"Dear Dr Amir, I hope you are keeping safe and well during Covid.
I am contacting you in the hope that you may be able to help me with some medical/dental issues that I am currently experiencing.

Many years ago (1999) I had braces/restorative work done at my local dental hospital, and during this treatment, I started developing some nagging symptoms. E.g. Pain behind eyes, tension headaches etc. I had been very fit and healthy prior to this and took a regular part in competitive bike racing.

As time went on, my health worsened into tiredness, sinus like pressure in my head, tension headaches and poor sleep. I followed the conventional route through my GP and undertook scans of my head etc. but nothing ever showed up. My GP suspected I might have fibromyalgia. I tried to just put up with it."

My Comment: Please note that a diagnosis of 'Fibromyalgia' is very suspect and while some 800,000 people have been given this label, probably none have any such artificially created disease. The medical fraternity have cleverly selected a certain cluster of symptoms which cause certain painful areas in the body and called such cluster of symptoms a separate "disease" - Fibromyalgia(FM) or Fibromyalgia Syndrome.
When properly evaluated patients labelled with FM have many more symptoms than what convention dictates. Here is a graph which many patients will find useful.

It is extremely easy for patients to go through their symptoms and realise that what they are really suffering is represented in the graph above rather than in the “disease profile” generated by numerous authoritative groups and societies about "Fibromyalgia".

The crux of the matter is that treating any of the individual symptoms or a small group of symptoms in the real disease profile absolutely no resolution comes about of ANY symptom. Treating the jaw asymmetries rapidly starts resolving most of the symptoms.

"Fast forward to 2017, I had found some information on TMD and sought out a dentist locally. I discovered my jaw muscles were actually referring pain, especially my lateral Pterygoid and Masseter muscles. A short trial with an NTI splint brought significant relief and we also noticed my lower jaw seemed to want to relax slightly to one side of my habitual bite.

A local dentist fitted an upper expander (RN Saggital) and over some months, I developed spaces forwards and outwards. After about 6 months, I had a significant amount of relief. My lower jaw came forward and over to the left. I believe it re-centred and it appeared to match my facial midline, but somehow the upper jaw seemed slightly to the right. By now, symptoms had reduced considerably.

However, instead of restoring me at this bite, the dentist wanted to continue with expansion braces. He fitted me with top and bottom braces. Slowly over time, I seemed to lose my 'bite', which had brought relief, and the symptoms came back.

To try to even out my bite, he filed some teeth on one side.

At this point, I decided to stop treatment and let nature take its course. Unfortunately, as the expansion relapsed, I started developing some muscle spasms and very sore muscles around my face and surrounding areas. For these symptoms to subside, I let things settle for about 4 months. Then the following merry go round occurred:
- GP referral to a maxillo-facial surgeon for muscle spasms."
Comment: An utter waste of time has been the experience of almost every patient I have seen. Generally, a maxillofacial surgeon has little or no knowledge of orthodontics and even less about functional orthodontics.

"- Maxillo-facial referral to dental hospital to review poor bite."
Comment: I am hardly surprised.

"- Dental hospital orthodontist referral to oral medicine because the bite cannot cause muscle spasm".
Comment: A pathetic understanding of orthodontics as I see regularly among numerous patient experiences. An orthodontist who may have an advanced degree in orthodontics is not necessarily equipped with the knowledge about the intricate relationship of occlusion with the rest of the body, as this is not taught in dental colleges. They often perpetuate the illness with their extraction orthodontics dogma.

"- Oral medicine consultant - told me I should leave occlusion alone and take amitriptyline. Even though I informed the consultant that 17 years of TMD had previously been resolved with a different jaw position. "

Comment: Amitriptyline is the chief cop-out for many symptoms. Probably a million patients in the UK take this drug with possibly ZERO outcomes. Patients remain hooked on it for years and still have all their symptoms.

For informational purposes, NICE guidelines recommend this drug as an initial treatment for 'neuropathic pain' in the non-specialist setting.

It is actually a tricyclic antidepressant and it is widely prescribed for the treatment of depression and 'depression of late-life'. Pharmacologically its most important effect is the decreased reuptake of norepinephrine and serotonin.

It is however also prescribed for many other conditions including TMJD. A physical problem cannot be treated by drugs. The information provided on this web site will show you that many of these symptoms are dental in origin and do not warrant a prescription of Amytriptylline.

"- Oral medicine consultant referred me to neurology due to jaw spasms and facial spasms.
- Neurology diagnosed me with Oromandibular dystonia and dystonia of soft palate."
Comment: Plenty of fancy names but no real treatment coming forth. Unbelievable. And we all pay for this expertise!

"- Dental hospital will not do anything now neurology is involved."
Comment: In medicine neurology is like visiting the almighty. In the experience of very many patients and my own investigations, nothing could be further from the truth.

"The neurologist has indicated he thinks it's dental-related but has referred me to the movement disorder ward for Botox. (I do not want the Botox)"
Comment: You are intelligent. You are lucky you were not recruited into Multiple Sclerosis.

"I apologise for the in-depth commentary above. As you can see, I feel I have exhausted the NHS and even private standard healthcare."
Comment: I have at least a couple of hundred patients who have gone through this merry go round. You described it very aptly.

"I would like to leave everything alone but during the last 6 months, I have started developing breathing issues and neck pain. I would best describe this as postural collapse, and I strongly believe my bite is contributing to a twisted neck/head position. I believe this to be structural and certainly not anxiety-based."
Comment: You are absolutely correct. The breathing issue may have been present at the start of your problems and perhaps you have become more aware of it now. Extensive experience shows a link between the jaw asymmetry and the ability to breathe; impairment in breathing can cause numerous symptoms, thus fixing the jaw problem may resolve the breathing problems and consequently, the secondary symptoms may subside.

"I am currently managing with a flat plane splint and visits to a local osteopath, but it does not hold."
Comment: Splints have unpredictable outcomes and are possibly a damaging choice of appliance over the longer term.

"I found no relief in any medication provided other than sedating me."
Comment: There is no medicine out there for PHYSICAL dental problems which are unfortunately being treated medically wth drugs.

"As such, I am only occasionally taking Paracetamol and Baclofen on a needed basis.

I found your website an amazing wealth of information and I hope you will see me for a consultation to see if you would be able to help."




Reviewed January 2021
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