Your Shimbashi Number And Your Bite

I am writing this article in honor of Dr. Henry “Hank” Shimbashi, a practicing dentist and researcher from Edmonton, Alberta who passed away this week. Dr. Shimbashi was a very influential friend of comprehensive restorative dentists and his research is used every day in offices like mine where problems with the bite and TMJ’s are treated.

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As a result of his research, the Shimbashi number was established to indicate an ideal relationship between the upper and lower jaws. When there is an optimal position of the lower jaw relative to the upper jaw, the muscles which are connected to them will also be at their optimal length and can function ideally.

If the relationship between the upper and lower jaws is altered, one or more of the many muscles of the head, neck and face may be overworked causing them to go into spasm — i.e., be painful. This can happen if the lower jaw is too close to or far from the upper jaw, too far forward or back, or shifted in any direction relative to the upper jaw.

Dr. Shimbashi’s research measured muscle activity in over 500 patients. He found that there was an ideal vertical dimension at which the jaw muscles functioned at their maximum potential. In addition, at this ideal position, patients had no symptoms of muscle pain. This vertical dimension was found to be universally applicable in all age groups and all races.

This simple number which we use is the measurement from the gum line of the upper front tooth to the gum line of the lower front tooth. Dr. Shimbashi found this ideal distance to be approximately 19 mm plus or minus one mm (about three quarters of an inch) when a patient bites.  In our office, we often see patients with bite problems whose Shimbashi number is significantly less than ideal  measuring as little as 10 mm or even less. In such patients, the lower front teeth are often nearly completely covered by the upper teeth. Such patients are much more likely to develop tooth and pain problems resulting from their bad bites.

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So what is your Shimbashi number?  If you have any questions about your bite as a result of this article, please feel free to call our office at 908.359.6655 or via our website at www.DesignsForDentalHealth.com

Is It Really A Migraine??

Last week in the course of a routine examination, I asked a standard question of our young woman patient: “Do you have any problem with headaches?” She replied that she does have “migraines”. So I asked a few relevant questions about the headaches, and as is often the case, this patient’s answers led me to believe that her headaches are, in fact, not migraines.

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In our office, we often treat patients with head and neck pain who have been diagnosed by their doctors as having temporomandibular joint dysfunction. Oftentimes, such patients visit their doctors because they assume that the headaches from which they suffer must be migraines.

What are the typical signs and symptoms of a migraine headache? A typical migraine may last several hours to as many as three days. The pain is moderate to severe, pulsating, and usually on one side of the head. Typical associated signs of migraines include nausea and/or vomiting, as well as sensitivity to light and noise. Many migraine patients describe an “aura” just before the migraine begins. Auras are exhibited as a change in vision or hearing. Episodic migraines occur fewer than fifteen times per month with only some of these headaches being actual migraines. Such headaches occurring more than fifteen days per month with pain lasting four hours or more over a three-month period are considered to be “chronic migraines”.

Migraines may be triggered by various factors, and three out of four migraine sufferers describe specific triggers. Common examples of these triggers are physical exertion, stress, hormonal changes, weather changes, and others.

Tension headaches are the most common primary headaches. Such headaches may be misdiagnosed as migraines and vice versa.

Cluster headaches are severe attacks of pain on one side of the head lasting between fifteen minutes and three hours. These headaches may occur every other day or as often as eight times each day. Cluster headaches may be associated with facial sweating, restlessness, agitation or nasal congestion.

Other types of headaches include those brought on by exertion or coughing.  They may be described as feeling like stabbing pain or other equally unpleasant feelings.

If you or someone that you know suffers from headaches, we can generally help determine whether or not migraine headache is a proper diagnosis. The determination is made based upon the patient’s history and description of the pain as well as a screening examination to rule out the possibility of TMJ-type pain. We even have a computerized evaluation system to diagnose which muscle or muscles may be causing the problem. Patients often find it hard to believe that their headaches may be related to their jaw joints or their bite. The truth is, the connection between head and neck pain and the muscles involved in moving the jaw as well as those holding the head erect are commonly the source of such pain.

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If you have a question about headaches or would like additional information please feel free to contact us via our website www.DesignsForDentalHealth.com or by calling our office at 908.359.6655.

I Learned First Hand What Being a TMD Patient Feels Like! AND, It’s All About the Bite!

First, I believe that this is one of the most important articles that I’ll write.  For the past twenty plus years, the study of occlusion (how the teeth meet plus A LOT more) has been my passion.  It is very difficult to explain to patients how the bite can be responsible for so many dental issues.  And, it is even more difficult for patients to understand that fixing the bite does not generally mean just getting braces (orthodontics).

richardtensTENS To Relax Muscles

Having just returned from a three-day advanced TMD (Temporomandibular Disorder or TMJ disorder) program, I learned updated techniques to assist in the establishing of proper bites for patients –  especially those who suffer form head, neck and facial pain.  We were able to see objectively with the help of computer analysis how getting the jaw position right results in muscles which RELAX, and, therefore, STOP HURTING!

 And that is the big paradigm shift that is difficult for patients to understand.  Occlusion involves a system which includes the teeth, the upper and lower jaws, muscles, ligaments, nerves, etc.  And, when this system is out of balance, there may be a variety of signs (what the dentist sees) and symptoms (what the patient experiences) which develop.

If a person’s occlusion is out of balance, he or she may develop loose teeth, sensitive or painful teeth, worn and broken teeth, headaches, neck and shoulder pain, facial pain, dizziness, clicking or popping jaw, ringing in the ears, tingling fingers, and much more.  Most people, if told that they have problems due to their bite, assume that the only way to fix it is by having orthodontics or braces on their teeth. 

Orthodontics is a dental specialty which addresses how to straighten teeth and how to make the upper and lower teeth fit together.  It does not address the position of the jaw nor the muscles and other “soft” tissues which support the jaw.  And it is the jaw position and the muscles which need treatment to solve most bite-related problems.   Picture the jaw just hanging from the skull by muscles and ligaments.  As we close our mouths, we bite to bring our teeth together as best we can.  If our ideal “physiologic” jaw position and the tooth biting position do not match, the jaw is forced into a ”bad” position requiring muscles to work overtime.  Muscles which are over-worked build up lactic acid and begin to hurt.  Most people experience such pain when they begin a new exercise program.   So, just straightening the teeth without regard for jaw position nor muscle relaxation will not solve most problems of occlusion.

 Please do not misunderstand the value of orthodontics.  Due to various hereditary and environmental conditions, children develop crooked teeth which require straightening.  Such “malocclusions” are best treated early and after a thorough analysis of how the problem developed.  Orthodontists provide an excellent service and help both children and adults to look great and function well.  Having dabbled in orthodontics, I have a real appreciation for the amazing work that they perform.

richardk7Establishing a Correct Bite

But this article is intended for those who have true “occlusal” issues which tooth straightening alone will not resolve.  A thorough examination including a complete history, comprehensive examination, necessary xray evaluations, and diagnosis by a doctor or dentist who is well-versed with occlusal issues is the first step to successful  treatment.

 I am very excited about the wonderful advances that are being made in this field, and I welcome your comments and questions.  I plan to continue addressing this subject in upcoming blog articles.  Please let me know if you have specific questions which you will find interesting and pertinent.  You may contact me by calling the office at 908.359.6655 or through our website at www.DesignsForDentalHealth.com .