TMJProtocal

Julian Protocol Therapy
For Craniomandibular Dysfunction
Therapy for Optimum Health

The objective of the Julian Protocol Therapy is to gently and naturally balance the maxilla 3- dimensionally, in order to align with the cranial system. In other words, the head literally teeters on top of the cervical spine with the center of gravity anterior or forward to the spine.  It is tethered to the body by the muscles of the joint systems.  Functional and resting head posture is dependent upon the proper tension in these muscles.  It follows then that jaw movements must be intimately associated.  Movement of the jaw is not only related to the muscles of mastication and chewing, but also to chewing patterns and head and neck posture.  Head posture, neck posture and jaw relationships are therefore all intimately related and a change in one necessarily affects the other.

Because of this dynamic relationship between head and neck posture, jaw position and dental occlusion and its ultimate disturbance that is seen in TMJ dysfunction, migraines, headaches and head and neck related discomfort, it becomes necessary to provide appropriate treatment for optimum results.

Providing my patients with relief from the adverse effects from the above conditions is a priority at The Julian Center . We are able to provide this comprehensive treatment in our office, as well as offer instruction for simple and effective techniques for stress relief in these areas.  Our goal is to allow you to be pain free and thereby improve your quality of life.

Dentomandibular Sensorimotor Dysfunction (DSD)  is acomplex condition involving the muscles and joints of the head,  jaw and neck and is chronic in nature.  It also includes that upper and lower jaw and their proper relationship to one another.  Regular maintenance is required and necessary.  That is why we have done such an extensive history and evaluation at your initial visit.  The best therapeutic improvement is a result of good patient and clinician communication and mutual cooperation in the treatment.  We anticipate improvement in your discomfort in 6 – 8 weeks.  The full complement of treatment takes approximately 12 – 15 weeks.  Due to the chronic and complex nature of DSD, it could take longer, depending on your individual progress. 

As part of your comprehensive therapy, you will have both in office and at-home exercises and therapies.  Your JPT Home Care Kit  will be given to you at your first session.  In order for you to experience optimum results, it is imperative that you commit to full participation with the at-home exercises as well as the in-office therapies.


JPT Home Care Kit Contents:

  • One bottle of MSM Lotion – MSM lotion is a topical form of MSM that goes directly into the areas of inflammation to decrease the inflammation and associated pain.
  • 2 bottles of MSM Gold Capsules – The MSM Gold capsules are natural plant enzymes with MSM that help to speed up the healing process and break down the toxins that are being released into your system during the in-office and at home therapy processes.  These enzymes neutralize the toxins to help get them through and out of your body faster than normal.  They also help carry the MSM to parts of the body that have inflammation, thus decreasing the swelling that is present.
  • Hot/Cold pack – Helps to decrease the inflammation in your muscles in its “cold” state, and helps soothe muscles in its “hot” state.
  • Micro 3.0 Kit – The Micro 3.0 is a micro-current device, which uses non-invasive electrical stimulation for the relief and management of chronic pain.  More information about this device will be available to you if needed.
  • Relaxation CD – Play the CD during your home care to help get your mind and body into a more relaxed state.
  • Alpha-Stim SCS instrument :  To control anxiety and/or insomnia. Use it while reading, working at your desk or watching T.V.

For optimum results, read the below instructions carefully:

  • Take 2 MSM Gold capsules twice daily (total of 4 per day) for 30 days.  From then on, take 1 capsule twice a day (total of 2 per day).  Keep replenishing the MSM Gold capsules as needed.
  • Prepare the following things as you get ready for your JPT Home Care  routine:
    • Remove the Hot/Cold pack from the freezer or microwave and set it next to the place you will be sitting to do your exercises
    • Prepare the Micro 3.0 by inserting the wires into the unit and connecting them to the electrode pads
    • Have the MSM Lotion close by, to rub on your jaws, neck and upper shoulders after the Micro 3.0 usage
    • Wrap the Hot/Cold pack around your neck and keep it there for 10 minutes.  The ice pack helps to decrease the inflammation in your neck and make the upcoming exercises more effective.  Practice taking deep cleansing breaths.  To do so, just breathe slowly and as deeply as you can to the count of 10, then exhale slowly to the count of 10 until you can no longer get any air out of your lungs.  Repeat this 2-4 times.  Remove the ice pack after 10 minutes.
  • Begin the following Neck Stretching exercises immediately.  Remember to BREATHE through each stretch.
    • Place your right hand over the left side of your head and gently pull your head toward your right shoulder until you feel some tightness and hold for 10 seconds.
    • Repeat the same process by placing your left hand over the right side of your head and gently pull your head and gently pull your head towards your chest for 10 seconds.
    • Place your hands behind your head and gently pull your head towards your chest for 10 seconds.
    • Next, place your right hand on the left side of your chin and gently turn your head to the right for 10 seconds then reverse the hand and pull your chin gently to the left and hold for 10 seconds.
    • Repeat this series of exercises one more time, holding each stretch for 20 seconds.
    • You may feel and/or hear a slight release in the neck from time to time.  This is a good thing, as the tension in the neck is releasing, and it will have a positive effect in your condition.  Do not stretch to the point of feeling pain at any time.

 

  • Opening and Closing of the Mouth exercises:
    • Place the tip of your tongue as far back on your upper palate as comfortable possible while you are doing these stretches
    • Put light pressure on your chin as if you were trying to push your chin backwards
    • Open and close slowly until you feel light resistance.
    • Do this twice a day for 60 seconds.  For the 12 weeks or until notified by the doctor.
  • Micro 3.0 (refer to pages 7-24 in the Micro 3.0 instruction booklet)
    • The unit and pads should have been prepared before you sit down to begin your treatment. 
    • Wipe any moisture, oil or lotion off of your skin where you will be placing the pads
    • When using 4 pads, use the black wire connected pads on the cheek muscle area and use the red wire connected pads to another area such as opposite sides of the neck or opposing shoulders.   Place prepared pads (remove protective paper and save them for after use) on the appropriate muscles for 20 minutes.  Wet electrodes slightly by rubbing them with ordinary tap water before applying to the skin.
    • If necessary, tape electrodes in place with a paper surgical tape (available at your local pharmacy)
    • Be sure to let us know if you have any skin sensitivities to adhesives
    • Adjust the controls:
      • Set timer to 20 minutes
      • Set frequency to 0.3 Hz to begin, if no tingling is felt, up the setting to 8 Hz
      • Adjust the output by turning the Amplitude control knob for Channel 1 or 2 clockwise.  The indicator will light up while the unit is in operation.  Slowly turn the channel control in a clockwise direction until you reach the proper setting,.  Repeat for the other channel if you are using 4 pads. 
    • Press the Start button to begin the timer.  The “Cycle on” light will blink for the preselected amount of time.
    • At the end of the timing cycle, the cycle light will go off.
    • Remove the electrode pads from your skin and replace the protective paper.  Return the unit, wires, and pads to their case.
    • Wash the electrode pad sites with mild soap and water, then rinse and dry thoroughly.
    • Refer to the Micro 3.0 manual for tips on skin care and/or irritations.
  • Gently rub MSM Lotion into your jaws, neck, shoulders and any other painful areas.
  • Repeat this entire process including the neck and opening/closing stretches, Micro 3.0, and MSM Lotion 1 more time during the day.  Get in the habit of doing this routine in the morning and in the evening for optimum results.  It will take no more than 40 minutes each time you do the exercises.  If all you had time for was 20 minutes with the Micro-current, it is best to always do this therapy.
  • It is recommended that you purchase an additional heating band (one with small beads that can be heated in the microwave) to use throughout the day on painful areas.
  • Healthy sleeping recommendation;.  Ideally, you should sleep on your back as this allows for maximum breathing capaEllicott City but it also allows for the tongue to fall into the back of your throat and reduce your airway.  Avoid sleeping on your stomach as much as possible.  Support your body with a Tempur-pedic pad and a medium-filled down pillow to keep your spine straight and supported.  Sleeping on your side is preferable with the proper pillow to support your head and neck
  • Breathing and stretching exercises

Quick Reference to Home Care Routine:

  • Take 2 MSM capsules (first 30 days only, after 30 days switch to just 1)
  • Prepare Micro 3.0 with pads and wires, everything in its place, ready to go
    • If you have been given the AID (only for Headache/Migraine patients), prepare the AID unit with the Ear Clips as well.
  • Ice pack on neck for 10 minutes
  • Neck stretches – hold each stretch for 10 seconds and then 20 seconds
  • Opening/Closing mouth stretches
  • Micro 3.0 (and AID if given) – 20 minutes (use at the same time)
  • MSM Lotion gently rubbed into jaws, neck and shoulders

Alpha-Stim SCS -  Additional Home Care
This very effective tool uses electrotherapy stimulation to help reset the brain chemistry to decrease the frequency, duration and intensity of headaches and migraines.  It is also helpful in treating anxiety, insomnia and depression, as it stimulates the relaxing alpha and theta brain waves. 

You will use it in conjunction with the Micro 3.0 unit.  The AID comes with Ear clip electrodes that you will clip on your ear lobes for 20 minutes at the same time you have the pads from the Micro 3.0 on your pain areas.  Be sure to put the settings on a comfortable intensity.

The therapist will have you try out this device in the office for 20 minutes or more depending on if you had any adverse affects.  Use the same settings that you agreed upon at the office.

Steps for using the AID:

  • Clean the ear lobes
  • Connect ear clip electrodes to the AID by plugging the green plug into the outlet receptacle
  • Attach a round felt electrode to each ear clip
  • Saturate each electrode pad with several drops of the Conducting Solution
  • Place the earl clips on your ears as high on the lobe as possible
  • Turn on the device by pressing the power button
  • Set the timer to 20 minutes
  • Use the up and down arrows to adjust the intensity.  If you feel a prick, itch or get vertigo, then the intensity is too high,  Lower the intensity until you feel nothing
  • Relax
  • The power will automatically turn off when the 20 minute cycle is complete
  • Disconnect and remove the ear clip electrodes.  Return the unit to its case.

Refer to the instruction booklet for more detailed information on using the device.  Remember, you may use the ear clips at the same time as using the pads from the Micro 3.0 unit.

 

Things to AVOID:

  • Chewing gum
  • Hard and chewy foods
  • Food such as:  Dairy products, alcohol, fried food
  • Food with preservatives and other additives
  • Perfumes, cigarette smoke, other strong smells
  • Yawning widely
  • Electromagnetic frequencies (EMF’s) while you are sleeping

Things to DO:

  • Eat a healthy, whole foods diet with plenty of  organic, fresh vegetables
  • Drink lots of water, approximately ½ of your body weight in ounces. (Do not allow yourself to become dehydrated)
  • Exercise (Yoga, Pilates, walking, swimming, etc.)
  • Practice deep breathing at least twice a day and whenever you feel stressed.  Avoid shallow breathing.
  • Make a conscious effort as you are falling asleep to keep your lips closed, but teeth apart. Repeat to yourself, “lips together, teeth apart”
  • Your JPT Home Care routine twice a day…per persistent, diligent, and consistent.
  • Practice good sleep hygiene (review the report given as part of the Julian Protocol.

In office care:
Your weekly therapy sessions will include some or all of the following:

  • Fabrication of a temporary orthotic and a lower full-arch orthotic device (Julian Protocol Therapy (JPT) Stabilization Appliance)  to:
    •  help correct tongue posture which will improve breathing,
    •  stabilize the cranial corrections that will be made at each therapy session, as well as adjustments made by your chiropractor
    •  reduce the stress to the neuromuscular system
    •  Balance out the dental bite forces
  • Adjustment of the orthotic on a bi-weekly basis based on phonetics, heart rate variability, pulse oxygen, blood pressure, checking 3-dimensional relationship as well as providing some stability to hold the recent cranial manipulations and chiropractic adjustments
  • Periodic monitoring to establish the efficacy and effectiveness of the treatment including specific measurements of the cranial system (3-D relationship)
  • An evaluation with the 3-D Scanner to check for any systemic issues that may be preventing you from healing properly and timely, as well as reveal any imbalances in your neuro transmitters
  • A ZYTO evaluation, which is a biofeedback instrument to determine any nutritional supplements that are needed during this healing phase. Any supplements (in addition to a supply of MSM and Enhansa) will be purchased separate from this agreement. Nutrition and lifestyle recommendations may be given during this session.
  • 3 therapy sessions on the ZoneRx to reduce any instability in the cranio-mandibular and neuromuscular systems as a result of lower body imbalances
  • 3 30-minute sessions in the Life Force to help balance the Autonomic Nervous System (done every 4 weeks), which will lower the overall stress to the mind, body and spirit

The weekly sessions include ultrasound therapy, electro-stim therapy, manual muscle therapy, cold laser therapy.  Cranial sacral therapy which will be alternated weekly with adjustments to your appliance and massage/Reiki therapy.

Cranial-Sacral Therapy:  This therapy is extremely important to create a natural rhythm in the cranial-sacral system which involves expansion and contraction 12 times per minute and allows the cerebrospinal fluid to be delivered from the brain down the spinal cord to nourish the entire nervous system and then returning waste products to the lymphatic system.

It is imperative that you make your weekly appointments as well as do your home care therapy, as it is the consistency of the therapy that reduces the overload to the nervous system thereby resetting the brain and re-establishing normal homeostasis.

 

JPT Stabilization ApplianceWear and Care Instructions:

The JPT Stabilization Appliance  you have been given,  will help us achieve a few things as we restore the balance in your dental foundation. 

  • It reduces the pain and swelling from sprained ligaments by reducing the excessive forces placed upon the temporomandibular joints
  • Clenching and grinding at night and during the day will lessen
  • Pain triggers are reduced
  • Myalgia patients have seen a reduction of facial pain symptoms
  • Tinnitus (ringing of the ears) is reduced or eliminated
  • Vertigo is reduced or eliminated
  • It helps patients to sleep better at night by allowing more oxygen to enter the blood stream and even reduces snoring
  • It opens the airway by relaxing the posterior position of the tongue
  • It centers the bones or condyles, enabling the facial muscles to go neutral
  • It reduces the intensity, frequency and duration of headaches
  • Patients have reported that they can breathe better through their nose when wearing the appliance
  • Maintains the current stable position set during therapy sessions and prevents relapsing to the previous cranial imbalance.

Keep a journal:  Notice if and when you are clenching during the day and document.  Review the journal until you have those moments of clenching under control.

Stress Management Therapies:

  • Use of the LifeForce
    • This non-invasive apparatus uses the frequency of sound and light to create a relaxing environment that allows the body to enter a balanced state where natural healing can occur.
  • Reiki and Chakra Balancing:
    • An alternative form of healing known as energy work.  Our bodies are comprised of physical elements as well as an energy system that allows life force (chi) to flow through us, allowing us to feel, think and function.  This energy system, known as the chakras, acts as regulators and allows the energy to flow freely through our spiritual, emotional and physical being.  There are seven major chakras or energy centers in the system and these are the centers we focus on with Reiki.  There are secondary chakras that can be addressed using Chakra balancing.  When we have disease, illness or stress, our chakras become out of balance.  Reiki helps the body achieve balance, allowing the body to heal itself.
    • Stress is one of the main causes of energy to be blocked in the chakras, causing problems from low back pain to headaches to digestion issues and many others.  The use of Reiki and Chakra balancing can greatly increase the body’s ability to manage stress, and help to prevent or alleviate disease.  There are many hospitals and clinics including Cleveland Clinic, UCLA and the New York Presbyterian Hospital/Columbia University Campus that support, offer and recognize the use of Reiki treatments to promote healing and manage stress.
    • During the session the patient is clothed and laying on a massage table.  Soft music is playing and the room is dimly lit.  The practitioner will place hands on the chakras or an area of discomfort on the patient’s body to help balance and restore the energy flow in the body.  During the treatment the patient may feel comforting heat and/or a gentle vibration.  The patient often feels relaxed, and it is not uncommon for the patient to enter into a meditative state or fall asleep, waking refreshed and peaceful.
  • Some benefits of Reiki/Chakra Balancing are: 
    • Accelerates the healing process
    • Aids in removing toxins from the body
    • Aids in relaxation and promotes healing
    • Increases flow of energy
    • May reduce pain/inflammation
    • Creates emotional and spiritual balance
    • Creates a sense of peace and well being
  • Brain entrainment CD’s
    • A Relaxation CD will be provided with your Home Care Kit

All of these modalities will reduce the stress to the Autonomic Nervous System which will be periodically measured using the Heart Rate Variability.

To care for the JPT Stabilization Appliance, follow these simple steps:

  • Upon removal, soak appliance in OrthoFresh
  • Keep it away from dogs and cats, as they may find it a great chew toy.
  • Do not place it in direct sunlight, even if it is in its case.  It can warp or distort since it is heat and light sensitive

Post treatment care (once you have completed your in-office therapy sessions)

  • Schedule monthly, quarterly or other therapy visits as recommended by Dr. Sambataro to maintain your dental foundation balance, thus preventing any reversal of the progress you have made
  • Continue use of JPT Stabilization Appliance  - wear as Dr. Sambataro prescribes.
  • Continue use of MSM Lotion and MSM Gold Capsules.  Replace as needed
  • A common reaction when someone starts to feel better is to stop doing what got them to feel better, don’t allow this to happen.  Keep with the program so you will not revert back to where you were.  Get used to the fact that in order to feel better and maintain this balance for the rest of your life, you need to keep up with the prescribed regimen and visit the office regularly.  It is comparable to taking care of your car.  You must bring it in for maintenance visits to keep it working in the best condition possible.  Same goes for your dental foundation.  Use the MSM products, wear the splint, do your Home Care daily.
  • If you ever experience future trauma to your body, especially to the head or neck area, be sure to get in to see Dr. Sambataro right away so we can assess your condition and take rapid measures to get you back in balance.

Phase II – Therapy may be necessary due to the new relationship between your upper and lower teeth, a and as your cranial-sacral, musculo-skeletal and neuromuscular systems become balanced.  Remember, your bite was determined by the imbalance in the above systems.  As these systems are balanced, your bite will also need to be altered to make the new balance systems.(Additional information will be provided if it becomes necessary)  This may require comprehensive crown and bridge or orthodontics.


Deep Breathing and Relaxation

  • Shallow breathing causes increase of stress.  The heart has to work harder to bring oxygen to the tissues.  Therefore, there is less oxygenation of the muscles and the stagnant air is never removed from the lower part of the lungs.  Avoid this type of breathing and practice deep breathing instead.
  • By practicing deep breathing several times during the day, you will be able to overcome one of the causes of stress.  Just breathe slowly and as deep as you can to the count of ten, then exhale slowly to the count of ten till you can no longer get any air out of your lungs.  Repeat this 2 – 4 times.  Do this exercise at least two times daily, plus whenever you start to feel stressed.  As you are doing this exercise, stay focused on only the breathing.  After a while you will start to notice a relaxed and less stressed feeling. These exercises will be shown to you by one of our therapists.

Additional therapies that will help your condition are:

  • Massage (this therapy is available at The Julian Center)
  • Accupuncture
  • Chiropractic
  • Sleep Hygiene (speak to our Nutrition Counselor for more information as well as read the packet that you were given with your Home Care Kit)
  • Nutrition and Lifestyle Counseling  - You may be given holistic nutrition and lifestyle recommendations by Renee during your initial ZYTO Evaluation.  If you feel you need additional support in this area, please ask about our counseling programs.

Five Step A-W-A-R-E strategy:  (anxiety control)

  • Accept the anxiety instead of fighting it.  Replace your rejection, anger and hatred of it with acceptance.  Don’t make the anxiety responsible for how you think, feel and act
  • Watch your anxiety.  Look at it without judgment, not labeling it as a “good” or “bad”.  As you watch the peaks and valleys of your anxiety you will see ways to lesson it.
  • Act with the anxiety.  Normalize the situation by acting as if you weren’t anxious.  Slow down if you have to, but keep going.  Remember to breathe deeply.
  • Repeat steps 1-3 until your anxiety reaches a comfortable level
  • Expect the best.  What you fear the most rarely happens.  However, get rid of the magical belief that you have licked anxiety for good.  By expecting future anxiety, you are putting yourself in a good position to accept it when it comes again.

Ask About Remedies that can help with Anxiety.

  • Rescue Remedy – Carry with you all day, use when experiencing feelings of anxiety
  • Tranquinol and Magnesium (use at night before going to bed)