TMJ treatment: Orthodontics vs dental orthopedics

 

TMJ treatment: orthodontics vs dental orthopedics

It is embarrassing to myself and my profession that dentistry is so ill informed as to the difference between orthodontics and dental orthopedics.  Orthodontics is used to straighten teeth (typically done with braces).  Dental orthopedics treatment is done to shape the jaws and to align the upper and lower jaw bones to each other (dental orthopedics cannot be done with braces, typically done with appliances that contact closer to the gum level or with repositioning appliances that cover the top of the teeth).   TMJ is most often caused by a jaw misalignment, an orthopedic problem; one that cannot be solved with orthodontics!   Most of my patients with long term TMJ have submitted to orthodontic treatment (braces) in the past at the recommendation of well meaning dentists in an attempt to correct the TMJ dysfunction. It rarely is helpful in the least.

Patients present with dental orthopedic defects in any of three dimensions in any given dental arch, as well as frequent defects between the upper and lower dental arches.  Jaws can be too narrow, not long enough, and almost always not tall enough.  This causes broad  muscular and neurological dysfunction leading to a wide spectrum of disease conditions.

Orthodontics as it is primarily taught in the country, is designed to give you pretty teeth, not align your jaw.  In my opinion, this is due to the fact that orthodontists don’t understand the biomechanical principles of occlusion, nor do they take any functional tests to assess where the jaw posturing muscles want the jaw to be.  Orthodontists typically fail to diagnose and recognize orthopedic defects.  This leads to brutal therapies like extraction of bicuspids or orthognathic surgery.

And when orthodontists are in the process of doing orthodontics and encounter TMJ symptoms (headaches, facial pain, ear pain, jaw clicking, etc.) they typically continue with only braces in an effort to correct a dental orthopedic problem.  This is doomed to fail.  Braces move teeth, not jaws!! When orthodontist use elastics to move jaws (e.g. class II dental defect), they can be dentally successful, but rarely orthopedically successful (teeth can move without the jaw moving).

Once a dental orthopedic appliance locates the correct jaw to jaw relationship, then orthodontic techniques are often helpful to move the teeth so as to support the jaw in the new  position.  This protocol is poorly understood by dentists/orthodontists.  Dental orthopedic treatment should precede orthodontic treatment, though rarely done by orthodontists.

Most orthodontists are also confused about the difference between intra arch dental orthopedics vs inter arch dental orthopedics.  Intra arch dental orthopedics is used to develop the individual jaw bone (so as to accommodate all the teeth). Where as inter arch dental orthopedic techniques are used to align one jaw to the other (different appliances to accomplish different goals).

The very vast majority of orthodontists proceed with orthodontics without ever doing any functional tests to see if the jaw is out of alignment (most people are out of alignment).  Traditional orthodontic records are only static records of structure only!  It is necessary to take functional records (or do functional tests) to assess whether the jaw is aligned.  How to do functional tests and check jaw alignment is not taught in dental schools.

As you can see TMJ treatment: orthodontics vs dental orthopedics is a very confused area for dentistry and medicine.  Osteopathic medicine which often assesses cranial function  typically does not understand how to assess whether the jaw is aligned.  This leads to a lack of communication and under utilization of dental orthopedics in treating many health conditions.

For further insight into this difficult area see: dentalorthopedics.com

 

 

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Magnesium deficiency and TMJ

Magnesium Deficiency and TMJ

Medical research  is very clear that magnesium deficiency causes highly elevated substance P levels, but high substance p levels are also found with jaw misalignment.  When both conditions are present it could easily account for the generalized hypersensitivity, severe allergic responses, and sensory abnormalities often found with TMJ dysfunction.  Though in many cases the TMJ may be covert and not readily apparent to neither the patient or their dentist.

Magnesium deficiency is also found in a number of other illnesses including type 2 diabetes, fibromyalgia, asthma, heart disease, osteoporosis, migraine, premenstral syndrome, and restless leg syndrome.  Magnesium deficiency and TMJ in combination would only worsen any of the above illnesses.

Mental disorders, mood disorders, anxiety, TBI, and PTSD are all known to be affected by magnesium level in the brain.  Substance P levels can become dramatically elevated very rapidly in situations of acute stress.  When there is an overlayed bite problem causing further elevated substance P levels, it can prevent the brain from ever recovering.  The combination of magnesium deficiency and TMJ can condemn a person to lifelong dysfunction that would be hard to recognize by most medical practioners.

Magnesium is available in many forms. Recommended types include magnesium citrate, magnesium gluconate, and magnesium lactate, all of which are more easily absorbed into the body than other forms.  One should also take vitamin B6 as it determines how much magnesium is absorbed.  One might consider topical forms if they find too many side effects from oral supplementation.

 

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TMJ Treatment Bay Area and Substance P

TMJ Treatment Bay Area and substance P

Substance P measurement is an essential part of dental orthopedic treatment directed at resolving neurogenic inflammatory disorders.  It is the measurement of substance P that verifies that any treatment was effective, and to what extent it was effective. For TMJ treatment Bay Area our office is now starting to incorporate substance P testing routinely in many of our cases.

A  big problem for TMJ treatment Bay Area and substance P testing is that Quest Diagnostics has a major error in what they list as normal levels.  Our clinical cases are starting to provide us with a better idea of what is ideal levels for substance P.

Case treatment with other medical professionals continues to surprise me at the lack of knowledge about substance P, the pain neurotransmitter.  Doctors must spend at least 70% of their time treating pain, but their knowledge of the pain neurotransmitter is severely lacking.  This knowledge is important for them to make decisions about other conditions the patient may be experiencing.  The dental profession has failed to educate the medical community as to the influence of dental orthopedic defects on systemic substance P levels.

TMJ treatment Bay Area and substance P hopes to remedy some of these shortfalls and provide evidenced based data to provide insight into the cause of a number of associated medical pathologies.

 

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Cancer, Substance P, and your bite

Cancer, Substance P, and your bite

Note Substance P: the neurotransmitter for all pain signals to the brain. Substance P naturally becomes elevated with eating. Systemic levels are heavily influenced by jaw alignment (which is off in the vast majority of people). Substance P has two primary influences on the body: 1)primary mediator of inflammation 2) hypersensitizes all sensory neurons

Extensive medical literature exists about how substance P (see substanceP.info) is a suspicious compound as to the cause of many types of cancer. I have known for decades that “precise dental orthopedic therapy” based on “biomechanical principles of occlusion” is highly effective at reducing substance P levels as dental orthopedic treatment is readily resolves many medical conditions associated with elevated substance P (see Substance P Cascade).

Over the past couple years I have been measuring substance P levels (Quest Diagnostics Note: their normal levels are severely off) on a number of cancer patients with jaw misalignment before and after precise dental orthopedic treatment.  The results have been nothing but dramatic.  The treatment has been able to reduce substance P levels by up to 90%.  The leukemia and lymphoma cases have responded dramatically over about a two month period of time.  Cervical cancer cases CA125 levels have dropped slowly over time to around 11.0. This is only preliminary results and will need to be tested further with a greater number of cases, but due to the non-invasive manner of the treatment, dental orthopedic therapy should be considered when faced with much greater invasive options.  Lowering substance p levels should also be the goal of medical treatment to prevent the recurrence of cancer.

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Headache Treatment Confusion

Headache Treatment Confusion:

Headache treatment confusion is all around us.  This  became very

headache treatment

Finding the solution to headaches

evident this week with a new patient that has gone to great lengths to find a solution for her constant headaches for the past 9 years.  The following is further evidence of this catastrophe-even when addressed by such a notable organization as the World Health Organization.

“A number of notable facts about headaches from the World Health Organization:

A minority of people with headache disorders worldwide are diagnosed appropriately by a health-care provider.  Headache has been underestimated, under-recognized and under-treated throughout the world. Headache disorders are associated with personal and societal burdens of pain, disability, damaged quality of life and financial cost. Globally, it has been estimated that prevalence among adults of current headache disorder (symptomatic at least once within the last year) is 47%. Headache disorders impose a recognizable burden on sufferers including sometimes substantial personal suffering, impaired quality of life and financial cost. Repeated headache attacks, and often the constant fear of the next one, damage family life, social life and employment.

Treatment

Appropriate treatment of headache disorders requires professional training of health professionals, accurate diagnosis and recognition of the condition, appropriate treatment with cost-effective medications, simple lifestyle modifications, and patient education. The main classes of drugs to treat headache disorders include: analgesics, anti-emetics, anti-migraine medications, and prophylactic medications. However a large number of people with headache disorders are not diagnosed and treated.

WHO response

These evident burdens call for action. WHO recognizes this, and is a partner, with the non-governmental organization Lifting The Burden, in the Global Campaign against Headache. This initiative, began in 2004 and aims not only to raise awareness of headache disorders, but also, to improve the quality of headache care and access to it worldwide. WHO published the Atlas of headache disorders in 2011 describing the burden due to headache disorders and resources available to reduce them.”

 

Headache treatment confusion results from a lack of knowledge of the anatomy and  physiology of headaches. It is evident from the treatment approaches listed by the World Health Organization (only pharmacological), that the doctors advising them do not understand headache anatomy and physiology.  It is unlikely that they will change headache treatment confusion to any degree.

Headache treatment confusion will only be corrected when the contribution to jaw alignment (dental orthopedics) on head pain receptors becomes better recognized.

 

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Substance P and Oxygen- impact on cancer and brain health in San Francisco Bay Area

Substance P and Oxygen:

Substance P and oxygen are two of the most fundamental compounds necessary for proper function of the body.  Substance P is present in most tissues in the body, and perhaps the best way to view it is as the most primitive sensory system in the body.  As such, all other sensory systems are built on top of it, so when its levels go awry, so do other sensory systems (like endocrine, glucose, etc.).

Jaw misalignment causes substance P levels to become elevated throughout the entire body.  Excess levels of substance P causes all sensory neurons to become hyper sensitized, hence causing a loss in homeostasis, and subsequently   a wide spectrum of medical disorders.

What is little known is that substance P directly influences oxygen levels (see abstract below).  Substance P is known to be the primary regulator of the oxygen sensor component of the carotid body.  This has the potential in selected cases to seriously impact oxygen levels in all tissues, and most importantly in critical brain cells.  I n addition, substance P is a major mediator of inflammation.

Substance P has also been shown to have the ability to significantly increase mitochondrial activity level.  This is important in a number of illnesses: cancer, neurodegenerative disorders, autism, etc. (see abstract below).  These are major new insights supportive of the suspected link between dental orthopedic defects and cancer.

 

Peptides. 1989 Sep-Oct;10(5):1003-6.

Substance P and mitochondrial oxygen consumption: evidence for a direct intracellular role for the peptide.

Prabhakar NRRunold MKumar GKCherniack NSScarpa A.

Source

Department of Medicine, Case Western Reserve University, Cleveland, OH 44106.

Abstract

Substance P (SP), a member of the tachykinin group of peptides, has been shown to augment the sensory discharge of the carotid body, an oxygen sensing chemoreceptor. In this study we present evidence that the excitatory effect of SP, in part, could arise from a direct effect of the peptide on mitochondrial oxidative phosphorylation. Measurement of the partition coefficient of SP showed that the peptide has a relatively high apolar partition, which could be consistent with its distribution across lipid bilayers and in intracellular organelles. In addition, the effects of three concentrations of SP were tested on oxygen consumption of mitochondria isolated from rat hearts. The results showed that while the lower concentration of the peptide (0.5 microM) did not affect O2 consumption, higher concentrations, i.e., 1 and 2 microM, enhanced the rate of state 4 respiration by 52 and 64%, respectively. The rate of state 3 respiration, on the other hand, was unaltered with 0.5 and 1 microM, and was only slightly decreased with 2 microM of the peptide. The ADP:O ratio was unaffected by any concentrations of SP tested. The peptide-induced effect on state 4 respiration was even more pronounced with glutamate as a respiratory substrate and in presence of K+ in the medium. These results indicate that SP, in addition to its more accepted role as a neurotransmitter or modulator in the carotid body, may elicit intracellular response by interfering directly with oxidative phosphorylation.

PMID:2481845

 

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Cancer Treatment San Francisco Bay Area

Cancer Treatment San Francisco Bay Area

Cancer Treatment San Francisco Bay Area is about finding real solutions for cancer.  Clinical case histories are further validating the strong theoretical  foundation that elevated substance p secondary to jaw misalignment are a major contributory factor to  the development of multiple types of cancer. See prior blog.

Today I saw two cases that I have been treating with dental orthopedics for 6months and fifteen months respectively.  Both have had major improvement in their cancer markers.  The first case with leukemia has dramatically improved his blood cell types.  In this case, his substance P levels have dropped from over 300 to 39 (less than 60 is normal). It is suspected that the elevated substance P was impacting stem cell differentiation (based on research).

The other with breast cancer has documented many months of continued improvement in CA125.

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TMJ, Substance P, and Cancer

TMJ, Substance P, and Cancer:

substance P

Substance P molecule

Case histories suggest daily, ever stronger, that bite dysfunction with its sub-sequential elevated substance P through trigeminal nerve stimulation, is likely a major contributor to the development of many types of cancer.  This belief is based on a multitude of clinical observations and very strong medical literature.

Medical Literature:Substance P is known to be a major regulator of tumor cell proliferation (favoring tumor growth), angiogenesis, and migration of the tumor cells for invasion and metastasis (see article-particularly look at extensive references in article or abstract below).  The role of substance P in stem cell differentiation strongly suggests that bite dysfunction is likely cause of a large percentage of leukemias and lymphomas (see article or abstract below).

Case histories:

The incidence of breast cancer amongst my TMJ patients is very high.  Currently, I am providing optimal dental orthopedic therapy in conjunction with physician managed treatment for a number of other cancers with good early response.

 

 

Neurokinin-1 Receptor: A New Promising Target in the Treatment of Cancer

Published on October 8, 2010
Author: Miguel Muñoz
Specialty: Pediatrics
Institution: Research Laboratory on Neuropeptides, Hospital Infantil Universitario Virgen del Rocío
Address: Sevilla, 41013, Spain

Author: Rafael CoveñasSpecialty: Neuroscience
Institution: Laboratory of Neuroanatomy of the Peptidergic Systems, Institute of Neuroscience of Castilla y León (INCYL), University of Salamanca
Address: Salamanca, 37007, Spain

Abstract: Substance P (SP) has a widespread distribution in the whole body. After binding to the neurokinin-1 (NK-1) receptor, SP regulates biological functions related to cancer: tumor cell proliferation (favoring tumor growth), angiogenesis, and migration of the tumor cells for invasion and metastasis. SP also exerts an antiapoptotic effect. The peptide is secreted from primary tumors and from peripheral nerves, and reaches the whole body through the blood stream. NK-1 receptors are overexpressed in tumors (cancer cells express more NK-1 receptors than normal cells). By contrast, after binding to NK-1 receptors, the NK-1 receptor antagonists specifically inhibit tumor cell proliferation (tumor cells die by apoptosis), angiogenesis and the migration of the tumor cells. Thus, 1) the SP/NK-1 receptor system plays an important role in the development of cancer, angiogenesis, and metastasis; 2) a common mechanism for cancer cell proliferation mediated by the SP/NK-1 receptor system occurs; 3) NK-1 receptor antagonists act as a broad-spectrum antitumoral agent; 4) the NK-1 receptor could be a new promising target in the treatment of cancer; 5) NK-1 receptor antagonists could improve cancer treatment — the development of antagonist molecules of the NK-1 receptor represents an important opportunity for exploiting these molecules as novel therapeutic agents.

 

Postepy Hig Med Dosw (Online). 2009 Mar 2;63:106-13.

[Substance P as a regulatory peptide of hematopoiesis and blood cell functions].

[Article in Polish]

Source

Zakład Hematologii Eksperymentalnej, Instytut Zoologii Uniwersytetu Jagiellońskiego, Poland.

Abstract

SP is an undecapeptide that belongs to the family of related neurokinins termed tachykinins. SP is one of the mediators responsible for the neural-immune/hematopoietic cross-talk. It is released from the nerve fibers of the autonomic and enteric nervous systems in lymphoid organs and is also produced by the resident, stromal or hematopoietic cells. SP stimulates the production of hematopoietic cytokines (e.g. IL-1, IL-3, IL-6, SCF, GM-CSF) by bone marrow stromal cells. It enhances the proliferation of bone marrow progenitors, both directly by binding to progenitor’s receptors and indirectly by interacting with marrow stromal cells. SP can also modulate immune and hematopoietic functions like phagocytosis, immunoglobulin production, lymphocyte proliferation and platelet aggregation. SP fragments derived from endopeptidase activity could also exert immune and hematopoietic regulation. The biological effects of SP are mediated through interactions with certain G protein-coupled receptors: the neurokinin (NK) receptors. Different studies have shown that NK receptors are localized on immuno-competent cells, including monocytes/macrophages, neutrophils, mast cells, dendritic cells and T or B lymphocytes, bone marrow stromal cells and hematopoietic progenitors. The disturbance of the neural-hematopoietic-immune axis may be implicated in hematological malignancies. SP seems to be important in the neoplastic transformation of bone marrow, leading to the development of acute leukaemia in children; myelofibrosis and also metastases to bone marrow of solid tumors in early stages of these diseases.

PMID:19252469  Free full text

 

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Dental Orthopedics

Dental orthopedics is the area of dentistry concerned with the structure, function, and alignment of the upper and lower jaw bones.  It is some times referred to as dentofacial orthopedics, craniomandibular orthopedics, or jaw orthopedics.  The term is applied to efforts to expand the size of jaw bones (vertical and horizontal), lengthen the upper or lower jaws, or reposition either the upper or lower jaw.

There are many appliances that are designated as dental orthopedic appliances like Crozats, Bimler, Schwartz, Bionator, Sagittal, etc.  Splint therapy, occlusal guards, and sleep apnea appliances  are also a form of dental orthopedics as they reposition the lower jaw.

The American Dental Association some years ago changed the official title of orthodontists from “orthodontic specialist” to “orthodontic and dentofacial orthopedic specialist” without substantially changing their educational requirements.  Hence, many orthodontists know very little about dental orthopedics and concentrate on aligning teeth with braces.  This treatment often falls short of the most ideal treatment.  Giving someone a pretty smile does not assure that their jaw is appropriately developed laterally, vertically, or positioned properly in space.  This has to be done with proper assessment (medical history and functional tests), and often appliances other than braces.

Before the proper orthopedic treatment can be rendered to a patient, it is necessary to have a good understanding of ideal structure and function.  This is missing in orthodontic training.  Research shows that modern man has devolved with substantial retrusion of both the middle and lower face.  Too many orthodontists are too willing to work with the structure that their patients present with since most orthodontic training programs impart a poor understanding of ideal structure and how to achieve it.

In addition, in order to provide proper orthopedic treatment, it is critical that the correct diagnostics are perfomed before treatment begins.  Before orthodontic treatment is initiated there are certain dental records that are required legally to satisfy the standard of care.  They include study models, photographic pictures, and dental x-rays and cephalometric x-ray (side view of head).  These are only structural tests.  This list does not include the critical functional assessment of where the muscles want the jaw to be, nor how much tension is in the muscles when the teeth are brought together, etc.

It is not surprising under such circumstances, why many patients end up after orthodontic treatment with significant dysfunction and TMJ pain.  Corrective treatment then is to do the dental orthopedic diagnostics that were never done.

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Another reason why TMJ treatment fails

There is something to be said for years of experience.  One of the things that I have observed from treating thousands of TMJ cases is that compressed jaw joints continue to decompress for months, if not years.  This is demonstrated by the fact that over time many cases develop excess anterior contact or the lower jaw functionally wants to be more forward.  This is such a consistent phenomenon that my treatment is designed to allow for this movement.  In less experienced professional treatment plans I suspect that it leads to many cases of recurrent pain and joint dysfunction.  It is but another reason why TMJ treatment fails.

The best way that I have found to remedy this moving structure is over treat TMJ cases such that I leave them with an anterior open bite for approximately three to 6 months (function brings them back together).  I find that if the anterior teeth contact sooner than that, that the likelihood of eventual failure is high.

Other aspects of why TMJ treatment fails can be found at my Youtube video.

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