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Hamidreza Nassery , DMD, FICOI, FAGD, FICCMO  
Male, 52
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 Pain and head and neck position. Elegant ecology.

Jan 16, 2018 - 14 comments
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Headaches

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Neck pain

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TMJ disorders

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poor posture

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teeth grinding

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cervical disk pain

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airway obstruction

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severe tmj pain

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neck clicking popping pain

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Miamibeachdentistry

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TMJ

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TMD

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pain relief

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jaw pain

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tinnitis

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Nueromuscular dentist



If you have followed the sequence of my other blogs about TMJ pain and TMJ Disorder in general, by now you could come to the following conclusion on your own.

Dentistry is closely related to the functional and dynamic systems of the body. This relation which has been termed an “Elegant Ecology” is so intertwined that discussing one without the other would be an artificial separation of anatomy and physiology.

Any change in dental anatomy, position and mechanics will have an influence on the Craniosacral System and other functional systems of the body. It really is a simple matter. The position of the teeth affect the function of the jaw, which in turn effects the head position.

Rene Cailliet, Director of Physical Medicine and Rehabilitation at the University of Southern California, has put it best: “It is an axiom that the body follows the head. You can realign your whole body by repositioning your head. Head held in a forward position can pull your entire body out of line. It can reduce the vital lung capacity by as much as 30 percent. The gastrointestinal system is affected, particularly the large intestine. When a hunched position is assumed, the body becomes more rigid, and the range of motion decreases.  Since endorphin production is reduced, an increase in pain and discomfort results.”

Treating hundreds of patients including those with TMJ pain and all kinds of neck or cervical neuralgia, over the past 15 years in my Clinic at Miami Beach Dentistry, I have come to see this connection first hand. The body works as a complex unit, and when trying to treat it all parts need to be addressed based on their own merit.

What does this mean? I’ll elaborate. A very dangerous and persistent trend I see in patients today is the sum of fragmented information they have amassed from different sources be it websites or support groups. I say dangerous, because some of these patients believe that there is a holy grail in the form of a clinician or treatment that will take all their issues away.

The truth is far from that. Proper diagnosis and correct sequencing of the treatment is the key. This means that each segment of this complex “Craniosacral System” must be addressed by the correct practitioner specializing in that specific part. Yes, in my view, the best approach to treatment is a multi-disciplinary approach.

I have made no secret of my trainings and studies with Dr. Chan. I am a true believer in the fundamental basis of a physiologic bite, and the power of micro occlusion as taught by him. However, this is not a magic wand. While the correction of the jaw function can help many, it is not the only factor that needs to be addressed. What about the “Pain in the Neck”?

Many of the very advanced patients I see in my Miami Beach Dental Clinic today, have extremely poor postures, scoliotic spines, forward head and hips and unevenly developed musculature. Patterns that have developed over many years. Repositioning of the jaw and stabilizing the occlusion does not automatically correct all these issues. It does put you in a better position to correct them but it does not do the job for you. Without addressing the posture on its own, there will be residual symptoms, and in cases it can relapse the bite back to the previous position. It is a two-way street.

One of the most common issues I encounter, is lack of stability or integrity in the vertebral column. Specially in the cervical spine. Many of these patients have been cracking their own necks since they were kids. Later in life they have possibly seen Chiros and or other practitioners who have adjusted them. The result is the same, hyperlaxity of the connective tissue and ligaments that hold our skeletal system together. These patients can pull their vertebrae out by turning their heads suddenly or picking up a heavy object. This laxity needs to be addressed separately by another professional.

To look at this from another view consider the following. In my Dental  Practice, I have a handful of patients that are partially edentulous and based on everything I know and have learned these past 20 years, they should be in severe pain and discomfort. However, they are not. A closer look at these patients revealed that they were in great physical form. They are swimmers, dancers, trainers and so on. The effects of proper postural stance and integrity should not be discounted.

Another complicating factor that is somewhat overlooked is airway patency.  Although airway as of late, has become a hot topic, most of the solutions currently thrown around are quick fixes and palliative in nature. I believe that another segment of our patients who do not get the expected results are suffering from poor airway patency.

In my Practice, I try to anticipate these and other factors ahead of time in our patients and to address them each accordingly. This means working with other like minded and progressive practitioners and physicians who could help me bring a more complete treatment to my patients.

Here always for any progressive discussion.

Hamid Nassery, DMD, FAGD, FICOI, FICCMO
Owner of Miami Beach Dentistry/ RealSmile and Co Founder of The TMJ Research Foundation.

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Avatar universal
by yvonne_ev, Jan 17, 2018
The tying together of these body systems is becoming more and more obviously connected to our overall balanced health and dynamic function of our bodies.

Witnessing this firsthand in myself recovering from a head and neck injury fall, sometimes the best relief comes from wearing my upper and lower space expander, physical therapy, massage and guided stretching of my neck and back area, quiet walking meditation and healthy diet. My next step is receiving the PRGF injections from a highly experienced and knowledgeable Neurologist, at the base of the skull, neck and spine. Which will engage in repair and healing to the ligaments in those areas most deeply affected.

I am grateful to have a progressive team of Progressive Doctors; Dentist, Neurologist and Therapists to bring this all together.

Thank you for your continued studies and advancement in understanding and translating this to the world
Dr. Hamid Nassery.

Sincerely,
Yvonne x

Avatar universal
by doctordoolittle, Jan 27, 2018
How very interesting.  I couldn't agree more which is why I practice yoga, prefer to use homeopathy.  Yvonne you might try arnica & ruta grav in addition - not in place of.  There is a great deal of controversy re 'alternative remedies' ....... with the 'establishment' saying there is no 'scientific evidence'.  All I know is that I've been using it for 40 years ....... and it works for me.  I was diagnosed with early osteoarthritis 30 years ago.  If I complained enough the GP's would have had me on ever increasingly strong painkillers (with their side-effects ....... not to mention the animal-testing issue)........ I'd already used homeopathy for some time but that was when I began to learn yoga.

Best wishes.

Avatar universal
by Sunshinestarz, Jul 08, 2018
Dr Nassery,

I’ve read a number of your blog posts after finding this forum - I’ve had neck and shoulder pain since the age of 15 (there was no specific accidents that caused the pain except for a very stressful time going through my parents divoce). I’ve seen a number of chiropractors, acupuncturists, physical therpists over the years and have been able to manage the pain through exercise, tons of foam rolling and stretches, yoga and massage therapy. My dentist told me about 5 yrs ago that i needed to start wearing a night guard due to grinding so i got a customized hard nightguard and have been wearing it for over 4 years. In the last 1.5 yrs, I’ve experience (and getting worse) signs of TMJ with headaches, migranes, left jaw pops , facial pain, worsen neck and shoulder pain. I spend an hr a night before bed to foam roll, stretch, doing face and mouth exercises, using a massager and doing meditation to get nice and loose befoee bed but while sleeping, im clenching (i sometimes wake up from this) and I wake up very tired and jaw and neck is in pain. I’ve seen a couple of TMJ specialists- one is a chiropractor by trade and she did some adjustments and we talked a lot about posture and exercises/ poses I can do regularly but it not help much. Another TMJ dentist I saw recently said that in looking at the structure of my mouth- narrow arch both top and bottom, decent size tongue, i was a mouth breather since I was young, gummy smile, I likely have a blocked airway which is causing me to grind/ clench at night. I’ve always felt that my breathing is shallow esp when laying down so his theory/ assumption makes sense. He suggested me using an oral appliance - DNA for 1.5 yrs 8 hrs a day to open up the upper arch to help open up my airway. Have you heard/ used the DNA appliance with your patients and how effective is it? It will be an $8k investment over 2 yrs so I want to do my due diligence before moving forward. Another TMJ specialist has put me on a CPC machine to check my sleep pattern and we’re doing this this wk. based on my description of my symptoms and his exam, he said i will likely need braces to open up my upper and lower arch- when i open my mouth, my jaw moves to the right and then back to center. I am 40 years old and I recently took a sleep study to rule out sleep apea. I am in search of a neuromuscular dentist in my area based on your recommendation - do you have one you recommend in N california? I live in Silicon valley. I did searches on neuromuscular dentists but th search results seem to be general dentista. Anything else you’d recommend I do or docs that I see before commiting 2 yrs and braces or the dna appliance? I plan to go see a chiro and get an xray of my neck and spine as well as an ent to check on my airway. Thanks in advance.

Avatar universal
by Ballgame17, Jul 09, 2018
You describe a few anatomical issues : narrowed upper and lower arches , decreased airway competence " experience (and getting worse) signs of TMJ with headaches, migranes (sic) , left jaw pops , facial pain, worsen neck and shoulder pain.". These are classic growth and ( under) development issues. I would encourage you to consult an oral and maxillofacial surgeon with DEMONSTRATED experience in assessing and managing someone with your presentations. All of the existing anatomic abnormalities  and the  subsequent development of altered occlusion of the teeth/ bite likely resulted in aberrant growth of the condylar component of the mandible and alteration of the normal menisco-condylar relationship with the glenoid fossa((google it for clarity) . For all intents , this is a mal-loaded , dysfunctional joint NO DIFFERENT than other orthopedic joints. Orthogmathic surgery with a combined orthodontic preparation approach would likely alleviate many of your complaints . Likely bimaxillary surgery resulting in advancing / widening the upper jaw ( maxilla) and subsequent mandibular advancement ; both would create increased naso/pharyngeal space. Additionally,  the condylar segments MAY be positioned in a more favorable loading relationship. Everything else , IMO. is dancing around the obvious. Yes, I am a retired OMFS.  

Dear Sunshine,

I am sorry you are having so much difficulty. I was speaking to one of my patients today and I told her that I would not want to be in her or for that matter your shoes. There is so much information and perhaps as much if not more misinformation. There are many questions in your comments and I will try to answer as many as I can.
You have done many things right, but your ability to compensate is wearing down. Many clinicians still do not understand the  Craniocervical/ Craniomandibular connection. Much like our well intentioned friend above. His suggestion is no different for me than the other two you mentioned. Start a course of action without knowing for certain if you will be ok.
I agree that many of your signs and symptoms are due the malformation or developmental abnormalities. I further agree that you need to properly develop your arches be it orthopeadically or surgically as the good surgeon recommends. However, would it not be more prudent to find the correct position for the  lower jaw first, recapture the dislocated minicus, and bring function into its proper plane first and essentially render you asymptomatic first? without making any irreversible changes in your mouth, specially surgical..

To me all the options you have been given are just tools. You mentioned DNA. Yes, I know what it is. I am a certified provider. I have used it, and may use it again in the future. In my experience a very symptomatic case like yours, is not a good indication. Just my personal opinion. I would want to first stabilize your bite and joint and get your neck into the right place, before I start moving teeth into positions where I do not know would bring you comfort and relief.

Hence, I recommend that you would do neither. You need stabilization first. To answer another one of your questions, about a Nueromuscular dentist, they are general dentists. Mostly. I know a couple of orthodontists, that practice this philosophy.

Best I can recommend is to look up the map in the link below and find someone close to you; Ask more questions.

https://batchgeo.com/map/ab93500357547df41bb5e83c52ed3c8e

I wish you all the best. Do not do any irreversible treatments till you have all your questions answered.

Regards,

H.Nassery, DMD
www.miamibeachdentistry.com

20843573 tn?1532283434
by PokerFaceJess, Jul 22, 2018
Dear Dr. Nassery,
I am sorry that you are geographically so far away from Pittsburgh! I have Ehlers-Danlos, Type VIII, which if you are not familiar with is Periodontal, Vascular, and Hypermobility all rolled into one HUGE and painful disorder :-(. I have just 11 teeth left, and they are in terrible condition, and my gums are VERY worn away, with "raw" jaw showing through in one spot. The TMJ is also terrible, with my jaw being "locked" every morning and having to "crack" about 10 times before I can talk, drink my coffee, etc. In addition to all of that, I have herniated disks at C2, C6, and C7 (and a number down the line in T and L, as well), severe cervical instability, Chiari I, a right head-tilt, and a straightened C-spine (no natural curve whatsoever on the x-rays). I have swan-curve scoliosis, am fused from L3-S1 with the left L5 pedicle broken off from hardware malfunction, and severe L1-L2 stenosis, with nerve root and spinal cord compression (actually, spinal cord compression in three different spots, but that is the worst spot). I do wear a back brace for posture and support, so that helps somewhat. I do not really want to wear a neck brace (vanity), but would it help anyway? My question is: should I have TMJ surgery, get full dentures (I have only a broken partial on the bottom), or do you suggest something else?? I "need" back surgery to relieve the spinal cord compression, but cannot take the time off work for the long recovery. Oh, and I have hemophilia, as well. Any suggestions are more than welcome!!!!!!!

Dear Pokerface,

For sure this is a very complex case. Many issues complicating the treatment. In this case I would say that having partial dentition and incomplete arches is probably causing more harm to you and you must re-establish proper bite. Lack of proper
dental support will cause more issues in your neck and jaw joint which will then contribute to more pain and damage in both those structures.
I would say that depending on the amount of damage in your joints it is entirely possible that you need the surgery but a proper functional path and position for your jaw should be established prior to any of those treatments.

I wish you success in finding the right practitioner to help you in your recovery.

regards,

H.Nassery, DMD
www.drnassery.com

Avatar universal
by LFoltz, Jul 24, 2018
I have had 2 bi-lateral surgeries for TMJ.  The first was to reshape the  condials due to boney spurs on the condials.  This procedure was of no benefit.  The second bilateral involved removing cartilage from my ears and transplanting it into my jaw joint.  This proved to be very helpful.  My surgeon at the time was the head of the Dental School at Allegheny General Hospital in Pittsburgh Pa.  The surgeon was Dr. Guy Catone. In 2012 my jaw became very painful.  No local oral surgeon would even see me let alone do a panarex  x-ray or see me.  They all stated to return where I had it done, It was done approximately 30 years ago and I   wanted to know if the cartilage replacement was a common procedure for TMJ. I have severe arthritis In both jaw joints and need bilateral jaw replacements.  My jaw opening is extremely limited.  I had arthritis 30 years ago which was causing my TMJ pain. I did not have condial replacements. The last surgery I had some nerve damage on my left side. Lately, I been having feeling a spiderweb is over my cheek.  The sensation is not present all the time but comes in spurts.  Is this a complication of the nerve damage I had years ago.

Very confused In Pennsylvania!!!










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Dear Foltz,

Your story sounds familiar. This is exactly the argument we have for appliance therapy prior to any surgeries. The replacement of the cartilage helped you but the traumatic bite was not addressed. Hence the damage  once again occurred.

You may very well need a new surgery but before you do that you must find your physiologic bite, where it would not cause trauma and damage in your joint. You may even find that this new jaw position would be comfortable enough that you would not need a new surgery.

As for the feeling of the spider web , I would guess that is not related to your previous surgery but rather to the compression of your facial nerve somewhere along its path.  Some what  normal in TMD patients.

I hope this information helps you.

H.Nassery, DMD
www.miamibeachdentistry.com


Avatar universal
by jhcullen, Jul 26, 2018
Hi Dr. Nassery,

Thank you for your in depth studies. I watched your videos on youtube and it is a relief to see a professional that promotes the whole-body connection as a primary theory for dentistry. I'm 26/M/athletic and had braces for years as a kid. Something went wrong and I've had an underbite that has consistently grown since the age of 19. Since then my neck, shoulder, spine, hips, and all sorts of weird symptoms have been showing up and worsening. I've been chasing relief via meditation, yoga, acupuncture, chiropractic, cranial sacral etc... etc... I find it very interesting that the cervical solution is probably top-down and not bottom-up. Naturally I would have thought it to be the opposite but I am realizing that the root is probably in my bite.

Ultimately what I'm asking is are all GNM dentists created equal? Just by watching your videos and reading your website + material it is clear that you are on the frontier of Neuromuscular Dentistry. Preferably I'd start the process with you in Miami but I'm a kid living in Boston. Understanding that you have a background in Boston, can you make a recommendation for the area? I've checked the GNM map but it's hard to tell if someone is truly qualified or not. My e-mail is ***@****


God Bless - John





Dear John,

Thank you so much for your kind words. I am  glad that I may in some way be of help to you, a fellow Bostonian. That's right, I still consider myself a Bostonian, and so do my children, who were born here. Hahaha

You happen to be in luck. My good friend and mentor Dr. Ramin Mehregan is up in your neck of the woods. A bit outside the city limits but well worth the trip. I can recommend him with my eyes closed. He knows his stuff, and was very instrumental in getting me into this field. Look him up.

All the best,

H.Nassery, DMD
www.drnassery.com
www.realsmiledentistry.com

Avatar universal
by jhcullen, Aug 02, 2018
!!! Thank you Thank you Thank you !!!

Avatar universal
by EdieAS, Aug 30, 2018
Does the wear of or badly made dentures effect the TMJ and the ear?

Dear Edie,

Quick answer, Yes. Of course.

Regards,

H.Nassery, DMD
www.drnassery.com

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