Tag Archives: Fatigue

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.

Fibromyalgia cured!

It is probably hard to believe that Fibromyalgia can be resolved – dare I say ‘cured’ – without medications. Especially so, if that Fibromyalgia diagnosis came from Mayo Clinic specialists. Surely, they are the final word, right? Is it possible that they are NOT the final answer?

Deana was diagnosed with Fibromyalgia 13 years ago in her 30’s. She had debilitating fatigue, constant headaches, generalized tenderness all over the body. Her right hand had a tremor that no one could find a reason for it. MRI and other tests were done to diagnose the cause. She went to Mayo Clinic in Minnesota for a detailed work up.

At Mayo, she was seen by specialists in Neurology, Rheumatology, Gastroenterology, Opthalmology, physical medicine and Fibromyalgia. Their Fibromyalgia specialist diagnosed her as suffering with Fibromyalgia. Bob and Deana attended two day long ‘clinic’ that educated them on coping with FM for the rest of her life. She was also prescribed medications to ‘manage’ her FM. One of the side effects of the medicine affected her gall bladder which needed to be surgically removed.

Deana was helping with the family business and being a home maker raising three children. It took sheer will power to get through her days. She said that it felt like driving a car that had one foot on the brake the whole time. It was just a drag to get through the day.

It was only through chance – or divine plan according to her – she came to our office for a second opinion on a dental implant problem. She had absolutely accepted that she will live with FM the rest of her life. When I casually mentioned about my observations of her jaw alignment problem and how that can result in whole body musculo-skeletal problems such as Fibromyalgia, Deana reacted like a drowning person reaching for a ring buoy tossed to her.

Following a through neuromuscular testing with advanced protocols, we delivered a lower jaw fixed orthotic 6 weeks ago. It is only a trial change of her jaw / neck alignment to see if it is helpful in improving her conditions at all. The upper jaw has not been changed and so the orthotic has to fit against that. Yet, the change was dramatic.

After 90 days of this orthotic, they may choose to have me further improve the jaw alignment and stabilize for long term. This may be through moving the teeth orthodontically and possibly adding bonded porcelain restorations. Stabilizing options are up to Deana and Bob to choose. My role is to educate them of the options and have the expertise to provide those options.

Helping nice people like Deana and Bob reclaim their lives is the most rewarding part of practicing advanced Neuromuscular dentistry.

A call for a truly comprehensive view – Part 2 of 2 – Case history

This is a patient case history to support my call for a truly comprehensive view of the entire musculo-skeletal system – the whole person! The hyper-focused view of a specialist is useful but risks a “tunnel vision”.

Moira was fighting severe fatigue for over 8 years. It gradually worsened so much that every 5 days she will “crash” for 2 or 3 days. Her Primary Care Physician (PCP) referred her to an endocrinologist who prescribed hormone supplements for deficient thyroid function.

Few years later, her general dentist noted exposed tooth roots and referred her to a periodontist for gum grafts. The gum tissue receded after bone around the teeth were lost.

The next year, she developed migraines which devolved into a chronic 24/7 migraine for 8 months. One neurologist ordered MRI and diagnosed it as a psychosomatic headache. Lyrica, prescribed by another neurologist, broke the headache but gave her a foggy feeling and weight gain.

In the mean time, her teeth were getting very loose. Her general dentist got concerned and sent her to her periodontist again. He could not see a reason for the looseness and sent her to an orthodontist. He made her a hard plastic mouth guard to prevent further looseness. But Moira could not wear it since it was uncomfortable.

Later, she had ear pain and was referred to an ENT specialist who did not find any problems with the ears.

She consulted with her children’s dentist who referred her to a ‘TMJ dentist’ who made her a soft mouth guard. This one was more comfortable to wear but all of her symptoms – fatigue, headaches, ear pain, neck pain and shoulder pain remained. After all the time and money spent with the various doctors, she had come to a place of acceptance. She will just have to learn to live with these symptoms.

For 18 months one of her colleagues was telling her about our practice & NMD. But Moira did not see any point in going to “another dentist” when she has already seen so many. Finally she saw Michelle’s video. She saw that a common denominator for her symptoms could be a poor jaw- head- neck alignment which can be improved through NMD.

Moira saw that while I am a dentist, our NMD approach takes a comprehensive view of the musculoskeletal postural chain of the entire body. If jaw relation is poor AND it is shown to be the primary source of postural compensation, then correcting that it through NMD would be beneficial. Then the seemingly unrelated symptoms – debilitating fatigue, severe ‘migraine’ headaches, constant neck pain and ear pain would improve as well. While these are “medical symptoms”, the postural chain does not care what kind of doctor corrects the imbalances or through what methods.

After a lower fixed Neuromuscular orthotic, Moira started noticing improvement. She had the option to have that orthotic removed, if it did not help her significantly. The fatigue improved almost immediately. So after 90 days she chose NM orthodontics to move her teeth to an optimal position. Within few weeks, ALL of her symptoms have completely resolved. For the last two months, she remains 100% symptom and medication free. We are far from achieving the most optimal end results from my perspective. It will be another 2 years to complete the NM orthodontics. Her progress will be tracked with K7 jaw computer scans to measure her muscles and CT scans to check her TM joints. Moira is fine with that since she has no further
symptoms. She has not had a single “crash” since the beginning of NM orthotic, while the longest she had gone without a “crash” in the last 8 years was only 6 consecutive days.

Does this case illustrate a need for a truly comprehensive view of he entire postural chain? Moira will answer that question with a resounding “YES”.

A call for a truly comprehensive view Part 1 of 2

When someone has a tooth – dental – problem or symptom they go to their dentist.  If it is more than a routine tooth problem, then she may be referred to a dental specialist.  If it is a gum / bone support issue to a periodontist, if is a surgery issue to an oral surgeon, if it is a tooth alignment issue to an orthodontist and so on.

If the same patient has medical symptoms such as headaches, neck pain, ear pain or general fatigue, then she will go to her primary care physician.  PCP may, in turn, refer her to a neurologist, orthopedist, ENT or an endocrinologist for these symptoms respectively.

Specialized knowledge in one area is useful. But does it also lead to a “tunnel vision” view?  Human body, after all, developed from a single cell.  The various parts are very much connected.  This is especially true of the musculoskeletal system.  A human on two feet is constantly resisting gravitational forces.  So any imbalance in one area affects the entire postural chain from feet to head.

It truly is a chain – both in the left/right and front/back planes.  The spine with its alternating front to back curves from the head to tail connects these sections and allows flexibility in compensating for the imbalances, especially when the body is in motion.  These are the lordotic curves of the cervical and lumbar regions and the kyphotic curves of the thoracic and sacro-coccygeal regions.

This compensating system is challenged even more when walking and running in a gravitational field than when standing still.  When DOES this person really gets looked at as a “whole person”?  Let me share a case history to support my call for a truly comprehensive view of the entire musculo-skeletal system.

Neuro Muscular Dentistry and Posture – What is the connection?

Modern medicine has splintered into multiple specialties and subspecialties due to the need for expertise in a specific area. When I met a Pediatric Neuro Radiologist, I realized how far this phenomenon has gone.

Dentists also tend to think of themselves as tooth doctors due to our training. But the human body works as an integrated unit. So it is useful to think globally when treating our patients.

The human body delegates the automatic functions to the autonomic nervous system (ANS). This allows us to function in the voluntary realm of cortical functions.
Hence a stroke victim may “forget” how to walk.

The amount of input into this ANS is mind-boggling. There are up to 3 million bits of data processed by this system per second to keep our heart, lungs, temperature control, balance etc. etc. going. This affords us the luxury of conscious thoughts.

The single biggest contributor of data in to this system is the mouth area. When you look at it from a survival perspective, this makes sense. Alignment of the mandible impacts breathing, eating and swallowing. If these basic functions don’t work, the organism would not survive another day. So our Autonomic Nervous System will make whatever compensation necessary to facilitate these vital functions.

The muscles of mastication that control the movement and hence the posture of the mandible have to contract each time the teeth come in to occlusion. This occurs usually about 3000 times a day during swallowing. They also work in controlling the jaw movements during chewing.

Poor alignment of the lower jaw to upper jaw, position of the teeth or missing teeth necessitates these muscles to contract excessively. Then to maintain equilibrium, their antagonists need to contract as well.

What we call posture is nothing more than the dynamic equilibrium of opposing muscles that compensate for destabilizing forces such as gravity. If one muscle contacts, there has to be other muscles that help stabilize the body part to which the first muscle is attached. This, in turn, affects other muscles resulting in a domino effect. Neck, shoulder and back muscle spasms are often the result. This is called the Descending effect of posture. This often results in head aches, neck aches, back pain, ear pain, vertigo and other symptoms.

Here is the connection to Neuro Muscular Dentistry (NMD). A NM dentist diagnoses the mandibular (jaw) position where the masticatory muscles are unstrained. So the input in to the ANS is normalized. This, in turn, has normalizing influence over the entire ANS. This explains the profound homeostatic effect of Neuro Muscular Dental therapy. Fatigue and other non-specific symptoms are often resolved because of that.


Autonomic Nervous System has a big role in posture. Fatigue, head aches, ear pain, neck aches, back pain may result from poor head and neck posture. Poorly aligned lower jaw (a bad bite) affects the head and neck posture.

Neuro Muscular Dentists correct the bite to a position where the jaw and neck muscles are unstrained. As such Neuro Muscular Dental therapy often corrects those symptoms from poor posture, not just manage the pain.

Key Words:

Neuro Muscular Dentistry, Fatigue, head aches, neck aches, back pain, ear pain, vertigo, bad bite, neck posture, head posture, muscles, equilibrium