Latest / Clearly Hormonal / Ep 19: The Menopause-TMJD Connection with Dr. Priya Mistry

Transcript

Ep 19: The Menopause-TMJD Connection with Dr. Priya Mistry · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to the Reset Recharge podcast with your host, Dr.
• 0:05
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist.
• 0:11
  Dr. Komal Patil-Sisodia: This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health.
• 0:18
  Dr. Komal Patil-Sisodia: And recharge the conversations you are having with your healthcare providers.
• 0:22
  Dr. Komal Patil-Sisodia: While I am a physician, this podcast is purely for educational purposes.
• 0:26
  Dr. Komal Patil-Sisodia: No individualized medical advice is being given on this podcast.
• 0:30
  Dr. Komal Patil-Sisodia: If you do find information that is helpful, please discuss it with your healthcare provider at your next visit.
• 0:40
  Dr. Komal Patil-Sisodia: Hi everyone.
• 0:41
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge.
• 0:42
  Dr. Komal Patil-Sisodia: Today's a very special episode.
• 0:44
  Dr. Komal Patil-Sisodia: I'm excited to have the TMJ Doc on my podcast, Dr.
• 0:48
  Dr. Komal Patil-Sisodia: Priya Mistry, who happens to be my younger sister, and is a phenomenal TMJ dentist that is nationally renowned.
• 0:56
  Dr. Komal Patil-Sisodia: She's built up her practice, which originally started in Portland, Oregon and has.
• 1:00
  Dr. Komal Patil-Sisodia: Since moved to Vancouver, Washington.
• 1:02
  Dr. Komal Patil-Sisodia: She trained under Dr.
• 1:03
  Dr. Komal Patil-Sisodia: Arthur Parker after she attended UOP, university of the PA Pacific for Pacific, for both undergrad as well as dental school.
• 1:11
  Dr. Komal Patil-Sisodia: So welcome Dr.
• 1:13
  Dr. Komal Patil-Sisodia: Mistry, AKA Priya, which is what I'm gonna call you the whole episode.
• 1:17
  Dr. Priya Mistry: Thank you for having me, Komal.
• 1:19
  Dr. Priya Mistry: I'm excited to be here.
• 1:20
  Dr. Komal Patil-Sisodia: I know.
• 1:21
  Dr. Komal Patil-Sisodia: I'm excited to have you.
• 1:22
  Dr. Komal Patil-Sisodia: We've been talking about this for such a long time.
• 1:24
  Dr. Komal Patil-Sisodia: Especially as I was starting to concept out my practice and think about what it is I wanted to do with my podcast.
• 1:32
  Dr. Komal Patil-Sisodia: You had asked me some very interesting questions about hormonal health and the effect on TMJ and I didn't really have a great answer at the time, but now having spent more time studying menopause and perimenopause and really understanding what my patients are going through.
• 1:47
  Dr. Komal Patil-Sisodia: What I see typically happen is that as estrogen and progesterone levels decline, we know now that muscle mass decreases.
• 1:56
  Dr. Komal Patil-Sisodia: There's an increased risk of arthritis in the joints, and pain gets a lot worse for women during this time in their lives.
• 2:03
  Dr. Komal Patil-Sisodia: So.
• 2:04
  Dr. Komal Patil-Sisodia: I think the impact between both is really between how menopause and perimenopause affect the jaw is really important.
• 2:11
  Dr. Komal Patil-Sisodia: So I'd love to hear from you, Priya, in your words, what exactly is A TMJ disorder?
• 2:16
  Dr. Komal Patil-Sisodia: We hear so many people say, I have TMJ.
• 2:19
  Dr. Komal Patil-Sisodia: I have TMJ, but that's different than a TMJ disorder, correct?
• 2:23
  Dr. Priya Mistry: Yeah.
• 2:23
  Dr. Priya Mistry: Yeah.
• 2:24
  Dr. Priya Mistry: So many people think that you have to have clicking or popping noises in your jaw joints to have a TMJ disorder.
• 2:30
  Dr. Priya Mistry: And so if their jaw clicks or pops.
• 2:32
  Dr. Priya Mistry: Many people will say, oh, my dentist told me I have TMJ.
• 2:34
  Dr. Priya Mistry: And yeah, it's not ideal if your jaw like clicks or pops, so you should get that checked out.
• 2:39
  Dr. Priya Mistry: So technically yes, you do have TMJ disorder, even if you have just noises and absolutely no pain.
• 2:45
  Dr. Priya Mistry: But you can also have TMJ disorder without any jaw joint noises.
• 2:49
  Dr. Priya Mistry: Interesting.
• 2:50
  Dr. Priya Mistry: So yeah, your joints could be totally silent.
• 2:52
  Dr. Priya Mistry: No clicking, no popping, no crackling, no snapping, nothing.
• 2:55
  Dr. Priya Mistry: But you have daily headaches.
• 2:56
  Dr. Priya Mistry: Yeah, or you have daily jaw pain or you have daily neck pain or ear pain or eye strain, or really any pain or discomfort around here in this general area.
• 3:05
  Dr. Priya Mistry: In your head, neck, or jaw, and you could have dizziness, you could have stuffy ears, you could have ear ringing.
• 3:12
  Dr. Priya Mistry: So a lot of people, and there's a lot of overlap between a TMJ disorder versus a hormonal migraine versus a vestibular migraine versus vere disease versus trigeminal neuralgia.
• 3:24
  Dr. Priya Mistry: All these symptoms can like overlap and sometimes because of that things can be like misdiagnosed, but I would say A TMJ disorder would be joint noises and or so you don't have to have joint noises.
• 3:35
  Dr. Priya Mistry: Again, headaches, jaw pain, neck pain, ear pain, dizziness, stuffy ears, lots of different things.
• 3:40
  Dr. Priya Mistry: And so the number one reason people actually come to see me is headaches.
• 3:43
  Dr. Priya Mistry: And you don't necessarily connect your head ache with your jaw.
• 3:46
  Dr. Komal Patil-Sisodia: You don't.
• 3:46
  Dr. Komal Patil-Sisodia: And so just to back up for a second, TMJ, what does that stand for and where is it located?
• 3:52
  Dr. Komal Patil-Sisodia: Can you show me on your face?
• 3:53
  Dr. Komal Patil-Sisodia: Sure.
• 3:53
  Dr. Priya Mistry: Yeah.
• 3:54
  Dr. Priya Mistry: So TMJ stands for temporomandibular joint, so that's a fancy way of saying jaw joint.
• 3:59
  Dr. Priya Mistry: So it's right here.
• 4:00
  Dr. Priya Mistry: If you put your finger right in front of your ear and you open and close, you'll feel some movement there.
• 4:04
  Dr. Komal Patil-Sisodia: Oh, yeah,
• 4:05
  Dr. Priya Mistry: yeah, right here.
• 4:06
  Dr. Priya Mistry: Okay.
• 4:06
  Dr. Priya Mistry: Yeah.
• 4:06
  Dr. Priya Mistry: So that's where the jaw joint is and it's unique joint because.
• 4:11
  Dr. Priya Mistry: It's one of one of the only joints in the body where if one works, the other has to work too.
• 4:16
  Dr. Priya Mistry: You can move your knees independently.
• 4:17
  Dr. Priya Mistry: It has to be symmetric.
• 4:19
  Dr. Priya Mistry: Yeah.
• 4:19
  Dr. Priya Mistry: So if there's a problem in one joint, it definitely affects the other joint.
• 4:23
  Dr. Priya Mistry: It affects everything, the musculature, the bones, the ligaments.
• 4:27
  Dr. Priya Mistry: So it's kind of a unique joint and it's the most used joint in the body and it just doesn't get enough.
• 4:32
  Dr. Priya Mistry: It doesn't get enough love.
• 4:33
  Dr. Priya Mistry: And just another thing to point out is that medical and dental insurances don't cover.
• 4:38
  Dr. Priya Mistry: GMJ disorder care and really medical should, in my opinion,'cause it's muscles and joints.
• 4:43
  Dr. Priya Mistry: No, that makes
• 4:44
  Dr. Komal Patil-Sisodia: sense.
• 4:44
  Dr. Komal Patil-Sisodia: Yeah.
• 4:44
  Dr. Komal Patil-Sisodia: It's not actually your teeth.
• 4:46
  Dr. Priya Mistry: Your teeth can cause it the way they come together.
• 4:48
  Dr. Priya Mistry: But yeah, because the two, these joints are the only joints in the body that have a hard end stop where the teeth come together.
• 4:56
  Dr. Priya Mistry: It's dependent on how your teeth come together.
• 4:58
  Dr. Priya Mistry: So if your teeth come together, like a crossbite.
• 5:01
  Dr. Priya Mistry: It causes lateral strain in the joints if you're, yeah.
• 5:04
  Dr. Priya Mistry: So your bite can have a big impact on what's happening in the joints and the musculature.
• 5:08
  Dr. Komal Patil-Sisodia: Okay.
• 5:08
  Dr. Komal Patil-Sisodia: So I talked a little bit about how I got interested in this overlap between hormonal health and TMJ dysfunction.
• 5:14
  Dr. Komal Patil-Sisodia: What was it for you?
• 5:15
  Dr. Komal Patil-Sisodia: Yeah.
• 5:15
  Dr. Komal Patil-Sisodia: Were you noticing more women in midlife who were presenting with TMJ symptoms?
• 5:20
  Dr. Priya Mistry: Yeah, so it was two things.
• 5:21
  Dr. Priya Mistry: So one is when my mentor taught me that estrogen and relaxin, which are found in much higher levels in women Yes.
• 5:27
  Dr. Priya Mistry: Than in men.
• 5:28
  Dr. Priya Mistry: That those really have a big impact on the jaw joints.
• 5:32
  Dr. Priya Mistry: So together, when they're together, they have been linked to degeneration in the jaw joint one and relaxin.
• 5:38
  Dr. Priya Mistry: It makes things loosey goosey in the body.
• 5:40
  Dr. Priya Mistry: It makes it so we can have babies, things loosen up.
• 5:42
  Dr. Priya Mistry: The baby can come outta the birth canal, but it can.
• 5:44
  Dr. Priya Mistry: Also loosen things up so much in the jaw joint, it can loosen up the ligaments that the little disc of cartilage inside the joint can start to come in and out of alignment or even get dislocated.
• 5:54
  Dr. Priya Mistry: Interesting.
• 5:55
  Dr. Priya Mistry: Okay.
• 5:55
  Dr. Priya Mistry: Yeah, so that's like the one thing is my mentor would always say you, you're gonna notice the majority of our patients are women, and this is why it's the hormonal aspect.
• 6:03
  Dr. Priya Mistry: One and then two.
• 6:04
  Dr. Priya Mistry: I did notice an increase in women in like perimenopausal or menopausal years coming in because, and I think what's happening, like you said, is those hormone levels are dropping and it's affecting the joints, but it also affects the tone of the muscles in the throat.
• 6:17
  Dr. Priya Mistry: I.
• 6:18
  Dr. Komal Patil-Sisodia: I did not know that.
• 6:19
  Dr. Komal Patil-Sisodia: Explain.
• 6:20
  Dr. Komal Patil-Sisodia: Can you explain that a little bit more?
• 6:21
  Dr. Priya Mistry: Yeah.
• 6:21
  Dr. Priya Mistry: Yeah.
• 6:22
  Dr. Priya Mistry: So having high level, normal levels of estrogen, progesterone, normal meaning like before menopause or perimenopause, before they start dropping, those hormones keep these muscles toned and strong.
• 6:33
  Dr. Priya Mistry: And so that's important when we're sleeping because once the tonicity, the strength of those muscle starts to go down, uhhuh, the AirWave can start to collapse.
• 6:42
  Dr. Priya Mistry: So even if you never had like sleep apnea before.
• 6:46
  Dr. Priya Mistry: Or like the precursor to sleep apnea, which is called upper airway resistant syndrome.
• 6:50
  Dr. Priya Mistry: It could come on during menopause because you're going through so many changes and your airway just can't stay open the way that it used to.
• 6:57
  Dr. Komal Patil-Sisodia: That's fascinating.
• 6:58
  Dr. Komal Patil-Sisodia: I wanna pause there for a second and just acknowledge something you said.
• 7:01
  Dr. Komal Patil-Sisodia: So that is the tenicity or the strength of the muscles in the neck, not necessarily.
• 7:07
  Dr. Komal Patil-Sisodia: Associated with somebody who has gained a lot of weight and developed obesity during menopause.
• 7:13
  Dr. Komal Patil-Sisodia: I think traditionally we think about sleep apnea affecting people who are struggling with overweight and obesity and not necessarily because of a weakening in the neck muscles.
• 7:24
  Dr. Komal Patil-Sisodia: Are you seeing.
• 7:25
  Dr. Komal Patil-Sisodia: A di a difference in those two populations and then what do you see when you see it together?
• 7:30
  Dr. Priya Mistry: So definitely I think like the mold that we're taught in dental school and just in life in medical school is, you know, to have sleep apnea, you have to be an obese man over 50 with a huge neck.
• 7:41
  Dr. Priya Mistry: And that's just not the case.
• 7:42
  Dr. Priya Mistry: Again, the majority of my patients are women.
• 7:44
  Dr. Priya Mistry: And many of them are petite women.
• 7:45
  Dr. Priya Mistry: Yeah.
• 7:46
  Dr. Priya Mistry: And some of them have had a type of orthodontia where teeth are extracted and everything is pushed backwards.
• 7:51
  Dr. Priya Mistry: And if you push everything backwards, where's the tongue gonna go?
• 7:54
  Dr. Priya Mistry: The only place is the airway.
• 7:55
  Dr. Priya Mistry: So I'll give you two examples.
• 7:57
  Dr. Priya Mistry: I had a lady who was petite, I mean like tiny, tiny little neck, tiny little everything.
• 8:02
  Dr. Priya Mistry: But she had a tiny little mouth and she had had teeth extracted.
• 8:05
  Dr. Priya Mistry: And if you think of our upper teeth and our lower teeth, like a little box that houses the tongue.
• 8:09
  Dr. Priya Mistry: Yeah.
• 8:09
  Dr. Priya Mistry: If you pull teeth out and pull everything backwards, where is the tongue?
• 8:13
  Dr. Priya Mistry: You're making the box smaller, but the tongue stays the same size.
• 8:16
  Dr. Priya Mistry: So where's it gonna go?
• 8:17
  Dr. Priya Mistry: The only place it can go is the airway.
• 8:18
  Dr. Priya Mistry: That's the only space is backwards.
• 8:20
  Dr. Priya Mistry: So you're making the airway smaller.
• 8:22
  Dr. Priya Mistry: And many orthodontists will come out and say there's no connection between orthodontic work and TMJ problems or sleep apnea, and that's just a bunch of bs.
• 8:30
  Dr. Priya Mistry: So that's one thing.
• 8:32
  Dr. Priya Mistry: So this lady that I saw and she had had the extractions, everything pulled backwards and she's like, I have been begging for like 20 years.
• 8:38
  Dr. Priya Mistry: For a sleep study.
• 8:39
  Dr. Priya Mistry: And because I told her once I imaged her airway with a cone beam CT scan, I said, your airway is so small.
• 8:47
  Dr. Priya Mistry: And I said, with a small airway and major TMJ problems, her jaw was locked, closed.
• 8:51
  Dr. Priya Mistry: She could barely open.
• 8:52
  Dr. Priya Mistry: She was in a ton of pain.
• 8:53
  Dr. Priya Mistry: I said, those two are connected and I'm not diagnosing you with sleep apnea'cause I'm not allowed to do that, but I really want you to meet with a sleep doctor and see what they say.
• 9:02
  Dr. Priya Mistry: So she pushed and pushed and pushed and she got her sleep study, moderate obstructive sleep apnea.
• 9:08
  Dr. Priya Mistry: And then my other patient, tall and thin, like willowy and beautiful, and was a swimmer her whole life.
• 9:14
  Dr. Priya Mistry: Also had a tall, thin, narrow airway.
• 9:16
  Dr. Priya Mistry: And so you don't have to be.
• 9:18
  Dr. Priya Mistry: Obese with a big neck.
• 9:20
  Dr. Priya Mistry: You can also have a long swan like neck and have a really thin airway.
• 9:24
  Dr. Priya Mistry: So I told her and she said, there's just no way.
• 9:26
  Dr. Priya Mistry: I don't have sleep apnea.
• 9:26
  Dr. Priya Mistry: I'm just too healthy.
• 9:27
  Dr. Priya Mistry: I this, I'm that.
• 9:28
  Dr. Priya Mistry: And I said, okay.
• 9:29
  Dr. Priya Mistry: But if you're open to it, meet with sleep.
• 9:30
  Dr. Priya Mistry: Doctor diagnosed with severe.
• 9:33
  Dr. Priya Mistry: Obstructive sleep apnea.
• 9:35
  Dr. Priya Mistry: Fascinating.
• 9:35
  Dr. Priya Mistry: I know.
• 9:36
  Dr. Priya Mistry: So they started treating their sleep apnea with C Paps and treating their TMD with me.
• 9:40
  Dr. Priya Mistry: Interesting.
• 9:41
  Dr. Komal Patil-Sisodia: So I don't know if you got a chance to listen to the episode that I did with Dr.
• 9:45
  Dr. Komal Patil-Sisodia: Andrea Matura on sleep apnea, but she brought forth a very interesting statistic.
• 9:50
  Dr. Komal Patil-Sisodia: Which was that 80% of women who have sleep apnea are not diagnosed.
• 9:55
  Dr. Komal Patil-Sisodia: Yeah, and that actually tracks a lot with what you say.
• 9:58
  Dr. Komal Patil-Sisodia: One of my questions is that when people are on the thinner side of the spectrum and they're not thinking about TMJ or sorry about sleep apnea, a lot of times we tell people to watch for snoring or have their partners tell them if they're snoring, will these women who are on that thinner end of the spectrum still have snoring, or will they just not necessarily have acne?
• 10:19
  Dr. Komal Patil-Sisodia: Where you stop breathing.
• 10:21
  Dr. Priya Mistry: Not necessarily.
• 10:22
  Dr. Priya Mistry: Some will, some won't.
• 10:24
  Dr. Priya Mistry: But I think a good way to start tracking things if you suspect it or if you have met with resistance from a sleep doctor, which can happen not with all sleep doctors, but, and I'm thinking of my one patient that was begging for a sleep study.
• 10:35
  Dr. Priya Mistry: You can start tracking things with an Apple Watch or a smart watch that they can check oxygen saturation.
• 10:40
  Dr. Priya Mistry: I'm not saying that's a sleep study.
• 10:42
  Dr. Priya Mistry: You can't diagnose yourself with that, but at least it's some data.
• 10:45
  Dr. Priya Mistry: Or you can track yourself with an aura ring, OURA.
• 10:48
  Dr. Priya Mistry: I'm not affiliated with them, but this ring is pretty amazing and I think it's more accurate than like a smartwatch, but it tracks like not only oxygen saturation, but it also tracks the levels of sleep that you reach.
• 10:58
  Dr. Priya Mistry: So like many of us don't get enough deep sleep and we can't reach deep sleep if we keep struggling for oxygen at night.
• 11:05
  Dr. Priya Mistry: So there's a bunch of different things that this tracks, including like Night Arousals, like many people are not even aware that.
• 11:10
  Dr. Priya Mistry: They'll wake up gasping to try to get more oxygen and then they just go right back to sleep and you'd forget it.
• 11:15
  Dr. Komal Patil-Sisodia: Yeah.
• 11:16
  Dr. Komal Patil-Sisodia: That's terrible.
• 11:17
  Dr. Priya Mistry: Mm-hmm.
• 11:18
  Dr. Komal Patil-Sisodia: That is terrible.
• 11:19
  Dr. Komal Patil-Sisodia: Okay, that's really helpful because I think that gives our listeners a little bit more validation that even if they're not having those.
• 11:27
  Dr. Komal Patil-Sisodia: Stereotypical symptoms of what we call sleep apnea, for men mostly really that they should still get evaluated.
• 11:36
  Dr. Komal Patil-Sisodia: How often are you checking these cts in your patients to, to check their airway?
• 11:41
  Dr. Komal Patil-Sisodia: Every single one.
• 11:42
  Dr. Priya Mistry: So any patient that takes treatment, they come back.
• 11:45
  Dr. Priya Mistry: So they do the new patient exam, they come back, they take treatment, everybody gets A-C-B-C-T,'cause they have to visualize the joints.
• 11:50
  Dr. Priya Mistry: Interesting.
• 11:50
  Dr. Priya Mistry: So I look at the airway on every single one because the link between TMJ and sleep apnea is definitely there because if we're struggling for oxygen at night.
• 12:00
  Dr. Priya Mistry: What happens is that we will, our body goes into fight or flight mode.
• 12:03
  Dr. Priya Mistry: We want, we need oxygen, so our body's like super stressed.
• 12:06
  Dr. Priya Mistry: And when we're stressed we tend to clench and grind our teeth with more force, more frequency, and for longer durations and grinding the jaw forward opens the airway.
• 12:16
  Dr. Priya Mistry: Think of the chin tilt and CTR.
• 12:18
  Dr. Priya Mistry: You're bringing the jaw up forward and all the clenching and grinding activity night after night strains mu the muscles and the jaw joints and you end up with TMJ problems.
• 12:26
  Dr. Priya Mistry: So there's a definite like correlation.
• 12:29
  Dr. Priya Mistry: There.
• 12:29
  Dr. Komal Patil-Sisodia: Thank you.
• 12:29
  Dr. Komal Patil-Sisodia: That is a great explanation.
• 12:31
  Dr. Komal Patil-Sisodia: So is there any research that links an increase in TMJ symptoms or sleep apnea or facial pain?
• 12:43
  Dr. Priya Mistry: Research indicates a significant connection between sleep apnea and TMJ disorders with studies showing that people with TMJ issues are more likely to experience sleep apnea and vice versa due to the body's attempts to maintain an open airway during sleeps.
• 12:55
  Dr. Priya Mistry: Do you trust National Institute of Health?
• 12:57
  Dr. Priya Mistry: Yeah, that's sleep apnea symptoms and risk of TMJ disorders.
• 13:01
  Dr. Priya Mistry: The strength of association between obstructive sleep apnea signs and symptoms and TMD may be underestimated in this young.
• 13:07
  Dr. Priya Mistry: Population.
• 13:07
  Dr. Priya Mistry: It is likely that the relationship between OSA and TMD is stronger among older adults, especially those with comorbid conditions including obesity,
• 13:14
  Dr. Komal Patil-Sisodia: menopause.
• 13:16
  Dr. Komal Patil-Sisodia: Disorders in women are not really studied particularly well, and since this is something that affects primarily women, unfortunately there's not a lot of research.
• 13:24
  Dr. Komal Patil-Sisodia: I know that you practice more of a holistic style of dentistry where you were trying to incorporate everything.
• 13:30
  Dr. Komal Patil-Sisodia: Is there a research that is, has started or has been done around TMJ and menopause specifically, or just TMJ and women?
• 13:38
  Dr. Priya Mistry: Yeah.
• 13:39
  Dr. Priya Mistry: So TMJ itself doesn't have a ton of research or and there's so many different schools of thought, like every TMJ dentist across the nation will practice from differently from the one next to them.
• 13:49
  Dr. Priya Mistry: And there's arguments and there's, I just try to stay outta the drama.
• 13:52
  Dr. Priya Mistry: But in terms of a link between TMJ problems and sleep apnea, I know that there's a research, there's a study from.
• 13:59
  Dr. Priya Mistry: I know that there's a study from the National Institute of Health that does link that correlation, or that does link the two and they are correlated.
• 14:06
  Dr. Priya Mistry: But I feel like there's just not enough research in this field and in disorders especially that affect women more than men.
• 14:13
  Dr. Priya Mistry: There's also not a lot of research, so I'm hoping that'll change in the near future.
• 14:17
  Dr. Komal Patil-Sisodia: Yeah, and I think that the tide is turning.
• 14:19
  Dr. Komal Patil-Sisodia: Unfortunately, women were not included in research until 1993 and.
• 14:24
  Dr. Komal Patil-Sisodia: The Women's Health Initiative kind of paused women's health research anyways, so hopefully we'll see some changes moving into the future.
• 14:31
  Dr. Priya Mistry: Yeah.
• 14:32
  Dr. Komal Patil-Sisodia: Let's see here.
• 14:33
  Dr. Komal Patil-Sisodia: So I have lots of questions for you because this is such an interesting topic.
• 14:36
  Dr. Komal Patil-Sisodia: I think that really the patient experience is.
• 14:40
  Dr. Komal Patil-Sisodia: The most important piece of this, what should people be looking for?
• 14:45
  Dr. Komal Patil-Sisodia: What are hidden symptoms of TMJ symptoms that women may not connect to their jaw?
• 14:50
  Dr. Priya Mistry: Well, I would say headaches is a big one.
• 14:52
  Dr. Priya Mistry: Neck pain, stuffy ears, dizziness, ear pain.
• 14:55
  Dr. Priya Mistry: Like we don't necessarily, when those are happening, we don't think that's coming from the jaw.
• 15:00
  Dr. Komal Patil-Sisodia: Interesting.
• 15:01
  Dr. Priya Mistry: And I'm not saying it's coming directly from the jaw, right?
• 15:03
  Dr. Priya Mistry: Or directly from the joint.
• 15:04
  Dr. Priya Mistry: It's everything.
• 15:05
  Dr. Priya Mistry: All of this is connected.
• 15:07
  Dr. Priya Mistry: So if you can calm the muscles down in this whole area, which is what I do, well then you can bring those symptoms down.
• 15:12
  Dr. Priya Mistry: So I think those are the main ones.
• 15:14
  Dr. Priya Mistry: 'cause noises in your joints, everyone thinks, oh my gosh, it's a jaw problem.
• 15:18
  Dr. Priya Mistry: But all those other symptoms, you don't necessarily think that.
• 15:20
  Dr. Priya Mistry: And I had a patient who she said, as soon as I started menopause.
• 15:24
  Dr. Priya Mistry: I started waking up at 4:00 AM with these awful headaches and I was like, I can help.
• 15:29
  Dr. Priya Mistry: So as soon as she started treatment, immediately her headache stopped and I really encouraged her to get,'cause I saw her airway was small, and I know that in menopause, the hormones change and that affects the tonicity of these muscles, et cetera, et cetera, et cetera.
• 15:41
  Dr. Priya Mistry: So I really encouraged her to get a sleep study or not get a sleep study.
• 15:44
  Dr. Priya Mistry: I'm not allowed to diagnose this, but I really encourage her to see a sleep.
• 15:47
  Dr. Priya Mistry: Doctor.
• 15:48
  Dr. Priya Mistry: And she kind of didn't want to, and then she ended up moving away, so I couldn't follow through with all that, but she's feeling much better.
• 15:55
  Dr. Komal Patil-Sisodia: Okay.
• 15:55
  Dr. Komal Patil-Sisodia: That's great.
• 15:56
  Dr. Komal Patil-Sisodia: That is, that's great.
• 15:57
  Dr. Komal Patil-Sisodia: Now, I know on one of your social media posts, you had a friend of yours who's a pelvic floor pt.
• 16:03
  Dr. Komal Patil-Sisodia: Talk a bit about the connection between the pelvic floor and TMJ and when I heard that, I was kind of blown away, but the way that.
• 16:11
  Dr. Komal Patil-Sisodia: You both explained it, it made sense.
• 16:13
  Dr. Komal Patil-Sisodia: Could you explain that to our listeners?
• 16:15
  Dr. Komal Patil-Sisodia: Because I think Sure.
• 16:15
  Dr. Komal Patil-Sisodia: Yeah.
• 16:16
  Dr. Komal Patil-Sisodia: One, there's so many symptoms of perimenopause and menopause.
• 16:19
  Dr. Komal Patil-Sisodia: Nobody's journey looks the same.
• 16:21
  Dr. Komal Patil-Sisodia: But if you are having, say, headaches and then pelvic floor issues, what are the chances they're connected and how do you go about solving for that?
• 16:29
  Dr. Priya Mistry: I mean, I think the chances they're connected are high.
• 16:31
  Dr. Priya Mistry: 'cause that's what I see all day, every day, right?
• 16:33
  Dr. Priya Mistry: So the way that the physical therapist explained it, and a lot of physical therapists, chiropractors, and.
• 16:39
  Dr. Priya Mistry: The good TMJ dentist.
• 16:40
  Dr. Priya Mistry: So not all of'em recognize the connection between the jaw and the hips.
• 16:44
  Dr. Priya Mistry: So many people even say that the many practitioners, whole body practitioners even say that the jaw is like the upper hips or the hips are like the jaw.
• 16:52
  Dr. Priya Mistry: Yeah, exactly.
• 16:53
  Dr. Priya Mistry: So they're very similar.
• 16:54
  Dr. Priya Mistry: They function similarly.
• 16:56
  Dr. Priya Mistry: Like the hips are also like, you can't really move one hip without the other moving, kind of like the jaw, right?
• 17:01
  Dr. Priya Mistry: You can't move one hip joint without the other doing something.
• 17:04
  Dr. Priya Mistry: So they are really connected and they're connected with fascia.
• 17:07
  Dr. Priya Mistry: The dural tube.
• 17:08
  Dr. Priya Mistry: I mean, there's so much that connects it.
• 17:10
  Dr. Priya Mistry: And so many people who hold a lot of tension in their pelvic floor also hold a lot of tension in their jaw.
• 17:16
  Dr. Priya Mistry: And if we can release that fascial tension, that muscular tension, everything gets better.
• 17:21
  Dr. Priya Mistry: So I do have patients that are in pelvic floor therapy right now as I'm treating them too.
• 17:25
  Dr. Priya Mistry: And I just think that whole body connection.
• 17:28
  Dr. Priya Mistry: Is missed because we're just not taught it in medical school or dental school.
• 17:32
  Dr. Priya Mistry: And kind of off topic.
• 17:33
  Dr. Priya Mistry: Like I'm realizing too that I'm limited as a dentist, I'm limited to clavicle and up.
• 17:38
  Dr. Priya Mistry: Yeah.
• 17:38
  Dr. Priya Mistry: I can't do anything lower.
• 17:40
  Dr. Priya Mistry: It's outta my scope.
• 17:41
  Dr. Priya Mistry: Yeah.
• 17:42
  Dr. Priya Mistry: So it is interesting.
• 17:43
  Dr. Priya Mistry: It is really great working with other practitioners.
• 17:45
  Dr. Priya Mistry: Yeah.
• 17:46
  Dr. Priya Mistry: That understand that connection.
• 17:48
  Dr. Priya Mistry: And do you have
• 17:48
  Dr. Komal Patil-Sisodia: a group of practitioners that you work with locally that you collaborate with frequently?
• 17:53
  Dr. Priya Mistry: I do.
• 17:53
  Dr. Priya Mistry: I do.
• 17:54
  Dr. Priya Mistry: I have physical therapists, upper cervical chiropractors, and many people shy away from the word chiropractor, but the chiropractors I work with don't do any pop twist or crack or high velocity manipulations.
• 18:05
  Dr. Priya Mistry: And I'm not saying there's anything wrong with those.
• 18:07
  Dr. Priya Mistry: I just, I shy away from those in the neck for my own patients.
• 18:10
  Dr. Priya Mistry: Because of how it can affect the jaw.
• 18:12
  Dr. Priya Mistry: So the chiropractors I work with are very, use very subtle, gentle adjustments and techniques and it really has a profound effect or can have a profound effect on the jaw.
• 18:21
  Dr. Priya Mistry: Like we had one patient who she was locked, closed, she could barely open her mouth.
• 18:25
  Dr. Priya Mistry: And I gave her, we started treatment.
• 18:27
  Dr. Priya Mistry: And I could get her a little more open, but I couldn't unlock her.
• 18:30
  Dr. Priya Mistry: And I said, you know, I think your neck is really involved.
• 18:32
  Dr. Priya Mistry: I could see it on the CT scan that her cervical spine, the vertebrae were like rotated, tilted, misaligned.
• 18:38
  Dr. Priya Mistry: I said, you would you be open to just getting it checked.
• 18:40
  Dr. Priya Mistry: So she went to our cervical chiropractor across the street and as soon as they adjusted her, boom, she opened up.
• 18:47
  Dr. Priya Mistry: That is first and only time I've ever seen that so far.
• 18:50
  Dr. Priya Mistry: It usually takes a bit more work than that, but she was like, that's a very dramatic change.
• 18:54
  Dr. Priya Mistry: Yeah.
• 18:55
  Dr. Priya Mistry: I mean, she opened to like 50 millimeters and she was opening to like 32 when I sent her in there.
• 18:59
  Dr. Komal Patil-Sisodia: And millimeters is like how far the mouth is open or is that angle of the jaw?
• 19:04
  Dr. Priya Mistry: It's how far the mouth is open.
• 19:06
  Dr. Priya Mistry: 40 to 45 is considered normal.
• 19:08
  Dr. Priya Mistry: And I could barely, I couldn't even get her to 40.
• 19:11
  Dr. Komal Patil-Sisodia: Okay.
• 19:11
  Dr. Priya Mistry: 35 and then suddenly, boom, she could open her full range of motion.
• 19:15
  Dr. Priya Mistry: And then I saw her like once after that and she's like, I'm good.
• 19:17
  Dr. Priya Mistry: I was like, yeah, you are.
• 19:18
  Dr. Priya Mistry: We're good to go.
• 19:19
  Dr. Priya Mistry: You don't need me anymore.
• 19:20
  Dr. Priya Mistry: You don't need me anymore.
• 19:21
  Dr. Priya Mistry: I mean, it's usually not that dramatic.
• 19:22
  Dr. Priya Mistry: It's usually a little more subtle, a little more slow.
• 19:25
  Dr. Priya Mistry: But that was really telling to the connection between the jaw and the neck.
• 19:28
  Dr. Priya Mistry: And there's a really well known, renowned physical therapist named Dr.
• 19:32
  Dr. Priya Mistry: Mariano Rado that he has.
• 19:34
  Dr. Priya Mistry: His whole protocol focuses on.
• 19:36
  Dr. Priya Mistry: C one, C two, C3, and how they're connected to the jaw.
• 19:39
  Dr. Komal Patil-Sisodia: Okay.
• 19:39
  Dr. Priya Mistry: So it's like I'm not the only one out there saying this my mentor learned from him.
• 19:43
  Dr. Priya Mistry: Interesting.
• 19:44
  Dr. Komal Patil-Sisodia: That's such a cool story, right?
• 19:46
  Dr. Komal Patil-Sisodia: Yeah.
• 19:46
  Dr. Komal Patil-Sisodia: To see such a profound impact from one treatment and like you said, the journey is not always like that, but it seems to be very important in your line of work as it is in mine to make sure we're taking the whole picture into account.
• 20:00
  Dr. Komal Patil-Sisodia: For women as their, or any patient really that's trying to navigate TMJ?
• 20:05
  Dr. Priya Mistry: Yeah, definitely.
• 20:06
  Dr. Priya Mistry: And I think that's what makes it so hard for patients is they're like, well, I've been here and I've been here, and I've been here and I've been here, and nobody even knows how to diagnose it.
• 20:12
  Dr. Priya Mistry: No one knows what's going on, nobody.
• 20:13
  Dr. Priya Mistry: And so they're like looking for answers, right?
• 20:15
  Dr. Priya Mistry: And so the more we spread the word, the more we do these podcasts, the better for our lovely patients.
• 20:21
  Dr. Komal Patil-Sisodia: And then, I know this is on menopause and TMJ, but for any of our male listeners that might be tuning in, do you see this also when men suffer from low testosterone?
• 20:30
  Dr. Komal Patil-Sisodia: Because I imagine it's much the same as it would be for women who are going through menopause, because most men will have high testosterone levels until they hit much later years.
• 20:39
  Dr. Priya Mistry: You know, I didn't think of that, but yeah the men that.
• 20:42
  Dr. Priya Mistry: Come to see me, which is kind of rare.
• 20:45
  Dr. Priya Mistry: The few older men, the few men that have locked they're older one or they're hypermobile.
• 20:52
  Dr. Priya Mistry: Oh, interesting.
• 20:53
  Dr. Komal Patil-Sisodia: So the Aler lows,
• 20:54
  Dr. Priya Mistry: aler, Sandlos, hypermobility, loose goosey joints, but yeah, I didn't even think about the testosterone connection.
• 21:00
  Dr. Priya Mistry: I really don't know, but I do know.
• 21:02
  Dr. Priya Mistry: I had a patient that was transitioning from female to male.
• 21:06
  Dr. Priya Mistry: Okay.
• 21:06
  Dr. Priya Mistry: And those hormones that patient was on, they were in their probably late teens, early twenties.
• 21:12
  Dr. Priya Mistry: Oh my gosh.
• 21:13
  Dr. Priya Mistry: That poor patient's jaw was all over the place.
• 21:17
  Dr. Komal Patil-Sisodia: That's so hard.
• 21:18
  Dr. Priya Mistry: I felt so bad for her.
• 21:20
  Dr. Priya Mistry: But I do think that the hormone therapy contributed not in a good way.
• 21:25
  Dr. Priya Mistry: To the jaw being so dysfunctional and painful.
• 21:27
  Dr. Komal Patil-Sisodia: Interesting.
• 21:28
  Dr. Komal Patil-Sisodia: So those are two good awareness points
• 21:30
  Dr. Priya Mistry: mm-hmm.
• 21:31
  Dr. Komal Patil-Sisodia: To definitely pass out to any and all listeners, which is that men's low testosterone levels can be affected and to our patients who are part of the trans community.
• 21:40
  Dr. Komal Patil-Sisodia: If you're noticing that after you're starting hormone replacement for your transition, that may be something you need to go see a TMJ specialist for.
• 21:47
  Dr. Komal Patil-Sisodia: Come see me.
• 21:48
  Dr. Komal Patil-Sisodia: Yeah, come see her.
• 21:49
  Dr. Komal Patil-Sisodia: She is in Vancouver, Washington.
• 21:50
  Dr. Komal Patil-Sisodia: This has been just such an interesting discussion, so thank you.
• 21:53
  Dr. Komal Patil-Sisodia: I think another part of menopause that people struggle with and may not connect to TMJ and you tell me if there's a connection, there might not be, but brain fog and fatigue tend to be two of my most common complaints.
• 22:06
  Dr. Komal Patil-Sisodia: But, there's a multitude of symptoms that happen for menopause.
• 22:10
  Dr. Komal Patil-Sisodia: Two of the most significant of which are.
• 22:13
  Dr. Komal Patil-Sisodia: Brain fog and fatigue.
• 22:15
  Dr. Komal Patil-Sisodia: Do you see that with your patients who have TMJ disorders?
• 22:19
  Dr. Komal Patil-Sisodia: Can TMJ cause brain fog and fatigue?
• 22:21
  Dr. Komal Patil-Sisodia: And if so, how do you know which one is which?
• 22:24
  Dr. Komal Patil-Sisodia: Or do you have to go?
• 22:25
  Dr. Komal Patil-Sisodia: It's so hard.
• 22:26
  Dr. Priya Mistry: Yeah, like what's causing what, right.
• 22:27
  Dr. Priya Mistry: So brain fog, definitely, because many of my patients come in with so much pain.
• 22:32
  Dr. Priya Mistry: They're in like a, they'll say six to nine out of 10 pain level every single day.
• 22:36
  Dr. Priya Mistry: Every single minute of every single day.
• 22:38
  Dr. Priya Mistry: Yeah.
• 22:38
  Dr. Priya Mistry: And when we're in that much pain, again, our body is in fight or flight mode, and we're not meant to live in that mode.
• 22:44
  Dr. Priya Mistry: We're meant to run away from a bear in that mode.
• 22:47
  Dr. Priya Mistry: Yeah.
• 22:47
  Dr. Priya Mistry: And like then get back into like escape.
• 22:49
  Dr. Priya Mistry: Yeah.
• 22:50
  Dr. Priya Mistry: Not fight or flight mode.
• 22:51
  Dr. Priya Mistry: So I think that their nervous system is just so activated all the time that of course it's gonna cause brain fog.
• 22:58
  Dr. Priya Mistry: We're not supposed to live in that much stress.
• 23:00
  Dr. Priya Mistry: So that much pain can definitely cause brain fog and fatigue.
• 23:04
  Dr. Priya Mistry: Because we're just, our body's stuck in fight or flight mode.
• 23:07
  Dr. Priya Mistry: And again it's exhausting.
• 23:08
  Dr. Priya Mistry: Yeah.
• 23:09
  Dr. Priya Mistry: So I have seen some people's brain fog get better.
• 23:12
  Dr. Priya Mistry: Fatigue is a hard one.
• 23:13
  Dr. Priya Mistry: Yeah.
• 23:13
  Dr. Priya Mistry: Fatigue is a hard one because that goes back to sleep and then that goes into like sleep apnea.
• 23:18
  Dr. Priya Mistry: I.
• 23:19
  Dr. Priya Mistry: It's little sister, upper airway resistance syndrome, and then with sleep, I have patients that say, yeah, I had a sleep study and I was diagnosed with mild obstructive sleep apnea, or mild.
• 23:28
  Dr. Priya Mistry: It was just mild, so they didn't encourage me to do anything.
• 23:31
  Dr. Priya Mistry: I'm like, mild is twice as bad for you as it is to smoke every day.
• 23:34
  Dr. Priya Mistry: Ouch.
• 23:35
  Dr. Priya Mistry: Mild is a big deal.
• 23:36
  Dr. Priya Mistry: It's a misnomer.
• 23:37
  Dr. Priya Mistry: They should call it something else and I'm, you should be treating that.
• 23:41
  Dr. Priya Mistry: Yeah.
• 23:41
  Dr. Priya Mistry: Go back to your sleep doctor and ask for A-C-P-A-P.
• 23:43
  Dr. Priya Mistry: Do something mild is a big deal.
• 23:45
  Dr. Priya Mistry: And so fatigue is a really tough one.
• 23:47
  Dr. Komal Patil-Sisodia: Yeah.
• 23:48
  Dr. Komal Patil-Sisodia: That I, and I see that in my practice also.
• 23:51
  Dr. Komal Patil-Sisodia: When patients are coming in for.
• 23:53
  Dr. Komal Patil-Sisodia: Hormone replacement, or they have a thyroid disorder, or adrenal or pituitary or something else.
• 23:59
  Dr. Komal Patil-Sisodia: The fatigue, even when we replace things, may not go all the way back to baseline.
• 24:04
  Dr. Komal Patil-Sisodia: Yeah.
• 24:04
  Dr. Komal Patil-Sisodia: And part of it is with the, you know, unfortunately we're not perfect at having the exact hormones that our body is making and, the delivery and the absorption of that is a question mark for, I'd say probably about 10 to 15% of people.
• 24:17
  Dr. Priya Mistry: Mm-hmm.
• 24:19
  Dr. Komal Patil-Sisodia: 85 to 90% actually do fine.
• 24:22
  Dr. Komal Patil-Sisodia: And then I think the other part of it is just not understanding that there could be other things that are contributing and you may get incremental difference from each thing that you treat, but you need to do all of it together to really see an improvement and an impact, and that, that's hard in our very siloed medical and dental system.
• 24:40
  Dr. Komal Patil-Sisodia: Like I, I think until you and I started talking about this, I don't think I really fully understood.
• 24:46
  Dr. Komal Patil-Sisodia: The whole overlap.
• 24:46
  Dr. Komal Patil-Sisodia: And I actually started, I think, asking you questions about osteoporosis and the jaw and those treatments, and you connected me with our friend Dr.
• 24:55
  Dr. Komal Patil-Sisodia: Matthew Hashimoto, who's a periodontist, and he was able to help with some of that.
• 24:59
  Dr. Komal Patil-Sisodia: But this hormonal connection didn't come until much later.
• 25:02
  Dr. Komal Patil-Sisodia: So I love that we're able to have these conversations.
• 25:04
  Dr. Priya Mistry: yeah, I think the medical and dental communities have failed a little bit in putting, connecting all these pieces in terms of like what we learn in.
• 25:10
  Dr. Priya Mistry: Our school be.
• 25:11
  Dr. Priya Mistry: And I think again, it's'cause there's not a ton of research connecting all of this one.
• 25:14
  Dr. Priya Mistry: But then also, you know, there's a little bit that's on the patient too.
• 25:19
  Dr. Priya Mistry: So I had one who, smallest airway in menopause.
• 25:23
  Dr. Priya Mistry: So tired.
• 25:24
  Dr. Priya Mistry: We were able to get rid of her pain, but she was exhausted and she absolutely refused to meet with a sleep doctor.
• 25:30
  Dr. Priya Mistry: She was just like, Nope, this is not, I don't have sleep apnea.
• 25:33
  Dr. Priya Mistry: There's just no way.
• 25:34
  Dr. Priya Mistry: And my primary care is helping me with my hormone stuff through menopause, and we're gonna fix it that way.
• 25:40
  Dr. Priya Mistry: Okay.
• 25:40
  Dr. Priya Mistry: And so I subtly brought it up a few times and then I could tell she was getting kind of annoyed and I was like, okay, you know what?
• 25:45
  Dr. Priya Mistry: I did my best.
• 25:46
  Dr. Priya Mistry: I'll document it.
• 25:47
  Dr. Priya Mistry: Like I'm not gonna bring it up again.
• 25:48
  Dr. Priya Mistry: 'cause she just was like, absolutely not.
• 25:50
  Dr. Priya Mistry: It's not my sleep, it's not my, I, there's no way I can have sleep apnea.
• 25:53
  Dr. Priya Mistry: So I feel like keeping an open mind as a patient too is a good way to approach things.
• 25:58
  Dr. Komal Patil-Sisodia: Yeah I think that's a great point.
• 26:00
  Dr. Komal Patil-Sisodia: And it also goes to.
• 26:02
  Dr. Komal Patil-Sisodia: The fact that patients have autonomy over their own bodies, right?
• 26:05
  Dr. Komal Patil-Sisodia: And we, in our roles, we can bring forth data and knowledge and do our best to educate people about what their choices are.
• 26:13
  Dr. Komal Patil-Sisodia: But at the end of the day, the true decision makers, the patient themselves, of course.
• 26:18
  Dr. Komal Patil-Sisodia: And so I think your point of having an open mind to thing and to things, and especially knowing that if you're going down a road and in whatever the designated time period is.
• 26:28
  Dr. Komal Patil-Sisodia: To see an improvement with a treatment.
• 26:30
  Dr. Komal Patil-Sisodia: If you're not seeing that, then opening your mind to maybe exploring other options.
• 26:35
  Dr. Priya Mistry: Yeah,
• 26:35
  Dr. Komal Patil-Sisodia: yeah,
• 26:36
  Dr. Priya Mistry: definitely.
• 26:37
  Dr. Priya Mistry: Yeah.
• 26:37
  Dr. Komal Patil-Sisodia: Just on that same page, how long does it take people to see improvement with treatment?
• 26:44
  Dr. Komal Patil-Sisodia: And I know that's a loaded question because it's probably different for everybody, but on average for a perimenopausal menopausal woman, what is the timeframe that you see that you would recommend they go through treatment for before knowing it's really, yeah, they need to go look for other causes.
• 27:00
  Dr. Priya Mistry: So most people are in treatment with me anywhere from seven to nine months.
• 27:03
  Dr. Priya Mistry: This is not a quick fix.
• 27:04
  Dr. Priya Mistry: Once the muscles and joints are super angry that it's causing constant pain and like major dysfunction, it's, I can't fix that overnight.
• 27:11
  Dr. Priya Mistry: It usually takes years of clenching and grinding to get there, and then the hormones don't help.
• 27:16
  Dr. Priya Mistry: Which I have no control over.
• 27:18
  Dr. Priya Mistry: So there's factors that are out of my control too.
• 27:21
  Dr. Priya Mistry: I will say though, that most people, even in that seven to nine month span, they experience less pain within a month and or a month and a half of starting treatment.
• 27:28
  Dr. Priya Mistry: Oh, okay.
• 27:28
  Dr. Priya Mistry: So that's awesome.
• 27:29
  Dr. Priya Mistry: Okay.
• 27:29
  Dr. Priya Mistry: So pain can go down quickly.
• 27:31
  Dr. Priya Mistry: It's the joint stuff, like if your jaw's locked closed mm-hmm.
• 27:35
  Dr. Priya Mistry: Or you have true trismus, like a muscle spasm.
• 27:37
  Dr. Priya Mistry: Yeah.
• 27:37
  Dr. Priya Mistry: That can take a bit longer.
• 27:39
  Dr. Komal Patil-Sisodia: That's good to know.
• 27:40
  Dr. Komal Patil-Sisodia: Just for expectation setting, I have another question that is, a little off the questions that we had decided on, so I'm gonna put you on the spot a little bit.
• 27:48
  Dr. Komal Patil-Sisodia: Autoimmune illnesses, I think 80% of autoimmune illnesses happen in women.
• 27:53
  Dr. Komal Patil-Sisodia: I believe that's what the data says.
• 27:55
  Dr. Komal Patil-Sisodia: Wow.
• 27:55
  Dr. Komal Patil-Sisodia: In terms of what you see in your practice, how frequently are women in menopause coming in with other autoimmune disorders and what kind of an impact?
• 28:04
  Dr. Komal Patil-Sisodia: Does that have on your treatment?
• 28:06
  Dr. Komal Patil-Sisodia: I'm thinking like the rheumatoid arthritis, psoriatic arthritis, lupus, or mixed connective tissue that they don't really have an answer for.
• 28:13
  Dr. Komal Patil-Sisodia: Do you see that somewhat frequently, and then what has been your approach with those patients?
• 28:19
  Dr. Priya Mistry: Sure.
• 28:19
  Dr. Priya Mistry: I wouldn't say I see it super frequently, but I've definitely seen it and I think we even called my patient.
• 28:24
  Dr. Priya Mistry: That had just been diagnosed with psoriatic arthritis.
• 28:26
  Dr. Priya Mistry: We called you'cause you know a lot about it.
• 28:28
  Dr. Priya Mistry: And I was like, you should call my sister because she knows a lot about it.
• 28:31
  Dr. Priya Mistry: 'cause she was scared.
• 28:32
  Dr. Priya Mistry: She had just gotten diagnosed.
• 28:33
  Dr. Priya Mistry: She didn't know what medications to take.
• 28:35
  Dr. Priya Mistry: Like she was overwhelmed, she was stressed, she was crying.
• 28:38
  Dr. Priya Mistry: But it's interesting because the people that.
• 28:40
  Dr. Priya Mistry: Have these autoimmune disorders also typically have more pain and have a s more severe level of A TMJ disorder.
• 28:46
  Dr. Priya Mistry: It's not just a little bit, it's a lot bit, yeah.
• 28:48
  Dr. Priya Mistry: So, everything's connected.
• 28:50
  Dr. Priya Mistry: Autoimmune disorders, generalized inflammation in the body, of course it can affect TMJ pain and dysfunction.
• 28:57
  Dr. Priya Mistry: And so these patients tend to be in treatment a little bit longer, and so the seven to nine months, they're usually in treatment over a year.
• 29:04
  Dr. Priya Mistry: Well over a year, sometimes two.
• 29:06
  Dr. Priya Mistry: And I see my patients fairly frequently, every three to five weeks or so at some point.
• 29:10
  Dr. Priya Mistry: Sometimes it's weekly until we can get them feeling much better.
• 29:14
  Dr. Priya Mistry: And that's the main thing I've noticed is it just takes longer to heal because the whole body's involved connected.
• 29:19
  Dr. Priya Mistry: Yeah, so I would say.
• 29:21
  Dr. Priya Mistry: I'd say that's what I've seen.
• 29:22
  Dr. Komal Patil-Sisodia: That's great to know.
• 29:23
  Dr. Komal Patil-Sisodia: And then question for you.
• 29:25
  Dr. Komal Patil-Sisodia: what is your approach to treatment When somebody comes into your office, what can they expect to go through and talk to you about so that they can start navigating this potential of A TMJ disorder?
• 29:36
  Dr. Priya Mistry: Yeah.
• 29:36
  Dr. Priya Mistry: During the first appointment, we do a very thorough exam, but before I even do a physical exam, I get the whole history.
• 29:42
  Dr. Priya Mistry: I wanna hear everything.
• 29:44
  Dr. Priya Mistry: So if they put that they have joint noises or their jaw is locked, or if they have headaches, I am like, when did the joint noises start?
• 29:50
  Dr. Priya Mistry: 'cause sometimes they start when you're like four years old.
• 29:52
  Dr. Priya Mistry: Well, not four, probably eight.
• 29:53
  Dr. Priya Mistry: When did the headache start?
• 29:54
  Dr. Priya Mistry: Sometimes those can start at four years old.
• 29:56
  Dr. Priya Mistry: Yeah.
• 29:57
  Dr. Priya Mistry: When did the jaw pain start?
• 29:59
  Dr. Priya Mistry: So oftentimes it's like one symptom starts, then a few years later, another one.
• 30:02
  Dr. Priya Mistry: And then another one.
• 30:03
  Dr. Priya Mistry: And then another one.
• 30:04
  Dr. Priya Mistry: The history is important.
• 30:05
  Dr. Priya Mistry: I need to know when all this came to the forefront, were there any neck injuries, head or neck injuries preceding these symptoms?
• 30:12
  Dr. Priya Mistry: Because that can affect it.
• 30:13
  Dr. Priya Mistry: That can be why they happened.
• 30:14
  Dr. Priya Mistry: So I asked them a ton of ques, like, I wanna know their whole life story.
• 30:16
  Dr. Priya Mistry: I.
• 30:17
  Dr. Priya Mistry: With these symptoms, who they've seen, how they've been treated, if they've had Botox, if the Botox is still in their system.
• 30:23
  Dr. Priya Mistry: I have a gazillion questions.
• 30:24
  Dr. Priya Mistry: Yeah.
• 30:25
  Dr. Priya Mistry: So I, and I think my patients appreciate that because they're like, oh my gosh, I just saw this TMJ dentist in Portland.
• 30:30
  Dr. Priya Mistry: He didn't ask me anything.
• 30:31
  Dr. Priya Mistry: He looked at my mouth, he didn't even do a physical exam and was like, this is what you need.
• 30:34
  Dr. Priya Mistry: And they're like, you're so much more thorough.
• 30:36
  Dr. Priya Mistry: And I'm like, because it's important.
• 30:38
  Dr. Priya Mistry: Yeah.
• 30:38
  Dr. Priya Mistry: The mystery is in the history or the, yeah, that's what my mentor would always say.
• 30:44
  Dr. Priya Mistry: Yeah, I love it.
• 30:45
  Dr. Priya Mistry: And so I ask them a gazillion questions and then I do the physical exam because by the time I get to the physical exam I usually have a pretty good idea of what's going on just based off the history.
• 30:54
  Dr. Priya Mistry: So yeah, it's really interesting.
• 30:56
  Dr. Priya Mistry: And then my physical exam includes like a postural exam.
• 30:58
  Dr. Priya Mistry: I check the against a grid.
• 31:01
  Dr. Priya Mistry: I have You stand and I say shake out and.
• 31:03
  Dr. Priya Mistry: Stand your normal posture.
• 31:04
  Dr. Priya Mistry: Don't try to make it perfect for me.
• 31:05
  Dr. Priya Mistry: And you can see when there's a grid behind you if one shoulder's way higher than the other.
• 31:10
  Dr. Priya Mistry: Interesting.
• 31:10
  Dr. Priya Mistry: Yeah.
• 31:10
  Dr. Priya Mistry: Or if the head is tilted.
• 31:12
  Dr. Priya Mistry: When the grid is behind you, you can see everything.
• 31:14
  Dr. Priya Mistry: 'cause you're like, and then if the patient's spouse has come in, they're like, oh my god.
• 31:19
  Dr. Priya Mistry: Because they're looking too.
• 31:20
  Dr. Priya Mistry: Yeah.
• 31:20
  Dr. Priya Mistry: Yeah.
• 31:21
  Dr. Priya Mistry: I'm like, yeah, and, and they're like, but why are you checking all this?
• 31:23
  Dr. Priya Mistry: So I say, well, the jaw, the shoulders, the spine, the hips, the feet, they all interact with one another and they can all affect each other up and down that chain.
• 31:31
  Dr. Priya Mistry: And so I think my exam is process is like really thorough.
• 31:34
  Dr. Priya Mistry: The only thing I don't do at the exam is imaging because that drives the cost of the exam up.
• 31:38
  Dr. Priya Mistry: That makes sense.
• 31:39
  Dr. Priya Mistry: And I'd, I like to keep the cost lower for.
• 31:41
  Dr. Priya Mistry: The patient's sake.
• 31:42
  Dr. Komal Patil-Sisodia: So then, your treatment modalities, it sounds like are very, all encompassing in terms of, the orthotics or the devices that you're making and orthotic you always point out is very different than a night guard.
• 31:55
  Dr. Komal Patil-Sisodia: Mm-hmm.
• 31:55
  Dr. Komal Patil-Sisodia: One, I want you to explain that, but you also incorporate massage and chiropractic therapy like you were saying.
• 32:01
  Dr. Komal Patil-Sisodia: So probably by the end of that first appointment, does a patient have a general sense of what their treatment plan is going to look like?
• 32:08
  Dr. Priya Mistry: Yeah, so I always go over it with them.
• 32:09
  Dr. Priya Mistry: So I have two primary ways of treating.
• 32:11
  Dr. Priya Mistry: So just like you can't get an orthotic for your shoe to help with your hip alignment.
• 32:15
  Dr. Priya Mistry: You can get an orthotic for your jaw that fits over your teeth to help with your jaw.
• 32:20
  Dr. Priya Mistry: Interesting.
• 32:20
  Dr. Priya Mistry: Yeah.
• 32:21
  Dr. Priya Mistry: So many people think, well, I already have a night guard.
• 32:23
  Dr. Priya Mistry: It's not a night guard.
• 32:24
  Dr. Priya Mistry: A night guard just protects your teeth.
• 32:26
  Dr. Priya Mistry: It doesn't do anything for the alignment of your jaw.
• 32:28
  Dr. Priya Mistry: In three dimensional space, that's what we do.
• 32:30
  Dr. Priya Mistry: Okay.
• 32:30
  Dr. Priya Mistry: So we have technology and software that measures where the muscles are sitting at their correct resting length, their neutral, relaxed position.
• 32:38
  Dr. Priya Mistry: And where the joints are decompressed.
• 32:39
  Dr. Priya Mistry: Okay.
• 32:40
  Dr. Priya Mistry: And the technology and software shows us your teeth are holding your jaw here.
• 32:45
  Dr. Priya Mistry: But your muscles and joints actually want your jaw to be here.
• 32:48
  Dr. Priya Mistry: That's really exaggerated.
• 32:49
  Dr. Priya Mistry: It's never that extreme, but it's usually a little bit more forward and maybe a little bit more to the right or left or whatever.
• 32:54
  Dr. Priya Mistry: So I just exaggerated that a lot to show you that there's quite a difference, again, between a night guard and an orthotic.
• 33:00
  Dr. Priya Mistry: So an orthotic treats the muscles and the joints, and it protects the teeth.
• 33:04
  Dr. Priya Mistry: A night guard just protects the teeth.
• 33:06
  Dr. Priya Mistry: They might look similar, but just like all eyeglasses look similar and fit similarly, it's the prescription built into them that makes a difference.
• 33:14
  Dr. Priya Mistry: And a night guard does not have a prescription, but a true well-made TMJ orthotic.
• 33:19
  Dr. Priya Mistry: 'cause not all TMJ orthotics are created equal, a well-made one has the right prescription that's customized, individualized to you.
• 33:25
  Dr. Priya Mistry: So that's one way I treat.
• 33:26
  Dr. Priya Mistry: And the other way is we go hard after the bite.
• 33:29
  Dr. Priya Mistry: Sometimes it's simply the way the teeth come together that's making the muscles fire too much.
• 33:34
  Dr. Priya Mistry: So we make micro adjustments on the teeth to bring the muscle firing down and bring the pain down.
• 33:39
  Dr. Priya Mistry: Okay.
• 33:39
  Dr. Priya Mistry: So that's, yeah, that's the second way that I got certified.
• 33:42
  Dr. Priya Mistry: And then I got my fellowship in it recently that I've been treating with a lot of success at my practice.
• 33:46
  Dr. Priya Mistry: So those are the two primary ways.
• 33:48
  Dr. Priya Mistry: And so by the time people go.
• 33:50
  Dr. Priya Mistry: They have an idea of what I recommend for them.
• 33:52
  Dr. Priya Mistry: And how much those are, and payment options and when they can schedule everything.
• 33:57
  Dr. Priya Mistry: Oh, that's
• 33:57
  Dr. Komal Patil-Sisodia: really
• 33:57
  Dr. Priya Mistry: fantastic.
• 33:58
  Dr. Komal Patil-Sisodia: And have people had success with putting that through, like their flex spending accounts and things like that for healthcare?
• 34:04
  Dr. Komal Patil-Sisodia: That's good.
• 34:05
  Dr. Komal Patil-Sisodia: Yes,
• 34:05
  Dr. Priya Mistry: we can totally do that.
• 34:06
  Dr. Priya Mistry: And then we also accept care credit and we have flexible payment plans'cause most people are in treatment with me from six.
• 34:13
  Dr. Priya Mistry: To nine months.
• 34:14
  Dr. Priya Mistry: It's a long time.
• 34:15
  Dr. Priya Mistry: So for many of them, I say, put half down now and then six monthly interest free payments till it's paid off.
• 34:19
  Dr. Komal Patil-Sisodia: It's so important to have options, especially since.
• 34:23
  Dr. Komal Patil-Sisodia: Medical and dental insurance don't really cover this type of very necessary treatment.
• 34:28
  Dr. Komal Patil-Sisodia: Are there any at-home practices, nutrition, exercise, stress relief that you recommend?
• 34:33
  Dr. Priya Mistry: Yes.
• 34:34
  Dr. Priya Mistry: So I would say like a really good exercise.
• 34:36
  Dr. Priya Mistry: We'll do two of them.
• 34:37
  Dr. Priya Mistry: Right where your like frontal bone, this big bone here?
• 34:40
  Dr. Priya Mistry: Meets, I think it's actually your sphenoid bone.
• 34:42
  Dr. Priya Mistry: I think I said in another video there was the parietal, but I think it's actually the sphenoid bone.
• 34:45
  Dr. Priya Mistry: Okay, so there's a depression.
• 34:47
  Dr. Priya Mistry: Yeah.
• 34:47
  Dr. Priya Mistry: I can feel you feel that?
• 34:48
  Dr. Priya Mistry: Right?
• 34:48
  Dr. Priya Mistry: So put your fingers in there and press inwards.
• 34:51
  Dr. Priya Mistry: Doesn't that feel good?
• 34:52
  Dr. Priya Mistry: Yeah.
• 34:53
  Dr. Priya Mistry: Like hurt so good.
• 34:53
  Dr. Priya Mistry: It can be a little sore and then rub clockwise and then counterclockwise five times and that can release so much tension.
• 35:00
  Dr. Priya Mistry: Okay.
• 35:00
  Dr. Priya Mistry: Ever since I started incorporating this into my therapy, my, my kind of therapy sessions with my patients.
• 35:06
  Dr. Priya Mistry: Yeah.
• 35:07
  Dr. Priya Mistry: They have loved it.
• 35:08
  Dr. Priya Mistry: They're like, oh my God, what are you doing?
• 35:09
  Dr. Priya Mistry: That feels so good.
• 35:10
  Dr. Priya Mistry: I had a lady ask me if I could just follow her around and do that for her all day.
• 35:13
  Dr. Priya Mistry: I was like, you can do.
• 35:16
  Dr. Priya Mistry: You can reach the, it was funny.
• 35:18
  Dr. Priya Mistry: And then another one is the masseter.
• 35:19
  Dr. Priya Mistry: I mean, this is a huge muscle and for its size, it's actually the most powerful muscle in the body.
• 35:24
  Dr. Priya Mistry: It can generate the most force for it.
• 35:25
  Dr. Priya Mistry: Oh, more than the gluteus maximus?
• 35:27
  Dr. Priya Mistry: Well, for its size, right?
• 35:29
  Dr. Priya Mistry: No, that's what I mean.
• 35:29
  Dr. Priya Mistry: That's what I mean.
• 35:31
  Dr. Priya Mistry: You would bring out the butt sister.
• 35:32
  Dr. Priya Mistry: You have to keep that in i'll and my might as well.
• 35:37
  Dr. Priya Mistry: So yeah.
• 35:38
  Dr. Priya Mistry: I love it.
• 35:38
  Dr. Priya Mistry: So with this one, you can take your knuckles.
• 35:40
  Dr. Priya Mistry: You're gonna gently put some pressure, like float your jaw until your back teeth barely touch.
• 35:45
  Dr. Priya Mistry: So don't clench.
• 35:46
  Dr. Priya Mistry: Just a little pressure.
• 35:47
  Dr. Priya Mistry: And then with pressure inwards, right under your cheekbones, right in front of your ear.
• 35:51
  Dr. Priya Mistry: You're gonna.
• 35:53
  Dr. Priya Mistry: Put pressure inwards and rub all the way down.
• 35:55
  Dr. Priya Mistry: That
• 35:55
  Dr. Komal Patil-Sisodia: feels
• 35:56
  Dr. Priya Mistry: good.
• 35:56
  Dr. Priya Mistry: And you might feel some little speed bumps in there.
• 35:58
  Dr. Priya Mistry: Those are knots in the muscles.
• 36:00
  Dr. Priya Mistry: Those are trigger points, and you can massage those out.
• 36:02
  Dr. Priya Mistry: And people feel really good when they do that.
• 36:04
  Dr. Priya Mistry: I might need to come see you.
• 36:05
  Dr. Priya Mistry: Come see me, baby.
• 36:06
  Dr. Priya Mistry: I need to come see you for my hormones.
• 36:08
  Dr. Priya Mistry: I know
• 36:08
  Dr. Komal Patil-Sisodia: that's right.
• 36:08
  Dr. Komal Patil-Sisodia: So as we close this session out, Priya, can you tell me what you see as the big exciting thing that's happening in the field of TMJ?
• 36:17
  Dr. Komal Patil-Sisodia: Sure.
• 36:18
  Dr. Priya Mistry: I think something that's, you know, it's been around for 35 years, so it's not like new and exciting in general, but for me it is.
• 36:25
  Dr. Priya Mistry: And I think that there's a lot of room for growth and I think every dentist should have this in their office and they definitely don't.
• 36:29
  Dr. Priya Mistry: So it's disc exclusion, time reduction, DTR therapy, and that is where we make micro adjustments on the teeth to calm the muscles down and bring pain down.
• 36:38
  Dr. Priya Mistry: And I honestly think every dentist should have this technology in their office to help prevent TMJ problems.
• 36:45
  Dr. Priya Mistry: Because I had a patient that came to see me.
• 36:46
  Dr. Priya Mistry: She's like, I had a big filling done, and all of a sudden I had eight out of 10 pain every single day.
• 36:52
  Dr. Priya Mistry: That shot up to 10 out of 10 when I chewed.
• 36:54
  Dr. Priya Mistry: And so I adjusted that feeling and her pain went to zero.
• 36:57
  Dr. Priya Mistry: Oh, fascinating.
• 36:57
  Dr. Priya Mistry: But I adjusted it with this technology because when we, what we're taught in dental school is put the bite paper in, tap, tap, tap, rub, rub, rub, and we're taught that the, that mark size and force correlate.
• 37:09
  Dr. Priya Mistry: So the bigger the mark, the more the force.
• 37:11
  Dr. Priya Mistry: That's not true.
• 37:12
  Dr. Priya Mistry: Interesting.
• 37:13
  Dr. Priya Mistry: The smallest mark could be the highest force.
• 37:15
  Dr. Priya Mistry: So the way we're taught in dental school is No, exactly.
• 37:18
  Dr. Priya Mistry: So the way we're taught in dental school is only 14% accurate.
• 37:21
  Dr. Priya Mistry: When we use this technology, it puts a very highly sensitive sensor in your mouth that's a hundred microns thin, that's tiny, and it calculates your bite force with 95% accuracy.
• 37:32
  Dr. Komal Patil-Sisodia: That's so cool.
• 37:33
  Dr. Komal Patil-Sisodia: How would
• 37:33
  Dr. Priya Mistry: you rather have your bite adjusted?
• 37:35
  Dr. Komal Patil-Sisodia: I mean.
• 37:36
  Dr. Priya Mistry: 95% baby.
• 37:38
  Dr. Priya Mistry: So I think, I'm gonna go on this like crazy rampage of trying to promote this technology and I, I don't have any financial interest, whatever connection Yeah.
• 37:45
  Dr. Priya Mistry: Interest in it.
• 37:46
  Dr. Priya Mistry: And so I, for me that's very exciting'cause I definitely wanna start doing that.
• 37:50
  Dr. Komal Patil-Sisodia: That's really fantastic.
• 37:51
  Dr. Komal Patil-Sisodia: And then just to close out.
• 37:53
  Dr. Komal Patil-Sisodia: If you had one piece of advice to give to women who are dealing with facial joint pain or just some unexplained symptoms, the headaches that you talked about, what is your one piece of advice to them for seeking care?
• 38:05
  Dr. Priya Mistry: I would start with your dentist, because most dentists do ask if you have headaches or neck pain.
• 38:12
  Dr. Priya Mistry: I hope they do anyways.
• 38:13
  Dr. Priya Mistry: I think they do.
• 38:13
  Dr. Priya Mistry: Yeah.
• 38:14
  Dr. Priya Mistry: But see if there's a TMJ dentist in your area.
• 38:16
  Dr. Priya Mistry: Many ENT, ear, nose, and throat doctors know about us too, because they have patients that come in with like ICE pick, stabbing ear pain, and they're like, it's not from your ear, your ears fine and functional.
• 38:27
  Dr. Priya Mistry: Yeah, it has to be.
• 38:28
  Dr. Priya Mistry: TMJ ENTs, I think are the MDs that like, know about us the most because of the either related symptoms.
• 38:34
  Dr. Priya Mistry: So yeah, think outside the box.
• 38:35
  Dr. Priya Mistry: Try not to go to Botox as your first line of treatment.
• 38:38
  Dr. Priya Mistry: It is a neurotoxin and all it does is paralyze the muscles.
• 38:41
  Dr. Priya Mistry: It doesn't calm them down.
• 38:43
  Dr. Priya Mistry: It just atrophies them.
• 38:44
  Dr. Komal Patil-Sisodia: Okay.
• 38:45
  Dr. Komal Patil-Sisodia: Which can cause long-term issues, I'm assuming.
• 38:47
  Dr. Komal Patil-Sisodia: I.
• 38:48
  Dr. Priya Mistry: Totally.
• 38:49
  Dr. Komal Patil-Sisodia: Priya, thank you so much.
• 38:50
  Dr. Komal Patil-Sisodia: This has been so much fun.
• 38:51
  Dr. Komal Patil-Sisodia: I wanna give a shout out to our other sister Neha, who we are also working on a podcast with.
• 38:57
  Dr. Komal Patil-Sisodia: We will be having our Po Sister podcast called You Should Call My Sister Launch next month with me as the physician, Priya, as our TMJ dentist and Neha as our mental health therapist.
• 39:09
  Dr. Komal Patil-Sisodia: So very.
• 39:10
  Dr. Komal Patil-Sisodia: Excited to bring that to you all and I will look forward to seeing you.
• 39:14
  Dr. Komal Patil-Sisodia: On the next episode, we'll link all of Dr.
• 39:16
  Dr. Komal Patil-Sisodia: Priya Mistry's information for where you can find her, how you can engage with her, all of her social links down below in the show notes.
• 39:23
  Dr. Komal Patil-Sisodia: Have a great day, everyone.
• 39:24
  Dr. Komal Patil-Sisodia: Thank you again, Priya.
• 39:25
  Dr. Komal Patil-Sisodia: Thank you.