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

Interests: My family, Dentistry, all sports, Travel

Hamid Nassery, DMD, FICOI, FAGD
305.672.4444
Miami Beach, FL
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TMJ/TMD Question Posed

Jul 30, 2012 - 20 comments

TMJ/TMD

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

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

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

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

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

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

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

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

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

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

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


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by sameerakhan198, Jul 30, 2012
For 6 months I have been suffering with dizziness,slight imbalance,pressure and pain my ears together with a soar throat.My ENT assured me it was just an inner ear infection.Over a period of 2 months I visited him 5 times and each time his response would be ,give it another 2 more weeks.During one of my visits i mentioned to him that I had a clicking jaw,difficulty swallowing and sometimes even speaking.It was just dismissed as insignificant.I then went to a neurologist,had an mri,everything was normal.He put me on an anti depressant and told me to see a phsycologist.I then went to another ent who told me i had inner ear nerve damage,so i went back to the neurologist who said refuted the ents theory.Have had numerous blood tests,hearing tests imbalance test and nobody can tell me whats wrong with me.Eventually i had 3 wisdom teeth removed as they were impacted, now i cannot open my jaw at all,it feels as if its going to break.Through this whole ordeal all Ive been asked if i was taking my anti depressants and to pull myself together. My pain and grief is very real,nobody would visit doctor after doctor for no reason.THIS HAS AFFEECTED MY WHOLE LIFE,WILL SOMEONE PLEASE HELP ME.

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by Hamidreza Nassery , DMD, FICOI, FAGDBlank, Jul 30, 2012
Dear Sameera,

I am so sorry about your situation. As I mentioned in my post above your story is far too familiar to me.  If all medical issues have been ruled out, find yourself a good TMJ/TMD specialist.
Many of  your symptoms correlate with this disease, and the solution should be functional.

Let me know, if I can be of anymore help.

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

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by Lisamarl, Jul 31, 2012
I know how you feel,in June of this year I had a sinus infection,shortly after that the ear popping and clicking started along with bad headaches and head and nose congestion,saw ent he gave me another round of antibiotics,this did not help at all,saw my family dr. Again today he is sending me for ct scan and an allergist,so we will see what happens,I have been miserable,and I can barely work for the ear pain and dizziness,maybe it might be tmj but I already wear a night guard for that every night,so I don't know,I'll keep you posted.hope you find relief as well! Good luck!

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by sameerakhan198, Aug 01, 2012
So sorry to hear . I too have a sinus problem ,I take flixonaise and xy































So sorry to hear.I too have a sinus problem I take flixonaise and xyzal but my doctor has assured me that my sinus is not the cause of my dizziness and ear pain.I also have ear popping.Do you experience any ear pressure as mine is extreme.Im currently on serc for dizziness and imbalance.Ialso have severe throat pain.I saw my doctor today who who did a doppler carrotid test,hope I got the name right,that was to see if blood was flowing propperly to the brain.Everything was fine. he still does not think that my painfull clicking jaws are causing it.I am starting vestibular rehabilitation tomorrow as the doctor seems to think it will help,but no one can tell me whats causing my dizziness.I would like a definite diagnosis as not knowing is killing me.I cant make plans in advance to do anything or go anywhere as i dont know whether id be dizzy or not.At times I cant even help my kids wit h their homework,this depresses me as my kids have always come first.Stay positive,hope you feel better.Keep me updated on any progress.















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by supermum_ms, Aug 04, 2012
I'm not sure if you are aware of how rare you probably are, lol I've had periods of left side face pain and or jaw issues for over 20 years and in all that time no professional has ever named it, and yet it was pretty obvious the last 2 dentists i've had, more than likely knew what it was. Both have had to double any appointment times, tears flow down my face, the pain is 'not' from the dental procedure but from my jaw. For years i've needed breaks to give my jaw a rest, due to my bite getting smaller and smaller each year. Just trying to open it wide enough is difficult, to do so with out intense pain, well thats impossible. My current dentist has stated more than a few times that "I've never seen anyone with it this bad" my bite is now less than 2 inches, my lower jaw has receded with a slight twist, so my teeth no longer sit together properly anymore. I dont let my self think of the pain after these TN episodes, you probably understand thats its more the shoot me now type than the ouch type of pain.

It was only this year that i've discovered it has a name, i'm from the MS forum and TN is something we do talk about sometimes, i just didn't know that what i've been dealing with for all these years, is actually the same thing. It was only due to my curriosity during the last episode that i did some research on MS related issues, and basically fell over it's true name. I can't say for sure how big a part this plays with me but my verbal skills are progressively disapearing. I now have daily difficulty talking, chewing and with articulation, even when i'm not stuttering, its soooo not helping me any having no solution and i have to wonder just how long i'm going to still be able to talk. It would be so nice to not only have its name but something to fix it too.

I want to thank you for all the care you give your patients with TN, its really nice to know professionals like you exist! :o)

Cheers............JJ

PS if you ever want to pop over to our MS community forum and impart some wisdom to the pwMS who have TNJ, i'm sure more than a few of us would think your the best thing since sliced bread!  

  

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by Hamidreza Nassery , DMD, FICOI, FAGDBlank, Aug 04, 2012
Dear Supermum,

Thank you for your kind words. I am just a little practitioner, though maybe with a big mouth, who is trying his best to help his patients. From the sound of it you have a closed lock situation.,where your disc complex is torn an sits in front of the head of your jaw bone and now your muscles are too spasmodic to allow you to open. There are ways to correct all that.

We know,by we I mean myself an many of my colleagues who treat this complex, that many of the symptoms of TMD have global effects on the rest of human body. Many of our patients have previously been diagnosed with fibromyalgia, and Minier's disease to name a few, and once treated for TMD, found much relieve in their health.

I wish you all the best.

H.Nassery, DMD FICOI
www.miamibeachdentistry.com

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by MISTY14, Aug 05, 2012
I HAVE SUFFERED FROM LYME DISEASE, AND TMJ SURGERY. SINCE HAVING A TITANIUM PROSTHETIC IMPLANT 10TH FEBRUARY 2010 MY SYMPTOMS HAVE BECOME INCREASINGLY WORSE.
LAST WEEK I GOT THE RESULTS FOR A CD57 BLOOD TEST - MINE IS 10
I WILL BE DROPPING OFF MY PERCH IF SOMETHING IS NOT DONE FOR ME P.D.Q.
HERE IN THE UK THE NHS ARE SO IGNORANT ON ANYTHING TO DO WITH LYME, AND WILL NOT ATTEMPT TO PUT RIGHT WHAT I KNOW TO BE WRONG WITH THE IMPLANT. I AM HAVING TOOTHACHE, EARACHE THROUGHOUT THE WHOLE OF MY RIGHT EAR, SORE MOUTH, AND OTHER SYMPTOMS TOO NUMEROUS TO LIST.
JUST NEED HELP A.S.A.P.

ANY INFORMATION WILL BE APPRECIATED

MANY THANKS

THELMA

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by Hamidreza Nassery , DMD, FICOI, FAGDBlank, Aug 05, 2012
Thelma,

I am saddened by your troubles there. The only Nm Dr. I know in London is
Dr. David Cook
39 Harley St.
London, W1G 8QH
020 7323 1363

Please let me know about your progress.

All the best.
H.Nassery, DMD FICOI
www.miamibeachdentistry.com

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by blondegirl123, Aug 07, 2012
I have had TMJ/Bruxism since I was 13 years old and I am now 40. I have gone thru braces, tons of different mouth guards and medications. I also have FMS along with TMJ so i am on tons on meds for pain. I take klonopin,ultram, flexeral at night just to sleep. My jaws flare up all the time so i use hot and cold packs at night before bed. I do grind big time and my othro and I are trying to come up with a mouth guard that would prevent me from grinding at night. This guard would entail my top teeth and bottom teeth do not touch at all during the night. With all the guards out there they only protect the damage of teeth not help the pressure and contact of teeth at night. This is a awful condition to have and yes most of it is from stress and aniexty. Bio-feedback does not work for me and relaxing and trying to retrain your brain not to grind at night is very hard to do since you do it without knowing it. My neck, jaws, headaches, shoulders, eye pressure and ear pain all stem from TMJ. i wish there was a cure but for right now all we can do is tolerate the pain and live life as best as we can on pain killers all day. Thank you for writing this article - nobody is alone in this.

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by Hamidreza Nassery , DMD, FICOI, FAGDBlank, Aug 07, 2012
Blondegirl,

Your story is way too familiar. You would be happy to know that many of your symptoms could be eliminated with the correct approach. This is not an incurable situation.
Let me know if you want help finding some one qualified.

H.Nassery, DMD
www.miamibeachdentistry.com

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by blondegirl123, Aug 08, 2012
I would love some help if the person I am to go to knows what they are doing. I have seen many dentists, ortho's and doctors over the years and wasted tons of money. I will look into the recomendations you give me with great effort. I live in Chambersburg PA area.

Thank you

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by Hamidreza Nassery , DMD, FICOI, FAGDBlank, Aug 08, 2012
Blondegirl,

I understand your skepticism, as far as the costs, I would have to agree that these type of work is costly. I think the issue is when the results are not there.
http://batchgeo.com/map/?i=findinganeuromusculardentist&q=chambersburg%252C+PA
I checked your area, the closest to you would have been Dr. Brugler, however, I know for  fact that he is not feeling well and practicing limited hours.
Check on the map and see who is closest to you. Most these practitioners have studied in much the same arenas as I have and can help you.
I hope this will be beneficial.

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

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by blondegirl123, Aug 08, 2012
Thank you

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by Weary333, Nov 06, 2014
Dear Dr. Nassery
I saw your post on msd.org
I too am one of the many tmj sufferers. I have masseter and temporalis muscle spasm from clenching brought on by loosing tooth3 which led to tooth4 pulled. I had some bridge work and I am doing a little better with bite but still clinch at night and have a problem with a parafunctional habit that I constantly move my lower jaw due to a clicking feeling between tooth 4 and 5. This feeling began after first extravtion and remains stilI. It does not csuse pain only a crackling sound like a popping behind the teeth near the gumline but the teeth are gone and ground down as anchor tooth so I feel the habit is making the sound and I can't seem to stop which in turn had caused my jaw movement and pain
Is there anyone you can suggest in the pittsburgh pa area?  I Have tried and tried but can no find anyone that knows or treats tmj
Thank you for any help you may have
Linda



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by Hamidreza Nassery , DMD, FICOI, FAGDBlank, Nov 06, 2014
Linda,
It sure sounds like you have a collapsed bite on that side. the closest person to you , I can recommend is


Dominic A. Sabatini, D.M.D.
8700 Pennsylvania Ave
N. Huntingdon, PA 15642 USA Zoom
Phone: (724) 864-0070

I hope this helps.

Best.
H.Nassery, DMD FICOI, FAGD

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by Drika1974, Nov 09, 2014
Dr. Nassery,
Hello Dr.
Last November 2013, exactly  I started having ringing in my left ear,  I thought it could be related to my jaw because I was wearing a pharmacy splint at the time and during the night I would wake up with a louder ring in my ears, but when I open and relaxed my jaw the ring would subside a lot, so I thought it could be from clenching too hard on the cheap pharmacy splint I was wearing, which end up changing the shape of my bite a little.
Since I am not able to touch my front and side teeth anymore. The ringing was driving me crazy.. I went to 3 Ear,nose and thought specialist and did all the hearing tests and everything was normal... After a few weeks of a lot frustrating research in Jaw/ear ringing, decided to do a stretch and opening my mouth as an exercise  and I think strained the other side of my jaw and I end up having a really bad vertigo for over 2 weeks, my right ear started to feel hot ..   I tarted having clogging ears, pain in both ears and trismus.. went to 5 dentists no one could help me... After 5 months living this hell.. my right side started to go in to a very light spasm. Everyday waking up with pain .. some days better then others.. Now I am having twitches on my right  side of my face and sometimes my entire face will contract. my looks changed with ion 4 months, which it has been a major cause of stress for me lately. I look tired ALL the time, bags under my eyes, look so much older, lost a lot of fullness of my face. I got less symmetrical,one eye is higher then another....deep hallow under cheek bones,more on the right side and thinner face. I always looked younger than my age, round face and now I look  and feel horrible.  I feel Fatigued from all the facial muscles spasms and contractions. I do not have many headaches, thankfully!
Because of all this nightmare I got a major depressive episode with Anxiety attacks in the last 4 months and I still feel very self conscious about the way a look..  My biggest concert at this point is...will my face go back to what it was if I treat the misalignment , bite and relax those muscles in the right position? I have seen 3 so called "TMD specialists", and I still have not made my decision,, because I am scared of starting such expensive treatment (Over $5000 for TMD phase 1 with no garantee)  and get no results or making it worse.. not sure what to do.. What is the difference between Regular TMD specialist vs Neuromuscular dentistry vs Gneuromuscular?
ANY HELP WILL BE MUCH APPRECIATED!!!


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by Hamidreza Nassery , DMD, FICOI, FAGDBlank, Nov 09, 2014
Dear Drika,

From the sounds of it, you have done lots of research. That's good. Not too many people know about the different forms of treatment, and it seems like you have read a lot.
First let me answer your concerns about your symptoms. The issues you are mentioning all can be explained. The sort version is that you have always had mal-occlusion , and it is juts getting to the point that you can no longer accommodate this wrong bite. The mal-occlusion will cause a reciprocating movement in your neck, and subluxes your cervical spine. In your case and based on your symptoms, the impingement seems to be between C1 and C2.. more than likely your C2 is stuck to one side or the other..
The difference among different approaches to treatment is a much bigger and longer discussion. I am not one to berate other modalities. I think they all work to some degree. I can only tell you about my personal experience, and modality of treatment that has proven best in my hands. I started with Nueromuscular close to ten years ago and found that Gnathological principles historically thought do still apply. This is based on the teachings of Dr. Clayton Chan, premier TMD/TMJ specialist in the country, in my opinion. Hence we call our modality Gneuromuscular. We believe in fundamental correction of this musculoskeletal issue.
As per a guarantee, I would tell you that there is no section of medicine or dentistry that can give you a guarantee about anything. I would look into speaking with some of the doctors patients who have had similar issues, check their credentials.

Hope this helps.

H.Nassery, DMD
www.miamibeachdentistry.com



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by Drika1974, Nov 09, 2014
Thank you for answering my questions Dr... I have been doing lots of research, but I wish all the information I've collected would make my decision easier, but it does not.  I don't have any symptoms in my neck, like pain or locking. I also have good motion, but I do notice that when I look UP or DOWN my neck get in to spasms . Why will the face get hallowed under chick bones, could be a MIX of atrophy (from the mal-occlusion) and muscle tightness? or is the neck to be blamed? Should I see a Doctor or a Neuromuscular dentist? Thank you very much!!

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by Drika1974, Nov 09, 2014
I also don't have headaches, isn't headaches one very strong symptom of C1 and C2 being stuck?  

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by Hamidreza Nassery , DMD, FICOI, FAGDBlank, Nov 09, 2014
Drika,

We are now getting into a lot of speculation. I usually ask my patients to rule out all possible medical reasons. If no medical issues found then your best bet is a Dentist that is familiar with TMJ therapy.

As for your facial changes, yes they are possibly due to muscles that have shut down basically due to extreme fatigue.
While you are right to assume that many people have headaches that are caused by cervical problems, not everyone will have the same symptoms. The problem with spasmodic neck muscles is a big indication that things are not in alignment. In my practice, I see a plethora of different symptoms in different patients, based on their age, and or their gender.
So not having any real diagnostic info on you it is neither right nor professional on my part to try and be more detail about your condition. All I can say that your story reads like many I have talked to and or treated.
In short, if you have seen physicians and medical issues have been ruled out, I would suggest a Dentist that has been trained  to treat these issues.

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

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