Spreading the Word

Does Physiologic Neuromuscular Dentistry seem ‘just too simple’ to resolve debilitating Migraines?

Does Physiologic Neuromuscular Dentistry (PNMD) seem ‘just too simple’ to resolve debilitating Migraines? Is it too hard to believe that neck pain (after an injury) and back pain (after disc herniation surgery) could ALSO resolve through PNMD? Dana thought that there is no way a ‘dentist’ could help her with Neurologist diagnosed Migraine that was barely controlled with Zomig. Even after a friend that had her Mayo Clinic diagnosed Fibromyalgia resolved through PNMD referred her, it was just too hard to believe! Until she checked it out herself as a ‘last resort’!

Dana suffered with debilitating migraines and severe neck pain for 14 years. At times the pain would get so bad that she would have to go to the hospital and gets shots. She felt as if she had so many lost days in her life. Dana was on several medications to try and control the pain that were prescribed to her by a neurologist and her general practitioner. These medications consisted of Naproxen, Zomig and Phenergan for nausea.

Dana heard about Dr Raman through a friend who had also suffered with TMJ symptoms and was already in treatment with him. She was skeptical at first because she has tried so many other things. At this point she started to feel very depressed and sick almost every day. She thought that she was going to have to live with the pain for the rest of her life and felt like this was her last try at getting help.

Dana came to see Dr Raman initially for a consultation and then went through a series of neuromuscular diagnostic testing. Once the correct jaw alignment was determined she was then fitted with a fixed Physiologic neuromuscular orthotic for 90 days. She first felt the biggest difference in her neck pain and range of motion. She said that she has improved immensely and has no more back spasms, sleeps better, headaches much improved and no more lower back pain.

Dana is now in the Physiologic neuromuscular functional orthodontics phase of her treatment. She now has a lot more energy and even her family sees a difference in her. She is very excited. The best part of this is how it impacted her daughter’s wedding. Dana felt so well that she made all the table decorations and made all the hors d’oeuvres at home by herself over several days. She could not have even imagined being able to do all of that prior to her treatment. That made the wedding very special for the whole family. THAT is the power of PNMD and its impact on families as well as on the guests we help.

Ear pain, tinnitus, jaw pain resolved through Physiologic Neuromuscular Dentistry

10% of all patients that go to an ENT specialist for ear pain, ear congestion etc. have NOTHING wrong with their ears at all, according to ENT specialists. Their pain is from TMD / TMJ disorder.

Unrelenting Ear pain, ringing in ear called tinnitus, jaw pain resolved through Physiologic Neuromuscular Dentistry. Physiologic Neuromuscular Fixed Orthotic resolved these symptoms when pain medications did not help.

Stan was having ear pain and dull jaw pain about a year ago. He went to his primary care doctor who told him that his jaw and face was constantly hurting. The doctor thought it was from clenching. Stan then went to his general dentist who also confirmed that his pain was coming from clenching. A couple of months later he started having ringing and sharp pain in his ear. He decided to see an ENT who examined his ear & throat which were normal. He told him to take over the counter Aleve for 2 weeks but it made no difference in the pain and then he was referred to Dr Raman.

Stan owns a construction company and always felt very fatigued. He also noticed that he could not lift heavy items as easily but just blamed these things on his job and age. Once Dr Raman evaluated Stan and determined that his symptoms were stemming from his poor jaw alignment he was then fitted with a fixed neuromuscular orthotic for 90 days. Within this 90 day period Stan saw an 80% overall improvement with his symptoms.

Stan said that he feels a lot better, not fatigued and that most of his pain has calmed down quite a bit. He can also lift more than he used to and feels more balanced.

If ear pain, ear congestion and ringing in the ear called tinnitus is affecting your life but the ear examination is normal, Physiologic Neuromuscular dentistry may help resolve those problems once and for all. It may also improve your overall balance and lessen fatigue.

Who needs a seat belt? Part 2

It is common for the chronic TMD sufferers to have over stretched the ligaments of the TMJ.  This results in the joints being too loose.  When sleeping, the jaw often falls back and interfers with breathing.  There are studies that link bruxism ( clenching and grinding) to Sleep Disordered Breathing. 

Gilles Lavigne, a researcher in the Faculties of Dentistry and Medicine at Université de Montréal, explains that “the development of neurobiology has enabled us to better understand the structure of sleep in clenchers and to define bruxism clearly as one of many cyclic phenomena that are characteristic of sleep.” The researcher and his team at Sacré-Cœur hospital in Montréal have now gained international recognition for establishing criteria to identify nocturnal bruxism.

Many medications that are classified as Selective Serotonin Reuptake Inhibitors (SSRI) have been shown to induce clenching especially during sleep. 

Drugs in this class include (trade names in parentheses): (source: Wikipedia)

  • citalopram (Celexa, Cipramil, Dalsan, Recital, Emocal, Sepram, Seropram)
  • dapoxetine (no trade name yet; not yet approved by the FDA)
  • escitalopram (Lexapro, Cipralex, Esertia)
  • fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Fluctin (EUR), Fluox (NZ), Depress (UZB))
  • fluvoxamine (Luvox, Fevarin, Faverin, Dumyrox, Favoxil, Movox)
  • paroxetine (Paxil, Seroxat, Sereupin, Aropax, Deroxat, Rexetin, Xetanor, Paroxat)
  • sertraline (Zoloft, Lustral, Serlain)
  • zimelidine (Zelmid, Normud)

These medicines are used so commonly for a long list of indications, this is definitely something to be aware of.

When I wear my seat belt before driving my car on the street, it does not show a lack of confidence in my driving ability.  There are other drivers on the road that may be impaired or inattentive.  There may be a mechanical problem such as a blown tire from a nail on the street.  So wearing a seat belt is a sensible thing to do.

If we prescribe a sleep appliance such as Somnomed MAS after finishing a Neuromuscular Reconstruction, it shows prudence.  Not a lack of belief in our ability.  Just like wearing a seat belt.

Who needs a seat belt? – Part 1

Neuromuscular dentistry is based on these fundamentals: 

  • measured, objective data is fact; while all else is just opinion
  • start with unstrained jaw and neck muscles that move the mandible
  • allow the lower jaw to move through a trajectory which is determined by the simultaneous contraction of all of these unstrained muscles and optimal TM Joint conditions
  • freedom of entry in to and exit from, a stable bite position
  • address ascending posture factors with co-treatment from physical therpists and AO (Atlas Orthogonal) chiropractors



With this level of attention to muscles, posture and joints as well as micro occlusion of the bite, most of the usual reasons for breakage of restorations (crowns, veneers etc.) are successfully addressed.  As such the usual cause of breakage, interferences when chewing and bruxism is resolved to a great extent.

Should a NM dentist then prescribe a “seat belt” for his restored patients? If he or she gives a sleep appliance or night guard, after NM full mouth resotrative treatment, does it exhibit a lack of confidence in the priciples of Neuromuscular dentistry?

Let us look at this more closely in the next post!

Locating Prabu Point ….safely!

There have been some instances that the myotrode has been incorrectly placed right over the SCM at the level of Carotid sinus. This is potentially dangerous.

When I looked into it, this occurence is related to HOW the Prabu Point.

One way to locate SCM is to have the patient turn the head to the side. But if the Prabu Point is located when the head is turned, when the patient turns the head straight, the SCM rolls…as it should..and roll under the previously located point. This turned out to be culprit.

The proper way, as I had described in my ICCMO Masterhip thesis….is to have the patient continue to look straight. But offer resistance to the head to turn against. This makes the SCM stand up…even in heavy people…but once the Prabu Point is located…in the middle 1/3 of the Posterior Cervical triangle.. the SCM does not change location.

I have attached a Power Point to illustrate this here.

Download locating_prabu_point.ppt

Dental health affects fertility

The connection between dental health and overall health….the “Oral systemic link” is widely recognized. Most of the studies related to periodontal ( gum support) disease and heart disease, stroke, diabetes and low birth weight babies. It makes sense to expect that infection in one area of the body is bound to affect other areas. But this new study has an interesting twist.

Male infertility is often connected to connected to chronic bacterial infection of the epididymis. This is the structure that “stores” semen. This study from Germany showed a direct connection between male sterility and dental infections. An abstract with the references is below.

They only studied those that were resistant to antiobiotic therapy. I wonder if the results would be even better if all of the sterile subjects were included in the study.

One more reason to make dental health and its maintenance a high priority!

1: Andrologia. 1993 May-Jun;25(3):159-62. Links
Bacterial foci in the teeth, oral cavity, and jaw–secondary effects (remote action) of bacterial colonies with respect to bacteriospermia and subfertility in males.
Bieniek KW, Riedel HH.
Department of Obstetrics and Gynecology, University of Halle-Wittenberg, Germany.

Bacteriospermia requiring medical treatment were diagnosed in more than 70% of the subfertile patients who had since 1988 attended the gynecological clinic at the RWTH hospital in Aachen. In 23% of all cases specific treatment with antibiotics did not reduce the concentrations of bacteria in sperma. Thirty-six patients with bacteriospermia resistant to antibiotic therapy were then subjected to dental examination. A high incidence of potential dental foci was found in all patients. In a test group of 18 patients these sources of potential infection were eliminated. Between dental operations and therapy swabs were taken to determine bacterial levels and bacteriological composition. It could be demonstrated that the bacterial spectrum of the intraoral samples was almost identical with the spermiograms. Six months following completion of dental treatment a further spermiogram analysis was carried out. In the test group about two thirds of the spermiograms proved sterile. Spermatological parameters, such as motility, density and morphology, had also clearly improved. In the control group the findings of the spermiogram remained poor. This study indicates that a direct causal relationship exists between bacterial colonies (dental foci) and therapy-resistant bacteriospermia which probably leads to subfertility.

Upcoming Speaking Engagements

Speaking engagements:

November 8, 2007 : Scottsdale, Arizona

ACEsthetics Occlusion Symposium

Academy of Comprehensive Esthetics has convened a symposium on Occlusion and Esthetics from November 7 – 10. The educational objectives of this symposium include “an understanding of the differences between CR and NM occlusal philosophies and the clinical implications associated with those differences”.

Well known experts in CR and NM occlusal philosophies have been invited to give presentations allowing the audience an opportunity to learn through comparing and contrasting.

I was invited to present about how I treat my TMD patients using NMD protocols. The title of my presentation is “A Neuro Muscular dental practice in the “Show me” state”.

If you are interested in attending a meeting dedicated to understanding both CR and NMD, check out www.ACEsthetics.com to register.

Upcoming Speaking Engagments

November 16-18, 2007:

Vincenza, Italy

14th International Congress of The Internation College of Cranio Mandibular Orthopedics

This is a meeting of the International Congress that is held every 2 years. I was invited to give a presentation on “Neurally mediated ULF-TENS to relax cervical and upper thoracic musculature as an aid to obtaining improved cervical posture and Mandibular posture”.

About a year ago, I had proposed a new way of stimulating the cervical muscles. This new technique and the particular point of stimulation have since been named “Prabu Point” by Dr. Dan Jones of Chino, California.

Since I will be presenting to doctors from around the world, there will be live translations in to Italian, German and Japanese.

For more information go to www.ICCMO.org