Back when I was the guy who stood at Gold’s Gym at 05:00 hours.  That’s 5 am for anyone who is not familiar with the 24-hour time clock. Then one day I was driving home, and it was a dark and rainy night (sounds like a good beginning to a horror story, and as it turns out, it was). There was a jaywalker in the middle of the road, so I hit the brakes hard and stopped, but so did the bus to my right. Unfortunately, the guy behind me did not stop and slammed hard into the back of my car, doing around 40 mph. My neck snapped pretty hard, and my beautiful car was crunched up quite badly. (Sure, it was already 15 years old, but it was my baby :)). I took down the name of the guy who nailed me, went home and went to bed. The next morning my neck hurt so bad I could not move, could not get out of bed and could only call for help.

This was the beginning of a 20-year nightmare of neck pain and back pain that would never cease. I felt like I was living on Advil. My neck, traps, back, shoulders, everything had been in pain for so long that it felt like there was no solution. And then, I slowly began to notice that I was having difficulty swallowing my vitamins and eventually even food was tough to get down my throat. It was like I had to really ‘work it’ to force down my food and people were noticing that I had lots of issues, they actually asked if I was choking. Well, it turns out that I was indeed having swallowing problems sounding like choking!

As the years progressed, I sought countless physical therapy appointments, osteopath visits and any other doctor to help with the pain.  Some of them were really good, others not so much. The problem with all this treatment was that nothing would really alleviate the pain or swallowing problems for any length of time. It was all ‘palliative’ treatment, as they call it.

So, I already knew that I had a severely deviated nasal septum that would greatly affect breathing and healing, obviously. As a member of the ALF Academy, I learned more about my own problems. I learned that when the body incurs trauma, like I did, the ligaments that exist from the mastoid bone behind the ear and go to the hyoid in the throat will often calcify into bone. This calcification is our body’s way to help open up the airway and reduce spinal compression, both of which I had going for me. If you can imagine having long pieces of bone stuck in your throat on both sides and these darned things are blocking both your airway and your ability to swallow, then you can understand what I have been through, and many of my patients have experienced. Was this diagnosed as Eagle’s Syndrome? No, not really, but some of my doctors did suggest it. And what do you do about Eagle’s? You generally watch it and keep an eye on it. So that’s what I did until recently.

In my practice, we have always watched for this, and appliance therapy slows down the calcification process tremendously. To be clear it does not get rid of the problem.  The concern is the compromised airway and continued pressure placed on the carotid artery. Obviously, this is a concern that can lead to a stroke. This is why we have a CBCT X-ray completed from the neck up.

Now, back to my story. There came a time in middle to late 2022 when I was choking on most foods and literally gave up on all the vitamins and supplements that my doctor wanted me to take. I knew my hyoid ligaments were very calcified at this time. I took a good long look at my own X-rays and said, ‘That’s enough XXXX’, I need to deal with this problem. I made the call to the most wonderful ENT doctor that I have known for years. He and I discussed treatment and he explained he has dealt with these issues for many years now and knew exactly what to do. Needless to say, I knew I had to deal with this, so I scheduled a surgical intervention. His surgery involved correcting the deviated septum and removing the calcification from either side of my throat.

The next three days of my life were really rough. All I could do was to choke down the oxycontin and cry for the next five minutes or so. The oxy would kick in for a while and it was three days later before I could even think of consuming chicken broth or anything similar. So, for the next week, I would choke down my broth, and sometimes there was a bit of noodle in there as well.

At 12 days post-surgery, I am at the computer typing away with a very sore throat and just taking Tylenol as needed for the pain. Last night, I was able to choke down some noodles and sauce and it was a bit less difficult than the night before. No more oxycontin is needed. My nasal passages are also popping out lots of scabs these days and if I blow my nose, lots of junk comes out. Overall, it is getting better, but ever so slowly. I have been sleeping up to 12 hours each day; not sure if this is recuperative sleep from losing so much sleep over the years or just from the lack of sleep post-surgery. I am still having problems with swallowing, but the throat is still quite swollen, so I guess that’s par for the course.

So, how would I rate doing this surgery? The jury is still out. I do admit that I believe I can breathe a little better through the nose and hope this continues to improve. Also, when I take Tylenol, it does not get stuck in my throat nearly as much. The neck pain is still there – I had no expectations about curing that. Sleep is much better and definitely more restful. My main reason for writing this very long blog was to set expectations if one ends up doing such a surgery. Expect a lot of pain. Expect difficult days and rough nights. But in the end, as long as it helps, it was worth it!

The post The Case of the Calcification and the Correction or How I Handled Eagle’s Syndrome first appeared on Sleep & TMJ Therapy.

Some dental practitioners have learned that if you pull teeth out for braces, you could end up compromising not only the airway, but the cervical spine as well. What happens with an excision (extraction) of a tooth is that the face tends to draw back, which puts pressure on the airway- it basically causes the face to collapse backward, thus closing the airway more. In addition, this effect of collapsing the face backward changes how the skull sits on the neck, the cervical spine. Now imagine that if the cranial bones are not level and you pull out a tooth. This could cause the skull to become more asymmetrical, which could lead to more head and neck pain. It’s all connected- if you pull a tooth, or two, or ten, this could mess up your whole body. Sorry to be so technical, but hopefully you see the logic.

An awful analogy to this is that if you break your finger, you really do not want to amputate it, do you? It just does not make much sense. For some reason, human beings became complacent with the idea that you could just pull a tooth if it went slightly wrong. Today, of course, things are different, and we want to keep every bit of our body if possible. When you have a healthy smile, it not only affects your health, but it also affects your view of the world.

Speaking strictly from a cosmetic viewpoint, everyone is well aware that when you have a great smile, full of teeth, you are more likely to be confident about life in general and will have a better outlook on the world. A healthy smile makes us more attractive to the rest of the world and more likely to interact with others- in a healthy fashion! Not to mention, when we feel better, the endorphins tend to flow more, and this uplifts our spirits greatly. Bottom line is that when you look good, you tend to feel good, and this means a healthier mind and body.

The post A Healthy Smile Means a Healthy Body first appeared on Sleep & TMJ Therapy.

Did you know that your tongue can hold fat deposits, just like your belly? If you were ever overweight in the past, your tongue would likely have fat deposits in it, and these are kind of hard to lose. The tongue, like any other muscle in the human body, needs to exercise. But like most patients who are referred to a myofunctional therapist, they don’t go, they won’t do it. It costs money and time, and they feel like it’s kind of silly to exercise this area of the body. Well, folks, it does work and does make lots of sense, so get out there and start exercising that tongue!

In so many cases where a patient has sleep apnea, the tongue is quite large and is full of fat tissue. This can readily be seen on an X-ray that shows the tongue and what can be seen is that the tongue is elevated because it is thick due to fat deposition. Like so many areas of the human body, if you exercise the tongue and surrounding tissues, the fat will decrease over time which will effectively open the airway for better breathing. Snoring usually reduces as well as the tongue becomes smaller and tighter. The tissues around the tongue also become more toned with these exercises so if you have sleep apnea, it might reduce as you exercise this area over time. In fact, in many of the dental sleep medicine training programs, it is taught that myofunctional exercises are mandatory to improve a patient’s health.

There are other obvious benefits to exercising your tongue.  Your speech and articulation of words are improved, caused by the weakness in the tongue. If you have Dysphagia (trouble swallowing), your ability to develop a stronger tongue able to move more easily and then swallowing becomes easier. Finally, another plus is the jawline. Tongue exercises include the muscles groups below the chin and toning of the jawline begins.

So once again, dear reader, consider sticking out your tongue and making it work like it has never worked before. Get that tongue at attention! Get that tongue out there into the real world! Make that tongue healthier, happier, and improve your life!

The post The Case for Tongue Exercises – REALLY? first appeared on Sleep & TMJ Therapy.

In the past, it was quite common for an orthodontist to order extractions of perfectly good teeth to make the process of moving teeth and creating space with the use of braces easier. So many children are now presenting with narrow arches and crowded teeth that it made sense (somewhat) to remove the crowded teeth, thus allowing the orthodontic work to go faster and easier. But somewhere along the way a few practitioners noticed that the removal of the bicuspid teeth would often cause the upper and lower jaws to collapse backward which would lead to a collapsing of the airway as well. They also rather astutely noticed that the palate would become smaller, which made breathing more difficult as well. There are still orthodontists today who practice the method of extracting the teeth to make room and the braces go easier. However, many more are learning that there just might be better techniques.

The extractions of impacted teeth are a completely different need but also can cause the same issue. In this situation, the teeth need to be removed because 1) the lack of space in the bone means the teeth cannot erupt or 2) the tooth is growing in the wrong direction or position. In this situation, the stress placed on the jaw joint can cause the disc to be displaced and in addition, put a strain on the muscles around the jaw joint.

Of course, another method of expansion is the good old-fashioned RPE (Rapid Palatal Expander), but even this has its issues. The RPE will often just open the palate rapidly and the midline suture might not form into solid bone — it might just be a cartilaginous suture that can move around over time. This would not be very effective. The reason is on a skeletal level this instability can cause changes and distortions in the cranium. Another approach to getting some expansion is to use the ALF appliance as much as possible with the understanding that a few months with the RPE might be OK.

Another problem that is frequently seen among dentists, pulling out bicuspids, which makes the upper and lower jaws move and therefore are no longer in the same position as previously. This change can affect how the condyles (top of the jawbone) fit into the sockets and in turn, can lead to a TMJ problem. When that condyle is re-positioned after extractions, it will no longer be in the same relationship to the disc that covers it. The disc can end up displaced over time. This is what can lead to head and neck pain. So many extraction patients end up with similar problems later in life.

There are some practitioners who will actually use a palatal expander to re-open the extraction spaces to put in dental implants to ‘restore’ what was taken away. This is actually a controversial topic. As we get a bit older, the bones in the skull do indeed become more solid and if you were to try expansion a lot — like the width of a bicuspid that had been removed — it might be too much for the body to handle. Does that make sense? It might be that the expansion is just too much of a  ‘stretch’ and moving bones around might lead to more pain. This is another reason why the more conservative practitioners would use the ALF appliance to get as much gentle expansion as possible while minimizing trauma to the facial bones.

So, in general, extractions for the sake of doing braces may not be the best idea. Be sure to be careful when considering this.

The post Are Teeth Extractions Helpful? first appeared on Sleep & TMJ Therapy.