From The Doctor's Desk

It was an exciting day for Neuromuscular Dentistry on Sunday, February 21 when Bode Miller took home the gold for the US in the Super-Combined. Bode wears a Pure Power Mouthguard (PPM), which was developed by our colleague, Dr. Anil Makkar, based on neuromuscular principles that we have implemented in dentistry for over 40 years. In our office, we use neuromuscular dentistry to treat patients with a wide range of symptoms, from migraines to vertigo to clenching and grinding. The neuromuscular dentist understands that the teeth, joints, and muscles are part of an integrated system, and seeks to restore that system to proper function and balance through the use of appliance therapy, bite adjustments, neuromuscular functional orthodontics, and full mouth rehabilitation. Dr. Makkar noticed that his own patients who were using a neuromuscular appliance were exhibiting increased strength, flexibility, and range of motion throughout their bodies. Based on this observation, he developed an athletic mouthguard that places the lower jaw in an optimal neuromuscular position. The results have truly been astounding. Athletes like Shaquille O'Neal, Terrell Owens, and Superbowl XLIV Champion Tracy Porter all sport the PPM and swear by its benefits. The first study to examine the efficacy of the PPM came out of Rutgers last year and confirmed what we all suspected - the PPM does indeed increase strengh, flexibility, and range of motion. We are excited to be one of the few dentists on the Central Coast who offer the PPM to amateur and professional athletes, alike. Congratulations to Bode Miller who claimed his first gold medal while wearing the PPM!

We are thrilled to announce that our hygienist, Jeanne, has just completed her training in myofunctional therapy and is now an Orofacial Myologist! Myofunctional therapy is a program designed to correct improper oral posture during rest and swallowing. If you have read my blog, and specifically the posts about Biobloc Orthotropics, you know that oral posture has everything to do with the facial growth and malocclusions (poor bites). So much of the way our mouths and faces grow and develop are influenced by oral posture that there is a whole field devoted to correcting improper use of these muscles - hence, myofunctional therapy. Jeanne was trained by Barbara Greene and Joy Moeller at the Academy of Orofacial Myofunctional Therapy in a 4-day intensive course, followed by an internship at their private practices in the Los Angeles area. Not every student has the opportunity to partake in an internship, giving Jeanne the added benefit of clinical experience before she starts her own practice.

So who is a good candidate for myofunctional therapy? EVERYBODY! Here is an abbreviated list of some of the most common problems that can be corrected with myofunctional therapy:

Chronic headaches
Open-mouth posture / mouth-breathing
Open bite
TMD or neck pain
Oral habits such as finger sucking or nail biting
Grinding/clenching

Sound familiar? These are the types of problems we screen for every day in our practice. Myofunctional therapy alone can make a dramatic improvement in many of these cases, and when coupled with proper orthodontics the results are truly amazing. Please note, this is not speech pathology. Myofunctional therapists can certainly work in conjunction with speech pathologists, as well as chiropractors, cranial osteopaths, orthodontists, dentists, and ENT's to name a few, but the purpose is not to form proper speech patterns. Rather, it is to train proper oral function which can definitely assist with speech therapy.

In our own office, we will be incorporating myofunctional therapy into our orthodontic treatment plans because once those braces come off (or the Biobloc is removed) the most powerful forces left in the mouth are the tongue and oral muscles! After all, those muscles were responsible for the orthodontic problem to begin with - if we don't train the muscles to function properly, the chance of relapse after the braces are removed is significant. We are so thrilled about this new addition to our practice, and especially for Jeanne who has become a huge advocate for the benefits of myofunctional therapy. Next time you visit, ask her about it! She is a wealth of information on the topic.

It seems like just yesterday I posted our picture from last year's marathon, but here we are again! Last weekend, Tina, Max, and I ran the 27th California International Marathon in Sacramento. It's the same race as last year, but we had a much better showing this time around. I broke my PR by 17 minutes, and Mom and Dad both ran qualifying times for the Boston Marathon! It's amazing how quickly you forget what it felt like to run 26.2 miles - we're already picking the next race, and can't wait to cheer on Tina & Max at the 2011 Boston Marathon. See you on the road!

It's holiday season again. Silver and gold decorations abound on lamp posts, storefronts, and front doors. Some of you may have teeth to match - silver and gold fillings that most likely have been there longer than the old fruitcake in the back of the cupboard. Metal dental materials have gotten a bad rap over the last decade, especially as some of the more esthetic materials like porcelain and composite have improved. I have quite a few requests for completely metal-free dentistry. Some of that reputation is rightly deserved, but certain metals can actually be a good choice in specific situations. Let me explain why, in our office, we have chosen to use some metals, and avoid others, and when they are best suited for your mouth.

If you're over the age of 20 and you have a history of dental work, there's a good chance one or more of your fillings is silver amalgam. First introduced in the 1800's, silver amalgam is still used today as a low-cost alternative to the more aesthetic, tooth-colored composite resin. Amalgam is an alloy of mercury (~50%), silver (~30%), tin, copper, and zinc. There has been a lot of media attention on the presence of mercury in silver fillings. Some countries have outlawed them for use in pregnant women or small children. The American Dental Association has long supported their use and the FDA has continued to agree. Regardless of the controversy, silver amalgam has one very significant drawback that has prevented us from using it in our office for over 10 years: it breaks teeth. Witness exhibit A:

This upper molar seemingly had nothing wrong with it. That silver filling had been in the patient's mouth for 20+ years and never gave the patient any problems. Then one day, while eating something innocuous, a huge piece of the tooth fractured right off. Notice the filling is still in place, but the tooth around it is gone. This is very typical of what happens to teeth with silver amalgam fillings. Why? Silver amalgam is not bonded to the tooth, like composite resin. It is simply wedged into place. After placement, the metal expands and puts undue forces on the enamel. Microfractures start to form around the filling that continue to grow, much like a star in your car windshield, and can eventually split the tooth. If you're lucky, the fracture will just occur through the dentin, as it did here. Sometimes it can fracture into the nerve of the tooth, necessitating a root canal. And in really unfortunate cases it can actually split the tooth right in half, down the root, and require extraction. Major bummer from something as small as a silver filling. For this reason, we encourage our patients to consider removing the silver BEFORE the tooth breaks and placing a bonded filling that will hold the tooth together, preserve more of the natural tooth structure, and look a whole lot better. Witness exhibit B:


Now, what about gold? Gold is a different story. Gold does not wedge teeth apart - to get a bit scientific, it has a very similar coefficient of expansion as natural tooth structure. Gold also wears at a very similar rate as enamel, which means it is soft on the opposing teeth. For this reason, gold is a fantastic option for people who grind or clench their teeth. You can't break it, it won't break your other teeth, and, barring recurrent decay, it will probably last for well over 10 years. True, it is not the most aesthetic option, but when it comes to function and longevity it really is the gold standard, no pun intended.

So this holiday season, when it comes to your mouth, think about ditching the silver and keeping the gold.

If you suffer from chronic headaches or migraines, you know what a toll it takes on your daily life. Hours of headsplitting pain, sometimes accompanied by nausea, sensitivity to light, and an overall bad mood. Some people are literally holed up for days in a dark room trying to mitigate the pain. If you are one of these headache sufferers, you have also probably tried everything under the sun for relief. Advil barely touches these headahces. Chiropractic adjustments may work for a few days, but it rarely holds. Then there is the list of prescription drugs for both prevention and treatment. They treat the symptoms, but they don't always address the cause. So what is the cause, anyway? And why is a dentist talking about it?

Chronic headaches and/or migraines can be caused by several things. If you wake up in the morning with a headache, there's a good chance your headache is related to sleep breathing disorder like Obstructive Sleep Apnea (OSA). A lack of oxygen coupled with the grinding that occurs with OSA can easily translate to a severe headache. Patients who treat the OSA will frequently see the morning headaches subside completely. Headaches that occur later in the day can actually be due to a problem bite. Unbalanced or unstable bites create a lot of muscle fatigue, including fatigue in the anterior temporalis which is the huge fan shaped muscle over the temples responsible for jaw movement. The fatigue or spasm of this muscle, or any of the other muscles responsible for jaw movement, can cause significant headaches or even migraines. As neuromuscular dentists, we are uniquely qualified to address these problem bites and relieve the associated headaches and facial pain. Click here for more information on how we do this, or come in for a consult so we can answer your questions in person!