Dentistry Uncensored with Howard Farran
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1500 Dr. Ira L. Shapira, DDS, on the Science of TMD, Sleep & Neuromuscular Dentistry : Dentistry Uncensored with Howard Farran

1500 Dr. Ira L. Shapira, DDS, on the Science of TMD, Sleep & Neuromuscular Dentistry : Dentistry Uncensored with Howard Farran

11/13/2020 4:00:00 AM   |   Comments: 0   |   Views: 868
Dr. Ira L Shapira DDS, D,ABDSM, D,AAIPM, FICCMO, MICCMO graduated in 1977 but had a long history of personal TMJ disorders. Seeking treatment as a student, he was a designated patient in a host of continuing education programs at Loyola and he realized that experts had a lot to learn. He became involved in treating sleep disorders due to knowledge he received from Dr. Jim Garry that allowed him to recognize sleep disordered breathing in his son, Billy.

VIDEO - DUwHF #1500 - Ira Shapira

AUDIO - DUwHF #1500 - Ira Shapira

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*Please excuse any typos as this was digitally transcribed.

It is just a huge honor for me today to be podcast interviewing the man the legend Dr Ira Lee Shapira DDS diplomat i mean he's got so many things diplomat American board dental sleep medicine diplomat um alliance of uh tmd organization i mean it just goes on forever uh oh overrated him he's uh um diplomat American of integrated pain management past chair alliance of tmd organizations diplomat American board of dental state medicine diplomat American board sleep and breathing regen master and fellow international college of cranial mandibular orthopedics board eligible American academy of craniofacial pain professor neuromuscular orthodontics and cranial mandibular orthopedics university at castellon uh dental section editor sleeping health journal craniofacial pain section editor uh journal of cranial mandibular sleep practice member American equilibration society member academy of applied myofunctional sciences member academy of cosmetic dentistry life member ada i mean and and i mean he has how many websites two four six eight ten websites i mean the man needs no introduction I’ve known you on Dentaltown uh since 2004. um i mean I’ve um i i know so much about you and and um the reason i brought you on the show and I’m honored that you came on is um um the ada uh I’m sure you remember this post um the ada um they came out with a new specialty where is that uh uh where's that link and you wrote uh you the um anyway you posted a letter on Dentaltown uh when they did this uh deal and do you care if i read the letter no go for it okay um there it is right here aaop and ada in unethical sneaky move in dentistry that's uh that was a form it was on under dental town ethics he says in the ethics session and this time this thread just exploded i mean it was uh um everybody jumped on and piled on and now he says um he says this is vitally important please read and comment in the dark of the night and undercover of the coven 19 pandemic the American dental association has sanctioned especially in oral facial pain the ada has denied specially for over 30 years this is horrendous news for patients with tmj disorders who respond to occlusal therapy this is also a severe bloated dentist who treats sleep apnea especially those who have obtained diplomat status with the American board of dental sleep medicine and the American board of sleep and breathing these dentists have far more knowledge and experience in the treatment of sleep apnea than do most members of the aop the ada was previously sued by the American academy of head neck and facial pain many years ago for going behind closed doors to change create standards for treating tmj and the ada won this suit and the court said that the ada could hold a secret behind closed doors meeting but they could not implement that decision without open discussion the spirit of that court battle and precedence still applies the academy of oral facial pain in the ada should not take advantage of the cover 19 epidemic to sneak in changes that will forever adversely affect headache migraine and tmd patients and the membership of the ada i suggest every tmj patient every dentist let the idea know that open discussions in public should be held i have been told in the past by the current president of the aop that specialty designation is all about money and being able to change more and receive more from insurance companies and that it won't affect practice standards um and that was written to Catherine Baumann director national commissions on recognition of dental specialties and certifying boards um i mean i could go on and read the whole letter to her too uh but i when i saw that i thought oh my god I’m dentistry uncensored you can you could uh say whatever you want so that obviously i mean i i could see your face having pain when you when you wrote that why did this bother you so bad why why did this hit you so hard okay so a few things I’ve been doing neuromuscular dentistry for since 1980 and we've lived through other episodes like this in the past so in 1988 as you mentioned the ada tried to go through behind closed doors and say everything we did is wrong but they didn't actually have the knowledge for it later on the saint a lot of the same group of people went through the fda and they tried to get rid of neuromuscular dentistry by having the fda say oh my god this stuff is dangerous and a lot of the people who are well known in the oral facial pain committee actually ended up being subpoenaed by congressional committees the fda threw away all their discussions they had and basically a lot of these people are never allowed to testify at the ada again and a cash settlement was made to the company of mitronics for malfeasance on the part of the FDA panel so things happen over and over again personally to me many years ago i treated a patient he'd been in pain for 15 years i got him out of pain and gave him back his life and in the middle of this he had a motor vehicle accident and got rear-ended and all of a sudden he ended up in an oral facial pain office and he actually i ended up in the middle of a lawsuit and i had dr Charlie green on the other end of it and you find yourself in a position you never meant to get into and sometimes people tell lies but what happened to me during the course of this is dr green wrote a letter saying this is the worst treatment he's ever seen in his whole life and he said that sent it to the insurance company after thoroughly reviewing all the records of the of dr Shapira and he put this letter on northwestern university stationary and he said boy you messed up problem was there was a cover letter on that and it said i hope this gets the results you want and the whole thing was dated prior to him ever receiving the records so he made up his mind and decided to go for it these are things have been happening over and over again and it gets your dander up so as you said i wrote a letter to MS Bauman actually i wrote about 30 or 40 emails to MS Bauman and i was talking about what's going on with the council to approve a specialty in oral facial pain because it was approved well actually it wasn't approved actually the ada council that was meant to approve it denied it it did just what it's always done for the last 30 years it denied the thing except this time there was a special deal under the table we don't really know exactly what it is because all the ada members on the panel are sworn to secrecy by the ada bureaucracy now i know swearing to secrecy is in nowadays with trump around but you know the ada is supposed to be representing the dentists and taking care of the best interests of the dentists and the patients so but that's okay because there was an appeal process and on the appeal process they appointed a whole bunch of people to be the appealing things except all the people on the appeal are unnamed ms bowman refused to name him so there was an appeal meeting that overturned the council that had denied it after hearing the evidence and there's no minutes or if there are minutes they've never been released and we've asked over and over again to see them released so you say why do i get upset well I’m old I’m 70 years old I’m not going to practice that much longer but i care about my profession and when people start kicking the legs out from under it it's a problem and i don't know if we even need an oral facial pain specialty because we have medical specialties like neurology and neurosurgeons and all of them do exactly what the oral facial pain wants to do is treat these problems with medicine sometimes with psychology sometimes with psychiatry but they don't do anything different than their medical colleagues who treat oral facial pain and headaches and migraines and trigeminal autonomic staphalges what's their training they're trained as dentists why is there an oral facial pain specialty ah because the teeth and the jaw muscles and the joints are involved now there are some excellent oral facial pain doctors i had a lot of friends who are oral facial pain doctors and I’m not saying that you shouldn't learn the science and you shouldn't be able to use the medications but exactly how does that make it medicine versus dentistry so i think there's dentists and you can stop me if you want to put something in here go ahead i think it's done we have a crazy important role and the teeth are a super important part of it so the trigeminal nerve we all know what it is it's our nerve it comes right out of the brain which means all the nerves that we deal with that go to the teeth and the muscles and the joints they're not like peripheral nerves that go to your arms and your legs their brain cells you take out somebody's tooth you kill some brain cells so we have three divisions to that trigeminal nerve and it's like and they're built for feedback but if you look at all the input from the trigeminal nerve and then when it enters the brain it gets it gets multiplied it gets amplified like an old macintosh amplifier as it heads up into the brain and after it's been amplified it accounts for more than half the total input to the brain and that's we're the masters we're in charge of it we can mess it up but the oral facial pain people say boy you should never adjust occlusion to treat a tmj problem or a chronic pain problem so i just have a simple question for all your listeners have you ever put a filling or a crown in with a high spot and then the next day the tooth hurt and a week later they had head and jaw pain well according to the aop you shouldn't ever adjust the bite to treat the pain problem because it's not the cause this is a neuropsychiatric disease this is has to do with the hpa access the hypothalamus the pituitary the adrenals and i absolutely agree but there's nobody better to treat a lot of this than you and me so i think you ever treat a tmj patient Howard no not me there's no crazy people in phoenix um i I’m gonna I’m gonna keep going through your letter because i um these i mean we're dentistry uncensored and i think everything you're talking about today it would not get published uh in most places um it says dear miss Kathy Baumann um ada committee for the recognition of dental specialties and certified boards um number one not needed um especially in oral facial pain it's not needed many general practice dentists by education experience currently are able to recognize cause the oral facial pain and successfully remediate them through treatment modalities within the scope of their general practice number two anti-competitive the academy's request for recognition as anti-competitive for many reasons if granted will harm the public and gps many of whom are ada members price creating the specialty will eliminate the right of currently well-qualified gps to provide care within the scope of their experience without obtaining unnecessary specialty approval or supervision by the academy uh recognition will be in the long run exclude gps as competitors of academy members um prejudicial exclusion the academy avowedly opposes occlusion-based treatment modalities of op despite their indisputable bases in science and demonstrated efficacy through gps allowing the academy as manager of the proposed specialties standards which exclude occlusion-based remediation as one more way of limiting competition and patient access to relief currently provided subject power grab the academy and its members have not demonstrated knowledge and skill in the treatment of sleep apnea failed to practice which has enjoyed strong growth in recent years course educational fees and then this is interesting lack of grandfather status notably the academy does not propose to confer grandfathered status to those gps who are already fully qualified by training and practice to relief op in appropriate cases each of these anti-competitive designs and effects will undoubtedly draw the attention of federal and state anti-trust enforcement of bodies more litigation is the last thing the adhd wish lack of grandfather status a lot of these kids don't realize that the big endodontist of our day when we were little like like um um the mcspadden condenser out of Chattanooga Tennessee well they didn't go to endo programs they had practice limited to endo and um if you just decide all you want to do is endo you just stop doing everything else because all your friends aren't going to send you the root canal if you're going to do the crown and get them back for the cleaning and all that stuff so they realize that um what especially meant is it needs to be only that procedure to make the referring physicians in dentists feel safe to refer that you're not going to steal the whole family and the patient all that kind of stuff but when they did come out with like endodontics they grandfathered in all the people who said they were practice limited to indo do you think if they would have done that specifically with you who's got all these diplomats and i mean my god you got 10 different websites you got more initials behind your name than the greek and American and latin alphabet combined do you think if they would reach out to you and grandfather yen um this would have sat better with you and you wouldn't wrote this letter no i probably still i didn't actually write write the letter because i want the blue man standard like i said I’m old I’ve had my professional life if i want to retire tomorrow i can the reason i still treat patients is it makes me happy when i can get somebody in and change their life it's amazing i posted two videos today from two patients i saw one of them had horrible anxiety and panic attacks it's like when you can take somebody like that in a matter of few minutes take it away by working with the trigeminal nerve and the autonomic nervous system is huge why would i want to lose the ability and for young guys to lose the ability to do this the innovations in dentistry dental sleep medicine didn't come from the oral facial pain guys dental facial pain dental sleep medicine came from people who had a family member or had a sleep problem and looked for ways to fix it the very first dental sleep appliance was the equalizer by a guy named Larry glaze who was a lab neuromuscular lab tech Jim Gary did one of the very first modified herbs appliances uh did you know Jim um what is his name again Jim Gary he actually first Gary john Gary he first termed the coin or a myofunctional therapy he developed the nook not as a pacifier but as an exerciser to help kids jaws grow properly so the problem with experts is now you have an authority and authority knows better than everybody and you tend to lose things and you lose the innovation of the systems so i always do neuromuscular but i belong to the American equilibrium society this is a group of people who treat the same problems i do but they use a different methodology a different starting point and you know if you go through them an awful lot of them have very good success because even though we have different methods all of us are trying to do one thing we're trying to create a healthy patient and it's like when you define a healthy patient i define a healthy patient that when they as far as their jaw function that they function comfortably they don't have headaches and migraines and when they close their mouth from a relaxed position and they use their teeth it goes back to a relaxed position that's my definition of neuromuscular dentistry but it connects to lots of other stuff so when you take somebody in authority and they say well i don't like that and that's what happened with a lot of members of the aop when they tried to do some slimy things and destroy something they didn't like they didn't like the ability to measure that's what neuromuscular dentistry dentists do they measure they measure physiology they measure position and movement we can see where a click happens we can measure the frequency of the sounds it makes but you know all that measurements gave facts and those facts didn't agree with some people's opinions so you can't have your opinion be proved wrong by facts so sometimes the best thing to do is destroy the ability of people to measure these items and create show these facts so authority bothers me i mentioned before i was with uh in a lawsuit i did win it um but dr green was the expert witness against me and in his in his talk he mentioned lots of different things but the attorney actually asked them who's the expert and everything he said that i did was wrong and then he said well i think the academy of oral facial pain those are the experts so then i helped the attorney a lot with this we pulled out with the academy of oral facial pain head and their treatment pathology orthologies and dr green's and we mentioned them one after another and dr green says i don't agree with that and i don't agree with this and then finally he says well who do you think is expert and he says well I’m the expert i trust my opinions but not necessarily anybody else's opinions well that's fine and then he says but i don't treat tmj patients i choose not to so now you have somebody who's going to decide what the right way to treat him is but he chooses not to so i choose to treat people by correcting structural problems that put no susceptible input into the brain that's it and by doing so i change neurotransmitters in the central nervous system many of them choose to give people drugs to change neurotransmitters in the central nervous system i think there's a place for that and i think the neurologists and the psychiatrists are the ones who are best at it and the ones who really understand it better than anybody is probably the pharmacist that is i was not seeing that why do you say the pharmacist ah because they really study the medications and their effects and their side effects so long before i was a dentist i was a microbiologist at Ohio state and i still remember looking at drugs and they had a study on the very first cholesterol drug and it was going to stop people from making cholesterol that we wouldn't have any cholesterol problems well it turns out it stopped people from making cholesterol just a step or two before it became cholesterol and it turns out the products that accumulated in the body were a whole lot worse than cholesterol and it would kill people faster than arthur sclerosis ever would so every time we have a drug we have a side effect i understand that they want to use drugs to treat these problems it's easy the problem is read the list of side effects read the problems it's like if you can treat a patient without introducing lots of drugs and giving back their life why give them a toxic minefield of drugs that may or may not help most of the patients that come into my office and most of the members of ikma itmos the neuromuscular scientific group all of us have we have people who come in with a list of 10 20 30 drugs they've been in before they got into our offices well why did they come to us because they've been through the medical route and it didn't work well now if we send them to an oral facial pain person instead of having a neurologist psychiatrist neurosite guy giving him the prescriptions we're gonna have a dentist giving them the prescriptions I’m not sure that's how i want things done and it doesn't mean i don't like these people there's very smart people i listen to jeff Okeson the guy's brilliant but you know at a meeting recently with him about a year ago he's doing sphenopalatine blocks are you familiar with those yes i love sphenopalatine blocks they've been around for over 100 years they're one of the safest things in all of medicine and jeff operson uses them at the tmd program he's in and the residents go and do sphenopalatine ganglion blocks using an instrument called the sphenocath and every time the patient has pain they can come in and have a phenopalatine ganglion block I’ve been teaching for the last 35 years patients how to self-administer sphenopalatine ganglion blocks with cotton tip catheters that are sterile it's real easy i you know i love that video on your website but i don't interrupt you but you have so many websites um you have um think i hate delaneydentalcare icmo international college of um orthopedics um you have so many websites but when you're talking about that you put up those two videos which one should they which website should they see those videos ah that you have to go to my YouTube channel for so my YouTube channel the easiest way to find it is just to google think better life YouTube I’ve got about 200 uh i got over 200 videos there yeah his so his uh website is um um his YouTube i have it right here where is it um did you know you can um okay else I’ll go to think better life on YouTube think better life where'd you get that name at what was my web guy he said we need a good name what do you do i said i give people a better life so he says good we want people who are thinking about having a better life so those two videos that you uploaded today are those on your YouTube channel they're the first two on my YouTube channel right now um both of them only oh two hours ago once the uh DNA appliance okay so that see the girl okay so continue go ahead go on okay the first one with the dan appliance she was a terrible tmj patient she had five years of severe disabling and pain that didn't allow her to live her life she had to quit her job and move back home with her parents it destroyed her life she'd been to tons of medical specialists we put her in a neuromuscular appliance she got better the first video was three years ago she did a video talking about living with five years of severe pain and then this was the second video because she's been up in Canada for a long time and she moved back and so she we put her in a dan appliance epigenetic orthopedics we grew her a bigger airway and we shared her sleep apnea now ideally in a more civilized society we wouldn't have all these people with sleep apnea because if we had proper oral facial development we can grow kids out of it and when we grow them out of sleep apnea we grow them out of add we grow them out of adhd these kids all an awful lot of these kids have adenoid faces they don't look right they have these allergic faces and you can recognize them i talked about Jim Gary before in 1967 a book was published a stigmata of respiratory disorders so you must be catholic then right no but my son-in-law started out studying to be a catholic priest because i thought the stigmata wasn't that the yeah these are the signs of people who are suffocating when they're growing up in kids and we've been ignoring them so are you familiar with dr Corey Cheney uh Corey Cheney was he with um was he with um um James Gary he's the next generation at the same time as Jim Jim Gary was a neuromuscular dentist pedologist who was treating teaching us that we have to grow healthier kids and healthier healthier airways he was neuromuscular if you went to the centric relations side of the world brain palmer who's just a prince of a man was doing the same thing JAMES f Gary DDS out in Fullerton California was a pediatric dentist neuromuscular pediatric dentist yes damn huh that is uh i i i didn't realize he was a pediatric dentist but anyway um but sorry to interrupt keep going and forever i owe him a debt of great because what he taught me in the early 80s is what allowed me to recognize when my son was between three and four years old that he had airway problems and sleep problems at five years old my son was told he could not stop start kindergarten because he had add they wanted to put him on a ritalin for the rest of his life you know when your kid can't start kindergarten you worry what's going to happen to him i was talking to jim gary i kept talking to the doctors the pediatrician says it's not a problem ent says it's not a problem you know if it's your kid it's a problem i took my kid to rush medical school dr cartwright roslyn cartwright was there i just got very lucky because she's the mother of all of dental sleep medicine she brought my son in she did a sleep test turned out he had an apnea index of 60. he quit breathing once a minute all night long we took out his tonsils in an adenoids we widened his mouth orthopedically and this kid who couldn't go to school without ritalin became a straight a student and graduated college double major double minor magna laude drug of choice oxygen the American dental association now recognizes this my son just needed to breathe at night the American dental association has been having programs on pediatric airways kudos to the American dental association but it hasn't been accepted by the American college of orthodontists so robert corraccini wrote a book what anthropology teaches us about ortho ortho orthodontic diagnosis and what he showed in his studies was that for the last 400 years people are growing smaller jaws and smaller airways we are growing unhealthy children we are turning evolution backwards so epigenetic orthodontics is what we call the dna appliance because we correct the phenome the phenom we correct how people grow when they take out four teeth on a child and they do suck back orthodontics and they crowd the tongue the child has to make all sorts of compensations just recently just in the last month or two if you googled shrinking jaws in stanford there's a huge article about how humans are getting shrinking jaws and smaller airways all of these things lead to lifetime lifetime problems of pasture of memory of thought how we function it can lead to lipid problems in our bloodstream it can lead to insulin resistance problems as you get sleep apnea can lead to heart attacks and strokes this is important stuff and it's you need the innovators to do this the experts just want to follow the protocols somebody had to come up with the information to make the protocols you know i saw another article um you know we'll go to another especially um the uh oral surgeons there was that you know they made the new york times where was that article on um oh yeah new uh mu orthodontist getting new york times article how two british orthodontists became celebrities and uh and it's just a huge threat on dental town but i always i always think what's most interesting is um i you know i podcast interview 50 orthodontists on this show and i just point blank and like myofunctional therapy i said is there anything you agree with that or any nope I’m just like wow i mean just dead it's like next question it's like really you can just throw that whole thing under a bridge like that and they go yeah and and on this one um when i posted that i actually got personal emails from three arts and i was saying Howard why do you post that on your you know what i mean and number one let me let me answer that like like I’ll give you another example like um when it's some bad like a dentist gets arrested uh say it's arrested for opium or a hidden camera in the bathroom or whatever um you need to post that because when i posted that one about the canadian who hit a camera in his bathroom was filming his tab in the bathroom and all these people are downtown like oh my god you're ruining our reputation and why do you post that stuff and i said because i believe that some people have brain health issues and i think sociopaths don't know their sociopaths but maybe a sociopath who's a dentist who sees that might analytically think wow i should not do that maybe he'll quit doing it for all the own reasons it wasn't even six months and another dentist in the states was dressed for that so i put all this up there furthermore your patients are reading this stuff about um these two british orthodox i mean tell me the new york times so you're telling me that a story in the new york times about orthodontics that I’m the bad guy for posting it i mean how dumb can you be uh but anyway um but I’ve noticed this the whole time um some call it turf force but did you see that the the new orthodontic article in the new york times and is that kind of the same thing that you're talking about okay so i did see the mew article and the problem with mewing is it's too little too late and dr professor mu and dr mu both in england in england guess who rules all the specialties it's the orthodontists well the orthodontist didn't believe in two-stage orthodontics so they decided to get together and rule on whether or not this was good or bad and they said well we think it's bad because we don't do it because if we if we don't do it and it's good then we're not doing it right now in this country we've been putting people in expansion appliances forever and ever and there's all different types so i use a dna appliance a long time ago i did a crozats put their shorts appliance there's bionators and they all work so how do people grow how does orthodontic work orthodontic work you put pressure on a tooth and that puts pressure on the bone where the pressure with the bone is under pressure it shrinks away and you get osteoclastic action but on the other side of the tooth you have little periosteal ligaments that pull on the bone and so it causes the bone on the other side of the socket to grow well this is important stuff because that's why we can move teeth through bone ah but you can also move it too far through the bone so you can get too much of a good thing and that can happen as the chair of the tmd alliance i wrote letters and got other people to write letters to stand up for dr mu in our country in la we have dr hang who's growing people bigger airways in Chicago Illinois we have dr Kevin body he grows healthier children how does he he's not an orthodontist but he uses orthopedics and he does it starting at a very young age I’m thrilled he's there because if he wasn't there I’d be morally obligated to treat little kids and i don't want to treat little kids I’m too old for that when they come into my office i make them balloon animals but Kevin body he's changing the world if you go to Lauren Lori’s children's hospital connected to northwestern university they send all the kids with problems to him if you catch these kids early you can change their lives and the sleep expert at university of Chicago dr gaze he says if you haven't grown these kids bigger bigger by the time they're seven years old it's too late when i was young younger i used to think i was brilliant because i got my son in to have his sleep apnea treated at five i thought that was the greatest thing in the world but right now i know i was two years too late because those first five years of life is when we get the most brain growth how can we say we're going to wait till kids are 12 or 13 or 14 year old year old to work on making their airway better how soon how long do you want to go Howard without being able to breathe the rule of threes you can only go three minutes without breathing three days without water three weeks without food that seems a little extreme do you do i don't think the rule of threes is uh working here i think it's six minutes without oxygen but an interesting thing because i have a friend who actually developed their brain resuscitation machine and when you go without oxygen the problem isn't that you're going without oxygen that does not kill your brain what happens instead is when you re-oxygenate the brain you've built up lots of free radicals from the time you were without oxygen now when you add oxygen which is very reactive the oxygen combines with the free radicals that makes more free radicals which combined with free radicals and you get an oxidative stress disaster that's what destroys the brain there's a company called organ inc that actually pass cools off organs for donation and they pump antioxidants through them to keep them alive in some of the early studies they were able to take dead organs and transplant them with almost perfect success even though they didn't meet transplant protocols these are the things that are happening that are important there are so many things out there how soon is soon enough to treat a problem that can affect you for the rest of your life and it can be a cosmetic problem so the i talked about the adenoid faces if you went to university of michigan and you go to mcnamara's book he wrote a book oh probably 25 or 30 years ago talking about nasal respiratory function being able to breathe through your nose doesn't seem all that important but the kids who can't do it don't look right they have edenoid faces they have dark circles under their eyes they usually have forward head pastures he cited a study in that book where they put genius level kids with adenoid faces and they put them in classrooms with kids with pretty little faces and average iqs and then the teachers who didn't know this had happened had these kids in their classes and they called the ones with the pretty symmetrical faces smart helpful intelligence and the genius level kids who had adenoid faces with dull problem kids dull witted and all the negative adjectives and then these kids are in school and they respond to the teachers how the teachers respond to them and we start wrecking their lives at a very young age a good friend of mine is a doctor alex goldman he started his life in russia as a pediatric cardiologist by the time he left russia he was in charge of sleep for about a third of russia when he came to this country he ended up at the university of chicago at the same time bill dement was there and ross cartwright were there that was the birth of sleep medicine in this country well i used to teach at his school his tax he had the only school in illinois to teach sleep tax so i used to teach him how to adjust oral appliances during a polysonography well one day i showed up early before my lecture was due and I’m watching the previous lecture he's showing and he has all these kids that look like my adenoid facies allergy kids and he keeps calling them flks and he says how these kids are gonna more will end up in prison and they'll end up as dropouts and all these horrible things are gonna happen in their lives and he keeps calling him flks and i just had to ask him what's an flk and he goes funny looking kids they don't look right now aside from being a sleep doctor and a neurologist and a psychiatrist he was also the head of child psych at cook county for 25 years that's the hospital in the movie er the man's brilliant he writes lectures on everything he wrote the first book on sleep psychiatry it's like he writes poems and novels and scientific articles on sleeping cancer but how would you like it if your grandson kid was one of the kids that he called an flk and said hell this kid's probably going to have a bad life for the next 50 years and it's so true because the number one goal of a species is to survive long enough to reproduce and have offspring and you got to look as pretty as a peacock and if something is wrong with your face uh you know um you know it makes life more challenging and it's obviously life's a lot easier if you're uh handsome right yeah here helps too but we seem to have failed that do you know why um i cannot prove you that I’m not two-faced why if i was two-faced would i be showing you this one oh good point so yeah beauty is um very very important um you've said so many things i didn't want to interrupt you because you're uh um you're i mean just amazing um all you've done in all your qualifications but i I’m uh gotta speak for the the kids here so one fourth of the people listening us to us today are still in dental kindergarten school and really um you said you were old twice um I’ll go on the record and say I’m actually dead uh but these kids they get confused the first thing they get accused of tmj is some of you older guys call it neuromuscular and some of you guys uh call it cr pinky whatever um and that is a confusing thing they don't want to sign up for uh this course if they think well is that the right one so why are there two i mean is there two types of ortho or endo i mean if you want to learn how to do a root now they don't say well are you an apical barbarian like Howard who wants to seal her out the apex are you one of them pulp lovers like Ira who just wants to get a half millimeter from the end you know i mean so why this fork at the road and how would you answer that question okay so i'd be happy to talk i did actually give at the American equilibration society i wrote an article on neuromuscular dentistry and how i defined it and when i wrote that article it was specifically designed for cr doctors to read it but the first thing we have to understand about the draw it's a three-legged stool have you ever sat on a three-legged stool Howard yes okay all three legs are the same length it works pretty good right what if one or two of the legs are slightly different lengths does that rock bother you a little bit it kind of makes you crazy so if you sit on it for five minutes it's no big deal but now you're at a bar with friends and you're sitting on this three-legged stool that rocks and it's like if you had a pack of matches you'd put it under the leg to steady it but nobody carries matches anymore so instead you put one arm on the bar and you put a leg and stretch it out and you figure out a way to stabilize yourself and then you sit there and vibing for two hours at the end of two hours you hurt all over your body that's kind of how the jaw works we have two jaw joints and we have teeth and if everything closes perfectly all the muscles work the way they're supposed to we close we don't over stress our muscles and then we relax if it doesn't happen that way what do we get well we use our muscles to protect the hole so if you're going to give it a name i would call it muscular dentistry because if you use your muscles to protect the hole that's what's important that's what muscles do all over the body is they protect us and if we use them right they do a great job the problem is we use them wrong do you know what a repetitive strain injury is carpal tunnel rotator cuff tennis elbow if we use our muscles wrong they start to hurt according to janet travell they start to get myofascial pain and dysfunction they get shortened taut bands and trigger points that can cause referred pain now if you have a trigger point in your trapezius on your right side and you tip your head to the left it hurts but and it could give you a headache but if you tip it to the right it feels better so now you start to walk around with the head tip to the side well now that's like putting that three-legged stool on a floor that's tipped it doesn't work so good anymore even if the legs are the same length uh do you know what an aqualyzer is i think they sometimes are you sponsor them sometimes on dental sam an aqualyzer an aquila okay so marty lerman he's he's dead now he was a smart guy he enveloped he decided that we're going about dentistry all wrong and he developed an appliance that he called an equalizer it's a hydraulic appliance it works on pascal's third law of hydraulics what does that mean so hydraulics if you put fluid in a closed chamber wherever you measure the pressure it's equal so he made a little appliance that goes over the back teeth on one side of the mouth and the back teeth on the other side of the mouth and when you bite your teeth together the pressures always equalize the right side to the left instantly it's even you can look in somebody's mouth and see what's wrong but funny thing about laws of physics and science it doesn't change it's those laws are there we call them physics but they're they're physical laws that are unchangeable now all of a sudden you can see what happens I’m doing a research problem with some with some physical therapists right now that if i take a equalizer appliance and i put it in a patient's mouth who has a long leg short leg syndrome so they have a tip to their hips when they stand and we put that aqualyzer appliance in their mouth and i have them go up and down a flight of steps or walk around for several minutes and then they come back i can check the leg length on them and you know the majority of them the leg length is now equal well the question is if they had a long leg short leg and they walk around and they're now equal did somebody cut an inch off one leg or did the other leg grow well truth is that's not what it is what happened is we changed the curves in the thoracic lumbar spine and when we did that and how did we do it we did it because we balanced the mouth we took away the compensations that go from the head down to the toes and as we did that the muscles relaxed well when you have curvatures that are wrong in the thoracic lumbar spine that's sometimes called things like scoliosis but you can have a functional scoliosis and now if you have three and you can go to trebelle's book on myofascial pain and dysfunction she has a fabulous picture of it but if you go and you look where the taut bands are they're always on the inside of the curve and you get trigger points there and then you get back pain and it can be upper or middle or lower back pain now if you're going to make a tmj appliance for a patient and their whole body's out of whack and now you put an appliance or you do a crown in their mouth and now they change positions you don't have the same patient so do you know who sharington is okay so lord sharington he got a cheery nobel prize for work on what was called the writing reflex so I’m going to give a special thank you to dr Norman Thomas and you'll send me a link and I’ll send this to him because he's been pounding neurology into my head and anatomy into my head for the last 40 years except I’m kind of a sieve so i can't remember nearly enough of it what Sherrington did and this will never be repeated in humans because it's hard to find volunteers but he did tests and so if somebody was to poke you right here with a pin and you were standing what would happen is your head would pull one way and you'd fall over like a tree because you were out of balance but that doesn't happen actually what happens instead our head goes one way our shoulder goes the other our hip goes the other and we don't fall so it's called the writing reflex now a reflex kind of like the patellar reflex when they hit your knee and your foot kicks it doesn't go to the brain so in order to do his research sharing ton used these cerebral cats what does that mean ah he disconnected the brain that's why it's really hard to find people to volunteer for this project because most of us like our brains firmly attach to our spinal column but that reflex exists and it exists in all of us and it's like we can manipulate it but if we don't manipulate it our body that reflex is there to protect us so the most common place we see that reflex is when we look at new babies who are just learning to stand and walk and you look at a little kid and he's trying to stand and walk and he falls over where he tries to take a step and he falls over and we think well he's just not smart enough to learn to walk yet but the truth is it has nothing to do with the brain because the writing reflex is a peripheral reflex and what happens is his nerves aren't myelinated enough the nerve impulses don't pass fast enough that it's in intact so we have lots of reflexes when you put this on the podcast I’m going to tell you put this out there's a guy named aj miller i think he's at stanford or ucla and he wrote a paper oral and pharyngeal reflexes or oral and pharyngeal reflexes tongue reflexes so we have all these crazy reflexes in our body and they're important some of them are simple some of them are complex so when we're a newborn baby we have something called the tip of the tongue reflex it's important for development first time mom sticks her breasts in a baby's mouth the tongue touches the nipple and it immediately protrudes forward and when it does that it pushes the nipple against the roof of the mouth and the baby gets rewarded with milk baby's happy he does it again and nursing is a learned behavior but in order to learn the behavior you have a basic reflex that's there 50 years later you chip a tooth that tip of the tongue reflex is still there and now you touch the tongue tip of your tongue to the chipped tooth and by the time you get to the top to the dentist your tongue's a bloody mask you've been playing with it 24 hours a day seven days a week it's a hard reflex you say don't do that they can't stop it we have another reflex which has to do with the lateral surfaces of the tongue you touch the lateral surface of the tongue it's a retrusive reflex the tongue goes back into the pharynx you ever have it occludes the airway you ever have to fight like the devil to work on a lower tooth on somebody because the tongue is just out of control they're trying to protect their airway they're telling us i got an airway problem don't mess it up any more than it already is we know 40 of the men by the time they're age 40 are going to be having sleep apnea snoring upper airway resistance syndrome diseases like fibromyalgia that women get are related to upper airway resistance syndrome a guy named woldovsky years ago started to disturb people's sleep to see what would happen he took healthy young college students and every time they got into deep delta sleep he'd wake him up he'd disturb their sleep and what happened is they all developed fibromyalgia or fibromyalgia-like syndromes he said isn't that an interesting thing and then he quit waking him up but when he quit waking him up the symptoms didn't go away in fact these patients had developed something a pattern of sleep called alpha intrusion into delta sleep in their deep delta sleep they'd have wide awake brain waves and then they had pain well funny thing when women get pregnant first time they're pregnant even if they don't carry the baby to term their brain changes when when babies are in the house mom is the one who hears them cry not dad so what happens even when mom's in deep sleep her brain has alpha waves in her deep sleep that's so she can hear the baby cry because if you counted on dad he'd never hear the baby cry you may have a great dad he may warm a bottle or bring the baby in for mom to nurse but he doesn't hear the baby cry the only reason he knows the baby's crying is he got an elbow in his side wake up get the baby it's like so all of these things are reflexes and they live with us forever so you Howard me we all have genomes those are our genes our dna our hard wired hardware that's what our genes are made of and then we have something called a phenome so you can have identical twins and one gets fat and one say skinny they still have identical genomes but they don't have the same appearance and those are the epigenetic changes when we talk about shrinking jaws when we talk about coracini when i talk about dr hang in California and dr body in Chicago these are people who recognize this and they say why do we want to let these people develop completely wrong and once they're completely wrong now we can make their front teeth look straight by doing orthodontics well that's crazy we also know that this changes took place since the industrial age we had pollution we know the changes can be seen in utero so they're not just developmental out of the baby out of the body but also in the body so why would we wait to start to correct these problems so the brain's done developing why not grow these kids healthier mouth mouth mouths healthier airways you know ever known anybody who's had a heart attack or a stroke yes okay so we have an absolutely wonderful medication that they use for treating this except it was kept off the market for years because a side effect of it seemed to be worth a whole lot of money to the drug companies so what this drug does is it makes more nitric oxide it opens up the coronary arteries so people don't die ah but it also opened up coronary arteries in people's penises and that made it viagra so benefit and it made it so expensive that people who could use it for their heart couldn't get it because there was so much more money to be made using it as a drug for erectile dysfunction so we can make our own nitric oxide you know how to make nitric oxide keep yourself healthy um put electrical tape over your mouth just breathe through your nose you got it you breathe through your nose you got more and if you like beets eat lots of beets beets because the guy who got the nobel prize for his work on nitric oxide actually has a company um I’ve got a link to it on my website because I’ve been taking the stuff for 10 years some of the products and beats are the raw materials for turning the beats into nitric oxide when you breathe through your nose well i i first learned about this when the Arizona cardinals moved to uh from st louis to phoenix and they just happened to their headquarters right down the street from my office and a ton of them um bought homes in awatuki and i was running into a lot and they would get the um the what electrical tape is the silver i tell people that's duct tape i think i tell people to use paper tape well they would they would put out there and they would um they would all say the same thing they would say you know you uh if you just breathe through your nose you only need to breathe half as much blah blah and then the other thing they would do is they would get oxygen tents so they could be sleeping at you know phoenix like a thousand feet above sea level but to make them higher and sometimes they like to go to up to flagstaff but they'd always point out that everybody who wins the marathons they're always um oh um what's that companions because kenya is like the plateau tibet it's like a mile off the ground and humans always lived where the big river dumped into the ocean which is at sea level so when they live and breathe and do training at 6 000 and come down sea level they went just like when i went to um um the uh um mount everest i didn't climb the thing but i uh i i was thinking about it but i decided to rent an airplane to fly me over that was much more fun uh but um it was amazing the sherpas that you talked to when i was there it was no big deal they don't have auction tanks i mean they were when you're born as sherpa which is their their last name when you're born at 14 000 feet you don't impress anybody by running to the top of that hill with a bunch of rich germans so um anyway but continue on sorry you just gave a perfect lecture on epigenetics genetics genome and because the guys who've lived up high forever over thousands of years they've had genetic changes and it's in their dna but when you didn't have the advantage of living like that forever you can do your mouth taping or you can train up high in the mountains and you change the epigenetics so the genes on our dna are few and far between and in between the genes we have lots of other information on the dna and that stuff can be influenced and but you can also get epigenetic inheritance so when i when if some if a woman has a baby that baby has exactly the same epigenetic changes that the mother does and her kids will have it and it can transfer things multiple generations because the mother's eggs were in her from the time she was an infant when you're when a woman is born her eggs are already present in her uterus and so the changes that take place in this dna this is what's called epigenetics and it's crazy and this is what corey cheney talks about this is what they're talking about with shrinking jaws this is the effective environment on us and it doesn't just affect us it affects the next generation and the next generation so we can go to more standard dental work did you know that if a mother has periodontal disease she's more likely to have a low birth term or premature baby so women who have low birth weight or premature babies 50 60 years later those babies are more likely to have heart attacks and die young of a heart attack it's like the stuff that happens these are epigenetic changes but when you understand that you can have epigenetic inheritance then it can affect the generation before in the generation after so when we correct the young kids by growing in bigger airways we're going to correct the next generation as well this is kevin boyd i love it if you if you haven't done one with him you need to do one with him because he's one of the smartest people out there guys brilliant and if you talk to kevin he's worried about the future of the human race he's right we need to worry about the future of the human race you ever look around in this country and see a lot of fat people uh only when i look at the mirror okay so all the time we hear about stuff with the greek diet the french diet the italian diet the mediterranean diet you've probably been to those places the huge meals lots of fats tons of olive oil why are they fat and we aren't why are we fat and they aren't well they get fat when we give them mcdonald's and we give them burger kings my great uncle was the first guy to isolate vitamin b6 smart guy sam lukowski but during world war ii he was largely responsible one of the people largely responsible for c incurations he was a biochemist nutritionist hard science that's what he did except the last 20 years of his life as a professor emeritus at berkeley what his research was was that you couldn't get the proper nutritional value out of your food without gustatory enjoy enjoyment his words the savoring and enjoying of your food was an essential part of the nutritional process now we know we have taste buds that go all through our elementary tract we didn't know it back then we know it now what do you know about antibiotics for kids you ever see any kid get antibiotic for an ear infection oh he's got an area given addict he's got a sinus infection give him an antibiotic one of our most important organ systems and least studied ones and they're studying it now at the nih they did the genome project it took several years but now they're doing the biome project and the biome project basically says our gut our gut bacteria is an essential organ of our entire body there are 10 000 different species of bacteria in our gut and a lot of the nutrition we get we don't get from the food we get from the metabolites and the gut bacteria and then we say oh well who cares if this kid has big tonsils and adenoids and can't breathe well that's okay if he gets an eric we'll just give him an antibiotic or cut his tonsils out well that's great but every time you give him an antibiotic you mess that gut biome out a little more you also mess up the biome in the sinuses if you have a kid who gets lots of mucus in his nose what happens in the kids with allergies they get more cells that make mucus they get more goblet cells and less cells that make cirrus and inside our sinuses we have those little cilia that we learned about long time ago that moved the junk out well if you get too much mucus and not enough cirrus everything that comes in gets stuck in the muck and the little cilia can't move it out and then we start to get middle ear infections and throat infections but all these parts are connected you can't separate one from the other when i describe it to a patient talking about tmj problems but you can talk about it with nutrition problems too i tell them pretend that you're a beat up old jalopy you got a bad engine you got a bad transmission a bad u-joint you got two bent axles four bedrooms and four flat as can be tires but your husband says i love my old jalopy and I’m gonna fix her up so he gives you a brand new engine and a brand new transmission and a brand new u-joint two new axles that are perfectly straight four fantastic rims and four top of the line michelin tires and inflates the first three and balances them perfectly and damn the pump breaks so he just leaves the fourth one flat and he says it's okay it's 99 fixed I’m going to take a trip to california and before you go 100 miles you got four flat tires four battery rooms two bent axles a bad u-joint a bad engine and a bad transmission if instead you took the old schwinn pump out of the back of the garage wiped off the cobwebs and pumped it up halfway you'd be able to drive that trip 20 times it wouldn't be a great smooth ride but it would work things give it their weakest point so if you have somebody with a deviate swallow and every time they swallow they swallow wrong the tongue is the strongest muscle by weight in our body it's pushing things out of whack if you do orthodontics it's going to relapse that's what oral myofunctional therapy is it says let's use these normal tongue reflexes let's let normal function develop normal anatomy we all learned really early in our careers in anatomy form follows function we know that form follows function so if we get our mouth functioning right it'll be shaped right i go to the museum you look at skulls from a couple thousand years ago everybody has great big wide jaws and huge airways no crowded teeth when orthodontics started to do stuff a little over 100 years ago that was 300 years into the epidemic of small jaws so we establish norms but those norms were based on pre-existing pathology except for the steiner analysis who didn't develop a norm he just looked at his son and said well my son is perfect so I’m going to make that normal but all these things are are there the the normal is 400 years past are you a friend are you a fan of kurt vonnegut who's that kurt vonnegut the author no no okay so he wrote a book about how man about back into something similar to a seal um he writes interesting books should probably like them they're a little weird but so nice i don't mind them we are changing the evolution of human beings the problem is we're not evolving in a positive direction there are people out there who are devoting their life to it so kevin boyd who's a pediatric dentist and does all this stuff is also working on a phd in anthropology at penn doesn't that sound like fun that does it actually does does does so we can change things so I’m going to talk about something I’m going to pick my spg blocks right now you gonna throw me off no no i mean do that so um yeah that's a very um um interesting thing i um posted that your you have a look at it where did i post that um yeah the uh spheno palantine ganglion blocks uh i posted you you have a book on that i had an article in cranial on it um that was an accident because i wrote i wrote a paper as a mastership thesis for icmo and they said well we're not going to publish it now we want you to get it published in cranio first well they put you over the coals to get your references and everything else it was a horrible experience but now i met editor at cranio but it's but but i want to go back and before we switch subjects completely just because it's confusing to the kids okay so when we're talking about specialties and everything um you know in 1900 there were no specialties by 2000 mds had 58 we had nine now it's just 2020 we're up to 12 and they're just exploding everywhere but the equivalent especially over with the md side it's a word i can't even say would you say that's the um the um oh what is it the uh otter otolaryngology otolaryngologist ent is easier our that same thing is head neck surgery too right hns headaches head and neck surgery is a different group because those are surgeons who specialize in head and neck surgery okay how do you say oh how do you say the word otolaryngologist it's basically aaron aaron and larynx and then there's uh so there's that and um and that's the same thing as ent right it's the same thing as an ent yeah so they should just drop that what is oto rhino laryngologist oto rhino laryngologist he added the nose to the picture huh but anyway so is that our equivalent of your equivalent when someone like you is talking about oral facial pain tmj all that do you consider these ent guys your counterpart colleague on the md side so overall I’m going to say we're both looking at improving your way so when i first started treating people with sleep apnea they used to do up3s on them a up3 was a uvula palatal theram glass fairing oblasty they would cut away the tonsils the tongue the uvula to open up a bigger airway i was never a big fan of that because when i was at rush they showed it had 80 percent morbidity and less than 50 percent of the people got 50 better and they still all needed cpap i was kind of there looking at oral appliances cpap and you mentioned my website i hate well let me tell you i got a lot of flack from some of the sleep doctors who i work with because it says i hate cpap well i don't hate cpap in fact i happen to love cpap because if i can't treat a patient with an oral appliance you can give them cpap the reason i have a website called is because i'd see all these people looking for oral appliances and i just ask them the simple question why are you here and they all told me the same thing i hate cpap cpap works great continuous positive air pressure to maintain an open airway while you sleep it's like holding one of those buildings up with air by blowing fans into it that you play golf in during the winter so colin sullivan the guy who invented it wears an oral appliance to treat sleep apnea down in australia so prior to cpap though if you had sleep apnea they had a really easy fix that was a 100 percent effective for obstructive sleep apnea lift your chin up a little Howard put your finger right there yeah they'd put a trachea right there you'd breathe through your neck and you didn't worry about the size of your nose your mouth your tongue nothing blocked it because you just went below it now you had to cover it up if you wanted to talk when you were awake but it worked great so cpap wasn't an alternative to correcting things cpap was an alternative to a tracheotomy when we talk about everything we've done since then we're moving in the right direction so i did i did sleep appliances since 1982-83 um and they all did the same thing they held the draw downward and forward to open up the airway so people could breathe they pulled the tongue out of the posterior throat and they didn't only make the airway bigger front to back but they actually had a bigger increase side to side in the airway it was great people would wear it sixty percent of the people given cpap give it up completely fifteen percent struggle and only twenty five percent use it on a regular basis that's the gold standard good gold standard how would a gold standard that only works for one in four people stand up in dentistry um i think they would uh pull us off the gold standard they play off the gold standard so that's where dental sleep medicine came from now they're putting a pacemaker for the tongue to keep your airway open the inspire device except they're going to stick this thing on one side of your tongue only and it's only going to stimulate the muscles on one side do you remember that harbold and the experiments he did on rhesus monkeys um not off the top of my head okay so enid harbaugh he looked it airway and he said what happens if we block somebody's nose or we block somebody's and give them artificial tonsils in the back of their throat well you know those kids with adenoid facies i talked about yeah the movies he blocked the airways they looked more like those kids than those kids looked like normal healthy kids and they had smaller lungs and shorter legs and tongue thrusts and open bites and underdeveloped maxillas all because of an airway blockage but how soon is soon enough to fix this he can do it experimentally and then he could undo the experiment and it would reverse way back i think it was new orleans way back over 100 years ago said every child going through orthodontics should have our analogist involved somebody to see that he can breathe right this is not new all the there was a huge controversy should you take out tonsils and adenoids on developing kids well only if you want them to have a good brain about 10 years ago though at academy of dental sleep medicine in baltimore this doctor from sweden came in and she was saying yes you need to take out the tonsil adenoids but if you do rapid maxillary expansion on the kids before you take out the tonsils and adenoids a lot of times the tonsils and adenoids are shrink by themselves because the kids can breathe through their nose they get less infections the swelling goes away they get more nitric oxide breathing through their nose nitric oxide is the strongest anti-inflammatory in the body it takes a couple you can do rapid maxillary expansion on a three-year-old almost overnight the sutures haven't locked in together yet they're just like this and they go so if you do rapid maxillary expansion and then you can make the need for canceling adenoidectomies go away that's better yet well unless you're an ent who makes his living taking out tonsils and adenoids so then you want to take them out sooner but even the subject of tonsillonitenoids it's like a giant pendulum that swings up and back so a hundred years ago they took out they did tnas on everybody and we're not talking about tits and ash we're talking about tonsils and adenoids one kid in the family got it pull everybody else on the kitchen table and do them all then that whole pendulum swung the other way and they didn't want to take them out on anybody because they were worried we're going to mess up their immune system and truth is pendulums tend to swing too far one way or the other kind of like politics when you're at any of the extremes we're in trouble but we're not more in the middle we're always better off that pendulum swing it always swings too far so let's talk about I’m going to talk about my sphenopalatine ganglions now so way back in 1908 greenfield smooter discussed schluter's neuralgia which we now think was maybe cluster headaches maybe it was the original diagnosis of tmj headaches because we hadn't come up with the idea of tmj yet that came later and he found that by sticking a cotton pellet soaked in 20 cocaine into the nose these pains would go away well that was pretty good later on he wrote a book and then he wrote a second book nasal neurology all about the neurology of the nose and why did he call it neurology because he wanted the optometrist ophthalmologists and the neurologists to pay attention to it it didn't work as well as he wanted he described in detail what these did in 1929 in the annals of internal medicine a guy named hiram beard published a paper on sphenopalatine ganglion phenomena 10 000 patients 2 000 patients 10 000 blocks no negative side effects they were taking away headaches migraines nausea anxiety depression low back pain shingles you name it they took it it worked they published it this stuff was gangbusters and then it almost completely disappeared what happened ah drug companies came along and now instead of having to do something the doctor could write a script and the sphenopalatine ganglion block started to slip in something known as forgotten medicine there's a lot of things we learn and then we forget and when forgotten medicine happens the patient suffers but it's way easier to write a script i never would have heard about these things except in 1986 a book came out called miracles on park avenue and it was all about this octogenarian otolaryngologist named milton raider in new york city and this guy had one trick in his entire bag of tricks he did one thing he did sphenopalatine blocks on everybody he had famous people politicians millionaires coming from all around the world to his little office in new york city and he'd stick these little wires with patent pledges soaked in cocaine in people's noses and all these things got went away and that's kind of what saved it um interesting if you go on my video site one of my videos is a doctor he's a physician and when he was a young kid he was 10 11 12 years old he had this worse headache from hell i think he called it a sinus headache he was in agony and he goes into the doctor and he says it's the old-fashioned doctor so he's smoking a cigar while he's examining him a guy looks at him for a minute or two and then he takes this cotton pledge and shoves it up one side of his nose and he shoves it up the other side of his nose and like two minutes later all the pain is gone and this little kid goes outside he jumps for joy so he's so happy and eventually he becomes a physician except he couldn't do that because when he became a physician nobody ever taught him what it was he eventually gave up being a physician and became an artist he makes trees out of wire really nice work that's how i met him because i was buying one of his trees and a few years later i saw him again and he told me this story he never knew it was a sphenopalatine ganglion block until he told me the story i knew immediately in fact i didn't even get to tell him my wife shouts out anna next to me he didn't see no palatine block on you it's like life-changing today i had a patient who's been in horrible anxiety for months but the last three weeks have just been more than she can tolerate she's having panic attacks that makes her feel like she wants to die right now five times a day we we taught her how to administer with cotton catheters through her nose sphenopalatine blocks on herself the pain went like pain and like talking about pain but it's anxiety anxiety is horrible pain it went away instantly but i mean you give her cocaine to take home nope i give her two percent lidocaine oh okay you wouldn't be happy using two percent lidocaine with no vasoconstrictor in your office and it takes less than it's less than the equivalent of one carbil of two percent lidocaine with no vasoconstrictor that she puts in her nose well this is uh this is crazy that I’m gonna say this but i actually when i i was in school in 1987 there was actually one patient in there that they dispense spray cocaine because she is having a oral cancer and throw cancer and all that and she had to numb up to eat but she had 99.99 aerosol cocaine that she just sprayed in the back of her throat and i thought that was wild so when i first started to do the blacks 1986 i heard how dr raider did it so that's how i was going to do it i used a little cotton pledge it with cocaine you can order cocaine with your drug license it's a class 2 narcotic the problem was after a month or two later the dea came in and they wanted to know where my used swabs were and i figured you know i don't really want to talk that much to the government and i switched to lidocaine and you know it worked just as well as the cocaine for me sometimes it took a little bit longer yeah you can also do an injection you know Barry glassman Barry glassman oh my god okay so Barry and i don't agree about much oh really but he used to be a neuromuscular dentist and he used to be a member of ikmo and he still listeds on his biography he's an oral facial pain guy now but I’ve been doing i used to do sphenopalatine blocks through the greater palatine foramen on the roof of the mouth or sometimes they go through the masseter muscle and do it but Barry taught me how to do a super zygomatic sphenopalatine ganglion block and it's really easy and it's like it works better than any of the drugs in the er for acute migraine so let me let me talk about something first on a personal level so you and Barry okay you guys know each other forever you're both legends in your own field there's a lot of young kids watching how do you get along with people who you don't agree with like um so uh how does i hear people i don't agree with because if you have somebody agree with everything you're never gonna learn anything from people learn through disagreement you wanted to know the problem with the aop they don't want people to learn that way that's the way people learn for thousands of years they want to say this is what it is and just you listen to us that's why they don't teach kids in school anymore how to treat tmj they teach them virtually nothing because they want them to refer to this to the experts I’m a general dentist i still do root canals i have an endodontist in my office so i only do one canal root canals now but it's like i love doing everything i do crown and bridge I’ll do partials I’ll do dentures I’ll do implants i did my first implants back in 1980. i was to put an implant in in 1980 i was a quack absolutely and i want you kids to remember that because dentist dentists eat their own and the guys who pioneered all this stuff i mean i was out here in Arizona and there was a guy who was flying to Albuquerque from phoenix to this and he had like three implant practices and the first time you know all these patients that were dental cripples they had dentures they couldn't chew or eat he put in a sob and they would love it and he everybody was happy first time a case failed went to the damn board they took his license away and he ended up just being a drunk in a trailer at an apache junction and i just oh my god it's just yeah how many thousands of lives were ruined because he wasn't there to help him oh yeah and and you know you think dentists would be i mean eight years of college they'd be above all that crap but uh they're humans too they they uh i mean just because you disagree with someone shut up i mean i mean i always tell dennis look the first 110 billion humans that live that look like us i don't even know their name and they're dead so why are you freaking out that some dentist on the other side of the town or the country believes something different than you i mean you don't even know one thought of the first hundred billion people that lived and now you're gonna you know they just um god what happened to mind your own business and shut the up actually the first time i saw something with an implant but i didn't know what it was i went to the guy's office to see what the hell he was doing oh my god in my area i had a guy named beals who was a member of the alabama implant study club he got in instead of lenny lincoln way back when he was doing subperiosteals and ramus frames and i i didn't want to do those things they were a little yeah they're pushing it for me but i did i did a lot of subs i did them with oral surgeons because i really like my oral surgeon's body they're very good at surgery better than i am so i would work with them and we'd do these things and i was lucky because i wasn't in the first generation of sub-periosteal delivering dentists i was the second generation so the first generation did stuff and then they figured out where it went wrong so when they did the subperiosteals on the lingual side in the back of the mandible the little struts of the of the framework would start to show through the gum and nobody knew what to do with it and then they got mechanical engineers in who started to do flexion analysis of the mandible and what they found is the mandible flexes like this up and back gets wider and narrower in the back and it's like i had a big argument on dental town because i told somebody that the medial pterygoids are the flexors of the mandible oh my god they attacked me because i said they flexed the mandible and they said no they don't they close the mandible it's the masseter pterygoid sling and they close the masseter I’m going to hold my jaw up for you i got i didn't know if i needed something to show you but just in case so here's my friend george he used to be a patient he was a failed sub but the medial pterygoid muscle comes from the inside of the jaw to the medial pterygoid plates on both sides that's the direction of the vector or force when they both contract at the same time you flex the jaw well guess what if you're a dentist what happens if you put a 14 unit fixed bridge that doesn't let the jaw flex the jaw is still going to flex what's going to break first is the bone going to break down as the implants or the teeth get pulled out is the porcelain going to break are they going to break the structure or the superstructure something's going to give because when you put an unstoppable force and you put an immovable object in the same spot something breaks so let me ask another question that people are asking us sleep apnea snoring tmd occlusion there are some people on the circuit saying that um you cannot do any tmd without doing a sleep screening that the tmd equals sleep and to uh make someone a night guard without doing a workout for sleep apnea would be malpractice uh where how do you weigh in on that okay so it's way overblown however there is some studies that say if you put somebody in an upper flat plain brexism appliance and they have sleep apnea it may get worse so that's a possibility because I’ve been doing sleep forever when cranio changed the name of its journal from the journal of cranial mandibular practice to the journal of cranial mandibular and sleep practice rightly lund the editor asked me to write the guest editorial so i wrote the editorial um tmj has a tmj the great imposter has a co-conspirator sleep apnea so sleep apnea and tmj are part of the same underlying issue it's a developmental issue it's an environmental issue it's important do you have to treat both no you have to be aware of both and know when to refer and when to get a test absolutely positively can you grow people out of both that's one of the one of the videos i placed today was a patient first we treated her tmj that destroyed her life and then we used the dna rna appliances to grow her a bigger airway and cure her sleep apnea so she doesn't need to wear a cpap or an oral appliance now are any of these things perfect no do they work every time no is there a little bit of trial and error absolutely and you have to know enough to be able to look at things and re-diagnose every time they come in remember what they taught you about diagnosis when you first got into dental school the first course in the diagnostics they gave you a four-letter acronym to keep you clean do you remember what it was four-letter act what was it didn't start with an f it was soap so subjective obsess yeah subjective objective assessment and plan that was how we're supposed to diagnose our patient so now we live in a medical world with hmos ppos and doctors have no time to talk to patients I’ve been to a doctor lately where he sits at the computer and king he doesn't even look at you anymore now we have difficult patients with pain processes and they go to doctors and the most important information is sometimes the subjective information what the patient tells you old-fashioned doctors used to sit and talk with their patients doctors on an hmo ppo can't afford to do it anymore it's all turned to a game of volume hasn't it not the second thing was objective objective measurements so we can take x-rays we can do cone beams now and we can do mris ah we can also do emgs we can also do uh mandibular scans to see how the jaw moves we can see how fast it moves we can see if it gets displaced by a tenth of a millimeter on closure because if it gets displaced by a tenth of a millimeter we're irritating the periodontal ligament on the tooth it's displacing on there's at least 29 different neural receptors in the periodontal ligaments and they head right into the into the mesencephalon of the trigeminal of the trigeminal nerve which is our proprioceptive part of our of our job so it's like it's crazy important we're the trigeminal masters we are the masters of the trigeminal nerve the mandibular block that's the mandibular division the lower third of the trigeminal the maxillary block that's the maxillary division it goes to the sinuses it goes to the inside of the nose it goes all the saliva ducts and things and then we get the ophthalmic the trigeminal nerve goes to the cornea of the eye there's a paper that was published if they put a chemical and cause a burn on the cornea of the eye it causes inflammation in the brain on the trigeminal nerve so just an irritation to the cornea of the eye when we irritate other parts of the nervous system it does the same thing we treat people with headaches and migraines and cluster headaches trigeminal autonomic cephalogens you know what controls the blood flow to the brain carotid arteries ah the trigeminal nerve our nerve your nerve we are the masters of the trigeminal nerve and it controls the blood flow to the anterior two-thirds of the meninges of the brain what we do is crazy important and if we happen to have a margin that's not perfect but the crown is going to last for the rest of the person's life that's good but if we mess up the occlusion and the person's going to have migraines for the rest of their life that's a bigger mess up you can always fix a leaky margin you can't give somebody back their quality of life and i get people who've been in constant non-stop paying for five years 10 years 20 years they want to cure they all come in wanting a cure and the first thing you got to tell them there's no cure because the only way you can cure these people they've been in constant pain for 20 years the only real cure you can give them would be a do-over in the last 20 years of their life you got to fix them and you have to do it yesterday and if you're talking about airway you've got to grow bigger airways and kids so they can grow bigger smarter brains these things are crazy crazy crazy important and i'd love to say it's all my ideas but everything I’m talking about i stole from somebody that's science um did you want to say anything more about this uh um these uh spgs okay so so they've almost disappeared a couple companies came along one called sphenocath and then actually the product they make is a sphenocath and another one makes the tx 360. there are two little squirt guns they're very fancy squirt guns that you can squirt lidocaine through the nose over the area this of the of these uh sphenopalatine ganglion on the medial wall of the turbopalatine fossa all of a sudden neurologists who could usually only write scripts now have something they can do and they charge anywhere from 850 to 4 thousand dollars to squirt lidocaine in somebody's nose so once upon a time i used to get my cenopalatine ganglion blocks covered by medical insurance whether i did injection or through the nose in the last several years all the medical insurance companies following the lead of blue cross blue shield have decided that sphenopalatine ganglion blocks are experimental they won't cover them for any purpose whatsoever do you know what uh blood patches you ever hear that no so when women go in and they get an epidural for having childbirth yeah sometimes it works great but sometimes they wake up with the worst headache in the world and it's because they're leaking cerebral spinal fluid they think and i say they think because we're not always sure so the cure for this would be another invasive procedure where they do a blood patch over the area where the injection had been done well right now if you go and look online and look at epidural blood patch versus phenopalatine ganglion black sphenopalatine ganglion block is as effective or more effective as an epidural blood patch and there's no risk involved there's no surgical procedure in valves and blue cross blue shield says well we're not going to cover that it's experimental back in 1929 hyrum beared 10 000 blocks on 2 000 patients with no negative side effects but think of how many drugs have been out there that get approved by the FDA and then get yanked later how many people have been addicted to drugs because they've been given them for so long for their pain and where we're going to make them in a formulation where they're safe and then somebody crushes the pill and snorts it it's like we we've gone the drug around i love the drug companies i work with lots of abbott and baxter people it's amazing what the drug people can do but drugs aren't the answer to anything so I’m just a simple way if i said what do we do we want our we want our patients to heal how do people heal you just remove the impediments to healing if you if you have a nail coming through the bottom of your shoe and you walk on it for two days and you get a big infected blister at the bottom of your foot and you change your posture because you're walking funny and your knees and your ankle and your back hurts and you go to an orthopedic guy and you go to a wound care specialist and you go to the world's best physical therapist and massage therapist and a week later they have you all put back together perfect and now you put the pair of shoes with the rusty nail coming through the bottom of it back on and you're right back where you started you have to look at cause and effect if you don't look at cause and effect if you don't look at how to make it better and how to prevent it what's the point of being called a doctor it's about health not disease so um a lot of kids listening to you today how do you recommend they learn this i mean when they come out of school uh they need help and and everything implants everything so how do you what advice would you give to the kids listening right now that are in dental school they're in dental kindergarten school how do they learn more about all this stuff okay so I’m gonna tell you what i did so the American academy of implant dentistry just started when i went there and i said implants sound good I’m going to do implants and I’m going to be a rich dentist so they had a four course thing and i took course one course two course three course four oh god who's the guy in detroit the young guy carl mish carl mish says at the end of the fourth quarter if any of you go out and do implants after taking these four courses I’ll testify against you in court because you don't know what you're doing yet and he said go find somebody who does this and go study with them and i went to dentists who did implants and i spent time in their offices i would spend a lot of time with dick beals i went into the oral surgeon's office merv rosen used to be there i'd go and watch with him and then when i was going to do subperiodic deals i said yeah you know he can do the surgery and i can take the impression of the jaw we didn't have ct scans to do that yet so you had to take an impression of the exposed jaw it's a lot i started doing implants i did pin implants they're easy we used to put three little bone pins in a bone and you turn them into a teepee and put a crown on top of it they were orthopedic bone screws they weren't dental implants how did i learn that i saw somebody else do it i said isn't it hard to clean he says yeah but implants don't need to be as clean as teeth he was right they don't decay and they didn't get gum disease you really have to screw it up to get gum disease and usually we like to blame the patient when we get gum disease but it's usually we got cement on the implant that causes the bone loss is usually iatrogenic so that's what you don't want to do so what do you say to the young guy you want to treat tmj and pain go into people who are already doing it see what they're doing see the results try not to make the same mistakes if you don't learn from somebody who's already been down that road you're going to make mistakes I’ve been doing tmj for a long time and i stacked her up and uh retired orthodontic neuromuscular orthodontist in milwaukee was retiring dr sovenock and he had two or three of his friends die and he was like in his 60s and he said you know I’m gonna I’ve always wanted to travel across the country in my uh one of those silver trailers that people pull around ear story i want to travel in my airstream he closed his office he spent a year once every other week for a year he came and taught me not the tmj that he did he wanted me to know the history of the last 40 years of how he got to where he was because there's a thought process in every step of the way that you make and if you teach the technique but you don't understand the thought process behind it you're never going to be able to think yourself through problems so generation x the problem is we don't have problem solvers we need problem solvers you need to look at things and say what's the best way to do this i see people all the time they're perfectly willing to pull out somebody's teeth out and put in all them four implants i freak out when i see this stuff like the idea of people taking out perfectly healthy teeth to put in implants for no good reason other than making a lot of money bothers me there are lots of people where all on floor is a godsend and it's an absolutely wonderful procedure but there's a lot of stuff that's not necessarily done for the right reason and when we start to do that we start to destroy the trigeminal nervous system and the input to the brain and all these nerves that come in the brain make lots and lots of connections and some of them turn things on and some of them turn things off and it's like i have a light switch i can turn the light in this room on and off except in the brain we have thousands of light switches and different combination of those light switches cause different things to happen and we have to look at all of them to see what the net result is so we do an experiment on our patient and we take off all their teeth and we give them an all-on-four and then we say oh how did that work it's like sometimes it works good sometimes it didn't i went and when i was young right out of dental school in fact even before i was out of dental school i went into doctor's offices who were doing vitreous carbon implants they don't last when i got out of school i did a lot of kyocera single single crystal sapphire endodontic implants so we take a short route and we drill a hole through the bottom of an endodontically treated tooth and we drop this single sapphire crystal made by kyocera through the tooth and cement it in place and I’ll tell you what would invariably happen two or three years later the tooth would run away or crack but the implants kept working so we call them endodontic stabilizers but we were actually doing the first ceramic implants now there's lots of people who are worried about metal in the bone you heard about any of this yeah are you worried about it i like titanium implants but i have patients who are worried about it and they now make zirconia implants well we know zirconia is hard it doesn't break easy except i didn't like the company and i didn't like the system i love strauman implants and i trust them now straumann makes a zirconia implant and you can use the same instrumentation i like that it's like am i doing them no but that one but i had a patient one of the patients in that video went to a biologic dentist because she they pulled out a couple teeth that had ripped canals i don't do that but they felt it was necessary they took them out and then she left town and i didn't see her and so in my mind they took out her posterior teeth and i don't care how good she is i don't know if it's good enough she came back in they put two ceramic implants in and they did an absolutely perfect bang-up job on what they did it's great i listen to the biological dentist do i do all the stuff they do no but why wouldn't you listen to what they have to say if they talk about root canals being infected or how infected is too infected i don't know i have an ozone machine i don't use it in my dental practice but i certainly wouldn't fault anybody who does when i got my first laser that was kind of quackery now everybody's got a laser it's like things change and the the other thing i want to say is um um he just has something very profound um that um you know i mean the the the patients ask for this so if a patient believes metal i mean they asked me you know they said they want metal free fillings i always say well do you drive a metal free card um the southwest airlines have a metal-free plastic plane for people like you i mean why are you against metal and but anyway the bottom line is people are just batshit crazy i think one in four of the eight billion humans well what percent of humans would you say are pretty pretty illogical emotional or after I’ve treated them because i found that when i talk to patients i have these crazy people sometimes come in however i always like to suspend my opinion until i have the benefit of time my partner has will absolutely refuse to treat tmj patients because he thinks they're crazy no they they a lot of them what percent of the tfj patients are crazy I’m not going to call them crazy because I’ll tell you what i talk about instead of crazy but what i find is sometimes i don't meet the patient until they've been in three four five six visits because when they're suffering constantly right back to who they are and all of a sudden oh look at this i got this wonderful person here so i spend a lot of time talking to patients so they love everybody in oral facial pain loves the hpa hypothalamus pituitary adrenal excess axis ii that's great so they think in a lot of ways that everybody's got a psychosomatic problem years ago i was told by a pain practice doctor at lake forest hospital where if you what's the point of fixing their tmj if you make their head and draw better they're just going to have low back pain and stomach issues well the whole body is connected and maybe he's right but not for the reasons he thinks so i talked to my patients about the difference between a psychosomatic issue and a somato psychic issue so in terms of pain if you're treating a patient with pain a psychosomatic issue is one that means i hurt because I’m crazy and i ask my patient are you crazy and they go no and i say good because i don't think that's what you have then i ask them have you ever had a doctor who treated you like you were crazy and then they'll start telling you stories they hate those doctors well the point the point let me finish this and then I’ll have to then i say well you know what a somato psychic problem is same two words just in a slightly different order so if psychosomatic says i hurt because I’m crazy so man of psychic says my pain is making me crazy so Howard if you're hurt all the time really bad would you be a little crazy oh i I’m i i have a lot of pain every 10 years i had that kidney stone thing and me and my sister kayleen we both have that like everything with that for 10 years i know i know and you don't know but you know what it's possible that person with the tmj pain that we think is nuts that their pain might be worse than that kidney pain ah kidney pain they say is the worst but same they say the same thing with a hot pulpitis the guy who comes in with his mouth packed in ice and he won't let you take the ice out long enough to get them numb because it hurts too much and acute pulpitis is one of the worst pains known to man and it's put on the same level as a kidney stone and where does that information get into the brain oh it comes down our pathways our trigeminal nerve it's us that's our part of the brain where most of the stuff with pain comes in and it doesn't just go straight in it go the stuff in the trigeminal nerve comes and it enters the limbic system that's where we feel our emotions so we can feel happy excited accelerated all these great things and we can feel sad downcast and miserable and you know pain pain's a little bit under that sad down cast and miserable but it's really hard to be excited and exhilarated and great when you're in terrible pain you ever kick your toe on the foot of the bed in your bedroom where you gave it a really good whacking like you're holding onto your toe and bouncing up and down and one foot yes are you a crazy person when that happens yes and i learned new words humanity yeah that pain may be nothing compared to what some of our patients live with on a day to day basis we have people with trigeminal neuralgia i don't see very many of those what i see instead are people with atypical trigeminal neuralgia i'd like to call it idiopathic trigeminal neuralgia and the reason i call it that is because when it comes to the doctors we're usually idiots as to the pathology so we throw a drug at it we can give everybody lyrica and gabapentin but what if you can just fix what's causing the problem take that rusty nail out of the shoe instead of trying to drown it in chemicals to make it go away oh my gosh i i could talk to you for 40 days 40 nights um i love doing i i love getting you on because um i i just know you and i could tell by with that post you were just in you were in pain when you were at that place you were so mad if that happened and i wanted you to um talk about that and i also know that when the kids come out of school i just listen to them and and um this you know it's tough times um when when schools are doing good they hardly got to do any fillings crowns and root canals but they never get to place in tmj or you know sleep or you know this so um what you kids got to do is it's a lifelong learning process you practice dentistry you'll never master it and the dentists who take a hundred hours of ce a year their whole journey they run into so much exciting stuff they always find stuff they're interested in that are fun that their community needs that are profitable they make money and um i mean um Ira can't go to every small town in kansas and you just delivered him two hours of solid information about um one of the most controversial things of dentistry occlusion tmj tmd bite all that stuff and um it was just an honor um to um I’ve read your 500 posts over the years since 2004 you're a legend to so many and uh you're in chicago right now right I’m in chicago now but i have to say something about those small towns in kansas city after i learned about spg blocks and did my little play with cocaine i went to i don't remember where it was in kansas city and jack hayden was there and he taught me how to do it right he's a dentist remember old-fashioned older than me yeah and now with the price of you know when i started flying in 1990 to lecture i mean it was like eastern airlines every seat's a grand the planes were half empty everybody that got on the plane was dressed i can remember getting set home on america west because i had tennis shoes on and i was running late and they wouldn't even see a tennis court but as the price came down then it turned into a school bus now you can get on southwest airlines half naked uh with flip-flops and you know all that kind of stuff like that but what I’m saying is now people that don't have trust in their local dentist because he doesn't he called him a quack or he doesn't believe him they're getting on planes and flying and um i cannot believe um if you don't have your work on your website the implant doctors who have their work on their website routinely are having patients fly southwest airlines to go have their work done because they don't think their their dentist back home can do it and um but um so those blocks when you you putting up those videos that's massive search engine optimization i mean hell you got 10 websites you're always putting up YouTube videos and if you're looking at seo let me let me explain like this if i sent you a text hey homie i mean that's just a few zeros and ones if i took a selfie of Ira and text it to you now we got a still image that zeros and ones is a block long but if this hour long video that we just did on seo that would go to the moon and when you look at google's um search algorithms number one nobody knows at outside of google i mean you would end so the guy at the holiday inn at the dental convention doesn't know anything and if he does know so much why didn't he work over microsoft they give anything to be google but they will tell you that um two-thirds of those uh algorithms uh for seo are video so i go on your website and you got a um you got a um email address okay why don't you that just says erectile dysfunction all over maybe i should get a younger doctor why don't you get a gmail one since it's owned by the google boys and then uh alphabet owns YouTube that's what the seo is ira's you said you're 70 years old 70. 70 years old and he's put up two YouTube videos a day and you're a millennial on snapchat and you don't have a video on your website so get the videos get the um the gmail account get the content and find something you like i mean when you ask me should i specialize i mean i don't want to be a pediatric dentist specialist and i don't want to do what you're doing i really don't um and i don't want to be a cosmetic dentist i don't want to tell some 50 year old lady that she's going to be beautiful if i file all her teeth down and food veneers and all that stuff i i'd rather tell him hey you're great your ex is an uh just uh you know whatever but you find something you love we've got 12 specialties in dentistry you got a bunch of patients you don't have to go to specialty school remember we just challenged that in a challenge in texas where they try to tell an implantologist that he couldn't say he was a specialist implantologist and the judge is like why and they said well the American dental association doesn't recognize it and they're like well who cares they're a membership club they're not a regulatory agency they're not the government and and if um and I’ve seen people during the pandemic that we're gonna go back to endo school and now everything's a show and i told them just don't do it just go back to your eight dentist in that town and say you're just gonna be practice limited and for one tenth of money you could take every root canal continuous hell you could go live with cliff ruttle for that amount of money uh for a year and his wife phyllis cookie breakfast um so just uh keep listening 100 hours a year that's why i do these podcasts turning you on to people like Ira free of charge while you're driving down the road find something that's fun and interest you and stay with it and dennis would be good so I’m going to tell them some book they should read okay you need to read the book the outlier malcolm gold malcolm gladwell well yeah 10 000 hours makes you an expert that's what happened to steve jobs and steve wozniak and all the rest of these things he has another book called blink right i think it was one of his first books people have made their decisions in less than a second you know and that book has to be true it's true read those books i i worked with bill blackford forever it's a lot of money to go work with bill blachford yeah you know think like a businessman but you know and I’m going to review that blink real quick because it's very profound in the fact that you know when you know you've evolved i mean for i mean your life's been going on since the beginning if any broke breaking the chain where we'd be extinct but when you're walking down a path and all of a sudden a saber-two tiger jumps out you don't have time to sit there saying huh i wonder if that's an omnivore or a herbivore or a carnivore well he does have sharp canine teeth you'd be dead so your brain and your ophthalmic and audio you rip through all that instantly and you skedaddle fight-or-flight right up a tree and your whole life you don't since you're not out there getting eaten you know you don't have any brothers and sisters that you watch eaten by hyenas you start not listening to your intuition man and you saw it in college where they always say damn i went with b and then i erased it and changed it to c it's like dude your whole evolution in one second said it was a but you thought about it for five minutes and you thought back until you were a neanderthal and you erased it and do it so when you're with a patient you're treating and you feel stressful okay that the patient's stressed you don't you you know the young kids where the pace has to raise your hand before you're aware of it you should feel it when you're when you're doing a procedure and you think oh man that just really wipes me out well i think you're probably sitting next to someone who was wiped out um listen to your intuition when you ask someone do you think it'd be okay if i do well you just asked right well what the hell's making you ask your intuition so you already answered yourself if you have to ask you've already answered yourself but listen to this intuition and um you're right patients aren't always right but they they always got to be respected and uh when they come to you they don't need a priest they don't need a politician they don't need a police officer they need a doctor and and listen to him and uh ire you're a legend and uh thank you so much for coming on the show and if you ever want to do it again come back I’ll come back thanks for the opportunity it was it's fun to do it's a problem when you love to hear yourself talk well i mean you own i think that town that people understand what they're doing and if if you're all the young dentists you talk about I’ll give them one piece of advice find things you love to do and do more of them because if you love doing what you do every day you go to work and you get to play if you go into work every day you're not liking what you're doing it's work and the different attitude if you want to have the difference between work and play is attitude you want to have a good attitude do things you love yeah i mean when you do things you don't like to do for money it's going to lead to dysfunction depression disease and and uh just um just you know it it's a it's a problem if we all just do you know the word mensch no okay it's a it's a hebrew word right it's a hebrew word it's a yiddish word yiddish which is in the easiest explanation of mensch is every time in our life when we come upon a decision we have to think about what to do we always know what the right thing is to do and what the wrong thing is to do but sometimes the right thing is the thing that's good for us it's an easy decision sometimes the right the wrong thing to do is what's good for us and the right thing to do is what's bad for us we always know what we should do so much is when you make the decision that you should make even if it's not necessarily what's best for you at that moment but we all know that we we know hey you're catholic so you guys measure sins I’m jewish and we got we measure mitzvas so we count the good deeds but we get lucky because once a year we get forgiven for everything and we get a fresh clean slate of slate year after year but it's like do the right thing if you do the right thing by not doing the wrong thing or you do the right thing by choosing to do the right thing you're doing the right thing and every one of those young guys out there don't do the wrong thing because you're not going to sleep good at night don't do things that don't let you sleep all right my man thank you so much for coming on the show today thank you it's been a pleasure
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