Dentistry Uncensored with Howard Farran
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292 Musculoskeletal Disorders in Dentistry with Juanita Benedict : Dentistry Uncensored with Howard Farran

292 Musculoskeletal Disorders in Dentistry with Juanita Benedict : Dentistry Uncensored with Howard Farran

1/18/2016 6:54:19 AM   |   Comments: 0   |   Views: 563

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AUDIO - DUwHF #292 - Juanita Benedict

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VIDEO - DUwHF #292 - Juanita Benedict

From preventive to protective postures, from exercise to ergonomics, in this episode Juanita Benedict shares her passion for helping dentists practice longer and more comfortably.


Juanita Benedict, DPT, CEAS II is a physical therapist and certified ergonomic assessment specialist who is dedicated to improving the health of dental professionals.  Having previously worked in the dental field herself, she understands the physical and mental demands of dentistry.  Now she works as a consultant, speaker and blogger to provide high quality information to dental professionals for the purpose of preventing or relieving discomfort from musculoskeletal dysfunction so that they may be able to return to pain free practice and lives. 

Howard: It is a huge honor today to be part of the cast interviewing Juanita Benedict who is basically a physical therapist and a certified ergonomic assessor. I wish I would have known you in dental school because the reason I wanted to … First of all I met you by, you started blogging on Dental Town.

Juanita: I did, yeah.

Howard: I’m a big fan of your blogs, I love them. In fact if you ever want me to push out a blog that you’ve written on Dental Town to my Facebook, Twitter, whatever, just email me the link to your blog at and I’ll push it out because I really feel at 53 I destroyed my neck. I lean my head over and I did all my surgery standing up, placed all my implants standing up, sitting down, I don't know, I didn't pay attention to it and my neck just ended up getting more and more jacked and about at 50, it was to the point where it was always under pain. I’ve been unwinding it a lot with Bikram yoga and starting at 50 I started rotating services, I’ve been doing Bikram yoga, I’ve done 3 Ironmans, I do Ironman every year but I really feel like, I didn't know what you knew and what you’re teaching so I really am a big fan of trying to get your type of message out especially to the younger people so they don't show up at 50 years old all jacked up. How did you get interested in this?

Juanita: Well Howard, first of all, I appreciate your story because I have heard it a few times, I’ve listened to some of your podcasts, some of the people who want to share the same message that I do about not having to practice dentistry in pain. I admire your Ironman [feats 00:01:58] because I too, I run and I do different things but I’ve always been intimidated by that so I think that that's amazing. I actually became interested in doing this, to be honest it was dentistry that led me to physical therapy. My step father was a dentist and watching him when I was living at home, he would come home after a long days' work and the first thing he grabbed was his TENS unit. He would put that TENS unit, which is that electrical stimulation on his neck and on his shoulders and that was the night for him, he wasn't able to do anything else because he had been in pain working all day. He wasn't a big … Go ahead.

Howard: How old was he about when he was doing this?

Juanita: He was probably in his mid 40's. Yeah, he’d been practicing for a long time and his days were pretty, by today’s' productivity standards, he had his own small office and his days were pretty well scheduled, they weren't really long days but he couldn't tolerate a lot of long days because of the physical pain that he would have. He actually, just working on him and helping him learn some different body techniques and what not, that's really what drove my interests into therapy because I wanted to help him and people like him because it’s just terrible to live in pain.

Howard: How much of that pain he was suffering do you think, because the dental system was beating on him all day?

Juanita: Now, now, my mum might watch this so I [inaudible 00:03:38].

Howard: Your mum was his dental assistant, right?

Juanita: Yeah, she was.

Howard: Then later you became his dental assistant.

Juanita: I did become his dental assistant for a little while, yes. That was an interesting experience and as a dental assistant, not just with him but with a couple of other dentists, I really came to appreciate how the posturing and how much pain could be caused because of these awkward positions that you’re in quite frequently throughout the day.

Howard: I think a lot of young dentists think the older guys, or they see an older person in pain, the always think a one-time injury like because you hear their questions, “Were you in a car wreck? Did you have an injury in high school football?” They’re always thinking of some big acute wreck and they don't realize so much of these injuries are just the little small things we do every day for years, not a car wreck or getting your knee blown on a football field or something like that, right?

Juanita: Yeah, well you know what’s really interesting to me is that a lot of the injuries aren't necessarily credited to dentistry. What will happen is, you can spend a whole day in these awkward positions and go home and pull a weed out of your yard and throw your back. Then the assumption is that, it’s because you pulled the weed, but that’s not true, it’s actually because your muscle is weakened from being in these crazy positions all day long that it really takes nothing for it to go out on you if you will.

Howard: Tell me what you’re doing now, you are blogging, you’re lecturing, is your message something more preventive for kids in dental school and the young kids under 30 or do you actually help old fat bold guys like me unwind their pain? What are you doing?

Juanita: I do both. Obviously, we are all in that healthcare field so you understand the importance of preventative care, right?  When we’re going to or when I am talking with dental schools and faculty, that’s certainly something that I would love to stress is how to prevent these injuries in the first place because they are preventable. There are so many ways and so many tools out there and so much education that we can provide the dental students that can prevent this pain from even starting. I don't know if you know this but I also blog for Ignite DDS, I blog there as well because the message needs to be out there for these younger dentists who are coming in so the message is there as well. Yeah, I do office consultations as well so I will go into, what did you call yourself, an old, fat, bold guy?

Howard: I am an old fat, bold guy.

Juanita: I even fix like skinny, young, haired guys if they need it. You look at a couple of different aspects of their practice and then determine what strategies are best for them, not just exercise wise, but also ergonomic strategies. I really try to bring in really practical ways to change your dental practice so that you’re not going to end the day in pain.

Howard: How do you want to do this? Do you want to start talking about, the young kids in school and how they’ll prevent not turning out like me when they’re 53 or do you want to start with just how to practice dentistry without sitting in awkward positions? How should we talk about this?

Juanita: Well I would actually, let's talk about, I would rather talk about the ones who are already suffering in pain because I feel like they …

Howard: Are you talking about married men?

Juanita: Married men, unmarried men, I got it, I am a little slow sometimes.

Howard: We’re going to talk about married men who are already suffering and in pain.

Juanita: You’re more likely to live longer if you’re married.

Howard: I know that’s true, bachelor men live the shortest, bachelor women live the longest, when men marry women, our life expectancy goes up and theirs goes down.

Juanita: There you go, see I think that statistic there speaks all for itself.

Howard: Yeah. The funniest thing is when men yell that women can't drive and their insurance rates are twice are much as women it's like, “What's wrong with that picture?”

Juanita: Yeah, I know.

Howard: Okay so you want to talk right now that are dentists already practicing and they are already in pain?

Juanita: Yes, let's talk about that.

Howard: I assume the pain is going to be one end of the spine, either their upper neck, shoulder is jacked or their lower back is going out.

Juanita: Those are definitely some of the most common impairments that you have. You also have a lot of shoulder injuries, some hip injuries, some hamstring, even ankle injuries.

Howard: And carpal tunnel, I usually see that.

Juanita: Carpal tunnel, yeah, absolutely. That’s a lot of … Mostly what I am seeing and the statistic’s buried out as well is the neck pain is the most common, then some back pain associated with that. There are a lot of problems with the neck because as you’re trying to see and get in the correct position, you get in all kinds of weird crazy positions. I saw one dentist who was leaning laterally like this and trying to look into the patient’s mouth but he didn't just do it once or twice, I was actually videotaping him, he was surprised as to how much he did that and then was wondering, “How can I solve his neck pain of mine?” Well, don't bend that way.

For me going in, it’s more about finding the correct strategy for that dentist. We’re all creatures of habit and it’s really difficult to change habits that have been formed over even 5 years, but much less even 20, 30 years. It’s impossible to just go in and say, “Use this new tool or do this and you’ll be fine.” Really it is a matter of teaching small incremental change to people so that they’re able to implement the changes that are going to make a difference. It’s a process, it’s not just a one and done situation.

Howard: I see a lot of dentists going to great lengths trying to do … I know a lot of … It’s funny because some people all get into microscopes because they want to see and their quality goes up. For every 1 dentist I know that bought a microscope to increase their quality, like during root canals, another one bought it just so that they can look straight in like a periscope and have the microscope turn because they just can't lean their neck over anymore.

I see … Like in my office, I’ve got 3 hygienists, other dentists but they are all buying different chairs. You go into one hygienist, it’s like riding on a horse saddle and then you know everybody is … All these different chairs and I’ve got girls up in the front that are sitting on balls. Obviously lots of people going to great lengths trying to solve this problem.

Juanita: Right, the terrible part is that it could be prevented, that’s the terrible part is that it can all be prevented with proper education. I know you had someone a few weeks ago, Julie [Kegan 00:11:43] who talked about having physical education in dentistry. I thought that was an amazing idea, I thought “Wow, that's brilliant, that's really what should be happening.”

Howard: It’s so obvious, how did that get taken out?

Juanita: Yeah, I thought that was a brilliant observation on her part. Now that is hindsight, we can't look back and now say, “I wish I could have prevented that.” It’s just like anything else, it can be treated. What I find frustrating, not frustrating, I should say disappointing is that when you talk to dentists who are in pain, they'll say, “I’ve been to physical therapy, I’ve been to a chiropractor, I’ve been to massage, I ‘ve tried the TENS unit, I’ve tried all these different mechanisms.” Maybe, but usually what we'll hear is, “I’ve tried this, it didn't work, I guess nothing will.” Maybe 1 or 2 strategies that maybe worked for someone else but aren't working for them and then there’s this sense of, well I’m a dentist or dental hygienist or any kind of dental professional so I am just bound to suffer for the rest of my life. It is not true, there are definitely strategies for everybody but what works for you may not work for someone else. It’s really important to learn yourself, learn how you practice and then the best way to implement good strategies so that you can practice without pain

Howard: There’s even a darker side to this, I cannot tell you how many dentists I know that have had 2 or 3 of their discs fused in the back and then it seems like on all of them, I am a dentist, I’m not a [inaudible 00:13:35], it seems like all of them, like 5 or 10 years later then they end up doing the other end like the neck. Then a good chunk of these guys, maybe 25% or a third start eating pain pills all the time and then some of them get addicted to that and it's just a huge cluster, it's just a huge bad deal.

Juanita: Right. As a physical therapist I see people coming out from these fusion surgeries all the time. Our vertebrae were not meant to be fused, they were meant to move and they were meant to move for the entirety of our life. I am not an advocate of these types of surgeries unless there really absolutely is no other way. Often times on my end and not just with dentists, just with the general population, lumber fusions have a 50% fail rate after the first year. Would you try other treatments that only have 50% fail rate?

Howard: I think it’s funny on dental town where if anybody says anything about being holistic or a natural path or anything, all the dentist on dental town just throw him under a bridge. Yet when you go listen to the dentist talk and you get in their own value system, the bottom line is America has rapidly lost face with the healthcare system, it just seems like every time you go to the doctor, they want to give you a pill or cut something.

If I go talk to 10 60 year old men, the richest, smartest most educated ones will say, “I don't trust doctors, I don't want a surgery, I don't want to take your pill, I don't want your side effects.” Then the damn ignorant ones who maybe didn't finish high school, had a low paying job, are not readers and they are on 6,7 different medications, they've had lumber fusions, they've had all these different surgeries, they are just doing what the doctor says and the doctor is doing a lumber surgery, a lot of them are doing it because they can bill a big procedure out.

Then when I talk to dentists who on their website put, “I’m a holistic dentist, I do natural alternatives” whatever or that, there are new patients exploding. I’ve always had a good sense of the market and I think the market is huge for alternative healthcare, whatever that means. Like in my whole neck problem thing, I’ve got the MRI, I’ve got the catheter, I’ve gone to the specialist, I sure as hell am not doing anything they recommend, I’m not taking their anti-inflammatories, I’m not going to do a surgery, I’m not going to do anything like that. I’m doing yoga and Ironman and I don't take an Aspirin or a Tylenol or nothing.

Juanita: Right. I think that there is definitely a place for the traditional medical model but I don't think it fits for everyone.

Howard: It mostly fits for Wall Street brokers.

Juanita: You’re a little more cynical than I am about it but that's okay, my step father was like that too, that’s why he never went to a doctor and I understand that, I really do. Again, working with the general population still, you see the effects of entering the medical community and entering that medical care, a lot of times, often times it just results in more doctors’ appointments and more specialists and more intervention and this didn't work so let's try this. I understand that but the irony is that a lot of dentists, the way that they deal with their pain like you mentioned before is that they self-medicate. Not wanting to go to a medical doctor is one thing but if you’re using the same types of strategies which is just medicating yourself whether it be through Tylenol or pain pills, things like that. There’s a lot of statistics out there that … Dentists also because of their disability insurance, they don't want to be on the record of doing these things which I understand that too. T

There are so many other ways and so many other strategies of dealing with your pain that it's really not even necessary to go there I don't feel until you’ve exhausted a lot of these other possibilities.

Howard: What strategies would you recommend?

Juanita: When it comes to pain, basically I feel like there're basically 3 areas that need to be looked at. When I do a consultation, I go into an office, I look at 3 different arenas or areas for pain. First is one that everyone expects, which is the environmental, so what kind of environment is the dentist or dental hygienist in? What’s the setup of the office? What types of positionings are they doing? What kinds of tools are they using? The things that we normally think of; sitting postures, etcetera.

As a physical therapist, I also look at the physical structure. There may be some anatomical anomalies in that person, maybe their posture is a little off because they had an injury earlier on in life and they have never been able to recover, there is a lot of scar tissue there so there may be some specific treatment that needs to be worked in that area. Maybe their range of motion is just out. Look at their physical component too. There’s the environmental, the physical, but the third part I feel like it is left out a lot in dentistry and that is the psychological component. I see a lot about stress in dentistry which is important but there is a huge link between stress and between physical function. The higher level the stress, the harder time your body can actually function physically.

There are physiological consequences to stress, if it's chronic stress, you will have chronic pain, that’s just, no matter who you are. Taking a look at all those arenas and putting them together really can give you a complete look at what’s going on in the dental office with that particular dentist. Then of course looking at their habits and trying to integrate then things like doing specific exercises to activate specific muscles before you do specific procedures. Something that you would be at risk of hurting yourself, let’s look at these strategies first and then start to implement them so that your body is prepared to do these crazy movements.

Howard: Some of it is just … Like when you said you were filming a dentist, I think that would be a great start to … I noticed like my swim coach, every once a month we’ll swim [and doing 00:20:36] a couple of laps. Every time I look at it it’s like looking at another human, you just don’t see yourself … I’ve got a very good friend, one of my best friends, 100% of the time that I go to his office when he gets done giving a mandibular block, a lower shot injection, he’s holding his breath the whole time and then he pulls it out, he puts the needle on the [deal 00:20:58] and then he stands up and he walks out of the room and it’s until he’s out of the [inaudible 00:21:01] and he goes …

I would say to myself, “Man you do this 10 times a day for decades and decades.” He’s holding his breath and you’re talking about psychological stress. I remember one of the first things my boys’ grandpa, my ex father-in-law, when he was in the office, he always saw me 20 years ago move my shoulder. He hang a pull up bar right in my break room and he said to me, he said, “Howard, every time you walk back to your private office, I just want you to get [ahead 00:21:35] but the first thing you do, I just want you to hang on that bar and do a pull up.” You can see how people are trying to break cycles, break habits.

Juanita: That’s a perfect example of possibly a strategy that I would use. Going into a dental office is looking at an impairment, something that’s wrong and how we can fix it and employing strategies like that. I’ve given away thera-bands, the elastic things that we use in physical therapy. I’ve given those away and instructed dentists and their staff on how to use those when they have a 2 minute break in between patients. Let’s activate those muscles, let’s get them going, don’t let them get lazy, don’t give them a break. With specific procedures, you’re going to be in compromised positions so let’s fix that before you get in there, let’s prepare the body before you start breaking it down.

Howard: Are you into any of these types of chairs or anything else or …?

Juanita: The whole purpose of ergonomics is to make the job fit the person, that’s what ergonomics is supposed to do. It’s supposed to have dentistry fit the person and sometimes they work and sometimes they don’t. Again, it’s really depending on what’s going on with the dentist. Someone with really tight hip flexors, they may need the saddle stool, it might be a little bit more comfortable for them and their low back if they sit that way. If you don’t have tight hip flexors, it may just be a waste of money and time to invest in doing that. We’re purchasing some of these ergonomic equipment, it really just depends on the person.

Howard: Now your blogs are also on your website; and you have a lot of … Are all these blogs on Dental Town too?

Juanita: Not all of them, a lot of them are but not all of them are.

Howard: I love your blogs, ‘why electronic documentation can be such a pain’, ‘effective stretching that makes a difference’, ‘reconsidering your sitting posture’, you’re an amazing writer. Did you want to go for any of those blogs or topics or what other strategy do you have for dentists listening right now on pain?

Juanita: Let’s talk about something that you hit on really quickly. Something that I’ve been noticing a lot of is posturing with regard to electronic devices especially now that everything is computerized; we have these electronic documentation that we have to do. When you’re not hunched over a patient, you’re going to be hunched over a computer or a keyboard. That is an opportunity for you to really use some proper posturing and some proper alignment just in general and strategies so that you can give your body a break and to recover a little bit from the long day of being in these compromised positions.

It’s not just in the computer though, we forget about our phones and our tablets and our TV and everything. Really just being aware of your activity, I don’t know if you know this or not but there’s been a rise in osteoarthritis in young kids like teenagers in their thumbs because of the phones and using the phones and scrolling. There’s even a term now called text neck and that’s because your neck is like this all the time when you’re looking at a phone and that can obviously stress structures the same way that you’re going to stress structures when you’re practicing dentistry.

If you’re on your phone and your head is tilted, what’s the difference between practicing this posture and practicing a lot of postures where your head is down and you’re working on the patient? There are a lot of things outside of dentistry that can be contributing to your pain inside of dentistry. I would definitely caution and recommend that anyone who is having pain, that they take a look at their usage of electronic devices because it really can contribute to just overall general pain, not to mention the psychological component that is well documented with increased screen time and things like that. That’s something to really consider if you’re having a lot of pain.

Howard: I thought … Yesterday I was interviewing Debra Engelhardt-Nash and she was saying that the dental [scone 00:26:41] structures were talking about how the older dentists before we went to dental school, we used to make things with our hands and toys and we used to make all these things and we just were better at art and then transferring that to making teeth, fixing teeth. All these kids, all they did was video games and joy sticks and they don’t even have that manual dexterity of their fingers.

Juanita: I would agree with that, I think that that’s … I would even go a little bit further and this is just my opinion, I don’t have any statistics or anything to back it up. I would say that even if you once had it, my generation, even if you once had that dexterity because you were using that, you’ve gotten so used to the convenience of the electronic devices that we have and the entertainment that’s constantly around that you lose it. If you’re not constantly practicing those manual skills and … Of course as dentists you’re always working on those 5 motor skills.

It’s very easy to lose those things, it’s just like balance, if you don’t practice balancing every day, as you get older, you lose it and you don’t even realize it until you’re flat on the floor calling 911 for someone to come and pick you up. Those things that just … it’s over time.

Howard: I still have another 6 months before I get to that stage.

Juanita: Well if you’re doing yoga then I doubt that you’re going to get to that stage because that is a constant working of your balance.

Howard: You see that trend at the gym too. When I was younger, a lot of people liked to do machines but now people want freeway. You see a lot of people, when they’re doing weights they’re standing on one foot or they’re standing on a ball so balance and … It’s really getting more scientific. What do you think are things that dentists could do … What do you think the most common things that dentists are doing wrong when they’re sitting on a chair, well first of all, let’s ask that. When I was little, at least two thirds of dentists … When I was 10 years old, two thirds of the dentists in Witchstock, Kansas were still standing up.

When I got out of dental school, some of my friends in my high school who their dad was a dentist, a Dr. [Propard 00:29:01], he still stood up, I don’t think he ever sat down once in his life. Do you think moving to sitting down was a good idea or do you think the stand-up guys had better overall health?

Juanita: I think that it’s somewhere in between. I really think that moving in general is really important. If you’re standing up for long periods of time, there are lots of musculoskeletal problems that can come with that, if you’re sitting down, there’s a lot of issues that can come with that. Really, it’s a matter of changing positions if you can. Maybe some ops are set up to where you’re sitting and some ops are set up to where you’re standing. That’s one option or you can, “This hour I’m going to be sitting, this hour I’m going to be standing.” Depends on what you want to do or even one day of standing and one day of sitting, however flexible you want to be with that. Really, changing positions is the most kind to your body.

Howard: I’m just saying we don’t know what we don’t know about what’s causing a lot of this pain and this suffering.

Juanita: It’s true, you’re right, we don’t know but we also know a lot now that we didn’t know before. There’s been this giant push within the last decade or so for attention to be drawn to this. There’s no reason that dentists should practice in pain, I’m going to keep saying that because it’s true. Especially now, there are so many ways that you can adapt your job to you, adapt it to you instead of you having to adapt to it, there’s too much out there. You’re right, in 20 years they may say, “No, sitting and standing were both bad, you should have been on your head.” They could do that, who knows. I think we’re responsible for the knowledge that we have now and [crosstalk 00:31:01].

Howard: Speaking of standing on your head, I know a dozen where if you go in their break room, have that thing that you put your feet into and roll back and they hang by their own feet. What do you think of that?

Juanita: Inversion tables … In physical therapy we use traction units to pull apart the vertebrae a little bit and relax them. There’s a couple of reasons that we do that and I know some dentists use that, there’s this thing called posture pump, I’m sure you’ve heard of that before. It’s for your neck, it’s basically just a traction. There are some benefits to that and the inversion tables are basically the same thing as the traction because you’re just trying to alleviate the pressure that’s on your vertebrae. You’re not going to get a lot of distance in between those vertebrae which is a good thing, you don’t want too much distance between them because then you’re going to have a lot more laxity and a lot more play in that joint and actually cause more pain.

It can relax the muscle around the vertebrae to make it a little bit less painful. Sometimes it’s just fun to just spin on your head, it relieves stress a little bit but you know.

Howard: I remember my train of thought. My ex, 3 boys in a row, no morning nausea, no nothing, she totally believes in her head that everyone who gets nauseous, it’s all in their head. Then the 4th one, she total nausea [and all of a sudden 00:32:31]. I sometimes try not to be judgmental, I’ve got this bad attitude, so many of dentist and hygienist friends I know they got carpal tunnel syndrome, it seems like all of them, they’re [seeing out 00:32:43] their hands and their time or their vein and not one of them has ever done a push up. Sometimes I’m just sitting there thinking, “You’re going to all these doctors, you’re getting all these surgeries, you’re taking all these pills, why don’t you just get your fat butt on the floor and spread those palms out and do 10 push-ups everyday then do 20, do 30.”

Then I think to myself, “I’m a dentist, I don't know what I am talking about.” Is there any evidence that all these people were spasming hands and carpal tunnels, it’s just because they’ve never just done a push-up? Are the athletes who can do 25 push-ups every day that still get carpal tunnel? Am I being ignorant by associating those 2 together?

Juanita: No, not necessarily. Carpal tunnel is of course a compression of the carpal tunnel in your wrist, hand area there and it can lead to inflammation which is really when you start having pain because there’s only so much space in that carpal tunnel and when it starts to inflame just like anything else of course that takes up that space in the area. The idea is to prevent that so if you are stretching regularly, which a push up would do because it would stretch the hand backwards instead of forwards which is normally the position of hygienists and dentists, then it’s really going to take a lot of pressure and relieve a lot of pressure from those tendons that run through that carpal tunnel. Instead of the tendons staying in this position creating that inflammation, then you’re able to get them moving a little bit more and so a little bit more of a natural system instead of it just being one way, our bodies were meant to move all kinds of different ways.

Again, it’s a matter of being stagnant and being in a static posture for a long period of time. Plus, you’re having a lot of force when you are in that position so that’s demanding a lot of the muscles and often times there’s just not enough recovery time from there and so the muscles are injured, you’re not letting them recover and so that of course is going to lead to some more inflammation as well. I don't think you’re completely off base, I think it … It’s of course a little bit more complicated than that because once the inflammation sets in then it becomes more difficult to manage. If therapy when we treat it, that’s exactly what we do; we do a lot of stretching the other way and strengthening the other way, trying to relieve some of that pressure that’s in there.

Howard: What exercises do you think work best for dentists and hygienists?

Juanita: That’s a great question, again it really depends on what is going on but from my experience and we’ve talked about it before, really the neck-shoulder issue seems to be the most troublesome. There are a lot of exercises out there, there’s a blog on my website talking about neck exercises and you really want to work these neck flexors right up there, these deep neck flexors. There are some strategies there to help that. Also to bring these shoulders back because we’re hunched, again, we’re hunched, not just during the day while you’re practicing, but also when you’re watching TV, when you’re eating your meals, when you’re on your phone, when you’re on your computer, when you’re writing, when you’re doing anything, when you’re driving.

We live in this 3 by 3 box, that’s pretty much where we live, it may be down or it may be up but we’re not doing a lot of big movements to get full range of motion in our joints. Our muscles aren't going to be strengthened to those larger units. One reason I do love yoga is because it does require those big, large movements of your body and your joints and stability of that so I think yoga is a great exercise.

Howard: Yeah and I agree. Whenever I get an idea that instead of going to yoga I should go to the bar and drink beers and eat [pitches 00:36:57] about big old plates of wings. It’s just never really a good idea, there’s just nothing better than unwinding at the gym or in yoga or [bikes from run 00:37:07] or something like that and break the old habit of saying, “I’m just going to go watch …” Like tonight, I’m probably going to go to the bar and watch Thursday Night Football. I haven't found out who’s on yet, [I had been to watch 00:37:18] the Gamers. Yeah and then my son’s saying, “Maybe we should go to yoga.” It’s always such a better decision to go to yoga or lifetime, fitness or something.

Juanita: Right. Well because you're not only just taking care of your body, you’re taking care of your mind too, that psychological component is so important to be able to de-stress either after a long day or to prepare yourself for the day ahead of you, whether you exercise in the morning or in the evening. The psychological benefits of the exercise are very proven and to me, I think that they’re worth, I shouldn't say worth more but worth the same as the physical benefits.

Howard: Why do you think exercising increases mental health or reduces stress?

Juanita: This is just from … There’s tons of studies out there but they all get meddled in my brain. Let me tell you just from my own personal experience, when I’m performing a task that I have not perfected, which is what exercise is about, learning new tasks or performing tasks that you have not perfected, it requires my complete concentration to do that. I can't focus on anything else, I can't focus on the paper work that I have to do or the dinner I need to cook tonight or whatever. I have to really focus or I’m going to fall down or I am going to hurt myself. Really, I feel like mentally exercise and running, I love running, I’ve run a few half marathons, I enjoy that, I really love those long runs because it gives you time to clear your mind.

Same thing with swimming, swimming is great because there’s no stimulation when you’re swimming, it’s just you and the water, that is it, you can't hear anything, you can't see anything except for the bottom of the pool or the lake. I live in Florida so I really wish I could see it a little bit better so I could avoid the gators but really it is that total focus that’s required, whether it’s strength training, running, swimming, yoga, whatever it is, just that mental blocking.

Howard: Yeah and I even love that about swimming and biking and running outside, it's dangerous to wear headphones and music when you’re running on a street, biking on a street. I really like even that part like you get in a pool, there is no music, you are out running, no music, no nothing, no stimulus, no text, no email, no patient, it does totally clear out the mind.

Juanita: Yeah.

Howard: You were talking about that sometimes you give the dentists stretchy bands and that is to reduce your stress by strangling their dental assistant with it, is that what you do, you wrap it around...

Juanita: You know [inaudible 00:40:06], if need be, I suppose although I’m sure there are some very feisty dental assistants that may want to do that to their dentists instead.

Howard: I’ve had so many dental assistants over the years, they come and apply for a job they leave off a resume and we don't even have an ad and I’m saying, “Why did you leave your last guy?” A third of them, “He has temper, he throws instruments, he screams, he yells.” It’s like, you listen to what they are saying it’s like, “Oh my God!” There’s just some crazy environments out there in dentistry.

Juanita: Dentists have a certain temperament and I don't mean that in a bad way at all, it’s just that you have to have a certain personality type in order to be a dentist or to be a decent dentist I should say. You have to care about meticulous details otherwise your profession is just or your work is going to suffer. I don't think that that stops just at work, I think generally that’s just the personality type that goes into dentistry. Knowing that, yeah there can be some squirrelly dentists out there but you have to appreciate that about their personality. It’s a challenging job, it’s not easy what you guys do and it takes a lot of patience and a lot of focus to do it, you have to be able to do that.

Howard: You said 'you guys' which made me think of half the school’s boys half girls, do boys and girls have different physical therapy issues by practicing dentistry from different body types? Are guys more prone, less prone, any gender issues on physical therapy in dentistry?

Juanita: There’s actually a lot of them so I’m glad that you brought that up. Women will actually suffer more intense pain than men do. Men may suffer … Now there are some reasons that may occur because once men have the pain, they may be more likely to back away from the positions that are hurting them whereas women just kind of track on. Women typically have more intense pain in different pain areas, more in the neck and in the wrists. Men typically have more lower back pain, they also have a lot of shoulder and neck pain as well.

Howard: Women are more in the wrist and where?

Juanita: In the neck.

Howard: Women are more wrist and neck and men are more lower back?

Juanita: Yes. [Crosstalk 00:42:56] very general, everybody can’t have everything so that’s on the limited resources out there on gender.

Howard: Well they seem to have very different body types, men seem to carry more weight up in their shoulders; they seem to have more broader shoulders than you would think, if you have more weight on top than your little bitty waste spine might have more issues.

Juanita: Well and our world was set up initially for men, women are coming into it and having to adjust their environment so that it’s more women friendly in lots of different ways. That’s certainly something to consider and even things like the weight of loops.

Howard: Right.

Juanita: Often times a man will … I shouldn't say often times, sometimes, I’ve seen this happen in offices. You think all loops are the same in as far as weight goes but women will have, they will need a lighter loop often times because that heavy loop just doesn't work for them, it causes much more stress on their neck than a lighter loop with the same magnification and all that, with for a man.

Howard: I only have to wear loops when I go to the bathroom. That was a good one huh? That was a good one, I only had to count to 3 …

Juanita: It was unexpected.

Howard: It was unexpected, those are the best jokes. What do you find more … You said pain itself has 3 components; physical, environmental;, psychological. What do you have the most success with when you go into a dental office, changing their physical environment, the environment, the psychological?

Juanita: Okay, well that is a good question. Again it depends on the dentist, but it’s easiest to fix the environmental component because you can say, “If you use this tool or you position your tools in this way then it is going to be easier for you.”

Howard: I’ve seen a lot of hygienists get all new instruments where the diameter of each instrument is twice as big, instead of holding like a thin little toothpick they want to hold onto something.

Juanita: Right, there are some great innovations in ergonomic tools.

Howard: That would be considered an environmental issue and those are the easiest to change, a different chair, a different instrument.

Juanita: People are more willing to change those. When you’re talking about physical and psychological, that becomes much more difficult. Physical, if you are talking about, muscle imbalances and [weakness 00:45:38] which we all have but in dentistry it’s more pronounced and more important to fix those, then you’re talking about an exercise regiment, you’re talking about something to really fix your body and to become healthy and balanced. That requires a lot of discipline and as disciplined as dentists are and focused in some ways but they’re people, I think, just like the rest of us.

Howard: We’re barely people, we’re just technically people and only an anthropologist can see it in us.

Juanita: I see, okay. You know, like you said, sometimes it’s a struggle even if you’ve been doing yoga for 5 years, it doesn't mean that today isn't the struggle for you to decide to go so that’s always difficult. There is a study for physical therapy that people who are in physical therapy when asked how compliant they were with their home exercise programs, only 35% of the respondents said that they were compliant while they were actually getting physical therapy. I have a really hard time believing that all 35 of them were actually compliant with the exercises they were supposed to be doing at home. These are injured people that are supposed to be taking care of themselves. I think it’s just human nature.

Howard: In a dental office, you ask someone, “How often do you floss?” Usually most people say, “Well you’re the one who did it last time.”

Juanita: Yeah, right.

Howard: I totally see that.

Juanita: Yeah, it is the same thing, we all have difficulty, it’s a lot easier to say it than [crosstalk 00:47:20].

Howard: What do you think about some of these dentists and they post some pictures on Dental Town where they try to set up more physical stuff there like maybe between room 1 and 2 they’ll put a dip bar and between room 3 and 4 they’ll put a pull-up bar. Then their staff lounge, they have a stair master, are you seeing that when you’re out in the field? Does that seem to help or those all just become things to hang your uniform on?

Juanita: I have seen it a lot but … It’s definitely going to help as long you’re doing it properly. If you’re going out and using a dip bar to do some kind of crazy acrobatic routine and possibly risk injury, then that’s obviously not good. Yeah, I really promote exercise while you are performing your job and your tasks. Learning how to control your body while you’re doing those tasks is the most effective way to prevent and to relieve muscular skeletal pain.

Howard: Let's talk about beds because when you look at repetitive motions, probably a very long period of time you’re lying in your bed, have you seen any success in people … I notice some of these, what is it, Tempur-Pedics where you can inflate in different firmness, I see whenever you go to a chiropractor, everybody is trying to sell you their own pillow or this or that. When you’re talking to a woman dentist with neck pain, do you ever address what pillow you are using or how firm is your mattress or what is your Tempur-Pedic number or any of those? You seen any of that in the literature?

Juanita: To be honest I haven't really done a lot of research on that particular aspect, I haven't really experienced a lot of people who are complaining that they wake up fatigued, that would be my question. If someone’s telling me, “I have neck pain and I just can't, I’m never rested, I’m tired all the time.” That would be my number one question, is, “How are you sleeping, how well are you sleeping?” Then we would go into that kind of information gathering process, what kind of pillow, bed. As of this point, I have not run into that, I am sure that it's out there, I just have not [crosstalk 00:49:43].

Howard: You've been lecturing, how do you like lecturing?

Juanita: I like it, I know I haven't had a lot of opportunities at this point but I enjoy it. It’s fun to share my passion with people, I’m really not much of a writer, I don't like to write so much but it’s the only way to get my ideas and my passion out there for the masses

Howard: Do you want to lecture more?

Juanita: I would like to lecture more, sure, of course.

Howard: You know one of the biggest secrets in building your lecture reputation is?

Juanita: What is that?

Howard: Well there’s about 258 different societies just in the US that pick speakers and almost all the speakers are picked by volunteers so the executive director will get 3 volunteer member association dentists and they’ll say, “Okay, you 3 pick the speakers and you pick them for ENDO.” They’ll tell another guy, “You pick them for Crown Bridge.” They’ll tell a 3rdone, “The number 1 complaint of every lecture of all time, there’s nothing for the staff. You’ve got to go find something for the staff.” That’s where you would come in or practice management or motivation or whatever. These dentists, they don't know who to get, they say, “Well don't get the same ones we had last year [to year 4 00:50:52], get someone new.” You go into Dental Town where there’s 350 1 hour courses divided by sections and like if I am in charge of picking the ENDO, I’ll say, “Okay, here is 6 guys that gave a 1 hour lecture on root canals and they will watch the ...”

If you put a 1 hour course on Dental Town, it'd basically be like your demo tape. Then there’s going to be dentists, geeks all over America that say, “I need to find something for the staff.” If your presentation looks like it would be interesting to a dentist, a hygienist would find interesting. You should do that, you should make a 1 hour course on Dental Town.

Juanita: Absolutely, I have considered …

Howard: Yeah and when you’re presenting it, don't just focus on, don't always say dentists, say dentists, assistant, talk about receptionists, what chair … Let's talk about that, I have got girls that are sitting on, first it was a big ball, go back like 10 years it was a ball. The problem with the ball is that you would stand up, it was the bowling ball, it was crazy, the ball was everywhere. Then about 2 or 3 years ago, they got these little racks with 4 wheels where they would put the ball in the wheel thing so it would … Like a roving chair. What do you think of those?

Juanita: I think balls are great, they really help with your posture. Again, it doesn't matter what you are sitting on, if you are sitting for a long time then that’s really the problem. You can have the best posture in the world but there was a recent study that came out that talked about how just sitting, the act of sitting increases your risk of cardiovascular disease which shouldn't really be that surprising to us because you’re not active, you’re not moving.

I always, when I have people come into my office; accountants, front desk people, I have them set a timer so for every 45 minutes, they have to get up and move around in some capacity and some way. They’re not just sitting hour upon hour upon hour because it’s really easy to do that. There are strategies there, so the ball is great, I love the ball because it does help you. There are modifications of that now where you can have like little discs with the ball on it and you can put that on a chair so that you do have a little bit of back support there if you need it, if you get tired of sitting. It’s hard to go from poor posture to perfect posture, it’s almost impossible to do that without some sort of training of the body.

Howard: I got to tell you something, that is way too much information and we shouldn't be shared so we are definitely going to talk about it on Dentistry Uncensored. When you go to Africa and Asia, the public restrooms, there’s not really toilets, there are just pipes in the ground, even in nice first class areas. When you talk to gastroenterologists and [interns 00:53:54] and all that, humans were designed to squat. When in the rich countries, when you actually sit down on a toilet, all these muscles that were designed to help you take a bowel movement or defecate all go flaccid. Then you see in those countries where people take a magazine or a newspaper but I was amazed, the first time I ever had to go in the bathroom and you have to learn how to take off your clothes and poop in a …

You can't really take off your clothes and put anywhere because it’s filthy so you’re like putting your clothes over your head. I was amazed when you squat down on your feet and you’re not sitting on anything, it’s a projectile, it’s like you are launching a rocket. The doctors all understand this and they are like, “The Africans and Asians and Indians and the Middle East, they have a better pooping system because there is no chair to sit on.” I couldn't even imagine trying to implement that in the United States. Could you imagine going in to all the dental offices and telling all the girls, “We’re taking out the toilets and you’re just going to have to learn how to squat. It’s going to help your bowel movement, it’s going to help your back, it’s going to help everything, we’re going to take the chair out of the toilet.”

The reality is that is, that’s how you’re supposed to do it, that’s how you’re supposed to keep your muscles. Have you heard this or have you heard people talk about that?

Juanita: I haven't heard that particular thing. However, it’s certainly the same with child birth with women. We weren't meant to lie on our backs in order to give birth, you’re really meant for gravity to assist you there. When you’re lying on your back and the doctor has to bring the vacuum out to help the baby come out, well that’s exactly what gravity would have done without being …

Howard: I’ve seen them in the rice fields when they go into delivery and they stay on their feet and women come to their side and they keep them on their feet and they drop that baby. Then the craziest one is in these rich worlds after the baby is delivered they have all these post-partum depression and anemia and all that, when every mammal after they drop the baby turns around and eats the placenta and all the vitamins and minerals and nutrients. I imagine going to a hospital and saying, “We’re taking out the toilet seats, you need to squat on a pipe, you are having your baby standing up and when we are done you are going to eat the placenta.” Then they the blame it all on Obamacare.

Juanita: Yeah. There's some benefits to us moving into a more affluent society but there is certainly some detriments to it. I think we’ve moved very far away, look at our food, how many hands does our food typically touch before it gets to us? We lose so many nutrients that way as opposed to just eating it from the ground like we used to do. How many people and this is not … Especially with the … This is not meant to sound like it’s dirty or anything but we are not meant to have our carrots peeled and completely cleaned because we get our nutrients from the dirt, from the earth itself. People sometimes will whip out if everything is not perfectly sanitized. But in reality, that’s how we are going to stay healthy because that’s where our nutrients come from.

Howard: What’s funny is that doctors know this the most and they are the most crazy. When any dentist says they are holistic or they are natural and that’s where the actual dentist mind is, he just doesn't reframe it, he doesn't understand. When I talk to dentists, they don't want to be on 10 different prescriptions, they don't like the surgeons cutting on them and doing all these procedures. Then when one of the dentists in the area puts on their website holistic dentistry, natural alternatives or whatever, they go [ape shit 00:58:05] but that really gets smart people on the internet.

If I had a lower back problem, I’d be looking for someone who has advertised on their website, “Alternatives to back surgery, don't want lumber fusion, tired of taking pills.” I would want to exhaust all of those mechanisms before I went to the American healthcare system and gave someone my credit card and they start shoving pills down my mouth and cutting on stuff.

Juanita: Right, I agree with you, I actually have the same philosophy as you do. First you need to educate yourself about what’s out there and what is off the beaten path. I really do appreciate some modern medicine, without Penicillin and without some of these things,  we wouldn't have the lifestyle that we have now and the life expectancy. However, not every little thing needs a pill, not every little ache or pain needs a pill. You have to recognize for what it is, it’s a business and it’s a very profitable one and a very powerful one. I’m probably going to have somebody knocking on my door later today from the government because of the lobbies. You have to take that and realize that it’s not appropriate for everyone, maybe sometimes it’s appropriate and maybe sometimes you need that but sometimes it’s not and that’s really a self-awareness that you have to develop.

Howard: I’m not going to take a pill until they make one that grows hair and then I will try one.

Juanita: They haven't done that yet?

Howard: Well we are out of time, we’re a minute into overtime but Juanita again, I am a big fan of your blogs. If you are listening to this you can find your blogs on under blogs, you can go to Juanita's own site; but I’m telling you young kids, don't end up like me, learn how to prevent this stuff because my neck is jacked, I have so many dentist friends who can't run, they can't bite, they can't swim, a lot of them are about 60. 

I know a ton that had to retire, take disability or whatever and they never saw it coming, they were athletes in high school, they always thought they were healthy but they didn't focus on ergonomics, they didn't focus on posture, they didn't focus on the psychological stress, they didn't do everything Juanita is talking about. It cost them millions of dollars because if you just make the average pay, say 150,000 dollars a year, what is 150 times 10, that is 1,500,000 a decade. If you’ve got to go out of this profession at 55 instead of working until 65, what Juanita is telling you could have saved you a million and a half dollars.

There is … For every 100,000 dollars you want to make in retirement on a risk free 5% government bond, you take 100,000 divided by 0.05 and you need 2 million dollars of bonds to get 100,000 dollars of your income. Every year you can keep working and earning 100,000 dollars, that’s equivalent to having 2 million dollars in your retirement account. The bottom line is I don't want to retire, I want to be healthy, I would love to be able to do a root canal and pull [inaudible 01:01:30] on my 80th birthday like Bob Gibson does, like Gordon Christian does. When these dentists are going out disabled at 55, when you got Gordon Christian and Bob Gibson doing it at 80, the difference between 55 and 80, 55, 65, that is 25 years, 25 years at making say just an average is say, 150,000 times 25 years, that's almost 4 million bucks.

Yeah, do an online CE course, when you email me, I’m howard@dentaltown and the guy in charge of the online CE is Howard Goldstein, so his email’s and put up a deal, put a tag line on how to practice longer. Add millions of dollars to your retirement fund by not having to retire early. Anyway, hey, Juanita thanks so much for spending an hour with me, I think you are phenomenal and if you guys are watching us on YouTube, on dental town, I’m not going to tell your age but when I first saw her on her bogs and I first met her on Skype, I literally thought you’re 20 years old but you've actually been doing this a few decades, look. Whatever you’re eating, send some over here.

Juanita: Sure. Thank you so much Howard, I've really enjoyed this opportunity to get to talk to you and again to share my passion with everybody, I really appreciate it and hope that you keep doing your good work and spreading the gospel of health around.

Howard: Alright Juanita, thanks for your time buddy, bye bye.

Juanita: Take care, bye bye.

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