Dr. George Georgaklis – TMJ – TMD – Temporomandibular Disorders
Dr. George Georgaklis Cosmetic Dentistry & Orthodontics of San Diego Temporomandibular disorders (TMD) occur as a result of …
Welcome to 'Natural Healing', I'm Dr. Angela
Stengler here with Dr. Mark Stengler, today
we have such a fun show and a great treat
for you. We have a guest, a dentist, Dr. George
Georgaklis from San Diego, California. Specialist
in TMJ. He's actually treated thousands of
patients with TMJ. We have a lot of information
we're going to grab from him today to talk
about what it is, how it's treated, he's success,
why he's so successful. It's going to be a
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with Mark Stengler, NMD [End Intro]
Dr. A. Stengler: Hi, welcome back to 'Natural
Healing', I'm Dr. Angela Stengler, we're going
to start off talking about dentistry with
Dr. George Georgaklis. He's a 1980 graduate
from the Tufts school of dentistry in Boston.
He's been practicing for over thirty years.
Dr. George, as your patients call you, welcome
to the show. Thank you for being with us.
Dr. G. Georgaklis: Thank you for having me.
Dr. A. Stengler: This is going to be great.
I'm so excited to hear all of your knowledge
about TMJ. You know a lot of patients come
in, not feeling well, having headaches or
what have you, and often Dr. Mark's like,
"have you seen your dentist?". Lets talk about
TMJ, first of all, what is it?
Dr. G. Georgaklis: TMJ dysfunction refers
to a myriad of symptoms which we'll go over,
but first I'd like to go over the anatomy
of the joint so people can understand what
we're referring to.
Dr. A. Stengler: Excellent. Great.
Dr. G. Georgaklis: So I have a model of a
skull here and the temporomandibular joint
is located directly in front of the ear. If
you open and close your jaw you can feel it
And this skull shows one part which is the
condyle, which is the jaw part that fits into
the fossa, which is part of the skull. And
in between the two is a cartilage, piece of
cartilage, or a disk, as referred to. And
this is what the TMJ is all about, those parts.
Now, there are many symptoms people can experience
with TMJ dysfunction, also known as myofacial
pain dysfunction, also known as TMD which
is Temporomandibular dysfunction.
Some of the symptoms may be pain (chronic
or dull, or sharp) of the joint area. Muscle
spasms are another symptom. Headaches, referred
pain to the neck, shoulders, and head. Ringing
in the ears, which is a common symptom overlooked,
they go to ENTs and really its a TMJ related
problem most often.
Dr. A. Stengler: Wow.
Dr. G. Georgaklis: There are various types
of treatments I perform, and other dentists
perform, and the most common; well first of
all I'd like to go over the analysis we do
in the office.
We do a range of motion testing with measurements
to see if they're restricted due to the muscle
spasms. I test the muscle spasms for sensitivity
and tenderness also because that will tell
me how disoriented some of the muscles are,
related to each other, we need to be balanced.
I also evaluate the occlusion. The occlusion
pre-disposes people to TMJ dysfunction.
Some of the common causes of TMJ dysfunction
are trauma, or stress which creates clenching
and muscle spasms and a lot of, myriad of
Dr. M. Stengler: Tight muscles can pull the
jaw joint out of alignment, right?
Dr. G. Georgaklis: That's true.
Dr. M. Stengler: But on the other hand, if
just structural there's mis-alignment that's
going to cause muscle dysfunction so, I guess
with some patients it can be both, it can
be one's more dominant than the other, but
you help people to figure that out and get
Dr. G. Georgaklis: That's right, and another
common symptom I'd like to mention is that
we see a lot of popping and clicking, and
that represents that dysfunction of the muscles.
Some are pulling greater than others, in other
words there's a muscle that pulls the cartilage
independent of the bone, the condyle. So if
those are not in sync and there's different
muscle tension on one more than the other
you'll hear popping and clicking as the condyle
goes on and off the cartilage.
Dr. M. Stengler: So patients that aren't in
pain, would that still be a signal they should
get their jaw alignment, or dental alignment,
checked out before it becomes a problem, just
hearing the popping and clicking? That's a
Dr. G. Georgaklis: That's a very good question
because 80% of people have popping or clicking
or some joint noise but don't have any symptoms,
and the standard is not to treat the joint
noise only if there are symptoms such as pain.
Dr. M. Stengler: And we should tell the viewers
out there, people that have TMJ syndrome,
I mean, it can be excruciating pain in the
area, or the surrounding area. For people
that have never experienced it, it can be
Dr. G. Georgaklis: Quite honestly, there are
some people I've seen that can't even function
during the day. And when you have pain anywhere
in the body it drains your body of energy,
and people are desperate to seek help, and
I am very happy to help them.
Dr. M. Stengler: And of course they have to
be able to chew their food, they have to be
able to speak, and so it's an area where it's
just very limiting if you have problems in
Dr. G. Georgaklis: True; very critical area.
Dr. A. Stengler: Well, you know, that comes
to my question Dr. George; why would they
go to a dentist, if they're having a headache,
or like you were saying, shoulder pain, like
you said, they're going to go to an ENT or
something, so why do they finally realize
"Oh my gosh, this is something going on with
my jaw"? Do ask them as part of normal health
history when you see them and then you're
able to diagnose it? Or do they just come
in and say "I'm at my wits end can you help
Dr. G. Georgaklis: Both. On my questionnaire
I ask if they have any pain or joint noise
related to the TMJ and I'll do an evaluation.
And some people come in specifically to ask
and be evaluated for TMJ dysfunction.
And the reason why they seek a dentist for
treatment is because the temporomandibular
joint is affected by the occlusion so part
of the treatment is to make what's called
a splint, or sometimes referred as a night
guard if it's just going to be worn for grinding,
but a splint is specifically designed with
the occlusion in mind to, also known as a
repositioning appliance, so it repositions
the mandible and makes, to put it simply,
is to reposition the condyle also. So when
we reposition the jaw and the occlusion, we're
also repositioning the joint.
So we want to bring that condyle down and
relieve the stress on the nerves, arteries
and ligaments in that area, which reduces
the inflammation. And once the inflammation
is relieved, then you have a relief of symptoms
Dr. A. Stengler: It almost looks like a retainer
Dr. G. Georgaklis: So this is an example of
one, I specifically design special ones for
my patients that are a little less bulky than
this; but this isn't too bad. It covers either
the upper or lower teeth, not two of them,
and this repositions the jaw downward.
Now, some people, can wear this as a management
device, so they can wear this either at night,
or sometimes during the day to relieve their
symptoms and once their symptoms are gone
they can wear this just at night to prevent
damage from grinding.
Some people have, are dependant on this for
this new position that's healthy and if they
don't wear it the position that they had will
come back and create more inflammation, in
other words they have chronic problems.
So, if, to avoid wearing this the rest of
their life, 24/7, we offer, I offer, either
to rebuild the bite with crowns to replicate
this new occlusion, or to do orthodontics
to replicate the occlusion.
Now, when I do orthodontics I offer various
techniques. I offer the clear brackets, or
Invisi-line, which is an appliance with a
series of clear trays that will move your
teeth, or lingual braces, and this usually
takes about a year. Patients always want to
know; "how it will look in my mouth" because
they are concerned about how conspicuous they
are, and "how long will it take?"
If I'm just doing cosmetic orthodontics, as
you generally know it, I do treatment in six
months; I have a service mark called 'Straight
Teeth in Six Months'. I've been doing orthodontics
for almost thirty years and I found that patients,
especially adult patients, want to know how
they can get it done in less than two years
because most orthodontists are quoting two
years for treatment.
So I found a way with a series, with the latest
techniques of different brackets and wires
and special techniques to make space for teeth
to do it in six months. It's been very, very
popular for my whole career.
I'd like to give you an example of a case
I straightened in six months. Here is before,
very crowded in the front, narrow arch. Afterwards,
rounded arch, very nice smile.
One more example. This patient had more of
a square arch, but once again we ended up
with a nice round arch. So all this was done
in six months; very popular with adults.
Dr. M. Stengler: So you get the cosmetic benefit
of the straight teeth and of course that's
going to help the bite and the bio-mechanics
of the jaw, helping the TMJ indirectly, or
Dr. G. Georgaklis: Orthodontics almost always
has a positive affect, never a negative affect;
unless the orthodontist is extracting bicuspids.
And that often causes TMJ problems. So it's
very unusually to see orthodontists extract
bicuspids anymore because they've learned
that it can cause problems.
Dr. M. Stengler: And you know it's interesting
from a naturopathic view point, if you have
a structural problem in the TMJ, that then
can also throw off the alignment of the whole
cervical spine, technically the whole spine
of the body.
Dr. G. Georgaklis: Very good point; and that's
why, along with my splint treatment I recommend
muscle therapy either through chiropractic
or massage. and also, patients who can't be
resolved with this treatment we sometimes
do arthroscopic surgery but that's very unusual;
we usually don't have to.
Dr. M. Stengler: But it could be a patient
with a chronic, say neck problem, and they're
getting treated maybe a massage, chiropractic,
acupuncture, whatever they're doing, maybe
they're just on pain medicines, which isn't
a good long term approach; getting the TMJ
corrected, the bio-mechanics of that, could
solve other problems in the other areas of
the spine, neck and so forth.
Dr. G. Georgaklis: Absolutely.
Dr. M. Stengler: You've seen that with patients.
Dr. G. Georgaklis: It's been proven; yes.
Dr. M. Stengler: And course, a lot of people
out there, they're just on pain medicines
day after day, hard on the liver, hard on
the immune system, hard on the heart, they've
got to treat the root of the problem which
often is bio-mechanical bite imbalances, and
that's what you do.
Dr. G. Georgaklis: That's always the best
approach in my philosophy too; yes.
Dr. A. Stengler: Well, thank you Dr. George.
I really appreciate you coming and putting
us into your very busy schedule, I know you're
loaded today with patients, we really appreciate
the information. And to you viewers out there,
I'm sure you really enjoyed that as well.