Celebrating 30 Years- Thank You, Mentors!

Posted on December 8, 2014 by DrRichardNadler

I had wanted to complete all of our anniversary “Thank You’s” in November, but that was not meant to be. Liz and I enjoyed a wonderful long Thanksgiving weekend with our family and I decided not to rush through the final couple of articles as the people to whom they are directed have been important mentors in our lives.

With that being said, I feel extremely fortunate during my career for having found the perfect mentors who I needed at the exact time when I needed them. Each of these mentors helped our office and me personally to grow and focus on what is important and point out and help eliminate our weaknesses. I firmly believe in the value that mentoring provides for people in every situation and in every decade of life. It is my sincere hope that at some point in the future, I may give back to younger dentists some of that which I took away from my mentors over the years.

I have already mentioned in an earlier thank you article the first mentor who had a significant impact on my career – Dr. Peter Dawson. Shortly after dental school, I knew that I did not want to be an “ordinary” dentist who filled teeth all day, every day. I had also come to believe that a thorough understanding of occlusion was mandatory if I was to be an excellent dentist. The reason is because occlusion has an impact on just about every condition in the mouth including gum disease, TMD, appearance and everything having to do with the longevity of dental health. Since Dr. Dawson wrote the most important modern book on the subject, I decided to take his course and began to learn about this most complex subject. As I mentioned in the previous article, I had the amazing luck to run into Dr. Dawson in the airport as I was coming home after his class. It was at that meeting when he recommended that I begin studying at the L. D. Pankey Institute which I did.

It was on a gorgeous day in the summer of 1987 or thereabouts that I sat in my lounge chair with an occlusion textbook (which had been recommended as adjunct reading) on the beach at Spring Lake. That day was a turning point in my life as that was the day when occlusion began to make sense to me. To this day, whenever I choose to improve my understanding of any subject, I find no better place to do it than in a chaise lounge on a beach. Now, some 25 years later, I am still studying occlusion and have attended the Las Vegas Institute for Advanced Dental Studies where I learned another philosophy on the same subject. Thank you very much Dr. Dawson for helping me to begin on the right path.

Then, a few years later, as the office was getting busier, it became apparent that our lack of business management savvy was becoming an issue. My experience and reading had taught me that most businesses go through a progression of plateaus and the best businesses do what is necessary to face and address challenges as they arise. Common challenges include time management, team building, financial controls and the myriad of systems which make a business work.

To that end, I was extremely fortunate to have met Dr. Michael Schuster. He and I shared a similar practice philosophy as he, too, practiced Pankey style dentistry and had a school called the Center for Professional Development (now called the Schuster Center) where a philosophy of practice management and the tools necessary to run a dental practice were taught. My team and I studied in this center in Scottsdale, Arizona for two years; and, during that time, traveled there on several occasions to learn how to better manage our office. In addition to the meetings in Arizona, there were monthly phone conferences, many books to be read and book reports to write. This course of study was like an MBA for dentists. After the first year, I clearly remember feeling so positive that I had recurring dreams about being able to fly – seriously!

This course of study helped me to organize my entire life as well as our dental practice that eventually began to run like a well-oiled machine. Unfortunately, along with the process of self-discovery and success with the dental practice came the end of my marriage. I believe that if it were not for Dr. Schuster I would not be as successful as I feel today both professionally and personally. There, I was taught the value of setting goals and looking inward to take control of my life in a positive way. Thank you Dr. Schuster. I owe a huge debt of gratitude to you for providing exactly what I needed at that time in my life.

Finally, I’d like to thank Dr. Charlie Martin who is a dentist in Richmond Virginia and who ran conferences four times each year and facilitated a “mastermind” of like-minded dentists. Charlie is a passionate and hard-working dentist who has the ability to engage others with his point of view and extensive knowledge on various subjects. He was most helpful to me in helping to decide the most current direction in our dental practice. He provided what I needed to know, and, as a result moved to the next level of my career. Unfortunately, Charlie has retired, but the effects of his efforts on all of our mastermind members will be felt for years to come. Thank you Dr. Martin! This course of study helped me to organize my entire life, as well as our dental practice, which eventually began to run like a well-oiled machine. Unfortunately, along with the process of self-discovery and success with the dental practice, came the end of my marriage.

I am also grateful to Dr. Charlie Martin for having introduced me to a wonderful group of dentists who are equally passionate, hard working, intelligent and an absolute pleasure to share time with. I miss them and the conferences in Richmond, and I wish each of these friends much health, happiness and success for years to come!

Celebrating 30 Years- Thank You Technology

Posted on November 25, 2014 by DrRichardNadler

Before I begin today’s topic, I must correct a glaring omission from the thank you letter I wrote to April and all of our dental assistants. There is a woman who was our second dental assistant after Liz back in the mid 80’s and describing this person provides a perfect segue into today’s subject. The person to whom I refer is Remi, a very attractive young woman, who would come to the office dressed in popular clothing of the time, which were stretch pants and high heels with the top of her choice. Naturally, Remi was very popular among my male patients as well as being a top-notch dental assistant. I had the pleasure of working with her for a couple of years until her family moved to North Carolina but Remi and I stayed in touch. Then, during the 90’s, we became quite good friends socially. When April began her first maternity leave, Remi stepped in to help us and remained on a part-time basis until she left for a new full-time position. Remi is owed a big thank you for both her friendship and her contributions to our dental practice. Remi, please forgive me for not having included you in the first article!!

But what does Remi have to do with today’s topic? Today, I will express thanks for the amazing progress that we have made in dentistry owing to the development of various technological advancements. At the same time, I’ll have an opportunity to describe how the practice of dentistry has changed in the last thirty years. So, if you can picture Remi wearing stretch pants and high heels, you will realize that what we wear today is far different from the “uniform” of thirty years ago. Better yet, if you can picture what Remi was not wearing at the time, you will understand the first major change that occurred in dentistry in the last thirty years.

What Remi was not wearing back then was gloves, a mask and all the other outer protective garments, which are mandatory today. What changed was the AIDS epidemic had begun and the use of all protective clothing and shields became mandated. After having practiced “wet fingered” dentistry for several years, wearing gloves was initially quite a challenge due to the loss of tactile sensation that resulted. But we all adapted and have since incorporated a multitude of protocols and protective items to protect not only those who work in the dental office but also every patient.

The next major change for dental practices was the use of computers which began in the mid to late 1980’s. I remember buying my first computer, an IBM with a whopping 50 MB of memory! Bear in mind that is megabytes and I’m not referring to RAM. This computer took some getting used to, but relieved us of hours upon hours of paperwork every day as all appointments and transactions had been done by hand up to that time. As you can imagine, the computers kept getting bigger and doing more for us every year. Now, the practice of dentistry and the use of computers are totally integrated and amazing.

Today, the world of dentistry is becoming more and more digital. By now, most of my patients have seen the digital x-rays which we employ. These x-rays are so large and easy to read that patients can easily see what we see with minimum coaching. These x-rays can be manipulated in terms of contrast, size and various other features. Similarly, in the future, impressions will be taken digitally using a small intraoral camera rather than all of that impression gook which many patients are not fond of.

If you’ve been in our office for the last dozen years or so, you’ll note that we also use a digital camera to record photos of your teeth. In addition, we have an intraoral camera which takes close-up images of the teeth. The use of these photographs helps us to better diagnose what is going on in a given patient’s mouth as well as the ability to easily explain conditions and options to patients.

One of my favorite newer pieces of equipment is called the K7. We have been using this system for the past five years or so to help us better diagnose and treat patients who have Temporomandibular Joint Disorders. This piece of equipment allows us to evaluate the jaw muscles, jaw movement and joint sounds. Using this piece of equipment, we can determine in an objective way the best position for an individual patient’s jaw. Since using the K7, we have been able to help many patients who were suffering with a variety of TMD symptoms. If you have any interest in the subject, you may find additional information on the website www.myotronics.com .

Other technological advances which assist us in our day to day treatment of patients include the use of the diode laser, the Wave One root canal system, and the Diagnodent cavity detection device.

The diode laser has a multitude of uses including preparing teeth for impressions, cosmetic re-contouring of the gums, the treatment of periodontal or gum disease and the speed healing of canker sores and fever blisters just to name a few. This is a marvelous piece of equipment which is kind to patients for its healing properties, its gentleness not requiring the need for anesthesia in many cases, as well as its ability to work without creating bleeding.

The Wave One root canal system is an equally wonderful system which helps us to perform root canal therapy for patients in less time than in the past while being more thorough at the same time.

The Diagnodent cavity detection device uses a laser to detect the presence of decay in an extremely accurate manner. We had even seen that it finds decay which is not visible either on x-ray or in the mouth but serves to help patients avoid more extensive treatment due to lack of prompt care.

The descriptions provided above of the technological advances which we have seen the last 30 years is by no means a complete list. Suffice it to say, the practice of dentistry is far more enjoyable, accurate and just plain better than it was in the 80’s.

Thank you to all the pioneers who helped to develop the technology that we use today. It will be fascinating to watch dentistry continue to evolve in the next thirty years!

30 Days of Thanks- Post Graduate Teaching Institutes

Posted on November 7, 2014 by DrRichardNadler

Perhaps it will not be so surprising to hear that when a person graduates from dental school, he or she still has much to learn. To that end, there are a variety of post graduate teaching institutes available to engage those dentists who choose to carry on the learning process. There are schools or curricula for learning implants, dentures, crowns and bridges, cosmetics, TMJ and a variety of specialties and sub-specialties. It is up to each individual dentist to decide which path he or she chooses to pursue.

After graduating from dental school, and having served an “apprenticeship” in offices other than my own, I knew that basic drill and fill dentistry was not for me. I found that the study of occlusion – how the teeth, jaws and muscles work as a system – was fascinating for me and provided the basis for practicing dentistry with excellence. What we were taught about occlusion in dental school was adequate for a basic understanding only. So, I decided to begin studying this subject and have been studying it ever since.

I will be writing thank you letters to the important mentors in my life later this month, but I must mention Dr. Peter Dawson who is considered by many to be the father of modern occlusion–he actually wrote the book on it. In the late 1980s, I traveled to Richmond, Virginia to take a course from Dr. Dawson. As luck would have it, I ran into him at a restaurant in the airport as I was traveling home after his course. We had a very interesting conversation, and he suggested that I attend the L. D. Pankey Institute in Florida if I was serious about learning and understanding occlusion. I came to learn that this Institute was the premier of its kind and was attended by dentists from all over the world. So I did enroll as Dr. Dawson recommended.

I traveled to Key Biscayne, Florida on several occasions for the multi-day courses which were offered at this beautiful institute. I pursued the study of occlusion there over a four-year period and learned much, much more than simply occlusion. We learned about the practice of dentistry as well as a philosophy encompassing the balance between work, play, love, and spirit. The L.D. Pankey Institute changed my life, and allowed me to provide a level of dentistry of which I could be quite proud.

Many years later, as Y2K approached, I became fascinated with providing more and finer cosmetic dentistry for my patients. At that time, the economy was in major growth; and patients had the desire as well as the means to improve their appearance. I had heard about a place called the Las Vegas Institute where outstanding cosmetic dentistry was being taught. The name of the Institute caused a bit of apprehension on my part, because I assumed that dentists went there simply because of its location, but I proceeded to take a course there. I actually brought a patient and performed her dentistry in their clinic after the associated classroom lectures. The patient who came with me was my wife, Elizabeth, and both she and I were ecstatic with the result.

As it turned out, students from all over the world also attended this teaching institution, and like my experience in Florida, they taught a philosophy of dentistry with which I became intrigued. It is here where I learned a different point of view about occlusion, and it is here where I developed my ability to better help those with Temporomandibular Joint Dysfunction and head or facial pain. I traveled there on many occasions over a period of more than 10 years and completed their entire curriculum of courses. During that time, the quality of my dentistry constantly improved and I loved the entire process.

I feel blessed to have found each of these two institutions which helped to shape me into the dentist that I am today. It is the dedicated teachers and researchers at these facilities who provided such amazing information about technique and materials as well as the philosophical basis for providing excellence in dentistry and life in general.

The next time that you are in the office, you will see two walls which are covered with certificates from those institutes. I am proud to have attended these two prestigious schools and THANK them for shaping my career into one of which I am proud.

To learn more about Dr. Peter Dawson, please click on this link: http://dental.thedawsonacademy.com/author/dr-peter-dawson

To learn more about The Pankey Institute, please click on this link: http://www.pankey.org/the-pankey-experience/the-institute/photo-tour/

To learn more about The Las Vegas Institute, please click on this link: http://www.leadingdentists.com/about-lvi/

These Are a Few Of Our Favorite Things

Posted on October 3, 2014 by DrRichardNadler

In this article, we would like to share with you seven of our favorite products and technologies. These are all items or services which we as a team use on a regular basis and recommend to our patients. We feel that each of these is the leader in its field and offers solid benefits. So, without further ado, here is the list:

Number 1: Sonicare Toothbrush

Through the years, we have recommended a variety of toothbrushes ranging from the Rotadent to Oral-B and finally to Sonicare. In our estimation, the Sonicare electric toothbrush is simply the most effective tooth cleaning product on the market. End of story. Having used and Oral-B electric tooth brush for many years and having avoided the Sonicare because I found it to be uncomfortable initially, I began using it regularly and discovered that it was far superior at removing stains and plaque and maintaining gum health. What more is there to say?

Number 2: Closys Toothpaste

We have been recommending Closys toothpaste for the last 10 years or so. It contains chlorine dioxide which kills germs. It does not contain abrasives, extra chemicals or other unnecessary ingredients which would make it a lesser choice for effective oral health. Closys II toothpaste effectively kills germs, helps maintain gingival and dental health as well as providing clean fresh breath.

Number 3: Inter Dental Cleaners

There are a variety of ways to clean between the teeth which we recommend for different patients and for different reasons. I will lump these together as being the third most important thing we love. For those with regular spaces between our teeth, we love Reach Total Care floss by Johnson and Johnson. This is great floss which is effective, tastes good, and is well-designed.

Favorite Things

If you have bridges and are unable to use regular dental floss, then Superfloss by OralB is the choice for you. This product allows you to easily thread the floss underneath your bridges and thoroughly clean them with a minimum of fuss.

For those who have very wide spaces between their teeth, pipe cleaners are an excellent choice to quickly and effectively clean between your teeth. For those with moderate spaces between their teeth and for those who have had gum surgery ProxaBrushes are the weapon of choice. They are easy to hold and manipulate and are effective at cleaning larger spaces between your teeth. Finally for those people who hate to floss, there is a product by Sonicare called the AirFloss are which is very effective especially at removing debris which gets caught between your teeth.

Number 4: NeoStrata Skincare

We have offered the line of NeoStrata skin care / antiaging products in our office for the past few years. Though it has not been very popular amongst our patients, it is very popular with our dental team. This line of products is meant to care for your skin and these products do what they say they will do. If you have any interest, feel free to ask us for samples and I think that you will be surprised at how effective they are. For your information, this little-known company provides products to various larger corporations whose names you may well know.

Number 5: Zoom! Teeth Whitening

For many years, we used the BriteSmile system for teeth whitening. Zoom! Whitening became the standard for tooth bleaching when the show Extreme Makeover was so popular. Some years ago Zoom! Purchased BriteSmile and their newest system offers improvements which make the procedure both more effective and comfortable. For those people who desire whiter teeth, the in-office Zoom!bleaching system is the best.

Number 6: Invisalign

Invisalign orthodontics has been available for more than a dozen years. This company continually up grades their techniques and products to offer an excellent alternative to metal braces. There are various bite problems which can now be addressed using Invisalign, and more and more adults are taking advantage of this excellent service to help turn back the clock. FYI, the Invisalign system aligns and levels the teeth using a series of clear aligners which are changed by the patient every two weeks. The results we have achieved with this system have been very impressive.

Number 7: The K7 and TMD Orthotics

We purchased the K7 technology many years ago to assist us in treating patients with head, neck and facial pain. This system has proven to be a wonderful way to help diagnose our patients’ problems and to determine the best way to treat them. Using this system, we are able to have orthotics custom fabricated for patients to wear over their lower teeth. These orthotics have been very effective at eliminating various symptoms of TMD pain and associated symptoms. If you suffer from chronic pain, I recommend that you ask us about how the K7 system and an orthotic may be a blessing for you. Check out this technology at www.myotronics.com.

It is our hope that you find these seven of our favorite things to be useful for you. If you have any questions about any of these items, please do not hesitate to ask. You may contact us by phone at 908.359.6655 or via our website at www.DesignsForDentalHealth.com.

Smile Enhancements for Healthy Aging

Posted on September 22, 2014 by DrRichardNadler

Earlier this month, we discussed common dental problems which affect us as we grow older and how to address them. In this installment, we will describe three popular methods to improve both the appearance and the function of your teeth. At the end of this article, we will reinforce what we believe to be the best ways to improve the health and beauty of your smile.

smile enhancements You may be surprised to hear about the first popular procedure which has increased in frequency over the past several years. Once considered only appropriate for adolescents and teenagers, orthodontics has become an excellent means for adults (even those well into their 60s) to improve their smile, take years off their facial appearance, and improve their self-esteem. This, in turn, improves their overall outlook on life. Alternatives to the metal braces commonly seen in the past have grown in popularity as they have become more comfortable, effective and invisible. In our office, Invisalign™ orthodontics has proven to be a discrete and successful method for adults to address bite issues and crooked teeth. Even patients who had braces as a teenager find the system an excellent way to realign teeth which have relapsed over the years.

Invisalign™orthodontic treatment, combined with either tooth bleaching and/or bonding, can help you to achieve your dream smile, improve your appearance, help you look younger, and feel a renewed sense of self confidence. In addition, a properly aligned bite serves to preserve your overall health and well-being. Teeth which are not aligned and bites which are not properly balanced are much more at risk for a variety of dental issues. These issues include tooth fractures, tooth wear, loosening teeth, gum recession, ineffective chewing ability as well as a variety of jaw, neck, and shoulder pain and headaches.

The second popular dental enhancement which has steadily gained in popularity over the last twenty-five plus years is implants. Titanium implants have evolved and become a staple in the replacement of missing teeth for those who wish for comfort, convenience, and excellent appearance. Implants can be used in a number of different ways to replace missing teeth. The simplest way, of course, is for replacing a single missing tooth. But implants can also be used to replace a series of missing teeth or even an entire arch of missing teeth. Contrary to popular opinion, the placement of implants does not involve significant discomfort and their success rate is very high.

There are many patients who have struggled with dentures for years. Such patients have had as few as two implants placed to stabilize their existing dentures. The benefits of such procedures are astounding for those who have struggled to eat and speak with loose plates for years. We even see patients who are about to lose all their remaining teeth in one or both arches. Such patients can have their hopeless teeth removed, four implants placed, and a set of teeth mounted on those implants all in a single appointment. That procedure is called “All-On-Four” and requires collaboration between a prosthetic dentist, an implant surgeon and a laboratory technician. The results in these cases are life changing.

The third popular smile enhancement involves bonding or porcelain to restore worn, broken, or otherwise damaged teeth. “Bonding” utilizes tooth-colored filling material which is placed on one or a group of teeth to restore natural appearance, shape, and color. Similarly, porcelain is used in more advanced cases for those patients who wish to have the most long-lasting and cosmetic solution to their dental problems. Porcelain can be used to cover the entire tooth or limited areas of the tooth as needed in any given situation. The porcelain is bonded to the teeth which results in a very strong, cosmetic, and natural result.

Bonding and porcelain can be used to enhance smiles in a number of different ways. Teeth which have mild misalignment can be made to look perfectly aligned instantly using these materials. Similarly, problems with symmetry, proportion, color and shape can all be addressed using these materials. The next time that you are in our office, make sure to look at some of the photographs on our walls which exhibit the results gained by using these materials.

Finally, let us reiterate the best ways to ensure healthy aging at least as far as oral health is concerned. As we grow older, we are all more prone to have decay which can sometimes develop very quickly. It is not uncommon for adult patients to have some gum recession which results in the exposure of root surfaces. Such surfaces are very prone to decay and must be carefully monitored both at home and in the dental office. In addition, as our gums recede, food is more likely to lodge between the teeth creating another cause for decay developing. Increased use of medications and other medical issues may lead to a condition of dry mouth. Without the buffering effects of saliva, the likelihood for increased dental decay as well as gum disease is highly likely.

So what is one to do to prevent an increase in gum disease and dental decay? Here are our favorite as well as most effective recommendations:

Use an electric toothbrush and brush where the teeth and gums meet.
Clean between your teeth with an appropriate sized tool. Large spaces require a proxy brush and smaller spaces require fluffy floss.
Brush before bed!
Rinse with a fluoride mouthwash especially before bed. During this month we have been handing out Listerine Zero which is a good product found in the grocery store but any similar product which includes no alcohol can be used.
Have regular checkups! This is the best way to make sure that small problems do not become big ones! In the past few years, we have seen more and more patients who have returned after extended periods with more severe problems. Regular checkups will save you money and give you more peace of mind.

In closing, cosmetic dentistry may be key to a person’s health in later life. Here is a quote from a cosmetic dentist in Texas:

“We often hear older patients just wanting things patched up as opposed to getting something aesthetic. They may have the idea that they are not worth it, or their families have the idea that they are too old for cosmetic dentistry. This may lead to an attitude that things are ending.

“Improving an older person’s mouth can bring them more happiness and joy, not only by improving chewing efficiency, but also bringing joy back. They will want to smile more.”

If you have any questions concerning this article or any other dental questions, please call our office at 908.359.6655 or contact us via our website at www.designsfordentalhealth.com.

Crooked Teeth and Sleep Apnea

Posted on May 20, 2014 by DrRichardNadler

As I mentioned in our last blog, we will be describing various connections between oral health and systemic (or total body) health. Today, I’d like to report on a very interesting class which I attended about a week ago. This was an Invisalign Study Club meeting which was meant to increase our skills in planning Invisalign orthodontic cases. But, every now and then, we watch a gifted speaker provide you with much more information than the announced topic would suggest.

My longtime patients know that I have been a lifelong student of dentistry and especially occlusion’s (the bite’s) role in preserving dental health for the long term. I have studied the various connections between occlusion and overall health including TMD and head/neck pain, occlusion and advancing gum disease, as well as occlusion and the airway to name but a few.

Well, at this particular lecture, the speaker showed slides of various patients with crowded teeth as well as some with narrow dental arches. Many of these patients, like many of those I see every day in my office, have what we call, tori, on the inside of their lower jaws. Patients are often aware of these tori, most are generally not bothered by them, but some ask if they should be concerned about them. I had always considered these to be a sign of patients who are chronic clenchers of their teeth, and many of them are. However, the speaker made a legitimate case for the chronic growth of these tori in patients whose teeth are tipped towards the tongue.

Anatomy-of-Obstructive-Sleep-Apnea (1)

But perhaps I am getting off of the point. The combination of people who have narrow jaws and tooth crowding are very likely to have sleep apnea. I have always known that there is a connection between narrow jaws and sleep apnea, but this presentation made it so clear that patients like those described above do not have adequate space in their mouth for their tongues. As a result, their tongues are forced back into their airways, and the result is sleep apnea.

Such patients may have had orthodontics when they were children,and had four teeth extracted because of their crowding. Such patients are quite likely to have sleep apnea because their jaws are narrow and their teeth have been moved back to where the tongue wants to be to close the space created by the extracted teeth. The tongue is thereby forced to rest towards the airway. Now, I am considering whether or not to treat such patients orthodontically to expand their arches. This is one means of improving their airways and reducing their likelihood of developing obstructive sleep apnea.

When such patients come to my office, they must be carefully screened for obstructive sleep apnea, high blood pressure, adult onset diabetes, cardiovascular disease and other systemic issues which are related to obstructive sleep apnea.

If you have a bite which sounds like the type that I have described above, please contact us so that we can perform a proper screening for obstructive sleep apnea. If you have any questions about your occlusion or sleep apnea, please feel free to contact us by telephone at 609.359.6655 or via our website at www.DesignsForDentalHealth.com

Your Shimbashi Number And Your Bite

Posted on February 13, 2014 by DrRichardNadler

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.

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.

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??

Posted on January 7, 2014 by DrRichardNadler

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 www.DesignsForDentalHealth.com or by calling our office at 908.359.6655.

What Are Loupes And Why Must Your Dentist Wear Them?

Posted on November 16, 2013 by DrRichardNadler

Dr. Nadler and Zora Circa 2003

Dental loupes are the magnifying glasses that dentists wear to enlarge everything that they see in the mouth. There are two basic reasons why these glasses are worn. First and foremost, vision is improved simply because everything in the field of view is so much bigger. Secondly, loupes are worn to allow dentists to have a more “physiologic” posture while working, and thereby minimize the slouching which dentists are historically known to develop.

Why is it important to have an enlarged view of the working area? The most obvious answer is that a better and enlarged view of the treatment site automatically results in more precise dental work. Dentists are better able to see the shapes that they are carving or preparing in the natural teeth as well as in the final restorations which they are providing for their patients. Perhaps even more importantly, dentists are better able to make more accurate and complete diagnoses of what is occurring in each patient’s mouth.

As an example, I was testing out a new product which was touted to assist in better diagnoses of oral cancer. This system required the wearing of colored lenses used in conjunction with a special light. Using this system, I would be unable to wear my loupes. I first examined a patient using this new system without magnification. And then, put on my loupes and re-examined the patient. There was no comparison between the two examinations. Without magnification, even with the special light effect, much more was visible and apparent with magnification.

I began wearing loupes back around 1990 while I was taking advanced classes at the L.D. Pankey Institute in Florida. It was at this time when I truly feel that the quality of the treatment which our office provided moved to an entirely new and higher plateau. Not only was I learning some amazing skills, but also the use of the loupes alone allowed significant improvement in my ability to provide excellent treatment. Since that time, the loupes that I use have gotten increasingly longer and provide more magnification. These glasses are simply addictive to any dentist who is serious about doing his or her absolute best work.

A few years after beginning to wear them, I decided to try a headlight mounted right on the loupes. After the first patient to be seen with this light, and in spite of the discomfort of extra weight on my nose, there was no turning back. The benefits of the light are nearly as significant as those of the loupes themselves. As good as the overhead dental light is, there are still shadows as we lean in as well as from the lips and tongue, etc. Whereas, wearing the loop-mounted headlight, the light shines exactly where I am looking.

I don’t see how any dentist can work without either magnification or head-mounted lights. I believe that dental schools should teach the use of this equipment as mandatory – at least in the final year of dental school. If you’ve ever seen the intraoral photographs that we take for our patients, you’ll know what it’s like to look through loupes with light. It’s just so easy to see!

If you have not had the opportunity to see an intraoral photo of your teeth, please ask us for a demonstration at your next appointment. It will only take a moment and can be quite eye opening. If you have any questions or concerns please visit us online at www.DesignsForDentalHealth.com or call us at 908-359-6655.

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

Posted on May 29, 2013 by DrRichardNadler

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).

TENS 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.

Establishing 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 .

Designs for Dental Health Blog – Hillsborough NJ Dentist

Gentle, Caring Dentistry. Eat Well, Feel Great, Smile Beautifully.

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