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Cracking the Code of Chronic Problems

Unraveling the mysteries of TMJD (Temporomandibular Jaw Disorder) and sleep problems has become a professional passion for Dr. Charles Ferzli. “In fact,” he observes, “I would say that a significant part of my job is more detective work than dental work; it has to be. TMJ and sleep disorders are complex health problems—typically building over time—caused by multiple factors, and with misleading symptoms. Furthermore, they’re usually connected.”

Dr. Ferzli: “Patient choice is the biggest success factor in addressing any chronic condition. And I see myself as a conductor—guiding our patients in making those choices.”

The majority of patients Dr. Ferzli sees in his practice, the TMJ & Sleep Therapy Centre in Cary, are dealing with chronic problems—issues that have persisted for at least six months and often for several years. “We do see patients who have had a recent accident and suddenly cannot open their mouth,” he says. “These are acute cases and they’re rela-tively easy to treat. Chronic problems are harder for people to recognize and more difficult to treat.”

Chronic TMJ and sleep problems, notes Dr. Ferzli, typically develop slowly and then seem to happen all at once—producing acute symptoms. “But a sudden severe pain or locked jaw,” he explains, “is likely a symptom of a problem that has been building for a long time without being treated or corrected. Such issues are particularly difficult to fix because they require re-educating the body to function differently, slowly overcoming ingrained muscle memory.

“The first step is to determine the source or sources of the problem,” he says. “We gather a lot of information and then educate the patient about their condition so they have a better awareness of when it started and how long it has been going on.”

A Personal Mission

Dr. Ferzli developed his ability to see the big picture through deciphering his own health issues. “I had digestive issues growing up, and joint pains,” he says. “The headaches persisted into adulthood. In fact, I was still dealing with them even when, as a dentist, I began studying craniofacial pain. What I learned is that not only can poor sleep aggravate all those chronic issues, but can actually cause them. That is because sufficient, good quality sleep is essential to allow your body to heal itself.

“It was a stunning realization,” he recalls. “I thought: Wow, I’ve been like this since I was a kid! I’ve always had sleep issues—I just never recognized them. I never connected all the dots that paint a picture of how I am today.” 

The Detective Process

Dr. Ferzli’s own story illustrates how cause and effect are not always obvious, even to experts. “For example,” he observes, “TMJD can present with an amazingly wide variety of symptoms, many of which mimic those of other disorders. Jaw pain and headaches are common, but so are pains in other joints or the neck or back. Dizziness, ringing in the ears, and digestive problems are also symptoms of TMJ. There’s a reason the disease is called ‘the great imposter’.”

Dr. Ferzli uses a well-honed process to peel back the layers of symptoms and determine the source of TMJ and sleep problems. The starting place is a detailed questionnaire; it not only asks about commonly associated symptoms such as jaw or head pain, but explores a variety of less obvious problems caused or exacerbated by TMJD. Balance issues and motor movement disorders, including Parkinson’s Disease, for example, are two other conditions that can be greatly improved by treatment to decompress the temporomandibular joint.

And, Dr. Ferzli emphasizes, “TMJD and sleep disorders are not mutually exclusive—in fact they are very much connected. A patient might complain of seemingly acute TMJ symptoms but will deny awareness of any sleep problems. However, when I examine them, I’m likely to find a bony jaw growth, which is a sign of overnight jaw clenching. That’s a red flag for sleep apnea—something we will confirm with a sleep study.

“Those problems don’t happen overnight,” he continues. “Its causes very likely go back a long way. For example, when we dig deeper, we may learn that a patient was diagnosed with ADHD as a child and has been taking medication stimulants for years. They may have been diagnosed with ADHD and now, as an adult, have all these other problems but, in fact, they’ve always had a sleep problem.”

Making Connections

Dr. Ferzli also draws important connections between sleep and TMJD issues and other health issues. “Many of our patients come to us who grind their teeth all the time,” he says. “And the first question I ask them is if they are on any antidepressants. That’s because, with SSRIs—a commonly used antidepressant—one of the major side effects is clenching. So, the medicine they’re taking to treat their anxiety causes them to clench even more. At the same time, lack of sleep can make individuals more prone to anxiety or depression. It’s a vicious cycle—the medications worsen sleep, and the sleep disturbance causes or exacerbates depression or anxiety. But once we identify the problem, we can work together to break this negative cycle.”

Similarly, sleep problems are often connected to nutrient insufficiency and digestive problems. “For example,” explains Dr. Ferzli, “clenching your teeth at night—which affects how you sleep—affects the vagus nerve, which controls the digestive system. In addition, vitamin D deficiency can trigger sleep difficulties and cause vitamin B levels to plummet. So, fixing a sleep problem may also require dietary changes and nutritional supplements. Everything is connected.”

Choosing Wellness

To treat chronic TMJ and sleep issues, Dr. Ferzli offers a number of therapeutic options that may include the use of an oral appliance, nutritional support, and referral to other practitioners to address additional issues. Still, he emphasizes that patient choice is the biggest success factor in addressing any chronic condition. “I see myself as a conductor for our patients,” he says. “I try to make them aware of their lifestyle choices, their conditions—everything that brought them to where they are today. And then they have a choice: Do they want to address this holistically or do they just want me to fix their lockjaw?

“It’s not a simple choice,” he cautions, “because changing habits can be a slow process, particularly since these problems developed over a long period of time. But the payoff for these efforts can be life-changing, with a complete turnaround in some cases.

“My job is not simply treating people,” Dr. Ferzli says, “but making them aware of the possibilities and what they can do to heal. If they choose to get treatment, then they’re open to being better, and that’s the real shift.”