TMJ literally means temporomandibular joint. The term TMJ has been used for years to represent a whole bunch of symptoms related to the mandible, or lower jaw; the teeth and the muscles attached to the skull and mandible. The term TMD, temporomandibular dysfunction, is now used to represent these problems. Every normal human has TMJs, only some have TMD.

Like many fields of medicine that direct treatments at the symptom instead of the whole patient, the vast majority of educational institutions with recommendations on how to treat TMD represent nothing but “expert” opinions founded on junk science.  One institution teaches the use of electromyography to diagnose improper muscle activity, charging thousands of dollars.  Assuming that the muscle imbalance is caused by the bite, a.k.a. the way the teeth come together, extensive dentistry is usually prescribed, resulting in costly fees to follow.

A lecture I attended last year concluded that the best treatment choice was drugs, in this case Gabapentin, which has the side effect of depression. Therefore, the lecturer recommended a tricyclic antidepressant which has further, sometimes dangerous, side effects. Of the many continuing education courses in TMD I have taken, each one has been symptom-oriented, forgetting the patient and what caused the symptom in the first place.

Decades ago research was conducted that found those with TMD symptoms held their teeth together an average of 16 hours a day, while those without symptoms averaged minutes per day. The teeth are only supposed to come together when swallowing.  There is no question that a bad bite can be one of the underlying factors in TMD, but why is the patient holding their teeth together?

This is where a holistic approach can mean the difference, not only in treatment of TMD, but in all fields of medicine. Let’s take a look at the decades old finding mentioned above and ask why is the patient holding their teeth together?

One big factor preventing this approach is that it takes much more understanding of patients, requiring much more time, (money), and a greater understanding of physiology, psychology and general health of the patients.  One of the best medical books I have read is Dale Carnegie’s How to Win Friends and Influence People.  If you already read it, read it again.  If a doctor can’t communicate and get you to believe he/she cares, then how can you know that you are understood?

In a holistic practice, many times I recommend lifestyle changes.  Those changes won’t happen if the patient does not believe in me.  I have had cases where a change in the diet took away the symptoms after years of suffering.  In some cases the underlying cause of the headaches required referral to a gastroenterologist, pulmonologist or other specialist to get to the root of the cause.

Most of my difficult cases are stress related, but, again, what’s causing the stress?  It could be hormone imbalance, poor sleep, food sensitivity or many other factors.  There are side effects to giving drugs for stress.  The side effect of treating the cause to get relief is a healthier, happier patient.

If you are suffering from TMD or even have symptoms of sleep apnea, come in for a complimentary consultation.  Advanced Oral Diagnosis & Treatment Center is located in Danville. You can contact us at or  call 925-837-8048.




Nerve Blocks and Steroid Injections

Anesthesiologists have been performing nerve blocks for surgical anesthesia for centuries to allow a patient to undergo an operative procedure more comfortably with less general anesthetic and therefore fewer side effects. Modern anesthesiologists prefer to administer more regional anesthetics (i.e., anesthetizing only a specific region of the body) over a general anesthetic whenever possible because we find that patients have less pain, nausea and delirium postoperatively, as well as shorter, if not outpatient, hospital stays. Typical types of surgery that would fall into this category are surgeries on extremities including total hip and knee replacements; leg, foot, arm, shoulder and hand surgeries.

The pain management specialty was borne from the desire to help more patients who are not having surgery, but who are in pain nonetheless, with the same techniques. By offering interventional techniques such as nerve blocks and steroid injections, we can treat outpatient pain problems without having to rely on or use high dose oral pain medications. The most commonly performed procedures are epidural steroid injections for neck, mid-back and low back pain. Herniated discs and stenosis (spinal arthritis) can cause inflammation and swelling of spinal nerves to create severe pain in the neck, arms, low back and/or legs. The injection of steroid medication into the epidural space, which surrounds the nerves, helps reduce the swelling and inflammation and pain. We often inject a local anesthetic, aka “numbing medication,” with the steroid for some immediate pain relief, which is what makes the injection a “block.” Oftentimes the anti-inflammatory effect of the steroid provides long lasting pain relief for months or years; however, occasionally the pain relief effect may only last days or weeks. The difference in the result from person to person depends on multiple factors including: severity of the disc herniation or arthritis, weight burden on the spine, muscle tone surrounding the spine, and amount of inflammation, to name a few. Unfortunately, these steroids don’t cure the ultimate cause of the pain, but they can and do, for most people, improve function and reliance on pain medications. The injections can safely be repeated if the pain returns, however, the best way to avoid future pain exacerbations is to optimize spine health with weight reduction, core strength training and stress reduction/management.

As with any medical technique or recommendation, the benefit of the treatment should far exceed the risk. Cervical and thoracic epidural injections inherently carry more risk to perform because the spinal cord can be injured if they are not performed correctly. The spinal cord terminates at L2 and exists as long spaghetti-like nerve endings below this level, so lumbar epidural injections carry less risk of spinal injury, however all injections should only be performed by specialty trained doctors. Patients who are at higher risk for complications from injections include those with diabetes or bleeding disorders or those who are taking blood thinners. If steroid injections are done too frequently, side effects can occur including adrenal suppression (the body doesn’t make its own steroid hormones), early cataracts and hormonal imbalances.

My pain management philosophy is to use a balance of treatment options so the patient isn’t at higher risk from any one particular type of treatment. Also, the complexities of chronic pain are better addressed by using a treatment plan that is directed at alleviating more than one aspect of the pain. Oftentimes pain, anxiety, depression, insomnia, isolationism, anger and embarrassment are intertwined and there just isn’t one type of medication or injection or treatment that will make all of those symptoms resolve simultaneously. The best treatment plan is one that will reduce pain and increase quality of life and function for the short term and the long term with the least side effects.

Don’t Let Sciatica Ruin Your Game

The condition known as Sciatica is one of the most common conditions that we treat at Align Healing Center. Some of the typical symptoms of Sciatica are sharp pain in the low back and/or buttocks accompanied by numbness, tingling, aching or burning down the back of the leg. In severe circumstances, weakness in the leg may also be seen.

The Sciatic Nerve is large and travels down the back of the leg to the foot. The nerve is buried deep within the muscles of the buttock and leg making it difficult to treat with common physical therapy methods. The Sciatic Nerve is composed of several smaller nerves and originates from the low back. It passes under the piriformis muscle (underneath the main buttock muscles) on its way down the leg. Irritation of the Sciatic Nerve at any point along its path is commonly known as “Sciatica.

Understanding Sciatica

Let’s talk about nerves for a moment. Nerves are the electrical wiring of the human body. They carry the signals that allow us to move, feel, digest, detoxify, respond to our environment, and so much more. Plain and simple, if the nerves do not work the body will not work. That being said, it is important to understand that unlike other tissues, the primary blood supply to nerve tissue is actually located within the nerve itself.  So, if a nerve becomes impinged or compromised, so does the blood supply to the nerve.  Without proper blood supply, the nerve does not receive the energy and nutrition needed for the nerve to heal itself. Over time, neural impingement leads to a painful chronic condition called Neuropathy. The definition of neuropathy is a disease or injury affecting nerve cells. The common symptoms of Neuropathy include sharp pain, burning, muscular weakness, numbness or tingling either at the site of the nerve injury or wherever the nerve travels. The condition known as Sciatica is a form of Neuropathy that specifically affects the Sciatic Nerve.

What can I do to relieve my Sciatica without drugs or surgery?

Since 1999 Align Healing Center has been offering many different modalities to heal Sciatica. We have found that a combination of Class IV laser therapy and spinal decompression offer outstanding results in healing stubborn Sciatica. Class IV Laser Therapy allows the practitioner to stimulate healing within the damaged tissue by delivering the necessary energy directly to the injured area. This creates an optimal healing environment that reduces pain and inflammation, swelling, muscle spasms and stiffness. In addition to laser therapy we implement spinal decompression to restore spinal disc health. Decompression works by gently stretching the spine, creating a vacuum effect which can restore disc height and even reduce the severity of bulging disc conditions associated with chronic pain and neurological symptoms.

We have found laser and decompression therapy to be most beneficial for patients with pinched nerves, arthritis, herniated discs, and degenerative disc disease. This unique combination of non-invasive therapy offers a chance for realizing a permanent cure. The treatment is finite and typically lasts for about a month. This eliminates the long-term care commitment forced upon patients by other symptomatic sciatica treatments.  With proper care and rehabilitation of your spine and nervous system you can be back to your healthy self quickly!

Dr. Niele Maimone, DC of Align Healing Center in Danville, CA has been active in natural health and wellness since 1999. For more information or to set up a consult call 925.362.8283 or visit