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“t he pain was relentless and exquisite,” says Peggy Link-Weil of Raleigh. “I had horrible headaches, earaches, and

painful knots in my neck. I couldn’t open my jaw wide enough to eat a sandwich.

“This intense level of pain went on for months. I tried massages and chiropractors. My family dentist suggested I go to a pain clinic—but I was resisting the pharmaceuti-cal approach. I didn’t want to be dependent on drugs. So I put ice packs on my head at night to reduce the inflammation and treated the symptoms as best I could—but nothing worked.

“In desperation, my husband Googled TMJ on the Internet, and that’s how we found Dr. James Harold, right here in the Triangle where we live.

“When I first met Dr. Harold, he did a very thorough review of my medical and dental history and symptoms, and designed a treatment sequence that included making a detailed, definitive diagnosis.

In a second visit, he did a series of tests and computerized scans. As he gathered this information, he said he knew exactly what

was going on in my mouth—and he added that it was one of the most severe cases of misalignment he had ever seen.

“I wasn’t surprised when he said I had TMJD—temporomandibular joint dysfunc-tion. I was a grinder—in fact, I wore an appliance at night to lessen the impact of the grinding on my teeth—and Dr. Harold said that this kind of intense grinding will often precipitate TMJ. My whole jaw was out of balance.

“After further detailed, comprehen-sive testing, Dr. Harold created an acrylic orthotic that I wear faithfully, around the clock. It took several weeks to feel the full effects of repositioning of my jaw, but once that occurred I got complete relief from all of my pain problems. I’ve gotten a little paranoid about ever losing it or not having it in my mouth. I am at the moment totally dependent on this little device to keep me pain-free. One time I thought I’d lost it and I was completely freaked out—and fortunately I had simply temporarily misplaced it.

“Now Dr. Harold and I are talking about orthodontic options to permanently place my jaw in the balanced, healthy, pain-free position it is in when I wear this orthotic device. The whole experience with him has been a blessing in my life.”

MuScLe contRAction

Peggy Link-Weil’s good fortune is that she found herself in the care of one of the region’s top TMJD experts. Dr. Harold has completed over 1,000 hours of special training in studying and relieving TMJD, has helped literally hundreds of afflicted patients, and is often invited to speak on the topic to a variety of professional groups.

“We’re all exposed to stresses in our environment,” Dr. Harold points out, “and a typical reaction to these stresses is muscle contraction: tight shoulders and neck, balled fists, clenched jaws. If the jaws are habitually clenched, and the teeth do not support the jaws properly, the jaw joints become jammed and overclosed, causing damage to the joints.

“This damage to the joints and the as-sociated muscle spasm causes pain, not only in the joints themselves, but through muscle spasms in other parts of the body, result-ing in many of the symptoms this patient experienced.”

tMJd PRoBLeMSPeggy Link-Weil was typical in that

her symptoms worsened over time, says Dr. Harold. “Her headaches increased in frequency and intensity. She was clenching and grinding her teeth, all TMJD symptoms, which produced pain from the muscles in the head. Those headaches were so frequent and severe that they were misdiagnosed and in most cases would be treated as migraine headaches.”

Other related symptoms that respond well to TMJD therapy, Dr. Harold reports, “include facial pain, worn, chipping, or cracked teeth, cracking or chipping of dental restorations, neck and shoulder pain, jaw pain, ear congestion, ringing in the ears, clicking or popping in the joints, clenching or bruxing, limited opening of the mouth, loose teeth, and even tingling in the fingers.

“The simple goal of neuromuscular den-tistry,” says Dr. Harold, “is to bring the jaw and teeth into harmony with the muscles. If the jaw is not in proper relationship to

the muscles, muscles become overstretched and place undue strain on surrounding bones, nerves and tissues, causing increasing amounts of pain. Over time, the pain can be-come unbearable, as this patient can attest.”

After a careful initial exam, Dr. Harold uses an array of high-tech devices to properly align the jaw. “I need to palpate muscles to get a deeper understanding of muscular func-tion. What I often find is an imbalance in the position of the jaw as it relates to the muscles in the joint, and in the closing pattern of the jaw as it relates to the teeth.

“Our task is to find the position of the jaw where the muscles are relaxed and at rest—a three-dimensional position in space—and we rely on a series of neuromus-cular scans to accomplish this.”

tHeRAPeutic oRtHoticSOnce the proper and comfortable

position of the jaw is known, Dr. Harold fabricates an orthotic that allows the jaw to close to this ideal position. “In this position, the muscles are at the right length and will not go into spasm,” Dr. Harold explains. “Muscles will heal, pain trigger points will subside, and joint capsules will heal. We

leave this orthotic in place for 3 months, 24 hours a day. Some patients remove the orthotic while eating, most do not.

“Patients must be pain-free for two to three months while wearing the orthotic before starting the next phase, which may consist of either full mouth reconstruction, to permanently place the jaw and teeth into the new bite, or orthodontics, to move the teeth into the corrected bite. In some cases, a limited bite adjustment is all that patients need in order to correct the problems.

“Most of our patients—some had been in pain for 20 years—see an enormous improvement within 48 hours. The vast majority of them are completely free of pain within two weeks.” h&h

t he four providers at the Family Well-ness Clinic in Clayton blend compas-sion, competence, and exceptional

levels of cooperation for all the patients they serve, from age six and up.

Their combined talents and commit-ment continue their recognition, on the federal level, as a Patient-Centered Medical Home—acknowledged as the highest stan-dard of primary care. “The medical home is . . . a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on qual-ity and safety,” the federal guidelines say.

Dr. Bhavna Vaidya-Tank, founder of the Family Wellness Clinic a decade ago, is the architect and overseer of this unusual and highly effective health care delivery system.

“We all four see our own patients and each of us has a different approach,” she ex-plains. “That in itself makes us unique. Some patients like seeing Shannon, others choose Jamie, or Jason or me. Patients are free to choose whoever they want to see.

“We constantly share thoughts and information. We share articles and have meetings where we pull charts and talk in-depth about specific cases. Collectively we put all of our training and experience and knowledge together, and it’s pretty potent. We think this approach provides each of our patients the very best we have to offer.”

Shannon Mooring, an Adult Nurse Prac-titioner, has worked side-by-side with Dr. Tank for over four years. She completed her Master of Science degree in Duke University’s cardiovas-cular Nurse Practitioner program, and has had extensive experience in hospital and private- practice settings for more than a decade, with special interest and training in cardiac care.

“In this practice, I see patients 13 and older, and because of my interest and experi-ence, I often see patients who may have car-diovascular issues. One of the greatest things about being part of this practice is that we all collaborate in the care of our patients, which is a great advantage—having more than one brain on a case.

“All of us—Dr. Tank perhaps most broadly—keep up with current literature, and offer the best tests available. For example, we’re now offering the Corus CAD test that predicts the likelihood of obstructive heart diseases that is actually more sensitive that a stress test. And it’s only a blood test, and is thus completely non-invasive. It has been really helpful to us because it can tell me the percentage likelihood that an obstruction exists.”

Jamie Darby—Miss Sunshine to many of her patients—is a Family Nurse Practi-tioner, with a master’s degree from UNC-Wilmington. She has been with Dr. Tank for several years.

She especially relates well to children and their parents. “I have four children my-self,” she says with a smile. “One in college, one in high school, one in middle school, and one in elementary school. Therefore,

when it comes to children, I am a realist, and of course I draw on this long experience of parenthood when I work with parents and their children. When I share my personal stories with my patients, you can often just see the stress melt away.

“My daughter asked me the other day why I liked my job. And I told her, “I just love my

patients. Every patient is like a new story in my life, and each is a new opportunity to be helpful and enhance, as I can, their physical, mental, and emotional well-being.

“I coax and encourage many of my patients to engage in simple but extremely important lifestyle changes in an incremental way. Very often these are changes related to diet and exercise. Some patients think it’s a huge undertaking to make these changes, and I’ll often end up suggesting two simple tasks.

“For weight loss patients, who I see every day,” she notes, “I’ll ask them first and foremost to stop drinking their sugar—in sweet tea, lemonade, juice, and sodas—and walk for 15 minutes every day. Just those two things.

“These are important but simple re-quests. Most people feel they can do what I ask—and many do. And then they begin to see the results and suddenly they’re motivat-ed to do more, and even when they slip, they can remember their successes and move forward again.”

Jason Newman joined the practice this past January, after holding several research posts. He completed his Master-level stud-ies as a Certified Physician Assistant at Shenandoah University, in Virginia. He has

a BS degree from Virginia Tech in human nutrition, foods, and exercise, with a con-centration in dietetics.

“By training and by inclination, I tend to stress lifestyle issues with all of my patients,” he says. “I’m always encouraging a healthy diet, optimal weight, healthy exercise, avoid-ance of smoking, and alcohol in modera-tion—because each of these issues, collec-tively and separately, contribute to general well-being.

“Diabetes, for example, is a common chronic condition—typically the sugar level in the blood has been too high for too long. We need insulin to absorb sugar, which overworks the pancreas to produce insulin. Eventually, the pancreas loses its ability to perform. By the time a person develops diabetes, half of their pancreatic function is gone.

“And of course sugars are toxic, run-ning in the blood stream, potentially causing problems to the eyes, the kidneys, to the nerves and the sensation of the skin—and diabetes can increase the risk for infections and heart attacks and strokes. The sugars are so toxic, they contribute to chronic inflam-mation.

“A 28-year-old male came to me with an A1C of 12.5 percent—a test that gives the average blood sugar for the past three months,” he recounts. “He was three times over the level of a person without diabetes, and he was on medication for the problem.

“I tweaked his medications a bit, but more importantly, I encouraged him to change his eating habits, and start exercising. Three months later, his A1C was down to 6.6. He made awesome improvement. At 28, he is a young guy, no longer a ticking time bomb for uncontrolled diabetes for years to come. A commitment to lifestyle changes made a huge difference.” h&h

for more information about services at the clinic, contact:

Bhavna Vaidya-Tank, MD FAMILY WELLNESS CLINIC

�07� Highway �� west, #��0 clayton, nc �7��0

telephone: (9�9) ���-�7�� info@claytonclinic.com www.claytonclinic.com

f A M i L y w e L L n e S S c L i n i c - c L A y t o n A n d R A L e i g H - B H A V n A V A i d y A - t A n k , M d

Sharing Skills to Aid Patients“We all four see our own patients and each of us has a different approach . . .

that in itself makes us unique.”

a Raleigh PReSenCe

COMing SOOn!Responding to many

requests, dr. tank is opening a Raleigh

satellite office. for more information, call (9�9) ���-�7��.

Dr. Bhavna Vaidya-Tank Shannon Mooring Jamie Darby Jason Newman

Originally published in Health & Healing in the Triangle, Vol. 17, no. 2, health & healing, inc., Chapel hill, nC, publishers. Reprinted with permission.