Dr. Robert Brown

Diagnosing TMJ Pain

April 2, 2014 by Dr. Robert Brown Leave a Comment

Sometimes life will guide you… if you let it.

More than thirty five years ago, being frustrated by my referrals to others for TMJ treatment, I attended a year long training to better my understanding of the disease. I had already taken many weekend courses, but felt more understanding was necessary. At that time, almost all the emphasis was placed on the way the teeth come together and how that related to the joint position.

At the time my two year old daughter was diagnosed with a very serious asthmatic condition and she received the standard medications, with side effects and limited effectiveness. At a local dental meeting there was a talk by an oral surgeon whose sister was saved from having near fatal attacks of asthma by alternative medicine. The oral surgeon was so impressed that he was retiring from practice to start an alternative treatment center in Idaho. I took him to lunch and, learning his story, became an enthusiastic student of alternative medicine. With this approach, I had my daughter asthma free within six months and she has gone on to become a world class athlete.

Incorporating a holistic approach to my diagnosis and to the establishment of a treatment plan has greatly improved treatment effectiveness. A simple two day course in acupuncture at UCLA, for example, helped me to discover that some migraines are related to colitis. Migraines are a good sized part of a TMJ practice and, in a non holistic practice, are usually treated with drugs.

In general, TMJ is a very poor term for a complex syndrome that can include a number of factors, the most common being myofacial pain, or pain in the muscles of the face, head, neck and shoulders. This pain can be so severe that it was necessary for me to refer one patient to emergency for attempting suicide.

Most of the time, it is just annoying, as it interferes with eating, talking and the general enjoyment of life. It can also be a true “pain in the neck,” with severe neck and shoulder pain. True TMJ or TMD is pain or dysfunction associated with the joint itself and can include popping or gravely sounding noises when moving the jaw, mild to severe pain and, sometimes, ringing in the ear.

The pharmaceutical industry would have us believe that the typical migraine is a disease to be treated with a drug, when it can be a symptom of an underlying disease. It’s like our body is crying out the only way it can for help, and the practitioner says, “shut up and take this.”

As I mentioned earlier, an irritated colon can cause migraine headaches. Crohn’s disease, which is a name given to colon inflammation, can be the underlying factor, but wait, Crohn’s is more a symptom, but is called a disease and, if only the symptom is treated, may continue to return and worsen.

In my practice several cases of this disease were caused by food sensitivities and in one case, by the body’s inability to handle raw vegetables. It was definitely not caused by a dietary prednisone deficiency, a steroid commonly used to treat Crohn’s “disease”.

I have not strayed away from the original subject, TMJ. My purpose for using this example of incomplete medicine is to demonstrate the importance of the TMJ specialist understanding more than the limited field of his/her specialty. That practitioner could be missing the opportunity to discover the underlying factors that are causing the patient’s body to cry out for help. Many continue to view TMJ as a bite problem, and it may be just that, although most of the world has some kind of bite problem with no serious TMJ symptoms.

A good working relationship with other experts not only can be of extreme, even life-saving value to the patient, but makes a potentially boring practice become enriching experience. Belonging to professional organizations outside the field of dentistry can truly not only be of great benefit to the patient, but stimulating and refreshing, always opening new doors for the practitioner.

None of this would have happened had my daughter not contracted asthma and I did not develop an interest in holistic medicine!

Robert Brown, DDS has a TMJ, orthodontia, and sleep apnea practice in Danville and thoroughly enjoys discussing holistic medicine. You can contact him at 925-837-8048, at info@aodtc.com, or visit his web site at www.aodtc.com.

Pain is a Symptom: The Cause Must be Diagnosed

March 1, 2014 by Dr. Robert Brown Leave a Comment

It is quite tempting for both the doctor and patient to treat pain symptoms with medication rather than trying to get to the root of what is causing the pain in the first place. It’s much easier to apply this quick fix rather than to take the time to investigate possible underlying factors.

Unfortunately, many doctors are forced to practice this way due to the quantity of patients they must see during their work day and some patient’s preference for immediate relief. This is when it is important for you as the patient to be your own best advocate. Help your doctor find the root of your symptoms by giving a complete medical, dental and medication history.

In my TMJ/TMD (a.k.a. temporomandibular joint, or jaw dysfunction) practice it is quite common, upon reviewing a new patient’s medical history, to find that the patient has already been prescribed several prescriptions for the pain and almost always the patient has tried over the counter remedies to no avail.

In some cases the patient had been given a generic TMJ splint, relieving the immediate pain, but causing long term issues and damage by negatively affecting the bite.

I find it very valuable to review the patient’s medical history with them at their first appointment. There is almost always something, possibly important, left out or something that needs a lot more explanation, and yet, when I ask the patient if the last doctor/dentist reviewed the history with them, the answer is often no.

Sometimes I even find that the patient will diagnose themselves if you let them expand on their symptoms and tell you details such as: how long have the symptoms existed; what time of day do they occur; is there pain anywhere else in their body; what activity was taking place when the initial symptom occurred, etc.

If the pain is due to a systemic problem and the doctor tries to treat it locally the problem would not only be delayed in its diagnosis, but the treatment can only partially help the symptom.

The following case is an extreme example of the importance of the diagnosis of the cause of pain rather than just treating it. I was recently referred a patient for TMJ and myofacial pain by another doctor who was thinking that perhaps her reoccurring tooth pain and headaches were due to TMJ/TMD.

Though I did start treatment by fabricating a custom TMJ splint, her symptoms did not fit into the usual symptoms of this syndrome. Rather than simply giving her pain medication along with the splint I referred her for a 3D scan of her TMJ and head. The scan revealed a severe maxillary sinus infection that had penetrated all the way through into the boney sinus wall and into the ethmoidal sinus, which is at the base of the brain. I immediately referred her to an ENT who sent her immediately for emergency surgery to prevent cranial penetration, a potentially fatal condition.

Yes, I admit this is a rare phenomenon and the first time for me in 35 years of TMJ practice. In a similar situation in another patient last year I found a tumor in a boney nerve canal that had been treated by several specialists.

I just completed a book titled, Why? In it, the question, “Why?” is emphasized in detail. Ask your doctor or dentist “why?” Be your own advocate. Asking for or settling for a “quick fix” to any condition won’t solve the underlying cause in the long run.

It’s hard for me to understand how some people would rather risk their well being than change their lifestyle. It never ceases to amaze me what the lifestyles include: from smoking to excessive drinking; to “sleeping” with the TV on; eating processed foods only; living on soft drinks and hating vegetables.

What can you do to make sure you are not getting the “quick fix”? Make sure that the professional you are seeing is qualified to do what should be a specialty. Does he or she belong to a specific association in that field? How does the practitioner feel about holistic medicine? Does he or she belong to professional associations outside of their regular practice?

Is the professional interested in you enough to get to know you at your visit, and want to find out why you are there? Don’t be reluctant to ask WHY when it comes to the treatment. If a prescription is written ask about it. What are the side effects? Google the prescription and check out the side effects yourself.

It can be very helpful to educate yourself on the subject of your symptoms. If you have the bad luck to go to, for example, a dentist that took a weekend course and now practices TMJ, you might find you know more.

Are Children Getting Enough Good Sleep?

January 31, 2014 by Dr. Robert Brown Leave a Comment

It seems the further we stray from our natural environment and let society dictate our habits, the more health problems we encounter.

Something as simple as the invention of the light bulb has dramatically altered our environment, allowing us to not be guided by nature as to our sleeping routines, but by the rat race in which we have chosen to take part.

We are not satisfied losing sleep as adults, but force this ugly and unhealthy habit on our children. Adding night lights to our sports fields gives us one more way to cut into our children’s sleep; and then throw in excessive homework to be done after practice. To add further injury, add a very late dinner associated with no bedtime routine to make sure what sleep the kids get is poor at best.

A 2006 Harvard Medical School Publication came up with the following reasons for getting enough sleep:

Learning and memory: Sleep helps the brain commit new information to memory through a process called memory consolidation. People who slept after a learning task did better on tests.
Metabolism and weight: Chronic sleep deprivation may cause weight gain by affecting the way our bodies process and store carbohydrates, and by altering levels of hormones that affect our appetite.
Safety: Sleep debt contributes to a greater tendency to fall asleep during daytime resulting in mistakes and accidents as well as unhappy teachers.
Mood: Sleep loss may result in irritability, impatience, inability to concentrate, and moodiness.
Cardiovascular health: Serious sleep disorders have been linked to hypertension, increased stress hormone levels and irregular heartbeat.
Disease: Sleep deprivation alters immune function, including the activity of the body’s killer cells. Keeping up with sleep may also fight cancer.

How much sleep do you really need? The National Sleep Foundation recently recommended the following:

Newborns (0-2 months) 12 to 18 hours

Infants (3 to 11 months) 14 to 15 hours
Toddlers (1 to 3 years) 12 to 14 hours
Preschoolers (3 to 5 years) 11 to 13 hours
School age (5 to 10 years) 10 to 11 hours
Teens (10 to 17 years) 8.5 to 9.25 hours
Adults ` 7 to 9 hours

In children under ten, an evening routine that is very conducive to quality sleep includes a regular meal time with calmer activities and relaxation. Bath time, tooth brushing and story telling are all good. Frightening TV and video games reverse the desired state.

Being sure that your child is not a mouth breather will not only enhance the quality of the sleep, but may help prevent orthodontic problems. Mouth breathing is a major cause of the narrowing of the upper arch with the resulting crowding and blocking out of our canines.

Large tonsils and adenoids are usual suspects in this case. Sometimes merely eliminated dairy or gluten from the diet will take this problem away. Your family doctor should be well aware of the importance of enough good sleep. Ultimately, it is the parent who routinely checks the child’s sleep and demands something be done about problems found. Most of the children in my sleep practice have been brought in by their parents

Unless you are an extreme exception, we are all guilty of improper time management, having to stay up late to make up for it. Then the vicious cycle begins. You start to make mistakes and use bad judgment at work or school and you find you have to make up for them by working late again. This can become a habit which is not only destructive to your goals, but to the quality of life and ultimately your health and good nature.

You just can’t get away from it. Balancing your life is the answer, not only for your health and happiness, but to act as the proper model for your children to follow. Kids learn more from osmosis than opinion. It’s not what you say; it’s what you do that really makes a difference, right down to what we eat and drink and the part we take in creating our own happiness.

The Importance of a Healthy Mind and Proper Sleep

January 2, 2014 by Dr. Robert Brown Leave a Comment

In the last three issues I ad dressed the fact that controlling chronic inflammation can not only radically improve your health and slow aging, but literally save your life.We covered some foods and habits that create this condition. Then we covered foods and habits that fight this condition. In December’s issue we looked at how your lifestyle contributes to this problem and suggestions were given to guide you in addressing these problems.

In past decades the importance of good sleep and enough sleep never seemed to be a very significant part of the equation. Now that science has been able to establish how our body chemistry is influenced by our mental health as well as our physical health, those of us who treasure life can no longer think that a perfect diet, super supplementation and physical fitness is all we need.

Our emotional and neurological needs must be under control as well. We all know how stress can affect our sleep. How many of us know how we can personally take part in controlling our emotions.

Dina Colman, a local author, just released her book, Four Quadrant Living. In it Dina has many wonderful suggestions on methods to de-stress and finding inner peace. Simply identifying the cause of an emotional hang up can defuse it. Most importantly she emphasizes the need for balance, not only within us, but within our environment as well.

Having majored in Physiology in college, it has helped me to understand the chemistry controlling all of our body functions, not only how we screw it up, but what can we do to bring it back.

Very simply stated: emotions can cause stress which causes the fight or flight response in our adrenal gland which can strongly affect digestion, hormone balance and sleep. Improper digestion causes malnutrition and discomfort.

There are many factors that can affect sleep, the most common being stress, hormone imbalance and obstructive sleep apnea. The first two can be temporary and may just go away or can be treated.

OSA doesn’t go away and must be treated. To neglect treating OSA will likely lead to chronic inflammation and its horrible results which can include heart disease, Alzheimer’s and cancer. Children are not exempt from this challenge. Everyone needs proper sleep. Snoring in children has recently been determined to be a condition that must not be ignored.

Nasal breathing in ones sleep has been found to be so important that the researchers in this area are taping their mouths shut, yet many of our children are nocturnal mouth breathers. These subtle little things can have a large impact on the physical and mental development of the child. They have been proven to create cognitive problems in adults as well.

In my Dental Sleep Medicine practice there is much more to treating OSA than merely giving the patient an appliance. In children, many that suffer OSA do so because of an underdeveloped lower jaw. The sleep appliance of choice in this case not only helps to correct the obstruction, but stimulates more development of the lower jaw, hopefully to grow the jaw enough to correct that obstruction.

I use an Acoustic Pharyngometer to identify the obstruction and determine if jaw repositioning can lessen or eliminate the obstruction. An Acoustic Rhinometer may be used to identify nasal obstructions. The nasal obstruction is treated by an ENT doctor.

Hopefully ideal nocturnal breathing habits can be established. I do request a follow up sleep study to prove the goal has been achieved. Over the counter or quickly fabricated dental appliances should be avoided.

In the above example of the domino effect experienced by emotional problems resulting in physical problems we can begin to understand the importance understanding the intricate relationships that must be accounted for. Just like a large vehicle can be paralyzed by a small wire becoming disconnected, not dealing with an emotional problem or sleeping problem can have a similar result on one’s body.

Becoming more and more knowledgeable and informed about what makes us “tick” and taking care to make sure it’s “ticking” right is a big part of being rewarded with a great life.

Chronic Inflammation: Hidden and Dangerous

December 5, 2013 by Dr. Robert Brown Leave a Comment

In the last two issues I reviewed some of the dietary factors that influence chronic inflammation in your body, the foods to avoid and the foods to include in your meals. This subject is so incredibly important to your survival, not just good health, than I feel all of us should do all we can to learn and be knowledgeable.

It is a huge challenge to even try to keep up with the information coming in. Finally, so many mysteries are being solved as to how our total lifestyle can and should be altered to make optimal health possible. Science has discovered how the way we think and our happiness affects our health and much more. It has found how our thoughts and feelings can effect our aging as well. Our ability to perform in our work and endeavors as well as our intelligence can be affected. Finally we are finding out what the actual chemistry causes these things to happen.

In this issue, because space is limited, I will concentrate on what most of us think are the causes and how to find out if you are in trouble.

Normal causes are:

Poor diet
Lack of exercise or excessive exercise
Stress – not just the external stress, like work, but the stress of hurt feelings, dwelling on negatives, childhood abuse, lack of support and more. Being unhappy with yourself is not healthy.
Hidden or chronic infections (parasites, yeasts, bacteria, etc.)
Hidden allergies (food or environment, molds and yeasts)
Toxins such as heavy metals or chemicals
Neglected teeth and gum disease
Obstructive sleep apnea

Here are some things you can do about it:

Follow the guidelines for what to avoid and what to eat in the October and November issues of Alive
Regular exercise- there is so much value to your body and your emotions, along with your heart and immune system. Advice on what to do and how much from an expert is highly recommended.
Relax – meditation has been scientifically proven to improve areas of your brain.
Take supplements – a good multivitamin with chelated minerals and, past 40, probiotics and antioxidants.
Avoid any foods you are allergic to. If you are following an anti-inflammatory diet already gluten and dairy are out.
When you are in for a physical exam ask for a “C-reactive protein” test to be included. This test reveals the presence of inflammation. Ask the doctor what he/she thinks about chronic inflammation and any other test they might use. You should also enquire about the health of your intestine, especially if you are irregular or have spent a lot of time in not so clean countries. If a stool sample reveals a parasite it must be treated.

One can feel totally healthy and have a raging inflammation going on. Sometimes, due to symptom reducing drugs for diseases like arthritis or asthma the inflammation is hidden allowing it to produce damage and disease in other areas. The answer is not anti-inflammatory drugs such as ibuprofen, aspirin or steroids. Again, you are just masking the symptom while the problem gets worse and many die from these drugs.

It is becoming more apparent that the many facets of medicine are so specialized that true diagnosis and proper treatment plans are hard to come by. These new discoveries, I hope, will force doctors into a more integrated approach to medicine where they more understand the underlying cause of the symptom that appears in the area of their specialty.

In treating more than the symptom known to their specialty and going after the cause, your doctor could be saving you from problems in other areas. Even if you know someone who already has a disease like cancer or heart failure, it is extremely important to control and eliminate the biggest single factor that caused it –chronic inflammation. Their chances of survival can be greatly increased.

Fighting Chronic Inflammation

November 3, 2013 by Dr. Robert Brown Leave a Comment

As I pointed out October’s ALIVE, Chronic Inflammation is the number one cause of death, according to the World Health Organization. Some might disagree and say it is Heart Disease or Cancer, but chronic inflammation is the major cause of both of those diseases.

In my field of Tempromandibular Joint Disorders (TMJ) and Sleep Apnea, chronic inflammation is heavily involved. It is a major cause of arthritis and fibromyalgia, both involved in TMJ, and obstructive sleep apnea (OSA) causes chronic inflammation. This condition can result in severe stress, and stress can also cause chronic inflammation.

Your body creates chemicals that cause and fight inflammation. A major player is called “Prostaglandins.” They come from the nutrients in the foods you eat and, according to bad or good food; they will produce inflammation or fight inflammation.

There is a big plus here; the discovery of the importance of chronic inflammation has made it possible for the patient to be more proactive in preventing and even curing his or her disease. In October’s ALIVE I went over the bad guys that cause chronic inflammation. You can now find sources which give an inflammatory index which will help you value almost all foods as good or bad. Some of the best anti-inflammatory foods are:

Wild Salmon: (never farmed) Great source of omega-3. On the anti-inflammatory index, most fish score very high. If you don’t like fish, it is probably because you don’t know how to buy it and cook it. It’s great! Because I am and avid fisherman I can tell fresh just looking at it. I see fish for sale in markets that I would throw out. Find a fish market you can trust.
Olive oil (extra virgin): Olive oil is so good for you that you can almost consider it a dietary supplement. Great for the skin.
Organic vegetables: especially broccoli, kale, brussel sprouts and bok choy.

All veggies are great, but these are especially anti-inflammatory.

Garlic: Garlic and onions are quite high on the inflammatory index.
Ginger: Contains many other benefits in addition to being very anti-inflammatory.
Blueberries (organic only): organic because the small size makes them hard to wash for removal of sprays. This food is like a prescription drug for good health and it is anti-inflammatory.
Sweet Potato: everything good—fiber, beta-carotene, minerals and vitamins plus anti-inflammatory.
Turmeric: Multiple benefits and a great addition to not only you diet but to tastier cooking.
Kelp: could be one of the most anti-inflammatory foods around plus a great source of most minerals.

I am well aware that, to many readers, cooking is too much effort. It is so important to understand that eating fresh can totally change your life. Once you experience that new, healthy feeling, you might even have enough increased energy to want to cook. On the internet you can find not only recipes for anti-inflammatory meals but many cook books dedicated to eating for good health.

There are several other ways one can have an anti-inflammatory lifestyle. Recent discoveries, which are going to change western approach to medicine, have been able to find the actual mechanisms by which the mind can create disease as well as help to cure it.

Now we really know how important it is to have a holistic approach to an illness. Every aspect of the body, including one’s thoughts, must be considered when determining the many factors that create a disease. I would rather look at it positively and understand that now we are getting the knowledge that will allow us to be free of the enemies of health and youthfulness.

Finally, we are getting the information we need to truly be proactive in giving ourselves the best chance at a healthy, energetic and vital life. If the doctor you go to for a symptom does not react to what you have learned, you definitely need to find a doctor who does and is happy that you want to be proactive.

In the next issue I will go into other ways our lifestyle affects inflammation and what to do about them. Just following some of the guidelines can make a difference.

INFLAMMATION – A VITAL FACTOR INFLUENCING YOUR HEALTH

October 4, 2013 by Dr. Robert Brown Leave a Comment

You might wonder why an orthodontist and TMJ dentist is interested in inflammation. In my eyes any practitioner who is not holistic is lacking. Everything that goes on in our bodies is related to the rest of the body.

If you have habits that create inflammation, your life can be at risk and any responsible person in the medical profession should be aware of this. So many of the medical specialties are so specialized that they treat the just what relates to their work, not taking into account what is happening to the rest of the patient. Sure, sinus inflammation can affect the shape of the mouth, but that is not what primarily concerns me.

Cancer, diabetes, depression, heart disease, arthritis, Alzheimer’s and even your child’s recurrent sinus infections all have a common denominator: inflammation. Normally, inflammation is part of a healthy response of the immune system which brings in cells and chemicals that fight infection, or heal an injury.

The problem is there are hidden forms of inflammation which bring in an endless source of immune cells that interfere with the body’s healthy cells and tissues. Even worse, most people don’t know this is going on. The World Health Organization lists chronic inflammation as the number one cause of death.

There are many sources of this chronic inflammation, from the effects of obesity, to smoking and general poor health habits. In this issue I will address one of the most common sources of chronic inflammation: inflammatory foods. The following list includes the most common enemies of health:

Sugar: Since I entered the field of dentistry I always thought that if sugar rots your teeth, what else is it destroying? A Coke equals 10 sugar cubes. In nature, sweet foods are usually good for you, but man has learned how to make the sweet flavor. High fructose corn syrup is doubly bad. You not only get the glycemic effects, but fructose produces liver fat creating cirrhosis.
Cooking oils: High Omega 6 levels in vegetable oils promote inflammation. Polyunsaturated vegetable oils, such as grape seed, cottonseed, safflower, corn and sunflower, are all high in Omega 6 and low in Omega 3 and when used in cooking can easily become trans fats.
Trans Fats: Fat is an essential factor in causing food to spoil. Our wonderful industry has found that by changing to trans fats through hydrogenation, the shelf life of a food can be increased. Partially hydrogenated oil, such as margarine and vegetable shortening, are inflammatory foods. Deep fried foods are loaded with trans fats when cooked in vegetable oil.
Dairy Products: Researchers have found that the ability to digest milk after infancy is abnormal. Milk is a common allergen which triggers the inflammatory process resulting in gastric distress, rashes, acne and respiratory problems such as asthma.
Commercially Raised Grain Fed Meats: These animals are fed a diet high in Omega 6 fatty acids. Due to the cramped living conditions, they gain excess fat and contain high saturated fats. To make them grow faster they are given hormones and antibiotics. An inflammatory food is the result.
Red Meat & Processed Meat: A chemical exists in some red meats called Neu5Gc. The body can produce an antibody to this molecule that creates a low grade inflammation that persists for long periods of time. There is a high correlation between colon cancer and the consumption of red meats.
Alcohol: Regular consumption can create inflammation in the esophagus, larynx and liver. Small amounts can be tolerated, but heavy use is a killer.
Refined Grains: Over-refining of grains causes this food to become a similar inflammatory agent to sugar (a practically empty calorie with a high glycemic index). Even whole grains can be responsible for Celiac disease (an immune reaction to eating gluten. Over time, this reaction produces inflammation that damages the small intestine’s lining and prevents absorption of some nutrients) and have been found to be responsible for early aging of the skin.
Artificial Food Additives: Eating fresh is the answer. Processed foods contain flavor enhancers such as MSG, high fructose corn syrup and Aspartame, as well as preservatives such as BHA and BHT. Corn syrup has been found to stimulate ones appetite so our ever loving bread producers are adding this financial nutrient to improve their health.
Any Food You To Which You Are Sensitive: If a food makes you feel uncomfortable you should check into it. Some of the more common suspects are gluten, milk, eggs, legumes and nightshade related vegetables (eggplant, green peppers and tomatoes). Medical tests are not always conclusive, home tests are available.

The extreme importance of inflammation as a cause of dangerous diseases is relatively new to medicine. The quality of your life can depend greatly on its control.

Sleep Apnea and TMJ: The Relationship

September 1, 2013 by Dr. Robert Brown Leave a Comment

As many of my readers know, I have been practicing in the field of TMJ (the joint that attaches the lower jaw, mandible, to the temporal bone of your head) for 35 years. Over those years I have seen the usual fads come and go from simple little splints that attach only to the front teeth to full coverage splints.

Anything will work occasionally because most TMJ is simply because it is not natural to hold the teeth together. Just putting something in that interrupts this habit can sometimes work.

There is no “one size fits all” orthotic (splint) that works for everyone. One of my goals in treatment is to diagnose the underlying cause of why each patient has destructive oral habits and work on the factors causing the dysfunction. Over the years, working as a team with other specialists, I was getting very good results. Some patients, though, did not respond well or would have the symptoms come and go.

It was when medicine brought sleep apnea to the forefront and developed ways to diagnose and treat this problem that I got to the “root” of the problem. One finding was that during one’s waking hours, pressure when clenching reach forces in the area of 200 pounds per square inch. During sleep, by contrast, forces can reach over 700 pounds per square inch. Those that add grinding to their bad habits can literally grind their teeth to the gum line. These heavy forces can seriously exacerbate damage to the joints and disks.

A major factor causing this is that obstructive sleep apnea (OSA) has an effect on the brain, not letting it go into deep sleep mode in order to be awake enough to prevent suffocation.

Part of my initial exam questionnaire contains a test that is quite good at seeing the need for a sleep study. Most people go in for a study because of their friends that are kept awake with their snoring. I have found non snoring patients with acute OSA because the obstruction is below the tongue and palate where snoring occurs.

Treatment of the OSA using a dental appliance can not only bring the apnea under control, but help prevent any further damage to the teeth and joints. One comment I get from my OSA patients is that before the appliance they rarely dreamed and could not remember their dreams. “Now my dreams are much better, they are in color and I remember a lot of detail.”

One very important factor in the treatment of TMJ is that treatment of the bite by reconstructive dentistry, surgery, orthodontics or endodontics should not be attempted until a complete diagnosis has been made. I do not feel a diagnosis in possible, unless obvious, like trauma, until the symptoms are gone. Then the practitioner can register the bite, mounting the patient’s dental models on an accurate articulator in the pain free position.

I have seen cases with root canals on many of the posterior teeth, none of which was necessary. In most severe TMJ cases the chief complaint is pain in the muscles associated with the jaws. The same nerves that supply these muscles also supply the teeth. The muscle pain can imitate a toothache. The dentist treats the “tooth ache” by killing nerve of the tooth, but the pain persists, so the dentist goes on to the next tooth and even the next. If pain persists after treatment it never hurts to seek a second or third opinion.

Surgery has been used for TMJ but with mixed results. Properly diagnosed and with a team approach, wonderful results can be achieved. In a small number of cases surgery to correct the bite could also correct the airway. The results have been phenomenal giving the patients, in their own words, “a new life.” Most of this type of patient displays a severely receding jaw. This “new life” surgery is usually a “new face” surgery and can do wonders for the appearance and personality of the lucky patient.

My initial exam is with no charge in order that the patient can get another opinion.

Your Child’s Growth and Development: What Can a Parent Do?

August 1, 2013 by Dr. Robert Brown Leave a Comment

You may not be aware, but the growth and development of your child, both physical and mental, can be vastly improved by making minor lifestyle changes and correcting hidden problems that mostly go ignored.

I feel very fortunate to belong to the American Association of Physiological Medicine and Dentistry. The goal of this group is to bring a fuller, more integrated care to the public by building bridges and common understanding between all of the various health care providers. Much of the theme of the last meeting was on the subject of proper breathing and how it influences the growth and development of our children.

Sleep apnea can have a profound effect on both the mental and physical development of children. Children can be much more affected by a lower threshold for sleep disordered breathing (SDB) than adults. An adult with fewer that five apnea episodes per hour is considered normal. Most pediatric sleep centers view apneas or hypopneas occurring more than once per hour as abnormal.

Snoring is not cute, it is dangerous. Current research has suggested that snoring, even without apneas, can be associated with cognitive and psychosocial problems. Snoring in children has been shown to be associated with lower scores on memory and learning tests including some IQ tests. Growth hormone production can also be altered by SDB.

Proper sleep and breathing has also been associated with the development of the immune system. If your child has allergies, frequent colds, cold soars, is sleepy at school, has a weight problem or avoids exercise, it could be due to SDB. Dark circles under the eyes are a big clue.

Many years ago I was one of 25 American orthodontists lucky enough to learn the use of the Frankel appliance from Dr. Frankel himself. He developed an appliance that alters the growth of the oral complex and face, an received the Russian equivalent of the Nobel Prize for it.

This appliance is removable and only placed in the mouth at night. It corrects “bucked teeth” by causing the lower jaw to grow forward. Previous orthodontic methods push the upper teeth back with head gear or extractions, decreasing the airway. It is possible that OSA can be not only corrected in the child, using his appliance, but prevented in the adult.

WHAT SYMPTOMS SHOULD I LOOK FOR?

Does your child snore, gasp or does his or her chest heave while trying to breathe? If your child raises the chest and shoulders to breathe you should be very concerned and contact your doctor. If your doctor is not concerned, find one that is, because this serious problem is found in more recent literature which the practitioner may not be aware of.

In my TMJ and Sleep Apnea practice I have found a very high percentage of patients over 40 who should have had their nasal airway treated as a child. An ear, nose and throat specialist (ENT) can correct the nasal airway surgically, with very little discomfort. Don’t try nasal sprays unless they are prescribed by a practitioner and have no side effects.

In growing children, nasal congestion can create an alteration of the development of the nose and face. Making sure a child primarily breathes through the nose can not only help sleeping but create an environment in which the face can develop to what it was supposed to be.An ENT can be very effective in achieving this.

Growth occurs mostly during sleep and an open mouth causes the teeth to erupt more and forces a low tongue posture in order to breath. This results in a narrow and crowded upper jaw as well as creating a longer face with a more reduced chin. Now you have an orthodontic or even surgical orthodontic challenge.

When we control the apnea we are correcting an upper protrusion by growing the lower jaw forward. Not only is far more beautiful, but it increases the airway giving many additional health benefits.

Needless to say, being the one who lives with a growing beautiful child, you must take an aggressive part in that child’s development. The pediatrician is there to check if everything is going all right and treats any illness, but you must be there to make sure the little angel is breathing through his or her nose with closed lips and sleeps calmly.

Now that you have done your part for your child, it is very important for you to get your sleep. The same rules apply if you want to enjoy your life to its fullest. A good night’s sleep is not only a pleasure, but extremely essential to your health and to remaining youthful.

Robert Brown, DDS has a TMJ, orthodontia, and sleep apnea practice in Danville and thoroughly enjoys discussing holistic medicine. You can contact him at 925-837-8048, at info@aodtc.com, or visit his web site at www.aodtc.com.

POISONING YOURSELF WITH PROCESSED FOODS

July 3, 2013 by Dr. Robert Brown Leave a Comment

It has always bothered me that we go through twelve years of school without learning much about our body. It seems to me that our education should include what makes up that complex structure we have to live in and how to take care of it.

There should be a mandatory course in physiology from K through 12. I used to offer a class to fourth graders on what tobacco does to you which included rather gross slides of cancer and post surgical patients still smoking through a hole in their throat. I also showed them photos of the cancer caused by chewing tobacco with testimony from baseball players on the harms and consequences of regular use.

This was only one hour in one day of school. These kids went home and raised hell with their parents who smoked. Can you imagine what could be done if every day there was a period dedicated to taking care of your body? It would mean billions less for the medical and pharmaceutical industry, and years added to our life expectancies.

Part of a medical history that you have to fill out for your doctor should include the foods you eat. Processed foods are real foods that have been altered in some way to enhance their flavor and shelf life and make them “safer.” Do you eat such foods and how often do you eat these foods? Heart disease has been found to be much more serious when inflammation is present. Processed foods contribute greatly to inflammation.

Almost any food in a package or box is processed. So what does processed mean and why is it done?

The processing kills bacteria and other organisms which would spoil the food and not allow it to by shipped long distances or stored in markets. Natural fats can quickly go rancid. When replaced with cheap trans-fats the food can last months. Adding chemicals, heating, irradiating, milling and pressure treating are also used to extend shelf life (read profits) and, in most cases alter the food to be much less nutritious and often devoid of nutrition.

I like to refer to these foods as empty calories. The only problem is that empty calories do not supply the nutrients necessary for their digestion and assimilation requiring the body to give up some of the important vitamins and nutrients leaving it depleted. White rice and alcohol are examples of empty calories and can cause loss of B complex vitamins damaging many organs especially the liver. Thus you can see that potentially nutritious foods can be altered to become indirect poisons.

Two major ingredients found in processed foods are sugar and trans-fat. In order to entice your taste buds, the food industry uses high fructose corn syrup and hydrogenated trans-fats. These two ingredients can help to threaten your heart even more. Not happy yet with what they have done to your heart health, they add salt to boost your blood pressure. In this case the real motive is not just to preserve the food, it is greed without conscience.

The list of chemicals added to “preserve freshness” and enhance flavor would take pages to list and explain. Here are a few with their consequences: MSG is used for flavor enhancement and causes head aches, chest pain, mood swings and more. Artificial flavors are associated with ADHD and allergies. Propylene Glycol is used to emulsify and can cause reproductive issues, allergies, neurotoxicity and hormone disruption. High fructose corn syrup is used because it is cheaper than sugar and is associated with liver toxicity, stimulation of inflammation, obesity, oxidative stress, diabetes and more.

I know it is so tempting to simply open a box, a can, or take something processed out of the freezer, but is it worth the price? You also miss out on the fulfillment of creating something everyone enjoys knowing you are not hurting them but instead nourishing them physically and mentally. Chances are you and your family will live longer, too.

And at the end of the day, isn’t that why we nourish our bodies?