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Manyh Ways to Seek Balance and Relieve Pain

Balance is a key issue in all parts of his life for Dr. Charles Ferzli, a Cary-based dentist.

Dr. Ferzli has many visual aids to help patients understand the therapies the doctor is providing and/or prescribing.

Stand outside his practice doorways and you’ll see, to the left, the entranceway to the TMJ & Sleep Therapy Centre of Raleigh/Durham, devoted to dealing effectively and princi-pally with the many debilitating aspects of temporomandibular joint disorder (TMJ). To the right is the entrance to his dental practice, Smiles of Cary Family Dentistry. The practices are linked, balanced, and mutually supportive in many ways.

“As our ‘sleep therapy’ name suggests,” notes Dr. Ferzli, “we can tell if a prospective patient has sleep problems or not simply by using a home sleep test. But if they have a complicated medical history, such as high blood pressure or diabetes, then it is in the patient’s best interests for a medical doctor to render the diagnosis at a sleep facility—and not simply through a home sleep test.

“For the most part, I do not use my own sleep machines to check if someone has a sleep problem; I usually send them directly to a sleep physician. Often they will come back to us to be fitted for an oral appliance if their sleep problem is mild or moderate.”

If the problem is severe, Dr. Ferzli will recommend use of the CPAP device—which is Continuous Positive Airway Pressure. But, he says, “if the patient has problems tolerating CPAP, we can try an oral appliance to increase the likelihood of inducing restorative sleep.”

TMJ and Balance

HEALTH&HEALING: In the search for balance, you seem very willing to reach out to other practitioners in other disciplines for assistance.

DR. FERZLI: In assessing a patient who has jaw-joint pain or head and neck pain, we usually find the pain affects the body’s posture and therefore affects the patient’s balance and gait. By decompressing and reducing inflammation in the temporomandibular joint we are also helping the patient restore their balance.

However, at times, that balance has been altered by jaw pain for many years, because the patient carried him- or herself in a certain unbalanced way. Thus, when we restore the balance in the jaw with an oral appliance, there are shifts in body posture and the body starts to unwind. As a consequence, although the patient’s jaw pain is alleviated, they may begin to feel discomfort in other parts of their body. And often at this juncture we consider what treatment is most likely to be beneficial to the patient, based on testing and observation.

We may, for example, refer the patient to a physical therapist to help gain strength in the weak side of their body—often an important step in restoring balance. And there are many other options to consider.

HEALTH&HEALING: What kinds of complementary therapies do you seek and with whom do you collaborate?

DR. FERZLI: On a more regular basis, I work with Dr. Daniel Bannard, a holistic chiropractor in Cary. He offers a variety of therapeutic approaches that have been helpful in restoring balance to my patients—including, of course, chiropractic adjustments, but also acupuncture, physical therapy, and customized orthotics. His approach—like ours—varies to meet the unique needs of the patient.

I also work frequently with physical therapists who use PRI—Postural Restoration therapy. Basically, the posture—and therefore balance—is very responsive to this therapeutic approach. PRI physical therapists—and we have a number in this area—in turn work with certain optometrists to help patients level their gait and improve range of motion. They correlate exercise for the eyes with improved range of motion in the body, because the eyes affect posture and affect the way you carry yourself. It’s fascinating to become aware of how the body connects and how certain parts of the body affect other parts of the body.

HEALTH&HEALING: Any other practitioners offering support for the TMJ patient?

DR. FERZLI: There is, of course, an important support role for psychologists and psychiatrists. There are times when anxiety and depression are the root cause of physical issues, which in some instances is an event carried over from childhood. Psychologists will tell you that childhood abuse can sometimes trigger joint pain. In this practice, psychiatrists are a resource that we sometimes use.

“It’s also important to note the important role that ear, nose and throat specialists often have in rendering healing services to our patients. We work with a number of ENT practices, because many of our patients have obstructed airways and inflamed tissue, often with sleep-related problems because they cannot breathe through their nose. Most of the literature shows that if you can breathe through your nose, you’re less likely to have sleep problems, than if you primarily breathe through your mouth.

Many patients who come to us with head and neck pain have already seen a neurologist, and quite often, they have been to just about every medical specialist they can think of, seeking relief. Most often, the specialists have ruled out all organic causes of headaches—which means that the presenting condition is almost certainly not cancer or a growth of any kind. When the primary causes of discomfort are migraines and tension headaches, we can help posturally by altering their musculoskeletal system.”

Patient Health Questionnaire

New patients coming to the TMJ & Sleep Therapy Centre of Raleigh-Durham are asked to complete a patient health questionnaire seeking information about 100 different health conditions, indicating for each whether it is a recent or chronic in occurrence.

The list, notes Dr. Ferzli, underscores the important connections between body parts and systems. “And TMJ,” he says, “is perhaps one of the best examples of that interconnectivity. It has been called ‘the great imposter’ because its symptoms are so often the same as those for many other disorders. So the list of issues included on our questionnaire reveals those important connections and helps to provide an accurate assessment of the patient.” The list includes:

  • Headache pain
  • Ear pain
  • Jaw pain
  • Pain when chewing
  • Facial pain
  • Eye pain
  • Throat plain
  • Neck pain
  • Shoulder pain
  • Back pain
  • Limited ability to open mouth
  • Jaw joint locking
  • Jaw joint noises
  • Ear congestion
  • Sinus congestion
  • Dizziness
  • Tinnitus (ringing in the ears)
  • Muscle twitching
  • Voice problems
  • Kicking or jerking leg repeatedly
  • Swelling in ankles or feet
  • Morning hoarseness
  • Dry mouth upon waking
  • Fatigue
  • Difficulty falling asleep
  • Tossing and turning frequently
  • Repeated awakening
  • Feeling unrefreshed in the morning
  • Significant daytime drowsiness
  • Frequent heavy snoring
  • Affects sleep of others
  • Gasping when waking
  • Told that “I stop breathing” during sleep
  • Night-time choking spells
  • Unable to tolerate C-Pap
  • Tooth grinding
  • Teeth crowding