Dr. Roubal's Omaha, Nebraska blog

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2010-04-12T14:14:00.001-05:00

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Commitment to wear appliance

2010-04-12T12:09:00.002-05:00

I just counseled a young patient not to start treatment unless she was willing to wear an oral appliance during her school time (all day). She was concerned that someone may see her appliance and make fun of her. This was a teen who is missing some school already because of her headaches, but still had enough concern about peer pressure that she didn't know if she could commit to full time wear. I suggested we not start treatment until she was sure and pledged to wear it, or wait until school was over for the summer to start treatment. I am not sure want she will decide.

Yours for better health, Dr. Roubal

What is lock jaw?

2010-04-12T12:00:00.002-05:00

I had a sixteen year old female in this past week who had a "locked jaw." Based on her lower jaw range of motion, she actually did not have a locked jaw, but rather was experiencing a displaced disc with reduction. This means she could "wiggle" her jaw and it would "pop" and then she could open her jaw. She had a lot of other symptoms of dysfunction and pain which I feel very strongly that I could have likely reversed since she is so young. Funny thing, the mother called and cancelled a later appointment since I didn't "unlock" her daughter's jaw on the initial visit. I really learned something because of that. Even though I though they had really understood my explanation and reasoning, obviously I didn't do good enough. Sad. they are going to go to a chiropractor for treatment that will not be successful long term as the bite relationship is very seriously "off!" Staying this way could result in permanent jaw joint damage. Hopefully, they will call back and be treated properly.

Yours for better health, Dr. Roubal

Pain came back until orthotic was placed

2010-04-12T11:50:00.003-05:00

I had a women this month come in wondering if our treatment was helping or was she somehow better coincidentally. She had original symptoms of headaches, neck pain, and jaw pain that appeared after she had two crown preparations done earlier at another dental office. After a few failed attempts to get the pain/dysfunction problems taken care of, the treating dentist referred the patient to my office. She originally rated her pain at a "9" on a 0-10 scale; "10" being the worst pain you can imagine.

After about 45 days, she rated her pain at a "1" and on discussion she confessed the level was nearer zero. She had a non-removable orthotic placed because she required a non-intererence to speech appliance. I also discovered she had sleep apnea which was also treated concurrently.

Anyways, she decided she wanted the "fixed" orthotic removed as she had trouble believing the "piece of plastic: could deliver such a "miracle" of pain relief to her. We removed it. After three days, she called and low and behold, all of her pain and dysfunction was coming back! I could not see her for an additional two days. She was very happy to get back the orthotic. In fact, I saw her later the same day and she was already reporting feeling much better. Properly positioned orthotics can be amazing in times of pain improvement.

Yours for better health, Dr. Roubal

Fix the Cause

2010-03-29T09:02:00.003-05:00

Why do I keep blogging about headaches? I think I have read that a solution for a headache pain is the most common reason for medical office visits. Interesting isn't it? Visit a well qualified and experienced dentist for headache problems; find the cause and "fix" it. Get off the medications with all the negative side effects.

Yours for better health, Dr. Roubal

Headache patients usually have more symptoms

2010-03-24T08:44:00.003-05:00

It is rare to find a patient who arrives with the single symptom of headaches. Usually, there are many other symptoms such as ear congestion or pain, neck pain, jaw pain and often many other concurrent symptoms. After looking over the, I Hate Headaches site, I suggest you look at my personal site - http://www.whyallthispain.com/ for more information and the change to contact us directly. We do offer a complimentary phone consultation to discuss your situation and for me to answer any pain related questions you may have.

Yours for better health, Dr. Roubal

Chiropractors and Headaches

2010-03-17T11:50:00.002-05:00

If the chiropractor can help you with your headaches, but they keep returning after some time interval, you may have a jaw relationship problem that needs correction. I have successfully treated countless patients who have been helped by chiropractors, but the adjustments don't "hold". By the way, we often utilize the skills of chiropractors in the treatment of some of our patients.

Yours for better health, Dr. Roubal

Morning headaches and Sleep Apnea

2010-03-17T11:48:00.006-05:00

Morning headache patients should be evaluated for sleep apnea. I have had many patients report resolution of their headache pain with successful sleep apnea treatment. There is a lot of negative "buzz" surround the CPAP machines usually used in the treatment of sleep apnea. I use an oral appliance for those who can not tolerate the CPAP machine or for those who are looking for alternative treatment.

Yours for better health, Dr. Roubal

Migraine Medications

2010-03-15T17:27:00.004-05:00

If you have been prescribed migraine medication and it isn't helping, please give us a call as I have seen quite a lot of this recently. Or, if you are concerned about the negative side affects of medication, we could evaluate you for more conservative treatment.

Yours for better health, Dr. Roubal

Dental Intervention and Headaches

2010-03-15T17:22:00.001-05:00

I have had several common threads this week regarding failed dental intervention for headache relief. Also in common, checking jaw joint or other obvious dental problems such as worn down teeth and also neck pain. I would really encourage people to go into TMJ/TMD research and find a highly trained dentist to help them. Your family dentist may not have enough training and experience to recognize the dental/headache connection.

Yours for better health, Dr. Roubal

Headaches, Orthodontics, and Unhealthy TM Joints

2010-03-09T08:46:00.003-06:00

I just examined a headache patient who just completed orthodontic treatment. In fact, the headaches were so bad that the mother requested the orthodontist remove the braces. I do not think the orthodontics caused the headaches, but rather aggravated a TM joint that was already unhealthy. The inevitable bit changes taking place were too much for the body to accept. I recommend those who are looking to straighten their teeth make sure the TM joints are healthy. If there is any noise such as popping or clicking on jaw movement, or any soreness in chewing activity or limited jaw opening this could indicate a TM joint disorder. which should be corrected prior to starting braces.

Yours for better health, Dr. Roubal

Mouth Guards and Joint Noise

2010-03-04T17:16:00.004-06:00

I encourage those with jaw joint noise to be examined by a trained expert in regards to how much damage is present in the TM joints and how much strain is present in the muscles. I just had a patient in who has been told for the past 2 1/2 years that they didn't have enough symptoms to warrant treatment for their condition. Anyway, after 2 1/2 years of mouth guard nightly wear, this patient developed quite significant headaches, jaw pain, ear pain, and a very limited jaw opening. On review of the TM joint tomographic X-rays, the patient has one joint virtually destroyed. The good part is that she was seeking out help, it just wasn't enough treatment for her. I am not against mouth guards, I am against continuing the mouth guard if it isn't working.

Yours for better health, Dr. Roubal

Headaches and Neck Surgery

2010-02-23T08:48:00.003-06:00

I am surprised and disheartened by the number of headache patients I see who have had neck fusion surgery. Why am I seeing this? It isn't because the surgery was successful in controlling the headaches! I am always optimistic in treatment outcomes, but I have to admit the history of a failed surgery makes me nervous about results. I have just had such a patient. I am happy to report her results have exceeded any one's expectations. It truly was rewarding to me personally to see the fantastic improvement in her pain level. I guess the bottom line is to explore conservative treatment before any surgery is undertaken.

Headaches, headaches, headaches

2010-02-23T08:37:00.003-06:00

Headaches, headaches, headaches; this seems to be all I write about. Oh, yes, this is a blog about headaches. There are many causes of headaches. My task is to find the cause and treat the cause. The typical doctor treats the symptoms, unless, of course, there is a brain tumor or some gross medical issue. Our typical patients are on several medications for their symptoms. We have great success is minimizing or eliminating most medications! Because, we treat the cause.

Yours for better health, Dr. Roubal

Head and Neck Pain

2010-02-10T08:30:00.002-06:00

I find a lot of head pain arises from neck (cervical) problems. Very large muscles attach at the base of the skull. If the lower jaw isn't correctly positioned, the result is a forward head posture. This is a huge contributor to headaches and facial pain. By properly determining the proper jaw position, posture improves and then pain levels improve also. We can also speed up the healing process by use of chiropractic, physical therapy, massage, etc. In my office, we add laser therapy, ultrasound, micro current, and trigger point treatment. On those very stubborn cases, I can add injections of healing medications. We routinely see resolution of chronic headaches, neck aches, and migraines quickly; even those pains that have been present for decades!

Yours for better health, Dr. Roubal

Headaches

2010-02-08T08:52:00.002-06:00

The number one issue that I treat in my office is headache pain. Sometimes that is the only symptom reported. Patients often have a hard time believing their headaches could be related to how their jaws fit together. If I wouldn't see great results every day, I too, likely would be skeptical. The time the headaches are present is a critical analysis tool for me. My task is to gather the history, do the examination, and formulate a treatment that will work. I have many tools available as I have studied these problems for over 30 years. You can also go to my local website, www.whyallthispain.com for addition information.

Yours for better health, Dr. Roubal

Migraines

2010-02-05T11:05:00.003-06:00

I am drawing a blank right now, but this last weekend, I read an article in the newspaper where one of the NFL players would likely miss the game because of a migraine. It is apparent that all normal tests and typical migraine treatments have failed to help him. I wonder if his migraine could be related to jaw position and muscle problems? I have had many long standing "migraine: problems go away with proper jaw alignment treatment. I would encourage exploring this connection for those who have not been treated successfully with traditional migraine treatment, or for those who like to see if can stop taking medication for their migraines.

Yours for better health, Dr. Roubal

Sleep Disorders

2010-02-03T08:24:00.002-06:00

I have a patient who is complaining of morning headaches and daytime tooth tenderness. Tooth pain down in to the gum as she describes it. The sleep apnea screening test shows this is a problem. She has refused an overnight sleep study to absolutely confirm the presence of a sleep disorder, which must be diagnosed by a physician. The headaches and tooth pain is likely from tooth clenching all night long in the body's attempt to open or stabilize the likely collapsing airway. If she refuses to be treated for her sleep issues, the treatment we will be providing will be to lesson the effects of her clenching. Unfortunately, we will not be able to totally eliminate her discomfort, but I am hoping for a great improvement in her symptoms. Sometimes, patients choose for less than optimal treatment for their own reasons.

Yours for better health, Dr. Roubal

Back and Jaw Pain

2010-01-27T08:45:00.005-06:00

I had a patient referred to me by their general dentist. She had two new temporary crowns placed and almost immediately noted jaw joint popping, facial pain, and headaches. The general dentist could not find anything wrong with the temporary crowns, so the patient was referred to me for diagnosis and treatment. The patient denied any previous pain issues or jaw problems prior to the new temporaries. Upon initial exam, it was apparent that the woman had spent many, many hours in a dental chair. She had extensive dentistry present and many worn down teeth and other signs and symptoms of temperomandibular dysfunction (TMD). She did admit later in the exam to having "sinus headaches" and some neck pain for which she did seek chiropractic care. She also was getting routine massage therapy. Probably due to her extreme discomfort, she agreed to treatment for her TMD problem which pre-existed her temporary crown placement. In less than three weeks, she reported about at 75% improvement in all pain and dysfunction problems and even commented, "my chronic lower back pain is gone, could this be due to this TMD treatment?" Yes, we changed the posture of the entire body and after we see backs get better!

Yours for better health, Dr. Roubal

Patient was told she had no options is now a new woman!

2010-01-26T08:33:00.004-06:00

A middle aged female just was in for her one week post insertion orthotic check. She had a sleep apnea problem for which she was also being treated for by a CPAP machine. Or, should I say, she had a sleep apnea problem that was not being treated because she couldn't stand wearing her CPAP. She talked to her doctor about this and basically he told her that if she didn't wear it, she was want to stay sick!! Wow, what a response! Unfortunately, not the only time I have head this from patients. She was also having headaches, ear pain, facial pain, and fatigue. One week later, she is a new woman! Even I am amazed by her new energy and how well she feels and is doing! No pain, sleeping very well, and can work all day. She is thrilled beyond belief and is not very happy right now with her doctor. She told me she is going to see him and report on her recovery and is telling everyone who will listen about her new well being.

I love this stuff!

Yours for better health, Dr. Roubal

Skeptical patient is now a great success story!

2010-01-26T08:14:00.003-06:00

I just reviewed progress with a middle aged male patient. He was quite skeptical about starting treatment with me since his dentist told him he didn't have a TMJ problem. His complaints were headaches and facial pain. He even debated about stopping treatment about a week into treatment because at that point he wasn't seeing any changes in his symptoms. After some thought process, he decided to proceed with his orthotic wear since he had already paid for most of the treatment cost. He had a trip planned and I did not see him for about two weeks. When he came back for his post vacation visit, he reported a great improvement in symptoms. He continued to improve over our typical 90 day treatment time. Today I can report that he is thrilled with the results of our treatment for his muscle related/bite positional problem. His dentist was correct, he did not have a TM joint problem, but the other problems he did have were not recognizable by typical dental examination. We see this all the time as our approach is quite unique in the dental world, this is why we see such great success!

Yours for better health, Dr. Roubal

Pain Comes Back Worse

2010-01-13T08:12:00.002-06:00

We recently had a female patient who we first examined about four years ago. At that time, she declined treatment due to her feeling the cost exceeded her pain problems. Well, guess what, she's back. Now, the pain is much worse! On new examination, her ability to open her mouth is drastically less, her TM joints are much more degenerated and she has developed other painful problems. I would suspect we may not be able to get as complete resolution of her symptoms today versus 4 years ago; or it will take longer, cost more, or we will need to refer out for either (or both) chiropractic or physical therapy help. Her presentation of further suffering and degeneration without treatment is very typical of headache, facial pain, TM joint patients. These problems do not go away without treatment , they may "quiet" down occasionally, but that doesn't mean they went away. The old adage is very true, a ounce prevention is worth a pound of cure.

I'm back!

2010-01-12T08:41:00.003-06:00

Because of the holidays and our terrible winter weather, maybe just me being also a little bit slow (lazy), I have not posted for sometime. "I'm back!!"

Obviously, we have kept healing our patients and have had several patients reporting fantastic results. One patient had been in a very severe car accident over a year ago. She had neck surgery (cervical fusion) for neck pain, but continued to have remaining pain issues such as headaches, facial pain, and ear pain. She did not look or feel happy! She has not been able to work because of the pain. I am very pleased to report she had a very quick, virtually a 100%, resolution of her symptoms after her oral orthotic was placed. One week later, she is a new person, looks and feels great. Looking to get back and be a contributing member of society again! She is not unusual in that she got a lot better with our treatment. Our patients enjoy a 90% plus success in symptom improvement or relief.

Snowstorm and Pain from Shoveling

2009-12-31T13:01:00.004-06:00

We have had a really big snowstorm in Omaha - a real headache for citizens and government as well. Snow piled so high, it is difficult to see around the corners while driving. People shoveling out often get generalized pain from the extra work out. This can lead to headaches due to neck strain and from jaw clinching due to the workout pain. We can clench our jaw due to pain experienced anywhere in our body. Take it easy out there, rest up and take some anti inflammatories to feel better. Better yet, hire the next door kid or your kids to do the hard work. Their young bodies can handle the extra exercise better!

Yours for better health, Dr. Roubal

Headaches

2009-12-31T12:43:00.002-06:00

Probably the most common complaint I head when speaking to new patients. Almost never a stand alone symptom, but cant be at the top of the severity for the patient. We usually see neck pain, ear issues, and some problems with jaw movement, but not always. Most of their patients have been to many physicians for the help, but get prescriptions for the symptoms only. No one gets to the cause of the symptom. This is my underlying thought always ---> get to the bottom of the problem and "fix" that.

Yours for better health, Dr. Roubal