Blog - Page 6 of 10 - Donald R. Tanenbaum DDS

Despite recent press advocating Botox as the next cure for TMD/TMJ problems, my clinical experience using Botox over the last 5-10 years suggests that it represents another supportive treatment at best and may not live up to the hype over the long-term.

To start the discussion let’s focus on who is even a candidate for Botox, a chemical agent that can be used to partially reduce muscle contracture. Since most of the commonly seen TMJ problems are orthopedic in nature, patients typically experience muscle and joint pain, limited jaw motion, difficulty chewing and at times joint clicking, popping, and locking.

Those patients whose problem is mainly mechanical with clicks, pops, and locking are typically not good candidates for Botox injections.

If you look at the common muscle problems we encounter with TMJ, the vast majority of patients will get better with care consisting of:

Education, behavior, and diet modification
Postural awareness
Home exercise
Massage
Short-term medication

And the more stubborn problems will get better by adding:

Oral appliances
Prescription for physical therapy
Trigger point injections and/or acupuncture

That leaves only a small percentage of patients who would benefit from using Botox to alleviate some of the persistent jaw muscle pain resulting from the accumulation of lactic acid and other irritating substances.

These situations are likely the result of persistent negative emotions (stress), daytime overuse behaviors that fatigue the jaw and/or restless sleep associated with frequent arousals, and at times tooth clenching and grinding. Even if Botox were to be used in this select population of patients, success would only be achieved if the causes were controlled or eliminated. This is sometimes not an easy task!

It is also important to realize that Botox, if used in these difficult situations, will have to be repeated at least three times over the course of 9-12 months, which will be expensive. The Botox itself will cost $525 each time with an added fee of $400-650 for each injection session. However, if you are among the select few who are candidates, you have reason to be optimistic. The patients I have treated using Botox have experienced reduced suffering, though many are still clenching or grinding their teeth to the same degree, but feel less pain as a result.

The take home message is that Botox does have its place in the management of jaw muscle pain but is far from the “cure all” remedy it is made out to be by those trying to sell it as a remedy for TMJ problems.

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat facial pain associated with jaw problems, TMJ, referred pain, nerve pain, and migraines. Find out more at www.tanenbaumtmj.com.

Biteplates Need To Be Monitored

June 18, 2013 — by Dr. Donald Tanenbaum

Thousands of people every year are prescribed biteplates by their dentists. There are two common scenarios that prompt a dentist to make this recommendation.

Scenario 1: Tooth Grinding

You went to your dentist for a routine appointment and you were told that there is evidence that you are grinding your teeth at night (sleep bruxism). Your dentist may in fact show you areas of tooth wear on your teeth. You have no jaw or tooth pain, which is good, but a biteplate is made to protect your teeth at night while you sleep. This biteplates may be made of hard acrylic, dual laminate materials with a soft inside and hard outer shell, or may be totally soft and pliable.

Since you have no symptoms of jaw or tooth pain, there is no need to do anything else. Your dentist should ask you to bring it with you when you go in for a routine tooth cleaning appointment. Overtime it may have to be remade due to wear and tear, or adjusted if new dental restorations have been placed.

Scenario 2: Jaw Pain, Stiffness, and more…

You are experiencing pain/tightness/stiffness in the jaw muscles, pain in the Temporomandibular Joints (TMJ’s), or clicking that is new or getting worse. Your symptoms may be worse in the morning as many people often wake up with symptoms of jaw pain, diminished jaw motion, and even a jaw that feels locked and out of place. Your dentist will in this situation commonly make a biteplate that can be modified over time as your symptoms change. It may have a flat biting surface or inclines to address your specific problem.

These adjustable biteplates need to be monitored as your condition improves, or if it is not helping to reduce symptoms. Just like an orthopedic splint for the knee, problems, modifications, or changes are required overtime as the situation dictates.

If your jaw problem was due to a specific trauma or injury (sports related/eating/accidental) which lead to a joint sprain, muscle strain, or joint inflammation, as healing occurs you will likely wear the appliance less until you don’t need it at all.

However, if your jaw pain, locked jaw, decreased motion, sore teeth, or headaches resulted from persistent and aggressive sleep bruxism , then long term use of the biteplate may be required. Periodic visits to the dentist will be required to determine when, and if the biteplate use can be reduced or eliminated. Regardless of the reasons that you needed a biteplate to begin with, please make sure your dentist monitors its use at least once a year.

Learn more about biteplates and oral appliances.

Facial Pain and TMD: A Persistent Domestic Stress Disorder?

June 5, 2013 — by Dr. Donald Tanenbaum

Three patient visits in the past week alone made me think that it may be time to consider formulating a new diagnostic term to categorize the countless people that I see who are suffering with facial and jaw pain but who have no history of disease, identifiable injury, or illness. I am therefore proposing a new term: Persistent Domestic Stress Disorder (PDSD), modeled after PTSD (Post Traumatic Stress Disorder) which was coined in the 1980’s as a result of ongoing studies of Vietnam veterans who returned from combat as different people.

Though defined in many ways, the most classic definition of PTSD is a “debilitating condition that affects people who have been exposed to a major traumatic event” (“Post- Traumatic Stress Disorder, PTSD”). Traumatic events that may trigger PTSD include violent personal assaults, natural or unnatural disasters, accidents, or military combat. To fit the criteria of PTSD the individual must exhibit certain symptoms subsequent to the event(s).

Symptoms of PTSD:

Intense fear, helplessness, loss of control over daily life events
Persistent re-experiencing of the traumatic event
Continual avoidance of reminders associated with the event
Increased arousal, an overwhelming inability to cope with flashbacks, insomnia, and nightmares
A duration of these conditions for at least one month*

Surely many of these elements are absent in our pain patients but there are unfortunately many similarities, therefore my new diagnostic term: Persistent Domestic Stress Disorder. Though domestic challenges and specific events may not be as vividly upsetting as those encountered in war, they are no less traumatic to the mind and soul.

Consider the following scenarios I commonly hear: 80-hour weeks to preserve a job or to become eligible for advancement, 24/7 care for an elderly parent with progressive dementia, persistent worry in our young adult patients focused around achieving in school or finding the right partner, verbal or physical abuse at home or in the workplace, fragile and unsatisfying marital relationships, uninspired children that need ongoing emotional and financial support, and coping with personal medical infirmities that cast doubt on one’s future. These are just some of the profiles that are seen routinely in my practice.

As a consequence of these challenges I see increased arousal in my patients’ nervous systems (always in “fight or flight” mode with excess levels of adrenaline and cortisol being found in their bloodstream). I hear complaints of insomnia (inability to get to sleep or stay asleep), I see shallow breathing patterns (with the end result of imbalances in the levels of oxygen and carbon dioxide in their systems) and I see acquired behaviors (such as tooth clenching, furrowing of the brow, raised shoulder, etc.) that fatigue the muscles of the head, neck, face and jaw.

As these challenges persist well beyond one month, the brain remains under siege and ultimately subtle changes in neural thresholds and muscle tone result leading to pain symptoms along with complaints of ringing/fullness in the ears, burning in the mouth, loss of balance, or tingling in the face. Patients arrive at my office often exhibiting helplessness and are easily moved to tears when they are reminded of the issues in their lives that they have been trying to avoid thinking about.

Though bringing these concepts to light may make patients wonder if they can actually feel better when faced by these huge obstacles, there truly are strategies that can be employed that bring definitive relief.

If you are suffering from facial or jaw pain, your symptoms are real. They are common and familiar to those of us trained in the recognition and treatment of Orofacial pain and Temporomandibular disorders. There is no “quick fix,” rather comfort will only be realized if nerve thresholds return to normal, muscle tension eases, sleep is regained and optimism and control are restored within an individual’s personal world.

You can be helped to feel better. Fortunately there are strategies that work and health care providers like myself who can help.

Read more about how I work with patients suffering with facial and jaw pain, and the symptoms of TMJ on my website.

*Spinrad 1

Who is Monitoring Your Snoring or Sleep Apnea Appliance?

April 30, 2013 — by Dr. Donald Tanenbaum

Based on the number of emails I weekly receive advertising courses for dentists to learn how to make and provide oral appliances for snoring and sleep apnea I can only assume that an increasing number of adults are receiving these devices. Though these devices can provide great benefit socially (allowing bed partners to sleep in the same room) and medically by reducing the risk of heart related problems, once inserted these devices must be monitored.

Why You Should Always Monitor Oral Appliances

Is the oral appliance doing what it is intended to do? For the simple snoring patient the answer is easy. For the apnea patient, the answer is a guess unless a follow up sleep study (home test or laboratory) is done. Just the cessation or reduction of snoring may not mean that the apnea condition has been adequately addressed. The dentist who puts in the device must direct the follow up process.
These appliances can cause tooth shift, opening spaces between teeth leading to food traps, and lead to movement of front teeth that were straightened with braces. These problems can be eliminated or minimized with follow-up visits.
In approximately 15 percent of patients that wear these appliances over one year, there is a good chance that a bite change will occur not allowing the back teeth to hit as they once did. Heavy contacts are put on the front teeth with likely consequences such as chipping and reduced mobility. Follow-up visits can not only prevent this from happening but if noticed, modifications can be made with regard to how often the appliance is worn and where the position is set.
In some people these appliances can lead to jaw problems such as muscle or joint pain, joint noises, and even limitations in jaw motion and functional abilities. Since the jaw is an orthopedic system, healing will then be dependent on making appropriate changes, which can only be determined by follow-up visits.

The Take Home Message About Monitoring Oral Appliances

If your dentist is not insisting on follow-up visits, speak up and get back on his or her schedule. Also, these appliances do not last forever! Replacement is usually necessary after 3 -5 years based on normal wear and tear.

TMJ Symptoms: Is Technology Necessary To Feel Better?

April 16, 2013 — by Dr. Donald Tanenbaum

Recently as I flipped through a running magazine I came across an article that discussed the process of getting better following a leg injury. After reading this article I reflected for a moment on the current state of thinking within the dental profession as it relates to TMJ treatment options and the process of getting better following the emergence of symptoms in the TM Joints and jaw muscles.

The running article in a straightforward fashion outlined the principles of healing that would be required for typical leg injuries, inclusive of sprains/strains in order to get better. The focus, as expected, was on resting the injured tissues, supporting the injured tissues with wraps and braces based on the established diagnosis, heating/icing the area of concern, using medications to decrease pain, inflammation, and spasm, and employing home care strategies or formal physical rehabilitation efforts. The article repeatedly conveyed the theme that healing is a process and that similar orthopedic injuries may require different timeframes and treatment selections from person to person.

Unfortunately when it comes to TMJ problems, there continues to be a constant emergence of alternative strategies that seem to suggest that healing can only occur if assisted by some sort of high-tech wizardry and rearrangement of the teeth and jaw relationships. In fact, over the last 6 to 12 months endless email messages have been sent to dentists in the U.S. and abroad that offer new technologies that not only ‘cure’ TMJ problems but add an ongoing profit center to dental practices.

According to the ‘experts’ who are behind the sales pitch, accurate diagnoses can only be made with electronic instrumentation, which tracks jaw motions, and sensors which record the sequence, intensity, and duration of tooth contacts when the teeth are brought together.To the uninformed and sometimes vulnerable patient, these bells and whistles are rather convincing but unfortunately add cost and unnecessary treatment, usually inclusive of multiple sessions of ‘bite balancing’ or ‘bite reconstruction’ based on data collected on technology that has no scientific support.

To further cloud the issues, if a patient gets better during the weeks or months of technology guided treatment, success is attributed to the technology, not to the passing of time, or other strategies that may have been initiated.

The take home message

Jaw problems like other orthopedic problems typically get better without electronic technology. Though seeking professional care may be essential to your recovery, if more time is spent by the doctor you chose hooking your head and jaw up to sensors and tracking devices, getting a second opinion is recommended and probably in your best interest.

To learn about other possible jaw & facial pain treatments, please click below:

Are Anti-Inflammatory Medications Safe for TMJ?

April 11, 2013 — by Dr. Donald Tanenbaum

Though it is common for many TMJ sufferers to take anti-inflammatory medications called NSAIDs, which are available without a prescription in local pharmacies and in super-sized containers in big box stores, they are not as safe as presumed.

The most common of these over the counter medications are Advil and Aleve and many of my patients down them as if they are sugar-coated candies. Even when the medications are not working, patients continue to use them, wrongly assuming that since they are available without a prescription that they are safe in any quantity.

For the most part, short-term use of these medications for a period less than ten days should not pose any health concerns. Unfortunately, many TMJ problems may require weeks of use in order for muscle and joint inflammation to be controlled. As a result, these medications can pose cardiovascular, kidney, and gastrointestinal risk.

In particular, patients with a previous history of a heart attack are more at-risk for another episode when taking this class of medication. Medications for high blood pressure and so-called ‘water pills’ (anti-diuretics) may also not work as well when NSAIDs are taken at the same time. Kidney performance can suffer as well when taking these medications in an uncontrolled manner over an extended period of time.

Though these medications are commonly associated with stomach upset prompting patients to discontinue their use after a short period of time, many patients tolerate these drugs for long periods before the side effects of upset stomach and bloody stools are experienced. By this time, damage may have already occurred to the stomach and other parts of the digestive system. So here are some suggestions:

Using NSAIDs Safely

Don’t take these medications for more than two weeks without professional guidance.
Make sure you take these medications with at least twelve ounces of water or after a meal.
Take these medications at the recommended time interval between doses and not before, even if pain begins to increase.
Don’t rely on these medications to ease symptoms. Use other strategies at the same time to help decrease inflammation. These other efforts can include following a soft diet, using ice/heat, self or professional massage, stretching your jaw muscles; the list goes on.
If while taking these medications you begin to bruise easily, discontinue use immediately and consult with your physician.
If you have a history of hypertension, routinely take your blood pressure when on these medications.
If your stomach begins to hurt or your stools darken, discontinue these medications and consult with your doctor immediately.

In summary, NSAIDs are tremendously helpful medications, but benefit and risk should always be weighed. If you are not sure, whether to use or continue using these medications, professional consultation is always advised.

There are more treatment options available to help alleviate TMJ pain:

The Truth About TMJ Arthritis

April 2, 2013 — by Dr. Donald Tanenbaum

When people describe their arthritis pain they often mention knees, hips, hands and shoulders. Though rarely mentioned, arthritis can also be experienced in the jaws, specifically focused in the temporomandibular joints, or TMJs. Just as with these other joints, arthritis in the TMJs can be experienced as pain, stiffness, and limited motion and function.

Most of the arthritis experienced in the TMJs is the result of past trauma, or longstanding jaw problems that have caused wear and tear to the bones, cartilage, ligaments, and lubricating system (degenerative changes). As a result, friction develops giving rise to joint noise, and at times pain and function that is limited.

It is interesting to note that most arthritic changes that occur in the TMJs over time are not accompanied by acute pain. In fact, in aging populations around the world, most arthritic changes in the TMJs are not even accompanied by the need to seek care. The arthritic changes may prompt annoying and at times frightening noises, but for the most part do not limit eating, opening or closing the mouth, or talking.

At times however, arthritic changes in the TMJs cause bite changes that lead to changes in facial appearance and inefficient chewing. If pain accompanies the arthritis and lingers there may well be a need to seek professional guidance. The use of medications, steroid injections, exercise, massage, physical therapy, and dental splints may be essential in controlling the arthritic process. Treatment at times can span months in order for the arthritic process to be arrested.

The most problematic arthritis we see is in young females between the ages of 16-25. The arthritis often results from a number of risk factors including gender, genetics, overuse behaviors, sleep bruxism, and structure including the way the teeth come together. A multi-disciplinary approach is often needed to manage these problems. Certainly, painful arthritic problems need to be treated by a professional.

Other arthritis problems may include psoriatic arthritis, gouty arthritis, and rheumatoid arthritis. These may need to be investigated by a rheumatologist and at times require long-term care inclusive of medications.

If you are currently suffering from TMJ, please consider trying these 15 home remedies for TMJ pain. If they are ineffectual or the pain worsens, seek a medical professional immediately.

Home Therapy for TMJ

March 28, 2013 — by Dr. Donald Tanenbaum

I’m a TMJ specialist. Patients often tell me that they’ve been told that there is no treatment for TMJ problems and that they will struggle with this problem for the rest of their lives. To the contrary! TMJ problems like all other orthopedic problems are common and treatable.

We have many types of specific treatments for TMJ in the office, but there are also a number of home therapies that have shown to be rather beneficial for the vast majority of TMJ sufferers. Whether your TMJ problem is focused in the jaw muscles, the jaw hinges (the temporomandibular joints), or the associated tendons and ligaments, the basic principles used to treat all orthopedic problems apply.

Rest, support, medication, and rehabilitation are often the key ingredients to success. Though only some jaw related problems require professional care, ALL TMJ problems require home care strategies to achieve the goals of pain elimination and restoration of function. What follows is a thorough list of home care strategies for overcoming TMJ pain.

15 Home Therapies for TMJ Sufferers

1) Apply heat over tender muscles and apply cold over tender joints. At times, my patients choose to cool with ice packs first over both the muscles and joints for 5 minutes and then follow with heat for 15 minutes. This can be repeated several times a day.

2) Avoid overuse of jaw activities and behavior that fatigues the jaw muscles. This is critical to achieve healing. Overuse activities include gum chewing, nail & cuticle biting, biting on pens, pencils, straws, ice, plastic items, eyeglass frames; the list goes on.

3) Avoid clenching your teeth during the daytime. For techniques to help you overcome this behavior, click here.

4) Avoid cradling your phone between your shoulder and neck and try to reduce the amount of time you are texting. Your head in a forward posture for lengths of time wreaks havoc on your neck and jaw muscles.

5) Apply pain-soothing gels over the jaw, neck muscles, and jaw joints. These may include BenGay, Aspercreme, Biofreeze, but many other preparations are available in the local pharmacy. (Note: some of these products contain menthol, arnica, aspirin, and other anti-inflammatory ingredients so make sure you are not allergic or sensitive to these products.)

6) Try TENS stimulation. TENS is a form of muscle stimulation that can help reduce spasm, muscle tension, and relieve pain. TENS devices can now be found on the Internet, but be advised as they do require instruction in order to be used safely.

7) Muscle massage techniques can be used over the temporalis muscle and masseter muscle (which is the big muscle that bulges when you clench your teeth). These muscles can be rubbed and massaged as you would for a sore calf or thigh muscle, applying enough force to be uncomfortable but not too much force that your eyes tear. This can be done for 2-3 minutes 3-4 times a day and the best place to do it is in the shower. There are a number of YouTube videos you can watch to help guide your technique.

8) Avoid hard, large, tough, and/or chewy food. I don’t recommend a mushy diet but rather a thoughtful diet. If you experience pain during or after a meal, you probably ate the wrong food.

9) Minimize caffeine intake (even chocolate) and nicotine use.

10) Abstain from drinking alcohol close to bedtime hours as it leads to restless sleep.

11) Hydrate with a good amount of water throughout the entire day.

12) Try your best to get 7-8 hours of restful sleep every night.

13) Avoid electronic stimulation prior to going to bed. Your cellphone, laptop, and other various devices can all negatively affect your sleep cycle.

14) Exercise routinely, at least a few times throughout the course of the week, to build endorphins and reduce daily stress. Endorphins are our bodies’ natural painkillers.

15) Practice diaphragmatic breathing or even meditate during the day to slow the number of breaths you take per minute.

Certainly you may need more directions of care, as every patient is unique, but these ideas, if pursued consistently, will surely provide some relief or buy some time until you are able to see the proper medical professional. If any of these recommended techniques increase your pain or aggravate your jaw in any way, they should be discontinued immediately.

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat facial pain associated with jaw problems, TMJ, referred pain,nerve pain, and migraines. Find out more at www.tanenbaumtmj.com.

Women, Sleep, & Pain

February 27, 2013 — by Dr. Donald Tanenbaum

In my practice it has been a given that over the course of any, day, week, month, or year, the number of female patients seeking care significantly outnumbers male patients coming through the door. In fact, recent statistics have revealed that 77-82% of the patients we see with muscle pain, migraines, nerve pain, or TMJ problems are women.

As a result of this on-going theme in practices all over the world, researchers have focused on isolating the reasons why this gender dominance occurs when it comes to facial pain problems. Though absolute answers have not been agreed upon, there seems to be a general consensus that women seek care more than men for facial pain problems for three specific reasons.

Why Women Seek Care For Facial Pain More Than Men Do

The origin of many Facial Pain problems appears to be related to biologic factors. The most important likely relates to the hormone estrogen and it’s influence on inflammation, tissue injury, and the way the brain perceives pain.
Women have fewer ways to express anger than their male counterparts, and as a result their autonomic nervous system (involved in the “fight or flight” response) fires excessively.
Women look for answers to symptoms and medical concerns to a much greater extent than men and as a result women visit physicians more than men.

Other Gender Concerns?

Now there also appears to be gender concerns when it comes to the condition obstructive sleep apnea, which puts patients at risk for multiple medical problems including daytime sleepiness, cardiovascular disease and brain injury as a result of oxygen deprivation while sleeping. A small percentage of our facial pain patients have been diagnosed with this problem and many of them wake up with morning headaches and commonly report grinding and clenching of their teeth when they sleep. What is most interesting, however, is that according to a recent study at the University of California, Los Angeles, women who have sleep apnea may experience more damage to their brain cells as a result of the condition than men with obstructive sleep apnea.

In this study of 80 participants, researchers analyzed brain nerve fibers to find differences in brain cell damage between those with sleep apnea and those without, as well as between men and women with the obstructive sleep apnea. In addition to finding a higher severity of brain cell damage in the women with sleep apnea, they also found that the women with this sleep condition had more symptoms of depression and anxiety than the men. The researchers caution that additional studies are needed to fully understand these results.

Why is this important?

Knowing that between 2 to 4 percent of middle-aged women experience obstructive sleep apnea, and that upwards of 90 percent of them will never be diagnosed, there are millions of women who may be at considerable risk from the consequences of impaired breathing while they sleep.

As a result of these concerns, all my patients, regardless of gender, are screened for sleep-related breathing disorders including snoring and obstructive sleep apnea as a matter of course. As the stereotyped sleep apnea patient has always been an overweight male with a large middle section many of my female patients are rather surprised when testing reveals that they have an airway problem when sleeping. With this knowledge in hand my ability to help my patients is greatly enhanced.

PCOS, Toothache, and Facial Pain – The Connection

February 14, 2013 — by Dr. Donald Tanenbaum

Case Study: Regina, Female, Age 45

In this case study, I discuss the connection between PCOS (Polycystic Ovary Syndrome), Toothache, and Facial Pain.

For over two years Regina had suffered with toothache pains, which persisted despite several root canal procedures and ultimately the extraction of several teeth. Even with these efforts and consultations with a number of dentists and dental specialists, she continued to suffer.

Evaluations by an internist and a neurologist led to further upset as she was told that “there is nothing wrong” and that she should return to her dentist.

Regina did not know where to turn.

Like many other patients that I see, Regina did in fact have tooth pain but the origin was not in her teeth. Her pain was due to a type of neuropathy (damage to the nervous system) that was likely related to a medical condition called PCOS and it’s association with Type 2 Diabetes.

PCOS, the common abbreviation for Polycystic Ovary Syndrome, is a condition in which a woman has an imbalance of female sex hormones. This may lead to menstrual cycle changes, trouble getting pregnant, and other health issues. Most important, however, the disorder shares a key factor with Type 2 Diabetes; namely the imbalance of blood glucose and insulin called Insulin Resistance.

Simply stated, Insulin Resistance is a malfunction of the body’s blood sugar control system (insulin system) is frequent in women with PCOS, who often have elevated blood insulin levels. Researchers believe that these abnormalities may be related to the development of PCOS.

In individuals where diabetes is not well controlled there are often constant high levels of blood sugar. Over time this can cause damage to both blood vessels and nerves throughout the body, including these structures in the face. The nerves can become physically damaged or inflamed causing pain, numbness and weakness.

According to the National Diabetes Information Clearinghouse, when this affects the nerves of the face, it is called a Focal Neuropathy. In fact, Diabetes is the biggest risk factor for neuropathy today!

How Was Regina Helped?

With the knowledge that Regina’s tooth pains were unrelated to her teeth but rather to her underlying PCOS and Diabetes, the focus of her treatment completely changed. All dental efforts (which had previously done nothing but make her pain worse or spread to adjacent teeth) were suspended and she was put into the hands of a group of medical specialists, of which I was one, who focused on her blood glucose levels and her weight gain, which had made her anxious and constantly upset.

I prescribed medications to diminish Regina’s nerve excitability and taught her strategies to ease jaw muscle tension, spasm and pain, which had developed secondary to her tooth pain suffering, which had persisted without answers. An oral appliance was also prescribed while sleeping as her variable blood glucose levels has impacted the quality of her sleep and led to increased levels of night clenching. My interventions helped ease her suffering considerably while her other physicians addressed the blood sugar issues.

Regina Today

For the most part Regina is pain-free except the when her blood glucose levels fluctuate excessively during times of high stress or sleep deprivation. When she does come to my office once in a while complaining of tooth pain and sensitivity in teeth that are structurally sound, I provide reassurance that her pain is real, but just not in the teeth.

This validation and getting Regina back on track with regard to sleep, stress, glucose levels, and weight remain critical to her long-term comfort.