Practice Philosophy
Four principles govern how this practice works. They are stated plainly because in a field with limited evidence, unregulated titles and expensive irreversible options, how a clinician decides matters as much as what they can do.
Diagnosis before treatment
The same symptom in this field arises from entirely different structures — a toothache can be a tooth, a muscle referring into it, or a nerve disorder — and treating the wrong one can mean irreversible dental work on a healthy tooth. So the first appointment is mostly history and examination, and treatment follows a working diagnosis rather than preceding it. An appliance made before the diagnosis is a guess, and some designs make things worse.
Reversible before irreversible
Enamel does not grow back, extracted teeth do not return, and an adjusted bite cannot be un-adjusted. So reversible treatment is tried first: appliances rather than occlusal adjustment, conservative management before reconstruction, provisional restorations tested and lived with before definitive ones. This is also why extensive irreversible work proposed as a first treatment for jaw pain should prompt a second opinion — from anyone, including us.
Say what is uncertain
Several treatments in this field have promising but incomplete evidence, and several widely-marketed claims outrun what is known. Pages on this site say so where it applies — that platelet concentrate evidence is still developing, that laser therapy has modest support, that irreversible occlusal adjustment is not supported as a TMJ treatment, that a frenectomy is not a treatment for sleep apnea. Overstating certainty sells more treatment in the short term and destroys trust the first time a patient checks.
Refer rather than reach
This practice does not diagnose sleep apnea, prescribe for trigeminal neuralgia, manage primary headache disorders, treat periodontal disease or perform nasal surgery. All of those come up constantly, and all of them belong with other clinicians. Recognising the boundary and referring across it promptly is more useful than a practice that can plausibly attempt everything, and it is the difference between co-management and working around someone.
Common questions
- Why will you not just make me a night guard?
- Often we will, once it is clear what it should be treating. The reason for not doing it immediately is that guard is one word covering several different devices with different purposes — and one of the more common causes of worsened symptoms is the wrong design for the actual problem.
- What if you cannot help me?
- Then you will be told, along with who is more likely to be able to. Not every facial pain problem is dental, and a practice that never says so is not one to rely on.
- Do you offer second opinions?
- Yes, and they are a common reason for a first appointment — particularly where extensive irreversible treatment has been proposed elsewhere. Bring the proposed plan and any records; a second opinion is most useful when it can examine the actual proposal.
Not sure where to start?
Request a virtual consultation with Dr. Samadian. In-person visits are by appointment in New York.
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