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The Toxic Effects of TMJD

Over time, Sandra Smith, in her mid-fifties, became an expert on many aspects of pain.

Dr. Ferzli, here with a patient, and his staff frequently measure bodily functions of their patients related to proper and healthy breathing.

“I had a long-term extreme headache issue that had been misdiagnosed as continuing migraines,” she recounts.

“Beyond this issue, I was being treated at the time for a C-5 disc herniation in my neck by a chiropractor, Dr. Christopher Outten. I also had a spinal treatment with him, that relieved some of my pain—and he and I came to believe that I might also be suffering with TMJD—temporomandibular joint disorder.  He referred me to Dr. Charles Ferzli at the TMJ and Sleep Therapy Centre of Raleigh-Durham, for diagnosis and possible treatment.

“Interestingly enough, the weekend prior to this referral recommendation, I did a lot of research on TMJD doctors and had found from the literature on the web that Dr. Ferzli, right here in Cary, was one of the most progressive and comprehensive experts in this field—the treatment of TMJ disorders.

Sandra Smith

“And so I made my first appointment with Dr. Ferzli on March 22nd of this year. And it was an incredible experience. It began with the completion of a huge round of extensive, detailed questionnaires—about my eating habits and my sleep habits and my pain issues, and a good deal more. Fairly early on in this process, Dr. Ferzli said ‘I think you have sleep apnea and I think that is contributing to your TMJD.’ I was somewhat skeptical of that idea, but I was happy to take his home sleep test. And it turned out that the opposite of my beliefs was true. Sleep apnea was a critical issue. I was having interrupted breathing 23 times every hour.

“This condition led to the bruxism—which is the nighttime clenching. And of course there was another component that Dr. Ferzli understood so well: the type of jaw joint inflammation I had was so severe, it throws the entire body out of balance.

“I was shocked when Dr. Ferzli and staff were giving me balance tests—which of course I was not passing in the beginning, and which I am now passing with flying colors!

“I am continuing in Dr. Ferzli’s 12-weeek treatment plan. I see him weekly, so that he and his staff can precisely monitor progress we’re making—including, of course, balance testing and effective pain management. We are routinely testing the flexibility of my neck and jaw. They test me with a pharyngometer to determine the amount of air I am breathing, in and out, which also provides valuable information about airway size and stability.

“One of the procedures that was hugely important for me was that on my very first visit, Dr. Ferzli took a CAT scan that showed that I had a really serious blockage of my deviated septum, which could have been another major contributor to the sleep apnea. So, I ended up—even as I continued to see Dr. Ferzli—going to an ENT specialist to have surgery, called endoscopic septoplasty with turbinate reduction bilateral. And now my breathing is significantly better—as a result of this surgery and the continued use of my nighttime device. I’ve learned, first hand, that there are so many related aspects to treating TMJD. and how many aspects there are for complete health, head to toe.

“Right now, as I am nearing completion of my work with Dr. Ferzli, I feel I am 90 percent on the path of being completely well. When I first came to Dr. Ferzli, the opposite was true: I was having headaches over 90 percent of the time. They were debilitating headaches, exacerbated by humidity, by barometric pressure, by things that I ate, by any kind of tension that I might experience in normal everyday living. I’m right now experiencing about 92 to 93 percent improvement. I literally have my life back after four years of super suffering.” 

Health&Healing: Sandra Smith offers a remarkable testimony to your TMJD treatment plan.

Dr. Ferzli: Her case is also a good example of the complex nature of TMJ and the importance of taking a holistic approach to treating it. And it also illustrates one of the most significant health issues today: inflammation.

We are living in a world that is dominated by poor health choices, a great deal of fast foods, with too many children growing up with poor diets. And we have more and more inflammation in the population of all ages and both genders. One result of this onslaught is that we see more patients complaining of jaw pain, headaches, and poor sleep. Inflammation affects breathing. When the airway tissue becomes inflamed it becomes narrower. As a result, there is more congestion from the nose and there is more mouth breathing and associated sleep problems.

A good deal of our treatment focuses on curbing inflammation: how to treat it with the proper de-flaming diet, along with supplements to help curb inflammation in the system. We encourage our patients to eat balanced diets, drink water, relax, exercise, sleep 7 to 8 hours a night. All of these many different factors come together to support proper health and decreasing inflammation in the body.

TMJ Disorder:
What Is It?

The temporomandibular joint is one of the most complex joints in the human body; it resides directly behind the ear, connecting your jawbone to your skull and acting like a sliding hinge. Any problem preventing this complex system of muscles, ligaments, discs and bones from working properly may result in painful TMJ disorder (TMJD), causing stress, swelling, and pain—not only in the jaw, but in many parts of the body.

Symptoms of TMJD include jaw pain, difficulty chewing, and clicking and locking of the jaw. Jaw pain, neck pain, facial pain, migraines, and headaches are the most common complaints caused by or related to TMJ disorder.

Patients come to us because they have periodontal disease. We were taught that 75 percent of the adult population has some form of periodontal disease—an inflammatory process. And 90 percent of the people who have sleep problems have some form of periodontal disease.

There is a strong correlation with high blood pressure, diabetes, and acid reflux. All of these issues, and more, are inter-related and respond together to effective treatment.

Toxins are everywhere. And maintaining health in a toxic world is a real challenge for all of us. A lot of people don’t breathe through their nose, and it is the nose that filters the air when you breathe. Too many people breathe through their mouth because they cannot breathe through their nose. And the mouth is not designed to filter the air we breathe—so we have tonsils as a first line of defense against pollutants.

H&H: What role do hormones play in TMJ?

Dr. Ferzli: Hormonal differences between men and women affect who comes to see us, for sure. In fact, we do see quite a number of young, adolescent females who are having TMJ problems, and usually the issues are associated with the hormones that affect puberty in women more than men. And so we are looking at estrogen and progesterone, for example. Women have more pain receptors than men do, and they feel more pain than men do—and they are the first ones to complain of inflammation and TMJ. Boys—and males generally—do not have the same affinity to those pain receptors.

Usually after menopause, males and females have an equal likelihood of having sleep problems and TMJ problems—and men will less often complain of having TMJ problems as adults. Women will more often be sensitive to the pain affecting the jaw joint.

H&H: It seems when you are treating a TMJ problem that the oral appliance is just the beginning of the healing process.

Dr. Ferzli: Yes, the oral appliance or the oral orthodontic is a prop to decrease inflammation from the joint and allow the patient to function with less joint compression and inflammation. So then the muscle in mastication relaxes. The patient’s threshold for pain and inflammation increases. They feel less pain and over time, they get better. It is a complex process. For each patient, we need to address multiple issues: quality of sleep, their diet, appropriate movement. And much more. But properly done, it provides wonderful results.