Dr. Chase provides diagnosis and treatments to a wide range of dental problems ranging from cosmetics to pain resolution. Every patient is different and questions often are too. We invite you to read answers to questions we frequently hear. You are welcome to contact us if you have additional questions regarding neuromuscular dentistry.

1. General
2. Neuromuscular Dentistry
3. Sleep Breathing Disorders
3. Biolistic Orthodontics
4. Head and Neck Pain

Sterilization
Q: What precautions do you take to insure patient safety during treatment?

A: Concern with the spread of contagious disease keeps my entire office staff alert on issues of sterility and safety of our working environment. Current technology utilized and advanced training is the combination that shows our top priority is your protection.

We follow and often exceed guidelines of the Center for Disease Control and the National Institute of Health, as well as continually reviewing updates on infection control material and techniques. Annual work and patient safety seminars are attended by the entire. We provide you the same standards that we expect and demand for our own families and ourselves.

Working with health compliancy experts we have spent many long hours designing our patient protection system. Examples are gloves, masks, protective eyewear for staff and patients, timed disinfection for each treatment room, disposables or sterilizable instruments, ultrasonic scrubbing prior to pressurized steam autoclave, individual instrument packaging, handpieces sterilized, and disposable polishing angles all add to the highest level of commitment to our patients.

Education
Q: How can I learn more about some of these topics?

A: Feel free to fill out the Contact form or email us by going to the CONTACT US page and state what you would like to have more information on. Additionally there are more articles and references in the DOWNLOAD/FORMS page.

Payment options
Q. What forms of payment are accepted?

A: We try hard to not have money get in the way of health and a pain-free life. To help with this goal we have a third party company you can use to extend payments for your treatment over time, making the payment it comfortably into your monthly budget. Call or email the office manager on how to best coordinate treatment with this option. We accept checks, credit cards (MasterCard and Visa), and cash.

Q: Does insurance cover treatments?

A: Dental and/or medical insurance may or may not cover care. Treatments can be billed to your medical insurance plan. Dr. Chase’s office does not file claim forms for you. We can help with codes and you can send the forms. We do not take payment assignment. Payment is expected at the time service begins for a particular treatment.

Treatment/ Diagnosis
Q: What is involved in getting care?

A: Dr. Chase uses a variety of data gathering tools to make a diagnosis. Forms, photos, range of motion studies, electromyography, computerized mandibular tracking, electrosonography, cone beam tomography, muscle palpation exam, cranial nerve exam, and other tests can be employed for diagnostics.

Travel and Accommodations
Q: I do not live locally, where can I stay?

A: Santa Rosa has a multitude of hotels and Bed and Breakfasts. Three close to the office include:
Flamingo Inn, which is about 1 mile away from the Santa Rosa Office
http://www.flamingoresort.com/
Hyatt Vineyard Creek is about 2 miles away
http://vineyardcreek.hyatt.com/hyatt/hotels/index.jsp
Hoiday Inn Express is about 2 miles away
http://www.hiexpress.com/

Q. Is there an airport?

A. Sonoma County airport, service by Horizon Air (http://www.alaskaair.com/) is roughly 20 minutes away from the dental office of Dr. Chase and downtown Santa Rosa. Oakland International Airport and San Francisco International Airport are both approximately 50 miles from Dr. Chase’s office.

Additional FAQ’s can be found by clicking here:
Neuromuscular Dentistry
Sleep Breathing Disorders
Biolistic Orthodontics
Head and Neck Pain

Neuromuscular Dentistry
Q: Why Is Neuromuscular Dentistry important and is there scientific support for its efficacy?

A: Occlusion is the foundation of dentistry. It is of key importance in the success of every major dental procedure. Occlusion is affected by a triad of factors — the teeth, the muscles and the temporomandibular joints. Traditional dentistry has focused on the teeth — what might be called "one-dimensional" dentistry. Neuromuscular Dentistry (NMD) is a term that has been applied to the additional consideration of the "second & third dimensions" — muscles and TM joints.

The dental curriculum prepares dentists to deal with the teeth. Muscles and joints typically get a cursory once-over. As dentists begin to practice, it is not uncommon to hear them say that they have done procedures "by the book" and yet have less than satisfactory results.

Neuromuscular Dentists commonly report that taking muscle and joint status into consideration aids them in optimizing treatment, minimizing the times that they are "surprised" by less than ideal outcomes, and gives them the added insight needed to treat complex cases. There is a significant body of literature published over the past 35 years that supports the efficacy of neuromuscular dental principles.

Q: How would I know if I have a “bad bite?”

A: Symptoms may include:
Tooth grinding and clenching
Flat, worn teeth
Chipped or broken teeth
Retruded chin or overbite
Short lower third of the face
Short, square looking teeth
Missing teeth
Receding gums
Cavities occurring at the gum line
Snoring or sleep apnea
Recurring shoulder, neck or back tension
Ringing in the ears
Numbness in the fingers
Headaches

Q: What does treatment involve?

A: First step is to deprogram the muscles from their habitual position using a low-grade stimulus. It is called ULFTENS and is very different than a TENS from a physical therapist. This device improves blood flow and changes the metabolism of the muscles to a healthier basis. With the muscles in a resting position we can monitor and measure muscle activity and movements with computers and attached headgear. The jaw joints are also monitored to evaluate their health. Various treatments can be recommended and provided once we have the data. Treatment can include resolution of pain with dental orthotics, orthodontic movement in a body harmonic position, restorative care to ensure comfort over years, coronoplasty (adjustments to the bite), change airway and resolve breathing issues both during the day and the night. Other care is possible as well.

Q: What is an dental orthotic?

A: A neuromuscular orthotic is an appliance that positions the jaw where the muscles are in a comfortable physiological position as shown on the computer and with the diagnostic data. The orthotic allows a test of this new position and allows additional healing.

Sleep Breathing Disorders
Q What is sleep apnea?

A: Sleep apnea is a breathing disorder where breathing stops several times a night for at least ten seconds. It reportedly affects around 20 million Americans and can be life-threatening. There are two types of sleep apnea plus a third that is a combination of the two.
Obstructive Sleep Apnea (OSA) occurs when the airway is blocked by the soft tissue of the tongue with back of the throat, tonsils, and/or adenoids. Air stops flowing through the mouth and nose. OSA deprives the heart and brain of oxygen, which can increase the threat of stroke and heart.
Central Sleep Apnea (CSA) occurs when the brain and central nervous system are misfiring and do not tell the body to breath. Oral, throat and abdominal breathing may be affected simultaneously. This can affect breathing activity for up to two minutes.

Q: What are some causes of sleep apnea?

A: Causes are varied and include:
High Body Mass Index (BMI)
Neck size
Narrow airway
Orthodontic history
Congestion
Age
Smoke inhalation
Alcohol consumption
Genetic profile

Q: What are some symptoms of sleep apnea?

A: Symptoms vary for adults and children. Some include:
Loud snoring
Periodic episodes where breathing stops
Significant daytime fatigue
Restless sleep
Irritability
Poor memory
Difficulty concentrating
Personality change

Q: Why should I be concerned if I have sleep apnea?

A: Sleep apnea can cause as much trouble for you while you’re awake as while you are sleeping. It can lead to headaches, fatigue, depression, hypertension, strokes, and heart attacks. In children it can cause bedwetting, grinding of the teeth, fatigue, attention deficit syndrome, hyperactivity and learning disabilities.

Q: What treatments are available for sleep apnea?

A: There are several treatments. Which one is best for you depends on the severity and type of your apnea. It might be as simple as modifying your lifestyle behavior if you smoke, drink alcohol, or are overweight. There are also several medications, steroid sprays, and nasal decongestants that might help. The most prescribed solution is using Continuous Positive Airway Pressure (CPAP). Though this is the gold standard in the medical world it is often not used after being tried. Patients frequently have difficulty using the machine. Dental devices can help and/or solve the problem and are the most common form of treatment in Europe. America is just now realizing the magnitude of the problem and how valuable dental appliances can be in obstructive sleep apnea treatment.

Q: What does a dental appliance do?

A: Dental appliances move the jaw forward and as a result will move all the tongue and throat muscles forward opening the airway. These appliances fit on top of the upper and lower teeth. They can last for years. Newer shapes and improvements are continually becoming available.

Biolistic Orthodontics
Q: Is it required that I have a referral from my primary dentist or physician?

A: No, it is not. Many of our patients are referred by their primary health provider, yet many other patients are referred from other health professionals and current patients.

Q: At what age should an orthodontic screening be done?

A: Really it is much more that the teeth. It is important to have a cranialmandibularcervical screening done between the ages of two and three. Certain treatments start about four.

Q: Will I need to have teeth extracted for braces?

A: The removal of certain teeth historically has been a common practice. Neuromuscular treatment approaches rarely involve tooth removal or orthopedic and orthodontic success.

Q: How long will it take to complete treatment?

A: Treatment time obviously depends on each patient's specific orthodontic problem. In general, treatment times range from 12 to 30 months. The "average" time frame a person is in braces is approximately 22 months. This time does not include the first stage with neuromuscular data and jaw posture analysis completed.

Q: How much will braces cost? Are financing options available? How does my insurance work?

A: It is impossible to give an exact cost for treatment until we have examined you. We will cover the exact cost and financial options during the initial examination. We have many financing options available to accommodate your needs, and we will review these with you. We will also review your insurance policy and help to maximize your benefit and file your claims.

Q: How often will I have appointments?

A: Appointments are scheduled according to each patient's needs. Most patients in braces will be seen every 4-6 weeks. If there are specific situations that require more frequent monitoring, we will schedule appointments accordingly. Special techniques can be provided so that time lines can be lengthened for patients that travel long distances.

Q: Do braces hurt?

A: Generally, braces do not "hurt." After braces are first placed on the teeth, patients should expect soreness for the first few days. In these situations, pain medications, such as Advil or Tylenol, and warm salt water rinses will ease the discomfort. We also recommend wearing orthodontic wax, when necessary. However, after most follow-up visits, patients do not feel any soreness at all! This lack of pain is in large part due to new technology that employees space-age metals that have built-in memory and use very small forces over longer periods of time.

Q. Are there foods I cannot eat while I have braces?

A: Yes. Once treatment begins, we will explain the complete instructions and provide a comprehensive list of foods to avoid. Some of those foods include: ice, hard candy, raw vegetables and all sticky foods (i.e. caramel and taffy). You can avoid most emergency appointments to repair broken or damaged braces by carefully following our instructions. During the first week of braces, we recommend soft, highly nutritious foods for patient comfort. Please see our recipe section for suggestions in the DOWNLOAD/FORMS page.

Head and Neck Pain
TMD/TMJ
Q: How do I know if I have Temporomandibular Joint Disorder (TMD)?

A: The symptoms of TMD can vary significantly from one person to the next. Some of the more common symptoms include:
Pain and soreness in the jaw and facial muscles
Tooth grinding or clenching
Clicking/popping noise in the jaw
Ringing in the ears or feeling of congestion
Headaches, dizziness, nervousness
Sleep problems and/or snoring
Neck and shoulder pain
Tightness/ loss of range of motion in the jaw and neck

Q: How does a joint in the jaw affect the ears and neck/shoulder area?

A: The jaw joint (temporomandibular joint or TMJ) is a delicately balanced mechanism. Although the joint itself is small, it is essential to many interrelated functions such as speaking, eating, and facial expressions. It is also interconnected with the musculoskeletal function as a whole. Compression of this joint from a poor bite can place pressure to nearby bones affecting balance and hearing. Compensating muscles can entrap nerves leading to referring pain or numbness to other areas of the neck and upper back regions.

Q: How did I get TMD?

A: Research has not yet determined all the possible causes of TMD. We do know that TMD can be precipitated or aggravated by trauma, certain health care procedures, oral habits, and diseases such as osteoarthritis and fibromyalgia. Current research shows malocclusion (poor bite) can be a major contributing factor to TMD. Resolving malocclusion can provide relief and healing.

Q: Is TMD treatable?

A: TMD is treatable by trained neuromuscular dentists. Treatment consists of a thorough evaluation/ assessment. Oral removable appliances are often recommended. Permanent solutions such as orthodontics or dental restorations may be indicated. Sometimes lifestyle changes may be suggested such as change of diet, avoidance of caffeine, physical therapy, or smoking cessation.

Q: Can I just live with TMD as I have been and hope it goes away?

A: TMD never goes away on its own. As your body tries to accommodate the problems associated with it, it can actually become worse. In the vast majority of cases, TMD, if left untreated will continue to progress, causing pain, damage to your jaw and neck, tooth damage, and loss of bone and teeth.

Q: Is TMD common?

A: Yes, approximately thirty million people in the United States have TMD at any given time, according to the National Institute of Dental and Craniofacial Research, Many people go undiagnosed or are misdiagnosed with migraine headaches, Menieres disease, depression, or other unrelated issues.

Q: Does insurance cover treatment?

A: Insurance companies debate whether it is a medical, dental, or psychological issue. This shows the lack of information regarding the whole issue and the inability of the health communities to help treat the “whole” person under a single diagnosis. There are medical billing codes for these conditions/treatments and can be provided to you in your attempt to get benefits. We encourage you to check with your particular insurance carrier.

Headaches

Q: How can your bite cause a headache?

A: Tension headaches result from muscle strain, or contraction. When muscles are held tight for long periods of time they begin to ache. Headaches from dental stress are a type of muscle tension headache. A tension headache may be on one or both sides of your head. Or, it may surround your head as if a steel band were wrapped around it. The pain feels like a dull, non-throbbing ache. Specific signs which indicate that the headache may have a dental origin include:
Pain behind the eyes
Sore jaw muscles or "tired" muscles upon awakening
Teeth grinding
Clicking or popping jaw joints
Head and/or scalp painful to the touch

Q: Why do my jaw muscles ache:

A: Muscles that control your jaw and hold your head upright are very complex both in number and interactions. Every time you swallow, your upper and lower teeth must come together in a firm way to brace the jaw against the skull. We swallow over 2000 times every 24 hours! If your bite is unstable, as from crowded or missing teeth, the muscles must work harder to bring the teeth together. You can rest when your body is tired but your jaw muscles never get a break! Overworked muscles become strained. When muscles are under constant strain, pain results.

Q: How can a bad bite affect other muscles far from the teeth?

A: Pain may be felt in the cheeks or the jaw joints. Many times, however, the pain is "referred" to other areas of the head and neck. Referred pain is when a pain originates in a part of the body that differs from the area where it is felt. Even a single tooth can refer pain to the head. Other muscles may also become involved. Your head is delicately balanced on top of your spinal column by muscles in your jaw, neck, shoulders, and back. Your head weighs approximately 16 pounds the weight of a very heavy bowling ball. Imagine your head as a bowling ball balanced on top of a pencil by a number of rubber bands. When muscles are tense, they shorten. Now imagine shortening just one of those rubber bands. Some rubber bands would stretch, some would shorten, and the bowling ball would be thrown off kilter. Similarly, when even a single jaw, neck, or shoulder muscle becomes shortened, all of the other muscles are forced to overwork to keep the head balanced on top of the spinal column. We see then that dental headaches originate from an unstable bite, which cause the muscles of the jaw, head, and neck to overwork with pain and dysfunction resulting. The pain makes you feel tense and uptight. This worsens the muscle spasm, which in turn increases the pain.

Neck

Q: Why are my fingers numb?

A: As the neck muscles try to maintain balance for a poor position of the head and jaw they tighten for long periods of time. This puts pressure on nerves that travel through these muscles. The entrapment of the nerves causes them to stop transmitting and you get a numb feeling.

Q: Can a chiropractor help my neck?

A: Yes, many chiropractors can relieve symptoms. Dr. Chase, as a neuromuscular dentist, in conjunction with certain types of chiropractors work to fix problems long term. For this to occur you need data. Atlas Orthogonists and NUCCA (Neck and Upper Cervical Chiropractic Association) chiropractors take films, measure the problem and measure the changes. Using their data and treatment conclusions allows a neuromuscular dentist to develop a long-term solution.