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Any one heard of Dr. Sims


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Yesterday we went to see the osteopath who'll be working with Dr Nordstrom later on. We've never been to an osteopath before, and it was an interesting experience. He spent almost an hour asking questions (pregnency, development, trauma, etc') and then more than an hour just checking our daughter, measuring bone heights, symmetry, touching various points, checking reflexes, looking at the ways she swallows, opens and closes her eyes, etc.

He says there is obvious asymmetry and insufficiect development of her facial bones, expecially the chin. She also does not swallow properly (her tongue moves backwards instead of forward and up). His theory is that improper tongue movement leads to insufficient development of jaw and skull bones, which then in turn leads to other problems. He referred us to Myofunctional therapy (excersice meant to teach the tongue correct movement and placement in the mouth). Combined with osteopathic treatment (which is supposed to induce the bones into their right place) he says he expects to see a change within a month, that will be further enhanced by the treatment Dr Nordstrom will then do.

Treatment itself is very gentle, and it seems almost hard to believe that it can do anything (gentle touches, stretches), but I've been reading a lot about osteopathy, and it seems like a well established way of treatment. It's been around for a 150 years and (believe it or not) even accepted by the health insurance companies

We are going to try it and scheduled a second appointment already.

 

Dalit

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Today, we saw a local TMJ specialist to get his opinion before travelling to Maryland (Dr. Sims/Stack) or Florida (Dr. Garcia). I highly recommend doing this before travelling. Before today's appointment, I provided him with a letter describing my son's condition, Dr. Sims' journal article, and the Youtube video links. He read the article, watched the videos, and spent a whopping 45 minutes on the phone with me - no charge.

 

In my 14 year old son's case, his jaw muscles are very bulky and tight. (My son said, "So, I'm ripped?" ha,ha) He does have a space between his upper and lower teeth in the front. This puts more pressure on the back teeth when the upper and lower teeth don't touch in the front (they're supposed to touch). This puts extra stress and activity on the back jaw muscles. He does clench his teeth which also puts more stress on the muscles. His crowded teeth at the bottom will only get worse over time and cause more problems in someone who clenches. The doctor put a tongue depressor between the upper and lower teeth, but it was just to demonstrate that the stick was not in a straight line, it was cockeyed to the right. Incidentally, he had more pain on the right side when pressure points were touched.

 

He recommended that my son get braces first, then a splint. Yes, that's right. It's backwards from what we've been hearing! He agreed about giving the trigeminal system a break, but only after the teeth are straightened and the bite is correct. He surmised that once everything is corrected we may see some relief from the TS just from having braces. He said that the actual wearing of braces may even temporarily serve as a "distraction" to the nervous system and improve symptoms. He said he would make a splint after the braces are off. He agreed that the trigeminal system would benefit from a splint, but only after the bite is corrected. He said the splint could be worn any time, day or night or both.

 

As far as Dr. Sims' device goes, he said it didn't make sense to him to create a posterior gap and then have braces to correct that gap. He said that you would be right back where you started. If anyone has another understanding of this, please write and tell us all.

 

The best part was that the dentist today did not charge me!!! I couldn't believe it! He spent a whole hour with us! This speaks volumes to me. It still bothers me somewhat that Drs. Sims, Stack and Garcia are charging from $3,000-$5,000 for what someone here earlier described as a glorified retainer that may or may not work. Also, even though the doctor we saw today recommended braces, he does not do orthodontics so he had nothing to gain from recommending braces.

 

As an aside, I have had great success thinking outside the box in other areas of my health and my children's health where doctors have said, "Oh, that won't work"..."That doesn't make sense"... or "I don't have any studies on that..." I have also had near tragedy following doctors' advice, for example, when my son had a bad reaction to Geodon for TS and talked of killing himself at age 11. So, just because the dentist I saw today is not impressed with the science behind Dr. Sims' paper or the appliance that Dr. Garcia makes, doesn't mean that it's not worth pursuing. However, considering the cost, travel, and uncertainty whether it will work, and the fact that we will have to do braces anyway, I think I will go with what the dentist today said. Braces first, then splint.

 

Please share your thoughts!

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love_nfp,

 

Perhaps the braces first approach will be the simplest. It is hard to criticize the decision, given, when you have the jaw still growing, you don't know how that will end up, so, fix the teeth and see where you are seems reasonable enough, particularly if you are not desperate for immediate relief. One thing, though, just to keep in mind, if your soon is still needing a jaw realignment after that, you could end up going through the braces situation twice. For example, if you need the jaw moved down, the bottom teeth may need to be pulled up away from the jaw as a result.

 

A couple things I was hoping you could clarify. When you said your sons top and bottom teeth don't touch in the front ... do you mean, there is a gap in the top-bottom direction, meaning he could not rip a piece of bread with front teeth because the bread would slip right on through? (I think that would be called an underbite, and I'm saying that because mine cross way too much and they are calling that an overbite.) Or, do you mean that, when the top and bottom teeth do come together or at least cross, the bottom teeth are way behind the top teeth, so they don't come close to touching?

 

My other question relates to this paragraph:

 

"As far as Dr. Sims' device goes, he said it didn't make sense to him to create a posterior gap and then have braces to correct that gap. He said that you would be right back where you started. If anyone has another understanding of this, please write and tell us all."

 

I do not know what a "posterior gap" is that you are referring to. If you could try to explain, that would be great. Thinking about the Dr. Sims device, could you mean that the idea of moving the jaw down only to move the teeth back up to compensate doesn't make sense to the TMJ doctor you saw? My understanding of the benefit of doing that is the jaw movement is what is pinching the nerves, and so moving the teeth back up would not cause one to lose the benefit of adjusting the jaw down.

 

Michael

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love_nfp,

 

We haven't seen Dr. Nordstrom yet, but the ALF system is supposed to be able to do both things at the same time; correct allignment and bring the TMJ into correct placement. Maybe you should check this out.

 

Dalit

 

We are looking into the ALF system as well. In the meantime, my ortho has adhered something to my sons back teeth to see if he could get some relief from the TMJ. I don't know if it is coincidence or not but my son has completely settled down. The tics are still there, just not as loud or as frequent. We are going on October 2, along with my ortho, to meet with a number of ALF specialists and craniosacral specialists. I will post when we return.

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Oh, I'm so confused!!

 

["As far as Dr. Sims' device goes, he said it didn't make sense to him to create a posterior gap and then have braces to correct that gap. He said that you would be right back where you started. If anyone has another understanding of this, please write and tell us all."]

 

Someone correct me if I'm misunderstanding this, but I thought Dr. Sims' device works this way: the appliance keeps the mouth propped open and the back teeth, of course, don't make contact (posterior gap). After wearing it for 6 months to a year, the muscles are trained to keep it in that position, and at that point even when you are not wearing the appliance, the back teeth will no longer make contact (posterior gap). So then you get braces to keep the jaw in that position and bring the top and bottom teeth back together again. I thought this was pretty straightforward, but this is where my dentist said you would be right back where you started. I'm stuck and confused here. Is it possible, or not, to keep the jaw in the position where one is tic-free and have the teeth properly aligned? I guess it is according to Dr. Sims, however, the mom of the 10 year old on the video told me that no one Dr. Sims has treated has gotten that far yet...... I will email Dr. Sims to get a clarification.

 

["A couple things I was hoping you could clarify. When you said your sons top and bottom teeth don't touch in the front ... do you mean, there is a gap in the top-bottom direction, meaning he could not rip a piece of bread with front teeth because the bread would slip right on through? (I think that would be called an underbite, and I'm saying that because mine cross way too much and they are calling that an overbite.) Or, do you mean that, when the top and bottom teeth do come together or at least cross, the bottom teeth are way behind the top teeth, so they don't come close to touching?"]

 

It's more like the bottom teeth are way behind the top teeth, so they don't come close to touching. When my son's mouth is closed, the top and bottom back teeth make contact like they are supposed to. The top teeth are in front of the bottom teeth like they are supposed to be, but there is a gap. You could push a stick of gum through the space when his mouth is closed. Does that make sense? There is supposed to be even pressure all around when he bites down. Since the front teeth don't meet, more pressure is exerted on the back teeth, causing overactivity of the jaw muscles and, hence, his "ripped" jaw.

 

Last night I was looking at my daughter's teeth and she too has an overbite that is worse than my son's! And she does not have TS! I am very confused and exhausted from all of the time spent thinking and surfing the net about this....

 

 

 

[name=MichaelTampa' date='Sep 17 2009, 04:18 PM' post='38397]

love_nfp,

 

Perhaps the braces first approach will be the simplest. It is hard to criticize the decision, given, when you have the jaw still growing, you don't know how that will end up, so, fix the teeth and see where you are seems reasonable enough, particularly if you are not desperate for immediate relief. One thing, though, just to keep in mind, if your soon is still needing a jaw realignment after that, you could end up going through the braces situation twice. For example, if you need the jaw moved down, the bottom teeth may need to be pulled up away from the jaw as a result.

 

A couple things I was hoping you could clarify. When you said your sons top and bottom teeth don't touch in the front ... do you mean, there is a gap in the top-bottom direction, meaning he could not rip a piece of bread with front teeth because the bread would slip right on through? (I think that would be called an underbite, and I'm saying that because mine cross way too much and they are calling that an overbite.) Or, do you mean that, when the top and bottom teeth do come together or at least cross, the bottom teeth are way behind the top teeth, so they don't come close to touching?

 

My other question relates to this paragraph:

 

"As far as Dr. Sims' device goes, he said it didn't make sense to him to create a posterior gap and then have braces to correct that gap. He said that you would be right back where you started. If anyone has another understanding of this, please write and tell us all."

 

I do not know what a "posterior gap" is that you are referring to. If you could try to explain, that would be great. Thinking about the Dr. Sims device, could you mean that the idea of moving the jaw down only to move the teeth back up to compensate doesn't make sense to the TMJ doctor you saw? My understanding of the benefit of doing that is the jaw movement is what is pinching the nerves, and so moving the teeth back up would not cause one to lose the benefit of adjusting the jaw down.

 

Michael

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The Dr. Sims device ends up being something that is put on top of the bottom molars (back teeth). So, instead of closing your teeth together resulting in bottom teeth connecting with top teeth, it results in the device connecting with top teeth. It still does feel a lot like the bottom teeth are connecting with the top teeth, since the device is right on top of the bottom teeth. But, as far as the jaw closing, it means the jaw is never closing as much as it used to (at least while you are wearing the device). Once you take it out, your teeth will close all the way again.

 

The device can also adjust the jaw in other dimensions--to the left or right, and frontwards or backwards. For example, love_nfp, your son's bottom teeth are too far back compared to the top teeth, just like mine, so my device also adjusts the jaw frontwards. However, the adjustments in these two dimensions are done with grooves in the device, created by the top teeth literally making an impression in the device when the plastic is still soft. Because this adjustment is made by grooves, it only works when the mouth and teeth are closed together. So, when I go to sleep, the jaw falls open and in a backwards direction, presumably because this is more natural for it. This results in a very dry mouth in the morning, although it does go away after drinking some water and waiting a few minutes. But this aspect is why Dr. Garcia will say it is good to have an additional device for sleeping that really keeps your jaw the way you want it during this time. I can't explain how at this time, since I did not get a real explanation of that myself.

 

In a way, though, yes, love_nfp, Dr. Sims device works by keeping your jaw from closing as much as it would otherwise, and hopefully you get used to that over time. To me, he only spoke very generally about the transition to getting orthodontics, and moving the teeth where they need to be to keep the jaw adjustment you want. So, if you manage this, you are back to square one as your local TMJ specialist says--if you look from the perspective of your teeth coming together. But, where the jaw moves would truly be different. How does one accomplish this transition, I don't know. Can you use braces to move your teeth while wearing the device, and slowly make the device smaller as it is less and less needed? Maybe that's it. If you just took it out and put in braces, I really think your jaw would immediately start closing together all the way so your top and bottom teeth together would meet. It's just hard to imagine that not naturally happening. And, if you're going that route--why not just start with braces--why are we waiting the 6-12 months before braces? Well, I guess you could ask that question either way ... I don't know.

 

Hopefully that helps at least a little bit, but as you can see, I am not clear on a number of things as well.

 

Michael

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Dr. Sims responded to my email. I have to say that I'm impressed that he actually responds to my emails and does so timely. I sent this Friday and received a response today, Sunday. He definitely has patience because this is the third time I've emailed him. Here was my question to Dr. Sims:

 

"After wearing the appliance for 6 months to a year, one gets braces to bring the top and bottom teeth back together again, correct? I do not have a dental/medical background, so please bear with me. How is it that after the braces, the teeth would not be in the same position as when we started?"

 

Here is his response:

 

"Good question. After wearing the appliance the posterior teeth will not be in contact with one another. The bite must be opened to achieve the proper functional position to discontinue the tics. As it stands now the teeth are in the right position but the jaws are not therefore the tics are present. When you change the jaws the teeth position must change. Putting the jaws into proper position will not allow the teeth to be. Thus orthodontics is necessary to bring the teeth into the right alignment with the jaws afterwards. An orthodontists can be used in your area to complete this treatment."

 

My next step is to see an orthodontist. We have to see one anyway. I'm going to bring the journal article and get his opinion and then make a decision whether to proceed to Maryland or not.

 

I have another son with Crohn's disease. Two pediatric gastroenterologists have told me that "diet has nothing to do with it." Desperate because the medication he takes hasn't given the results it should, I did some research and put my son on the Specific Carbohydrate Diet at the beginning June of this year. His lab work recently came back normal for the first time in 4 years! My point is saying this is that just because some doctors say "that won't work" or "it doesn't make sense to me" doesn't necessarily mean that it won't work. So, now I am back to considering the trip to Maryland again.

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I found this posted here by Gemi on July 1, 2009 that might help explain a little more:

 

"After that he explained the steps of the treatment.

1. He puts the device for 6-9 month. He wants it to be worn 24/7. The less you wear it the more time you need for the muscled and jaws to be brought to the right position. Some people need the lower jaw device, some upper jaw, and some upper and lower jaws devices.

2 By the time the device is out, her muscles in the mouth will be trained to be put in a different position. Actually, he told, that if he will be performing the step # 2 (braises), he will cut the device gradually from the back and will put the braces along the way with the rubber bands in order to bring the jaws and teeth in the right alignment. As I understood, he will start doing braces when the tics are gone without the mouth piece being in. Guys if your going to go to the appointments, please clarify that he will start doing braces when the tics are not present even without mouth piece in. Braces may take 24-36 months.

3 Retainer to support the ortho work."

 

So, that would make more sense to me if he cuts the device gradually from the back and puts braces along the way to bring the jaws and teeth in the right alignment.

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We have been out of town - and on the run since Thursday. It is late, but I want to post to give you all the latest update. Please forgive typos, poor grammar....etc!

 

My son received his 2 bite splints on Thursday from Dr. Garcia - one for daytime and one for nighttime wear. The process of confirming the fit of the retainers required a lot of "in and out" of the retainers. There were quite a few adjustments to be made. What was so interesting/frightening was that as soon as one of the retainers were taken out of my son's mouth - a flurry of tics erupted. I was acutually a bit scared, thinking, omg, is this exacerbating the whole thing - or is it helping? At one point, Dr. Garcia left the room to work on the appliance, and my son said, Mom, when it is in my mouth, the feelings making me want to tic are gone." Ok, I was holding back the tears, but also reminding myself that we still have to wait and see. In the fitting process of the night time retainer, Dr Garcia, was intent on confirming that the back molars would not touch, regardless of how hard my son chewed on anything.

 

Dr. Garicia's instructions were for my son to wear the night time appliance as much as possible, as this is the one that will be of the most benefit. Even though it is quite large, my son LOVES to have this in his mouth, because he has complete relaxation. He looks a little odd, but is learning to talk with it - however, you can be sure that this 15 year old will not be out in public with it. The day time retainer is very easy to wear. Within a short time , he was speaking much better with the daytime appliance and wore it to school on Friday, the next day. However, by the end of the day on Friday, he had developed a sore spot from it - and wants to wait until it is adjusted (next Thursday), before wearing it again. So for now, he is wearing the night time appliance when we are home - and at night. We have been out of town all weekend, so it was worn only at night.

 

SO, what do I think so far - I have to tell you, I think the tics are less. In fact, today I saw very few. Are they gone? No, they are not - but they are better! But Dr. Garcia likened this process to peeling an onion - and we have quite a few layers to get through. One important piece of info - Dr. Garcia believes in wearing the night time retainer FOREVER. The day time retainer should only be needed for one year. Everyone in the office wears an appliance at night - and they all have the most beautiful teeth I have ever seen.

 

Praying that this continues to help.....will let you know if anything changes.

 

Beth

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Two things--

 

1. guy123--YES, IT IS HARD TO BELIEVE THE FIRST TIME YOU HEAR IT, I KNOW, BUT IT IS TRUE! A MOUTHPIECE CAN ACTUALLY STOP TICS AND OTHER SYMPTOMS OF TOURETTE'S! SORRY TO SCREAM BUT THIS IS AN AMAZING BREAKTHROUGH, AND ANY CLIFF NOTES VERSION NEEDS TO BE A SCREAM! At least for some, it is clear now, their Tourette's is related to trigeminal nerve being irritated by improper jaw alignment. The mouthpiece can decrease or stop this irritation. It seems almost like a variation of TMJ, and I will note that light sensitivity is one common symptom of both conditions. A few of us have gotten them for our children, or, in my case, for myself.

 

2. I noticed this morning after taking my mouthpiece out to swallow pills, that my jaw would not close "properly". I had no control over how it closed. Looked in the mirror, it turned out it was stuck in the position that it would close with the mouthpiece in--the new "correct" position. Sounds like progress, but, I was able to eat, which meant that I did get to close it a different way to eat. (Without the mouthpiece in, but with my jaw closing like it was in, there would be no eating, since no teeth would touch at all.)

 

Michael

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love_nfp,

 

Thanks for the info from Dr. Sims. It really does seem like the gradual reduction in mouthpiece along with braces is the only way to do it. Braces aren't going to move anything with the same mouthpiece, there will be nowhere to go. Braces all at once without the mouthpiece could perhaps work eventually, but there would be no relief in the meantime and it would probably be harder to guide the teeth into the place you want them as well.

 

Michael

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