Ep 151: Promoting Jaw Health: tips with teeth grinding, sleep apnea, migraines and more! with Dr Victoria Wexley, oral facial pain specialist

Episode 151 of Ask Dr Jessica, joined by Dr. Victoria Wexley DDS
Board Certified in Orofacial Pain and Fellow of American Academy of Orofacial Pain. In this episode we discuss everything you've ever wondered about the jaw and jaw health--And this includes proper texting posture, gum chewing, and teeth grinding.  We also discuss connection of jaw issues to sleep apnea and migraines.   Thank you to Dr Wexley, I learned so much and I appreciate you taking the time to share your knowledge with my listeners.

To learn more about Dr Wexley's practice, which specializes in head and neck pain, TMJ disorders and sleep apnea check out:
https://wexleymedical.com/

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

For more content from Dr Jessica Hochman:
Instagram: @AskDrJessica
YouTube channel: Ask Dr Jessica
Website: www.askdrjessicamd.com

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Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.

The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

Unknown: 0:00

Hi everybody. I'm Dr Jessica Hochman, pediatrician and mom of three. On this podcast, I like to talk about various pediatric health topics, sharing my knowledge, not only as a doctor, but also as a parent. Ultimately, my hope is that when it comes to your children's health, you feel more confident, worry less, and enjoy your parenting experience as much as possible. Welcome to episode 151 of Ask Dr Jessica. Today I'm joined by Dr Victoria Wexley. Dr Wexley is board certified in oral facial pain, and today we're going to talk about everything you've ever wondered about the jaw and jaw health. This includes proper texting, posture, gum chewing and teeth grinding. We also talk about the connection of jaw issues to sleep apnea and migraines. Thank you to Dr Wexley, I really appreciate you taking the time to come on the podcast and share your knowledge. Dr Wexley, so nice to meet you. Thank you so much for coming on Ask Dr Jessica. Well, it's such a pleasure to be here. I want to compliment you. You're doing amazing things for quality of life of patients and educating patients about quality medical care, and that's so important. Thank you so much. Thank you so much. So tell everybody. What do you do for work? I'd love to learn more about the field that you work in and your specialty. So I'm board certified and a fellow of orofacial pain. It's a specialty that nobody heard about, I think there's 500 people nationwide that board certified, and it's very small specialized field that deals with head and neck pain and apnea. So and I'm just curious, how did you get into this field? Have you always been interested in oral pain? Is there something in particular that led you to be interested in working in this field? Yes, I graduated dental school in NYU, and I was teaching at NYU, and I took one weekend course taught by orofacial pain people, and I completely fell in love, and I actually enrolled in NYU into your program in orofacial pain, because I always practice with passion, and dentistry is amazing. But to be honest, after first couple years, it's kind of mechanical. In my field, I could sit at the computer for 10 minutes daily and learn something new, and you change people's life, whether you treat pain, mostly my practice is headache, not only headache, but any head pain, including headaches, TMJ, including in that, and sleep disorders, and both of those patients categories change people's life, Because when pain becoming a character in your life. It's completely different outlook on life when that goes away. So and I'm so interested to talk to you, because I have to be honest, as a pediatrician, there's a lot that we learned in our training, but we really didn't learn that much about the jaw and jaw health and how the jaw connects to our health in general, I thought it may make most sense to talk about how to how, what parents should know to prevent jaw issues from happening in the first place. So for example, myself, as a pediatrician, is there anything I should be telling parents when they come to see me for their physicals, so that they know what to do to prevent problems from happening in the future? Believe it or not, that posture and texting is connected to the jaw, because it's, I know it's like, what does that have to do with anything? Because that puts tension in the muscles that, in turn, tends up these muscles that so Team J is used as diagnosis. But what TMJ stands for is the name of a joint that connects skull to the mendible and mandible connects the temporal bone. And it's called temporal mandible joint. But people come and say, I have TMJ. That's not a diagnosis. However, that's what is widely used as diagnosis. And it could be muscular issues, it could be joint issues, an actual joint, or it could be combination. And if it's muscular issues, it's very connected to a posture. I actually first thing when I have pediatric patients, I teach them how to text, and now tell me, how should we text? Okay, so the ideal posture for a youngster that nobody has anymore, that your year should be above the shoulder. Okay. Now look what happens when I text. Okay, so you could text like this, which I promise nobody will, because it's not comfortable. I do not know how to show it in the screen, but basically, you put your arms on your knees, your knees on the ground, and then look at my neck and where my ear is in. Relationship so the shoulder, basically, I just sit and put my arms on my knees, and that's supported and comfortable, and my neck is not a foot away from my shoulder. Now I'm in trouble. Dr Wexley, as I see you, I worry that I'm at risk for TMJ issues in my future, it's not it's for young people, more tied in, but it's causes neck tension and issues, muscular issues in adults, I teach everybody texting on the first visit blows their mind, but coming back to your actual question, preventing is hard. Posture is very important, because the neck problems produce phase tension, and things go rolling, roller coasting from there. That's so interesting. You're right that I don't think about when I think about jaw health, posture is not the first thing that comes to my mind. I think about the back relating to posture and back pain relating to posture. But that's really interesting, that jaw health is improved with good posture children more because, like, I look at children, everybody is like this because of sexting and computers and forward posture and to the side, and besides, the C spine controlling, I don't want to go to the C spine, but it controls a lot of neurological functions in children, and then all this tension, it's not good, and it will produce certain TMJ issues, which might be not of an adjoint issue, but just Pain in a jaw that connected to muscular issues. One big question I have is gum. A lot of parents caution their kids don't chew gum because it'll be bad for your jaw. Is that true? Yes, is it? Is it the time that matters, or the kind of gum that someone's chewing that matters most? Kids chew on one side, if they chew gum equal on both sides. That's probably will not hurt them, but that's not what realistically happens, because interesting of something like on one side and then we have issues the other jaw. Jaw is loaded. When you chew on this side, it's actually this joint is loaded, and the one, it's contralateral side of a jaw. It's also could be a muscle spasm from constant chewing on one side that give a pain on the same side. Is that true? Is that true for chewing in general, that we should try to switch back and forth between sides? Yeah, but that's not realistic in adults. That's not a realistic expectation. Just, you know, you gotta work with lifestyles and what is just like. If you could do that, that's great. Just try to advise that anybody to do that. I remember when I was a kid, there was a candy and Vogue called a jawbreaker, and that made my mom crazy. She said, I can't believe that we're advertising a jawbreaker. It's called a jawbreaker, and we're promoting this for children. Is that true that candy in general is bad for the jaw as well? You need to be predisposed to it, so those 10 people who could do that, and nothing happens, and then one person out of 10 could bite on it, and Joe will go out in excruciating pain. And sometimes what actually happens that people say, Oh, I was just eating salad, and my Joe locked it did not happen when they were chewing salad. It was sure it happened with something else was happening. And that was just the last straw. So it could be the jawbreakers, and they did not feel pain. And then two days later, they eating, and they locked all right. So just to summarize, so for parents that ask, How can I promote good jaw health in my children? The answer would be to promote good posture, good texting posture, when they're that age, for their texting to stay away from gum, and if we are to chew gum to make sure we vacillate from side to side, that would be great, just very hard to implement that in children. Now, what about sleeping? Is there any is there any way to promote better sleeping for jaw health, absolutely so very often the sleep or breathing related night disorders correlated with Team J, sometimes it comes as TMJ issue, and I'll explain to you why. So I want to quickly explain what apnea is, sure I will very little to explain what it's in adults, because it's hard to correlate the difference in children without saying it's what it is in adults. So apnea happens only when you horizontally placed, and it's very. Hard to sleep vertically and when you sleep and what happens to airway? Airway closes many times and you stop breathing for prolonged period of time. In adults, very common symptom is snoring, even though you could have apnea or hypopnea without snoring. And with the way we treat in adults, there's a CPAP, and the way CPAP works, and I'm not advocate for CPAP, but the way it works, it's air under pressure, physically keeping the airway from closing. And there's a dental devices that I basically take everybody off the CPAP because CPAP works great, except nobody can sleep with it. The efficacy of CPAP is about 98% that how effective the gadget is and tolerability is less than 20% tolerability is what percentage of patients that giving a CPAP could actually use the gadget, and for that reason, I'm taking people of CPAP because most of the time it's under their bed and not on their face, and it doesn't work the same that way. So can I ask you in children, what are the signs and symptoms that parents should be aware of so they can think about apnea, mouth sleep with child sleeps with mouth open. It's a big problem, and that should be a question of every physical for a child, how the child sleeps? It's, they could snore. Sometimes they grind the teeth, and that's a separate problem. Sometimes it's actually could be sign of apnea, believe it or not, because they wake up and they grind trying to breathe. But to make a very long story short, how to assess it, if a child sleeps with a mouth open, we need to assess it. Why is there a nose issue? Is there an airway issue, and even if there's no apnea, mouse needs to be shot. So for parents listening, if they recognize that their kids, apart from having colds, because I feel like children with colds, they always have, they have a stuffy nose, they're gonna sleep with their mouth open. But if they're well, if they're healthy, and they're sleeping religiously with their mouth open, they should bring that to their doctor's attention to get it evaluated. Absolutely. Is he a sign that something is wrong with sleep? Okay? And out of curiosity, what is the treatment for children for apnea? Because you mentioned that the treatment for adults is different from the treatment for children, very I was just transitioning, your question is perfect, so we cannot use the same treatment in children, because we cannot put a retainer in a mouth when the jaw is growing. So the dental device, putting any bias or putting anything forward is not good in children, and the numbers are different. So for adults, before five, apnea is normal. From five to 15, it's mild. From 15 to 30, it's moderate. After 30, which word it means episodes an hour? So how many times they stop breathing in one hour before five is normal. From five to 15 is mild, even though I don't believe there's little apnea. It's yes or no. It's like being pregnant, because some people with very small apnea suffer tremendously, and you change their life by fixing it in children five is a big deal. So you're saying that there's no little amount of apnea, that any amount of apnea should be addressed. And I don't want to say it's in everybody, but very often children with apnea have ADD symptoms, and you fix the apnea and add goes away. And I don't want to say it, it's always, because there's a lot of add children that will fix apnea, and they still have ADD, but a lot of times it's one of the symptoms of apnea. And you could just imagine how many children are misdiagnosed and treated for add with medications that actually also sleep a little bit. I don't need to tell you that. You know, sleep stages the influence by add medication, and it could be apnea, so the five that is normal in adults is not normal in children and needs to be treated. Yes, no, I think everybody listening with little kids can think about a time when their kids not sleep very well, and they had really difficult behavior the following day. It's true that that good sleep definitely correlates with better behavior. I'll typically refer kids that have a snoring first to an ear, nose and throat doctor, and oftentimes they find that the children have enlarged tonsils and adenoids, and following their. Removal. A lot of parents will tell me that their kids behavior is so much better because they're sleeping better. So you brought an excellent point that I would have forgot to mention, but tonsil and adenoids removal, if they enlarge, works amazingly to treat apnea in children nine and below. For some reason, after nine or 10, it doesn't help anymore. So it's very important so assess that in younger children, because that sometimes is a treatment. But resolution of apnea before nine with the tonsil is huge percentage. I've always learned that the tonsils and the adenoids are the largest in relation to the size of the body of the child, and its largest usually around 567, years old. And as they get older, they sort of grow into their body more, and the airway enlarges. So that might be why it doesn't make as much of a difference to remove it as they get older. But nevertheless, this is so important, I think, to put on the radar of parents that if their child is not breathing properly at night, if they notice they're snoring, if they're breathing with their mouth open consistently, that there are things to think about medically that might be worth it. Might be worth investigating the cause, because we might be able to make them feel better, right? There's no benign snoring. Sometimes snoring is sign of apnea. In adults, sometimes there's other factors. But in children, snoring should not be taken lightly, because what I do to parents that question it, if you imagine a pipe and you turn the water on, it goes quietly, right? You abstract the pipe in couple places. That's That's what snoring is. The airway is blocked. And in children, even five episodes an hour, influence their behavior tremendously, and could be responsible for add. What do you recommend for children to treat the symptoms of apnea? Depending on their age, they need to see a sleep doctor. Okay, all right, so the big take home point I'm hearing from you is that snoring is not normal in children in any circumstance, and merits evaluation. Absolutely sleep in children development. Well, I don't need to tell you that the role of sleep in children's development is huge, and I want to bring another point, that between the maxilla, upper jaw is growing from 11 to 13, and children who do not breathe through their nose during their age, The upper jaw is restricted and that becomes apnea in adults 100% of the time. And when I do the full exam for every new patient, I put my pinky in the palate, and I already know whether they should be screened for apnea or not. If there's high palate that's and I tell them it's from 11 to 13, that's the development of that jaw. And if child has allergy or doesn't breathe through the nose, he will have apnea as adults, 100% of the time. So nose breathing is extremely important, whether it's adenoid, tonsils, allergies, what have you. Thanks for bringing this to my attention, to people listening, thank you for bringing it to their attention, because I agree anything to promote good sleep hygiene is so important. Now I'd love to ask you about teeth grinding. This is a really common question that I get from parents. They want to know what to do when they notice that their kids grind their teeth. So what would your advice be? So it needs to be evaluated just because they grind. So right now, broxing is classified as something that happens in the brain, and in children, they need a special night guard depending on the age, that will not restrict the joint growth, because you can't do the same night guard in children, because otherwise, the joy is not going to grow. But there's the way depending on the age, like a lot of just statistically, girls grind more than boys and come to the office around 13. You know that's where a lot of stress at that time, you could already do a certain night guard that will not interfere with the gel growth. Okay? So these are special fitted night guards that they wear at night, and no piece of plastic will stop them from grinding. What it will do, though, it will prevent any further joint damage. It will prevent teeth damage, and it will promote relaxation of facial muscles, but no piece of plastic will stop somebody grinding if it starts in the brain, okay, but it protects all the structures that suffer from grinding. I don't know if this was a bad thing that I did as a parent, but my son, when he was very young, he would grind his teeth as. Especially during the day, and so I would just touch his TMJ joint as a reminder to stop. And he did outgrow it. I don't know if I should have taken him to a specialist. In retrospect. Well, he grew up. He did. He's fine, yes, but you bring a great point nighttime and daytime is very different. So daytime, we call it clenching, because it's could be controlled behaviorally. So we call it a dot therapy. I tell them the right position of a jaw, and just say n and notice where your tongue is. So we call it the spot or n position, and I teach them the right position, and then I put give them dots that they should put everywhere. Every time they look at the dot, they correct the position, and in three to five days, they stop that habit. It's a very simple behavioral technique. It has other names, and some people do variation of it, but it's the same thing. Nighttime is different. Obviously, dots will not work. So nighttime teeth grinding you're saying is different. Do you have any advice for parents before they see a TMJ specialist on how to help their kids with nighttime grinding? It's hard because it just so many reasons that I cannot put it in simple advice. I hope I'm not avoiding a question, but it's there's so many reasons for that that I cannot put it in any one category, but in a day it's easier. It's a behavioral technique. Play a game and explain to them to get them on board, because if they're not on board, you can't do anything with children. Yes, no, games are a good idea. So once I had a patient, I thought this was really interesting. I had a patient who she was a very elite athlete, and she was suffering from migraines, and we sent her to headache specialists. We tried migraine medications, and literally, after seeing a few specialists, it turned out that she was jaw clenching, and that led to migraines. So I wanted to talk about that with you. Is that something that you see commonly, because it really wasn't on my radar until I had that patient, right? So let me tell you a couple things about migraine, because also in children, migraines are managed very differently than adults. And important thing to know that migraine is not a headache, it's a disability. So the pain is just one of the symptoms, but they can't function. They have a mood switch because it's central nervous system. Light bothers them. Noise bothers them. They cannot get up sometimes. So it's a disability, and it used to be taken very seriously, and there's 37 million people who diagnosed with migraine. I think there's more running around without being diagnosed with migraines. The way I treat migraines in both adults and children, I see the baseline, how much headaches they have, how long they are. We need to find the way to control that headache, because it's a disability, and they need to have a tool when it hits, not to have anxiety, and be able to take something that will not cause more headaches. And while you do that, you need to identify triggers, and TMJ and my facial pain, which is pain from muscle and the sleep, is the most common trigger. So you could make them feel better without the addressing sleep, but they're never going to be pain free if they have underlining sleep disorder, because that's a trigger. TMJ is a huge trigger, just like any muscle spasm, if they've been in car accidents, which sometimes people mild car accident, and they rear ended, and they go like this, and there could be a huge muscle spasm, which could be a trigger for horrible headaches. So I'm just gathering from what you're saying. My guess is that to help, to help them, would be to help encourage good sleep and maybe like promoting techniques in their life to help lower their stress. Yes, it's part of my so my headache program is about from eight to 12 weeks. It's always a short term structure program where, depending on severity and frequency, I need to stop the frequency, because if they frequent, it's a mechanism that keeps us going. It's called Central sensitization in a brain. So the first thing I do, I need to stop the frequency and make them feel better, and that's when I try to identify every trigger, and I addressed the triggers as they become better. And yes, stress control is definitely part of my program. I think that's so worthwhile, because I've read before that. The number one reason why people miss work is from migraines. I know they're incredibly debilitating, and those that get them frequently, how worthwhile to spend some time in a migraine program to and to get improvement right? Because people, when they people who do not have migraines, do not understand it's not a headache. God, this is a disability. People don't miss wedding of their children because of a headache. They don't miss graduation of their children because of a headache. They take aspirin and they go to graduation, but they miss it because of migraine. That's why, when I lecture, my first sentence, it's not a headache. It's amazing that you have something that you can offer your patients, because if they're suffering from migraines, just to know that there's something they can do that will offer them relief. That's wonderful. So the biggest statistically, kids have from 11 years old to 12, that's a big spike of them having migraines. And at that groups, boys and girls are equal one to one. About after 18, it's one to three women being much more once estrogen kicks in three times, it's one to three women and men. Any other lifestyle changes or habits that you recommend for children and teens to promote their jaw health as they grow older, anything that we did not cover yet, I think I can promote about migraines and headaches. So I treat children very different. We use all the natural supplements that proven and double blinded study to work for migraines with children, and they're very successful. So magnesium is one. I have magnesium, and everybody walks out with a bottle of magnesium. And very often it keeps those children from big chronic patients, chronic pain patients later on. So absolutely, sleep, hydration, magnesium, not taking wrong things for headaches. So certain substances like coffee, coffee is a double edged sword. So if you don't drink coffee and you have a migraine, you have espresso, it's going to take your headache away, especially in the child. If you drink too much coffee, it causes rebound headaches. And the same thing with narcotics. Migraines cannot take narcotics for pain because they etc, is probably next worst thing. So painkillers only, migraine brain. They increase frequency, and eventually it becomes one headache all the time. Not Yeah, we've always learned not to take we always learn not to take too many days in a row of pain, pain relievers like Tylenol, if you take it more than three days in a row, or NSAIDs more than three days in a row. It puts kids at risk for having withdrawal symptoms or rebound headaches. Yes, but rebound only is that severe in people with migraines. So in your so I'm just curious, in your practice, you take care of a lot of sleep apnea, you take care of migraines, you take care of jaw pain. Is there anything else that takes that that you see commonly? It's a head and pain, a head and neck pain, because there's about 150 types of different headaches. I believe migraine is just one of them, but there's a lot of variation in headaches, and obviously it's a different management, but yes, that's all I do is head and neck pain, including joints and sleep. And if people that are listening want to see you, Dr Wexley, where can they find you? Wexley Headache Clinic. Wexleyheadakeclinic.com, Wexley is my last name, so it was ish, you know, intuitive name, wonderful, wonderful. Well, thank you so much. Thank you for sharing your knowledge and expertise, and it was a pleasure to talk to you. It was a pure pleasure, Jessica. Thank you for the work you do. Thank you for listening, and I hope you enjoyed this week's episode of Ask Dr Jessica also if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr Jessica. See you next Monday. You.