Connor Street, Suite 421
Ottawa, ON K2P 1V3 Canada Zoom
Phone: (613) 232-6735

Regards.
H.Nassery, DMD


Avatar universal
by ProteusP, Mar 24, 2015
Thanks you so much Dr Nassery :)
The world needs more doctors like you.

Cheers

Paulo.

Avatar universal
by PomegranateBlossom, Mar 30, 2015
My issues with TMD are similar to many posts above and simply put - I have been in excruciating pain for about 8 months now (had TMD for decades, but it was always a minor pain that I thought I would "fix" when I could afford orthodontics, which never happened for financial reasons).
Now it has taken over my life and is getting worse - multiple symptoms, failed attempt with a custom night guard, self-care, etc. I keep getting the runaround, and I am so pleased to have found this webpage. I am more conscious of how I am carrying myself (posture) and how it seems so connected (scoliosis, congenital L5/S1 sacralization issue, constant cold, stress, and pain forcing me to "guard" and scrunch up all the time, malocclusion and missing teeth). I know it's connected but cannot get the treatment I seek.

My question is essentially: Do you know of any Neuromuscular trained professionals (or anything even CLOSE to this methodology) that take Medicare or have sliding scale fees, or anything that someone on Disability can afford; my estimates vary, but are getting up into the $10,000's.
Thank you for your time; I know it is a long shot, but I am lost. I found only 1 TMJ specialist nearby that took Medicare, but the custom splint worsened the pain and I felt he did not have the comprehensive approach that I sorely need. I live in Portland, OR but will travel quite far as my quality of life is horrible and worsening. I am going broke on acupuncture, massage, etc. that only help for a few days. I want to get at the root of this problem. I am in my 30s and I feel 100. I would not usually post this type of thing, but can barely think clearly anymore with the pain and the confusion about who to see next... I am overwhelmed.

Thanks! LM

Dear Pomegranate,

I hear the pain in your words. I wish there was a way for me to help you. Like many other clinicians, I too have struggled with the same issues.. many of our patients can not afford to pay for this treatments, as there is no real coverage, neither by dental nor the medical..
At its roots I believe TMD is a medical issue, as it has global effect on the body due to its main area of damage, the cervical region.
I wish I could tell you I know of some one that takes medicare, butt even if they did, it would not cover the oral appliance as things stand now. It would take a change in medical practices to do so...
In the meantime try and see a good PT to work on your neck, instead of the massage and acupuncture..you may find that gives you better relief.
All the best.

H.Nassery, DMD FICOI FAGD
www.miamibeachdentistry.com

Avatar universal
by natalieoa777, Apr 03, 2015
I bet most of your patients with TMJ are probably suffering due to a side effect of their antidepressants. I spent years not knowing that it was my antidepressant, what a waste of  life. 10 years of endless pointless appointments. I stopped the antidepressant and the TMJ went away.

Natalie,

Believe me, TMD and TMJ pain is very real. Most of my patients have been searching for relief for many years and many times they have been told that all is well and its all in their minds only.. That can drive even the strongest one of us to depression.

Regards.

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by bobs777, Apr 05, 2015
Hello Dr. Nassery,

I am someone who has sleep apnea and wears a mouth piece that brings my lower jaw forward so I can breathe while I sleep. Of course this situation has caused TMJ. Is there anyone who does your type of Dentistry in the Boston area?

Thank you for your reply.

Bob

Bob,

I can Highly recommend; a good friend and mentor.


Ramin Mehregan, D.M.D.
95 Washington Street
Canton, MA 2021 USA
Phone: (781) 821-2120

Warm Regards,

H.Nassery, DMD
www.miamibeachdentistry.com

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by Tammy2009, Apr 07, 2015
Is there anything else one can do when bite guards, NUCCA chiro, craniosacral, acupuncture and reflexology have failed to help TMJ?  I see Dr Curtis westersund and I am his only patient he hasn't been able to majority improve with his bite guards (sorry doc for ruining your percentage).  Everything else has been keeping the jaw pain to a minimum lately but my migraines are out of control and I have a feeling they are related. To the point need 3 different pain meds around the clock during an attack (on a preventative as well) and still I'm out cold on the couch at least once a week for a day or two. I have to use ketorolac , Tylenol 3 and maxalt for pain control and yesterday it only took the edge off, was a miserable day and again today i still am having to use them, sore, miserable and no energy.

I know my first vertebrate is out of alignment and refuses to rmemain in place since my jaw surgery where the surgeon "over corrected" so the open bite wouldn't come back.  I now have a posterior open bite instead ofanterior.  

Is there anything else I can do?  I have stopped going to the chiro because it was a waste of his time - my adjustment was coming out 20 minutes after we adjusted no matter what I or he did, we even both went to my dentist and adjusted my bite guard and made sure I was in alignment (tiniest correction would knock me out so it took three adjustments).  Thanks, I really don't want to give up and be resigned to taking pain meds the rest of my life, but I am running out of things to try!

Tammy,

I remember you. Dr. Curtis is a good friend and Ii know he is very detailed in his approach. I also know we all have cases that are more difficult. One of the main reasons is the instability of the cervical spine in these patients.

We already know that most of our TMD patients have generalized hyper mobile joints, but then those who have had a long history of adjustments , show even greater instability in their necks. For this reason, personally I prefer alignments done by a PT, rather than a Chiro. There should also be a plan for exercises to strengthen the neck and bring tonus and more stability to it.
We can have the best bite possible but if we can not stabilize the neck to keep its position, it will not work. It would be naive to think one modality can overwhelmingly affect this complex system.
I would suggest speaking to Dr. Westersund, about working with a PT, and starting some sort of regimen for strengthening your neck. Dr. Rocobado  has been advocating specific routines for this purpose for many years. Stay with it. I wish you all the best.

H.Nassery, DMD

Avatar universal
by 06cas, Apr 13, 2015
I have TMJ and I feel its effect from my mouth to my neck. I asked my dentist and he said a nightgaurd wil prevent the uncomfortable, muscle strain but Im not so sure...

Dear  06cas,

Night guards are palliative treatments. Meaning that they are band aid solutions, also not a;; dentists really know what to do with patients like yourself. Please try and find a dentist that has been trained in TMD therapy.

All the best.

H.Nassery, DMD
www.miamibeachdentistry.com



Avatar universal
by MommaDotty, Apr 20, 2015
Dear Dr. Nassery

                   I have spent the last 3 yrs fighting with most of the same symptoms that most of your other entry's.  I have seen 6 dentists, 2 ENTs. Even saw a TMJ specialist   His response was pretty much down hearting and disappointing. He said he could help with the jaw discomfort. But couldn't help with my main problem. Have u even had a patient that complained with numb and tingling tongue and lips along side with dry mouth sometimes, with TMJ or TMD.  All the scanning Ive had shows right side jaw is a little out of socket, artritous in the neck, cervical and lower back. I've  fought with cervical and lower back disintegration in the disks for 20 years. Never needed any surgery for either because i guess of all the physical therapy that I've done. I of course have the night guard which is my only form of relief   It seems to help with symptoms if I exstend my lower jaw forward and do my pt exercises for TMJ   I sometimes don't feel that I have TMJ because I have no problem eating in fact it feels better for awhile after I have eaten. I just don't know what else to do. My doctor has no answers for me   I'm 61 and am really frustrated that no medical doc or dentist has been able to help me.  

Can u help.   Just some answers. Please

Thank you
Dotty

Avatar universal
by reallynotfunny, Apr 20, 2015
Dear Dr. Nassery

Im so glad to have found this website.  I have been searching the internet for over a year now with my discomfort as nobody had answers and I have seen 2 Ent specialists, had 3 scopes,  had cervical spine and soft tissue MRI, CT scan, 2 neurologists, 2 General Practitioners, 1 Gastro Dr, 1 Allergist, 1 infectious disease specialist, 3 dentists, I oral maxifillo surgeon, an osteopath, chiro and 3 physio therapists and not one of them said it could be TMJ.   I diagnosed myself by massaging my pyterigoid muscles inside my mouth and finding trigger points as my main symptom was tightness in the neck just under the jaw and a tight cold hard palate.  I googled cold palate sensations for months and finally found pyterigoid muscles could be causing this from TMJ!!  and yes I am finally feeling some relief!  This is after being prescribed antidepressants which I never took and being told its physcomatic maybe!  I'm surprised I haven't become depressed after this carry on!  Its shocking that after spending all that time suffering and a fortune on medical costs I found it myself!  even the dentists said no swallowing issues of saliva (food is fine actually feels better) is not TMJ and everyone gave me this funny look when I mentioned my tight palate!

Please I live in Dubai, who can I see? Im coming to Orlando in July for vacation if nobody is here to help me I could visit you.

Many thanks
Lindsey


Dotty,

I am very familiar with all those symptoms. I am going to tell you that most all these are due to the neck...however, as long as your bite is not corrected you will be dealing with these.. Your bite is the last chip that holds your neck position.

So you can see your PT all you want, but the correction and adjustment will not hold unless your bite is corrected to that position.
So the question is not whether you can tolerate your joint problem, The issue is that your neck is done accommodating this wrong position. I hope that I am making this clear.

Regards,

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by reallynotfunny, Apr 20, 2015
Oh yes and I also forgot to mention I saw an Orthopedic specialist and a Neuro Spinal surgeon too, still no mention of my jaw.

Hello Lindsey,

very nice to hear from you.

"This is after being prescribed antidepressants which I never took and being told its psychosomatic maybe!  I'm surprised I haven't become depressed after this carry on!  Its shocking that after spending all that time suffering and a fortune on medical costs I found it myself! "

This is actually very common, the bulk of my patients are female (75%) and the median age is 46 y.o. by the time they get to me they have been going around searching for years and many are already on anti pshyc. and anti depressants..because they must be crazy, if the doctor does not know it, then it must be a fragment of your mind..

I actually do not have a referral for you there, I'll be glad to see what we can do for you when you get to the states.

Warm regards,

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by reallynotfunny, Apr 20, 2015
Thank you very much for your reply.  I will look into a visit. I know it's long term treatment but if you could at least diagnose my problem properly and give me advice for further steps as I don't live in the U.S. but could seek further help once you have seen me.
2 neurologists told me that something in my life is not making me happy and I need to find out what it is because I am holding back and not expressing myself!
Well one things for sure they will be hearing from me, I will be telling them what I have so they don't misdiagnose other patients,

Kind regards
Lindsey

Avatar universal
by doffs, Apr 24, 2015
Hello Doctor,

I've been suffering with TMD for over 30 years -- now 62 -- pain everyday -- migraines, neck pain, pain into the shoulders/arms etc but I've had to live with it.  Your approach is such that if I could afford to come to your clinic I would.  As it is, is there anyone you can recommend in NYC -- Manhattan specifically?  Thank you in advance.

Doffs

Avatar universal
by Theresadawn, Apr 27, 2015
For the past month I have suffering from nasal congestion in the right side mostly as well as dental problems. I have to sleep with my mouth open to get air. On top of that I through my neck out on the right side and I'm suffering right ear pain and nerve pain. I went to several doctors and an ent only to be told I have tmj and I need a dentist. On top of that I have a cleft palette.  Help? Is the anyone I can see in the  LA/Orange county areas in California?

Avatar universal
by Theresadawn, Apr 27, 2015
I also am on only Medi-Cal and Medi-Dental

Avatar universal
by JennFreud, Apr 27, 2015
I've worn night guards for over 20 years, so my teeth are no longer being worn down, but the popping in my jaw is as bad as ever.  Like Theresadawn, above, I am hoping to be referred to someone in the Los Angeles area, or, better yet, Thousand Oaks or Westlake Village.  Thank you for all the great information and keep up the good work!


Dear Doff,


In NYC I can recommend the following Docs;


NEIL ZANE, D.D.S.
Address:   550 Park Ave., New York, New York 10065-7369
Phone:     (212) 826-0777

Dr. Ramin Tabib
8 EAST 84TH STREET NEW YORK, NY 10028
TELEPHONE: 212.452.3344

I hope this helps. All the best.

H.Nassery, DMD
www.miamibeachdentistry.com

Dear Jenn,

I can suggest Dr. Yassamy with great pleasure;

Fary Yassamy, D.D.S.

Address:   825 Huntington Dr., San Marino, California 91108

Phone:    (626) 441-2231

Avatar universal
by nctgreene, May 01, 2015
Dr. Nassery,

I am suffering with self diagnosed tmj.  My symptoms are headaches, face pain, tennitis, ear pain, jaw pain, neck and shoulder pain, upper and lower back pain.  I have been to several drs but no one seems to help.  Only by my research have I come to the conclusion that it may be tmj.  Could you recommend a doctor in my area?  I live in Gaston County, North Carolina.  Just outside of Charlotte, NC

Thank You
Nancy Pasour

Nancy,

Glad to hear from you. The closest practitioner with the full qualification near you would be near Raleigh,

Amy H. See, D.D.S.

Address:   108 Southtown Cr., Rolesville, North Carolina 27571

Phone:      (919) 562-8200
https://findingagneuromusculardentist.wordpress.com/amy-h-see-d-d-s/

I hope this helps.

H, Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by nctgreene, May 03, 2015
Thank you, Dr. Nassery

Nancy Pasour

746512 tn?1388811180
by Tammy2009, May 03, 2015
Sorry to bother you so much Dr nassery but I have another question here - I did have a chat with westersund about the migraines and we had a good look at my bite guard and made some small adjustments hoping to help (unfortunately did not really) and of course I did forget to ask recommendation for physiotherapists so was just going to get through a couple super busy trade show weekends and then give him a call back.  Well learned a hard life lesson - don't push your body too hard.

Ended up with a migraine that flared so hard and fast I ended up losing control of my car at highway speed, long story short I'm super sore - headache ten times worse now (probable concussion, but CT clear), painful neck (whiplash I'm guessing), and pain down into my chest, arms, shoulders and back.  And of course my jaw is sore again, super nausea so I can't eat and already lost 3 pounds since Thursday (not good considering I only weighted 88 before and my doctor was getting a bit concerned with that- stupid med side effects).

I have an appointment with a physio through my insurance company to do the assessment thingy they have to do tomorrow and family doctor on Friday for follow up (why are they always on holidays when you need them)?  Since I may not have choice of which physiotherapist I see to have it covered under insurance is there anything I should watch out for them not to be doing during treatment so I don't ruin my jaw/neck more than it already is?  I'm hoping my muscles are just tight but I'm defintely not biting properly on it, so might have to go do another adjustment there too,sigh.  

Thank you for all for help, I really appreciate it!

Tammy ,

I am sorry to hear that your treatment is not going the way we hope it would. We all have challenging cases, wish they all could be easy.
So the first thing I want to know is if the PT is familiar with and comfortable manipulating your neck. It would be great if he/she has taken a course with Dr. Mariano Rocabado. Once the neck is better, then you want to retake the bite with Dr. Westersund and make a new orthotic.
This may put over the line and get you better.. What you have to remember, is that patient with advanced cases like yours also suffer from a lot of laxity in your ligaments in the neck and can easily go into a displaced position with even a slight accident.
I hope this helps. All the best.

H.Nassery, DMD
www.miamibeachdentistry.com


Avatar universal
by nwengel, May 05, 2015
Hi Dr. Nassery,
Can you recommend a specialist in the Seattle area? I am not sure if I am the type of patient you discuss in your article, as I have no known back or neck issues other than very tight muscles in my shoulders. While often uncomfortable, I have never thought it necessary to receive medical advice. However, my dentist is constantly worried about my grinding / clenching and due to insomnia, I cannot get used to wearing the night guard. The past couple years have been especially difficult and I have symptoms that no doctors have been able to address: ear pain that travels through my jaw and side of neck, "hearing noises" which may be tinnitus but what I think is more accurately described as "not processing white noise correctly" (i.e. a fan might sound like the radio), dry mouth / eyes, and a bewildering variety of headaches.

I've been to the neuro, endo, rheumatologist, ENT, and yes, psychiatrist - while certain things might be attributed to anxiety, there is empirical evidence of TMJ disorder, so it makes sense to treat that and see how things are after that.

Thanks very much,
N.E.

Dear NE,

It sure sounds like you have many of signs and symptoms of TMD.. you happen to be in luck for your area..I can recommend a very good Doc. in your area..

Yumi Abei, D.D.S., M.S.D.
Address:   1811 156th Ave NE #3, Bellevue, Washington 98007
Phone:     (425) 614-1098
Orthodontist Specialist

All the best.

H.Nassery, DMD

Avatar universal
by Laure0502, May 23, 2015
Dear Dr. Nassery, As I read through all the comments, I would like to say thank you for all the useful information. I had two pretty severe neck surgeries back in 2007, continues problems with ringing in the right ear, facial numbness, two implants on the right side, have used a nightguard almost every night.....Now I am suspicious that if this is all related, then I need to work with someone who really understands this. I live north of LA about an hour in the Santa Clarita Valley,CA. Do you know anyone around this area who would be a good Dr.
Thanks for your help!
Laure

Hello Laure,

I think Dr. Yassamy would be a good choice for you..

Fary Yassamy, D.D.S.

Address:   825 Huntington Dr., San Marino, California 91108

Phone:    (626) 441-2231

Please keep us updated about your progress.

regards.
H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by RachelVernee, Jun 04, 2015
Hi Dr. I am glad to have found this what you are describing is exactly me and now after one year of not eating normally it's still getting worse my disc is out of place in my jaw but I cannot find a doctor to help me. I have a disk problem in my back, then terrible neck and shoulder pain and now the jaw disc. After a year of this jaw problem it's getting worse and I have very bad pain across my jaw, forehead, etc. are there any doctors in the Washington Dc area?!? I cannot find one. Thank you so much- I cannot tell you how much thanks!

Dear Rachel,

I am happy to help, Please see below;

Stephen E. Burch, DDS

Address: 8270 Greensboro Dr #101, McLean, VA 22102
Phone:(703) 827-9250

He is a great clinician.

Please update us on your treatment and results.

All the best .

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by RachelVernee, Jun 04, 2015
Wow thank you!!

Avatar universal
by Elise23, Jun 07, 2015
Since everyone is asking, how about a referral in Nashville, TN please? Thanks much!

Dear Elise,

I wish I could give you specific answer, I currently have no docs in Nashville per say,  Please check the map in the link below, and see who is closest to you;

http://batchgeo.com/map/findinganeuromusculardentist

There are docs in Arkansas, and North Carolina, as I see it..

Hope this helps.

H.Nassery, DMD FICOI FAGD
www.miamibeachdentistry.com

Avatar universal
by joy9000, Jun 13, 2015
Dr Nassery,


Thank you for your posts.  Is there a dentist you can recommend in NJ.  I have been suffering terribly since having a bad crown placed 4 years ago.  Even though its been removed and replaced the damage to my bite has been done.  

Your help is greatly appreciated.'

Joy

Joy9000,
I'm sorry to hear of your issue. Please follow the link in the previous post and check the map. It's an easy way to find a qualified doc near you.
Their qualifications and courses completed are also listed so you can make the best decision.
All the best and please keep us informed of your progress.

H. Nassery, DMD FICOI FAGD
WWW.MIAMIBEACHDENTISTRY.COM

Avatar universal
by Neckandshoulderpain, Jun 21, 2015
Hi Dr Nassery,
                        I have had 2 surgeries for Eagle's syndrome. Main symptoms were swallowing difficulty and chronic neck and shoulder pain arising mostly from the levator scap - all only on the right hand side. Another thing to note is that I have long standing right sided tongue weakness and my right shoulder sits about 1 inch lower than the left. I am 37 years old. Again 6 years of physical therapy has not been able to address this.The first operation was on the hyoid bone and the second was an internal shortening of the styloid process. After the second operation, I woke from the anaesthetic with TMJ problems and have it ever since - 9 months. The stylomandibular ligament was cut during surgery but I have been told that this should not cause TMJ problems as it is only an accessory ligament. Another possibility is that it was caused by overextension during the surgery. Now my jaw on that side aches and crunches all of the time. I also now have Eustachian tube problems where I get squelching in my right ear when I move my head to the side. I went to a physical therapist for 5 months who specializes in TMD. She eventually concluded that it was a structural problem that would not be fixed by physical therapy. I went to a Maxillofacial surgeon who took one look at me and said that surgery wasn't warranted and that was it (I don't want more surgery!!). I  had an MRI of the head and neck prior to my surgeries which found nothing and the ENT surgeons never wanted to comment on the potential cause of my tongue weakness. I went to a neurologist who did a basic neurological exam and told be it was a local problem and to go back to the ENTs. He made a vague comment that no one is symmetrical! So now I am in a position of having TMJ problems added to my original problems that were unsuccessfully treated by the surgery and no place to go. I have a good dentist but he doesn't think that my bite is a major contributor to my problems. I am sure that there is a piece to the puzzle which is being missed. Any suggestions on which an avenue to pursue - MRI of the TMJ to try to identify if there is structural damage?  

Dear neckandshoulder,

I have not seen you or examined you so please take all with a grain of salt. This is not a diagnostic description.

Everything that you have described could be due to and related to one another.. so let me tell you what I see in your case.. Eagle syndrome or the ossificcation of the styloid attachments is generally seen in patients with severe class 2 bites.. are you a deep bite class 2?  This is due to the extreme forward head position and posterior head rotation in these individuals..
While in extreme cases surgery is needed, it is a last resort.. The positions of your tongue and hyoid bone are both affected by the skeletal positioning of your lower jaw, so while on surface you can eat and chew with your teeth, if I am correct and you are a deep bite individual, then your bite is the very core of your problems.
Please let me know more details of your case.

I hope this starts to shed some light on the issue for you.

Regards.

H.Nassery, DMD FAGD FICOI
www.miamibeachdentstry.com

Avatar universal
by jtmj, Jun 30, 2015
Hi Dr Nassery,

I have been grinding my teeth and clenching since I was little. Now raising my own family and stress of life. The clenching has become worse. Almost 2 years ago I went the emergency room with a bad headache pressure on top of my head. Also, tingling like sensation along the left side of my face. Well of course they sent me for cat scan, blood work etc. Medication never took care of it. I saw a neurologist, he thought migraines because I had an aura too. Well so him for 6 months stopped going nothing worked. Neck problems, lower back pain etc. I started seeing a chiropractor well my body felt better the off and on tingling sensation stopped. I also started wearing a night guard. Winter of 2014 till now my symptoms have increased again with other symptoms. Muscle twitches off and on everywhere. Ear pain, buzzing sensation in ear, dizziness. Sometimes muscles vibrate. I feel like my bite is changing to from the night guard. I just don't know where to go with this. I now have such anxiety over this I know I am clenching worse than every before. My clenching is so bad that I have a very large area of bone growth on one side of my upper gum line. One time I was sleeping I had my two sons in the recliner in my arms. One an infant and the other 18 month old. I walk up with such a grip with my teeth that I had to consciously think about opening my mouth. Almost all my joints crack now my neck is so tensed. Even as I'm writing my neck is tensed. Please help!!

Avatar universal
by PAB12345, Jul 07, 2015
3 1/2 years of agony after opening too wide and sustaining jaw injury. One week later, neck got involved. Closed lock for a  month, every pill, every chiropractor, every pain management, 4 TMJ dentists, physiatrist, orthopedic, several physical therapist, acupuncturist, radiofrequency ablations, etc., etc. etc. I have been taken to the cleaners financially. Had two equilibrations so bite theoretically level. Then had a TMJ doctor tell me never to do that.  Any referrals in central Illinois? Mattoon too far.

Avatar universal
by kaz065, Jul 07, 2015
Hello Doctor Nassery,
Thank you so much for all the incredible information you put out there for people who just can't seem to get help anywhere else.You are giving more people than you could ever imagine, some hope that there may just be a light at the end of the pain and discomfort tunnel they have been travelling down for many years. And as I am one of those people I was wondering, no hoping would be the word, if you could recommend someone/anyone in the Sydney, Australia area. I would be extremely grateful for any help you could offer and once again, thank you so much.
Kindest regards,
Karen.

Kaz 065,

Please see below..

Leading Edge Dental
Directions
Dentist
Address: 16 The Strand, Penshurst NSW 2222, Australia
Phone:+61 2 9580 3047

Although , he does not know me, I know that he has taken many of the courses that I have as well. He is a astute clinician.

All the best. Please keep us updated with your progress.

H.Nassery, DMD FAGD FICOI
www.miamibeachdentistry.com

Dear JTMJ,

You have many of the sign and symptoms. If your issues have been cleared medically, then look over the link below to the map and see if you can find some one near you.

http://batchgeo.com/map/findinganeuromusculardentist

I hope that you keep us informed about your decision and the progress off your case.

All the best.

H.Nassery, DMD
www.miamibeachdentistry.com

Dear  PAB12345,

Greg Yount is one of my most advanced and learned colleagues. There are not too many doctors with as many years of experience in this treatment modality. I highly suggest making the effort to see him.

Otherwise check on the map;

http://batchgeo.com/map/findinganeuromusculardentist

Warm regards.

H.Nassery, DMD FAGD, FICOI
www.miamibeachdentistry.com




5937540 tn?1377195380
by overdreamer, Jul 30, 2015
Dr. Nassery,
Dr Burch is retired, do you know of anyone else in the area. I have suffered for 3 years with this diblitating issue. I stay constantly dizzy and eye to stay focused. I wake up sore every day from the top of my head to the small of my back.

Dear Overdreamer,

Unfortunately, I don't have anyone in your vicinity to recommend that I personally know. However, I am sure there are other Neuromuscular dentists near you there.
Just look up under that heading and see who you come up with. Please keep us updated on your progress.

H.Nassery, DMD

Avatar universal
by sarahjeanwolf92, Aug 07, 2015
Thank you for sharing!

This would explain my back, shoulder blade, left rotator cuff (socket connecting to left shoulder blade) pain and weakness, too - wouldn't it? I was just issued a custom made TMJ bottom mouthguard by my dentist and I am what he called "weak"/I tested "weak" on my right side. What does this mean? I ask because, honestly, it is my left side of my body that feels weak and the left side of my jaw where my teeth are more ground/worn down; however my right side of my jaw feels the pain (I think because those teeth touch and feel the most pressure when I clench my jaw and my left side doesn't as much because the teeth are worn down on that side more).

Sarah,

Thank you for sharing your story. Please continue sharing your progress. As for the possible reason why? of course it is all speculation on my part , not having any data or diagnostics on you.
However, what I see in my patients, when a side is that short and hardly touches, the muscles on that side will go to a complete shut down due to fatigue. The other side will end up taking on the extra work and ends up being the hurtful one..
Its a little simplistic answer but its something like that.. hope this answers your question.

All the best and keep posting.

Regards.
H.Nassery, DMD FAGD FICOI
www.Miamibeachdentistry.com

Avatar universal
by Striving77, Aug 10, 2015
I have been diagnosed with Trigeminal Neuralgia. 7 years now. I have seen drs for bite and jaw function, neurologists, upper cervicals, chiros, etc. The fact that I respond to anti-convulsants is diagnosing me with a nerve related issue. I want to check teeth for cracks and pulp issues. Why cant TN be a result of that, when there are claims of TN being the result of dental procedures, root canals, etc? I want to be seen by an endodontist. However, the neurologist point of view is: -dont go, they will pull all your teeth out, its a brain related issue!
Any comments?

Dear Strivving,

In my experience, the causes of TN, could be either from the central nervous system, like your neurologists suggests, or from the pressure on one of many branches of the peripheral branches of  cranial nerve 5.. I know there have been cases of TN that were alleviated by physiologic re-positioning of the jaw into a neutral place and then balancing the bite there. However, I don't' know of any case that has been resolved by doing root canals. Further more, endodontists do not extract teeth, they do root canals. However, I do get the jest of his comment, as if you push hard enough some one may actually extract these teeth thinking they are doing you a favor.
I am not sure what kind of bite and jaw functional therapy you have done so I can not comment, however, I would continue seeking that route. I would not recommend any root canals or extractions.

Hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com

Dear Overdreamer,

I was able to find some one's name that may be able to help. Though he has not studies with Dr. Chan and I can not tell you exactly that he is following the same protocols, I did get good feedback from other clinicians about him.

Bernie Greenbaum, D.D.S.
***@****
(301) 530-3600
6410 Rockledge Drive 106,
Bethesda, Maryland
20817

Hope this helps, and keep us posted.

H.Nassery, DMD

15523765 tn?1441132933
by bscott915, Sep 01, 2015
Dr.Nassery,

I have severe TMJ and I also have Scoliosis and a Chiari Malformation which I am scheduled to have decompression surgery for. Are these issues related? If so, how do I treat all 3 of them?



Dear bScott,

Chiari is a congenital malformation..I don't believe it is related. However, we know that TMD and its cervical issues can exacerbate issues. Scoliosis is most likely related to the same underlying problem causing your TMD..

Once the surgical work for Chiari has been performed you can look into treating your TMD.

Best regards.

H.Nassery, DMD

Avatar universal
by luv4snow, Sep 27, 2015
Can you please recommend a neuromuscular dentist in the St Louis MO area?

Dear Luv4snow,

Close to you I can strongly recommend  the following Docs. Know them both and have studied with them. Thoug not exactly in St. Louis, they are worth the little Drive

GREGORY YOUNT, D.M.D.
Address:   225 Richmond Ave. E., Mattoon, Illinois 61938
Phone:   (217) 235-0434

Roger, Buzbee, D.D.S.
Address:    2104 Chesterfield Blvd., Springfield, MO 65807
Phone:    (417) 888-0771

Hope this helps.
Warm Regards,

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by e274362, Sep 28, 2015
Hello Dr.Hamid,

Thanks for your interest in answering TMJ related issues for which I am very much a candidate

Just to give you heads-up, my trauma started around 3 years ago with severe ear pain. Any phone call would make me worse. Numerous visits to ENT specialist yielded no relief but finally found thru websites that unexplained ear pains could be a TMJ symptom. I found a NMD dentist last December and after examining my TMJ open and Closed Xrays, OPG and Cephalogram, he gave me a daysplint and a night splint in Jan of 2015. Now its 8 months down and I can see a vast difference in pain relief, I can say 80% relief, but I have few questions:

Before I was able to open my mouth 32-33 mm but now I am able to open it 40 mm without pain, it extends up to 46 mm with pain. So just wanted to know if this is a case of good improvement or should it extend further?

Also the 20% discomfort that I have relates to pain in the jaw joint and right side of the tongue. Is this normal and if yes how long will take to get a better relief?

I get dull headache and dizziness at times when pain at times bother me, will it subside over period of time?

Finally but most important - based on the above facts, do you think my Disc has recaptured or?

Thanks,

Sam


Avatar universal
by Steviebt, Oct 01, 2015
If the TMD is caused by the neck or spine, could this be why I have numbness in my neck, and scalp? I have TMD, and have been given two different night guards that were molded for my mouth. There were two options, a hard guard, and a soft. I had to get the hard because of how bad I grind. I chewed through the first one. I was then made another guard for the bottom front teeth, and I chew this one too. I still grind during the day, and at night. I have grinder my teeth so much that my teeth have shifted, and I have what they think might be a small piece of bone protruding from my gum line. If this is an alignment issue than I can now see why the guards do not work. Is this the cause of why my TMD is not fixed by the guard? and why I have so many other nerve pains/numbness?

Avatar universal
by e274362, Oct 01, 2015
Doctor Hamid, I read your reply regarding my issue, unfortunately its not showing up now in the blog, looks like tech error and hopefully it should show up shortly

I appreciate the fact that Doctors like you are taking time to answer queries of TMJ patients which others do rarely and this is helping lot of us in this forum

My appointment is scheduled in the middle of October with NMD and I will have a chance to talk to him about your advice and will let you know the outcome

You had mentioned that single splint would be recommended in my case, just wanted to let you know that since my TMJ damage was bad, my mouth space had reduced leading to reduced airway and my tongue would move back when I slept causing severe tongue spasms so the Neuro-Muscular Dentist gave a night splint and then a day splint. Both were given after doing TENS and K7 or something called mandibular tracking device

You also recommended to read articles from Dr. Chang and what I noticed from the blog was that he would like to give patients a correct physiological bite using his methodology

During last visit, my NMD has stated that since 20% pain and discomfort still exists after 8 months of treatement, he will have new impressions taken and provide a new anterior splint which he says must provide relief from joint and tongue pain and align the jaw to its optimum position

Do you think that this approach should help me? Your advice would definitely benefit me as years of pain has taken toll on my health, family and work

Thanks,

Samuel

Dear Stevie,

Please note tat I did not say that TMD is caused by the neck, rather what I am pointing out here is that there is a direct correlation between the function of our jaw and the position of the cervical spine. Just guessing from the areas of numbness in your head I would say your head is severely rotated posteriorly. Compression of root nerves between occiput and C1.

You are on the right track. I stopped making night guards some years ago as I do not see any real therapeutic use in them. Nowadays, you can buy one from the pharmacy and have the same effect. They are just a bandaid solution.
As you have figured it out, the splint, or as I like to call it "Orthotic" should be made along the true physiological trajectory of function, which can only be achieved using tens and hopefully jaw tracking devices.
Once the position is captured, then an anatomically correct orthotic should be fabricated so that your upper and lower jaws can interact naturally and things will get better.

Hope this helps.

H.Nassery, DMD FICOI FICCMO
www.miamibeachdentistry.com
www.ICCMO.org

Sam,

I am glad you are putting more details. There is a large correlation between the TMD patients and Sleep Breathing issues. So I am glad your Doctor is taking care both.
With advanced cases, It is childish to think we are going to get the best bite the first time. Sometimes we have to let some healing to happen and then try and improve upon our bite...So yes absolutely, I have had cases where I did multiple orthotics before we had complete resolution. It is also important to remember that not all symptoms are going to get 100% better.. there are irreversible skeletal damages and deformities that has happened that we can not undo...So please keep in mind there is a certain level of medical attainability..
There are some symptoms that will only go away after phase two, meaning if the arches are too narrow, we can only get better so much. There are a lot of research showing   the correlation between cranial blood flow and the size of the dental arches.. The smaller the arches the less blood flow to the brain.  In phase two, if these issues are addressed then you can expect even better results.

Hope this answers more questions.

H.Nassery, DMD FAGD FICOI FICCMO
www.miamibeachdentistry.com
www.ICCMO.org

Avatar universal
by e274362, Oct 02, 2015
Thanks so much Doctor, now I know that things are moving in the right direction, I will let you know the outcome once I meet my NMD in the middle of the month

Sam

Avatar universal
by Steviebt, Oct 02, 2015
Thank you very much Dr. Nassery for your response. This was very helpful, and now I am relieved to know that the reason my mouth guard is not working is not because of some serious issue. I was beginning to think there was something wrong with me when every dentist told me the mouth guard would fix me, but it never did. It is nice to know that there is a possible solution for this that seems reasonable. I will definitely look into finding someone around North Carolina to see about getting the splint. Again thank you so much for all of your help.

Best wishes,
Stephanie(Stevie)

Avatar universal
by e274362, Oct 15, 2015
Hello Doctor, as informed earlier, fortunately I had an appointment with my Neuro muscular dentist yesterday and he took new impressions using K7, Tens and Jaw tracking device and said that my new day time splint will be delivered by him sometime next week...

In the meantime I was enquiring with him regarding the remaining 20% pain which stems from right anterior side of the tongue and right  side of the jaw in spite of wearing the current splint for a period of 9 months and his answer to that was - my jaw was still trying to move to the right side due to imbalance in the joint muscles and with the new splint the muscle laxity and a small degree of misalignment would be addressed thereby attaining a correct physiological bite over a period of 3 to 4 months thereby eliminating pain post which he would start phase 2 treatment

Request you to let me know if this procedure should help me get better. Also not sure if NMD treatment takes more than an year to resolve issues?

Any advise from you would be beneficial to me

Regards,

Sam

Dear Sam,

It seems to me that your doctor is being very thorough about his work. This all sounds very logical to me.
As for what I would do differently... As of the last three years, I do all my cases along side my physiotherapist. I have found that this way we have much better results and patients are more comfortable.

I have to mention that its not just me, who has come to this conclusion. In our last ICCMO meeting, it was general consensus that the true and complete treatment of TMJ will have to include other professional such as Physical therapists or Chiropractors. As a matter of fact in our annual board of directors meeting we officially opened the organization to these professionals for membership. The body is a complex machine, no one part can have over powering control on others. The whole body needs to be treated and healed.

Hope this helps.

H. Nassery, DMD, FAGD, FICOI, FICCMO
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Ivanchenko, Oct 18, 2015
Dear amazing Doctor,

This article is a god send, and you are phenomenal in responding to suffering humans. God bless you.
Here is my problem: for the last couple of months I have been having terrible tension in my TMJ muscles - I feel like I clench a lot but I don't think I do. My muscles tense up on their own like they are doing some sort of isometric contraction. I feel the tension mostly during the day, a lot less in the morning. My face hurts, I try to massage the inside of my mouth (masseter/ around the area) and it hurts like hell. I know that I have osteoarthritis in my C spine (loss of curvature) - had an MRI many years ago. My bite is probably not right either AND I know for a fact that my right TMJ is displaced because I can palpate and feel the coronoid process about 1 cm lower than the one on the right when I open my mouth all the way.
My question is: can I ever get my TMJ back into place? Where do I start? What needs to be corrected first and who can help me? I live in Toronto, ON, Canada
Can you direct me to a professional in the area?
Thank you. Looking forward to hearing from you.

Nicoleta
xoxo

Dear Nicoleta,

The short answer is YES, we can make you much more comfortable.. of course I am not promising on bringing you back to when you were 18, but rest assured you can get better and it will most likely help with your neck as well..Please follow the link here;

http://batchgeo.com/map/d8ce9d176685a50b5308e9d7c664facb

and look into your area.. Unfortunately the one closest to you is no longer practicing. My personal recommendation would be Dr. Hoa Nguyen closer to Montreal.
Please keep us updated of your decisions and progress.

All the best.

H.Nassery, DMD FICOI, FAGD, FICCMO
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by e274362, Oct 21, 2015
Thanks a lot Dr. Hamid. I am visiting him following week to collect my new splint and would ask him about physio and chiro and will proceed....In the meantime, will keep you posted once I meet him

I feel its a great forum to discuss and feeling much satisfied with your advise

Regards,

Sam

Avatar universal
by Ivanchenko, Oct 21, 2015
Thank you for the prompt response.

N

Sam,

Looking forward to your progress notes.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by deedee2604, Oct 23, 2015
Dr. Hamidreza, do you happen to know anything about Joseph Andary in Ontario Canada?  He is listed on the Oc website but I would rather work off of referrals.  Thanks.

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by Mistdean, Oct 24, 2015
Dear Dr. Nassery,
I have several questions for you. First, you are amazing and have already answered so many for me in your research, so thank you! I have been suffering for years without any relief of my pain! I have a malocclusion that was not corrected when I had braces as a teen. I'm 35 years old with migraines, herniated discs (3) in my lumbar region, and I'm now developing major pains in the thoracic and cervical regions of my spine. My hips have always frequently been "displaced" and I've always chalked it up to an auto accident (nothing major that most would consider to affect the pelvis) because I've had no other reasoning to rationalize it. I don't necessarily have jaw popping, which is why the last time I saw an oral maxillofacial surgeon (about 5 years ago) he dismissed me to the headache/migraine specialist that I've been doctoring with since. I DO, however, get intense pain in my temporal region and above both ears. Sometimes it hurts just to push on my face. My migraines have not really seen a significant improvement in the last 5 years in my current medication regimen. My entire back/neck hurts almost daily. There's also this weird swallowing thing; when I have to swallow, I have too tuck my chin downward. Is this common with malocclusion? After having a consult with my two childrens' orthodontist (who used to do jaw surgery) he first thought before the consult that I could be corrected with braces, but after the consult said I would require braces and jaw surgery. (Dr. Philip Dahar from Greensburg, PA) I've also had consults with neurosurgeons about my low back in the past because of the intense pain; 3 discs ago herniated from my running, since I used to be a runner. The last 2 disc just herniated for no apparent reason. I'm a slim person, so it's not a weight issue. Can you please give me insight? Your knowledge is so much appreciated! Have a great week!

Deedee,

I am not 100% certain but the last I had heard Dr. Andary was no longer practicing.  I may be wrong..check with the office.

H.Nassery, DMD

Dear Mistdean,

At 35 no one should be talking about procedure you are talking about. and to answer your questions.. yes, yes, yes and yes... unfortunately there is  a great disconnect in our profession with the rest of the body.. and there are many of my colleagues whose right to say what they say I respect, but not agree to , that completely negate my words here on this blog..but the beauty of this is that you don't have to be a doctor or rocket scientist to see the connection..

As far as your swallow pattern, it tell me your hyoid bone is too high, it is a common issue with TMD patient.. how is your posture? Forward head posture? how is your skeletal frame and muscle tone?
In short, if I am right on some of the above questions I just asked you and you want to get some relief.. here is what you do... find a good PT, and I mean research for one that understands upper cervicals.. have him see you once to twice a week to get your posture and neck better.. ask for exercises to strengthen your abs, and glutes..this will get your lower back better and bring more integrity to your spine.. as far as the neck you will have to continue with him/her till you find a dentist that can stabilize your bite so your get stabilization of your cervical spine..

Please let me know how did I do.. hope I am not far off..

All the best.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by deedee2604, Oct 25, 2015
Dr Nassary,  do you have any suggestions for GNM for one who lives in Buffalo, NY?  I checked out the OC map but was just wondering if you had a personal suggestion. Thanks

Deedee,

Unfortunately I do not have anyone in particular in Buffalo I can recommend.

Regards.
H.Nassery, DMD

Avatar universal
by woody65, Oct 26, 2015
Dr Nassery, I have been in contact with Joseph Andary's office and he is still practicing in Burlingon, ON. Do you know him, can you recommend him for TMJ issues?

Also  I am wondering about Andrew J Krause in New Baltimore, MI. Do you recommend him?

Thank you so much.

Hello Woody,

Dr. Andary has completed all curriculum with Dr. Chan, and therefore, though I have never met him I would say its a safe bet he knows what he is doing..
I don't know why I thought I had heard he had stopped practicing.. I am glad you checked. Thank you.
Please keep us informed of your decision and progress.

Regards.
H.Nassery, DMD

Avatar universal
by woody65, Oct 28, 2015
Thank you. Perhaps it had something to do with him moving his practice from Oakville to Burlington, not sure when that happened.

I hope to speak with him next week.

I am also wondering about Andrew J Krause in New Baltimore, MI?

I am presently in a fixed orthotic from an LVI trained NM dentist but am concerned with the height. It looks and feels too high, and I have read that GNM trained dentists are more conservative with the vertical height.

Thanks!

Hello Woody,

Unfortunately I don't know about Dr. Krause. As for the fixed orthotic.. We prefer to always start with a removable one.

Has it been decided then that your case will be a full mouth restorative case?

Personally I like to start with a full mouth contoured wax up after a removable orthotic phase. Just a preference based on what has best served my patients in my hands.

All the best.

H.Nassery, DMD FICOI, FAGD, FICCMO
www.miamibeachdentistry.com
www.iccmo.org


Avatar universal
by woody65, Oct 29, 2015
Hi Dr Nassery

I started with a removable 24/7 orthotic on April 9, 2015. That one was made using the TENS, but no K7, since the dentist did not own the K7 at that time. Was put in this fixed orthotic on Sept 8. This one was made using both the TENS and K7.

I have improvement in many symptoms but my stage 2 tmj disease symptoms remain - tinnitus and crunching, grating jaw.

Yes, a full mouth restore is supposed to be the next step, based on a vertical increase of 4.9mm. I am hoping that there is another way somewhere out there. I already have had 6 crowns placed in the past couple of decades (I am 63, and had been griinding my teeth for most of my life), but the thought of having the rest of my teeth crowned is daunting.

What is a full mouth contoured wax up? Thank you for your time and expertise!

Woody

Woody,

The progression of the case sounds about right.. The only thing I do differently is that I use a K7 and also I start all cases working with a PT that has been trained by Dr. Rocabado, and understands what we( dentists) do. The Ear symptoms are mostly caused by the compression of the cervical spine specially between C2 and C3, in this case.. therefore, I do not take a final bite till we get those facets moving and opened. Most these symptoms should be taken care of prior to moving to second phase.
Your case is exactly like one of the testimonials I have on my new page.. see this at the bottom of the page the very first video..
http://miamibeachdentistry.com/parallax/

The other way possible would have been orthopedics, but I have to agree that with that many crowns in the back it would be a daunting task to do braces. As for full mouth wax up, this means I don't like a one sided fixed orthotic.. once I have taken care of the symptoms , I want to put the correct shape into the mouth so I can see the patient functioning with the right mechanics.. a one sided ( lower fixed orthotic) is too long on the lower and its hard to have the right look and function..

I hope this answers some more of the questions for you.

H.Nassery, DMD FICCMO
www.miamibeachdentistry.com
www.iccmo.org



Avatar universal
by woody65, Oct 29, 2015
Dr Nassary

The K7 was used to take the bite for my fixed orthotic, which if I am interpreting what you said correctly, was a full mouth wax up - I have both upper and lower fixed orthotics on my teeth now.

I have been working with my chiro, in getting neck (and other, as needed) adjustments right before my dental adjustments, so that my neck is as straight as possible for the orthotic adjustment. This is something I figured out on my own. Prior to my removable orthotic in April, when the chiro tried to adjust my neck, some of it would not adjust, and the right side of my neck was also 'rock hard' (although I could still move it fine, and it didn't really hurt). After the orthotics being placed, the chiro was able to eventually adjust everything in my neck, and more recently, one time my neck didn't need adjusting at all!
She has been following the progress of my case with interest.

None of the adjustments ever make a change in the ringing and buzzing in my ears, unfortunately. But I have not had any neck xrays. I will mention the experience of the guy in the video to my chiro. My ringing and buzzing in the ears has been for as long as I remember. i do have hearing loss, but do not wear a hearing aid.

None of my 6 crowns are molars - they are all upper, 4 are the very front teeth, and then the incisor and bicuspid on my left side. But the height of my own teeth is only 12.1 mm. The NM determined that my teeth need to be built up by 4.9 mm, which is why he said that I would need upper and lower crowns to achieve that much added height, for a total of 17mm.

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by februaryrichard, Nov 06, 2015
Hello Dr Nassery,

Very glad to see you here with us and sharing that valuable information.

My TMJ issues happened during my first course of orthodontics around 4 years ago. I had 4 bicuspids removed then he 'closed' the spaces using retraction force. I now have bilateral clicking joints, scoliosis, cognitive and memory issues (school is on hold for now), digestive issues, diffuse hair loss, forward head posture (poor posture in general) and visual snow. I am truly hoping this treatment will help my symptoms as I am only 22 years old and this simply cannot go on anymore.

I am on my way to a TMJ treatment that will span over 2 years. Before any of that happens, my orthodontist asked to have my TM joints checked by MRI. When MRI is done, we will move to phase I which he said will be MARA appliance to position my lower jaw forward.

When all is done, we will be moving to phase II which involves expanding or widening the upper arch using braces or other appliances (we are not sure yet).

My theory is that the joints are not in the right position causing my spine and dura mater to twist starting from the atlas/axis which can create many neurological symptoms. I have a feeling my sympathetic nervous system is on overdrive. My heart beats like crazy all the time and I feel like my blood flow isn't right.

I must ask you doc, have you ever seen somebody in a similar situation get better? When teeth are extracted for orthodontics, is it necessary to replace them with implants? What do you think about my overall treatment?

Thank you,

Richard LEE

Richard,

Congratulations, you know more than most my colleagues. I just don't understand how more people don't question the extraction of four perfectly good teeth..

But to answer your question, you are absolutely right, your jaw was positioned posterior to its natural position and that accommodation is made possible by your C1 and C2 which are pulled  forward which gives you all the symptomology that you have described. So the way we approach this is working with a PT to correct the postural issues you have described and then re position the jaw to a neutral place where your neck can be relaxed and in its correct shape.
Then the case needs to be evaluated to see how it needs to be done.. I do expect that you will get better with most your symptoms, but 4 bi extraction cases are difficult ones, so don't get discouraged quickly..find yourself a good TMD doc..and ask questions and make sure you understand the modality.
Remember, if someone can not explain things to you in a simple manner then they  don't really understand it themselves.

Good luck, and keep us posted.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by soccergirl247, Nov 09, 2015
Dear Dr. Nassery,

After having an MRI done for suffering sever headaches, my neurologist told me I had fluid in my inner ear and sent me to and ears nose and throat doctor. I have severe ringing in my right ear but I've passed all of my hearing tests. I went to the dentist to have a root canal done and during that time he notice a lot of popping in my jaw and said it could be TMJ. When my jaw opens it pops often feels very tight and some times sounds like it's tearing. I grind my teeth at night and were and over the counter retainer that helps. I still wake-  up with severe face pain but I don't like taking anti inflammatory meds. My dentist said I would need to correct my bite first and then get a guard to fit my mouth to sleep with at night. Do you have any recommendations?  

Dear soccergirl,

If during running your meniscus kept coming out of your knee joint and then popped back in what would you do?

Yes, you most certainly have an issue with your jaw joint. Like most of us your teeth do not meet in the correct place so your joint is making that accommodation at the price of your meniscus.
Over the counter night guards are band aids...  they may work for a borderline case and keep them asymptomatic, but it does not sound like a good choice for you.
I would recommend finding some one that is well educated in this field and proceed with treatment. I have put a link on previous posts for finding qualified practitioners.

All the best and please keep us informed of your decision and progress.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Cmeg, Nov 12, 2015
Dr. Nassery,

What a blessing to find such helpful info and effort from a qualified Doc as yourself!  It's nice to read these posts and know I'm not alone in this struggle!  I wondered if you had any recommended coworkers in Houston?  I have just met a TMJ Specialist/Cosmetic Dentist, and we've discussed a removable Orthotic to fix my bite, which could (but won't be) followed by a full mouth restoration to the tune of 50k. I wanted to get a 2nd opinion and see if there was a less expensive Step 2. Any recommendations?

Grateful in Houston.

Dear Cmeg,

At times that is the way to finish the case.. I would say that to begin you must only focus on phase one.. and make sure most your issues are addressed and symptoms relieved.  Too often I see people rushing into the second phase with out getting good resolution in  phase one..

If you asked , I would say that 60% cases or slightly more should be done in orthopedics for phase two.. Only when my patients have too many old restorations do I go the full mouth restorative way.. So if you have healthy teeth, you do not want to start with restorative second phase.. If you already have lots of old restorations then it would be very difficult to do orthopedics.
As far as the price he/she is right in the mid ground..
I hope this helps you. As far as a recommendation in Huston , I have posted a link in previous blogs, which if you follow you would see the closest.. I know we have some one in Austin but not sure about Huston.

Warm Regards.
H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

16151837 tn?1447729680
by Mistdean, Nov 16, 2015
Dear Dr. Nassery,

First, thank you for the quick response. Second, I've been contemplating the idea of seeing a PT for a few weeks because of my back pain. Third, are you saying that you don't believe I need jaw surgery to correct my maloccluded bite? As for forward head posture, I'm not certain that I know what you mean. Could you please elaborate?

When you say to find a dentist that can stabilize my bite so I get stabilization of my cervical spine... What does this entail? Overall, I would also like to "fix" my bite for cosmetic purposes, as well as the pain that it seems to be causing me. Granted, most people don't notice it until I bite down and smile, but I notice it.

Thank you again for your time, knowledge, and sincerity.
Misty

Good morning Misty,

No need to thank me, I am just doing what I love.
Go see the PT. make sure you ask around about them just as you should about any practitioner. There is this feeling out there that any practitioner is the same.. like buying a washing machine, or something. Just as in dentists there can be vast differences from one practitioner to another. I know colleagues for instance that have been doing the same thing since they graduated from school, and though it sounds ok, its not.. schooling teaches you the bare minimum to pass the board exam. Once you come out the real education begins...by finding those lamplighters that forge ahead in any field and pave the way for progress.
So ask around, ask the practitioner, how many courses have they taken for cervical region. Do they have any certification other than their usual diplomas.. I know the Pt I work with is constantly taking courses in specific areas, and is certified specifically for Cervical region and TMJ.

As for the surgery, I have not seen you, or any of your diagnostic records to suggest any treatment. However, based on my experience I know that most cases are possible to correct in many ways. The surgeons only have one tool in their tool box, and hence everything starts to look like a nail. Unfortunately the generalists are not informed enough and therefore they rely on the opinion of the surgeon.  I guess what I am saying is keep looking and listen to another point of view before yo make a irreversible surgical procedure.

Forward head posture is a common postural issue that goes hand in hand with a recessive lower jaw. I am sure if you pay close attention you will see many of those in your daily meets.  Just look it up on google and I am sure you will see some images that will solidify it your mind.

As for the dentist that can stabilize your bite.. I am eluding to a Nueromuscular dentist that can stabilize your jaw to cranium relationship using an orthotic that you wear on your lower arch. The second phase of such treatment will also resolve your cosmetic issues.. To us cosmetic resolution is a side dish you get with your complete health.

I hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org



16151837 tn?1447729680
by Mistdean, Nov 17, 2015
Good evening Dr. Nassery,

Wow! You are really good at what you do! This helps a lot! I will look into it all. I just wish you were closer so that I could consult with you. Do you ever come to Pennsylvania? Haha.

Thanks again. I'll be in touch soon.
Misty.

Avatar universal
by e274362, Dec 01, 2015
Hello Dr.Hamid,

I was looking forward to share my progress with you. I received my new anterior splint and its a week since I started to wear it and this is made a big difference in my pain reduction in the jaw and tongue. I would say the pain has reduced from 20% to 10%. So I am hoping this may take few more weeks till the pain subsides completely

As far as Chrio / PT is concerned, my NMD checked the stress levels of my neck and shoulder and advised to take a neck and shoulder message from Ayurveda message therapist and I will have my first session this Saturday. Per him, this would really help the neck and shoulder muscles and this would be the last attempt before he switches me to the chiro

In the meantime, my friend advised me to take Cranio Sacral, I just Googled to find out some info and found some TMJ specialists recommend this therapy as well

Let me know your thoughts

Thanks,

Sam

Hello Sam,

Thank you so much for keeping us updated. This is the best part of this blog. Real testament from real patients. I am glad that things are resolving. I would say 90% is very good, its certainly better than most other medical treatments.

I am all for the massage therapist, after all the neck issues are due to spasmodic muscles and soft tissue, and massage will go a long way to correct this. Although I am not familiar with the specific style you have mentioned. Cranio-Sacral therapists also are helpful.. as long as they all are on the same page and understand each other's role and know what is the ultimate goal, not just empirically but specifically.

I look forward to your updates. Let me know if I can help in anyway.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by e274362, Dec 02, 2015
Thanks Doctor, I will keep you posted once I get the message this Saturday.

Another best practice sharing which I may have forgotten to share here is palpating and messaging the gums and the point which connects the TMJ inside the mouth. I feel this gives so much relief in loosening the muscles. I am feeling very great now!

As you have rightly pointed out in this forum, a multi-disciplinary approach with NMD playing a pivotal role will help the patients to become as comfortable as possible but with the warning not to open the mouth wide in the future as well

Hope you a great week ahead

Thanks,

Sam

Avatar universal
by e274362, Dec 09, 2015
Hello Doctor,

Happy to let you know that the tongue and joint pain is almost very low with the new splint. The neck and shoulder message gave me great relief and I have been advised to attend 4 sessions while Cranio was altogether something new for me. They just gave a very gentle touch and pressure at various points on the body and the therapist says 4 to 5 sessions would give a good relief in pain management and she says it also aids in healing.

Overall my condition is improving and I fell satisfied. My NMD is also quite happy and he said after a couple of months may do the orthodontics based on my progress once the pain is completely nil.

One interesting thing to note was when he closely observed my occlusion with the splint, he noticed that my tongue was quite big due to which when my upper teeth touches the lower teeth, Its slightly hurting the sides of the tongue which is causing redness and pain, else he says there is no cause of tongue pain. Also he says that I need to manage with the splint for atleast another 2 to 3 months depending on the progress before he starts the orthodontics. Per him once the Splint is taken out the tongue pain naturally stops, but what he did advise was to chew food slowly and consciously in order to avoid any side damage to the tongue.

Let me know your thoughts

Thanks,

Sam



Sam,

this is great news. As you have greatly reported and exemplified, this is a multi- practitioner approach that provides the most appropriate results.
The issue with the tongue sounds right on, as most patients in your situation have under developed arches, ( narrow), and there is hardly any space for your tongue, when we put the orthotic on we take some more of the space away and so it is not easy on the tongue. However, once the arch is developed, wider, and you finally get rid of your orthotic then  all will be ok.

The rest of the progress sounds exactly like I encounter with my therapist too. Please let us know the name of your doctor here and location. It is good to have this info for others that maybe looking in your area.

Thank you and regards.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by kimtony, Dec 09, 2015
Hi Dr. Nassery,

I contacted you back on October 15th and 16th of this year regarding my diagnose of TMJ.  At the time I was under treatment from Tufts Cranial facial Pain Center in Boston.  I have mouth guards made from TUFTS back in July.  I contacted you because I was not really seeing a big change.  I have been going though PT 2-3x a week which has helped some.  All of my pain is in the joint and ear pain, ringing, pressure etc.  No neck, jaw, or head pain.  You explained the differences in treatment and referred me to see Dr. Mehregan in Canton, MA.  I made an appointment but I was told their TMJ treatment is out of pocket because medical and dental insurance will not cover although my medical insurance plan paid and covered almost all of my experience plus guards through Tufts.  Unfortunately, Dr. Mehregan from Canton Dental Collaborative would charge me $8000 for treatment.  This is not within my financial means at this time.  I have two other referrals which are not from you.  One is Dr. Scrivani at MGH and Dr. Mehra at Boston Medical.  I really do not want more of the same.  I have been coping with this now since last June.  I'm taking pain meds and muscle relaxers.  I have a family to care for and I need to get my life back.  If you could please offer me any other referrals or advice.  I am in Boston but I will travel outside, Rhode Island and even lower New Hampshire is needed.  Thank you again for taking the time to read my message.

Best,
Kim

Kim,

Unfortunately, all the people I could suggest will be in the same category. What we do, although has all the medical coding, is not covered by med insurance. In dental schools they have the benefit of being in a institutionalized setting that has pre-set relations with Insurances. However, their approach is not effective in my opinion.

All my colleagues, including myself, work in a self pay environment. This is the sad truth about this condition. I know Dr. Mehregan can take care of your issues. I really don't know the other two Drs. and their approach to make comments.

H.Nassery, DMD

Avatar universal
by kimtony, Dec 10, 2015
Hi Dr. Nassery,

I understand.  Thank you for getting back to me.  I do agree with your statements in regards to the approach and treatment not being effective.  I will have to find a way to pay for the treatment I need to take care of my TMJ issues.
I will keep you posted.

Thank you again,
Kim

Avatar universal
by e274362, Dec 15, 2015
Hi Dr. Hamid,

Feeling very energetic at this moment. Message therapy gave me lot of relief but I felt Cranio was superb, I went for the 2nd session and I felt it was intense but the result was really great....my neck loosened up and is relaxed and I feel my tongue pain is bare minimum, no dizzy spells and the therapist informed that I need another 3 to 4 sessions where I can get a very good result. Right now I am able to concentrate and do all my work without the pain bothering me. I am hoping to get much better in the next few weeks. As you mentioned once the splint is taking away, my tongue pain should completely stop and, Alas! what a relief, was waiting for such a looooooooong time....

As far as the NMD treating me, it is Dr.Rajesh Raveendranathan. He visits Bangalore (India) frequently and is guiding me in the right direction. He is very thoughtful and explains all the queries that i have and makes us feel very comfortable

This is a lovely forum :), have learnt so much from you and the patients here

I will keep you posted about my progress

Regards,

Sam



Hey Sam..

Thank you for sharing. Raj is a great guy and clinician. Don't forget to get an adjustment to your orthotic after the next meet with your Cranio..It may show some changes in your bite that should be reflected in the orthotic.

Send my regards to Dr. Raj, and all the best wishes for the new year.

H.Nassery, DMD FICOI, FAGD, FICCMO
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by e274362, Dec 15, 2015

Thank you so much Dr.Hamid, I wish you a great new year ahead!

I will convey your regards to Dr.Rajesh and will talk to him about the adjustment.....Hoping for a pain free life in 2016

God Bless

Thanks,

Sam

Avatar universal
by Rebeccalj06, Dec 24, 2015
Hello there I am a  14 year old female with upper missing lateral incisors. I had braces to close all of the spaces giving me a class 2 bite and canines in the lateral incisor position. I noticed clicking in the last few months of braces when I ate, 6 months after the removal I got extreme pain on one side and a cracking and pulling sensation. This happened more and more frequently and both this and the clicking stopped. I have decreased mouth opening as well as head, neck and back aches. I am seeing a uk specialist named Helen Harrison and need your opinion on what is best to do. She is saying to stabilise my jaw with splints and then use an Alf expansion device on the upper arch to create space for the missing teeth. I will then have braces to finalise the bite and missing lateral incisor replacements. Does this seem like a good treatment for my TMD?

Rebecca,

First I want to congratulate you on being such a bright individual at your age. You officially understand more than your previous dentist and orthodontist.
I am sorry you had to go through that experience. Yes, the correct treatment would be to first stabilize your bite for open and forward and recapture the disc they displaced. Then open the space back up and put implants in those positions later on after your growth has stopped.
As for use of ALF, I am not big user, I like other tools, but it depends on the operator. I do believe she has the right sequence in mind. Please keep us updated on your treatment. I am always asked about docs in UK and have no one to refer to. As a good measure try and find a good Physiotherapist and have them work on your neck and back concurrently as this doctor to make sure you correct the damage to your neck and spine as well.

Happy holidays.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by hardtotrustdoctorsnow, Jan 04, 2016
Dear Dr. Hamid,

I am so grateful for finding this site and knowing that I am not alone!  In 2009, I made the foolish mistake of agreeing to have four bicuspid teeth removed for braces.  My quality of life has deteriorated quickly since then.  My tongue is now too big for my mouth and I have a constant feeling of suffocation.  I wake up throughout the night in a panic and my heart racing. I have to stick out my tongue to get in oxygen. Then, I have to pull my lower jaw inward, upward, and to the left to close my mouth. Soon, the suffocation starts again!  I feel like my neck is trying to balance a bowling ball on top.  I have constant pain in the back of my neck and find it hard to hold up my head for an extended period of time.  The pain is also traveling to my shoulder, down my left arm, and through my back.  I wake up with numbness in my fingers, but I don't know if this is related.  I get mouth sores now (never did before). My right nostril airway feels diminished.  I am embarrassed to tell my family and friends what I'm going through. I feel like the orthodontist did what was easy for him without regard for my heath.  When I told him (Dr. Stan R. Heiner in Modesto, CA), he was very cavalier.  He really didn't care one bit.  The mental stress is just as bad as the physical.  Thank you so much for your insight and information!

Dear Hard to Trust..

Look up
William M Hang DDS MSD
A Professional Corporation
30200 Agoura Road #220
Agoura Hills CA 91301
Telephone: 805 374 9377 or 888 404 FACE

He is one of my favorite lecturers, and has made a career teaching other dentists how to undo the harms of the 4 bi extraction modality. All your symptoms are related the numbness in your fingers are due to compression and degeneration of your disc space between your cervical spine C5-C8.. You need physical therapy  to open space there and your need to open those teeth spaces(extracted teeth) back up..
Forget this doctor, he is in a state of denial because if he admits to it then his whole career is in question.
Move forward, don't look back. Go see Dr. Hang, he is the man.

Regards.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by lorihay1962, Jan 07, 2016
OMG OMG OOOMMMGGG!!!! Dr. Nassery are you for real??? I feel like you are too good to be true! I don't even know where to begin with my story. I will try to stick to bottom line and highlights so this doesn't turn into a novel. lol I am a 53 year old mother of 4 grown children and have had TMD/TMJ problems since my late teens. However after a car accident in my early 20s, with severe whiplash injuries, my problems are too many to list.I have jaw pain, SEVERE headaches, MAJOR neck issues like 3 bulging discs at c4, c5, c6, horrible muscle spasms, unbearable pain in my spine between my shoulder blades, L4, L5 are horribly degenerated and more issues that are all related to this (the great snowball effect)
I have been told I have degenerative disc disease in my whole spine, diagnosed with Fibromyalgia, Myofacial Pain Syndrome, Chronic Fatigue Syndrome, PTSD, Severe Depression, Anxiety Disorders, Arthritis, and many more things that make me sound like a basket case. I have been labeled neurotic, attention seeker, hypochondriac, drug seeker, crazy ect... Some doctors over the years have treated me as if it's all in my mind, some have actually told me this to my face! I have been through some significant and PAINFUL proceedures to say the least. I KNOW everything is connected but it seems I'm the only one who thinks so. I have hade 2 radiofrequency ablations done on 3 levels of my lumbar spine, one RF ablation done on 3 levels of my Cervical spine, too many trigger point, edidural steroid injections, and facett joint injections to count, 20 years ago a dentist ground down all of my teeth so they wouldn't touch to help my TMJ and headaches! Needless to say my jaw tried to compensate for the abnormal bite. 6-7 years ago most of my top teeth had fractures down to the roots! Being disabled and having State insurance I have no dental insurance. I found a great program where dentists would volunteer their time and services to people that had no insurance. I had 7 root canals done over time, but the program was cancelled and I still needed at least 6 more root canals done and just couldn't afford the expense on my extremely limited income. I found another program through the state for very discounted dentures. That being my only option I braced myself and mourned the loss of my once beautiful strong teeth. On a Saturday I sat in the chair and had 10 teeth pulled to prepare for my dentures. After too many injections of novacaine to count my ten teeth were ripped out one by one. the novacaine wasn't controlling the pain at all...my dentist said my body blocked the numbing affect? Any way I felt every tooth being pulled.
Okay now 5 years later I can't eat and haven't been eating right for years it is just too painful. Now I have 10 teeth left on the bottom and only 2 of these teeth are not painful! I just don't know what my next step should be??? I am in pain EVERYDAY, so much so my blood pressure is too high even on meds! I don't know which part of my body I should work on??? I am so tired of hearing myself complain I can only imagine what my friends and family think. I used to be so fun, adventurous, funny, and outgoing, now I barely leave my little apartment. Please excuse the blabbering and confusing nature of my story and try to pick out the facts without emotions and MAYBE could you PLEASE try to give me some insight. I AM NOT OUT OF MY MIND AND I'M NOT JUST LOOKING FOR ATTENTION, just answers. Thank you for your time, Lori from NH

Dear Lori,

I wish I could say something to make things better for you. Unfortunately your story is all too familiar to me. As you know there are many advanced and irreversible changes that has happened in your case. This is not say that there is nothing to do. You could have physical therapy and open facets in your spine joints, also your denture could be made in a new position that would support those changes in your spine. More than anything you need to make yourself start doing some very light movements and exercise hopefully with the guidance of your PT.
Seeing patients in this scenarios for many years, I know that the ones who incorporate some sort of physical and muscular rehab always do better.

Hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by lorihay1962, Jan 13, 2016
Thank you Dr. Nassery for your time and advise. I have JUST started meditation and next yoga hoping the gentle stretching will help start my rehab. I am waiting to hear about PT to work on some of my issues, I will be doing a lot of hydro therapy for non wait bearing exercises. You are a GREAT inspiration and advocate for so many people! Thank you again for your time. :))

Avatar universal
by HaneenG, Jan 23, 2016
Hi Dr Nassery


So happy that this blog exists! Thank you so much! I have had TMJ for eight years and started out with over 5 or 6 night guards which didn't do anything, then was put in braces which made it worse after a few months so took that out and went into splint therapy and was given amitryptiline- ironically my symptoms went away for a whole year. I then got the symptoms back again tried the medicine again it didnt work and then came here to the US a few years ago to get my PHD and of course with the stress it got worse.  I went to over four recommended dentists in the area none helped. I then found a team of doctors- so the dentist made a lower guard that brought my jaw forward (i originally had an overbite) and I have been in that since April- 24 hours a day including eating. I then had an arthocentesis in September and it didn't help and the doctor suggested repeating it because he couldn't get into my joint. Anyways a few months ago I told the dentist I dont feel im making that much progress I want to bring my jaw in a bit cause it was effecting the way I look so we brought it in a bit. I then tried botox in november (low dose for first time) and for the first time ever I had barely any symptoms! Now my symptoms have not gone away from the splint but did from the botox and at this point when I take the guard out none of my teeth touch except my front teeth which is freaking me out. So I am wondering since now my dentist wants me to go to phase II. Do I need to go to phase II and if I decide not to will my bite return to its original bite if I start to ween off the guard and how I should I do this if my teeth dont touch? Braces are not an option for me because I have had them twice before and they just make things worse. Do you think my bite will go back to normal or should I go to phase II and have crowns? At this point all my pain could be clenching and not bite related but I dont know!  

Thank you
Haneen
***@****

Avatar universal
by jeanay2b, Feb 04, 2016
Hi Dr. Nassery,

I suffer from severe TMJ and as I read the posts in this forum, I find it unbelievable how there are so many that are suffering and are unable to get clear answers or results from their doctors. I was also diagnose with multiple sclerosis in 2012 and am constantly siding from one ailment or another it seems.   It's been very frustrating as shootings I feel that many of my issues are caused by dental issues or aggravated by them. Just like another visitor stayed here,  after getting a crown done, all my ms symptoms have gone crazy and I have a sinus infection I can't get rid of for over a month,  along with a migraine,  weakness and neuropathy.

Is there someone you can recommend that will take all of my issues into account and great me accordingly in the central Florida area? I am in Volusia County.  I am still blessed enough to have full time work with great benefits but have to take so many days off and many times wonder how long before they let me go or I have to file for disability.

I am only 39 and am exhausted from being in pain, feeling sick or weak all the time.

Please help. ?.

Jeannette

Avatar universal
by Jsmall1989, Feb 05, 2016
Dear Dr.Nassery , it's troubling and hard to know that all these medical specialists and people whos work in life is to "help people", but simply really do not care at all or take the time of exploring new and different medical procedures or practices to better treat patients. The karma that comes your way is more then earned. I cannot comment enough on my admiration appreciation and respect for you doctor. I'm James and unfortunately I'm just 26. At age 4 or 5 I ran in the bottom of the banister in my living room (the hand Rale, being that young I was even level height) . It knocked left front upper tooth almost completely out.My mom held it in place overnight until a dentist was open. I had a root canal done but things just never seemed to be right and at the very top of my gums above that tooth is a hole or opening in the gums. Last year after being looked at by a dentist other then the one I had my whole life, said the root canal had failed/malfunctioned in his opinion probably due to my eeth my teeth not yet being fully developed.I also maybe a year maybe two before I hit the tooth i was jumping from my jacuzzi at home to the pool and i slipped and busted my chin open and had to get stitches there.I Remember when taking family photos or any pictures of the people I was with being upset with me because a good photo seemed almost impossible. As far as I know I was looking striaght and smiling. Upon looking at the pictures my head would be titled all the way down almost touching my chest. When I was 18, i got in a horrible accident when driving and being t-boned which sent my car spinning and eventually head on into the light pole. I wasn't wearing a seatbelt and was shot up in the air violently and i hit my head/forehead on the steering wheel which spilt open my forehead from my right eyebrow through the start of my hairline evenly in the middle forehead. This of course adding to all my problems already having of course with all 3 of these injuries occurring almost perfectly in the middle of my face. From my chin, to my mouth and up to my forehead. I always pondered if the years of bad posture in my neck and mouth were the reason my forehead spilt in the first place and if same thing Happened to another that a gash that required 10 staples to occur. I have every symptom that's been listed on here including tremendous numbness in my fingers as well as toes. As well as other's. I'm currently living now in Las Vegas, NV. I would appreciate more then you'd ever know referring and steering me to whom can begin trying to fix all my problems. Thank you so much doctor I'll await your response and look forward to receiving your reply.

Dear Haneen,

Sorry about the delay in response. I over looked it.
Ok so if I have followed your progress. Basically, you did not have much relief from your mandibular advancing or re positioning device. The  questions in my mind;
1. Based on what principle was the jaw advanced? What were the diagnostic records?  Was a PT involved in the  process?
2.. How was the advancement measured?
3. Was the occlusion on this device adjusted based on Gnathologic Principles?

Only if you answered yes top all the above questions, would that be the correct evaluation of the effectiveness for this device. Otherwise, it is just as arbitrary as your previous bite.
Now the reason you can not put your back teeth together is that joint has been healing some and possibly your disc or remnants of it, have returned into their rightful place..  So if you take it off, you will go back there eventually, and restart the damage to your joint.
Look I am not a fan of botox, I think of it as a palliative treatment. It does not really do anything but mask your pain.. eventually the issue comes back..
I am afraid that you have not had the proper modality of jaw advancement and now you are getting tired and making a decision based on a negative experience.
At the end you must do what is in your best interest.
I hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Dear Jeanette,

Sorry to hear about your issues. There is a large correlation between MS and TMJ. Actually the very inception of Nueromuscular Dentistry can be credited to this ailment. Dr. Bernard Jankelson, was basically trying to treat his wife who had been diagnosed with MS , when he came up with Nueromuscular dentistry. That's a story for another time.

In Central  Fl ;
https://findingagneuromusculardentist.wordpress.com/mariela-k-lung-compton-d-m-d/

Mariela K. Lung-Compton, D.M.D.
Address:   5055 S Lakeland Dr., Lakeland, FL 33813
Phone:      (863) 647-3222

I know her well. She is a wonderful and caring doctor.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Dear James,

I hope all is well. You happen to be in the best place to see one of my colleagues.

Joseph G. Willardsen, D.D.S.

Address:  9061 West Post Rd, Las Vegas, Nevada 89148  USA
Phone:    (702) 523-3030
Website:  www.truedentistry.com

I would not try and read too much into the correlation between your poor posture and accidents, rather I would say that due to your poor posture you would have been more prone to injury.
Look forward to future and don't worry about what has happened so far, the important thing is to look for the solutions to your issues and fix them.
I would say that the numbness in your fingers is your lower cervical and the the ones in your toes from your lumbar compression most likely. I see this in many of the patients as the two curves are mirror images of each other.
Go see Dr. Willardson, Dr. Chan also works in the same office and you can benefit from all his years of experience. He is the master after all.

All the best and keep us informed of your treatments.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by poconos27, Feb 08, 2016
Do you recommend anyone in the Long Island, NYC area for one stop shop to TMJ analysis, treatment, scans, radiology etc?

Dear Pocono,

In long Island, I know

Gary W. Lederman, D.M.D.

Address:   100 Centre Avenue, Bellmore, New York  11710
Phone:      (516) 785-0032

Address:   635 Madison Avenue, Suite 1400, New York, NY 10022
Phone:      (212) 206-8824

He has taken many of the same courses as I  have and is a very caring doctor.

All the best.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

17217970 tn?1455196101
by mindvsmatter, Feb 11, 2016
Hi there
In 1978, at 18 years of age, I had a very bad bite and then surgery for a condylectomy. The left side of my face was paralysed for about a year and when the feeling returned it was excruciatingly painful.I have always been very healthy and sort of a mind over matter person so I would use hot/cold compresses and my TENS machine when things got too bad. Ten years later I was experiencing dizzy spells, pain all thru my left side, tinnitus and other bothersome symptoms.  My jaw would ache if I chewed too much, laughed too much or talked to much. In 1985 I was diagnosed with Eagles Syndrome (and Frey's Syndrome due to profuse sweating)  Now my teeth are falling out and my gums are withering away.  My dentist told me to consider suing the original surgeon just to pay for the dental work I was going to need!!  But I would never do such a thing.  Now I can't get dentures because my bite is so distorted.  I saw a specialist last year who told me I need 3 surgeries and $6000. to fix my problem.  He was so overwhelmed by my situation he had to consult with his peers and get back to me. I have not hear from him again.

Dear mind

You case certainly seems very complex. It however, sounds to me that your musculature were never made comfortable. Take all the negative energy and thoughts out of your mind. instead of looking to point the finger lets look for a solution.
The first step is to find some one that has familiarity with these type of cases..and it does not seem tto be the ones you  have seen so far.
Look for a clinician that deals with TMJ, and pain. here's a good place to start;

https://findingagneuromusculardentist.wordpress.com/


All the best.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org


17217970 tn?1455196101
by mindvsmatter, Feb 12, 2016
Thank you.  

Avatar universal
by Ally1975, Feb 13, 2016
Hi
Can u recommend someone in Columbia, St.Louis or Kansas City Missouri?

I would be so appreciative of any info you can provide
Thank you,
Sincerely,
Alisson Carlyle

Alisson,

Please use the link in the above in the previous answer and find someone near you. Let me know who that maybe and feel free to let know that they can use me as a resource.

Thank you.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org



Avatar universal
by DailyPain1964, Mar 03, 2016
Hi Doctor Nassery,

After reading many posts I am inclined to ask a question as I have been suffering for 4 years and have to make a difficult decision. You seem very genuine and I think you may understand my symptoms.

I am currently seeing a dentist, physical therapist and a chiropractor. My atypical facial pain started in March of 2012 in my # 3 tooth and remained in my #5 tooth after extractions of my #3 and # 4 teeth. I was diagnosed as atypical facial pain due to dental trauma.

Last summer my symptoms changed as pain began in in my # 12 tooth after a root canal and crown. Since then the pain has worsened and spread to my muscles in my jaw, neck and back. I am now diagnosed with TMJ and Forward Head Posture. I never replaced my #3 or #4 teeth, but I believe I must to start feeling better. I am nervous to get the implants as I am concerned that they will cause me even more permanent pain. Do you think I can successfully treat my other pains (teeth/gums/jaw/neck/back) without the implants? I where a upper and lower mouth guards at night and I wear an essix on top with teeth for the # 3 and #4 and a gelb on the bottom during the day.

Dear Daily pain,

I fully understand where you come from.. What ever the etiology of the pain, we know that we have to replace missing teeth as their absence will most definitely cause more problems.
I would replace the root forms with implants , however, I would hold off the tooth part till I would know where exactly the jaws should meet. I would hazard a guess and say that your chiro or Pt work does not last and its due to your collapsed bite.
So we need to have an interim prosthesis, to maintain your bite first and bring you some some relief. That would be the indication then to restore your mouth at that position.

I hope this makes some sense. It is a bit complicated, and I am overly simplifying here..

Keep us updated with your progress.

H. Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by WestTxGirl, Mar 06, 2016
Hello Dr. Nassery.

I am searching for answers to symptoms for which no dr. here has a clue.  I am currently seeing a neurologist for altered sensation (numbness would be incorrect - more like tightness) in my face which started on only the left side.  It began around my left eye and over a period of 48 hrs. extended down to my jaw.  I had passing headaches at the back of my head and around my left ear and sometimes between my temples.  Now the headaches are primarily on the left side beginning at the base of my skull going up the back of my head to behind my left eye. No real "pain" in my face... The "altered sesation" now has extended down my neck and to my back.  I have had an mri which came out clean.  I've noticed over the last 6 months or so that my bite has changed.  I have never been diagnosed with TMD but asked my Neuro if that could be the issue.  He said no as I did not have pain in my jaw.

Any suggestions?  Should I get a 2nd opinion?

Thanks for your help!
Maria

Maria,

Your experience with your Nuerologist is so typical of what we see. Unfortunately they don't really understand that TMJD is also a Cranio-Cervical disease..
Everything you have described could and would happen due to a poor bite.

If all other medial issues have been ruled out then you should see a Nueromuscular Dentist that could look into other etiologies of your issue.

Check this map and see if you find any one of my colleagues near you;
http://batchgeo.com/map/d8ce9d176685a50b5308e9d7c664facb

All the best,

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org


Avatar universal
by WestTxGirl, Mar 06, 2016
Thanks for your advice..... That gives me another path to discovering the answers.

Avatar universal
by SmGu, Mar 07, 2016
Hello Dr. Nassery,
I have been diagnosed with TMJ, and as a lot of other patients have pointed out, have been bouncing between doctors, who so far, havent done anything to alleviate my problem! I am wary of trying out more doctors after having spent quite a bit on this!

If you have a great recommendation for someone in the Seattle or greater Seattle area, would appreciate it!

Thanks,
Smita

Dear Smita,

Check the same map I put on ;

http://batchgeo.com/map/d8ce9d176685a50b5308e9d7c664facb

But I have to say that Seattle is the birthplace of Nueromuscular. There are many very good Nueromuscular docs there that are not on this map.

Here is another site that can be of help.

http://www.iccmo.org/find-a-tmj-dentist-2/

Cris Simmons, DDS, FAGD, MICCMO, DABCP

Dr. Simons is my personal favorite. Great mentor and clinician.

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Sculptura, Mar 13, 2016
Hi Dr Nassery, I had a Neuromuscular work-up with a TMJ specialist. Tomograms revealed the condyles are very compressed into the fossa. The plan is to decompress the joints with a lower mandibular repositioning splint and to move the condyles down. We believe the compression and the current position of the mandible is the reason for my TMJ symptoms. I had prior signs of TMJD since I was a teenager but no symptoms beyond a click on full open. The initial cause of TMD signs I believe was due to developmental factors which I was unaware of until I was an adult. I sucked my thumb til age 9, developed an open bite, had a tongue thrust, and was a mouth breather. I have a deviated septum 80% to the left. A dentist foolishly put me into Invisalign two years ago knowing I had features of TMD, did not inform me of the contraindications, and immediately a constellation of TMD symptoms began. Treatment stopped two weeks in. Flash forward two years later and every treatment has been tried but a repositioning splint. My symptoms at this point are headaches, eustachian tube issues (crackling sounds in my ears when I swallow and move my jaw around which will click open the tubes, and occasional jaw tiredness/soreness which flared up after the recent work-up)

My skeletal and dental profile is this:
class II skeletal relationship
class I dental relationship
overjet 2mm
<1mm overbite (about 1.5 mm openbite in protrusive; limited to the incisors)
mandibular retrognathia (hypoplasia/microgenia/micrognathia)
mandibular arch length discrepancy 3mm
vertical maxilla hyperplasia
excessive lower facial height
recessive facial profile
steep mandibular plane
forward head posture
slight scoliosis

Taking all of my issues into account I want to be comfortable there isn't any contraindications or potential foreseen problems with a lower mandibular repo splint in my particular case. I've read about anterior repositioning splints but don't know the difference between the two and want to have every confidence this direction is amenable to my situation. Thank you very much.

Wow Sculptra,

You are certainly an informed consumer.. You know more about yourself than most.
Well, from the description, certainly you have to concur that your lower jaw should have been more forward and down, The question is how to get there and how to maintain it there. Repositioning appliances are only as good as the trajectory they were based on, which is determined when you get your bite taken, and the occlusion that is carved out in it. If we assume that your clinician is a well trained one, then you should have reasonable expectation to have resolution to most your issues over time. In my experience, there are many aspects of your treatment that dictate outcome, and decompression alone as a goal is not sufficient. As you have alluded to your posture, there are cervical issues that need to be addressed concurrently and perhaps prior to taking the bite to allow us getting there easier.
Once we have a good physiologic bite then we can work on the occlusion and micro adjust it to perfection so that effects of our work can slowly settle into the rest of your body.
Furthermore, you have to work on your posture, and stance, as it is only obvious that it is a two way street. You can not have perfect bite in an imperfect posture.. remember, form follows function, and so deformity follows disfunction.
I highly recommend this treatment, but remember its not a panacea and it does not replace your need for helping yourself.

Regards,

H.Nassery DMD FICOI FAGD FICCMO
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Sculptura, Mar 13, 2016
Thanks, Dr Nassery! Many, many thanks to you for taking the time to answer all these patients. It's a wonderful thing you do and really appreciated. My plan in going forward is certainly to address the scoliosis and regaining the curve in my neck. I believe even the slight scoliosis I have may be causing a number of other problems, digestive, body performance etc. I've slowly been working on recurving the neck with an AO chiropractor. I was concerned which should come first (splint or cervical work or even if the work-up should wait) but I hope doing the work-up the way I am and getting the splint going at this point won't be a problem. I had the thought that since I was in the same situation cervically for so many years and without TMJ symptoms prior to Invisalign that addressing the jaw position first should be OK.  Is there any type of cervical work or process you find works best in adressing these cervical issues? I like your idea of micro adjustments once we get the disc space/condyles in the right place and the correct physiologic bite. Of course I hope to be able to resolve the symptoms and ween out without having to go to another phase and concurrently iron out the cervical issues. Thank you so much again.  

Dear Sculptura,

My protocol is generally after taking my diagnostic records and finding the issues in the neck to refer to my PT. While I am in favor of chiros specially AO or NUCCA, I find that the corrections made by a PT last longer and are more organic in nature.
Once the neck is primed and C1 is mobilized ( You will have a static C1 as you will find out), then the patients will arrange an appt with my PT and then right over to my office to capture their optimized bite. This is the best way to ensure we have all parts moving the right way.
Furthermore, all adjustments are scheduled accordingly the same way. As for your idea to wean off off the orthotic, I would say in my experience that is not in the cards for patients with Cl2 bites. You should get ready to get braces and correct your bite once and for all ..

I hope this makes sense.

Warm regards.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org


Avatar universal
by Sculptura, Mar 15, 2016
Dr Nassery,

The Dr did tell me I'd have sessions with a PT during orthotic treatment just like you would do. What concerns me in your response is that I didn't see a PT prior to bite capture. Does this mean we don't have the correct bite capture and this could be a problem? What do I do now? I do know my atlas was straight during capture because my AO confirmed it was in place a few days later. That was a relief to hear. I also don't know what's meant by a static C1 but I will ask my chiro about it. My neck is very mobile, as is my body, no range of motion issues. The Dr in fact had me walk up and down watching my gait and said we'd be splitting hairs to worry about what he saw there. I had no muscle pain when I was palpated except slight discomfort in two places - the temporal area and probably the medial pterygoids. I've been recurving the neck little by little over time but not using my recurver on a daily basis right now. Don't want to screw around too much there at this juncture.

I have read an artcle on treating C2 type TMJ patients and the Dr said basically what you did; with C2 skeletal patients who are far up and back, phase 2 usually happens. I'm not clear on why that would be and it seems rather general. I do understand that to get such a patient to that "ideal" place you would need to bring that patients mandible way down and way forward and stabilize that. But that doesn't sound like a necessity in order to resolve a patients symptoms. Can't a C2 patient get resolution of their symptoms if they were caused for example by too much compression and ween out once the condyles are brought into a better place and disc space is regained? I'm aware nobody can predict how quickly symptoms will resolve and how long you wear the orthotic will determine if there's a phase 2 but if symptoms resolve quickly, I don't know why weening would be atypical for C2 patients. What I'm saying in effect is although my alignment was never ideal, I was very comfortable prior to Invisalign pushing me over the cliff. After the Invisalign debacle you can probably understand why I'd be so hesitant, or more to the point terrified to mess with orthodontics again. I just want to be sure going forward that I haven't been remiss on anything I should do prior to getting this orthotic. Thanks for your response, please let me know if you feel I've neglected to do something that may make a huge difference in my treatment.

Sculptura,

The question you must ask yourself is "how did your neck get into this to begin with?"
You think it was the invisalign, or was invisalign the last straw?
What I know is that form follows function, and so deformity follows dysfunction. Where you are now is a dysfunctional position.

Regards.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by fitmom2girls, Mar 20, 2016
Dr. Nassery,

I have been suffering with debilitating symptoms the last few months, ear pain, headaches, sinus issues, anxiety, swallowing issues. I've seen my GP 4 times who prescribed me 3 rounds of antibiotics for a sinus infection that I didn't have. Then was referred to an ENT who did the camera down my nose and said I was swollen and prescribed me another antibiotic along with an anti inflammatory. Because of all of the medication I think that I developed awful acid reflux.

ENT scheduled a CT scan which came back all clear and he just wanted to refer me to an allergist or neurologist for the chronic 24/7 headache.

It was during a routine chiropractic visit that he discovered it was my jaw giving me all of the pain. I immediately scheduled a dentist appt. and got in right away. The dentist didn't even take any xrays or anything and wanted to fit me for a night guard.

I had braces 10 years ago but my upper teeth have shifted so I asked him if getting braces would help, he said sure and passed me off to an orthodontist. I saw the orthodontist and he recommended I do not get braces at this time because we need to fix the problem and get rid of the symptoms first. He suggested a night guard and splint (is that what is is?) to wear during the day.

I am scheduled to get fitted for both of those tomorrow, is this a good step? I can't live like this anymore, and it came out of the blue. I was a healthy 38 year old woman who did cross fit 4-5 days a week, to not being able to function on a day to day basis. I need help!

Avatar universal
by nursemom2016, Apr 06, 2016
Hello,
I noticed your site today and thought you might find this interesting.  I had a hemangioma under and posterior to my right mandible that began to misalign and push my jaw out around 4 years old.  It caused all kinds of misalignment problems in my mouth, and my uvula in the back of my throat rests on the right side of my throat - basically leaving me with a smaller oropharynx than most.  I had a neck dissection at 6 years old to remove what they thought was a cyst, and then realized it was a hemangioma - which they cut through and caused extensive bleeding and 9 more hours of surgery.  Then at 11 years old they found it had grown close to the base of my brain and so I had sclerotherapy to reduce the size - it worked as far as I know.  Now fast-forward to 37 years old.  I have lost my molars on the right d/t decay and extraction -probably bad vascularity.  But it is my LEFT jaw, it hurts in waves, often stress related I noticed, but lately almost constant.  Left lymph node, left side of throat, left very corner of mandible and behind it.  I'm sure I have some element of TMD. I have scoliosis too, imagine that.  I never knew that connection until this site.  I have no idea where to go with this pain.  I don't want meds, I want a fix, and my PCP has made it clear he has no idea what to do with me.  I also have a root canal on a molar on that side, thought about the mercury poisoning idea.  What are your thoughts?  Thanks for taking the time.

Dear Nursemom,

It sure sounds like many factors in this case. If most other medical issues have been addressed, then I would say our approach of getting your jaw also aligned would help.
The symptoms of your jaw ache and pain make sense as it seems like the only side working is the left. We need to have function on both sides.
At this point there maybe other factors such as nerve damage due to all the surgical work as well. Try and find as much of your med history as possible and the n see a Nueromuscular dentist and see about aligning your neck and jaw funcction.

All the best . Keep us updated.

H.Nassery, DMD
www. miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Ratad, Apr 09, 2016
Hello Dr Nassery,
I am a 40 y female. Had TMJ issues. Prosthodontist convinced me that my bite was off and adjusted my bite over a few m. Bite felt horrible, started clenching more. Seen another dentist who is supposed to be big on TMJ. He used multiple splints, chiropractors to make sure my neck was ok. He did occlusion adjustments 4 times over 2 years. Neck and shoulder and back tightness was better but still there. After the last adjustment L sided neck, shoulder and back hurts. Spine pops frequently. Who do you recommend in Maryland area. Planning to see physical medicine and Rehab doc and will do PT first.

Dear Ratad,

It sure sounds like you have been on the verge for some time now. This latest adjustment was the last push. Like most of us you are or have been over closed, and further adjustment finally pushed you too far.

check here; http://www.iccmo.org/find-a-tmj-dentist-2/
Unfortunately I don't know anyone in particular in that region. ICCMO is a good place to start.
As for Starecta, I have seen the site, I think that he/she is definitely on the right track in the connection, however, what they offer a removable appliance that you wear only to maintain jaw in a position. This appliance is not meant for chewing and function to my understanding. Also the way they decide on the bite is not disclosed, they do not see the patients, you send models and some pictures and the way they make the appliance is known only to them. Its not exactly scientific and measured with our standards. However, I do find them interesting.
What yo need is to find your physiologic jaw position, have you function there for some time and make sure all your symptoms are alleviated, then figure out how to bring your dentition together in that position perfectly.

I hope this makes sense.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org


Avatar universal
by Jynuine, Apr 29, 2016
Dr Nassery,

First, I wanted to thank you for the amount of personal commitment you have devoted to this thread, in general. I'm sure it's not even close to the extent of time you have spent overall to the matter.

My daughter is a 17 yr old with JIA and minor scoliosis, probably caused by the arthritis. Her first symptoms of arthritis were at 7 1/2 mos old and we were only able to fully bring it under control about 4 years ago when she was 13 with a study she is participating in to get Cimzia approved for use in children with Polyarticular JRA. It's a biological usually used in Crohns patients but still a part of the Enbrel/Humera family.
   She was diagnosed with TMJ about 5 years ago and we have a maxofacial surgeon, Dr Bell of Head & Neck Surgical Associates, who specializes in the TM joint with a heart for kids. He did cortisone injections for her then, in her tmjoints. She had arthritic damage in her left TMjoint and active arthritis in her right at the time. Prior to this, her gape was very poor and her pediatric rheumatologist noted her recessed jaw and that she may benefit from jaw surgery in the future and that it made a world of difference for his other patients who underwent the procedure.
   As her arthritis was brought under control her gape improved immensely however her bite was severe with a very small pallet and narrow jaw. Her bite has effected her TMJ negatively and now that she is done growing, we are pursuing corrective jaw surgery to pull her jaw forward.
We just met with her craniofacial surgeon who commented that her airway is fairly narrow and that she would benefit from seeing a pulmanologist but that the jaw surgery would greatly improve that. He said that although she has notable damage to her right tmjoint, it's still in good enough condition that he does not need to replace either of them which he recommends be done at the time of the jaw surgery, if needed- and that is great news!
   At this point we are waiting on insurance to be approved and the schedule is 1.) MRI, 2.) Wisdom teeth out and corrective braces with Dr Judah Garfinkle as the operating Orthodontist in coordination with Dr. Bell, and then jaw surgery where he would cut her jaw in 4 parts, use metal brackets and bone grafts for parts to pull her jaw forward. It is a lot for a mother to take in, but they seem at ease that she is an easy candidate.
  
   Right now my daughter is complaining not only about back pain but also jaw pain and I am suspicious she is having a flare up. She has also been mysteriously suffering from chronic hiccups for 2 months after a week and a half of Norco when she had a deep cavity filled that ended up needing a root canal a week prior to having major hand surgery (It was a very crazy week, that week was). We havent been able to figure out what is causing the hiccups to stay which happen throughout the day and even at night and seem to be agitating her TMJ. The doctors are at a loss, also. They started before the hand surgery when she started the norco so Im pretty sure it is not a lung clot or the sort.
  We are going to try PT in a couple of days for her mild scoliosis to see if that helps any- my only guess is she has something irritating her phrenic nerve. I cant seem to find any links to a narrow airway that would have been contributing, but I'm wondering if you have ever heard of anything to do with hiccups inflaming tmj? Would an adjustment from a chiropractor be beneficial in something like this?
Also, do you think she may still have TMJ issues because of her scoliosis and arthritis even after the corrective jaw surgery?
Thanks for your consideration! I just kind of threw it all out there because my daughter has so much going on.
Best regards,
Jyn


Avatar universal
by ronijane, May 01, 2016
Can loss of appetite and nausea be a symptom of TMD? Been suffering with what seems like random issues for a month now like back pain, facial pain..I do not have any jaw clicking or popping but do have lots of pressure on my jaw and on the TMJ especially on the left side. Along with constant headaches every single day and left eye pain and dizziness. Been evaluated by my regular doctor.. Everything comes out normal.. and they cannot figure out exactly what's wrong.

Dear  Jynuine,

I am sorry to read all that about your daughter. To say it is difficult is an understatement. While there are many factors here that are way outside of my small pocket of knowledge, I do see some potential pitfalls with the direction of your treatment.

First and foremost, the fact that your daughter has narrow dental arches and a recessive lower jaw is highly indicative of TMD potential. However, surgical correction is mainly an only aesthetic answer to a skeletal problem. Yes, the airway will improve, but the load on the jaw joint is not addressed. Actually is totally ignored. Hence the degenerative and arthritic process in the joint will continue.
The fact that she already shows all these signs and symptoms at her age is understandable when you plug in her Arthritic conditions. Another words she is suffering from symptoms I normally see in patients many years older.

I am fundamentally against irreversible procedures, specially surgical, prior to testing other methods of less invasive treatments. I concede this is a difficult case, however,  I believe the fundamental problems are the same. She is just showing severe symptoms because she has the JIA.
I can see how her bite has caused, the scoliosis, the neck issues, and even her lower back issues. BTW, her constant hiccups could definitely be part of this whole complex. Just look at he origin of the phrenic nerve, the roots start between C4 and C5. Where do you think I see most damage and lack of space in my patient pool.
Do me a favor and take her to a Pt that has training in cervical spine, and have them do a gentle decompressive treatment on her neck and to align it. I think you will see the hiccup issue resolve.

I would also try and find some one who can get her into a Nueromuscular orthotic, which will reduce the load on the TMjoint, this will be a forward and lower movement of her jaw. It also increases her airway, and help her issues with her neck and lower back. Once she is stable enough and out of pain, start with very light training, and little by little get her to develop some muscle tone in her postural chain. This will go a long way to keep her comfortable and pain free.

I hope I am not crossing the boundaries here but  if you read this tread you would know that maybe one out of twenty or so people who have had surgery, did get any resolution.

I hope my small experiences will in some way help alleviate her pains, and your suffering. All the best.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by thmarch2015, May 09, 2016
Hi Dr. Nassery,
I appreciate your expertise and willingness to take time out to share your advice.  

I've always had a small mouth opening, but recently it decreased in a way that profoundly affects eating and oral hygiene.  It's approx. < 15 mm and my jaw is swollen, occasionally numb, and seems like it's shifting.
In the last couple months, my bite changed suddenly, a tooth has loosened (and toothache), and I've been diagnosed with advanced gum disease.
Last Spring, the oral surgeon i consulted said I had a disc displacement on the right side and degenerative arthritis (osteo?), based on my MRI results: "Irregular flattening of the left and right condylar head";  
on right side "anterior dislocation of the meniscus'.  
He didn't provide other directives except anti-inflammatories, soft diet, and possibly botox or gap arthroplasty if the condition  worsened.  I wasn't sure about the botox and definitely was not interested in surgery.

--Over a year ago, the oral surgeon said my mouth opening was approx 17-19mm.  At the very end of last year, my dentist measured only about 13-14mm, but I'm not sure if they measured the same way.  

--These past 2 months (since March), tooth and jaw problems rapidly got worse. I've had much more difficulty maneuvering my tiny toothbrush to brush my back teeth, although I'm thorough.  My tongue feels like it doesn't quite fit in my mouth.  At times, I have to be conscious not to bite it, as well as consciously keep my mouth closed. My jaw feels sometimes like it's closing in.

Around the same time, I had a piercing toothache for a couple days.  That's when I noticed my bite had suddenly changed significantly, and it seems like it's shifted to my right side.  A tooth became loose, and along with the difficulty in opening, it became painful to eat.  This change seemed to happen within just days.

-I was diagnosed with rather advanced gum disease and malocclusion. The periodontist said I'd need osseous/flap surgery.  It sounds pretty extreme, but i'm going with it.  I'm unsure if I should let them do anything like shaving off a part of the teeth (which she suggested) or bone graft, until I get another expert opinion on my jaw and how it might be affecting my bite.  I'm nervous about the surgery and after effects, esp. given the complications with my limited opening and TMD.  

--My question is, What do I address first?  I know i need the gum surgery, but i want to understand what's going on with my jaw before deciding on changing my teeth or bite structure during gum surgery.  
I don't know whether the periodontal disease created greater bone loss in my jaw.  Or did my TMD create the gum issues (up til now, I've had good dental hygiene and never a cavity before)?

--More importantly, what kind of treatment seems best for me based on my very restricted opening, bad bite, disc displacement and arthritis?  I know I want to avoid surgery if at all possible. I've done physical therapy in the past but stopped.  
Now I'm scheduling consultations with dentists or orthodontists who state they have some experience in TMD, hopefully before I go through with gum surgery next week.  

What's the success rate for orthodics or orthodontics that address issues like mine? Drawbacks or risks?  I have read things about the therabite or dynasplint (passive ROM devices) as well as other splints, followed by long-term orthodontics.  
What or what combo of treatments has been shown to work most effectively for a case like mine?

Also, my face has changed, even my sister noticed a bit.  In the last month my cheekbones jut out more, a tad 'skull' like.  The lower right side of my face bulges out and looks a bit uneven, esp. my mouth and lips.  My face looks shorter than before. My skin feels saggier, thinner, and I have hollows below my eyes.  Lips are often very tight with lines.  I wonder how common this is, and if/how it gets better with TMD treatment.  
I'm troubled by how rapidly these issues have progressed.  After reading about the various treatments (splints, phys therapy, surgery, bite guards, retainers) and hearing that results simply vary, it's hard to see myself as a guinea pig. It seems there aren't consistent results, given the crazy amount of money these treatments will cost me out of pocket.  What's my best bet?  
Thanks so much for reading.  I look forward to your advice.  Hope to hear back at your earliest convenience.

--TH





Dear THmarch2015,

Wow, that's a long story. In short it seems to me that you need to first be able to open your mouth, with a 15 mm opening how's the periodontist going to do his/her job. Properly.
To answer your question, about your gum disease, you are assuming that it is from a  bacterial etiology. I would say that today, in my practice, middle class area, very rarely we see periodontal bone loss due to bacterial issues. It is most often due to a traumatic occlusion. Which you have a preponderance  of signs and symptoms of.

The first thing I would suggest is to find a clinician who has dealt with a closed locked situation like yours. If they don't understand that terminology you best find another one. At this point you may have built up scar tissue and the disc may not readily move back into its place.
Another thing to remember, is that not all splints are the same. You must find your physiologic bite, and trajectory, and the orthotic needs to be made along that line with intricate anatomy and design. This means you function with such appliance day and night at all times.  Only after a prolonged period of wearing this and relieving all your symptoms, I would consider moving your teeth orthopedically.

I hope this helps you understand your situation.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Sculptura, May 16, 2016
Hi Dr Nassery,

I started on my lower repositioning splint 4 days ago. My main problem with TMJD is I have eustachian tube issues (crackling sounds in my ear when I swallow and I can click open the tubes by moving my jaw) I have not had any bad symptoms come up since starting but the crackling may be slightly worse. Hard to say. My neck cracking got immediately better since starting the splint and my tinnitus may be turned down just a touch.

Today I was reading a post by a guy who believed the vertical height on his 2mm rubber splint (probably a night guard) caused his muscles to shorten/tighten and gave him eustachian tube dysfunction. He had some relief for an hour or so from the eustachian tube issues by a massage therapist who worked on the SCM and scalenes. His theory was too much height on the teeth under the TMJ caused the jaw to open more to accommodate the extra height and affected the muscles and caused him eustachian tube problems. My problems began with two weeks of Invisalign two years ago. My question is if vertical height on sometihng like invisalign could have caused my problems, why is a NM repositioning splint safe? It also has a vertical height so how are they different? I don't want my problems to get worse and wanted to check with you on this. My NMD is out of state but when I go back they do PT. I am thinking of seeing a TMJ massage therapist or cranial sacral guy now. Haven't had much luck there in the past. When I massage the temporal bones above my ears and swallow or try to click open the tubes, it lessens considerably so I'm thinking the temporal bones could be involved in this. Appreciate your advice!!!

Dear Sculptra,

It is fortunate I was reviewing some literature this morning, and one of the articles I came across was about the ear and ear symptoms.
According to this lit review , better than 80% of all ear symptoms are myogenic in origin. The person who made the conclusion about his his night guard and additional vertical and more ear issues, was making certain assumptions. Not all vertical increase is the same. Certainly too much of the vertical opening can cause issues, but 2 mm hardly qualifies as too much.
The difference in your Nm splint is that, done correctly ( I don't want to make any assumptions), it would be along your physiologic trajectory, where your neck and muscles would want to naturally work. The night guards are generally along the same wrong trajectory that has gotten the patient in to this problem to begin with.
As for your case with invisalign, it was more than likely the retrusive forces on your teeth that cause the issue than the thickness of the aligners.

The way I approach, is to start with my PT, to be honest most issues are resolved in this stage, although there is problem with stabilization. However, we know then we are on the right track and once I get them in the orthotic , they are stabilized in the correct position.
I hope this helps you understand, our approach and answers your concerns.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Sculptura, May 16, 2016
Thanks for your quick reply and clarification. That makes more sense. So while there is vertical height on the NM splint, it's not acting the same way on the joint.

By retrusive forces of Invisalign, I assume you mean it causing my jaw/joints to slip even further back or out of alignment. I had no symptoms prior to Invisalign but did have the proverbial click in the jaw and had the textbook mouth breather/thumb sucker/tongue thrusting/open bite development. Got signs of the click and TMJD when I was 16. I was uninformed when the dentist put me in Invisalign two years ago and it was the last straw.  

I asked my NMD since the splint decompresses the joint why would I still feel ear symptoms when I wear it? He said the muscles and not the compression are the problem with the eustachian tubes. Initially I thought the severe compression I have on my tomograms may be the problem. Any kind of PT you recommend I should investigate seeing when I'm away from his office? How regularly should I do this? I have no pain, just some mild headaches now and again. It's really just my ear ringing and crackling eustachian tubes.

Dear Sculptura,

I would want you to see a Rocobado trained PT, if possible.If not a choice, then some one who is well versed in Cervical issues. Adjustments to your cervical spine should be aligned with adjustments to your orthotic. Changes in your neck and head position will change your bite.

Ear issues are usually some of the last issues to appear and some of the last ones to go away. Patience, and perseverance. Ask questions and make sure you understand the process.

Hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Roxiigirl, May 17, 2016
Hi Dr Nassery,

I started having a vibrating feeling in my head and neck for the past couple of months. It was only at night and now it seems to be all the time in just the last couple of days. I went to the G.P. a couple of weeks ago and he suggested a night guard and muscle relaxers. He diagnosed me with TMJ. That helped and then it came on worse. I went back to the doctor's and he gave me a xanax to sleep. He thinks I am under a ton of stress and anxiety. My jaw is aching all the time and my head and arms feel like they are constantly vibrating. I have seen three doctors and they have all said it was TMJ, but I am trying all of their recommendations and it seems to be getting worse. Now, he wants me to see a neurologist tomorrow. I have been seeing a chiropractor as well. Just wondering if you have heard of any cases like me. My head feels so hard to old up.

Sincerely, Roxiigirl

Dear Roxii,

These are classical cervical symptoms. Find a good PT, and have them do some distraction and alignment on your neck and you should feel better.
Then try and find a TMJ practitioner to stabilize your bite in a more physiologic position.
Let me know how it goes.

H.Nassery, DMD

Avatar universal
by Roxiigirl, May 17, 2016
Thank you Dr. for your quick response. PT I am assuming is a Physical Therapist? They would be able to align my neck? Also, classical cervical symptoms are just neck related? Or have to do with my TMJ?

Thanks, Roxiigirl

Roxii,

The neck and your jaw work in close tandem, you can not have one without the other. As a matter of fact the most debilitating symptoms of TMJ are cervical in nature.
Yes, Pt is a physical therapist, and yes a good one with proper knowledge of the neck should be able to align you just fine.

Hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

134578 tn?1483549754
by AnnieBrooke, May 20, 2016
Hi, Dr. Nassery,

I really like this thread.  I've had TMJ for years on the right side of my jaw (never taken seriously by any dentist) that began with clicking and progressed to just feeling like the jaw is not as strong on that side (the clicking stopped).  I also have neck and shoulder pain on that side.  Now a skull MRI done for another reason commented in passing that I have arthritis in that side of the jaw.  Although I don't think arthritis can be repaired, I am still interested in improving the whole right-side problem.  Do you recommend any practitioners in the Portland, Oregon area?

Thanks again for your work,

AnnieBrooke

Hello Annie,

Glad you found this helpful. Try this link;

https://findingagneuromusculardentist.wordpress.com/paul-chung-d-d-s/

Paul is a great guy, and even a better clinician. Send him my regards.

H.Nassery,DMD
www,miamibeachdentistry.com
www.iccmo.org

Avatar universal
by westa06, May 26, 2016
Dr. Nassery,

I read this article and it makes perfect sense to me. I feel like I am being run around by doctors who have zero answers. Last March (2015) I had oral surgery to have my wisdom teeth taken out. They told me before the surgery that my bottom wisdom teeth sit on the nerves and that my nerves would be touched but not damaged and I will feel as though they are numb for a little while. After my surgery I couldn't feel anything because my mouth was so numb from them touching those nerves, however I felt as though something was wrong with my left jaw and I need to bit to the side. I was limited on opening my mouth and I went back to the Oral Surgeon a few days later to tell him what I was feeling...he said because of my age (27) that it was normal and it will just take me longer to heal. I then had lock jaw for about 3 weeks...and after that my jaw still wouldn't open properly.. I was eating mashed potatoes, apple sauce and ice cream...since it was the only thing I could seriously stuff in my mouth. Other than my tight jaws and unable to chew I would have a few symptoms about 5 to 6 times a day that came and went... it was pressure on my head, swishing in my ears and my eyes would get blurry. I ignored it thinking it had something to do with my jaw and eventually once I was healed I would be fine. Well that June I went to my dentist to have my regular teeth cleaning and I opened my mouth for the first time that wide since my surgery. The very next day everything was set up to an extreme. I felt like my head was bleeding and on fire...the pressure was so severe. The swishing in my ears was so loud I couldn't hear someone talking to me standing directly beside me. My vision was way worse and constant and my neck was in pain along with my jaws and face. I went to my doctor and she had me do an MRI and it came back clear...she told me that TMJ doesn't get that bad. But nothing else was done once my MRI came back fine. So i was living with this pain. By July I had double vision the entire time, I couldn't open my mouth, I couldn't smile, I could barley talk, I couldn't make any facial expressions, I seriously thought my brain was bleeding and I was slowly dying. I can tolerate pain very well, but this pain was to an extreme. I felt like the life was being sucked out of my head across my head as though I had on a head band, and my forehead felt like it was being squeezed from either side fixing to be smashed.
I spoke with an orthodontist who lead me to an orthodontist in Springdale, AR who helps people with TMJ. He told me he could help with the mouth part of it, but couldn't fix my eyes or the stuff in my head. He has helped me be able to open my mouth more, smile, talk and all of that good stuff, but the other stuff inside my head is still happening. I will say it has eased up some since my mouth is doing better, but it is still there and still hurts. My neck pain had gotten worse and then vertigo kicked in severely this past February my doctor sent me to a Neurologist. The neurologist had an MRI of my neck where he found a disk pushing into my spine and another one on the way and he also said I have osteoarthritis in my neck just above those two disks pushing into my spine. That's pretty much all he did for me so I decided to go to the eye doctor to see if maybe he could help me with my eyes... I am in constant dim vision and my left eye is always blurry now...and if the pain flares up in my head both eyes get worse and go into tunnel vision which then leads to double vision for me. The eye doctor said I had severe pressure behind my eyes and thought I had Psuedotumor Cerebri... and after having an additional MRI they concluded no and I wouldn't have to have a spinal tap done. I keep telling my doctors I believe this is all related to TMJ problems and they keep telling me TMJ isn't that bad. So obviously at this point I have thrown my arms up and am over it. I know the Doctor i see for the TMJ knows that there is something wrong, but he doesn't know how to fix the rest of these symptoms. Everywhere I read it says not to have surgery or do anything to make it worse so at this point I am just frustrated. My Neurologist has told me I am no longer able to work at a desk or on a computer, so I am in the process of changing jobs. I know stress sets off everything. I grind very bad at night, and i clinch during the day when I am stressed. I do have crowding in my teeth due to two baby teeth I have that I don't have adult teeth to grow in for...and the baby teeth are slightly bigger than what the adult teeth would be.My ears hurt, my eyes hurt, my throat hurts, my neck hurts, my back hurts, my head hurts...and thankfully my mouth doesn't hurt as bad as it did. So I came across your article on here... I've recently spoke briefly with a Chiro... but he seemed ignorant to TMJ stuff too. If what you are saying is true, is there a Spine doctor I can see who will know how this is all related? Do you know anyone in Arkansas or near me who is familiar with helping these situations? I am at the point that I am fixing to just get in the car and come down there to see you. Even if you tell me yes this is all TMJ related and I'm stuck with this pain forever...then that's fine.. as long as the doctors quit dragging me around everywhere playing a guessing game. I feel like a puppet by now and simple just want answers.  

Dear Westa,

I hear you. I wish there was a better communication between dentists and physicians too. We are all too busy in our caves doing what we do to take time and really understand what the other guys are doing.. To top it off, there are so many different approaches..
Lets get back to you. I really think that with the right approach you can get your life back.. come on at 27 you have to stop your work??
The correct approach would be to start you with PT, I don't know how your neurologist did not suggest this.. this is standard protocol..prior to any surgical intervention. You are correct that the effects would not last, until that is you get your bite to re-enforce the correct skeletal position..and keep the separation and spacing between your vertebrae..I know it sounds like science fiction but that's the way it works..
in your neck of the woods  I would recommend;

W. Brent Larsen, D.D.S.
Address:    3 Templeton Dr., Cabot, AR 72023
Phone:     (501) 843-9306

He has been through all levels with Dr. Chan, and I think he can take you to a comfortable state.. keep me posted and let him know that I am here for help if need be.

Warm regards,

h.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by westa06, May 27, 2016
Dr. Nassery,
Thank you for the information. And the encouragement. I will certainly keep you updated and reach out to dr. Larsen in Cabot. Thanks again

Avatar universal
by Delenn365, May 30, 2016
I am a 58 year old woman.  In grade school (probably around age 8), so this was 50 years ago, I wore a brace in the back of my mouth to correct my bite.  About two weeks ago for the first time, I think I dislocated the left side of my jaw by yawning too wide.  After reading this thread, I am not wondering if this was something that was going to happen even if I had not yawned too widely that day.  I felt that my jaw had popped out of it's socket and popped it back in.  I think I experienced a little bit of pain.  Then it happened again while yawning.  The third time happened while I was sleeping.  I woke up with it.  All three times I popped it back into place had minimal pain and did not think much of it.  Then today (Sunday) in the middle of the Memorial Holiday weekend, I did it again while eating Sunday dinner.  It hurt alot, but I popped i back in.  It did it again while eating.  It really hurt a lot, but I popped it back in.  It happened a third time, but this time, it would not pop back in and after trying several times to get it to pop back in, I decided to just leave it until I can get to the doctor.  It may have to wait until Wed. because I have to take a relative to their oncology appointment on Tuesday and there is really no one else to ask for help.  I have been really stressed lately and maybe have been grinding my teeth.  My husband didn't know because he is a very sound sleeper and has't heard any grinding.  I guess I am wondering if over the years, the work done by the braces has been undone.  Also, I take Dilantin for a seizure disorder that I have had for the past 20 years and I read that Dilantin can weaken tendons and ligaments and can sometimes cause TMJ problems.  I don't really want to switch to another med.  I have been seizure free for 14 years and want to keep it that way.  I was afraid this would require surgery, but after reading this, it sounds like I made need braces.  I am not thrilled about this, because it is difficult enough to keep my gums healthy because the Dilantin attacks my gums.  (99% of my health problems stem from having to take medication for seizures).  Any advice you could give would be welcome.  Also, I live near a University Medical Center.   Would it be wise to consult with their orthodontia clinic or should I find a private orthodontist?

Avatar universal
by Delenn365, May 30, 2016
Also, if you could recommend a good dentist/doctor.  I live in the Birmingham, Alabama metro area.  I live about 40 miles north of Birmingham.  Thanks.  

Dear Delenn,

From what I gather, it seems to me you are referring to opening wide as to translate over the joint eminence and then you get momentarily stuck, while you were able to pop your jaw back a few times, you are now stuck open..Did I get the picture correct?

I need to understand the situation better to comment.  
As for a referral, I unfortunately don't have anyone that I know in your close vicinity.. please refer to the following map for your closest choices;
https://batchgeo.com/map/ab93500357547df41bb5e83c52ed3c8e

warm regards,

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by am04myer, Jun 09, 2016
Dr. Nassery,
This forum has been extremely helpful. I wanted to quickly ask about the proper way for treatment. I saw a special GNM in NY who trained with Dr. Chan and fitted me with a neuromuscular appliance which I pick up early next week. I also know that I have neck/shoulder issues associated with this and she told me I would be going into PT as well after I get it to help correct this. However, if she made the appliance while my neck was out of alignment then would it still work okay? I read above how you recommend chiropractor/PT before hand. Thank you very much! I am only a 23 year old male and this started bad back in January. In your opinion would someone my age have a more favorable outlook since the scans x rays showed no joint arthritis etc? It is muscular issues.

Dear am04,

The younger you are the better the chances that this will do the job. You have to keep in mind that I do tend to get more complicated cases at this stage of my work and as a rule I start the way I have mentioned.
This does not mean that I did not have success prior to this. I practiced that way for many years and following Dr. Chan's protocols produced many successful cases for my patients and I.  
Please let us know how you progress thru..

Regards.
H. Nassery, DMD, FAGD, FICOI, FICCMO
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by am04myer, Jun 10, 2016
Dr. Nassery,
Thank you very much for the insight and I will let you know how I progress. As I stated mine is more muscular in nature and has affected my jaw muscles, neck muscles and even traps and shoulders. My left shoulder is actually elevated compared to my right one as a result of everything going on. I am praying that with the jaw stabilized from the splint that PT work will begin to loosen and retrain my muscles. I will keep you updated on this as I go. I have always ground my teeth since I was young (10 or 11) and Dr. Levine believes that that was a major factor that as my life has progressed and I've become an adult the force I have ground with has dramatically increased.

Am04,

Dr. Levine is a meticulous clinician. Send her my regards. and keep us updated.

H.Nassery, DMD

www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by 38352, Jun 15, 2016
Hi Dr. Nassery,

Thank you so much for this blog. So many of us are getting help and support from your blog.

My history is as given below:

I am a 30yr old female.19 years ago( when I was 11 years old) I met with a road accident when I fell on my face and lost 3 upper incisor teeth. After 1 year of healing, a permanent bridge was fixed by taking 3 more neighboring teeth for support. So I have a 6 teeth bridge in front.My original incisors were straight with a little overlapping. Due to bone and gum recession after the accident, the bridge was made with forward slanting teeth to make the upper teeth overlap the lower teeth. My lower incisors are also crowded and slightly forward slanting. So after fixing the bridge, my lower teeth are just behind the upper teeth with no gap.I also have narrow arches and my molars are slanting inwards. I have a narrow face and a slender neck. I am not sure if this accident has contributed to my TMD in anyway.

It was noticed by my family about 8 years ago that I clench/grind my teeth sometimes in sleep( when I was 22yrs old). I also had pain in my arms occasionally and neck pain, upper back pain and a few postural issues.

5 years ago, I started noticing asymmetry in my face, also have severe neck and low back pain for some months.I had severe fatigue and muscle cramps. I had also made some lifestyle changes during that time when I got married. I had started eating more of wheat products( gluten).I was also told by a Rheumatologist that I might have fibromyalgia which might be causing the fatigue. I was also told to stop gluten food by a dietician as it might be contributing to my fatigue.

Then 4 years ago in 2013, I had pain in all my right side teeth in general. My face muscles used to be tired. My regular dentist told me the pain could be due to an old permanent filling in the upper 6 right side (1st molar tooth) as there could be secondary caries/decay.

The permanent filling was removed.This filling also had a little high point before removing I guess. Soon after this filling was removed I started getting headaches everyday and  pain in this particular tooth. I was told to wait for 6 months before root canal can be done in the tooth.

During this 6 months I avoided chewing on the right side due to pain and chewed only on the left side. I suddenly developed pain in my right TMJ few months later.When I told my dentist about the TMJ pain, he did the root canal procedure on that tooth, as he thought that could be the cause of it . Then within a week I had pain in the left TMJ as well. My mouth opening reduced and got restricted to 28mm with normal opening and 30mm with maximum stretch.

When my TMJ pain started, my occlusion was totally gone and I could not find the right bite.My bite was lost overnight. When I woke up I saw that non of my teeth contacted. I started getting headaches in temporal and temple region, ear pain, itching in ear, intermittent ringing in ear, dizziness, neck pain, clicking sounds while speaking and swallowing.

I was given a soft rubber night guard by a Maxillo facial surgeon to protect my teeth from clenching,  which I wore for about 9 months. During this time,I was told to be on a soft diet and if possible liquid diet. So I just mashed soft food and gulped it down without chewing and sometimes i chewed on the left side since my teeth contacted only on the left.When I started wearing the splint, in the beginning it felt better but later pain increased and my clenching also increased .I started getting muscle spasms in my face.The left side muscles were very active and pushed the jaw towards the right side.And ringing sounds which were intermittent became constant. Along with this constant ringing(tinnitus) I also developed sensitivity to loud sounds (hyperaccusis). So I cannot tolerate sound of vessels, traffic, machinery and many others. I get dizzy and get visual disturbances.So I have been muffling these sounds by plugging cotton and wearing ear muffs to get out of the house in traffic.

The following symptoms are the ones which are affecting my daily life most:

My ringing in ear gets louder on tilting head & neck sideways, forward, up and down.Sometimes even when I shift my body weight from one side of the body to another while standing and walking the ringing gets louder , and also for tongue movements sometimes.According to my observation.

My visual disturbances include constant flickering vision ( which causes difficulty to read, focusing on patterns, focusing on fast movement for example:while moving in a vehicle, while scrolling the mouse of a computer ) floaters, flashes, sensitivity to light.

Dizziness comes when I hear loud sounds, when I chew food( the chewing action causes dizziness and vision disturbance), when I place my head on the pillow to sleep, When I open my mouth to brush teeth, bending head, turning heading.) I always sense the dizziness coming from the back of my head.
At this point, I saw an  ENT doctor, who told me that all my symptoms were due to one side chewing and my jaw x-ray shows that the right jaw where I did not chew for a long time is not as good as the left joint.

I started Neuro muscular(NMD) treatment in Jan 2015. I was given one splint for the day and another one for sleep apnea at night.

My first splint was 8mm high in front and 6mm high in the sides, the jaw was not brought forward in this splint. Eating with this splint was quite difficult because the splint was very high and my mouth opening was already reduced.I wore this splint for 10 months.  The jaw pain, blurred vision and ear pain came down with this splint. But the other symptoms remained. Also I started to loose my body balance after wearing this splint. My body started swaying backwards with all the weight on the heels/back of the feet and a lot of energy went into balancing the body both while sitting and standing.

The night splint was quite uncomfortable, it pushed my jaw to the right side while wearing it. So after wearing it for 9 months, I was told to stop wearing it. This splint kept the mouth open with jaw pulled forward, so I was mouth breathing at night. And even the day splint, I was told to keep my mouth slightly open and relaxed..So even during the day, I mouth breathe.

Then a second splint was given to eliminate other remaining symptoms. It was 3mm high on the sides and open in the front with no contact with the incisors. When I started wearing this splint, my neck pain and back of head pain became severe and I started getting tingling and numbing sensation in hands and legs along with weakness in limbs. Performing daily tasks became difficult. My dentist then explained that the splint was faulty. So he made a 3rd splint after 4 months.

During this time I was told to extract my third molars (all the 4) as they may be the cause for my TMJ. So they are extracted.After the extractions, I noticed that the clicking sounds in my right TMJ has changed to squeaky sounds while swallowing and also noticed some kind of friction sounds.

Then a third splint was made in March 2016, now the tingling and numbing which started with 2nd splint has reduced. But the weakness in arms and legs, eye, ear and neck symptoms remain and along with clicking and squeaking sounds.My body is still not properly balanced on my feet.

While making the third splint, the jaw has been brought much more forward. Unlike the first 2 splints, this one has no height at all. No adjustments were made on any of the splints. The first 2 splints had flat chewing surfaces with elevated borders at the edges to fix the upper teeth inside.The 3rd splint is made differently with tooth like elevations. However the surface is almost as flat as the first 2 splints and is difficult to chew.

Now my lower teeth are more forward than my upper teeth.Like my jaw is protruded now. My teeth and jaw were not aligned like this before the TMJ  pain started a few years ago.

After that my front teeth bridge was cut in the middle by my doctor since he says all my teeth both upper and lower molars are inward slanting with narrow arches and by cutting the bridge the teeth may expand outwards.

Apart from the NMD treatment, my dentist told me to undergo physiotherapy sessions in May 2016 and I notice some improvement with my posture. The Physio also told me I have a forward neck position.Some exercises were taught to strengthen the face muscles as well.

After the Pt sessions no adjustments were made to the splint.Now I am getting pain in the masseter muscles and spasms on both sides when I chew food and the muscles inside my mouth behind all the teeth are also strained.I also get little pain in the jaw joints these days.My jaw is not finding a resting position. The splint feels very uncomfortable now.

So my present symptoms are: Pain and spasms in masseter, difficulty chewing even soft food, pain behind the eye and above eyebrows on one side after chewing food, clicking & squeaking sounds in TMJ, restricted mouth opening, ringing in ears, sensitivity to loud sounds, eustachian tube block, itching in the ear, popping sounds in the left TMJ, neck & back of head pain, asymmetry in face( sagging lips and fatter cheek on right) dizziness, visual disturbances, pain in temporal region.

I have been on splint treatment (NMD) for 1.5 years now. Most of my symptoms are still present. My daily life is severely affected.

Your guidance and help would be really appreciated.

If I have missed out any important details please let me know, and I shall add it.

Thank you..

Regards,
Tan




Dear Tan,

I am saddened by all the difficulties you have faced. The things that I have noted..
1-  Your signs and symptoms are classical Nueromuscular signs
2- Your dentists definitely have no handle on how to treat your case
3- there are different NM camps, and these appliances are not prototypical of the way we make out appliance.
4-You should not allow any touching of your other dentition until your issues have been mostly resolved with your orthotic.
5- The PT corrections should have been made prior to your bite procedure, and the subsequent meets with the PT should be followed with adjustments to the appliance.
6- At this point I am not even sure how your bite was taken? did the doctor tens you and do jaw tracking?

There are many unknown factors here but here is a start. I wish you all the best.. keep looking for the right person.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.orrg

Avatar universal
by 38352, Jun 20, 2016
Dr. Nassery,

Thank you so much for your insight, I will certainly take care of the things you have mentioned in my further treatment.

The NMD doctor did tens and used the K7 machine to do jaw tracking before making the splint each time. However no adjustments were made to the splints later.

The PT and the NMD doctor have a different understanding about TMD. While the NMD sends some patients to PT with the splint and some patients without splint.While the NMD has brought my lower teeth more forward than the upper teeth, the PT pushed the jaw backwards with force several times in supine position because the protruded jaw is looking very awkward.
There is a basic lack of communication and coordination between the PT and NMD which is very confusing for the patients.

Due to the repeated handling of my jaw this way, I am really concerned about my TMJ status now.

I would like to understand a few things about my case.

1. Are there any medical tests that needs to be done at this point to know the exact status of my TMJ?

Since there is squeaky sounds in my right TMJ and clicking and cracking sounds in my left TMJ.

The tests done so far to see the status of my jaw are:

     1. TMJ open/close X-ray and OPG in Jan 2015  (just before starting the NMD treatment prescribed by the NMD dentist.)

     2. TMJ open/ close X-ray was repeated in Dec 2015 (by the NMD dentist)

     3. CBCT of the TMJ was done in Dec 2015 (by my local dentist.)

     4. TMJ open/ close X-ray was repeated in June 2016 ( this time my local dentist asked me to repeat this, for some reason the X-rays were not taken clearly even after repeating it in different labs..so I do not have a clear X-ray of the latest position)

2. The root canal done on my upper6 right tooth 3 years ago, which I had mentioned in the previous post was not done successfully. As there is still pain in that tooth. My local dentist saw the CBCT  X-ray of the tooth and said that a subcanal has not been filled and some dental files have been left inside while doing the procedure..there is infection in the tooth which is causing bone resorption.So the tooth needs to be extracted.

I want to know if extracting the upper 6 at this point cause any hinderance in the NMD treatment first phase or second phase with a missing tooth in the middle?

Also, my local dentist suggests that a removable single tooth denture be placed in the extracted tooth position to retain the space to place an implant after the NMD treatment is completed, so that the neighboring teeth don't move into that position. Is the denture a good idea? Would that cause any trouble during the NMD treatment?

3. When the 3rd splint was given, my jaw was brought much forward.Now my lower teeth are more forward than my upper teeth.
Before my TMD started, my lower teeth were just behind my upper teeth bridge without any gap. My original upper teeth before my road accident was also covering my lower teeth and in front of the lower teeth. I did not have a protruded jaw.

The NMD dentist says that during the second phase, keeping the jaw in the new position he will make the lower teeth inward slanting which will be in line or just behind the upper teeth.

So I want to understand, if bringing the jaw so much forward is necessary for the jaw to heal and make me symptom free?

4. My mouth opening is now restricted to 28mm normal and 30 mm when stretched, does the opening generally increase with the correct NMD treatment?

5. Some of my present symptoms include eustachian tube block at times, popping in ears, tinnitus, dizziness, sensitivity to loud sounds and vision disturbances. The ENT says the ear and hearing is completely normal by physical examination.

I want to know if it is safe for TMD patients with these symptoms to travel by flight? Is there any kind of risk involved due to pressure changes specifically for TMD patients?

6. With the symptoms I had mentioned in the previous post, I want to know if I could have any cervical spine issues with c1, c2  contributing to my symptoms?
If yes, then will a correct orthotic help correct the cervical or would any other therapy like physiotherapy or chiropractor be required along with orthotic (NMD) treatment?

7. A  PT once told me that TMD issues can cause vestibular issues and cervical spine issues. She said since all my eye symptoms, hearing symptoms and dizziness may be an outcome of the vestibular damage caused due to TMD and cervical spine dysfunction. She said though I don't have severe vertigo and nausea, all my other symptoms indicate a starting stage of a vestibular issue. And she shared the following links with me:

http://vestibular.org/understanding-vestibular-disorder/symptoms#


http://vestibular.org/cervicogenic-dizziness


http://vestibular.org/tinnitus


http://vestibular.org/sites/default/files/page_files/Vestibular%20Rehabilitation_0.pdf

And when I read about the connection between TMJ and Vestibule, I found the following links:

https://www.braddurhamdmd.com/tmj_vertigo_sufferers_may_someday_be_given_the_grace_of_ballet_dancers/

http://www.tmj.org/site/page?pageId=174

Does this sound relevant in my case? Should I go ahead and get vestibular rehabilitation at this point? Or would the eye and ear issues be resolved by the correct NMD treatment itself?

Please help me to get clarity on these topics. It would be of great help.


Thank you..

Regards,
Tan









Avatar universal
by eeperti, Jun 24, 2016
Hi Dr. Nassery,

Thank you so much for taking the time to answer everyone's questions! I am considering seeing one of the doctors you have recommended, but I am hesitant. Can you please explain why traditional dentists and others consider neuromuscular dentistry to be controversial?

For the past (almost) two years, I have been seeing Dr. Brendan Stack and Dr. Jeffrey Brown in Vienna, VA for my TMJ treatment. Dr. Stack is essentially retired now, though. When I started with them, they did some scans and an MRI and we found out that my discs were medially displaced on both sides. I was given a lower Gelb appliance to be worn 24/7, even while eating, which I complied with very well. They did not use any TENS or K7 when fitting me for this device.

This was supposed to decompress the joint so that the disc would have a chance to go back into place on its own. But I did not see any improvement after 11 months of wearing the appliance and the discs had not gone back into place (had a second MRI to confirm this). Then, the doctors and I discussed it and we decided to go ahead with a surgery to put my discs back into place.

I had this surgery with Dr. Eugene Gregory in November, 2015. After the surgery, I continued wearing the appliance, which was then indexed, and I did jaw stretches with a Therabite device. Now I am able to open to 50mm+, but have no improvement in my pain. Since the surgery, I have also been working with an osteopath, but really did not see my improvement after 6 very expensive visits.

I considered "giving up" my search for pain relief, but found that giving up sent me into a deep depression... So now I have stumbled upon this forum and am feeling hopeful again. I am so hesitant, however, to begin treatment with another doctor, not only because of the financial burden, but also because of the emotional burden I have felt when my various treatments, time after time, fail.

What do you say about others considering NMD to be controversial, and lacking in scientific evidence? Am I even still a candidate for NMD work, after all that has been done to me by these other practitioners? I just don't know what to do next. Please share your thoughts!

Thank you for your precious time!
Erin

Dear Tan,

Sorry for the delay. I was out of town for our summer retreat. I will try and address as many point as I can, there are many in your writing but I think many have the same underlying cause.

First let me say that just as in any field there are vast differences in application of any technology. I have a computer but that hardly makes me an expert in computer technology, what I am able to do with my computer is leaps and bounds more limited than a computer expert. I will leave that as that..

The things that jump out at me is the uncertainly of your doctor to just change the trajectory off your bite like that.. let me explain, when you bring the jaw forward or back what you are essentially doing doing is changing the trajectory of opening and closing.. You find this trajectory based on physiologic principles..couple of those important markers would be proper jaw range of motion, and cervical freedom of movement.. which based on your writing neither has been established.
So I can confidently say that your appliance is not on the correct optimized trajectory.. Please read the writings of Dr. Clayton Chan on the subject of optimization.
As for the bite you have now, your dentist should verify that bite with his K7..just the same scans he did to establish your previous bite was wrong, should be performed to see if this is correct? My gut feeling is that there will be very high cervical group tension in the EMGs.

The other factor is that your doctor and his PT need to have a gathering and both understand each other's role in this treatment. I know from first hand experience that this is not an easy sell to either professionals.. unfortunately..
However, both parties need to understand the objective of the treatment by the other, and realize that without cooperation they will just go back and forth..

I really liked the links you sent me , I think your PT is right on.. now the hard part.. get them to meet and study each others role in this treatment.. Your bite should be taken after your neck and joint issue has been addressed by the PT not the other way around..

I hope this helps.

Warm Regards,

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Dear Erin,

I am sorry to read about your pain. As you have noticed already perhaps you are in strong company here...
I wanted to address one thing first; your comment about Nueromuscular being controversial or lack science..

We do have science, they are called anatomy and physiology..what we studied in the first two years of our dental school and somehow found no place for it in our most fundamental part of our job, the finding of our patient's bite...
So the retractors try and discredit the people who are trying to make a scientific basis for finding the correct bite by making those comments..while for all these years they themselves can not explain the way they attain their bites..there are no two schools in the united states that agree on how to take the bite, they are as arbitrary as it gets, meanwhile they try to ridicule those who actually try and measure our work.
Luckily the new media have changed that, I respect all clinicians and the way they choose to practice and provide care to their patients, this is the way that I have been able to provide the best relief for mine. Now if they can get the results I have achieved and documented with video testimonies like I have and show case on my site, then more power to them. But let me see that..

Now back to your situation.
Dr. Stack is a giant of the the field, I love his work and what he has accomplished for furthering our knowledge in dentistry. I feel that our work in Nueromuscular is an adaptation or evolution of what he has started. I do believe that we have the same objectives in mind but we add a little more detail and measured objectivity to the process.
I have to say that I am fundamentally against surgery till the last possible moment, but there are some cases that the scars and inflammatory tissue cause adhesions and that makes recapturing the discs impossible without surgery.

Having done the surgery, and not having resolution to your pains, which by the way you did not specify, is a clear indication that they are myogenic in nature and not joint specific. I do believe that with the right combination of a PT and   GNM trained doctor you can find relief from your pains.

I hope this sheds some light on your questions.

Warm regards,

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Coneire86, Jul 11, 2016
Hello doctor just wondering can you recommend anybody for major tmj/cervical issues in Ireland? THanks a lot.

Avatar universal
by kas1972, Jul 12, 2016
Hi Dr Nassery,

I had a bad bicycle accident when I was 10.  I lost a couple teeth, had stitches in my mouth, plastic surgery under my nose and along the hairline on my forehead.  After that I had an underbite and the following year at age 11 was diagnosed with scoliosis.  My bite changed over time without orthodontics and I now have an over bite.  I feel my jaw sits back much further than it should.  I have suffered with back and neck pain for >25 years, I am now 43.  I have ringing in my ears and aching pain around my left ear.  The neck pain and associated radiculopothy down my arm has had me out of work for the past 5 months.  I am working on improving my posture with Schroth Physical Therapy, pilates, yoga and have been seeing an Atlas Orthogonal Chiropractor.  I feel I should get an eval with a specialized dentist as well, making sure I am looking at my body as a whole system.  The closest one I could find to me (I live an hour north of Albany NY) is Janet Levine, D.M.D.  She is about a Is three hour drive.  Do you know of anyone closer.  Are there any specific Occlusion Connections™ Courses that I should be looking for the dentist to have completed.  I appreciate your time and any advice you can provide.

Kelly

317787 tn?1473362051
by Dee1956, Jul 22, 2016
Hello, I just found this and am going to read all of it.  I wanted to thank you. As a child I had a severe underbite. I had to wear a palate expander for 7 years.
I never realized that my jaw could be causing my neck problems and perhaps the lower back.
The is a new concept to me.  I just wanted to say thank you!
Dee

Dear Dee,

You are most welcomed!!

Regards.
H.Nassery

Dear Kelly,

Please let me know if you got to see Dr. Levine. and how it is going..

Regards.
H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org



Dear Conerie86,

Currently I have no one I could recommend to you there., please keep us informed about you progress and any treatment if you do..

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by DancingGrace, Jul 29, 2016
Dr Nassery,

I have read your blog for awhile now. Your write up is excellent and the postings are educational.
I would like to present my situation:
- had a car accident 20 yrs ago and had chiropractic treatment but was not consistent for 6 months. I don't know if this has anything to do with my neck and teeth today.
- I just found out from my chropratic doctor in Jan 2016  that my neck was a reverse S at stage 2 or stage 3. It is straight. I am doing so me neck muscle exercise to strengthen my neck muscle accordingly. I have no neck pain.
- I have trouble with my cavities since teen. I have replaced most of the teeth with crowns over the last 40 yrs. The bite was not correct because going thru different dentists and replacing crowns over the years. In the last 6 yrs, I have 5 implants in place and started the Cpap machine 6 yrs ago. My crowns don't last very long, 5 yrs the most.
-  I don't smoke. I don't threw up. I eat vegi mostly and little meat. I keep 135lb/5'.4" figure.  I dance argentine tango, I hike. I floss and brush regularly. But my bone between teeth recessed dramatically in the last 12 months, for all teeth, viewing from x-ray. I am taking calcium everyday now.
- I started snoring 10 yrs ago in my late 40s. But I didn't realize about my apnea till the sleep study indicated 69% oxygen level. I am 60 yrs old.
- The reason for this request is my teeth. Here is the writeup from my dentist: She has been suffering from heavy anterior wear on both Maxillary and Mandibular Interiors.  I have opened her bite with composite.
- My dentist added composite material on the lower #19,#20,#21 and #28, #29 #30. to add height so that my front teeth won't touch first. This changed my bite and I couldn't chew well. I have up and down chewing action but not left and right grinding action because food fell off the teeth surface.
- As for my jaw. I have not had pain nor clicking nor opening problem.
- I grind my teeth at night and wore out my rear molars. The root for #18 and #31 were fractured and had to be extracted.
and I feel sort of relieved for now before I put implants to replace them.
- My question is that What's my next logical step. Do I replace all #19,#20,#21 and #28, #29 #30.with new crowns?
In addition, My only real teeth (5) are in the front lower ones and the color doesn't match with the composite neighbors at all. So it is not professional looking. My new dentist (periodontics) recommend to crown the front real teeth also to protect the wear once the 6 neighboring new crowns are replaced. I eat lemons and I rinse with baking soda water.
- I know that the 6 composites are temporary and they will fall off anytime and I have to make the tough decision of
replacing all 6 crowns to have a even biting surface and live a normal life again. The tough decision is to crown the real 5 teeth in the front. Even though they have worn to have 2/3 left but they are not sensitive to cold and hot. I hate to grind them down to put caps on.

- I just moved to Dallas.  I have scheduled an apt with John R. Zuniga, DMD for TMJ evaluation in Dallas for Sept 1 since there is a long wait. Any suggestion on dentists?

Could you advice me of my situation and do you have any suggestion for neck exercise? or jaw exercise?

Avatar universal
by Joleneban, Aug 02, 2016
Hi there,
All this makes total sense. I have TMJ and grind at night and sometimes during the day if I'm stressed out. My dentist made me a night guard which helps to stop me from cracking my filings(I had broken and gas to replace several before the night guard) I also suffer from headaches and pain in my neck, and shoulder, mainly on my right side. I had an MRI and found that I have a herniated disk. I tried the chiropractor and it was extremely painful to even touch my jaw. It helped for a little while but it's back with a vengeance!  Can you please recommend someone in San Diego that can help me.

Dear Dancing Grace,

Had been busy last few days..but here is main things I take from all your description..
You are ,and always have been,  over closed, which means that your jaw is continuously moving back from your natural physiologic trajectory.. Hence the constant clenching, and fracture of your teeth and roots and the bone loss..and so on..

If I were you I would not spend a penny more on my teeth and restorations until I found a dentist that understands how to place your jaw into its correct trajectory and that the right vertical height.. This should all be done with an appliance with out touching your teeth..Once most your symptoms have been resolved then and only then you can start designing how the restoration of your whole mouth..not just a few teeth or crowns..

I hope I got the point across. I don't know the doctor you mentioned but please let us know about your experience.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org





Dear Jolene,

All your symptoms scream TMD.. in San Diego you can see my good friend and colleague;

Rod Strober D.D.S.

Address:   3330 3rd Ave, Ste.302, San Diego, CA 92103

Phone:      (619) 299-5925
Website:   ***@****

He has taken the full curriculum with Dr. Chan and is a great and caring Doctor.

Regards.
H.Nassery, DMD

Avatar universal
by westa06, Aug 03, 2016
Dr. Nassery,

I reached out to you before and am grateful for your information and input. I've been getting my TMJ fixed over the past year, and am thankful that is getting better... After a year and 4 mo the I was finally diagnosed with Psuedotumor Cerebri. The spinal tap gave me amazing relief and my vision is improving for sure. Not sure if you've accosiated TMJ and Psuedotumor Cerebri, but I'd love to hear any connections you may have.

Thanks!

Dear Westa,

I am glad you were able to find some relief. I understand that in such cases the intracranial pressure exceeds normal values greatly. Also in most cases they do not have or can not find a cause...another words idiopathic..
Those of us working in this arena, know that in severe cases the position of the head and its subsequent effect on the neck and cervical spine can have an effect on the proper circulation to the head and neck. By extension it could be possible that the same compensations could possibly affect the cerebral fluid circulation..however, all this is a lot of assumptions, and ifs and maybes...I would not go blaming TMJD yet.. however, I do not see any harm in correcting your jaw position and improving your posture and cervical stance.
I am a great believer in postural health and its effect on our general health. I guess I sound like a chiropractor sometimes..however, the effect is real and no harm in it.

I am not sure if I answered your question, but that's the best I have..

Regards,

H.Nassery, DMD FICOI, FAGD, FICCMO
www.miamibeachdentistry.com
www.ICCMO.org

Avatar universal
by saurav_k, Aug 17, 2016
Hi Dr Nassery,

This is a very informative blog. Thanks.

I have been facing TMJ/TMD problem off late. About couple of months ago, it started with sharp pain on the left side and I had no idea what TMJ is until I went to see GP for this and he told me about this. He said, this nothing to worry about and will go away on it's own and suggested painkillers for SOS.
After 3 weeks, the pain went away but now, both sides of my jaw, click, pop, grind and locks when yawning or opening the mouth wide. There is a scary bone crushing sound sometimes.
I also feel my all my teeth slightly sore and slight neck pain and headache at times. Also, i feel like my upper and lower teeth touch each other a bit differently than it earlier used to. Maybe, this is just in my mind.
I met a dentist also, who suggested using a night guard. I am not sure, but I don't think I am grinding/clenching my teeth at night. Maybe I am?

I have consistent anxiety, stress and depression issues. More stress for the last 1 year.

I am from Bangalore, India.

My search on internet did not help me with any specialists as such for TMJ.

There is no pain now.

Shall, I just live with it and use a night guard or do something about it?
I am worried about it getting worse gradually.
I am specifically extremely worried about Jaw lock and ankylosis - are these possible with my kind of initial symptoms?

Kindly suggest.

Regards
Saurav

Avatar universal
by saurav_k, Aug 17, 2016
Do you think this is a reliable option:

http://www.tmjindia.com/for_patients.htm
http://www.invisiblebracesbangalore.com/invisiblebraces/tmj-treatments/

Regards
Saurav

Dear Saurav,

You are exhibiting very classical signs and symptoms of TMJ..
It does not go away, unfortunately. Yo need to see someone who understands this issue. Dr. Raveendranathan is good friend and colleague. Although we did not study with the same teacher, I know he is a very smart doctor and can provide you with relief.

Keep me posted with your progress.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by ChattT5, Aug 21, 2016
Thank you in advance for your help. I've suffered for over 40 years and currently wear a soft mouth guard, take Flexeril at night, and work with a physical therapist. The results have not been consistent. Was hoping you could suggest a colleague in the area, as the current oral surgeon I've been using lacks in empathy.
I live in the Daytona Beach, Florida area.
Blessings
Cathy

Cathy,

Please see

https://findingagneuromusculardentist.wordpress.com/nicholas-s-baumann-d-d-s/
Nicholas is somewhat new to the field but a very nice guy.

or a little bit farther;

https://findingagneuromusculardentist.wordpress.com/helene-ta-d-d-s/

Helena is more experienced and equally nice.

Regards.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by criscrozz, Aug 24, 2016
Hello Dr. Nassery,

I'm suffering from ear ringing, ear fullness and vertigo. I do have a clicking jaw w/ occasional pain and i have a bad bite. I'm interested in seeing an specialist, Do you happen to know one in the San Francisco area?

Thank you,

Chris

Hello Chris,

In San Fran I have

COLIN T. YOSHIDA, D.D.S.
Address:    3885 Beacon Ave, Ste C, Freemont, CA 94538

Phone:       (510) 745-1800

He has gone thru about half of our curriculum, and should be able to bring some relief and stability to your situation.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Mysticjeanie, Sep 18, 2016
Yes! I'm So Glad to have found your blog, and I actually live in Miami!
I was making my own correlations when no one else seemed to figure it out when a Chiropractor mentioned to "start doing yoga", pretty much a bandaid effort, for all my joint issues. I later learned, thanks to the Internet (yay!) that the topmost point of any joint is the jaw and any issues will compensate the other joints. At age 30, I suffer from a locked hip diagnosed by a Chiropractor when I had horrible sciatica at one point, and frequent neck problems; I always have to "pop" my neck for relief, and now "pop" my hip as well. I have always known I have bad posture, and developed TMJ disorder a few years back when my jaw stared "popping and clicking". I never mentioned this to the Chiropractor, figuring he would know if my posture or joints were out of wack. Also, at the age of 18, I had 4 wisdom teeth taken out the same time with a bit of crowding at the bottom. It wasn't until about 2 years ago I was diagnosed with gingivitis that the dentist mentioned a deep gum cleaning - the teeth then starts to shift and continues to shift to this day...as if straightening the teeth itself? However, previously I had mentioned to the dentist that one of the lower corners (mandable joint/jaw) looked bigger than the other- the dentist didn't know what to say but "to keep an eye on it". I later did some research and realized that dentists don't specialize in "jaw/gum structure" and that I should see an orthodontist, preferably a neuromuscular orthodontist/dentist. As of today my jaw has changed it's appearance and straighten my teeth (for the better..?) perhaps aligning itself naturally but I'm also afraid that it won't stop and lead to worse problems...What to do!?!?

Dear Jeannie,

It sounds like you don't have severe symptoms, but certainly have signs of this issue.  Well, to be honest, most of us would have signs and I don't suggest any treatment if the person basically has found his/her homeostasis. We educate the patient and ask them to let us know if things change and or symptoms increase.
Hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

317787 tn?1473362051
by Dee1956, Sep 19, 2016
Dear Dr Nassery, I have been clenching/grinding for many many years.  I wear a night guard made by a dentist but often wake up to find I have bitten my inner cheek so then I use a boil and bite as it is softer than the dental guard.  I am trying to find someone to help; all of my back teeth have been crowned.  Now 3 to 9 years later, the crowns are beginning to fail. I just had an implant placed in my jawbone and will need to soon replace another tooth.  I am about to get a crown due to decay under the current crown.  

I live near Springfield VA but can go to Maryland or even Washington DC if I need to.  Do you know of anyone in those areas?

Thank you for your help.  This is so depressing
Dee

Dear Dee,

Though I am sure there are some Nueromuscular Dentists in that area, I don't know any of them. I know if you do a quick search you can come up with a few names.
You need to interview a few and feel free to run your finding by us here.. Lets see if we can help you in choosing one that can help you.

Warm regards,

H.Nassery, DMD
www.miamibeachdentistry.com
wwww.iccmo.org

317787 tn?1473362051
by Dee1956, Sep 21, 2016
Thank you, I found one a neuromuscular dental office called RyeSmilesforlife run by Dr Gordon Rye.
I had heard that some people are trying Botox to help with grinding.  I asked my dentist, he had never heard of it.
Thank you again, Dee

Dee,

I don't know him but looking at his site looks like he has treated many patients successfully. Ask to speak to a recent patient, ask about his education ( TMJD in particular) and finally if you decide to go there keep us updated on your results.

Many thanks.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Bino70, Sep 21, 2016
I am very happy to see that you have mentioned Dr Hoa Nguyen in your thread. When I called his office to inquire about his TMD approach the receptionist passed the phone to the doctor himself!!  He spent 15 min speaking with me and answering all my questions. I have booked an appointment and am looking forward to solving my jaw issues that cropped up suddenly in Jan 2016. My question is, should I see a PT for neck adjustment before the impressions for a splint are taken, and each time before a splint adjustment is made.

Thanks

D

Dear D,

I am glad you spoke to him. He is a meticulous practitioner and great colleague. To answer your question, I would try to arrange this collaboration thru your dentist. Personally, I like to get a set of scans on my patients at the same state they are in, I also get MRIs aside from my x-rays. Then the patients are sent to my PT who has worked with me now for the past three years. I have to make a informed consent here. This type of collaborative work is not the rule, rather the exception. We are trying to bring the message to more professionals that a multi specialty approach to TMD is the way, but both sides need to make an effort to understand the other side's work.

Dr. Nguyen, must work with the pt. closely and they need to be on the same page with their work. Once my patients start to show more centricity in their spine, which is accompanied with better feeling, my PT will let me know that the patient is ready for his/her physiologic bite. We do another set of scans and send out for the orthotic to be fabricated.
I hope this helps you.
Keep us updated on your progress.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Amandahessel, Sep 23, 2016
I have been dealing with chronic pain for three years now  it started with vision change which I can't really explain it comes and goes and exteme headaches.  Which I can't really explain it comes and goes and extreme headaches  I have really bad muscle spasms in my neck and shoulders (and lower back but that's a different injury) I found out I have slipped discs in c4-6 but the only injury I can think of is when a kid hit me with his head during flag foot ball when I was little. I noticed growing up in chorus my jaw would hurt after singing but I never paid attention and sometimes my neck would feel like it couldn't support my head. But one day BAM terrible headaches/pressure behind the eyes and forehead, tinnitus, ear pain, jaw pain that comes and goes but recently it's been 24/7 that sometimes radiates into my teeth, sometimes facial pain/burning. I have been to ent's, neuro ents, acupuncture, chiropractor (she said my jaw was tight, physical therapy, infectious disease specialists, neuro chiropractor, I've been on muscle relaxants, anti depressants, epidural injections, facet injections, Botox (none of injections ever done in jaw), nerve blocking medications. Literally everything! I've even tried crazy diets. Please someone tell me if this could be tmj. I haven't had a headache free day in 3 years. Feel free to email me at ***@**** I'm at my end point. I don't know where to turn

Dear Amanda,

I am sorry about your difficulties. If none of the medical exams have transpired into a positive diagnosis, I would say you should look into TMJD possibilities. You sure have many of the signs and symptoms.
How would I go to help you? Let me know your whereabouts so I can recommend a practitioner near you hopefully.

Warm regards.
H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Bino70, Sep 26, 2016
Hello there,

I had my consult with Dr Nguyen today which went well however I'm confused as ever as usual after a consult. A few weeks ago before my consult with Dr Nguyen I had a consult with Dr Judith Cope not knowing the difference between a neuromuscular dentist and a GNO. Dr Cope's approach is very similar to that of Dr  Nguyen but not the same for example her approach is one splint for day and another for night as opposed to 1 splint worn 24 hrs a day. Both approaches made sense to me. My hesitation is Dr Cope's practice is devoted only to Tmj/Tmd while Dr Nguyen was honest about having 10% of his practice devoted to Tmj/Tmd. Also no Mri or Xrays were recommended,only something called an I Cat Scan. Dr Cope recommended PT as a complimentary to her treatment with Dr Nguyen recommending PT shortly before appointment for impressions. Confused as ever.

Dear D,

I completely understand your dilemma. There are many different approaches. I really don't know Dr. Cope. I say this with all honesty, I would not want to be in the patients shoes. As much information there is out there, there is more misinformation.

I see if I can try and help you. I know how Dr. Nguyen works. The questions in my mind are; How do they take their respective bites? how do they ascertain the physiologic position of the mandible? So I think this will be a good exercise for you and our other readers. You have to see which makes more sense to you..

Personally, I don't understand the idea of night and day appliances? Are we supposed to have two separate sets of teeth for night and day? Shouldn't we be able to function with one set all the time?

What is the end game?  What I mean is this; they will take you from your state of discomfort hopefully to comfort using the appliances, correct? once they stabilize you in that position, how do they keep you there? are you to wear the appliances for ever? or is there a phase two and you can be maintained in the state of comfort with out your appliance?
You have to get the whole picture in your mind.
The pick the one that makes more sense. Also do't be shy to ask for patients to speak to.. I routinely give names and numbers of my patients, of course with their permission, to new patients.
Hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Amandahessel, Sep 26, 2016
Thank you! I live on Long Island New York. It's so hard to know who to go to when so many people say they specialize in tmj but they don't really and just give bite plates and send you on your way. Thank you for any help you can give me!

Amanda,

That's easy. You must go to one of my teachers and mentors Dr. Peter Ferro
http://www.peterpferrodmd.com/
He is a wealth of knowledge, with close to 30 years of experience treating TMJ issues.
Please keep us updated on your progress.

H.Nassery, DMD  
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by ibienepakate, Oct 01, 2016
I recently noticed a clicking sound in my throat when i swallowed, and it felt like there was phlegm in my throat that wont go down but keep coming back up. The back of my throat often felt dry and my mouth was smelly even after brushing and flossing, and i thought it was tonsil stones, but nothing was coming out. The smell is so embarrassing, as even i can "taste the smell", and i can smell it from the back of my throat, and people stylishly shield their noses when i talk around them. I'm far from a good hospital and don't want the doctors here telling me there's nothing wrong, like i was only imagining it. Please is this a real condition or do i have nothing to worry about?
Ibienepakate.

Dear IBIENE,

Many things come to mind and none are good. I would recommend that you see and ENT at your earliest possible time.

Warm regards,

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by CussewagoFred, Oct 03, 2016
Dr Nassery, I have cervical fusion on C5/C6 from MVA in 2000. Ever since, I felt like there was something in my throat whenever I swallowed. The hardware was removed in 2006 thinking it may be the cause. Nothing helped. I hit a deer with my car the end of February of this year which caused increased headaches and earache on my left side. I had a CT scan which only showed mild degenerative changes in my neck. I also noticed that my bite is not like it used to be but the feeling of something in my throats is mostly gone. I also have clicking on the left side of my jaw. At a recent dental appointment, they did a panoramic set of X-rays. They found my styloid process is broken on the left in 2 places. Upon reading your article, I realize just how much sense it makes. I live in Pennsylvania, so unfortunately coming to see you is not logistically possible. What type of doctor would you recommend I see? Neurological, ENT, or oral surgeon? Thank you for any advice you can render! CussewagoFred

Dear Fred,

This is a very interesting case. There are several things that come to mind.. however, at present the way I would approach this would be as follows.
I don't think the styloid process is addressed..in general, there are times that we actually, cut them off our selves.. ie,Eagle's syndrome. What you are describing to me in terms of your neck and previous conditions actually makes think that you perhaps always had a very closed bite... Correct me if I am being presumptuous.
I would go through our normal routine of finding the physiologic bite, we know that when we place people in such bite, we open spaces between cervical vertebrae. That would be the case between all except the fused one, those should be open already.
This could be done by a Nueromuscular dentist. Bringing stability to your bite and neck simultaneously. Please look over the map in the following link and find a practitioner near you..

https://batchgeo.com/map/ab93500357547df41bb5e83c52ed3c8e

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org




Avatar universal
by Saraaftab, Oct 15, 2016
Dr nassery ,I have been diagnosed with TMJ in last year November changed 3 dentists till this year may then went to my mom most trusted dentist.he gave me pain killer do sum exercises and massage i felt temporarily relief .he call me sumtimes for 3 consecutive days and sumtimes once in a week or 15 days.but after all this I was not feeling completely fine but now I felt he is flirting v much so luking for other dentists .today I went to one of the best dentist here in Karachi and he gave me felden and duragesic for 10 days ..just want advice from u that whether these medicines will help.I also have ITP since March 2014 took deltacotril for 2 months along with imuran ( for 6 months) but now on homeopathy medicines and platelets keeps on fluctuating ...


Dear Sara,

It seems to me that all they are doing is to try and mask the inflammatory process by medicating you. Find yourself a real TMJ practitioner who can try and fix the underlying functional and skeletal issues.


H.Nassery, DMD FAGD FICOI FICCMO
www.miamibeachdentistry.com
www.iccmo.org


Avatar universal
by AllisonChaynes, Oct 18, 2016
Hello Dr.Nassery, i too am experiencing similar issues. I was diagnosed with lower lumbar disc degeneration more than 20 years ago. Within the last 10 years, however i was also diagnosed with disc degeneration and stenosis in c spine. I was told by a dr that the lower lumbar being messed up for so long caused the c spine issues. Made sense to me. With the onset of the c spine issues, i began getting migraines. The dr told me the migraines were being caused by the stenois, (also makes sense) but it is my other symptoms that dont seem to make sense to them. The neck pain and stiffness will often be to one side and the stiffness will extend to my jaw and ear. On several occasions i felt pressure in my teeth (like they were going to pop out from pressure) so i ran to the dentist, who told me there were NO problems with my teeth. Desperate for relief, u went next door to the chiropractor who said he felt a (warm pocket) behind my ear and suggested i see the md. The md decided that my sinus cavity was impacted and could not drain due to swelling from...you guessed it, swelling and muscle tension in my neck. However, when i complain that it feels like someone is sticking an icepick in my ear, that is somehow not related to neck? Really? Because it certianly feels like it to me!

Avatar universal
by AllisonChaynes, Oct 18, 2016
I also wanted to ask, can tmj cause tinnitus? Or is that from my neck? Or both? Or neither?

Dear Allison,

Your story exemplifies the disconnect between all different branches of medicine and dentistry. Your question is a chicken or egg sort of question. I would have to have a more detailed med history on you to really give you a better answer, but I would say that your issues with your jaw did not just happen.
Until the day that we as physicians, both of the mouth and the body realize that the jaw is a big part of the postural chain, we will have more stories like yours.
Your observations are right on. Most my patients show the same trends. Locked upper cervicals, straightened out necks, degenerative disc disease in the lower cervicals and mirrored effect in the lumbar. Of course this all gets more complicated with other medical histories. As an example, women with history of c-section will always show more damage and issues in lumbar area for obvious reasons, yet I have never found one of my patients being warned about this by their OBGYNs.
To answer your other questions, yes your issues in the neck are definitely related to the jaw, and yes you can have ringing and pain in the ear from it. It is most likely from the lack of space between your C4 and C5 especially on the side that your jaw is more collapsed. It can be helped with the right approach.

I hope I have answered your questions.

H.Nassery, DMD

Avatar universal
by GianmariaVal, Nov 03, 2016
Hi, can my vision problem be related by TMJ, I have a lot of pain when I wear glasses, and I check many timed and they are right.If yes, do the vision problem go away with the right splint? I know I have TMJ problem from long time and can you suggest me somebody in UK? I saw ther is a GNM dentist in Spain, do you suggest me to go there?

Dear Gianmaria,

It would be foolish for me to render you a diagnosis based on the three sentences above. There are ways that long term dysfunction of the jaw and the cervical consequences could affect the visual field whether that is your issue or not is hard to promise.

As for Dr. Alicia Molina, has studied with us and we discuss cases often. I think she can help you. I know that she also arranges to have another one of our colleagues from Germany in her office sometimes to collaborate jointly on cases. Contact her and see if you can arrange one of those days.

All the best.

H.Nassery, DMD

Avatar universal
by GianmariaVal, Nov 03, 2016
Sorry, actually I could go to Germany aswell, wich is the more experienced dentist that you suggest me there o in Spain?I wanted to make the best for this problem. And do you think is much better seeing a GNM dentist than a neuromuscular, in England I found just the last one.

Dear Gianmaria,

Dr. Soeren Linge in Germany has a K7 jaw tracking device, where as Dr. Molina does not.  Also , Dr. Linge has completed all Dr. Chan's series, which in my mind gives an edge to him They are both great conscientious clinicians.
As for the difference between, Nueromuscular and GNM... All GNMs are essentially Nueromuscular practitioners, We just have a greater influence of Gnathology in our work, hence the G..

I hope this answers your questions.

Keep us posted.

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by nuttydave127, Nov 10, 2016
I need help bad.  I'm 28 years old now.  I never had back and neck pain.  At the age of 22 the dentist ran the 360 X-ray and it showed my wisdoms teeth impacted and also supernumary teeth.  Off to the oral surgeon my parents and the dentist kept telling me I had to have this done.  I was reluctant about it nothing was causing me pain yet I was unfortunately forced to.  In this process he also took out my bottom left 2nd molar with was perfectly fine as he thought there was no room in my mouth for it.  About 3 months after the surgery I started having back pains and neck pains.  I have bad forward posture now and everything hurts I've spent an easy 5 grand per year for the last 5-6 years trying to get treatments. Most recently a daytime/ nighttime splint both guards costed 3500 dollars and did nothing for me.  The treatment was to be non refundable and the Guy felt so bad he refunded me about 75 percent of it.  As a result of all this clenching and the nightguard my dentist made 5 years ago it messed with my bite all my back teeth don't hit now and I can't eat very well as only my front teeth gnash together. At night when I grind my jaw tends to move a differnt way and all the pressure goes into my back teeth. Major aches and pains everyone I've seen doesn't know what to do with me.  I'm located in Vancouver British Columbia .  Any thoughts on what I can do ?   My neck pain got so bad I took a leave from work between March 2015- aug 2015 and all I did was Physio and postural stuff and removed my stress.  Eventually everything sort of came back together I don't remember how good my bite was but I remmeber feeling normal again.  Most of my physians figured it was just giving my body a break from holding itself together that led to the symptoms of pain subsiding but once it was back to reality of real life my body couldn't hold those spots together anymore l.  It's come back worse then it was before leaving work .

Dear Nutty dave,

I hear you. I am sorry you have suffered so much. I have to say that many of your signs point to the TMD issues. I do believe that you had these issues prior to the extraction but that the extraction of the second molar perhaps was the trigger you needed to get things started.

It sounds to me that you have no bite support in the back of the mouth. I know it seems like this is a very complicated situation but it is absolutely correctable. In Vancouver area you have several good choices, check out the map in the link below and choose one.
https://batchgeo.com/map/ab93500357547df41bb5e83c52ed3c8e

Keep us posted and let us  know about your progress.

H.Nassery, DMD FICOI FAGD FICCMO
www.miamibeachdentistry.com

Avatar universal
by Hammer967, Nov 22, 2016
Dr Nasser I have a many dental problems started early childhood now 42 years young over a 200,000 spent and all I have is some broken teeth, bridges,crowns,veneers etc. Let me elaborate a little about myself I have a form of md called Charcot tooth Marie it's a neurological disorder that effect's nerve impulses I'm just been let go at work when they found out I had md I lied on a work physical. Since I've been getting older my teeth are grinding out mostly broken makes brushing are flossing impossible not to mention not many teeth left that aren't broken I do go to pain management and a neurologist for the muscular dystrophy and a physch for depression and and anxiety. But not sure what to do about my teeth jaws always clenching and offline due to missing broken bridge and several broken crowns my teeth are in shambles my neck is always killing me and jaw and mouth pain off the charts I've played college football and tore an ACL that hurts less than the pain I'm in now I'm reduced to eating small soft meals my jaws get too sore and tired from chewing worst yet I know I'm out a lot of money spent on shoddy what they call dental procedures. I currently only have state insurance but good news my ssdi got approved in only about 8 month's not sure what if any Medicare or Medicaid or how even to apply just AZ state insurance ahccs for now. Wish I go back and see different dentist than the ones I've seen but that's a lesson learned for $200,000 I should have a smile but do not is there any major health issue with broken missing teeth bridges etc I went from a college football standout with a good almost perfect smile to a now medicaly disabled adult who can't smile always been paranoid of teeth since I was a child and had the worst case of overcrowding teeth ever seen in AZ looked like I had 2 sets was able to get all that fixed up some teeth pulled braces and dental implants and my teeth looked normal for about 10 years in my early 30s my upper bridge implant split right down the middle top to bottom leaving it very loose til it eventually fell out in vain I tried otc dentemp etc to try and hold it in but noticed the gab were it cracked was separating more and more I spent the rest of my savings to get it fixed and after all the x rays and there plans for fixing this costing me well over another $98,000 to I guess pull all remaining teeth and put I guess magnets into the roots of some teeth to align a magnetic implant for dentures was told this would alleviate allotta jaw and mouth I knew that but also neck possibly even the ringing I've had in my ears since my late teens Early's 20s always attributed to various ongoing concussions or related to such early injuries hard to believe I recovered from a roll over accident off the highway truck rolled almost 2 dozen times I walked out of the er that same night feeling normal in a few days to know all this neck,mourh,teeth and jaw pain beating me down to a point I feel like giving in. Is there any dental, neurodental, or procedures I could have done that aren't as expensive since I lost my work insurance all those years paying for dental and never using it still aggravates me 20+years of paying for dental and never using it always went to my dentists i had from my 20s didn't accept bc\bs what oh well I had I great paying job could afford it then now that I'm on on disability and have state insurance my teeth have been almost all destroyed from what my most recent dentist told me the teeth are still moving and shifting which is what split the bridge apparently had to have a few more removed to hopefully relieve the jaw pain that hasn't worked now almost all my teeth are broken or removed have a consistent foul flavour in mouth get frequent swelling on gums,cheeks, and even black eyes or what looks like black eyes anyways lots of black and brown decay on remaining teeth barely enough to chew softest foods living on mostly a liquid diet for last 2 years as everything seemed to spiral outta control my muscular dystrophy getting worse which is what c.m.t. does very cruel as if age isn't enough to deal with now I can barely walk but still do everyday I can and get regular exercise to fight the muscular dystrophy I'll fight this battle til I win it may have won a battle and got me away from football but also learned a few tricks the brain is a muscle too that needs exercising as well I've went on to become a successful ace personal trainer, nutritionist , working soon on doctorate's physiology almost done but my smile is probably killing me figuratively and literally I've gone to college got my degrees but bad health md turned my life around I'm not the 225lb football player im the 225 lb guy who everybody wonders what happened to since we don't talk to friends embarrassed by how horrible our teeth are tired of being looked at as a druggie or drug addict cause of teeth I've never been a fan of drugs I like to think utilize my brain more than to damage it for ever for a little fun not for me .    Dr Nassery   is there anything I can do to help my situation since being let go of at work for basically lying 20+years about my muscular dystrophy I now have a very limited income only ssdi and have AZ  State insurance ahccs not sure how Medicare,medicad, work or even apply for or if I already have it since I'm legally disabled don't know how it works is there any dental procedures that can be done to help with the excruciating pain in mouth,neck,teeth and jaw I've been so beating down about my sudden decline in health doing all I can think off to stay healthy but afraid malnutrition, infections in mouth teeth gums black eyes from swelling anything that can be done willing to let someone rip them out if that's what it takes to he able to live again without the excruciating pain that can only be described as broken teeth everywhere missing teeth and misaligned implants gone bad need directions for help as well as how long could one fight off major mouth and teeth,jaw disease's before there's no hope fells like cancer in my mouth consistently been to the er sent me to dentist wants to do a major overhaul pull remaining and do the magnetic dental implants only problem I have with that is money now seems to be the most important thing to your health while I had a very successful career suddenly cut short by illness,made a few financial mistakes aka getting married lol 2 times but have my daughter's college tuition taken care of and mine going back since I got all this extra time now if there was a way to fix my teeth on state insurance that would have little coming outta pocket since aka bad financial agreements ex wives never marry on looks alone I learned after 1st the 2nd taught me not to be so naïve always believing the money will be there til it's gone and your left alone which in hind sight is better so 1.   Is it okay too leave it alone til I can get the money to afford the 98,000 dental plan previous dentist set up may never see that kind of money again guess he's messed the memo I'm all but broke in many ways 2 Could my sudden onset of health issues be contributing in any way to my dental problems example body getting weaker getting flu various virus's even an apparent stroke 5 years ago which left me paralyzed head to toe for a month til I could start feeling and moving my limbs around than another 9 months in rehab learning to walk again which I did even made it back to work being a little sneaky with the work always leaning on something for balance hospital,rehab all Dr's we're stumped by the speed and severity of the paralysis as it took over my whole body til I was on a ventilator looking at an upside down clock praying for 1 more hour my vision could no longer autocorrect everything is upside down constant feeling of falling was all I could feel for weeks til it suddenly subsided got my vision back 1st than slowly starting from center of body to limbs got feeling back movements took awhile longer had to relearn them Dr.s have all guessed from Guillaume berrete to my own Charcot tooth Marie to foreign disease's guess we'll never know as long as I could walk out but that's when I noticed my upper bridge was splitting not sure if I face planted just remember waking up not being able to balance myself called my wife next thing I'm in and out of consciousness in er.  i.c. u. as I was starting to go completely paralyzed very scary cheated death many of the Dr's actually told me yet I was pissed my bridge was splitting which fell out 1 week into rehab about 1 month after being taken to hospital made it even harder to communicate when I was still learning to talk without a stutter or stammer no Dr. Specialist,anyone ever asked about my teeth which where now starting to break easily even on soft sandwiches teeth were breaking some with some without cavities it was crazy my body returned to almost normal but my mouth hasn't it's getting worse daily and fast The neurologist I see now runs a sleep center so he's almost no help unless I need a c pap machine . Could the mystery illness "stroke" have anything to do with my degenerating teeth before my stroke I had a very swollen tooth gums and cheeks and a very foul taste in my mouth .         Sorry for big write-up on my health info figured if anybody could guess this one you could or at least stear me in the right direction to get it taken care of and the pain to stop , the ringing to go away, then I'll fix my teeth up with whatever procedures I can afford . Just hope it's not too late thanks.        

Avatar universal
by Hammer967, Nov 22, 2016
Oh and the last dental procedure I had was my wisdom teeth pulled out and 2 teeth up top believe he called them eye teeth something weird like that had some pain from the wisdom teeth extraction but more pain from my upper teeth probably cause of the overcrowding the teeth came in through the gums could only be seen if I was to lift my upper lip over them never really hurt before being pulled just getting married and wanted that million dollar smile even had my teeth whitened only to find out I was allergic to an ingredient they used said fluoride but always be pushed me teeth with a.q. which has fluoride no problems there but never the less I had an entire mouth that swelled and oddly  enough felt like it was on fire after having the wisdom,2 upper teeth that came in through the gums sat right above the teeth that were already in .         Don't know if my form of muscular dystrophy c.m.t. could cause so many dental problems with teeth kept coming in  into my mid 20s it's like I had a third set come in and most of them teeth had to be pulled because of location some were unreachable even to brush.     Now after all that got my teeth aligned final stages done on a reconstructive total mouth build which included a gold and porcelain implant bridge to fill the gaps I had between some teeth dentist thought it'd last forever nope it's broke almost all my teeth are broken some have cavities some are just broken but almost all entire mouth seems infected after all that work done to watch it deteriorate before your eyes is almost as painful as it actually is the pain in my jaw comes not just from eating but opening up mouth talking which also tires out my mouth I can't even finish a pb&j sandwich without my neck\jaw tiring which I guess causes the pain to go through the roof I've been through many MRI on the brain cat scan,ct scan ,you name the test I've probably had it done trying to stop the ringing in ears which causes head teeth neck mouth all pain I'm guessing I'll just have all my teeth pulled that are remaining,. Til I can afford some good implants would this help line up my jaw so it'd be straight again right now it's way off center from missing crowns ,bridges, and broken teeth.     Might this be an alternative mode to go for someone on a limited budget sorry for long postings just wanted to get all info included.     Thanks and looking forward to hearing from you and maybe a few answer's or a direction to go that's affordable on a tight budget with AZ State insurance ahccs also just received my first ssi check which comes before my my ssdi check back payed for the 8months it took them too approve me feel lucky I received social sercurity disability heard all the horror stories and how many years it takes and everybody gets rejected the first time it'll be years before I receive any money guess you can't believe everything you hear I got it under 8 months 1st try all I did was schedule appointments with Many different kinds of Dr.s neurologist,physches,every ear nose and throat specialist I could find til somebody explains this constant ringing nobody now's what causes it gets dismissed as tenure or whatever that word was for the ringing in ears mine has gotten so bad and loud it's almost like I'm going deaf can't hear my phone ringing have to have the tv up all the way could all this be part of my dental problems arising again .   Couldn't be that simple know any good neurologist are any ENT. Specialist in AZ who would like to see if they could help me feel human. I.   was born with muscular dystrophy cmt. for 42+years I've dealt with it taking away sensations to the hands and feet can't button my favorite shirt hands won't let me cant run or jump feet won't let me almost 90 of the posterior calf muscle has deteriorated not atrophying I'm still able to walk OK not great but OK I can deal with the disability but the constant pain in jaw, neck ,mouth and ringing in ears is getting to hard to handle tired of everybody jumping in the muscular dystrophy c.m.t. band wagon for every pain in my body if c.m.t. is a form of neuropathy I've been dealing with 42 years found out I had it in my late teens had many broken bones in my feet from it over the years I can deal with all that if someone would please look somewhere else for a solution to part of the problem that just maybe something else all along has been going on with the muscular dystrophy I've had many MRIs done have some spinal stenosis mostly lower vertebrae and an annular tear between one of my cervical disc all tests showed brain functioning properly. Dr's ruled out post concussion syndrome not sure if the teeth even play enough of a role to cause neck pain, and head aches or ringing in the ears but it sounds plausible what would be my next move find a different neurologist,dentist,ENT or anyone that could help maybe ease my suffering a bit and by suffering I mostly mean my headaches migraines and ringing ears oh yeah and my blood pressure is a little on the low side nothing Dr says to worry about just to be careful when seated to standing always cause's me to loose balance thought it might have been an inner ear problem but everything checked out there so still looking for hope to at least stop this loud constant ringing in my ears .   TAKE MY LIFE BACK

Avatar universal
by Noel77877, Dec 08, 2016
Hello Dr. Nassery great blog. I am age 55 and had issues with my neck and spine for the past 20 years, and the doctors and chiropractors I have seen over many years have generally attributed my problem due to poor work posture as I work in an office with computers. At the same time in parallel with this spine problem I was also gradually and progressively experienced problems with my bite, so that in my early thirties the first symptoms I felt was lisping and a general deterioration though slight of my diction and ability to flawlessly speak. This speaking problem gradually became worse together with my spine and it was only fairly recently few months ago when I consulted with a well experienced TMJ dentist (in Philippines) that the dentist explained to me my TMJD condition, and the connection between this affliction with my spine related problems. While I felt this TMJ dentist was good, I do not think she is NMD specialized, and she recommends that since I do not experience any pain on my jaw and only mild clicking on right side she feels Phase I is not necessary and I can proceed with Phase II and get fitted with braces. After reading your entire blog I seem to think that my deteriorated speaking ability and spine stiffness problems was probably caused by a bite that has also deteriorated over the years, hence my current bite most likely cannot be my natural physiologic bite, even though I do not feel and jaw TMJ pain. Is it possible the TMJ dentist may be correct that I do not need a Phase I and can proceed safely with Phase II? Like most in this forum I wish to proceed in a direction that is methodical and not subjective trial and error. Would greatly appreciate your thoughts.

Dear Hammer,

I am sorry but honestly the story is too long and winded, please abbreviate the post and only place the facts pertaining to your dental issues and symptoms.

Thank you.

H.Nassery, DMD

Dear Noel,

I always have a problem with jumping steps. SO my question to you and probably to the doctor is;
How do you know that the place you are going to move the teeth to will be giving you relief of your muscle spasm.

Should  we not first establish the position of health and then go there? To me Phase I is the real deal. That's when you know  you have resolution to your issues. If you just assume you are gonna get better and move all the teeth, and lets say you don't feel better, then what? is he/she going to redo it ?

Should we not know the destination before we start driving?

I think you know the answer. Keep us posted on your treatment.

H.Nassery, DMD
www.miamibeachdentistry.com
www.iccmo.org

Avatar universal
by Noel77877, Dec 13, 2016
Dr. Nassery the TMJ specialist I think made the determination I do not need Phase I after she studied my XRAYS and also because I reported that I do not have any jaw pain, and only minor and occasional jaw clicking. However the TMJ specialist I believe was aware of the importance of Phase I as she made me watch a video explaining the role of Phase I and Phase II in TMJ treatment. She also commonly require Phase I in most her patients, except for some reason not in my case. Next week I will meet her and I will inquire more about this. The reason I doubt her prognosis is because I feel 1) my speech ability and lisping has deteriorated materially in the last 3 years w/c I feel is caused by change in my bite where my open bite condition is worsening, 2) my ability to chew foods has also deteriorated materially in last 3 years probably due to the same reason and 3) if my neck stiffness condition is really related to TMJ my neck condition has also deteriorated materially in last 3 years. In the Philippines (my home country) is there someone you can recommend? Alternatively I can also have treatment in Indonesia where I work.

Dear Noel,

What do you mean if your neck is related.. is your head attached to your body?  You should read this other blog ;

http://www.medhelp.org/user_journals/show/1350355/TMJ-TMJ-The-Connection-Between-Teeth--Neck--Spine--Skull

You have to become asymptomatic first. I do not know any one in Philippines or Indonesia. However, I do know Dr. Yue Weng Chue in Singapore. I highly recommend him for this job.

Regards,

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by Noel77877, Dec 14, 2016
Dr. Nassery thanks for the link I have started reading and wow what a wealth of information. I am beginning to realize my neck has absorbed a cumulative effect of decades worth of accommodation from my jaw/TMD problem. My question is this... my neck xrays show that the condition of my neck spine is stage 4 out of a scale of 5, to the point where the natural "C curve" of the neck is gone and is now straight and even leaning towards a very slight reverse curvature. Assuming I receive a proper Phase I treatment and subsequently a proper Phase II treatment, will the combined result of these two treatments provide remedy to my neck problems. Or is my neck problem already irreversible as one chiropractor has suggested to me and that I may just need to live with a life time need to receive PT and chiropractic treatment. Of all my TMJD symptoms (speech lisping, tinnitus, occasional jaw popping, poor smile and neck stiffness) it is the neck that is most affecting my life hence my primary interest to cure. The other symptoms I can live with.

Dear Noel,

To answer your question, I believe that its never too late to start healing ourselves. You are right, the most debilitating issues with TMJ are the cervical symptoms.
We work all our cases up by first diagnosing the cervical issues through x-rays and MRI.Then they start  with our PT who is Cervical trained and then  we place them into an orthotic.
As for your question about the recreating the curvature in the neck, we have found that it is more involved that just that. There is a big correlation between the neck and the airway, and I believe until the airway is not totally addressed, the neck will not go back fully.
This is not to say that you should not go forward.

H.Nassery, DMD
www.miamibeachdentistry.come



136956 tn?1425609872
by ticked, Dec 18, 2016
I really could some help.

Above I have seen that you have posted a couple of Toronto doctors and I might look into the one as it is closer to me but I am wondering if you can help me identify exactly what is happening to me.

I started to wear a mouth guard at 14 due to strong clenching and grinding and popping in the left jaw joint.

One day my jaw locked open (Shattered my articulating disc) and eventually had surgery at 17 to reconstruct the joint.

I was fine for about 20 years but I have a lot of weird pain and symptoms the last 5. (I am 39)

I have burning mouth syndrome for 2 yrs, , I had this weird feeling like I was going to get a migraine but my left ear went numb with tinnitus for about and hour., I have so much pain in my face, jaw, neck etc. I have a 7 cm curvature in my neck and a 10 cm curvature in my spine. I have had major back and neck pain for so long.

The last time my jaw locked was when I went to a cranial therapist and he did this move to unstick my sacral joint but it caused my jaw to lock. When I had an xray done at the hospital it showed that I had mild degenerative disease and that my left disc was out of place and the right disc was folded. I am getting a lot of weird nerve symptoms but I can't get anyone to listen to me. I was told it wasn't bad enough for surgery and I really don't have the financial income to pay for any treatment. I was at the wasser pain clinic in Toronto for a bit years ago but all they wanted me to do was get nerve block injections, eat soft food and a new $1000 night guard.

My teeth feel so crooked and I have a noticeable overbite. I am not sure what else to do but the pain is insane and I take flexeril and have for the last 4 yrs but that is really my only options that I am getting.

What should I do?

Dear Ticked,

Your story reads like manny who have been on my other blogs. All the treatments you have had or offered are simply focusing on your symptoms and not the cause.
You need to find the right person. I have no doubt that your symptoms are all cervical related. The burning mouth syndrome is one of the symptoms we can find.
Find yourself a good PT, and one of the docs that would work closely with him or her. The PT should ideally be well versed in Neck therapy.
Once your neck gets better alignment, then you can find your physiologic jaw position and fabricate an orthosis. I have no doubt you will find relief in doing this. How much? that is the unknown part. Certainly we must accept that there is a limited amount of healing we can attain. Another words we can not undo the damage done to your joints, or bone from the dysfunction or surgical work. However, the muscular function can be improved to a great extent, and that is the source of most symptoms.

I hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com


Avatar universal
by lisa342, Jan 18, 2017
Dear Dr. Nassery,

I have a question for you If you could help. My jaw joints and  muscular system is defected, due to inadequate treatment and I am experiencing severe pain everyday. I would really appreciate if you could recommend a good specialists near me. I am from Slovenia, EU, but I would also go to nearby countries like Germany, Austia, Italy etc.

Thank you for your time and help.

Hi Lisa,

In Germany I can recommend

Sören Linge, Med. Dent.
Bilsteiner Born 11
Kassel 34132 Germany
Phone: 49 (561) 408585
soeren.***@****

Please keep us informed of your progress.

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by lisa342, Jan 19, 2017
Thank you Dr. Nassery

Avatar universal
by PB86, Feb 22, 2017
Dr. Hamidreza Nassery,

Thanks for interesting posts, I think most people still dont realize how important teeth are to their general health.

Below it's interesting article, it explains how bite change posture and spine
http://www.kos0808.co.jp/en/teeth_muscle.html

And that guy have fixed his scoliosis after bite adjustment
http://starecta.com/body-posture-depends-teeth/

For the last 8 years I was trying to restore my eyesight like some people did already (ophthalmologist may not belive in something like that but it's true), and I have found out why eye muscles change eyeball and cornea shape (people have bad eyesight because of that). It all starts with teeth and spine compression. When muscles around the neck are strained because of spine compression, eye muscles gets strained as well, and eyeball gets distorted (because of distorted muscle pull). What's interesting, I have found out a way, to fix eye muscles strain with exercise, and even almost blind people can see perfectly during that exercise (eyeball shape change dynamically, literally in few seconds when eye muscles will work correctly).

But the thing is, after my exercise bad eyesight always returns, because that relaxation is result of exercise, and cant be sustained. Normal (healthy) people dont need exercises in order to see perfectly for long periods of time, because their spine provide constant relaxation to their neck and eye muscles. So in order to fix eyesight permanently, spine must be fixed permanently first, and in order to fix spine, root cause of spine compresion must be fixed first, and that root cause is our teeth (missing teeth, or result of bad dental work). After I started working on my bite and posture, I started noticing how important teeth are. If someone have bad posture, he would most likely not see that bite influences his posture, because his body already adopted for his current bite (and spine is already compressed). But if you work on posture, and when spine starts to lift up your whoe body from that compression, there's a point where you can see that teeth are starting to be used, and then it's possible to really feel on witch side you actually miss your teeth more (because that occlusal force rise and tilts my whole skull coresponding to bite, and if you tilt your head correctly, there will be gap in teeth on the left or right molars, and there will be no equal molar support)!

Right now I have build my own posture method, that enables me to hold good posture even with my current bite, and sometime I can see long periods of eyesight improvement without any exercise for eye muscle relaxation. But when that happen I can really feel how much teeth I miss on my left side (and what's interesting, I have cervical scoliosis
on that side). I have no dobuts that in order to fix my scoliosis and fix my eyesight permanently, I have to fix my teeth first. But the thing is, it will take some time until I will be able to afford all missing teeth. I live in very poor country (300 dolars is avg, salary), and teeth are expensive.

I wish I would know something like that when I was young. I should never eat that many suger and bad food (that destroyed my teeth), and with all teeth in place I would restore my eyesight very fast.

Here's another interesting link in regards to teeth, that even tell a story of person, who restored his eyesight after teeth correction.
http://hazo-concept.blogspot.com/2008/10/section-3-1-teeth-also-induce-disorders.html


Dear PB,

Thank you for sharing your experience. Yes, you are absolutely correct, there is much we still figuring out about the connection of posture and complete health.
Smarter people than us had figured things out;

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi4zIfY_6PSAhWE7yYKHW2tByMQjRwIBw&url=http%3A%2F%2Fdrscottamills.com%2F5-holistic-health-quotes-to-live-by%2F&psig=AFQjCNHNzskEe-ktoOIWvhgCbBpFddJIXQ&ust=1487862986815210

Regards,

H.Nassery, DMD

Avatar universal
by guigos, Mar 08, 2017
Dear Dr. Hamidreza Nassery,

Thank’s for your valuable information.

I would like your opinion about my situation. I had the both rigth third molars teeth extracted in 2008 and after two years I started to have some neck pain which later, went to my whole left back and leg. I asked a dental prothestic to make a splint based on the same splint that you show in your website and now I’m pain free. I received a copy of my dental cast from the dental prothestic and after doing a thoroughly examination, I find out that my left superior third molar is touching my left inferior third molar and because of that my first and second left superior and inferior molars are not touching each other ( no oclusion). Do you think if I extract my left superior and inferior third molars, my left side oclusion will improve? I also have my left inferior arch lower than the right inferior arch. Do you think that after my left superior and inferior third molars extraction, my teeth on the left inferior arch will move backwards allowing better teeth distribution and oclusion?

Regards,

Guilherme Monteiro



Dear Guillermo,

It is very hard to make recommendations or diagnosis based on just some small facts. Having said that, it is possible that in some cases that the third molars have erupted on the incline of the jaw, their positioning wold have a distalizing effect on the whole lower jaw as a whole. In this scenario, the extraction can be helpful and produce relief for the patient.

As per your question about the teeth moving backwards, I am fairly certain no such thing can or would happen.

I hope this helps you.

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by guigos, Mar 13, 2017

Hello Dr. Hamidreza Nassery,


Thank you for your quick reply!

After your answer about the position of my third molars, I checked it and could see that my left lower third molar have erupted completely, but it is not aligned with my left superior third molar, I mean the external side of my lower left third molar is higher ( and is touching my left uper molar) than the internal side. I think it is the reason why I don't have a proper oclusion on my left first and second molars. Do you think that I can use a brace to align the left lower third molar to improve my oclusion or I should extract my left uper and lower molars to get a better whole lower left side oclusion?

Guillermo,

No one is going to put a bracket on a third molar. Just go and get them out.

regards.
H.Nassery, DMD

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by guigos, Mar 14, 2017


Dear Dr. Hamidreza Nassery,


Thank you very much again!


Ragards,


Guilherme Monteiro

Avatar universal
by brandama, Apr 09, 2017
Dear Dr. Nassery,

I have been reading your blog all night....
I have been suffering TMD symptoms for years.
My dentist has diagnosed Bruxism, from wear on my teeth.
I have the popping of the jaw (on my left side) when I open my mouth, and when I move it side to side. My dentist recommended the Dr's Night guard found online to protect my teeth. I believe this guard has made things go from bad to worse. For years, I have gone through Clenching episodes, where I have so much jaw and muscle pain, I can barely talk and eat, but the episodes have turned to more an everyday life occurrence now.  The straw that broke the camels back though was, I'd been experiencing the worsening TMD/Clenching symptoms, and then one day 3 weeks ago I started experiencing severe Tinnitus.  The ringing is completely affecting my sleep and quality of life.  The ringing is primarily heard through my left ear, although I do have fainter ringing intermittently in my right ear. Do you recommend anyone in the Georgia (Atlanta) area for TMD treatment?  I am also considering flying down from Ga to your FL Office.

Thank you so much for your help,

Amanda

Dear Amanda,

Your symptoms have been coming for  while. Regular night guards can sometimes exacerbate the symptoms, yes. They increase the vertical dimension and for patients that are bruxers or grinders it can backfire. Clenchers are the patients that can do well with a night guard.
You have further decreased the space between your cervical spine and hence clamping down on those nerve roots between  the cervical spine. I suspect that you have lots of compression between C3 and C4. That is generally the culprit for the ringing in the ear. Early on it can still be reversed, hopefully.

I am sorry that I have no one in Atlanta area that I know, and can vouch for. The closest I see to you is;
Chris Mohler, D.D.S.
200 Midtown Drive Beaufort, SC 29906 USA
Phone: (843) 522-1442

all the best. Keep us informed of your progress.

H.Nassery, DMD
www.miamibeachdentistry.com

Avatar universal
by nettecam, May 06, 2017
Dear Dr Nassery,

I have come across your page, whilst trying to learn what can be done for my condition, as doctors have been unable to do so, and I am now feeling frustrated, on top of my mystery problem, which has me put my entire life on hold.

I am 50, have used a mouth guard for over 10 years, as my dentist says I grind at night, my jaw feels like it locks on occasion, and I have ringing in the ears, and an audiologist says I'm one step off needing hearing aids.  I live with all this okay, (though annoy my family members sometimes when I mishear what they're saying!)

Towards the end of last year, I saw my GP for sore upper back and neck, and headaches. An MRI identified cervical degeneration with C5/C6 mild central canal stenoses with severe left C6 nerve root compression, together with C7 nerve root irritation. I dealt with this purely with heat packs and the occasional anti inflammatories and did not follow up with any medical practitioners with this.

At the beginning of March, I went for a remedial massage, and the massage therapist said she had to work on the deep tissue in my neck. It was so painful, I realised I was holding my breath. The next day, whilst driving, I turned to the far right to look for oncoming traffic and immediately felt as though I was fainting. I slammed the handbrake on and recovered  without actually fainting, and since then, even the slightest movement of my head gives me the weirdest sensation, up through the back of my neck and head/ears area, like a wave of weirdness going through. Very difficult to explain, but not pain as such.  It almost makes me feel like I am going to faint again, though not to the extent of the fist incident whilst driving.  It's just a very bizarre but sore feeling.

I ended up in hospital one day and after seeing a whole host of doctors, and having more tests, they just scratched their heads, neurologist included.

I have put myself in a neck brace - on and off - for the last couple of weeks, as I find this helps with restricting movement and therefore experiencing this weird feeling. I waited a couple of weeks to see a neurosurgeon, who was baffled, but, because I wasn't experiencing tingling in my arms, said the problem wasn't my neck, and called a neurologist for advice. She told him to refer me to her as it could be vestibular migraine- so now I'm on a list to see a neurologist. My feeling is this is sending me in the wrong direction. I have no medical training whatsoever, but it's not the first time I have been let down by the medical profession, and have had to find out for myself what it could be -and I was right and got eventual treatment -completely unrelated (an eye problem).  I know what dizziness is, as I have  benign positional vertigo, and this is nothing like that.

On researching what I can find, I feel there may be a link with TMJ, as, I have noticed that, when I put pressure on the area around my jaw/ear, I often have a strange, very uncomfortable sensation similar to when I just turn my head in the slightest. and am hoping you could shed some light on this as to what sort of professional I could see. I cannot safely drive, I can't look down to do any paperwork so have had to give up work, and am finding it very difficult to do anything at all other than stand and look straight ahead. I urgently need someone who can identify what is happening, and then help me out of it, both urgent short term, and long term for prevention. I just don't know who to approach new i.e. what specialist.

Hoping beyond hope, you may have a suggestion. Thank you in anticipation.

Kind regards,

Nette  




Dear Nette,

There is actually a great connection between, TMD and cervical degeneration. Actually, I think many of the cases that are marked idiopathic degeneration are actually TMD related. You see, most people think TMD/TMJ is a disease of the jaw joint only. However, the latest research in the field shows direct correlation between the jaw joint dynamics and that of the cervical spine.
Hence some people show symptoms in the jaw while some in the neck and of course there those that are symptomatic in both areas. The mere fact that you mentioned you have more lack of space on the left side of your spine, tell me that your jaw is more distalized on the left as well. I know this after studying hundreds of cases over the past 10 years.

I am sorry that we did not see you before this stage of the degeneration happened, because in my view this condition is absolutely preventable with proper physical therapy and bite correction.

In my view you still need to go through splint therapy to stabilize your bite as you have de-stabilized your C1 when you had your deep tissue massage. Now any movement that challenges the limits of your neck range of motion, will cause a truncation in your vertebral artery and hence you feel like you are going to pass out. This is very dangerous and you must stabilize your vertebral spine asap. Discuss this with your neurologist.

I hope this information helps you understand a little more about your situation.

H.Nassery, DMD
www.miamibeachdentistry.com
www.tmjresearchfoundation.com

Avatar universal
by Lisadpk, May 16, 2017
Dr. Nassery,

I have been diagnosed with TMD from a doctor at Nova University in Ft Lauderdale,FL. He has tried laser therapy and acupuncture on me. I have had severe gum pain since May 2015. I have been to periodontist, no gum disease, I have been to an adult orthodontist who looked at me for 5 minutes and wanted to put braces and a mouth extender on me to correct my bite. No way I could do that with this severe gum pain. Nov 2016, I had a crown replaced on a root canaled tooth. It is very uncomfortable(top left) my dentist and oral surgeon took xrays and say it is fine.  The bone is growing outward on that side. DEc 2016, my neck, shoulder and left side of face started hurting.  I got a TMJ, brain and C Spine MRI. I have a bulging disc between C-5 and C-6. By jan 2017, my face, meaning jaw and chin started hurting bad. Feb 2017 the left side of my tongue started hurting, April 2017, my right jaw now has pain. I have had extensive bloodwork to find nothing. Been to so many specialists. Gums and Tongue hurting affecting my mentality. Doctors want to put me on anxiety meds. I tried them, they gave me more anxiety. I am 50 and vibrant.  I need help. Can you help me? (305)502-6382.
Lisa Kuhnley

Dear Lisa,

Your case is exactly what we do in my practice. No need to be anxious. I love these challenging cases, specially when you have been to the schools and no real answer was provided.
I will have one of my staff call you and get you in for a consultation.

Warm regards,

H.Nassery, DMD
www.miamibeachdentisrty.com
www.TMJresearchfoundation.com

Avatar universal
by Tiffanybabb, Jun 01, 2017
Dear Dr. Nassery, I wouldn't love your advice on my case as I'm only 22 y/o. I never had braces or work on my mouth other than some crowns. I was diagnosed with scoliosis at 13 but played sports through school and never noticed it much. Around 20 I started to really notice and it's affected my confidence so much. One hip looks like it has no muscles or didn't develop and is inward so I look so awkward and not even womanly. My butt is less developed on one side and one leg seems shorter than the other with muscles working differently. My I don't have a defined waist but only weight 120. One shoulder I feel the need to constantly hold tension in and my neck is never straight. My jaws are misligned so my face is not symmetric. I understand the relationship between the loswer just and the skull. I have read into starecta and Kacelia method. I don't have the finances to keep going to a chiropractor or even get dental work done to fix me jaws and teeth. My lower jaw looked very under developed and I was a mouth breather as a child. Now I don't use an appliance but do try to make nose breathing a habit.
I practice yoga and am always looking at videos for self adjusting to correct hips and neck and atlas on YouTube. But none help, once I release all tension from trying to maintain a "proper posture" once j release I slump horribly to the right and just wanna be balanced and more symmetric!! This affects the spinal cord and nerves and causes all sorts of things within the body. I'm not sure of which degree my spine is.. by I am constantly dealing with tension in my jaw and body to try and maintain a dented of gravity that just isn't there. Please help me!!! Please tell me the steps in order of which will correct what I'm dealing with?
Should I get a atlas adjustment then days after fitted for a dental appliance to hold the position and allow my muscles to pick up on that posture?? Should I go to a dentist first and get anything done?? I have macclusions and my bite is def off. I want my facial muscles to be balanced along with the rest of my body. Thanks for everything!!

Dear Tiffany,

It is extremely difficult to make specific statements, even though you have provided a detailed description of your physical state.
Proper and thorough diagnostic records needs to be taken to make definitive statements.  However, having said that , your combined set of signs and symptoms do point to this issue we call, Cervical Dystonia. A medical term I prefer to TMJD related complex.
It sure sounds like you have educated yourself on many different aspects of the issue like breathing, and oral rest posture and jaw position.
I think you should eliminate the simplest of the factors first. I would start with a tongue assessment and if tide or less than mobile would release. Also you can start with some myofunctional therapy and see if that can help you stabilize your jaw position to a degree. Finally, if all fails, then assess your plane of bite and try and correct it with an orthotic.
If you get to that point, then my preference is to work with a Craniocervical Physical therapist. Once the therapist has brought balance and centricity to the cervical spine, I take my physiologic bite.
The orthotic is then fabricated and the patient is stabilized further. I do not recommend exercise till some basic balance has been restored to the body, and then only with the direction of my physical therapist.
I hope this gives you a basic idea of how I proceed with these cases.

H.Nassery, DMD
www.miamibeachdentistry.com
www.tmjresearchfoundation.com

Avatar universal
by patti2149, Jun 06, 2017
Dr. Nassery,

Can you recommend a doctor in the Chapel Hill, Cary or Raleigh area in NC?

Thank you,
Patti

Dear Patti,

Please see the link below and check the map for the closest qualified person to you. You can also check their level of education ..

https://batchgeo.com/map/ab93500357547df41bb5e83c52ed3c8e

Sincerely,

H.Nassery, DMD
www.Miamibeachdentistry.com
www.tmjresearchfoundation.com

Avatar universal
by patti2149, Jun 07, 2017
Thank you.  I'll see what I can find.  It is difficult to find a dentist that lists TMJ and tinnitus in our area as an issue.  I found one, Dr. Harold James, but I'd like to get a second opinion.

Avatar universal
by westa06, Jun 20, 2017
Dr. Nassery, I've reached out to you a few times...what's the likelyhood of me coming to you for a good overlook to see if my teeth problems, TMJ are what's causing neck problems and the Pseudotumor Cerebri. After being pushed around from doctor to doctor... I think I would much rather travel to you from Arkansas to be examined and determined if it is all connected before just letting anyone else "work" on me.

Dear Westa,

I am humbled by your offer. However, why don't you tell me what records you have already and send me what you have to see if I can find anything that maybe helps us.
I would like to make sure I can help you before make the trip down.

Regards,

H.Nassery, DMD
www.miamibeachdentistry.com
www.TMJresearchfoundation.com

Avatar universal
by westa06, Jun 22, 2017
I'm not sure what records you would need...most of the doctors I've talked to look at me like I'm crazy when I keep telling them it's related to my jaws.

Only records I have is a general outline of what the orthodontist did for me to help with my jaws (not very detailed, or not to my understanding of it). I have two MRI's of my brain. One from 2015 and Onw from 2016. And I have an MRI of my neck from 2016. And then I have visual field test results of my eyes and pictures of the optic nerves behind my eyes.

I can send those to you and what notes of have from doctors. And I can give you my list of symptoms from when this started to now and what I've done along the way to help me. I can also get a recent copy of my teeth images from my dentist.

I couldn't convince any doctors to look at my spine, although I kept telling them my posture has everything to do with it. If you could let me know what all you want/need and where I need to send it I would be glad to.

Avatar universal
by Noel77877, Jun 23, 2017
Hello Dr. Nassery. I have been having chiropractic treatment the last few months in order to correct the faulty curvature in my cervical spine and back which was likely caused by my TMJD problem which has become worse over a period of 25 years. This has helped a bit to ease pressure and chronic stiffness in my spine particularly the neck. The chiropractor suggested that I should get my TMJD fixed as if not the spine problem will never get fully resolved. My last visit with TMJD specialist in Philippines who was also an orthodontist wanted to put jacket on all my teeth to address my open bite. I was rather unimpressed as there was even no discussion of correcting first my bite, but the doctor explained I have no problem with my TMJ hence we can skip phase 1 and go straight to phase 2. I wonder how you feel about this. Here in Indonesia where I work in the GNM map locator there is Dr. Leonard Nelwan. Do you know of him, if you recommend him I will make an appointment. Also would appreciate if you can recommend someone in the Philippines. Noel.

Westa,
I'm out if the office till Monday, let's try and speak on that day and figure things out. Contact my office and let's see how we can help you.

Regards.
Hey. Nassery, DMD
WWW.MIAMIBEACHDENTISTRY.COM

Dear Noel,

I don't personally know Dr. Newlan, but that does not mean anything. It seems to me that he has gone through the international week with Dr. Chan and should be knowledgeable enough to get you stabilized.

However, if you need some one that is more familiar with these issues and the practitioners in that region please contact
Yue Weng Cheu, B.D.S., FRACDS
205 Hougang St-21 Heartland Mall-Kovan Singapore, Singapore 530205 Singapore
Phone: 6562820122

He is very well educated and knows  many more good practitioners than I.
I hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com
www.TMJresearchfoundation.com


Avatar universal
by Javiersoto, Jul 26, 2017
Hello Dr. Nassery. I have TMJ for about 3 years. In the last 7 months the pain is terrible. Pain in my face, headache, eye , neck, ears and ringing in my ears.  I live in San Diego Ca. Can you recommend any TMJ specialist in San Diego? Last week I went to see Dr. See Solomon on Santa Monica California but he want $8,500 for the appliance and $290.00 for the consultation.  And I have to drive 3 hour.
Thank you

Dear Javier ,

I am sorry to hear about your hardship. In San Diego I can recommend,

Rod Strober D.D.S.
3330 3rd Ave, Ste 302 San Diego, CA 92103 USA
Phone: (619) 299-5925

Rod is a great clinician and good colleague. As far as the fee, I have to warn you that is an average fee among most clinicians. I hope this helps.

H.Nassery, DMD
www.Miamibeachdentistry.com
www.TMJresearchfondation.com

Avatar universal
by Javiersoto, Jul 28, 2017
Thank you Dr Naseery. I will call Dr Strober on Monday to make a appointment.  

Avatar universal
by Rford512, Aug 01, 2017
Hi Dr. Nassery. I have had tmj since I was a small child and Im almost 100% certain it was inherited. I also have an odd scoliosis case where my spine curves at the bottom close to my hip. It causes my hips to look uneven when you look at my frontal view. It's strange and I havent seen it in anyone else. My sister and I were adopted and she does have it as well, which is why I know it is genetic. I recently have been suffering more often because of severe neck pain, on the same side as the goofy hip (right side). I have also noticed rapid aging in my face and a lack of mandible giving almost no jawline definition. I know I have a crossbite on my left side involving my upper and lower canines and also moderate tooth crowding in lower jaw. The teeth issues are definitely more on the left side. And my severe neck pain, which is causing extreme anxiety, breathing issues and fatigue, is on the right side. I can hardly care for myself lately, and caring for my young children has become so so hard in so many ways due to this problem. I'm in need of help. Would fixing the crossbite and crowding fix the bite and the tmj/neck pain? Especially if I continue my facial and full body exercises and get regular spinal adjustments afterwards? Also would this possibly correct my strange scoliosis? And lastly, I live in southern NJ, is there an affordable specialist that can help me in my area? I have state insurance (horizon nj health) at the moment but can make payments. Thank you so very much in advance, your time is more than appreciated!

Dear Dr. Ahmed,

Thanks for feeling compelled to advertise your services here. I think you missed the main point of the article, however. While Atlas disposition needs to be addressed, the main reason for this misplacement is poor occlusion. Check the work of Mr. Casey Gauzey, the quadrant theory. So you can adjust the atlas all you want, it will not help TMJ ( the joint itself) per se, and it will not be stable.
Open your mind, and you may learn something. We, as healthcare professionals, need to work together, to fix this complex thing we call human body. I can not adjust the Atlas, but I can help a professional like you to keep it in the right place.

It seems like you are a very educated professional. Try and add to the discussion next time.

Thank you,

H.Nassery
www.miamibeachdentistry.com

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