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

As if menopause didn’t already bring enough changes, many women are surprised to discover that the hormonal rollercoaster doesn’t just impact reproductive health—it can also wreak havoc on your jaw. Research shows that fluctuating estrogen levels during menopause can contribute to TMJ (temporomandibular joint) disorders, which can cause jaw pain, clicking or popping sounds, difficulty chewing or speaking, and even headaches or facial pain. These symptoms are often overlooked or dismissed, yet they can seriously affect your daily life.

In this episode, I’m joined by none other than my sister, Dr. Priya Mistry, a TMJ specialist with years of experience helping patients find relief from chronic pain. Dr. Mistry walks us through TMJ disorders, explaining how they are linked to menopause and sleep apnea. She shares the latest in TMJ treatment options, including how dentists can help with diagnosis and care, and how women can take charge of their jaw health during this stage of life.

References

Ep. 14: How to Sleep Better with Dr. Andrea Matsumura

Connect with Dr. Priya Mistry 

Website 

Instagram

“Unclenched” Podcast

Connect with me:

TikTok

Instagram

Eastside Menopause & Metabolism

Audio Stamps

02:10 - What TMJ is, common symptoms (beyond jaw clicking), and why headaches are often overlooked.

05:08 - How menopause-related hormonal shifts contribute to TMJ dysfunction and symptoms like jaw pain, headaches, and sleep apnea.

12:30 - The growing recognition of the connection between TMJ and sleep apnea, despite limited research on TMJ and menopause.

14:42 - Hidden TMJ symptoms, particularly during menopause, and the jaw-pelvic floor connection, highlighting the value of whole-body care.

20:21 - The influence of hormone changes (including low testosterone and gender-affirming hormone therapy) on TMJ issues.

21:53 - How TMJ pain impacts brain fog and fatigue, emphasizing the need for a holistic approach to treatment.

27:42 - Women with autoimmune disorders often face more severe TMJ, with treatment taking over a year in some cases.

29:23 - Dr. Mistry's patient-centered treatment approach and the role of thorough patient history in managing TMJ.

34:28 - At-home TMJ relief tips and the benefits of disclusion time reduction (DTR) therapy for bite adjustments and pain relief.

38:14 - Dr. Mistry recommends seeing a TMJ dentist or ENT for facial pain and exploring treatment options beyond Botox.

Thanks for listening. Find more info about Reset Recharge on the website or Instagram.

Transcript

Dr. Komal Patil-Sisodia 0:01

Welcome to the Reset Recharge podcast with your host, Dr. Komal Patil-Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist. This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health. And recharge the conversations you are having with your healthcare providers. While I am a physician, this podcast is purely for educational purposes. No individualized medical advice is being given on this podcast. If you do find information that is helpful, please discuss it with your healthcare provider at your next visit. Hi everyone. Welcome back to Reset Recharge. Today's a very special episode. I'm excited to have the TMJ Doc on my podcast, Dr. Priya Mistry, who happens to be my younger sister, and is a phenomenal TMJ dentist that is nationally renowned. She's built up her practice, which originally started in Portland, Oregon and has. Since moved to Vancouver, Washington. She trained under Dr. Arthur Parker after she attended UOP, university of the PA Pacific for Pacific, for both undergrad as well as dental school. So welcome Dr. Mistry, AKA Priya, which is what I'm gonna call you the whole episode.

Dr. Priya Mistry 1:17

Thank you for having me, Komal. I'm excited to be here.

Dr. Komal Patil-Sisodia 1:20

I know. I'm excited to have you. We've been talking about this for such a long time. Especially as I was starting to concept out my practice and think about what it is I wanted to do with my podcast. 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. What I see typically happen is that as estrogen and progesterone levels decline, we know now that muscle mass decreases. There's an increased risk of arthritis in the joints, and pain gets a lot worse for women during this time in their lives. So. I think the impact between both is really between how menopause and perimenopause affect the jaw is really important. So I'd love to hear from you, Priya, in your words, what exactly is A TMJ disorder? We hear so many people say, I have TMJ. I have TMJ, but that's different than a TMJ disorder, correct?

Dr. Priya Mistry 2:23

Yeah. Yeah. So many people think that you have to have clicking or popping noises in your jaw joints to have a TMJ disorder. And so if their jaw clicks or pops. Many people will say, oh, my dentist told me I have TMJ. And yeah, it's not ideal if your jaw like clicks or pops, so you should get that checked out. So technically yes, you do have TMJ disorder, even if you have just noises and absolutely no pain. But you can also have TMJ disorder without any jaw joint noises. Interesting. So yeah, your joints could be totally silent. No clicking, no popping, no crackling, no snapping, nothing. But you have daily headaches. 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. In your head, neck, or jaw, and you could have dizziness, you could have stuffy ears, you could have ear ringing. 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. 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. Again, headaches, jaw pain, neck pain, ear pain, dizziness, stuffy ears, lots of different things. And so the number one reason people actually come to see me is headaches. And you don't necessarily connect your head ache with your jaw.

Dr. Komal Patil-Sisodia 3:46

You don't. And so just to back up for a second, TMJ, what does that stand for and where is it located? Can you show me on your face? Sure.

Dr. Priya Mistry 3:53

Yeah. So TMJ stands for temporomandibular joint, so that's a fancy way of saying jaw joint. So it's right here. If you put your finger right in front of your ear and you open and close, you'll feel some movement there.

Dr. Komal Patil-Sisodia 4:04

Oh, yeah,

Dr. Priya Mistry 4:05

yeah, right here. Okay. Yeah. So that's where the jaw joint is and it's unique joint because. It's one of one of the only joints in the body where if one works, the other has to work too. You can move your knees independently. It has to be symmetric. Yeah. So if there's a problem in one joint, it definitely affects the other joint. It affects everything, the musculature, the bones, the ligaments. 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. It doesn't get enough love. And just another thing to point out is that medical and dental insurances don't cover. GMJ disorder care and really medical should, in my opinion,'cause it's muscles and joints. No, that makes

Dr. Komal Patil-Sisodia 4:44

sense. Yeah. It's not actually your teeth.

Dr. Priya Mistry 4:46

Your teeth can cause it the way they come together. 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. It's dependent on how your teeth come together. So if your teeth come together, like a crossbite. It causes lateral strain in the joints if you're, yeah. So your bite can have a big impact on what's happening in the joints and the musculature.

Dr. Komal Patil-Sisodia 5:08

Okay. So I talked a little bit about how I got interested in this overlap between hormonal health and TMJ dysfunction. What was it for you? Yeah. Were you noticing more women in midlife who were presenting with TMJ symptoms?

Dr. Priya Mistry 5:20

Yeah, so it was two things. So one is when my mentor taught me that estrogen and relaxin, which are found in much higher levels in women Yes. Than in men. That those really have a big impact on the jaw joints. So together, when they're together, they have been linked to degeneration in the jaw joint one and relaxin. It makes things loosey goosey in the body. It makes it so we can have babies, things loosen up. The baby can come outta the birth canal, but it can. 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. Interesting. Okay. 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. One and then two. 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. I.

Dr. Komal Patil-Sisodia 6:18

I did not know that. Explain. Can you explain that a little bit more?

Dr. Priya Mistry 6:21

Yeah. Yeah. 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. 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. So even if you never had like sleep apnea before. Or like the precursor to sleep apnea, which is called upper airway resistant syndrome. 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.

Dr. Komal Patil-Sisodia 6:57

That's fascinating. I wanna pause there for a second and just acknowledge something you said. So that is the tenicity or the strength of the muscles in the neck, not necessarily. Associated with somebody who has gained a lot of weight and developed obesity during menopause. 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. Are you seeing. A di a difference in those two populations and then what do you see when you see it together?

Dr. Priya Mistry 7:30

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. And that's just not the case. Again, the majority of my patients are women. And many of them are petite women. Yeah. And some of them have had a type of orthodontia where teeth are extracted and everything is pushed backwards. And if you push everything backwards, where's the tongue gonna go? The only place is the airway. So I'll give you two examples. I had a lady who was petite, I mean like tiny, tiny little neck, tiny little everything. But she had a tiny little mouth and she had had teeth extracted. And if you think of our upper teeth and our lower teeth, like a little box that houses the tongue. Yeah. If you pull teeth out and pull everything backwards, where is the tongue? You're making the box smaller, but the tongue stays the same size. So where's it gonna go? The only place it can go is the airway. That's the only space is backwards. So you're making the airway smaller. 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. So that's one thing. 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. For a sleep study. And because I told her once I imaged her airway with a cone beam CT scan, I said, your airway is so small. And I said, with a small airway and major TMJ problems, her jaw was locked, closed. She could barely open. She was in a ton of pain. 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. So she pushed and pushed and pushed and she got her sleep study, moderate obstructive sleep apnea. And then my other patient, tall and thin, like willowy and beautiful, and was a swimmer her whole life. Also had a tall, thin, narrow airway. And so you don't have to be. Obese with a big neck. You can also have a long swan like neck and have a really thin airway. So I told her and she said, there's just no way. I don't have sleep apnea. I'm just too healthy. I this, I'm that. And I said, okay. But if you're open to it, meet with sleep. Doctor diagnosed with severe. Obstructive sleep apnea. Fascinating. I know. So they started treating their sleep apnea with C Paps and treating their TMD with me. Interesting.

Dr. Komal Patil-Sisodia 9:41

So I don't know if you got a chance to listen to the episode that I did with Dr. Andrea Matura on sleep apnea, but she brought forth a very interesting statistic. Which was that 80% of women who have sleep apnea are not diagnosed. Yeah, and that actually tracks a lot with what you say. 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? Where you stop breathing.

Dr. Priya Mistry 10:21

Not necessarily. Some will, some won't. 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. You can start tracking things with an Apple Watch or a smart watch that they can check oxygen saturation. I'm not saying that's a sleep study. You can't diagnose yourself with that, but at least it's some data. Or you can track yourself with an aura ring, OURA. 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. 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. So there's a bunch of different things that this tracks, including like Night Arousals, like many people are not even aware that. 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.

Dr. Komal Patil-Sisodia 11:15

Yeah. That's terrible.

Dr. Priya Mistry 11:17

Mm-hmm.

Dr. Komal Patil-Sisodia 11:18

That is terrible. 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. Stereotypical symptoms of what we call sleep apnea, for men mostly really that they should still get evaluated. How often are you checking these cts in your patients to, to check their airway? Every single one.

Dr. Priya Mistry 11:42

So any patient that takes treatment, they come back. 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. Interesting. 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. What happens is that we will, our body goes into fight or flight mode. We want, we need oxygen, so our body's like super stressed. 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. Think of the chin tilt and CTR. 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. So there's a definite like correlation. There.

Dr. Komal Patil-Sisodia 12:29

Thank you. That is a great explanation. So is there any research that links an increase in TMJ symptoms or sleep apnea or facial pain?

Dr. Priya Mistry 12:43

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. Do you trust National Institute of Health? Yeah, that's sleep apnea symptoms and risk of TMJ disorders. The strength of association between obstructive sleep apnea signs and symptoms and TMD may be underestimated in this young. Population. It is likely that the relationship between OSA and TMD is stronger among older adults, especially those with comorbid conditions including obesity,

Dr. Komal Patil-Sisodia 13:14

menopause. 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. I know that you practice more of a holistic style of dentistry where you were trying to incorporate everything. Is there a research that is, has started or has been done around TMJ and menopause specifically, or just TMJ and women?

Dr. Priya Mistry 13:38

Yeah. 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. And there's arguments and there's, I just try to stay outta the drama. But in terms of a link between TMJ problems and sleep apnea, I know that there's a research, there's a study from. 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. But I feel like there's just not enough research in this field and in disorders especially that affect women more than men. There's also not a lot of research, so I'm hoping that'll change in the near future.

Dr. Komal Patil-Sisodia 14:17

Yeah, and I think that the tide is turning. Unfortunately, women were not included in research until 1993 and. The Women's Health Initiative kind of paused women's health research anyways, so hopefully we'll see some changes moving into the future.

Dr. Priya Mistry 14:31

Yeah.

Dr. Komal Patil-Sisodia 14:32

Let's see here. So I have lots of questions for you because this is such an interesting topic. I think that really the patient experience is. The most important piece of this, what should people be looking for? What are hidden symptoms of TMJ symptoms that women may not connect to their jaw?

Dr. Priya Mistry 14:50

Well, I would say headaches is a big one. Neck pain, stuffy ears, dizziness, ear pain. Like we don't necessarily, when those are happening, we don't think that's coming from the jaw.

Dr. Komal Patil-Sisodia 15:00

Interesting.

Dr. Priya Mistry 15:01

And I'm not saying it's coming directly from the jaw, right? Or directly from the joint. It's everything. All of this is connected. 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. So I think those are the main ones.'cause noises in your joints, everyone thinks, oh my gosh, it's a jaw problem. But all those other symptoms, you don't necessarily think that. And I had a patient who she said, as soon as I started menopause. I started waking up at 4:00 AM with these awful headaches and I was like, I can help. 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. So I really encouraged her to get a sleep study or not get a sleep study. I'm not allowed to diagnose this, but I really encourage her to see a sleep. Doctor. 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.

Dr. Komal Patil-Sisodia 15:55

Okay. That's great. That is, that's great. Now, I know on one of your social media posts, you had a friend of yours who's a pelvic floor pt. 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. You both explained it, it made sense. Could you explain that to our listeners? Because I think Sure. Yeah. One, there's so many symptoms of perimenopause and menopause. Nobody's journey looks the same. 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?

Dr. Priya Mistry 16:29

I mean, I think the chances they're connected are high.'cause that's what I see all day, every day, right? So the way that the physical therapist explained it, and a lot of physical therapists, chiropractors, and. The good TMJ dentist. So not all of'em recognize the connection between the jaw and the hips. 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. Yeah, exactly. So they're very similar. They function similarly. Like the hips are also like, you can't really move one hip without the other moving, kind of like the jaw, right? You can't move one hip joint without the other doing something. So they are really connected and they're connected with fascia. The dural tube. I mean, there's so much that connects it. And so many people who hold a lot of tension in their pelvic floor also hold a lot of tension in their jaw. And if we can release that fascial tension, that muscular tension, everything gets better. So I do have patients that are in pelvic floor therapy right now as I'm treating them too. And I just think that whole body connection. Is missed because we're just not taught it in medical school or dental school. And kind of off topic. Like I'm realizing too that I'm limited as a dentist, I'm limited to clavicle and up. Yeah. I can't do anything lower. It's outta my scope. Yeah. So it is interesting. It is really great working with other practitioners. Yeah. That understand that connection. And do you have

Dr. Komal Patil-Sisodia 17:48

a group of practitioners that you work with locally that you collaborate with frequently?

Dr. Priya Mistry 17:53

I do. I do. 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. And I'm not saying there's anything wrong with those. I just, I shy away from those in the neck for my own patients. Because of how it can affect the jaw. 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. Like we had one patient who she was locked, closed, she could barely open her mouth. And I gave her, we started treatment. And I could get her a little more open, but I couldn't unlock her. And I said, you know, I think your neck is really involved. I could see it on the CT scan that her cervical spine, the vertebrae were like rotated, tilted, misaligned. I said, you would you be open to just getting it checked. So she went to our cervical chiropractor across the street and as soon as they adjusted her, boom, she opened up. That is first and only time I've ever seen that so far. It usually takes a bit more work than that, but she was like, that's a very dramatic change. Yeah. I mean, she opened to like 50 millimeters and she was opening to like 32 when I sent her in there.

Dr. Komal Patil-Sisodia 18:59

And millimeters is like how far the mouth is open or is that angle of the jaw?

Dr. Priya Mistry 19:04

It's how far the mouth is open. 40 to 45 is considered normal. And I could barely, I couldn't even get her to 40.

Dr. Komal Patil-Sisodia 19:11

Okay.

Dr. Priya Mistry 19:11

35 and then suddenly, boom, she could open her full range of motion. And then I saw her like once after that and she's like, I'm good. I was like, yeah, you are. We're good to go. You don't need me anymore. You don't need me anymore. I mean, it's usually not that dramatic. It's usually a little more subtle, a little more slow. But that was really telling to the connection between the jaw and the neck. And there's a really well known, renowned physical therapist named Dr. Mariano Rado that he has. His whole protocol focuses on. C one, C two, C3, and how they're connected to the jaw.

Dr. Komal Patil-Sisodia 19:39

Okay.

Dr. Priya Mistry 19:39

So it's like I'm not the only one out there saying this my mentor learned from him. Interesting.

Dr. Komal Patil-Sisodia 19:44

That's such a cool story, right? Yeah. 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. For women as their, or any patient really that's trying to navigate TMJ?

Dr. Priya Mistry 20:05

Yeah, definitely. 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. No one knows what's going on, nobody. And so they're like looking for answers, right? And so the more we spread the word, the more we do these podcasts, the better for our lovely patients.

Dr. Komal Patil-Sisodia 20:21

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? 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.

Dr. Priya Mistry 20:39

You know, I didn't think of that, but yeah the men that. Come to see me, which is kind of rare. The few older men, the few men that have locked they're older one or they're hypermobile. Oh, interesting.

Dr. Komal Patil-Sisodia 20:53

So the Aler lows,

Dr. Priya Mistry 20:54

aler, Sandlos, hypermobility, loose goosey joints, but yeah, I didn't even think about the testosterone connection. I really don't know, but I do know. I had a patient that was transitioning from female to male. Okay. And those hormones that patient was on, they were in their probably late teens, early twenties. Oh my gosh. That poor patient's jaw was all over the place.

Dr. Komal Patil-Sisodia 21:17

That's so hard.

Dr. Priya Mistry 21:18

I felt so bad for her. But I do think that the hormone therapy contributed not in a good way. To the jaw being so dysfunctional and painful.

Dr. Komal Patil-Sisodia 21:27

Interesting. So those are two good awareness points

Dr. Priya Mistry 21:30

mm-hmm.

Dr. Komal Patil-Sisodia 21:31

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. 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. Come see me. Yeah, come see her. She is in Vancouver, Washington. This has been just such an interesting discussion, so thank you. 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. But, there's a multitude of symptoms that happen for menopause. Two of the most significant of which are. Brain fog and fatigue. Do you see that with your patients who have TMJ disorders? Can TMJ cause brain fog and fatigue? And if so, how do you know which one is which? Or do you have to go? It's so hard.

Dr. Priya Mistry 22:26

Yeah, like what's causing what, right. So brain fog, definitely, because many of my patients come in with so much pain. They're in like a, they'll say six to nine out of 10 pain level every single day. Every single minute of every single day. Yeah. 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. We're meant to run away from a bear in that mode. Yeah. And like then get back into like escape. Yeah. Not fight or flight mode. So I think that their nervous system is just so activated all the time that of course it's gonna cause brain fog. We're not supposed to live in that much stress. So that much pain can definitely cause brain fog and fatigue. Because we're just, our body's stuck in fight or flight mode. And again it's exhausting. Yeah. So I have seen some people's brain fog get better. Fatigue is a hard one. Yeah. Fatigue is a hard one because that goes back to sleep and then that goes into like sleep apnea. I. 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. It was just mild, so they didn't encourage me to do anything. I'm like, mild is twice as bad for you as it is to smoke every day. Ouch. Mild is a big deal. It's a misnomer. They should call it something else and I'm, you should be treating that. Yeah. Go back to your sleep doctor and ask for A-C-P-A-P. Do something mild is a big deal. And so fatigue is a really tough one.

Dr. Komal Patil-Sisodia 23:47

Yeah. That I, and I see that in my practice also. When patients are coming in for. Hormone replacement, or they have a thyroid disorder, or adrenal or pituitary or something else. The fatigue, even when we replace things, may not go all the way back to baseline. Yeah. 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.

Dr. Priya Mistry 24:17

Mm-hmm.

Dr. Komal Patil-Sisodia 24:19

85 to 90% actually do fine. 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. Like I, I think until you and I started talking about this, I don't think I really fully understood. The whole overlap. 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. Matthew Hashimoto, who's a periodontist, and he was able to help with some of that. But this hormonal connection didn't come until much later. So I love that we're able to have these conversations.

Dr. Priya Mistry 25:04

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. Our school be. And I think again, it's'cause there's not a ton of research connecting all of this one. But then also, you know, there's a little bit that's on the patient too. So I had one who, smallest airway in menopause. So tired. We were able to get rid of her pain, but she was exhausted and she absolutely refused to meet with a sleep doctor. She was just like, Nope, this is not, I don't have sleep apnea. There's just no way. And my primary care is helping me with my hormone stuff through menopause, and we're gonna fix it that way. Okay. 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? I did my best. I'll document it. Like I'm not gonna bring it up again.'cause she just was like, absolutely not. It's not my sleep, it's not my, I, there's no way I can have sleep apnea. So I feel like keeping an open mind as a patient too is a good way to approach things.

Dr. Komal Patil-Sisodia 25:58

Yeah I think that's a great point. And it also goes to. The fact that patients have autonomy over their own bodies, right? And we, in our roles, we can bring forth data and knowledge and do our best to educate people about what their choices are. But at the end of the day, the true decision makers, the patient themselves, of course. 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. To see an improvement with a treatment. If you're not seeing that, then opening your mind to maybe exploring other options.

Dr. Priya Mistry 26:35

Yeah,

Dr. Komal Patil-Sisodia 26:35

yeah,

Dr. Priya Mistry 26:36

definitely. Yeah.

Dr. Komal Patil-Sisodia 26:37

Just on that same page, how long does it take people to see improvement with treatment? 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.

Dr. Priya Mistry 27:00

So most people are in treatment with me anywhere from seven to nine months. This is not a quick fix. 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. It usually takes years of clenching and grinding to get there, and then the hormones don't help. Which I have no control over. So there's factors that are out of my control too. 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. Oh, okay. So that's awesome. Okay. So pain can go down quickly. It's the joint stuff, like if your jaw's locked closed mm-hmm. Or you have true trismus, like a muscle spasm. Yeah. That can take a bit longer.

Dr. Komal Patil-Sisodia 27:39

That's good to know. 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. Autoimmune illnesses, I think 80% of autoimmune illnesses happen in women. I believe that's what the data says. Wow. 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? Does that have on your treatment? I'm thinking like the rheumatoid arthritis, psoriatic arthritis, lupus, or mixed connective tissue that they don't really have an answer for. Do you see that somewhat frequently, and then what has been your approach with those patients?

Dr. Priya Mistry 28:19

Sure. I wouldn't say I see it super frequently, but I've definitely seen it and I think we even called my patient. That had just been diagnosed with psoriatic arthritis. We called you'cause you know a lot about it. And I was like, you should call my sister because she knows a lot about it.'cause she was scared. She had just gotten diagnosed. She didn't know what medications to take. Like she was overwhelmed, she was stressed, she was crying. But it's interesting because the people that. Have these autoimmune disorders also typically have more pain and have a s more severe level of A TMJ disorder. It's not just a little bit, it's a lot bit, yeah. So, everything's connected. Autoimmune disorders, generalized inflammation in the body, of course it can affect TMJ pain and dysfunction. 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. Well over a year, sometimes two. And I see my patients fairly frequently, every three to five weeks or so at some point. Sometimes it's weekly until we can get them feeling much better. And that's the main thing I've noticed is it just takes longer to heal because the whole body's involved connected. Yeah, so I would say. I'd say that's what I've seen.

Dr. Komal Patil-Sisodia 29:22

That's great to know. And then question for you. 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?

Dr. Priya Mistry 29:36

Yeah. During the first appointment, we do a very thorough exam, but before I even do a physical exam, I get the whole history. I wanna hear everything. 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?'cause sometimes they start when you're like four years old. Well, not four, probably eight. When did the headache start? Sometimes those can start at four years old. Yeah. When did the jaw pain start? So oftentimes it's like one symptom starts, then a few years later, another one. And then another one. And then another one. The history is important. I need to know when all this came to the forefront, were there any neck injuries, head or neck injuries preceding these symptoms? Because that can affect it. That can be why they happened. So I asked them a ton of ques, like, I wanna know their whole life story. I. 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. I have a gazillion questions. Yeah. So I, and I think my patients appreciate that because they're like, oh my gosh, I just saw this TMJ dentist in Portland. He didn't ask me anything. He looked at my mouth, he didn't even do a physical exam and was like, this is what you need. And they're like, you're so much more thorough. And I'm like, because it's important. Yeah. The mystery is in the history or the, yeah, that's what my mentor would always say. Yeah, I love it. 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. So yeah, it's really interesting. And then my physical exam includes like a postural exam. I check the against a grid. I have You stand and I say shake out and. Stand your normal posture. Don't try to make it perfect for me. And you can see when there's a grid behind you if one shoulder's way higher than the other. Interesting. Yeah. Or if the head is tilted. When the grid is behind you, you can see everything.'cause you're like, and then if the patient's spouse has come in, they're like, oh my god. Because they're looking too. Yeah. Yeah. I'm like, yeah, and, and they're like, but why are you checking all this? 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. And so I think my exam is process is like really thorough. The only thing I don't do at the exam is imaging because that drives the cost of the exam up. That makes sense. And I'd, I like to keep the cost lower for. The patient's sake.

Dr. Komal Patil-Sisodia 31:42

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. Mm-hmm. One, I want you to explain that, but you also incorporate massage and chiropractic therapy like you were saying. 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?

Dr. Priya Mistry 32:08

Yeah, so I always go over it with them. So I have two primary ways of treating. So just like you can't get an orthotic for your shoe to help with your hip alignment. You can get an orthotic for your jaw that fits over your teeth to help with your jaw. Interesting. Yeah. So many people think, well, I already have a night guard. It's not a night guard. A night guard just protects your teeth. It doesn't do anything for the alignment of your jaw. In three dimensional space, that's what we do. Okay. So we have technology and software that measures where the muscles are sitting at their correct resting length, their neutral, relaxed position. And where the joints are decompressed. Okay. And the technology and software shows us your teeth are holding your jaw here. But your muscles and joints actually want your jaw to be here. That's really exaggerated. 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. So I just exaggerated that a lot to show you that there's quite a difference, again, between a night guard and an orthotic. So an orthotic treats the muscles and the joints, and it protects the teeth. A night guard just protects the teeth. 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. And a night guard does not have a prescription, but a true well-made TMJ orthotic.'cause not all TMJ orthotics are created equal, a well-made one has the right prescription that's customized, individualized to you. So that's one way I treat. And the other way is we go hard after the bite. Sometimes it's simply the way the teeth come together that's making the muscles fire too much. So we make micro adjustments on the teeth to bring the muscle firing down and bring the pain down. Okay. So that's, yeah, that's the second way that I got certified. And then I got my fellowship in it recently that I've been treating with a lot of success at my practice. So those are the two primary ways. And so by the time people go. They have an idea of what I recommend for them. And how much those are, and payment options and when they can schedule everything. Oh, that's

Dr. Komal Patil-Sisodia 33:57

really

Dr. Priya Mistry 33:57

fantastic.

Dr. Komal Patil-Sisodia 33:58

And have people had success with putting that through, like their flex spending accounts and things like that for healthcare? That's good. Yes,

Dr. Priya Mistry 34:05

we can totally do that. And then we also accept care credit and we have flexible payment plans'cause most people are in treatment with me from six. To nine months. It's a long time. So for many of them, I say, put half down now and then six monthly interest free payments till it's paid off.

Dr. Komal Patil-Sisodia 34:19

It's so important to have options, especially since. Medical and dental insurance don't really cover this type of very necessary treatment. Are there any at-home practices, nutrition, exercise, stress relief that you recommend?

Dr. Priya Mistry 34:33

Yes. So I would say like a really good exercise. We'll do two of them. Right where your like frontal bone, this big bone here? Meets, I think it's actually your sphenoid bone. I think I said in another video there was the parietal, but I think it's actually the sphenoid bone. Okay, so there's a depression. Yeah. I can feel you feel that? Right? So put your fingers in there and press inwards. Doesn't that feel good? Yeah. Like hurt so good. It can be a little sore and then rub clockwise and then counterclockwise five times and that can release so much tension. Okay. Ever since I started incorporating this into my therapy, my, my kind of therapy sessions with my patients. Yeah. They have loved it. They're like, oh my God, what are you doing? That feels so good. I had a lady ask me if I could just follow her around and do that for her all day. I was like, you can do. You can reach the, it was funny. And then another one is the masseter. I mean, this is a huge muscle and for its size, it's actually the most powerful muscle in the body. It can generate the most force for it. Oh, more than the gluteus maximus? Well, for its size, right? No, that's what I mean. That's what I mean. You would bring out the butt sister. You have to keep that in i'll and my might as well. So yeah. I love it. So with this one, you can take your knuckles. You're gonna gently put some pressure, like float your jaw until your back teeth barely touch. So don't clench. Just a little pressure. And then with pressure inwards, right under your cheekbones, right in front of your ear. You're gonna. Put pressure inwards and rub all the way down. That

Dr. Komal Patil-Sisodia 35:55

feels

Dr. Priya Mistry 35:56

good. And you might feel some little speed bumps in there. Those are knots in the muscles. Those are trigger points, and you can massage those out. And people feel really good when they do that. I might need to come see you. Come see me, baby. I need to come see you for my hormones. I know

Dr. Komal Patil-Sisodia 36:08

that's right. 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? Sure.

Dr. Priya Mistry 36:18

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. 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. 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. And I honestly think every dentist should have this technology in their office to help prevent TMJ problems. Because I had a patient that came to see me. She's like, I had a big filling done, and all of a sudden I had eight out of 10 pain every single day. That shot up to 10 out of 10 when I chewed. And so I adjusted that feeling and her pain went to zero. Oh, fascinating. 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. So the bigger the mark, the more the force. That's not true. Interesting. The smallest mark could be the highest force. So the way we're taught in dental school is No, exactly. So the way we're taught in dental school is only 14% accurate. 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.

Dr. Komal Patil-Sisodia 37:32

That's so cool. How would

Dr. Priya Mistry 37:33

you rather have your bite adjusted?

Dr. Komal Patil-Sisodia 37:35

I mean.

Dr. Priya Mistry 37:36

95% baby. 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. Interest in it. And so I, for me that's very exciting'cause I definitely wanna start doing that.

Dr. Komal Patil-Sisodia 37:50

That's really fantastic. And then just to close out. 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?

Dr. Priya Mistry 38:05

I would start with your dentist, because most dentists do ask if you have headaches or neck pain. I hope they do anyways. I think they do. Yeah. But see if there's a TMJ dentist in your area. 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. Yeah, it has to be. TMJ ENTs, I think are the MDs that like, know about us the most because of the either related symptoms. So yeah, think outside the box. Try not to go to Botox as your first line of treatment. It is a neurotoxin and all it does is paralyze the muscles. It doesn't calm them down. It just atrophies them.

Dr. Komal Patil-Sisodia 38:44

Okay. Which can cause long-term issues, I'm assuming. I.

Dr. Priya Mistry 38:48

Totally.

Dr. Komal Patil-Sisodia 38:49

Priya, thank you so much. This has been so much fun. I wanna give a shout out to our other sister Neha, who we are also working on a podcast with. 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. So very. Excited to bring that to you all and I will look forward to seeing you. On the next episode, we'll link all of Dr. 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. Have a great day, everyone. Thank you again, Priya. Thank you.