Treatments

The Gelb Centers specialist doctors for TMJ, Headaches, and Sleep Disorders/ Sleep Apnea have seen and treated a broad spectrum of illnesses and trauma, as their field of study spans from TMJ disorders, headaches, to myofunctional therapy, to breathing related sleep disorders & snoring, with emphasis on how they relate to fatigue, focus, pain, and the effects all of these can have on a person’s life. Our best in class doctor’s treatments combine a western medical background with an eastern medical expertise. Apart from being recognized for clinical achievement in their field, our doctors’ current patients include students, professional athletes, musicians, singers, dancers, and performers as well as physicians and titans of business.

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The Gelb appliance, Farrar appliance, Gelb NYU and MORA appliances all reposition the jaw to decrease clicking and decompress the

Breathing related sleep disorders are often diagnosed in conjunction with TMJ disorders. Oral sleep appliances can be prescribed in these cases.

Manual therapy can be used in the myofascial release, mobilization of the TMJs, and deep muscle therapy. Postural correction, Feldenkrais, the Alexander technique, cold laser, ultrasound, stim, heat and cold are also used. Some therapists also find craniosacral therapy to be helpful.

Applied kinesiology, ART, SOT, atlas orthogonist, and cranial therapy are all used. Foot orthotics are prescribed when needed.

Headaches that are throbbing in nature accompanied by nausea and vomiting, as well as phono- and photophobia, can be classified as migraines. An aura may or may not precede the migraine and there is often a dull headache following the migraine. There are new abortive medications as well as preventive medications for migraine headaches. Some of these medications can also help relieve tension headaches. Most migraine patients are under the care of a neurologist or family doctor and have had a brain scan which is within normal limits. Some migraineurs have low magnesium levels according to Mauskop.We have found that Botox injections have been helpful for other refractory patients. We see many patients with a migraine or mixed headache history which still have negative input into their trigeminal system. By minimizing this trigeminal convergence, we can often reduce or eliminate migraine headaches. Patients, however, still need to be mindful of food sensitivities and other triggers such as alcohol.

By stabilizing the jaw and alleviating harmful trigeminal input, neck pain can often be successfully treated by chiropractors, osteopaths, and physical therapists. Our trained specialists take a thorough trauma history and look at the cranial system as well.

By working with our team of physical therapists, chiropractors and dentists, we can determine the source of your headache. Our nutritionist will also be able to balance your biochemistry and reduce inflammation. An appropriate diagnosis can then be made and treatment recommended. Our physical therapy and chiropractic team is trained to manage myofascial pain and cervical dysfunction through a variety of modalities such as myofascial release, applied kinesiology, and cranial treatment. Doctors Michael and Harold Gelb correct disc displacements, locking and compressed TM joints, decreasing trigeminal convergence. Trigger point injections, pain blocks and Botox are also used where indicated to manage headache pain. Our team philosophy is to make the best diagnosis, implement minimally invasive treatment in the shortest amount of time and free the patient from the healthcare system with ongoing headache relief. To begin, we will work to determine what type of headache you are suffering from. We often deal with tension headaches and migraines, and also help alleviate neck pain that may be causing a headache.

The use of therapeutic Botox for chronic myofascial pain, headaches, and hypertrophic masseter and temporalis muscles has been used successfully over the last five years throughout the United States. Following the work of Dr. Andrew Blitzer and Dr. Andrew Blumenfeld, as well as headache doctors like Dr. Alex Mauskop in numerous headache centers throughout the United States, Botox is commonly used for the treatment of tension type headaches, migraine headaches, and chronic TMJ and myofascial pain. Therapeutic Botox is injected into the masseter muscles and temporalis muscles as per the protocol of Dr. Andrew Blumenfeld and Dr. Andrew Blitzer. Therapeutic Botox has also been used in the corrugator, procerus, and frontalis muscles throughout the United States for the treatment of frontal temporal headaches. Other headache centers have also injected Botox into the trapezius muscles and posterior cervical muscles. At The Gelb Center, Botox has greatly enhanced the efficacy for patients with chronic tension type headaches and facial pain secondary to bruxism or parafunction.

Diagnostic lidocaine blocks are used systematically to identify the source of one’s pain. For example, the neck muscles commonly refer headache pain to the temples and forehead. Blocking trapezius and sternocleidomastoid muscles can alleviate tension type headaches. The greater occipital nerve radiates pain over the top of the head to the supraorbital region. Once the source of the pain is identified, treatment can be directed to the appropriate area. If the pain can be duplicated, it usually can be alleviated.

Trigger Point Therapy involves the injection of a procaine and saline solution into tender points to eliminate pain and re-educate the muscles into pain-free habits. After several treatments, the swelling and stiffness of neuromuscular pain is generally reduced, range of motion is increased, tension is relieved, and circulation, flexibility and coordination are improved. Trigger point is most effective for neck, low back, shoulder and rotator cuff pain

At times the sutures of the skull become compressed. This can occur if the patient has experienced some form of head trauma. A patient who is a chronic teeth grinder or clencher can also be prone to cranial distortion. An automobile accident, sports injury and even a simple fall can create sutural compression. An accident experienced as a child, may not become symptomatic until teen or adult years. Cranial work loosens the sutures so that the cranium can come into balance. This will allow the mandible and maxilla to be correctly positioned in relationship to each other. This relationship is extremely important for those patients with temporomandibular joint dysfunction. Headaches and neck pain are common symptoms associated with cranial distortion. This treatment involves using gentle pressure on the skull and neck to release the sutures.

Manual therapy can be used in myofascial release, mobilization of the TMJs, and deep muscle therapy. Postural correction, Feldenkrais, the Alexander technique, cold laser, ultrasound, stim, heat and cold are also used. Some therapists also find craniosacral therapy to be helpful.

Breathing related sleep disorders are often diagnosed in conjunction with TMJ disorders. Oral sleep appliances can be prescribed in these cases.

Oral appliances – nonsurgically positions tongue, soft palate and lateral pharyngeal walls to open airway.

Smiles can now be simulated, displayed on a computer and set in wax to be created just for you. At The Gelb Center, we model a three dimensional smile that is in harmony with the TM joints, cervical spine and airway to aim for optimal health. What good is a gorgeous smile in a body suffering from headache, TMJ pain, snoring, sleep apnea, tinnitus or an earache? At The Gelb Center, we place the teeth in an ideal position. Advanced 3D Imaging and software, as well as our physical therapy and cranial practitioners, help optimize treatment results.

For those patients suffering from sleep apnea, a CPAP machine is often used as a treatment option. With the CPAP Machine, users will experience a continuous level of positive airway pressure while they sleep.

The Gelb Center works with top pharmacies which specialize in compounding medications to help our patients with complicated neuropathic, TMJ and myofascial pain. Materials are prepared that can be incorporated into our customized appliances to aid in the direct application of the painful site.

The Gelb Center of New York has been using and developing oral appliances for sleep medicine for over 20 years. Oral appliances work by maintaining a forward position of the tongue and soft palate as well as widening the lateral pharyngeal walls. It accomplishes this feat mechanically as well as by stimulating the oropharyngeal muscles. At The Gelb Center various appliances are used.

• Dr. Michael Gelb originally taught with Dr. Wayne Halstrom on The Silencer System of oral appliances. He then codeveloped the Norad appliance. Dr. Gelb has also taught with Oasys developer Dr. Mark Abramson. The Oasys allows nasal and pharyngeal dilation.
• Dr. Bryan Keropian the inventor of the Full Breath Solution is a friend and lecturer with Dr. Gelb. The Full Breath maintains a forward tongue position. The SUAD , Somnomed and EMA are also excellent appliances often used by Doctor Gelb and his team of specialists, as well as the TAP series of appliances and the TAP-PAP hybrid therapy.

Recently Doctor Michael Gelb has co-developed The Respire™ blue series in New York City. The Respire is an adjustable comfortable appliance with many features.Oral appliances are titrated to an optimal position to alleviate fatigue and snoring and to reduce apneas and hypopneas. Follow up home sleep studies are routinely used to insure effectiveness of treatment.

Applied kinesiology, ART, SOT, atlas orthogonist, and cranial therapy are all used. Foot orthotics are prescribed when needed.

Smiles can now be simulated, displayed on a computer and set in wax to be created just for you. At The Gelb Center, we model a three dimensional smile that is in harmony with the TM joints, cervical spine and airway to aim for optimal health. What good is a gorgeous smile in a body suffering from headache, TMJ pain, snoring, sleep apnea, tinnitus or an earache? At The Gelb Center, we place the teeth in an ideal position. Advanced 3D Imaging and software, as well as our physical therapy and cranial practitioners, help optimize treatment results.

The Gelb Center for sleep apnea, chronic headache and TMJ in NYC introduces our wonderful works with Top NYC Dential Hygenist, Khrystyna Vyprynyuk. Fully licensed and certified, not only does Khrystyna provide excellent dental cleanings, periodontal care and teeth bleaching, she offers her dental patients careful, clear instruction on practicing good oral hygiene related to overall wellness. Many recent studies have shown the relationship between proper dental hygienic care and heart disease, and other systemic conditions. Let Khrystyna, assisted by The Gelb Center, prepare a plan for a healthier smile.

Many patients come to The Gelb Center with a copy of their PSG and a diagnosis of sleep apnea. The American Academy of Sleep Medicine (AASM) recommends oral appliances as a primary treatment for mild and moderate sleep apnea. The PSG measures how many obstructive breathing events occur each hour as well as oxygen desaturation levels throughout the night. The percent of the night in Stage 1, 2, 3, 4 NREM as well as REM is measured. Patients who snore and obstruct while laying on their back do better with oral appliance therapy. Lack of stage 3 and 4 NREM can lead to fatigue and widespread muscle pain. Restorative sleep is when repair and regeneration occur and a human growth hormone is released.

Orthodontic Services Include:

• Braces for adults, children, and teens: including orthodontic lingual braces (invisible braces), ceramic braces, Invisalign, and clear braces.
• Craniofacial Orthodontics: focusing on the multidisciplinary and interdisciplinary treatment of patients with birth defects such as cleft lip and palate.
• Dentofacial Orthodontics:  the orthodontic guidance of facial growth and development for a more attractive appearance and employs special techniques aimed at realigning teeth and jaws.
• Myofunctional Therapy: a breakthrough technique to treat symptoms relating to breathing problems, tongue thrust, mouth breathing, negative facial aesthetics (skeletal structure), TMJ, headaches and more.
• Palatal Expansion:  custom orthodontic palatal expanders create more space in a child’s mouth by gradually widening the upper jaw.
• Invisalign: We are one of the only orthodontists in NYC successfully treating very complex cases for teeth straightening with Invisalign®, and based on our experience and skills, local and overseas orthodontist seek our Invisalign advice o best practices for treatment. We are one of the first provider to successfully treat more than 2000 INVISALIGN® cases in New York.