Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1252 Dr. Clayton A. Chan on Gneuromuscular Dentistry : Dentistry Uncensored with Howard Farran

1252 Dr. Clayton A. Chan on Gneuromuscular Dentistry : Dentistry Uncensored with Howard Farran

9/19/2019 6:00:00 AM   |   Comments: 3   |   Views: 76
Clayton A. Chan, D.D.S. is a general dentist, clinician, teacher, world class educator, mentor and is considered by many to be the pre-eminent educator and authority on neuromuscular and Gneuromuscular (GNM) dental occlusion.  Dr. Clayton A. Chan is a trained gnathologist, who has combined expertise in both gnathology and neuromuscular approaches which is a rare combination of skills in the dental field to treat complex occlusal problems as well as handling difficult craniomandibular/ TMJ cervical dysfunction cases. His clinical knowledge and understanding on dental occlusion and its relationship to craniomandibular dysfunctions/TMD, orthodontic/orthopedic and complex restorative/prosthetic problems is what helps him convey a unique three-fold clinical message to thousands of dentists, specialists, technicians and dental leaders nationally and internationally.  His training and experience as a general dentist and dental laboratory technician along with training in the areas of gnathology, TMD, orthodontics and mastery of neuromuscular instrumentation has led him to convey a unique three-fold clinical message to dentists, specialists, technicians and dental leaders nationally and internationally who are seeking clinical answers to their occlusal and diagnostic challenges.

VIDEO - DUwHF #1252 - Clayton Chan

AUDIO - DUwHF #1252 - Clayton Chan

Dr. Chan has provided more than 4,100 hours (over 404 days) of continued education since 2009 to the present August 2019.  He has given over 202 courses on the subjects related to dental occlusion, TMD, restorative, orthodontics and advanced electro-diagnostic instrumentation (K7 kineseograph, Myotronics).

He has presented to dentists from all over the world including the United States, Canada, Australia, Japan, Germany, France, United Kingdom, Russia, Singapore, Taiwan, Indonesia, Philippines, Malaysia, Vietnam, and Cambodia.

Howard: it is just a huge honor for me today to be podcast interviewing Dr. Clayton Chan and DDS a general dentist clinician teacher world-class educator mentor and is considered by many to be the preeminent educator and authority on neuromuscular and neuromuscular the G G neuromuscular GM dental inclusion he is a trained pathologist who has combined expertise in both non ethology and neuromuscular approaches which is a rare combination of skills than dental field to treat complex occlusal problems as well as handling difficult cranial mandibular TMJ cervical dysfunction cases his clinical knowledge and understanding on dental occlusion and its relationships to cranial mandibular dysfunctions TMD orthodontic orthopedic and complex restorative prosthetic problems is what helps him convey a unique threefold clinical message to thousands of dentists specialists technicians and dental leaders nationally and internationally his training expertise as a general dentist and dental laboratory technician along with the training in the areas and ethology t md t md orthodontics and mastery of neuromuscular instrumentation has led him to convey a threefold clinical message I just said that sorry about that I repeated myself he's provided more than forty 100 hours that's four hundred and four days of continuing education since 2009 to the present he has given over two hundred two courses on the subjects related to dental occlusion tmd restorative orthodontics advanced electrodiagnostic instrumentation k7 Kinsey grab my atronics he has presented to dentists from all over the world including the United States Canada Australia Japan Germany France United Kingdom Russia Singapore Taiwan Indonesia Philippines Malaysia Vietnam Cambodia I mean I could read his bio for forty days and forty nights but let me tell you this when I would go to some of those countries like I remember when I in Singapore we saw we did a podcast with wings shoot y'all and his wife Lisa Louise yeah and that was that leader yeah and my god I mean they were your they were your idols they only associate American dentistry with you and then we went next door to Cambodia and Malaysia same thing I mean you I I think you might even be bigger in Asia than you are the United States which makes sense since they have five people for everyone in the North America but so gosh I wanted to get you on the show since day one and actually I was a podcast interviewing Las Vegas aesthetic dental lab I'm so 12:24 with ray Foster and they said well we'll get up on the show for you Howie and they delivered I got the man I got the man right today how are you doing 

Clayton Chan: I'm doing great Howard thank you for even entertaining the thought to have us on your podcast and we really are very appreciative to be able to share with you some of our thoughts and thinking 

Howard: well you're too humble my gosh so you know we just had a passing of a sort of a temporomandibular disorder guru with the late Peter Dawson this is seems to be well first of all what would what thoughts or words do you have to say - Dawson now that his career has completely passed 

Clayton Chan: yes I tell you it was a sad day for me because we recognized that Pete was fantastic he was a real leader and it really reminded me of the wonderful time I had back in 2007 after I left the Institute and he invited me out him and me and my wife to come out in 2007 to to meet him to have wonderful dinner and we had a great dinner together six of us do it Wilkinson one of his good partners and colleagues with David Newkirk Runner instructors and John Force and then Pete and my wife and we had a great wonderful dinner it will never be forgotten and I I you know I just really honored those  colleagues really upholding some fantastic light within our profession and one of the things that I recognize you know a lot of people wonder what did you talk about we really honestly talked about how we can bring our profession closer together that was the question that DeWitt Wilkerson asked me that dinner night it wasn't about philosophy because we recognize that we all have our own philosophies they weren't going to sway me one way the other and I knew that there I'm not going to play them because we live our lives and practice with conviction and but the time was just really wonderful Pete whether you can see as a wonderful father figure and we were all very humbled by each of this and then when I went to you a couple years ago to Chicago I saw John cram  and he reminded me of that dinner time that they all heard about and I saw John Force there their head that runs the Dawson Academy again she reminded me of the wonderful time and I we exchanged wonderful words and the thought was bringing our profession together that to me was really what hit home and that's what I've been trying to help with in our our dental community best we could 

Howard: well humans are complex and they're not you know they need to be together from A to Z I mean you can't even get a dentist to agree that amalgam last longer than composite if you can't get them to agree that then does evidence even matter I mean you can show them a hundred studies they show amalgam last twice as long as a posterior composite no say oh not in my hands do you think of all the specialties do you think inclusion has camps the furthest away or do you think there's other can especially these that are more opposite 

Clayton Chan: well you know my arena has always been in this interesting topic of occlusive I know it's been very emotional and heartfelt by many that really get into it because it comes down to how do we relate the lower jaw to the upper jaw with our patients what about right and you know whatever materials we want to put between those top and bottom teeth that's a whole different interesting discussion but even my interest was always in that area of occlusion I know it's been a hot topic for over 170 years and what really hit me was when I came out of dental school when I'm actually when I was in dental school I was delivering a three-quarter gold crown one of my requirements and at Loma Linda where I'm a graduate and I remember doing that first crown and putting it in and the patient came back he says my tooth feels like it's aching a little bit and instinctively I said well there must be a high spot so I started looking around for the high spot and I found it and I relieved that and for the very first time as a dental student having that response from the patient saying wow that feels better wasn't a huge Epiphany realizing slight  in in the bite that would throw the patient off could cause a tooth ache or a sensitivity or some you know odd feeling and to me that always really hit home as a new beginning dental student and and it launched my thinking into my whole profession to this day 

Howard: what I love most about the occlusal cam I don't care what camp it's from it seems like any dentist that wants to go learn more about occlusion gets serious about dentistry there they're no longer thumb printing in and amalgam and taking a mush bite for a denture they actually turn into dentists scientists yes you know 

Clayton Chan: occlusion is really an interesting subject because you can't you can't see it you can't see it on x-ray you can't really grasp it because it's not on an image it's not an eye cat not on cone beam you can't see if necessary on an MRI you can't sell it because no major company or sponsorship can basically put a hand on it because it's not a product it's something that actually relates and it's actually physically within the confines of the oral cavity only the dentist has control of that relationship between the upper lower jaw when they need to and as starts back from early childhood development when the teeth begin to evolve and have a lower cavity begins to form and then the that the teeth sprout in and they become part of the belt the rate the alignment of how the arches are developed and and the vertical dimension then the answer posed are all these things in six dimensions create the lower face and the jaw and how we breathe and function so I find that a very interesting thought but years ago of course I was very mechanically oriented you know we were all into the hinge axis concept and our cheek lehder and face bows and all these things and I just wanted to know how can we do great dentistry what can I do to be much more precise more predictable in when I'm delivering my dentistry and I did a lot of a collaborations back then and I was searching for an answer of how we can bring and relieve some of the mass Kotori muscle problems that my patients were having you know like headaches and neck aches and joint derangement problems like clicking and popping and that always was not interesting to me so that's kind of like the starts of my questioning of what was happening within our profession just seeing what was happening in my own clinical practice with my patients

Howard:  so you graduated one year you graduated in 1998 one year I was one year before you how was occlusion changed or you know did occlusion change in 30 years at 32 years how was it changed since you got out of school from the didactics of it 

Clayton Chan: Wow I'll tell you I have seen over my 35 years of practicing a whole profession as leery change before as you know Howard I mean we mentioned Malcolm's the dental school was performing amalgams and now you know coming into dental school I remember doing composites I used to work for Carter cyber on Corporation and we developed hercule xrv as a former Dell technician and I saw the whole wave of light cured composites and sub-tree composites take whole throughout this profession I saw all the different four of small particle hybrids and and that went with me because it helping develop some of the light composite technologies in the shading I was part of my involvement and then I got out of dental school I got into dental school and  they're you know you're  trying to develop the skills to know how to basically do the dental thing you know from periodontal to tooth preps through fillings and root canals and all the things dentures all the things that we consider ourselves as dentists and then after I began to get out dental school you know then you'd begin to start practicing and then you realize the reality of what  is important you know what are your clinical skills like how's your communication skills and how to communicate comprehensive quote-unquote dentistry to your patients and I was practicing down in San Diego California with my brother on the coast and you 

Howard: also in 2000 and 2006 which was I can't believe how long ago that was 13 years ago you were the director of neuromuscular dentistry del VI which for a decade Elvie I was the front dog of the whole cosmetic revolution I mean what Bob Ganley and IVA Clair and Bill Dickerson on LBI and you with that neuromuscular dentistry that would you you three man you were you were the three amigos of revolution I mean it was really it's Bob Hanley dicker sitting you talk about that journey and why did that and then then later you open up your own but but talk about the lvi years 

Clayton Chan: well you know I was practicing I thought great general dentistry dance and you go with my brother Curtis I Curtis Chen he's also general Denson so we're doing soul group practice in and I was just very passionate about this topic of occlusion trying to do carpenter dentistry and basically trying to survive and  be financially successful the bottom line is we want to be able the net well not just how a large production so I focused my practice on being very small very unique and I basically communicated a lot of these concepts that we now practice to my patients back then but somehow I was on a michael maroon generate Dilla form they wouldn't get me off I wanted to get out of it's unstuck and subscribe to their program but I kept seeing these emails coming through my computer and I began to make a posting related to a proof of concepts and joint arrangement issues and I didn't know any of the players that were involved there I'll be there's largely a lot of big names there and eventually sooner or later I had a email from dr. builder person who privately emailed me and was asking me about the questions and in short he eventually invited me out to elastics into to which I never even heard of and long story short he invited me out and I presented the concept that I was practicing I asked him to come to my practice but I knew he was very busy so they arranged the time that I would come out it was in October I believe October 9th 1999 when we had that interaction I came out and I presented the concepts and and then from that point it evolved into being part of the program I moved my whole family out to Las Vegas to be part of this process mainly to convey under master concept that I was very passionate about and I called Bob Jenkins in my mentor who's the main guy up there who is a fantastic teacher and and we collaborated together to come to Las Vegas to present these concepts - this is - and for that I'm very grateful to Bill he really helped us convey the message it's spread like wildfire and we pretty much can you know capitalize on that opportunity because bill was a great marketer conveying a concept that really has been around for many many years with the science and an objectivity so we felt pretty strongly about it we knew it would wake up the profession we knew it would shake it up on multiple levels and I think many of the Ducks that were in order we were raped you know we're willing to take on the bombardment of questions and for four years between 2000 and 2004 I had nightly emails after emails from just about everybody asking questions and we were in the fray you know it was like this big battle of philosophies but you know now after all these years I recognize as far as I'm concerned there is no war there is no battle there might be some in some people's minds but in my mind that the the evidence is is overwhelmingly there but for those that have interested to find it and I think I was very proud of the fact that to see this change it became evident when I spoke at the Chicago Dental midwinter meeting this past year and from my understanding I was the only one that was speaking on the top of occlusion and was chosen to speak there at that meeting on roster you couldn't see any other topic on occlusion but I spoke on G&M; occlusion and the rooms were packed both in the morning session and in the afternoon sessions and it was very intriguing you see a lot of older gentlemen there a lot of older doctors and they're all girl respectful this listening to the message because I believe that we what we have is makes sense it's logical and it's just very clinical and it's real so saw happen over this period of time huge changes in thinking about where the jaw joints are how it works there is much more greater awareness about the muscle skeletal signs and symptoms and TMD issues and that's kind of a thought that I try to bring to light it worth in a person to wake the doctors up it's more than just bytes you know how to put teeth together in some kind of occlusion but there's physiology to this to get reliable consistent results 

Howard: so um let's um let's cut right to the chase these kids just got out of dental kindergarten school and a lot of people throw dental schools under her bus because all the kids didn't learn all those things oh my god I'm amazed they taught him everything they did in four years give him a license and turn him loose and they don't kill anybody um so so I want to first start out with with the journey she just walked out of school an hour ago she just got a job as an associate um she she knows what she knows she doesn't know what she doesn't know um what should she worry about the most what does she need to pay attention to so that she can learn from you so she has that's a sticker tongue in a light socket on a case or two where should she start this journey

Clayton Chan:  well you know the  dental journey is a double journey when you get out of dental school we don't know everything but one of the basic things I think every dental student has a desire to is that they basically can make some money you have to be able to be successful to pay the bills let alone the big huge dental bills that love bill schools are coming out but so they need to acquire some basic skills in doing basically normal everyday dentistry you have to understand that being able to look at your patients understand periodontal considerations and how to do good-quality basic dentistry fillings aesthetic dentistry and then learn how to do some great cosmetic dentistry you're very simple in a normal everyday bite I think that is a fundamental for every good dentist and to have those basically understand those skills those skill sets and then as you're practicing be aware that there are signs and symptoms that as dentists as you begin to get beyond just doing the fillings and making sure that the margins are good and your x-rays are great and there's no pure dental once you get past that concept and understanding you begin to look at your patients as much more of a human being rather than a filling or a crown or a root canal or an implant but you begin to look at and listen to their concerns of what is really ailing them and what causes teeth to break what causes teeth to become sensitive and why do gums begin to recede and those are the some of the next level of concerns that as Dennis we begin to look at for preventative reasons because when you do your next crown or the next group of quadrants of dentistry's or your necks of a group of veneers what assurance do we have as clinicians that it's not going to break and you then have to begin to realize that muscles underlying will take hold of the masterís system and create a lot of havoc that we see in dentistry and that creates the perpetuation the Unknowing creates the the unknowing of what to do a lot of Dentistry is being performed out there insurance companies are there to help support some of that but we recognize it doesn't cover getting the patient hunch percent healthy and so as dentists it depends on your philosophy of what you want to do as a practitioner if you want to do drill Phil bill that's one way and you can be a great dentist doing being very successful at doing that kind of - be then there is another group of dentists that basically I'm looking at how to be more comprehensive in their skill sets and how to diagnose better to have longer term stability of your Katia's cases not just that the fillings and crowns don't break but how do you get the whole stone mathematics system the facial system the neck shoulders and the head muscular to musculature that are part of the job mechanism how can we get that stabilized so the implants don't fail or we don't have a recurrence of need for further root canals and for pain problems that we didn't understand and how can we resolve these things that relate to the bite forces and so this is kind of like the evolution of the dentist so from the beginning doctors that are learning get some basic skills that take courses out there to help them understand you know how to do basic everyday dentistry and then when you're ready to move up to the next level then take some courses on what does dental occlusion really mean and listen to all the all the big speakers out there there are fantastic lectures and teachers and eventually I'm sure eventually you will find your way at our program occlusion connections sooner or later because you're gonna be comparing notes and seeing what actually makes sense 

Howard: so dental town there's always there's 50 sections on no time you mentioned Mike maroon generation acts he was the the pioneer for this format he he was my mentor brainchild I thought he was doing with Generation X I thought he was amazing yeah on dental town one of the forms is TMJ it's the last one just because of the tea but here's here's a the the post for today on dental town which already has like a hundred replies this guy has seven questions he says number one is there any kind of general agreement on a definition for TMD 

Clayton Chan: well you know in the team dear world it really comes down to two basic philosophies there is the one and the main group which comprises many  organizations that of whether it's Central Asian or of neuro master philosophy but it's more of a I call it a a bio physiologic based neuro master bio physiologic based concept that they recognize that the bite does relate to some of the team D symptoms the master muscle pain problems headaches neck aches issues and then the other philosophy is more of a psychosomatic philosophy where they basically don't really espouse so much that the bite or the occlusion has a lot to do it but more of an emotional stress factor and they want to basically manage the pain syndromes through either medications or other modes of therapy to manage the pain cycle so there's those are two different map and methods by which patients are recognizing where they go so it's psychosomatic or what psychosomatic psychosocial versus a bio physiologic of philosophy where we recognized actors recognize that the jaw the relationship between the top and bottom teeth relate to a lot of the pain symptoms  that actually a patient can experience okay so these C's one fits really well with the pharmaceutical company because you basically just sit there and write prescriptions as if you're gonna pacify that serious pain problem and then there's the other group of doctors which I'm more of that belief is that if the bite is off and if there is high purposes of clues or interfering problems it can trigger muster strains lateral pterygoid problems clicking and popping the jaw joints as well as neck issues and this is really what we find interesting within our profession so

Howard:  so I'm just finish off that so is so she just lost her job she's our credit cards max she just got a divorce she just found out her kid is gonna go to U of A so uh is there any psychosomatic component to TMD 

Clayton Chan: absolutely there is definitely I would say most of the team D even from research we found that eighty to ninety percent of these TMD temporal member joint dysfunctions are really muscle related problems bite muscle problems of course the joints are involved but when the patient is not able to find a good remedy or a resolution to the problem it does turn into psychosomatic issues you get very stressed you get depressed hangs ID kicks in all these factors are very real but I would say that that is a threat you know in general a ten percent problem relative to the bigger picture of what patients have as far as team D problems most of these TV problems I say I see in my practice uniquely out here in Las Vegas patients fly in from different parts of the country and wherever states to see us but they all recognize that there is some jaw bite problem from either previous dentistry orthodontics or something happened in their full mouth rehabs and that their muscles are paining it's just killing them and then very rare do I say oh it's a psychosomatic problem let's just get over it even though you got a bite problem you got screwed up in your full mouth so just get over it and get used to it that's not going to happen so we have to go search for that and then these patients become very sensitized to what goes on occlusal II they don't know it necessary but it can drive them pretty pretty crazy and so then it then let's at least - what philosophy is going to remedy that kind of problem those are the ultimate challenges I find that will press any clinician as far as your philosophy and a skillset of how how well does your philosophy handle those complicated cases like cervical dysfunction anti open mic problems with pain I class - division - wretched Natick problems and then a true TMJ joint arrangement problems and so what philosophy will handle that so you know the new doctor that's coming out you know he has big paying bills I think you know some of these these pain cases are gonna take a lot of time and you don't really want to be involved in that necessary as a new dentist because you got to keep the production rolling because some of these patients will take quite a bit of your time so it's either you have to charge adequately for your awareness of what that problem is instilled or make the proper referral if you don't have time to sit and take time to take and deal with each of these patients that can take some time then you need to know where it can refer them to to effectively get the job done and I find that a very interesting fact of these patients are going around the country there's a lot of millions of people like this North America Canada they're all over our profession and they don't know where to go to seek and find that help so they go from Doctor to doctor everybody has an opinion everybody has a technique everybody has a splint an orthotic or some method to pacify the situation but eventually the patient will get are spending a lot of their money and they're gonna find where it's gonna be could be a dead end for the ever so this is very frustrating you can see that on Facebook for example a lot of team Jade groups out there and these are lay people that are searching for an answer and a lot of them have been pretty well lamed and maimed four for various reasons but not intentionally by their doctor because all doctors have a good intent typically but they couldn't seem to resolve these difficult problematic cases so either our profession says you're wack we don't know what's wrong with you so you become part of the waste heap of our profession and we just don't want to deal with it or you know recognize that these people are real there is a real problem and we just didn't have the nuances as a profession or know how to understand what was really going on

Howard:  so again I am really interested in your journey so you started out with your your brother Curtis and I'm Delmar and that must be so fun your brother and then you did the LBI years and then you started your own years ago occlusion connections where it seems like you've gone from neuromuscular where it's in and dentistry to put a G in front of its eyelid I don't know how to tell you I'm there on the radio but a neuromuscular with the G so nasa k-- plus neuromuscular and the only thing I know about NASA is it's Greek the Greek word for Jah so why did you put a G in front of neural mass neuromuscular and what does that G mean to you 

Clayton Chan: well I was I was pretty much raised you might say evolved early on in my career as an ethologist I had a great teacher dr. Phillip Taylor who taught me fantastic occlusal concept it was all heavy-duty upper most real most central relation but it was a really fine fine approach to understanding how some of those things worked as far as jaw joints and jaw closing and specifically the precision in how we would adjust our bites that's where I really got a lot of influence in that natus the net the study of the jaw we were really more influenced by Charles Stewart and BB McCallum some of these great nath ologists in from Ventura and San Diego area but then as we evolved I you know one of my students after I resigned from the Institute says you know you're really an apologist and you've always been teaching neuro muster in him from an ethical standpoint and he says why don't you just put the G in front of the NM since you have resigned from the Forman Institute that was espousing a form of nm and he says I think that would be much way a better way to blend the process you know and I thought that makes total sense because I am an apologist I am an ER master doctor I believe in both philosophies and that's how we evolved with the novice in the neuro master blending together and that's really what I've been practicing for quite some years now and that's what doctors come to what I understand what is it that they're missing in their approval or team D philosophy

Howard:  so um the reality is that of the hundred and fifty thousand general dentists out there if someone has any problems with anything to a TMJ or whatever probably 90% just do a FA for a night guard and they someone comes in and does the insurance range of her night yard and they leave then the assistant comes in and takes alginates and makes an upper you know just a splint and that's how it's done ninety percent time so she just graduated dental school she became a dentist because she want to be like her mom now she's in this size family practice that's how her mom teaches TMJ and she's sitting there wondering you know is is that how you stabilize patients with masticatory dysfunctions and is that how you do it is that what you do to start you just take alginates and send it to the lab and make an upper property I mean you agree or disagree that that's how the already even is treated 

Clayton Chan: yeah I remember you know you know in dental school they don't teach you how to find the proper bite your job relationship with patients that have jaw dysfunction problems if your patient has clicking and popping in the jaw joints just asking the lab to take upper/lower impressions I have some malls here and then just opening up in size of pin to millimeters and make some kind of appliance is not necessarily going to work all the time you're going to end up guess where grinding when you deliver that splinter appliance is you're going to end up grinding often in the second molar region so the question is why are we having to grind in the second lower region it's not because the lab screwed up but it's typically that we as dentists never recognize the other dimensions the  pitch the yaw the roll dimensions or the decompression acts of aspects of the jaw joints that were dysfunctional that when we just ask the patient to the lab to open up the bite and you make a splint it's only going to be fitting to that relationship when you put that splint into the mouth naturally it's going to be high if the condyles and the jaws are up and back so in order for me to be much more consistent and reliable for my patients that come in from wherever I don't have time to be wasting time and they don't have time to be wasting on me because we charge a pretty good hefty fee but they want something precise so when I take my bites to a new graduating student I say hey pay attention to how your patients jaws are talking when the patient is talking with you they're not talking in some kind of retracted position when they're speaking and their front teeth are opening closing watch that anterior poster relationship look at the front of relationship as they're talking with you and then when you then say hey bite your teeth together typically the job and goes back but that's not the but you want to build to you want to bite build the or construct the the splint to a much more physiologic relaxed position and you can see that but oftentimes you know we think that the jaw joints are the the focus on how you're going to get the proper jaw relationship and I'll tell you it's not specifically when you have dis dysfunctional problems bent conned outs beaking sclerosing all this osseous regenerated degeneration you can't we can't as a profession rely on those pathological conditions to restore something physiologically back to health so your patient I have told our doctors even in our Chicago Dillon did Midwinter Meeting shake take some cheek retractors break up the proprioceptive in grams of the jaw and watch to see how that lower jaw and the teeth relate to one another and you'll see that oftentimes people that have joint arrangement problems are going to naturally flower slightly forward not in this prognostic position but in in a slightly more relaxed position and facial form is going to look prettier too 

Howard: so on the Dentaltown throat it's kinda interesting he said he's got 7 questions on TMJ and this threads exploding and the first one is there any kind of general agreement on the definition TMT you answered 

Clayton Chan: well his second one is there any agreement on a set of condition sign septums that is considered diagnostic 40 MD which is exactly what we're talking about she came out of dental kindergarten school what clinical signs and symptoms should she be looking out for well there are a number of them and see this is where it's so amazing that the dental student is fresh with their physiology they're fresh with their their anatomy and if they can then relate what they just recently learned they took their state boards for example on for example the muscles of mastication when we do a examination for a muscle palpation we should consider this and I'll ask the question to our young colleagues when the temporalis muscles are tender what does that mean to us clinically when the mass tory muscles are tender to palpation what does that mean to us clinically occlusive lee when your SEM muscles are tender and they're not feeling too good or anywhere around the head neck or the jaw when these muscles are tender it should mean something clinically to us and not just to forget about it so let me give you a couple little tips for the ardent young colleagues if you're tipper alice is tender what that means is that the anterior poster relationship of the jaw is slightly off it's basically functioning slightly poster to really where it should be if the facial muscles are tender it tells you that the front teeth are hitting slightly prematurity more than the back teeth think about that when the occipital muscles back here or these muscles it all relates back to specific things on the teeth that's how I kind of convey it even in our level one course at occlusion connections and all of a sudden the lights go on and say wow this is what muscle palpation means to me because we were as dentist trying to be comprehensive our patients are laying there with our gloved hands and we're going through this most of our patient process and we have no understanding what this means right we just write this down it's tender here and tender there and and then on with the show let's go ahead and find the existing conditions of where the the deficient margins are what's broken and what's where is parallel but we don't have any relationship of what this meant and in dental school we should have emphasized when muscles are not comfortable when they're tight when they're showing some tension that means that the whole lower jaw mechanism is not totally neutral that means the occluding positions of what's presently there is not necessarily reliable anymore so adjusting the bite to that existing position only will enhance the tenderness of these abnormal muscle problems so that's just the beginning of how some of the signs and symptoms relate there are many signs and symptoms that we show doctors a whole list of things like headaches TMJ pain limited mouth opening ear congestion feelings ear you know vertigo a loose teeth a clenching and grinding are all some of the many symptoms that relate to unresolved or unhappy muscles of your patients that will relate to strain tooth breakage to sensitivities stuff like that which end perpetuates the dental cycle

Howard:  okay number three if I just keep going on this list this is something she says the next one be hope is there any diagnostic test equipment that she needs some some people like like you talked about my electronics um is there what would TMD equipment does she need?

Clayton Chan: first before it make that this next statement about equipment I'd say first the dentist needs to be astute on their diagnostic awareness just as a human being understanding how jaw muscles a jaw joints and relate to the jar relationship that is fundamental with whether you use instrumentation or not just having that diagnostic awareness of jaw relationships that there can be a better job relationship if if the patients are having these symptoms all right now from an objective standpoint and this is where neuro mustard nm shines it's basically with the my electronic technology that I specifically use and endorse the objective technology allows us specifically and I'm going to emphasize this way that we can 8-bit we're able to see from a physiologic standpoint using low-frequency tens and in Vantaa jar relationship not a strain relation we're an involuntary movement and we can see that by jaw tracking it we can see that on our computers without touching the patient the patient's sitting up you can actually physically physiologically see a job position in space in six dimensions I should say at least three dimensions sagittal frontal and vertical and you can see where that jaw would like to be without forcing the job and the way you see that is with frequency tends where you actually get a stimulus of the jaw that decrease a involuntary movement of the jaw and that involuntary movement creates a pattern that's consistent that you can actually see the frontal ap frontal our relationships now you might most doctors that are hearing technology always hear the emphasis on EMGs well I will put this to bed here EMGs don't take a bite mg's does not relate the jaw lower jaw to the upper jaw physiologically but you do see muscle activities so when we are listening to a word neuro monster in our occlusion connection philosophy we emphasize to our doctors understand what the low freq sweet ends does to find the jar relationships and then you can track the jaw objectively without manipulating the jaw in a fizzle out manner and you can see the dirts between habitual closing patterns versus physiologic closing patterns and that to me is the essence of why I do what we do and teach mainly emphasizing that part of mythology with the neuro much instrumentation and then we will then layer that there later on down the line with what does EMGs mean main meaning that if you monitor muscle activities and you can see if the muscles are hyperactive or low but you can pair that with Tenzing before and after and therefore it then it gets into a lot of diagnostic concepts another aspect is using electro sonography where you can actually monitor and measure objective joint sounds vibrations of the patient that has dysfunction so these are four pieces four devices you have the K 7 which is the kinesio tape thing with the sensor ray you have the Tenzing which basically creates the stimulus of involuntary movement and then you have EMGs that mention muscle activities but doesn't take the bite but it gives you some nuance of what muscle activity conditions there are and an Alexa sonography is a fourth diagnostic tool that I use in my practice to to to decipher the the subjective concerns versus the objective that I see and then we want to blend that together and make sense out of it Howard: and and what's the difference between my atronics and tex can 

Clayton Chan: well Tex can is a recording device that is that was endorsed by another competing company Tex can is basically a digital wafer and I'm not an expert on Tex again but it's a digital wafer that basically allows the doctors to see high low spots in their mouth it is a way for about a hundred or yeah hundred microns thick but of course it has many sessle's that are the sensing devices within that digitized wafer and the patient basically can pretty much bite down in their existing but excuse me in their existing bite to find the high spots all right I'm not an advocate of that because I'm when I'm adjusting my bites I don't want to just bite have the patient bite down in a habitual a voluntary manner to clean out high spots I want to find the physiologic jaw relationship so we use different parts of our k7 to find out more physical position and then refine it with what I call a scan 12 which is a high-low chart pattern first tooth contact at probably between 10 and 20 micron levels of detail

Howard:  so what would be her basic you said training first you want to you want to educate your brain the last thing you want to do is hand someone an MRI that doesn't know what they're doing um what would the basic equipment from my atronics be for to get started in this 

Clayton Chan: Howard it's very simple I think all dentists that are going down does a clue the route should have a fundamental tens unit specifically I would advocate very strong in specifically the j5 my monitor or the j5 dental tens unit the reason why this Tinian is so valve and has been heavily underrated within our profession is because well number one the j5 ten basically gives a involuntary movement a tapping sensation that breaks up the purpose of engrams breaks up the proprioceptive engrams it's not there to relax although it can do that but it breaks a proprioceptive Ingram's of jaw positioning and jaw you know resting characteristics this way I don't have to rely on joint conditions to determine my rotational and translational closing path so the tens I think is a very simple device it's not that expensive when you consider the overall bigger picture of how much dollars we spend in technology these days but the tenth unit is very key from my attracts number one because it's FDA approved but specifically it's designed for dental use it's FDA approved for dental use not just medical use and the reason why is tens is very valuable because it allows you to find jaw relationships mass your muscle dysfunction it's also that break up proprioceptive engrams and it basically helps you deal with Team J issues as far as you know these things that we've been talking about so to me Tenzing is invaluable to what we do as  GM doctors

Howard: okay and again she's very confused because her moms are idle yeah she's working with her Monday through Friday 8:00 to 5:00 and then they do any filling or a crown or anything and then the patient comes back and they're sore everybody just has some bite down on some paper and smooth it off till it doesn't hit anymore all right what-what-what does she need to be observant about a clue so we're you know I mean she's great stuff because she's confused her moms are idle and this is what her mom's been doing for thirty years and she's even in one of those fancy states like California we're not talking Kansas or Oklahoma where you'd expect this she's out in the fancy state and this is what her mom's been doing for thirty years how does how should she look at a clue zl-- where differently how should she look at him look at it differently 

Clayton Chan: well I would I was a resident of the fancy state born and raised in the fancy state of California okay San Diego gets pretty fancy you know a six minutes away from the beach and I practice four days a week there and surf the remaining two or three days a week for 15 years all right that's fancy all right so when I when you begin to look at patients bites you have to consider is this a painting patient or is this a non painting patient if the patient is not painting and they want a single crown or a single tooth just go ahead and do that normal dentistry in that existing bite don't change anything don't go around and grinding up somebody's bite that would be the worst thing you can do but if in your conversation that the patient is telling you that they get tender muscles and you begin to recognize that their opening closing path is really opening in a certain path creating anterior where facets or AB cracks and lesions and you begin to see they hit and they slide back and they hit and slide back although they always will close on their back teeth to avoid the front hit but you see the evidence of wearing of the front teeth and gum AB fractions and buccal you know where you then have to rethink what do I need to do in my cover and shake with my patient to convey to them that there is this we're and ter going on that relates to their clicking popping jaw joints and to what level is their need if you find that the patient is not really concerned about it you need to still record this and monitor it mainly not monitor it but basically let the patient know how it will impact the overall jaw condition and the long term longevity of their existing dentistry all right because it's going to end time slowly where and and create some havoc to their system if they are coming to you and you recognize that they have muscle skeletal issues that should be fundamentally addressed before you did occlusal - tree then you need to consider how can I relate the lower jaw to the upper jaw much more physiologically so you don't have to repeat the process so when you are now restoring this case properly whether it's a quadrant dentistry or group of teeth we need to know what is that jaw relationship in six dimensions that opens it for comprehensive level of concerns and now the skill sets of the doctor astronomically goes up as far as what and where do I begin alright so the bottom line is don't open up lights crazy just find a job relationship that physiologically fits the patient you can use a lower splint for for good beginners right and just watch to see what happened but just make the I would say do a lower slit don't do an upper splint because the upper sling is usually bring the job back but do a lower splint that just realigns the jaw so that clicking and popping and the jaw joints goes away so the muscles calm down when that calms down then you begin to then realize now what do I need to do how do I restore the case back so I don't have clicking and popping in my jaw joint or how do I restore that rejuvenate the case logically in a systematic way without creating more muscle tension so these are two type of patients that a young doctor has to be aware of majority of eight percent of the patients or a City percent of the practice are gonna be with every day patients that are just coming to see you for you know normal everyday dentistry all right that's fine just keep doing that dentistry that we learned in Dale school but then there's a probably another 25 percent of the patients that are gonna have these other signs and senses but they don't realize that you as a doctor has some extra knowledge to identify what would be the better jaw relationship and if you can begin that conversation that you see there's a better job relationship for them then you need to find how can i acquire that for them and stabilize and stabilize in that way specifically if they got deeper with speed warned and dentition missing teeth these things you can't just let go and to say Oh everything is hunky-dory and now if the patient doesn't value that then just let them be and carry on doing normal dentistry it's not about hooking up with a bunch of wires and Tenzing every patient that walks in a door it's about being conservative being reasonable and respecting your patients feelings

Howard:  I'm just curious I have to ask I live in Phoenix and there's 3.8 million people and every single one of them wants to live in San Diego what caused you to move from heaven to Vegas I mean the Vegas well I was wondering because is a big part of reason to go to Vegas I mean and the ABA is pulled Dennis for as long as I've been a dentist and Vegas is always the number one choice when you asked him did you stay in Vegas because it's a better dental continuing education landing place for your Institute occlusal occlusion connections comm 

Clayton Chan: yes Howard I you know I was I've been a as a former surfer I love the beach oh my goodness I love the beach and I love like the ocean air I like surfing in general but when I found an opportunity and was asked to come to present this neuromotor concept out here I have been on the most amazing dental wave ever in my life and that that surfing of this wave occlusal II has driven me to  appreciate dentistry on a whole different level and because Las Vegas has been such a great location for fly-ins great flights it's a great destination it's hot out here alright but the  location the infrastructure for hotels and  supporting is a great venue now our teaching is a very small teaching entity I but I believe we make a huge impact you don't have to be big to make a huge impact for family in our profession I found that out all right secondly the reason why I still live out here in Las Vegas because I found that the type of practice I have is very unique in that most in fact all my patients I don't have a patient of record here in town over the last umpteen years all right not a patient of records but I've been able to survive because of what we teach what we are practicing because we practice what we preach and all my patients from pain problems and whatever fly from either out of the country or out of state North America whatever and they come in because the city is able to support that process they don't come here for gambling you know they're not doing some crazy stuff out here but they mainly come specifically for treatment and  our philosophy so this really what we do here and that's one of the reason why I stayed at here sometimes being out in the desert allows you to recon template many many things in life and you consider what is valuable important so for me and my patients finding the right bite it is really very valuable it's basically for the type of Dentistry we do all right

Howard:  you know I'm looking at your courses you have one advanced principles at the physiologic conclusion level one the next one this is a September for your next one is October 1011 2019 and then you've got a advanced diagnostic principles level 2 3 oh you have introduction of micro occlusion then number 5 but anyway you have all these courses and you know what I really think you should do because I listen to my homies they email me Howard at dental town comm or they put comments in YouTube or whatever but pinky the pink is that due to something which I wish you would do they  went on Dentaltown it's hard for to go from I've heard it all the way to flying to Key Biscayne so they did a the Pinkett sue did a series of online scenes where they said we're gonna do a one-hour class for each one of our weeks so I'm Erin Becker and all those guys I did four classes for four of their week-long Continuum's and they said it bridged the gap you know so for her to sit there she's in Fort Scott Kansas City she's like Pam so it's gotta Vegas for two days but if she could hear you for an hour on an online CE that that would help her my job as a leader is trying to get her to motivate her to go but my gosh some of this stuff and then orthodontist I wish you'd make one we on ortho town - we got half the orthodontist in America on that thing orthodontists are always thrown under a bus that the in the and for the beauty they blow away the curve SP and Wilson and they they're not good an occlusion a lot of a lot of dentists say when I get these patients back from the orthodontist it's like they're not impressed is that is that a bad rub or is that a real thing you know I think because as we have to be respectful to our exist our all our colleagues

Clayton Chan:  I don't like the badmouth our colleagues because they're doing exactly what they were taught and trained to do Orthodox are there to basically treat and align teeth mal line teeth that I have that problem and

Clayton Chan:  I would agree with you they as all of us we weren't taught the concept of how to relate the lower jaw to the upper jaw physiologically and bring the teeth properly together to harmonize and support the overall body posture let me make one question a point the occlusion is not just teeth connecting but occlusion is really a a means of nature as instilled in the body's mechanism to help support long term pop proper postural stability from head to toe that's what occlusion is is if you have malocclusion or a lack of supporting bites in structures basically you jaw joints begin to collapse your discs begin to enter your eyes your head neck begins to become forward your hips begin to rotate forward your knees begin to roll in you begin your feet begin to become flat-footed so Orthodox is you really should be considering the not only the Orthodox but the orthopedic development of the jaw and this is one of the things I find of unfortunate that most Orthodox don't understand the vertical ization orthopedic aspects of how we get the jaw and the disc and the joint arrangement problems resolved now in young kids it's easy because they're they're so adaptable anything is going to go alright but in the adult problem now when adults have good relatively decent dentition they don't have a bunch of crowns they need some orthodontics as an adult stage but those are becoming much more complicated because it's not fast but we need to grow the bottom teeth up orthopedically to support the  collapsing jaw joint and the disc issue so that is what I consider orthopedics I do orthopedics my patients come in with orthodontics with team J problems and we basically help them with a orthopedic concept of how we can help them get out of the pain problems and still have a good have you know looking to eat and smiles so that

Howard:  so when you talk when I'm on your website I'm looking at um orthodontics and dental facial orthopedics yes what's the difference between orthodontics and dental facial orthopedics 

Clayton Chan: well a lot of its terminology all right as far as I'm sir and Orthodox creates the straightening of the teeth and yes some orthodontist will say oh look at we have great smiles all right but here is the next part we want not only just great smiles and great looking teeth not only just great looking profiles but we want function we want jaw joints that are dysfunctional to be functional again we don't like clicking and popping a problems we don't want airway problems we don't want breathing problems after we want long-term stability here's my thought why do orthodontist routinely give their dent at their patients retainers or lingual eyes retainers why because we know as a profession teeth begin to move again why are the teeth moving after Orthodox was performed what causes the teeth to move and I say because the teeth aren't were put in a neutral position where the master muscles and the tongue muscles was neutralizing with the proper bite if you can find that then typically ideally retainers aren't necessary to be there mechanically the body should retain itself the tongue should be retaining the arch shape the occlusion and cut spots the forms should help retain me that arch shape proper breathing should create that retention and or all those things are master muscles are all helping to support that that that that orthodontic correction but if it's not properly at just addressing the correction properly if they're not stabilizing in then things are gonna collapse and then just go right back to away so retainers I guess you're just masking the problem 

Howard: not to get too controversial but we do call this dentistry uncensored so it lives mean out um so does that what do you woody we retirement orthodontics um orthodontist you don't want to bash him or anything but now smiles direct club is gonna do an IPO very soon probably within a month what are your thoughts on that do you think this is a good thing for America um do you think it's an innovation or is a concern you or is your thought something 

Clayton Chan: yeah I'm not I'm not very familiar with you know forth events direct whatever you mentioned there I'm not sure what th

Howard: at is all involved so you could have to fill me in a little bit more about that what is it that you well it's a it's a it's a play on tell identity so you would go to somewhere the someone would scan they'd send the scanned to somebody they make things so you get Invisalign without having to see an orthodontist 

Clayton Chan: okay I see what you're tell me you know look at digitized dentistry is fantastic 3d imaging all the stuff is is technology is evolving but I don't believe that it's going to ever take away from the need for clinical dentists to make the final decision they're gonna have to be the actual treaters of this thing you can digitize and robotize all you want but it's going to take the human touch I believe that's going to have to make the ultimate decision of what art shapes are going to supposed to be you know how you gonna deal with the  breathing thing that the proper mouth breathing the tongue of posturing problems the abnormal swallowing patterns digitized dentistry can't address those factors they can't address necessary the joint arrangement issues that we as clinicians need to be very aware of as as treating clinicians when we're doing our regular dentistry so there's a place for it all it's part of the evolution of Dentistry you know this day and age is very digitized many years compared to previous years that I've been in the past but again as dentists we easily get distracted by all the the things that are dangling us and the things that we see and big conventions these things we think that's dentistry but I'm saying no those are the things that are being sold to us as dentists but dentistry is really in the dentists it's their understanding and the need for our wisdom our understanding and skill sets to be the true physicians of the mouth that's comes from here and then then we can apply these tools of the trade in the technology with our our know how to treat the human being properly

Howard:  um there's another thread and I wish it's on the under prosthodontics and this these lab guy is basically saying articulator it's the tools of the trade for success so again this little girl she's twenty five she's pregnant with her mom who's as old as we are her mom hasn't used an articulator um since Mickey Mouse met Minnie Mouse um does she ever need an articulator when does she need her to care is it okay that her mom does all these big cases and has never used an articulator

Clayton Chan:  well you know that that is a great point I you see you know I'm  very familiar with articulator alright face bows and hinge access the whole nine yards the human jaw is the best and most reliable you might say the human jaw is the ultimate articulator all dental mechanic arterial are trying to simulate the human jaw but I  don't think that there's anyone articulator that actually simulates joint arrangement problems or dist interference disorders or these kind of things and so we see that they're articulate is just a device to hold the upper and lower models together so I call them in arctica a great model holder all right so on my er tickler you know I lock all my sisal pins they're all epoxy shut I don't have adjustable pins for me the least moving parts on any identity the better I don't even worry about articular eminence now that sounds crazy but I don't really worry about article eminences anymore I used to but them all my patients have joint arrangement problems and one side is different than the other so should we use articular sure but then go ahead and mount it at least reasonably to at least simulate an open and closing jaw closure path properly to hold the bike to then create the proper whacks up or the proper device that you're trying to fill in intra orally that's deficient vertically that's all I use the articulate for I don't use it to simulate jaw lateral movement or all these things that we as Dentist  got into believing because no articular is accurate enough for a patient that is live and has joint arrangement problems but again I have articulator s in my practice here but I don't use them for those reasons all right it's how I take the bite and now a just the bite in all the Natick movements that's what the articular doesn't do 

Howard: so now are you ready for me to just get you in trouble with everybody so again I'm not an orthodontist but I do I do own the orthodontic community ortho town and send them all a magazine every month one of the most trigger words you can say is oral facial myofunctional therapist and at least 90% of the orthodontist are anyway what is your thought on oral facial myofunctional therapy

Clayton Chan:  I have never heard of it and that terminal in that manner but I do believe that there is mild functional therapy I believe that there is some valid validity to it as far as getting the tongue to posture properly dr. wing shoe in Singapore has been a very strong advocate of that I applaud him for that to me he's the new up-and-coming Jim Giri as far as that motivation drive as far as oral development and so I'm all for having the tongue properly postured and function because if you if you have tongue-tied that needs to be cleared out because you do need the human being does need to have a normal tongue that functions because if you don't have a normal tongue that's functioning with a normal swallowing pattern a normal swallowing pattern where a teeth are bracing propping together I don't believe that tongue should be posturing and swallowing with their tongue between your teeth like some others that believe that it's normal to have tongue between your teeth but from our jaw tracking technology and what I understand has stability no tongue between teeth is only a shim that's showing up a deficiency in the oropharyngeal airway space that's blocking normal tongue patterns if the oral cavity is normally developed both vertically in the back transversely and AP wise there is no reason why the tongue or the tongue should be between the teeth when you swallow teeth should be bracing against their teeth normally all right not that we were clenching and grinding all the time like that but that oral cavity in the back should have sufficient space when you do the swung act where the tongue is not going between the teeth posterior lateral tongue thrust or the tongue is now having to be displaced and really to create antrum bite problems so we want normal swallowing patterns so mild functional therapy to me is great now as far as oral facial whatever you know I know there are some great advocates of that anything to get the case in neutral I think is very important but one thing they can't the the oral facial my ologist can't always do is how to deal with joint arrangement problems joint the Ranger problems clicking popping displaced this no matter what if you don't have that result none of the oral facial whatever tongue muscle therapies are going to resolve until you get the proper supporting bite to help some of those tongue patterns and then the Orthodox is not going to be stable without a proper vertical support in the back of the bite all right posterior support is absolutely key to create joint proper joint health dis proper disposition so it's captured or recaptured or reduce it however you want to call it these things are absolutely critical so the jaw can open and close properly not just deviating to one side and then having that proper orthodontic occlusal support will help to create neutralize muscles so that patient is truly stabilized and the amazing thing is in our arena of Technology we can define and quantify what truly is stable when we mean by stable it's not just a fancy term stable should be equality of good terminal centric contact free of any interferences stability also means calm new normal muscles hurt in both the cervical group all over the head and neck you should have stability in the closing path so it's are nicely reproducible with no clicking and no popping all right and then the patient should be pain-free off meds I not pacifying themselves with stuff to keep them calm and comfortable so the functional matters I think occlude Liara quantifiable and very reasonable goals to to get our patients happy and healthy

Howard:  I still got a couple questions you do need a runner can I keep you in overtime or do I want to talk about dentistry insisting I want to talk about anything that anyone agrees on I want to talk about everything that I want to ask questions that upset you and this is basically um yeah go ahead there's basically a lot of people sleep dentistry that make a lot of claims about the relationship between sleep apnea and TMD yes so some people say there's one guy on dentaltown saying that it that if you know if you don't do a tmd workup on a sleep apnea person he thinks it's malpractice so succinctly is sleep apnea and TMD how are they related I 

Clayton Chan: there is a correlation of team D problems and sleep apnea you know one thing

Clayton Chan: I found though this sleep thing this the way you know the whole profession has shifted into an awareness of sleep and sleep apnea that really came I have to give a lot of credit to dr. James F Geary who was my former mentor he passed away in 2004 he was the doctor that basically was a pediatric dentist that basically relinquishes license in California to go into GP desert because he saw their early development of his kids in his practice creating and developing malocclusion all right from lack of airway and proper tongue posture and then turned into full-blown team D so when you can't properly breathe yes you will clench and your grind all right and these things do happen and of course there are different levels of sleep apnea there is mild moderate and severe all right I don't treat the severe kind and in those cases that do have severe sleep apnea snoring and things like that with a lot of apnic episodes then you have to work with a a sleep position and and these kind of guys to help support what we do is for inter oral appliances but here's the rub that I see the sleep the sleep thing which was a great venue for many doctors to this day because it's another financial venue for them and many and there's nothing wrong with that but if we say that all patients that are grinding and clenching is because it's a sleep problem then I think we still miss the boat because I have many patients they have had plenty of sleep studies they are normal as far as their airway issues and they have gone to sleep and they still are clinching grinding then we have to ask our profession it's not just be giving the patient a sleep excuse saying you're you have a sleep problem because you're Clinton grind and that's you know the problem no it's not there can be other underlying factors beyond just the sleep just beyond having a sleep study all right what happens at the patient already is sleep study and they're not having they're clinching and granny resolved then we have to look beyond and find out what is the occlusal problem that actually triggering this problem all right so I believe abnormal or a normal swallowing patterns normal tongue posture no oh are as occlusal jaw joint stability let me make this statement as I tell out many of our doctors at our occlusion connection courses when we understand the NASA logic and nervous principles you should be able to stop clenching and we should be able to stop grinding can't stop grinding then you might be missing something in your nap illogical and neuro muster under standing well this has been so wonderful 

Howard: I am so honored that I got to get you to come on this show I I really do think you know it would help these kids if you put a one hour online C course I think it would bridge the gap between because once she hears you for an hour she's gonna fall in love with you and like you say Vegas is that it's the best thing about Vegas is it's every city in America has existing infrastructure to fly their convenient times hotels are low-cost and like right now the ABA meeting next week is in San Francisco I mean I mean these dentists are gonna pay four to six hundred dollars a night for a crappy hotel room that has five homeless people living at the front door Vegas is just great and just just love it but um thank you so much for coming on the show if you ever want to do great something for dental town magazine or an online C course we'd love to have it it's been a complete honor to podcast you today thank you so much find some more information they can go to occlusion connection com we're always passionate in Howard thank you very much for having us on on your podcast it was a great honor and I hope what we shared will make a difference to bring our profession together thank you

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