Hamidreza Nassery , DMD, FICOI, FAGD, FICCMO  
Male, 54
Miami Beach, FL

Interests: My family, Dentistry, all sports, Travel
Miami Beach, FL
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TMJ/TMD Question Posed

Jul 30, 2012 - 28 comments


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

TMJ, Orthodontics (tooth movement) and dentistry’s Dark Cosmetic Secret

May 31, 2011 - 5 comments

I was reading an email on my Gmail account the other day and one of the corner ads got my attention. A fellow colleague was advertising as a “Holistic Dentist”.  Though I had heard it before, I have never put much thought into what it really means.

I suppose that the most basic tenets of “holistic dentistry” should be to do no harm and for the dentist to look at the mouth , teeth, gums and the jaws as an integral part of a larger, whole body system.  Interestingly, in most countries around the world, medical students recite an oath equivalent to “the oath of Hippocrates”, sadly though no student of our profession undertakes such oath upon graduation. I do however believe that we are implicitly bound to honor the trust placed in us as “medical professionals”.

Considering the above we all should be holistic dentists. The reality is different though.  Case point is the orthodontic profession in that it has veered away from being a health science, and has become more pre-occupied with being purely cosmetic at the expense of our health.  Our orthodontic colleagues have been perfectly positioned to be at the forefront of TMJ/TMD treatments. However, not only there has been a total void of leadership on their part, there have been well orchestrated attempts to stop the progress of science.

An example of this is the prevalence of premolar (bicuspid) extractions in private practice. Data is not clear on this but it is estimated that as much as 25-85% our children get their healthy teeth removed in the name orthodontics.

The rational behind this methodology goes back to a 1954 paper by P.R. Begg, which has been proven wrong soundly many times since. Subsequent studies have shown that these cases have less than 10% stability over a 10 year period. This alone should suffice to explain, never mind that we are encroaching on the tongue space and therefore compromising the patient’s airway, creating persons with great susceptibility to sleep breathing disorders. Talk about “do no harm”.

Here we are in 2011 and biomedical instrumentation is available to dentistry. Rather than subjectively guess the position of jaw and move teeth, we can now objectively and scientifically find the position of the jaw and move the teeth according to the patient’s physiology.  Everything we do in the mouth must reflect a healthy echo to the rest of the body.

Many patients often ask what has caused their particular malocclusion (their incorrect bite), on this matter literature supports muscle function and posture. Regretfully, though there are no active teaching programs connecting the two together. (Mainly due to politics, another sad testament to our profession)

If dentistry aspires to be taken seriously as a medical profession, then it must put aside its antiquated ways of the past and re-orient itself towards more objective and scientific ways that are health oriented and less subjective.

The Truth on Porcelain Veneers

Mar 30, 2011 - 0 comments





Cosmetic dentistry


Musculoskeletal- occlussal Sign and symptoms

Mar 04, 2011 - 0 comments

Musculoskeletal – Occlusal Signs Exam Form

NAME _____________________________________________________
DATE _____________________________________________________
AGE _____________________________________________________


                                       SIGNS (Intra-oral)
1.   Headaches2.                           1.      Crowded Lower Anteriors
2.     TMJ Pain
                                                          2.      Wear of Lower Anterior Teeth
3.     TMJ Noise                                           3.      Lingual Inclination of Lower Anteriors
4.     Limited Opening                           4.      Lingual Inclination of Upper Anteriors
5.     Ear Congestion                                  (Div. II Occlusion)
6.     Vertigo (Dizziness)                           5.      Bicuspid Drop Off
7.     Tinnitus (Ringing in the Ears)           6.      Depressed Curve of Spee
8.     Dysphagia (Difficulty Swallowing)           7.      Lingually Tipped Lower Posteriors
9.     Loose Teeth                                           8.      Narrow Mandibular ( lower) Arch
10.   Clenching / Bruxing                           9.      Narrow Maxillary( upper) Arch
11.   Facial Pain (Nonspecific)                                      (High Palatal Vault)
12.   Tender, Sensitive Teeth (Percussion)         10.    Midline Discrepancy
13.   Difficulty Chewing                         11.    Malrelated Dental Arches
14.   Cervical Pain                                         12.    Tooth Mobility
15.   Postural Problems                         13.    Flared Upper Anterior Teeth
16.   Paresthesia of Fingertips (Tingling)         14.    Facets( Excess Wear)
17.   Thermal Sensitivity (Hot and Cold)         15.    Cervical Erosion ( wear at the gum line)
18.   Trigeminal Neuralgia                           (Abfractions)
19.   Bell’s Palsy                                         16.    Locked Upper Buccal Cusps
20.   Nervousness / Insomnia                         17.    Fractured Cusps    (Particularly
                                                                  Cl. I & II Non-functional Cusps )
                                                        18.    Chipped Anterior Teeth
SIGNS (Extra-oral)                                         19.    Loss of Molars
1.     Facial Asymmetry Bilaterally          20.    Open Interproximal Contacts
2.     Short Lower Third of the Face          21.    Unexplained Gingival Inflammation
3.     Chelitis                                                       and Hypertrophy  
4.     Abnormal Lip Posture                           22.    Crossbite
5.     Deep Mentalis Crease                           23.    Anterior Open Bite
6.     Dished-Out or Flat Labial Profile           24.    Anterior Tongue Thrust
7.     Facial Edema                                           25.    Lateral Tongue Thrust
8.     Mandibular Torticollis                           26.    Scalloping of the Lateral Border
9.     Cervical Torticollis                                   of the Tongue
10.   Forward Head Posture (Lordosis)
11.   Elongated Lower Face
           (Steep Mandibular Angle)
12.   Speech Abnormalities