A Day in the Life: Run Your Practice Like the Experts

At Nierman Practice Management, we have some upcoming lectures that I think you will love! For today I want to touch base on A Day in the Life: Run Your Practice Like the Experts. I highly recommend attending this lecture series to further enhance your practice and your understanding of how to properly run your practice when incorporating Dental Sleep Medicine.

What is it?

This is a two-day “over-the-shoulder” seminar that gives you the opportunity to firsthand experience how the experts run a successful dental sleep medicine or TMD practice. By having a credentialed mentor, it can help to propel you and your team to the next level in expanding your practice. Through shadowing, you will be able to discuss how to overcome specific roadblocks you may be facing. And, the pieces will come together at a much faster rate than trying to do it all on your own. After all, don’t you wish you could have questions answered immediately rather than having to wait for a response through email or a tutorial? I thought so; me too.

[Insert Video – “Dr. Mayoor Patel & Nierman CE Shadowing for Dental Sleep & TMD”] https://www.youtube.com/watch?v=3BqStiC8Xpw

This course is perfect for practices that have already taken several courses and are ready for a dedicated hands-on learning experience that will be essential to their growth as a sleep medicine dentist. Remember, though, in order to keep each session as personalized as possible, attendance is limited to three practices by application only.

I look forward to seeing you in December and hopefully working together to get your practice on track for dental sleep medicine and TMD services! You can also visit the lectures section of my website for more dates and times for different lectures.

How Does High Risk OSA and Sleep/Wake Bruxism Relate to TMD?

It seems like the symptoms are never-ending and always combining. Even when that is the case, it is important to fully understand each option so that you can provide the proper treatment for your patients. After all, we know that a misdiagnosis can make treatment unbearable and we don’t want to do that to our patients, do we? I didn’t think so.

Today I want to shed a little light on how high risk obstructive sleep apnea and sleep/wake bruxism can relate to TMD. Let’s take a look.

What is TMD and OSA?

First, here is a little background for those who may not be too familiar with this topic area. TMD stands for temporomandibular joint disorder and it is a musculoskeletal disorder characterize by persistent pain in the temporomandibular joint (TMJ), periauricular region, and/or the head and neck muscles. And, OSA is obstructive sleep apnea, which is a sleep-related breathing disorder characterized by repetitive collapsing of the airway during sleep.

The Connection

Sleep-related bruxism and wake bruxism have both been associated with TMD, headaches, and sleep and behavioral complaints. According to Dentistry IQ, one hypothetical mechanism is that OSA might be associated with an increase in parafunctional activity. This would be sleep bruxism or awake bruxism, and contributes to the initiation of TMD in susceptible individuals. Bruxism is a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or bracing or thrusting the mandible. Bruxism can occur during sleep or even while awake.

To look into the connection, the Academy of Dental Sleep Medicine hypothesized that OSA symptoms, awake bruxism, and sleep bruxism at baseline were independent predictors of developing TMD in initially pain-free individuals. This data was analyzed between 2006 and 2008 with men and women between the ages of 18 and 44.Before the investigation began, each participant reported sleep bruxism and wake bruxism. And, to evaluate risk for OSA, each reported loud snoring, daytime sleepiness, witnessed apnea, and hypertension.

The Results

Up to five years after this initial phase, participants completed a TMD screening questionnaire every three months. Clinical re-examination determined TMD in the presence of 5 days per month of pain in the masticatory structures and findings of arthralgia or myalgia. This study found that symptoms of OSA, reports of wake bruxism, and reports of sleep bruxism all have a significant effect in predicting first-onset TMD. And, wake bruxism had a stronger association with OSA symptoms than sleep bruxism did.

You can read more about this study by visiting Dentistry IQ’s recent article. I found it very interesting and am looking forward to even more information on this topic because it helps us in properly treating our patients and potentially preventing further complications.

It’s Back to School Time! Where Do You Come in?

It’s that time of year again! With kids going back to school, where do you, the dentist, come in? I know what you’re thinking, “I’m a dentist, what does that have to do with school?” A lot, actually. As a dentist offering craniofacial pain and dental sleep medicine services, you play an important role in the back to school season. Whether it is for younger children, high school kids, college students or even the parents of each age bracket, you can play an important role by offering tips to combat stress.

I have touched base on this before, but stress can be a leading factor in TMD pain and sleepless nights (in addition to sleep apnea, of course). Let’s take a look at some helpful tips you can offer your patients to help them relax during the stressful back to school months.

Take Deep Breaths

One of the simplest things a patient can do is to take deep breaths in. Have them concentrate on slow deep breaths, which, in turn, will help them transfer their focus onto something other than their stress. You might even want to recommend yoga—hey, it is extremely relaxing and good for your body! At the end of the day, stress can take a toll on everyone, but thinking and taking deep breaths in and out can help bring a sense of calm to the situation.

Call a Friend

Another stress relieving thing your patients can do is to take a break and call a friend or a family member to talk about whatever their problems are. Good relationships with friends and loved ones are important to any healthy lifestyle, and there is no time that is more evident than when a person is under a lot of stress. By hearing a reassuring voice, it can really help you put everything in perspective again. When you are stressed, who is your go-to person to call? That answer might be just what your patients need to hear.

Eat Right

Food can play a role in a person’s stress and how he or she manages it. Stress levels and a proper diet are closely related. Unfortunately, it is when we have the most work that we forget to eat well and resort to using sugary, fatty snack foods as pick-me-ups. When stressed at work, encourage your patients to avoid the vending machine and plan ahead. Instead, they should put together fruits and vegetables, and add in fish with high levels of omega-3 fatty acids—a tuna sandwich really is brain food!


Exercise doesn’t have to mean power lifting at the gym or training for a marathon. A short walk around the office or simply standing up to stretch during a break at work can offer immediate relief in a stressful situation. By getting the blood moving, endorphins are released—this can improve a person’s mood almost immediately.

Remember to tell your patients not to let stress get the best of them. By offering these helpful tips, hopefully your patients can find relief from their stress without causing further complications. I mean, I think I need to follow these tips to help me relieve stress, too! What about you?

The Connection between TMD and Tinnitus

Tinnitus is often referred to as “ringing of the ears,” and can be one of the less common symptoms of TMJ disorders. Many patients suffering from temporomandibular joint disorder (TMD) with coexisting tinnitus find that TMD therapy often helps to improve or resolve their tinnitus in conjunction with their TMD symptoms. Let’s take a closer look at the relationship between TMD and tinnitus so you can help provide proper treatment to your patients.

The Relationship

There is a close relationship between certain problems with the TMJ and tinnitus. Some scientific studies even show that people with problems with their TMJ are more likely to suffer from tinnitus, while some individuals who have sustained an injury to their neck may also suffer from tinnitus. If your patient suffers from TMD or neck problems, he or she may find that they can alter the intensity of their tinnitus by moving their mouth, jaw, face and neck.

Tell Me More…

The chewing muscles are near some of the muscles that insert into the middle ear. This, in return, may have an effect on hearing, which promotes tinnitus. There is also a direct connection between the ligaments hat attach to the jaw and one of the hearing bones that sits in the middle ear. Through the nerve supply from the TMJ, a connection has been shown with the parts of the brain that are involved with both hearing and the interpretation of sound. The general discomfort associated with TMJ problems can also aggravate any pre-existing tinnitus.


By learning more about TMD and how it relates to tinnitus, you can provide your patients with further treatment options. There are a variety of treatment options currently available to help improve TMD symptoms, as well as symptoms of tinnitus. If you would like to learn more about tinnitus and TMD, feel free to contact my office or to attend one of the upcoming fall seminars!