Medical / Dental Consultation

Dr. Gittelson has been in private practice for more than thirty years as a general dentist. For the last thirteen years, the focus has been primarily on TMJ, head, neck and facial pain diagnostics and treatment.

Dr. Gittelson has extensive and ongoing training in the science of jaw joint and facial pain diagnostics and TMJ MRI interpretation. He received this training at the prestigious Piper Education and Research Center (, in St. Petersburg, FL under the direct tutelage of Mark Piper, M.D., D.M.D.

There are three areas of diagnostics to consider when evaluating the TMJ patient as all are potentially inter-related.

  1. Status of jaw joints
  2. Status of the bite
  3. Type of pain patterning the patient may be experiencing

These three variables must be accounted for at the initial presentation of the patient and then a projection can be made as to how they might change in either a positive or negative fashion over time.

Jaw joints can be:

  • Unstable
  • Painful and limited during movement (e.g. talking and chewing)

Bites can:

  • Change with teeth no longer touching properly in the front and/or back of the mouth

Teeth can:

  • Break, wear and loosen

Pain can be directly from the:

  • Jaw joint itself
  • Muscles that control head, neck and jaw position

Pain can be referred from the jaw joint to the side of the:

  • Head
  • Jaw
  • Ear

Pain can be referred from the muscles to the side of the:

  • Head
  • Forehead area
  • Into the teeth

TMJ patients also have neck problems presenting with:

  •  Forward head posture
  • Pain radiating from the upper cervical region over the top of the head to the forehead
  • Pain radiating from the upper cervical region wrapping around the side of the jaw

TMJ patients also have facial/skeletal distortions involving both the upper and lower jaws with:

  • Retrognathia
  • Chin point

In order to properly diagnose and treat the array of symptoms the patient with TMJ related problems can present with, an MRI of the TMJs must be obtained as a staring point, so that a diagnosis of the hard and soft tissue structures of the TMJs can be properly made. The MRI scan protocol followed is very detailed and specific to the TMJs, allowing for proper diagnosis and prognosis of all TMJ related issues as mentioned above.

Dr. Gittelson personally reads and reviews the results of every MRI in detail with each patient, relating his findings to the patient’s presenting symptoms. He then discusses and guides the patient through all treatment options.

All patient referrals are followed up with a detailed written report and telephone conference with the referring doctor.