Hamidreza Nassery , DMD, FICOI, FAGD, FICCMO  
Male, 50
Miami Beach, FL

Interests: My family, Dentistry, all sports, Travel
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Jaw like a Plane?

Jun 18, 2013 - 14 comments





Neck pain







Jaw like a plane?

Head and neck pain and discomfort can run a wide range, being a simple nag to severe radiating pain. These pains can be different from day to day, side to side, or up and down. These variations can cause much confusion for all as to where they stem from and how to fix them.

In my practice I see many head and neck and myofacial pain patients who had thought that the pain might have been migraines; sinus and or tension headaches and so on. Most of these sufferers have been seeking medical advice for many years, actually decades in most cases. Most often for a large number of them x-rays, MRI’s and CAT Scans report nothing wrong. Since there is no definitive diagnosis, there is no treatment other than medications. As a matter of fact, there is a whole industry banking and betting on these patients accepting that they are going to be miserable all their life and continue to take these meds as their only relief. It is also my observation in meeting with these patients that they feel  they are not being listened to or believed by their families, friends and doctors.

Now here comes the jaw. The jaw is attached to our head by a set of intricate and complex muscles. Under certain conditions, these muscles can cause all the symptoms mentioned earlier. However a properly trained dentist can recognize this and help relieve and dissolve these pains.

To better explain the above, I will use an analogy once used by one of my mentors to describe the action:

The closing of the jaw is much like landing an airplane. When landing a plane, the pilot must control three movements, the angle or the steepness of the approach, the straightness of the approach and the evenness of right to left. So basically if the angle is too steep, the nose will damage, or if it’s too high the tail can drag and break. If the approach is not straight, meaning it’s sideways and the head is one direction and the tail is another, who knows what happens. Finally, if one side hits before another it can also cause much damage and destroy the plane. In pilot lingo these movements are called Pitch, Roll, and Yaw. Luckily there are sophisticated electronic instruments that handle all these today.

The Jaw can also have Pitch, Roll, and Yaw. As the lower jaw moves towards the upper and the teeth proximate for “landing”, the same rules apply. If the brain perceives that there are inaccuracies in the way teeth will come together, it will activate certain muscles to pull the jaw in any which way required to bring the teeth together or “land” them just perfectly. Most of us can accommodate these movements and lord knows we need to. Orthodontic research has shown us that for the past 250-300 years our teeth have not exactly come out in the correct position. Current estimates tell us that less than only 3% of us have our teeth naturally in the correct place. Our muscles and jaw joints have had to make the accommodation for our teeth to come together. Multiply this oral gymnastic by many years and you will have some very over worked and unhappy muscles.  Muscles that can go into spasm and cause many of the symptoms mentioned before.

With the use of specialized technology and proper training, some dentists can accurately measure good or bad activity of major muscles that open and close the mouth. This computerized technology tracks your jaw and muscle activity at the same time. The dentist looks for a jaw position where the muscles are happiest. We can then record and capture the position using specialized materials, and from that fabricate an appliance that fits over the lower teeth. This appliance, or as we call it “orthotic”, will mimic a good bite or if you want to call it a “good landing”. This will allow muscles to stay happy and as we all know happy muscles don’t cause headaches and neck pains.

The modality of treatment described above is called “Neuromuscular Dentistry” and it is fascinating to watch and experience as it helps people have healthier lives and their well-being improve.

Hamid Nassery, DMD, FICOI, FAGD is a practicing dentist at Real Smile Dental Spa located in Miami Beach, Florida. For more information you can call the office at 305.672.4444 or visit our website at www.miamibeachdentistry.com

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746512 tn?1388811180
by Tammy2009, Jun 20, 2013
The only problem as I have found out with these orthotics (I'm on my third one) is that since you can't eat with them - there is never a complete deduction in pain and spasms.  


I have seen your comments before.. It makes me think that your orthotic is not properly made.. when done correctly you should feel better eating with them than not.Tell me where you are and I'll try and find you a GNM trained dentist.. there is a difference in training.
Look up occlusionCConnections.com and read about and find dentists that have been trained by Dr. Chan. You will find your  solution..

Best regards.
H.Nassery, DMD


746512 tn?1388811180
by Tammy2009, Jun 23, 2013
But you aren't suppose to eat with the orthotic .... doesn't that wear them out very quickly?    It feels awesome when I keep it in if I'm eating yogurt or something but eating chicken or other meals I obviously  must take it out and that is where the problem is.  

I have a very good dentist - I'm starting to frustrate him because I am his only patient that hasn't improved greatly with his orthotics, I was given his name from someone here .... Dr. Curtis Westersund in Calgary, Alberta.  The greatest problem with me is that the jaw surgery I had also messed up my alignment in the neck and since then (almost 3 years ago) I have not been able to hold my C1 alignment from a NUCCA chiro for more than 20 minutes.  Thus, when we do all the scans and such for the bite guard I'm not in my true position.  We tried bringing the NUCCA chiro to the office and adjusting me during the scans - I was adjusted 4 times in 2 1/2 hours and still didn't work 100%.

I've now seen a craniosacral therapist every week since October and we are making some process, my misalignament is now down from off the chart with a 9-10 degree left lean to only a 2-4 degree left lean (still not holding alignments though).  The most postiive part is the appointment to make my third bite guard - I DID NOT hurt after the hour of the tens machine!!  I seriously use to drive home crying because my jaw hurt so much after and this time there was no pain meds on board and still no pain.  Unfortunately with the current flooding in Calgary I think it will be a couple of months before I recieve my guard because my office is downtown and the building has major flooding on the main floor (likely dentist is on the second floor).  We had to do all the scans with my old bite guard in and make the molds off of that so there is an extra step involved to mounting it before the guard is made.  

I am very optimistic for the new bite guard and maybe (finally) we got the bite correct.  :)  I do love reading your articles and keep up the good work!

Great , I know Curtis. However, I am not sure who told you not to eat with your orthotic.. Personally, I have been wearing my orthotic for 7 years and have always eaten with it.. and yes I have to resurface every 1 1/2 year but that is exactly why you are not holding your adjustment.. Think about it, when you eat is when you are really using your muscles of mastication, its like taking a step forward and one back.. you'll never move on.. you should feel more comfortable with it than without it eating...There are some patients that can get away with that type of usage, but those are marginal patients with milder symptoms, you don;t sound like one of those....with patients like you I almost rather bond my orthotic over the teeth so they can't remove it..that is the only time you can truly say whether it really worked or not.. hope this helps and all the best to you.


Avatar universal
by kstevens, Sep 23, 2014
Can you recommend a physician in the Orlando, FL area. I have been having SEVERE TMJ/facial pain for the past 5-6 years. I've gone the splint route which only seemed to aggravate the problem. I've have my bite readjusted to no avail. Each physician promised I would get extreme relief, but nothing has helped so far except taking Klonopin, which slightly takes the edge off the pain. I need to find someone in this area that will truly find the problem and fix it. Thanks so much.

Dear Kstevens,
the two practioners I can recommend near you with some Nueromuscular training are as follows;

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

Helene Ta, D.D.S.
1503 Buenose Aires Blvd, Suite 125
The Villages, FL 32159 USA
Phone: (352) 753-5838

Of the two Dr. Lung, has been through all levels, while Dr. Ta, has covered half. However, they both should be able to get you to a comfortable point. I hope this helps.

H.Nassery, DMD

Avatar universal
by kstevens, Sep 24, 2014
Thank you so much. ...You are not familiar with anyone in the Orlando area? ....Karen

unfortunately , no one that I could recommend based on training. These are clinicians who have all or some of the training that I know could help you.

H.Nassery, DMD

Avatar universal
by Dwigee, May 15, 2016
Hi Dr Nassery,

Have you ever determined a bite for someone and just had it not work out for that particular person and have to retake the bite?  How long do you give it before you determine that bite does not work?  What do you do it someone can never find that TENS bite once off the TENS and the muscles want to go somewhere else?

Thanks in advance for your reply.


I hear the frustration in your tone. I can only speak of my own journey thru this treatment modality. When I first started, yes, it would take sometime three orthotics for me to get my patients to a comfortable state. It was a process of chasing a good bite.
However, as I studied more and gained more experience, specially after taking my second set of classes with Dr. Chan and incorporating his optimized bite system, I started to get more predictable results sooner.
Later on as I incorporated yet another element, which was the Cranio- Cervical component as taught by Dr. Rocobado, I made another leap to gaining better results sooner.
Today I average one orthotic and three adjustments per patient. Yes, there patients that are high proprioceptive and may require more adjustments but rarely more orthotics.
I hope this answers your question.

H.Nassery, DMD

Avatar universal
by deedee2604, May 16, 2016
Thanks Dr Nassery. Do you feel the Dr Rocobado technique is better than an A/O or NUCCA?  Just curious how it differs or if there is somewhere on the web I can read more about it.  I know I am seeing a very experienced and good dentist which is even more puzzling.  The discomfort I feel in my bite wanting to go where it wants to is to the point now that I don't even want to wear the orthotic.  I didn't know my frustration would be so obvious :)

Dear Deedee,

I am a good listener.. but no seriously, it is just as frustrating for us, I want you to know.. again answering based on my own search and experience..I have worked with both chiros and PTs. It comes down to the personality of the practitioner. If they are open to learn and understand things from our perspective.
Personally, I had to take the courses with Dr. Rocobado to understand what they know and do. Once I got  a grasp of the information and shared our work, with the PT it was natural progress of the treatment.
To answer your question about the approach difference. In my view the missing part in chiro approach was the addressing the soft tissue. After all the misalignment in the neck is due to spasmodic muscles, if you just pop the vertebrae in but don't address the muscle, your correction will not hold. By the time you reach your car your cervical spine is moving back to its wrong place again.
With the PT approach, they first extend and elongate the muscles, create separation between the vertebrae and then by activating the  opposite muscle group they will gently pull your spine back into centric position. Now I don't want you to think I am anti chiro, not at all, as a matter of fact I have actively campaigned for the integration off all these professionals into our  organization, and as of last year, ICCMO is no longer just a dental organization. Locally in my area we have created a study group which includes my PT, an A/O chiro and a Craniosacral practitioner.
The biggest issue I had in the past was that our efforts were not on the same page. We no longer take a bite until such time that my PT has treated the patient several times and has brought the neck into a more physiologic state. Otherwise, how can I expect to get the best bite ? This is the part that needs to be improved upon.
I am guessing , you saw your dentist, he did his work up and took his bite for the orthotic, and then said its not a bad idea to see the chiro..now you've seen the chiro he has mobilized your C1, and that changes the bite, but your orthosis re-emphasizes the position prior to the adjustment, so you keep going back and forth.
let me know if I am wrong..don't want to make too many assumptions.

Hope this answers some questions..


h.Nassery, DMD

Avatar universal
by deedee2604, May 17, 2016
I must have created two accounts and depending on the iOS device I'm logged into I post with different usernames. Oops.  You might have hit the nail on the head.  My bite was taken first and the neck adjusted second.  Funny because there were a few times I would go to get my atlas adjusted thinking my bite feels more even when my neck is out.  Then other times I didn't notice that at all so I dismissed it, but maybe it also depends on the degree of dislocation as well.  I definitively fit into the category of lots of cervical symptoms. I find the PT approach very interesting.  Kudos to you for taking those extra steps to help patients even more to get it as perfect as possible!  I've always wanted to visit Miami.....:)

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