Can Acupuncture Help with Your TMJ Pain?

Drugs are hardly the only solution when it comes to TMJ pain. Take acupuncture, for instance.

New research in the Journal of Acupuncture and Meridian Studies offers some new evidence that the therapy may provide at least temporary relief from TMJ problems by rebalancing the energy (Qi) along the meridians.

The temporomandibular joint, or TMJ, is a hinge for your jaw. There’s one on each side of your head. Injury, misalignment, and behaviors like bruxing can damage these joints and adjacent structures and cause them to work incorrectly.

Here’s how the TMJ functions normally:

Here’s how it looks in one type of dysfunction:

TMD can lead to ongoing problems with headaches and pain in the jaws, face, neck, and shoulders. You may have ringing in your ears or other hearing issues. You may feel toothache-like pain. You may have popping, clicking, or grating sounds when you chew. It can become hard to even open your mouth.

Suffice it to say, TMD is no fun.

But back to the study, in which 43 TMJ patients were separated into two groups. For four weeks, one group was treated with traditional acupuncture; the other, with sham acupuncture (no needle penetration). Meridian assessments were taken before and after each session.

acupuncture diagram of headInterestingly, both groups experienced less pain. Both groups experienced a decrease in Yang energy.

But only those who received real acupuncture maintained Yin energy levels over the course of the study. They were also more able to open their mouths on their own without pain.

According to Traditional Chinese Medicine (TCM), Yin and Yang energies must be balanced to maintain good health.

Increasingly, the medical establishment is accepting acupuncture as a valid treatment for various forms of pain. In fact, earlier this year, the FDA gave it a preliminary endorsement for pain management.

On a similar note, the Joint Commission – a major medical accreditor – also now recognizes acupuncture as an effective stand-alone or combination treatment for TMD. According to commentary in Integrative Medicine: A Clinician’s Journal, this turnaround provides great opportunities for integrative pain treatment.

[Integrative clinicians can] use it to convince naysayers by showing them that the evidence behind these services and practitioners in pain treatment has been prevetted by a conservative organization that serves as medicine’s police force. Notably, the pharmacologic approaches are appropriately—if only for alphabetical reasons—listed prior to pharmaceuticals. Clearly these typically more high-touch, time-, and human-intensive approaches are not relegated to the past role of if all else fails, try acupuncture.

Of course, there are other therapies that can help, as well, in providing long-term relief from TMJ problems without drugs and without surgery. The key, as ever, is to identify the cause and address that through treatment suited to that specific cause. In some cases, that might be appliance therapy; in others, DTR; in others, neural prolotherapy.

One size seldom fits all.

Image by Mot

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Guest Post: Dental Ozone Is for More Than Just Fighting Pathogens

Our thanks to the office of St. Louis biological dentist Dr. Michael Rehme for letting us share this post from their blog. The original is here.

ozone moleculeWhen you hear about ozone in dentistry, it’s usually about its power to fight infection. That power comes courtesy of a third oxygen atom that turns “breathing” oxygen (O2) into ozone (O3). This makes the molecule unstable. It really wants to lose that extra atom and become “regular” oxygen once again.

That instability is what makes it such a powerful antimicrobial. That third atom readily attaches to bacteria, viruses, fungi, and parasites, interfering with their function. Ozone also stimulates oxygen metabolism and activates the immune system, further defending against harmful microorganisms.

So ozone is ideal for treating infectious conditions such as gum disease and dental caries (tooth decay). It’s also used to support healing from dental surgery and preparing teeth for restorations.

What you don’t hear about so much in dentistry is ozone for treating pain, such as from tooth sensitivity or TMJ disorders. Yet here, too, it may have a role to play.

A new study in the Journal of Oral Rehabilitation focuses on this – in particular, treating chronic pain in the chewing muscles. The trial compared treatment results between two groups of women, one that received ozone therapy, one that received sham ozone as a placebo.

Both groups experienced improvements, actually.

However, the study hypothesis that bio-oxidative ozone application to the sites of most severe pain would produce better results than sham bio-oxidative ozone application at predetermined points was supported. Bio-oxidative ozone application appeared to be superior to sham bio-oxidative ozone application and differences were significant. [emphasis added]

Pain intensity went down and patients’ pressure pain thresholds went up. They also experienced ”significantly better results” with respect to their ability to move their jaw compared to the placebo group.

masseter muscleThe follows earlier research suggesting that ozone may be more effective than drugs for treating TMJ pain. In one such study, 87% of patients receiving ozone therapy either improved or recovered completely. Only about a third of the patients in the drug group showed improvement, and none recovered completely.

Why should ozone help with pain? Dr. Frank Shallenberger, among others, has suggested that chronic pain results from a lack of oxygen utilization. “Reverse this,” he says, “and an area of chronic pain will become normal again. Reverse this, and an area of chronic degeneration will begin to regenerate exactly as it was supposed to in the first place.”

Cells need oxygen to heal. Ozone stimulates the healing response.

This makes it even more valuable to dentistry – and medicine – than ever. Powerful. Effective. Non-invasive. Safe. What more could you ask for in a treatment?

Masseter image by Anatomography

Trouble with Titanium Dental Implants

corroded titanium dental implantWhen it comes to replacing teeth with dental implants, we opt for biocompatible ceramic instead of the usual titanium. Now new research offers even more support for this choice.

One of the biggest risks with implants is the potential for peri-implantitis. This condition is marked by inflammation and bone loss around a failing implant. It’s not something to be taken lightly. According to implant expert Dr. Stephen Jacobs, studies suggest that one-third of patients will be infected.

And according to a new study in the Journal of Periodontology, titanium may elevate the risk.

Researchers took plaque samples from 20 implants with peri-implantitis and 20 without, coming from 30 total patients. Then they looked for evidence of titanium. Why?

Increasing preclinical data suggest that peri-implantitis microbiota not only triggers an inflammatory immune response but also causes electrochemical alterations of the titanium surfaces, i.e., corrosion, that aggravate this inflammatory response.

That is, the bacteria causing the infection also corrode the titanium, and that makes the inflammation worse.

Thus, it was hypothesized that there is an association between dissolution of titanium from dental implants, which suggests corrosion, and peri-implantitis in humans.

And this is indeed what they found.

Greater levels of dissolved titanium were detected in submucosal plaque around implants with peri-implantitis compared with healthy implants, indicating an association between titanium dissolution and peri-implantitis.

Other studies have looked at other triggers for corrosion. According to research in the Dental Materials Journal, fluoride appears to have a significant impact on the dissolution of titanium.

Although titanium is well known for its superior corrosion resistance, it is not strongly resistant to corrosion caused by fluoride.

Hydrogen peroxide was also found to break down some titanium alloys. Peroxide is commonly used to bleach teeth and so appears in a good number of oral hygiene products and is often seen as an ingredient in natural DIY home care recipes.

Yet other research showed that ultrasonic scaling – deep cleaning – released titanium and thus increased inflammation. More, that inflammation triggered bone loss, which the study authors suggest ”is unlikely to be reversible.”

We’ll stick with ceramic.

For even more on corrosion, check out this excellent article by implant specialist Dr. Sammy Noumbissi.

Image via Dr. Noumbissi

How Thermography Can Help You Take Charge of Your Health

Most of us are raised with a rather reactive and passive relationship with healthcare. You see your doctor or dentist only once something goes wrong and expect them to fix it.

But functional and biological medicine remind us that by the time you get symptoms, most conditions are fairly well advanced – and often more costly to treat. Fortunately, there are a number of technologies available to help us spot potential problems before they get to that point.

Thermography is one of those technologies – one that we’ve just recently begun making available in our office via the Texas Thermography Clinic.

Thermography is a radiation-free way to scan your body for early signs of dysfunction or imbalance on the cellular level. It’s been used by European integrative doctors for over 30 years and was FDA-cleared for use in the US in 1997.

The technology itself is based on your body’s ability to thermoregulate. This ability to keep a steady temperature is controlled by your autonomic nervous system.

When your internal temperature changes, your hypothalamus is signaled to initiate changes to bring your temp back to its norm. You sweat; your blood vessels widen or contract; your muscles and other organs generate heat – that kind of thing.

So by making a sort of heat map of your body, thermography aims to shed light on this key aspect of your body’s self-regulating abilities.

Alfa thermometryTexas Thermography Clinic uses a particular type of thermography known as thermometry. This technique uses a lightweight, infrared sensor to measure the temperature of your skin. The scanner is somewhat similar to a wand thermometer that a nurse or doctor swipes across your forehead to check for fever. But with thermometry, more than 100 points are checked, including points on the teeth and jaws.

This is followed by a 10 minute period in which you’re exposed to a cold stimulus. Then the thermographer takes readings of those same 100+ points again. Differences in the readings reflect how well your organs and tissues are functioning and how they deal with physiological stress.

Both sets of readings are run through a sophisticated computer program which maps out the temperature patterns of your body. That information can help your doctor identify imbalances that you can address proactively – through follow-up diagnostics and, as appropriate, treatment – before they can become bigger problems.

You can see how this is a perfect fit with our holistic, biological approach. Prevention is the foundation.

A Look Back at…Biocompatibility & Dental Implants

Updated from the original post for August 4, 2016

Replace a Tooth by Mimicking Your Body’s Nature

Dr. Masoud Attar & Dr. Hamid Shafie

Dr. Attar with dental implant expert Dr. Hamid Shafie at a 2016 implant seminar in San Francisco

As we say on our home page, perfection is our passion – which is perhaps the biggest reason why Dr. Attar consistently pursues additional training and education. You can’t achieve perfection without being a perpetual student.

In fact, there’s a quote well-known in dental circles, by a fellow named G.V. Black, who’s considered the father of operative dentistry: “The professional man has no right other than to be a continuous student.”

Among the best learning opportunities Dr. Attar has had over the past year was a seminar in San Francisco that focused on replacing missing teeth with zirconia (ceramic) implants.

As a biological office, we constantly strive to use the most compatible materials for our patients. We know many of you have worked hard to eliminate metals from your mouth. We also believe when you’re looking for a way to replace your missing tooth, you shouldn’t have to compromise. While many offices place conventional metal alloy implants (usually titanium), we use only ceramic for the dental implants we place.

Here are 6 reasons why:

  1. Biocompatibility

    While any material placed in the body has the potential to react, zirconia appears to be very biocompatible for most patients. The firm bond that establishes itself between the bone and the ceramic implant is believed to be bio-inert. This means your body doesn’t react with an inflammatory response as it would with a foreign body.

    In contrast, research shows titanium-based implants both corrode and degrade, generating metallic debris. This debris may have harmful biological effects over time, including the development of renal hepatic injury and renal lesions.

    Additionally, an increasing number of individuals with titanium implants, dental or orthopedic, present with allergies, sensitivities and other skin and immune reactions that necessitate removing the implant from the body. These reactions happen over time with continued exposure to the metal. An allergy or reaction to a dental implant may cause pain, inflammation, infection, bone loss and implant removal. Material testing for implant materials should be considered, especially metals.

  2. Maintenance

    dental implant illustrationRegardless of the type of implant material you select, much attention should be giving to keeping the gum tissue around it clean. Like teeth, implants can fail if bacteria accumulate along the gum. To complicate the matter, tissue doesn’t attach to an implant in the same way it attaches to your natural teeth.

    But research indicates the lack of electric conductivity in ceramic implants makes it harder for bacteria to stick. This makes it easier to maintain healthy tissue with proper cleaning technique. And unlike a bridge, which can be hard to floss effectively, an implant, for all practical purposes, is like a tooth. You can, and should, floss like you do with your natural teeth.

  3. Meridian flow

    Because they’re biologically inert, zirconia implants may offer the best option for maintaining meridian flow from tooth to organ, and organ to tooth. This is especially important to those who employ the principles of acupuncture and pay particular attention to their body’s meridian flow and blockage.

    Not familiar with this concept? You can learn more about it here.

  4. Esthetics

    In contrast to titanium implants’ grey color, ceramic implants are white. This may not seem like a big deal because, let’s face it, they’re implanted in the gums. But in patients with gum tissue recession or thin gums, the grey cast of titanium can become visible. Ceramic implants, on the other hand, retain a natural look with no grey shadow or show through.

  5. Biomimicry in Design

    Ceramic implants have been optimally designed to mimic your natural tooth. Like your tooth, ceramic implants are a one-piece design. There’s no abutment connected with a fixation screw as you commonly see in titanium implant designs.

  6. Functionality

    When you’re looking at replacing a tooth, you want it to be successful. You don’t want to have to revisit this tooth again. To succeed, it must hold up with how you use your mouth, especially the forces of chewing. By creating the diameter and length to that of natural teeth, ceramic implants are foundationally tempered to withstand chewing force.

Any way you look at it – functionally, aesthetically, holistically – when opting for implants, ceramic is clearly the best option for mimicking your natural teeth.

Want to Beat Tooth Decay? Address the Cause

There are plenty of reasons to say no to fluoridation, but what about fluoride applied directly to the teeth?

If the idea is to prevent decay, a new study in the Journal of Dental Research suggests that, at best, it may minimize damage but not prevent it all together.

fluoride varnish For this study, researchers followed 1248 young, caries-free children over the course of three years. (“Caries” is the clinical term for tooth decay.) Half the kids got a “preventive package” of fluoride varnish, fluoride toothpaste, toothbrush, and standard dental education every 6 months. The other group got education only.

By the end of the study, 39% of the kids in the control group had developed caries. So had 34% of those who got fluoride.

The mean number of cavities was 9.6 in the control group…and 7.2 in the fluoride group.

The “success” of fluoride here is clearly underwhelming.

The trial had high retention and compliance rates but failed to demonstrate that it did keep children caries free. There is evidence from the trial that once children develop caries, the intervention does slow down its progression. [emphasis added]

So what if, instead of trying to mitigate damage we were to actually prevent it by addressing its cause?

That cause is, of course, the overconsumption of sugars. In the rush to fluoridate, this tends to be forgotten. As another paper in the JDR put it,

The importance of sugars as a cause of caries is underemphasized and not prominent in preventive strategies. This is despite overwhelming evidence of its unique role in causing a worldwide caries epidemic. Why this neglect? One reason is that researchers mistakenly consider caries to be a multifactorial disease; they also concentrate mainly on mitigating factors, particularly fluoride. However, this is to misunderstand that the only cause of caries is dietary sugars. These provide a substrate for cariogenic oral bacteria to flourish and to generate enamel-demineralizing acids. Modifying factors such as fluoride and dental hygiene would not be needed if we tackled the single cause—sugars. [emphasis added]

Other research suggests that caries can be prevented by limiting sugar intake to less than 3% of your total daily calories. (For a 2000-calorie per day diet, that’s just 60 calories or about 15.5 grams of sugar a day; for a 1500-calorie diet, a mere 45 calories or about 11.5 grams. To put that in perspective, there are 39 grams of sugar in a 12-ounce can of Coca-Cola and 47 grams in a bag of Skittles.)

At the same time, increasing intake of nutrient-dense whole foods further supports your teeth’s natural ability to remineralize, protecting them from the oral pathogens (“bad bugs”) that cause decay. Toothpastes containing theobromine may also be helpful as a part of a good, overall home hygiene plan.

Bottom line? Decay and cavities are not inevitable. But preventing them isn’t up to fluoride. It’s up to you.

Image via healthcare-news

Do Crooked Teeth Predict Your Death?

It’s a headline built to make parents freak out:

Daily Mail headline

And as is usually the case, the reality behind the headline isn’t quite so sensational. Impressive, yes. Sensational? No.

The reality is new research out of the University of Washington School of Dentistry, which “suggests that an asymmetric lower face is a novel marker that also captures early life stresses that occur after birth.” Those early stresses can lay the foundation for ill health later in life.

[Study author Philippe] Hujoel, a professor in the UW School of Dentistry, described a crooked, or asymmetric, bite as the teeth biting backward or forward on one side of the face and normally on the other side. Backward-biting asymmetries, the most common lower-face asymmetry in the U.S. population, were found to fluctuate randomly between the left and right sides of the face. Such randomness is evidence for early life stress, he said.

Hujoel emphasized that crooked teeth, overbites and underbites are different than an asymmetric bite. Those conditions can be associated with asymmetric and symmetric bites, the latter of which is largely a reflection of genetics, not environmental stress, he said.

So, no, crooked teeth don’t predict early death in and of themselves. It’s the bite that’s telling – how the teeth come together. Even then, an asymmetric bite isn’t a death warrant, particularly if you take action to support your health and lower your risk of all manner of chronic diseases.

malocclusionThere’s also plenty you can do to correct bite problems, whether they’re the result of early environmental stresses or later ones. In fact, correcting issues with the bite can lead to overall health improvements.

Consider bruxing, for instance – habitual clenching and grinding, often during sleep. While commonly associated with stress, it can also be an unconscious way of coping with a bad bite or even a compromised airway. Bruxing, in turn, is associated with sleep apnea in both adults and children.

And sleep apnea is associated with a wide range of chronic health problems, including heart disease, diabetes, and stroke.

Interventions like oral appliance therapy and appliance-free DTR can do wonders for correcting bite-related problems. Lifestyle changes – especially in the area of diet and nutrition – can likewise be of help. The specific approach, the best approach, depends on your specific health situation and how it got that way.

For above all, and always, we want to treat the cause, not just help you mask or “manage” symptoms.

Image by Parveen chopra

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4 Books on the Mouth-Body Connection that Just Might Change Your Life

Woman reading bookMany who seek our services have immune system challenges. They’re looking for the most biocompatible materials and the least invasive approach to dentistry they can find. Others have nagging symptoms they – and their health care providers – have been unable to identify.

As a biological dental office, we believe the best solutions to nagging health issues require a comprehensive look at the whole person, not just the mouth. We recognize that medical doctors are trained to focus their attention on the body, minus the mouth. Yet current scientific research indicates the mouth can be a focal point for health issues.

This means, the more familiar you are with the mouth’s connection to your body, the more you can help yourself.

One way you can do so is through reading. So we offer up this short list of new books to help you navigate both the medical and the dental realms and bring them together into a cohesive whole.

Mirror of the Body: Your Mouth Reflects the Health of Your Whole Body by Dr. James Rota
If you’re concerned about the materials in your mouth, you’ll want to read this book for sure.

Though Dr. Rota had an inkling of mercury amalgam dangers when protestors first handed him a brochure on mercury’s toxicity, it wasn’t until faced with his own health crisis that he dug beneath the surface of this commonly placed material.

His book not only describes his own journey but looks at the politics behind dental associations and their assurances of safety to the public despite a lack of scientific evidence. It will encourage you to have more than a voice in your health care; it will encourage you to listen to your body.

Six-Foot Tiger, Three-Foot Cage: Take Charge of Your Health by Taking Charge of Your Mouth by Felix Liao, DDS
Using case studies from his patients, Dr. Liao showcases how the mouth and body relate. In doing so, he allows us to see how body symptoms can refer back to mouth issues. From posture, neck and muscle pain, and headaches to numbness, fatigue, sleep disorders, dizziness, and more, your mouth may be the culprit.

This powerful book gives you the tools to

  • Understand the role your mouth plays in your overall health.
  • Recognize that an impaired mouth can lead to health conditions that often defy easy diagnosis.
  • Seek holistic or biological support.
  • Think of dental care as part of whole body care.

book jacketsThe Holistic Dental Matrix: How Your Teeth Control Your Health and Well-Being by Dr. Nicholas Meyer
If you’ve ever wanted to speak up to a health care provider but didn’t feel you knew enough to actually do so, this book will empower you. By book’s end, you’ll realize that no one can know your body like you do. Sure, doctors and dentists have specific training, but many fall back on methods that are, at best, one-size-fits-all – despite the fact that each of us is unique, from what we eat to how we think, the exposures we face daily, the stress we encounter, the foreign materials placed in our bodies, and more.

Not only does Dr. Meyer address the systemic effects of dental materials such as mercury and fluoride, he delves into some of the most challenging dental situations and how they can impact overall health.

The visual resources here – including meridian charts, diagrams, photos, and resource pages – promote a deeper understanding of the material. This particular book will help you go to your next dental office equipped to be your own best advocate.

Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America by Mary Otto

Medical journalist Mary Otto is the only author in our selection who is not a dentist. But her investigative experience provides a well-rounded approach to oral health as it relates to overall health.

From a biological perspective, what we find particularly interesting about this book is how Otto illuminates the distinctly negative effect that the separation of dentistry from general medical care has had. Like those of us who work from a holistic or biological perspective, she notes the devastating and wide-reaching effects of this segregation. But her perspective goes far beyond the individual desire for well-being, extending to the role dentistry plays in societal health, as well. Otto’s book encourages you to look beyond your own well-being to see the bigger picture.

Image by Paul Bence

Acupuncture & Dentistry

acupuncture points on headWhen it comes to complementary medicine, acupuncture is often the first therapy people think of. After all, traditional Chinese acupuncture has a long and rich history – 2500 years, in fact.

Yet despite the test of time, the US has been slow to accept its benefits.

Those benefits certainly have a role to play in dental care, spelled out nicely in a 2014 literature review in the journal Medical Acupuncture.

Focusing on systematic reviews and research articles written in English, researchers plugged in key words specific to dentistry: acupuncture in dentistry, myofacial pain, temporomandibular disorders, xerostomia, dental pain and gag reflex.

As you may know, this Eastern practice uses specific points on the body’s energy highway – the meridian system – to stimulate the nervous system. This stimulation changes the way the nervous system processes pain signals and encourages the body to release its own painkillers, namely serotonin and endorphins.

And while technically, acupuncture means to “puncture with a needle,” stimulation can be achieved using a variety of techniques – for instance, moxibustion, electroacupuncture, acupressure, cupping, or microsystem acupuncture.

Whatever the technique, research shows that such stimulation

  • Normalizes physiologic functions.
  • Eases pain.
  • Modulates the limbic-para-limbic-neocortical network.
  • Increases local microcirculation.
  • Protects the body from infections.

Back in 1979, the World Health Organization endorsed acupuncture to treat just 43 symptoms. Less than two decades later, that list expanded to 64. By 2003, controlled trials had shown acupuncture to be effective in treating a number of dental conditions, including

  • Dental pain.
  • Dental anxiety and gag reflex.
  • TMJ/TMD.
  • TMJ clicking and locking.
  • Chronic muscle pain or spasm.
  • Atypical facial pain.
  • Headache/Migraine.
  • Dry mouth.
  • Nerve pain.
  • Paresthesia.

“In dentistry,” write the authors of the review,

the ability of acupuncture has been proven for managing various chronic orofacial disorders. There are numerous reports of randomized controlled trials on the analgesic effect of acupuncture for postoperative pain caused by various dental procedures and by other chronic disorders. According to the literature, acupuncture is more effective than a placebo or sham acupuncture.

Of course, as they say, more studies still need to be done. But we think it’s a good bet that, as an adjunct to good dental care, acupuncture offers promise as a nontoxic, safe alternative for treating dental symptoms with few, if any, side effects.

Image by Elizabeth Briel

Your Mouth Is the Gateway to Your Body

In honor of October’s designated status as National Dental Hygiene Month, we’d like to share an excellent video we recently ran across – “Gums to Guts: Periodontal Medicine,” Professor Mark Ryder’s talk on oral health and its relationship to the body’s systematic health.

It not only offers great visuals and useful info on markers of health and disease; it supports the importance of seeing the mouth as an integrated part of the body, not a separate feature.
 

 
If it’s been awhile since your last hygiene visit and exam, remember this key message: The mouth is a gateway to the body and has much to do with what’s going on in your body. Good oral health not only supports good body health and wellness; it’s a key factor in it.