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.


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.


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

Cracked Tooth Syndrome – What You Need To Know

We have had several patients recently who have had problems related to cracked teeth. The symptoms of which these patients complain can be difficult for both the patient and the dentist.  Both can become frustrated because the underlying cause of symptoms is frequently difficult to pinpoint.  Often, patients will complain about pain which is caused by biting pressure and sometimes temperature.  It is frustrating for both parties because the described symptoms are often difficult to duplicate in the dental office.  It’s kind of like bringing your car to the dealer with a specific problem which suddenly vanishes as soon as you arrive at the dealership.

Cracked teeth generally occur for two reasons.  First, silver or amalgam fillings expand and contract as we consume hot and cold foods and beverages. The expansion and contraction of the filling is slightly greater than the tooth itself.  So, after years of such cycling in temperature-associated expansion and contraction, cracks frequently develop in the teeth.  Second, cracks may occur while chewing foods.  Commonly patients will describe a sharp pain in a tooth while they had been chewing, and the tooth will remain sensitive to biting pressure and/or temperature.

Cracked teeth are addressed in stages depending upon symptoms.  First, a bonded filling may be placed in an attempt to prevent the cracks from propagating further.  Depending on the depth and severity of the crack, an onlay or crown may be necessary to prevent the tooth from breaking.  An onlay covers any thin walls of the tooth which may be at risk for fracture and is considered a conservative, aesthetic and long-term restoration.  If the tooth has an extensive existing restoration or a more severe crack, then a crown which covers the entire tooth will be required to prevent the tooth from breaking.

In either case, the problem needs to be addressed as quickly as possible to prevent the crack from propagating further into the tooth leading to more severe dental problems.  For example, if the crack reaches the pulp of the tooth, then root canal therapy will be required as well.  The most severe complication would be the vertical tooth fracture which includes the root thereby making the tooth non-restorable.  In such cases removal of the tooth and replacement in some fashion will be required.




The important points to remember are as follows:

1. Determine the exact source of discomfort first

2. Address the symptoms as quickly as possible

3. Begin with the most conservative treatment and progress as needed to eliminate all symptoms

Such teeth need to be followed on a regular basis to ensure that damage to the pulp has not occurred.  Appropriate x-rays at routine intervals will be helpful for this.  Keeping your dentist apprised of precise symptoms will also go a long way to help in diagnosis.

If you have any questions about cracked tooth syndrome please do not hesitate to contact our office by calling 908.359.6655 or on the web at

Expressions Of Gratitude From Members Of Our Team


The holiday season means different things to different people. For some, it may be that they look forward to celebrating and spending time with family and friends. For others, it may be a time for faith and devotion.

 We’re Reflecting On The Things We’re Most Grateful For…

Everyone on our team has taken some time to reflect on her (or his) life and to list some of the things we’re grateful for.  We want to share those thoughts with you!  FYI, there was no collusion amongst we participants…

 What we are thankful for:

 Dr. Nadler


“I’m thankful for having found my wife, Elizabeth, thirty years ago!  And, for our many friends who provide our lives with so much joy and meaning.  And, finally, for my dental practice which has been my raison d’etre for three decades…”



“I am most thankful to have found my best friend, my soul mate, my husband, Richard.”



“This year I’m most thankful for my family. Having a baby changes your life and I’m so thankful to have the continuous support from my loved ones.”



“I am thankful for my beautiful family and wonderful friends, also for our freedom, the Country that we live in and everyone that helps keep us healthy and safe.  I am thankful for my daughter Sara, she is my sunshine and she makes me smile every day!  I am grateful for learning new things every day and being able to find humor in the craziest places.  And Lastly, I am thankful for my Parents.  When I became a Mom I gained a priceless appreciation for all parents!  Wishing everyone a Great Thanksgiving!”



“This year, I am most thankful for my family, friends and life. I’m thankful for my husband, the love of my life and my best friend. I am thankful for my beautiful daughter that I love unconditionally and am so proud of everyday.  I’m thankful for my supportive parents who sacrifice a lot in order to give me and my brother a better life.  But above all, I am most thankful to have a great job that I love, and work together with amazing colleagues that I respect and appreciate.”



“I am thankful that I have the opportunity to spend this holiday with my loving family and reconnect with great friends that are visiting during this time of the year. I am also thankful for all of the wonderful opportunities I have had throughout my life including schooling, traveling, and being involved in my favorite sports and activities.”

We Would LOVE To Hear From You Too!

As the holiday season approaches, what are you grateful for? Please share your thoughts with us in the comments section below.

 One More Thing…

We’re so grateful for each of you—our wonderful patients and friends! Because of you, we love working here each day. We’re thankful for our relationships, and for the trust you place in us each time you visit and reach out with your health concerns and feedback.

We wish you a very happy holiday season!

Dr. Nadler Lectures at SMC


This past Thursday evening, I had the pleasure of speaking to the Diabetes Support Group at the Somerset Medical Center.  The title of the talk was “Diabetes in Dentistry –What You Need To Know.”  Two themes were emphasized during the hour-long lecture.

First, all systems and organs in the body are connected.  And, in this case, diabetics are at risk for more severe periodontal infections than the general population.  In addition, uncontrolled periodontal disease actually aggravates the diabetes as well as the reverse.

Second, it’s all about prevention.   Those with diabetes often have xerostomia or “dry mouth.“  So, not only do diabetics have a compromised ability to fight infections, butdry mouth also contributes to an increased risk of decay and gum disease.  As a result, cavities and gum disease can progress rather quickly in these patients.  And, by the time a person realizes that a problem exists, the issue is often quite advanced and requires more aggressive, costly and involved treatment to be addressed.  Prevention through regularly scheduled care  as well as proper home care is the best way to avoid such major problems. 



The entire lecture as well as the questions and answers segment that followed was videotaped.  It will be on the hospital television channel as well as online at under “Live TV.”

If you have any questions about diabetes and dentistry, it will be my pleasure to answer them.   I can be reached in the office @ 908.359.6655 or online at  


Improve Your Workouts And Lessen TMJ Pain With Six Exercises

Mariano Rocabado, DPT is a physical therapist who specializes in problems with the head, neck and spines. His work with Temporomandibular Joint Disorders (TMJ or TMD) is very extensive, and he developed an exercise program that is taught to all over the world to address postural relationships with the head to neck, neck to shoulders and lower jaw to upper jaw. The objective of this home exercise program is for patients to learn a new postural position, fight the soft tissue memory of the old position, restore the original muscle length-tension relationships, restore normal joint mobility and restore normal body balance.

Temporomandibular joint (TMJ) disorder is a term which encompasses inflammatory disorders of the jaw. Symptoms of TMJ may include headache, earache, neck pain, jaw tenderness and clicking or aching facial muscles. TMJ usually occurs when the muscles used for chewing and your jaw joint are out of balance.  The cause of TMJ is most commonly improper alignment of your teeth, and is exacerbated by stress and tooth grinding.

What is most interesting is that when the body’s posture is corrected, amazing things happen with regard to strength, flexibility and balance.  Similarly, there are bite appliances which place the jaw in its “physiologic” neuromuscular position.  Such appliances are used not only to treat TMJ but are also worn by athletes of all kinds to improve their performance – golfers, basketball players, football players, etc.  I have seen demonstrations of such “instant” improvements and they are amazing.  Feel free to ask me for a demonstration the next time that you visit the office.

I began using one of these exercises during my workouts in cycle classes which I have grown to love.  These spin classes have been the core of my cardiovascular exercise for many years now.  Proper posture improves performance while exercising and playing sports, and I find that that there is a simple maneuver to help ensure good body position to allow me to get the most of my workouts.  It’s the last exercise in the series described below.

Rocabado advocates that the program be performed by the patient at home, and it consists of six different exercises and six repetitions of each exercise, performed six times per day until symptoms subside. The Rocabado exercises emphasize correct postural position and help to combat the soft tissue memory of your old posture. Perform the exercises one after the other until your session is complete. It will take about one minute.

The six exercises:

  1. Place your tongue on the roof of your mouth. Position the tip just behind your teeth and take six deep breaths.
  2. Keep your tongue on the roof of your mouth and open and close your mouth six times.
  3. Your tongue remains on the roof of your mouth and two fingers are placed on the chin to open your mouth against gentle resistance. Following that, place your fingers on both sides of your jaw and move the jaw sideways six times.
  4. Place your hands behind your neck and bend your chin down as if nodding your head.
  5. Move your chin down and back as if making a double chin.
  6. Finally, correct your posture by lifting your ribs and chest upward while squeezing your shoulder blades together.

Perform six repetitions of these exercises six times a day.

Give these exercises a try.  If you feel pain while performing these exercises, stop doing them and consider calling us to arrange a TMJ screening or consultation about your symptoms.  If you have questions, feel free to call us at 908.359.6655 or send us an email via our website at

Change your diet, Protect your teeth!

Change Your Diet, Protect Your Teeth

Food and Oral Health

Every few months, we remind our blog readers about the basic formula that leads to tooth decay and poor oral health:

Bacteria + Food + Time = CAVITIES or GUM DISEASE or BOTH

You probably already know that the foods that put you at the greatest risk for tooth decay and gum disease are those high in sugar, any kind of sugar.   An easy way to address this is to opt for snacks that are lower in sugar and higher in nutritional content.  This not only reduces the risk of cavities, but also helps to strengthen overall health by nourishing the body.

For “mouth healthy eating”, the ADA mouthhealthy website makes the following recommendations:

“For good dental health, keep these tips in mind when choosing your meals and snacks:

  • Drink plenty of water.
  • Eat a variety of foods from each of the five major food groups, including:
  •  whole grains
  •  fruits
  • vegetables
  • lean sources of protein such as lean beef, skinless poultry and fish; dry beans, peas and other legumes
  • low-fat and fat-free dairy foods”

    Are there foods that can protect my teeth?

Beyond controlling sugar intake to make a positive impact on your oral health, there are also some foods that are known to help protect and strengthen the teeth.

Cheese: Cheese, especially cheddar cheese can help balance the pH levels in your mouth, neutralizing the natural acids found in foods.  Neutralizing these acids can help protect the enamel on your teeth, which erodes when exposed to acids.

Crunchy Vegetables: Crunchy veggies actually help clean your teeth while you eat, helping to remove food particles as you chew, limiting the build-up of plaque.  Also, chewing crunchy vegetables can help increase saliva production in the mouth, which helps wash away food particles and neutralize cavity-causing acids.  And they are extremely nutritious!

Sesame Seeds: These flavorful little seeds are abrasive enough to help remove plaque from your teeth while they are being chewed.  In addition, they are high in calcium and can help promote strong teeth in children.

 Are there supplements that can help support my oral health? 

There are certain supplements that can help keep your gums healthy, which in turn can help promote your overall oral health.  Check out the answers provided by Dr. De Vizio DMD and Dr. Gerry Curatola on the Colgate Oral Health Sharecare website:

Yes, supplements such as Vitamin B and iron can help keep your gums healthy. Vitamin B is essential for growth and iron for healthy blood, which in turn contributes to healthy gum tissue. Vitamin C keeps gums healthy by producing healthy connective tissue that holds teeth in their sockets. The antioxidant nutrient, co-enzyme Q10 (CoQ10) provides energy needed for gum cell growth and healing of gum tissue. Other nutrients important for gum health include vitamin A and beta carotene, zinc, vitamin E, selenium, and flavonoids. ~Dr. De Vizio DMD

Japanese researchers in the 1970’s biopsied diseased gums and discovered that there were deficiencies of key antioxidants necessary for proper cell function. Since then, ongoing research has identified the most important are Vitamin C, Coenzyme Q-10, Vitamin E, Folic Acid, B-12, Vitamin D, and Essential Fatty Acids- Omega 3, 6, 9. ~Dr. Gerry Curatola

 Promoting Your Health with Food

As you can see, not only can eating certain foods CAUSE cavities, but eating others can actually help PREVENT them.  This won’t replace the need to brush and floss regularly and get regular dental check-ups and cleanings, but it can help to promote and protect your oral and overall health.

To learn more about maintaining your oral health, schedule a consultation with Dr. Richard M. Nadler by calling our Hillsborough NJ dentist office at (908) 359-6655. Remember to visit our website at for more information about our office and services.