Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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829 TMJ Breakdown with Dr. Prabu Raman : Dentistry Uncensored with Howard Farran

829 TMJ Breakdown with Dr. Prabu Raman : Dentistry Uncensored with Howard Farran

9/2/2017 8:47:21 AM   |   Comments: 0   |   Views: 415

829 TMJ Breakdown with Dr. Prabu Raman : Dentistry Uncensored with Howard Farran

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829 TMJ Breakdown with Dr. Prabu Raman : Dentistry Uncensored with Howard Farran

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Dr. Prabu Raman has practiced dentistry in Kansas City since 1983.  He is an alumnus of William Jewell College, UMKC – School of Dentistry & The Las Vegas Institute of Advanced Dental Studies, where he served as a Clinical Instructor & Featured speaker. He currently teaches lecture and live patient courses on Aesthetics and TMD treatment sponsored by Myotronics – manufacturer of bio-electronic instrumentation for Neuromuscular dentistry.

His Kansas City practice, The Raman Center for Advanced Dentistry, focuses on four areas of excellence:  

1. Neuro Muscular Dentistry / Temporo Mandibular Dysfunction

2. Aesthetic Dentistry / Complex restorative Dentistry

3. Neuro Muscular Functional Orthodontics

4. Sleep breathing Disorders / Oral Appliance therapy

He has achieved Mastership status of The International College of Cranio Mandibular Orthopedics & Mastership of Las Vegas Institute of Advanced Dental Studies. He is also a Fellow of American College of Dentists & a Fellow of Pierre Fauchard Academy.

Dr. Raman has lectured on TMD in Argentina, Australia, Canada, Germany, Italy, Japan, Russia and the USA. He was selected by the ADA Council on Scientific Affairs as a TMD Expert to participate in the Science Forum at 2011 ADA annual meeting.  He was also selected by the Journal of the California Dental Association to be an invited author to contribute to its August 2014 TMD issue. 

Dr. Raman currently serves as President of the Missouri Dental Association, as a delegate to the ADA House of Delegates, Member of the ADA Council on Dental Education and Licensure, Chair of Recognition of Dental Specialties and Interest Areas in General Dentistry Committee. He is also the Vice President of the International College of Cranio Mandibular Orthopedics (ICCMO), Past President of the International Association for Comprehensive Aesthetics (IACA), and past President of Greater Kansas City Dental Society. 

His other memberships include:

- International Association for Orthodontics (IAO)

- American Academy of Craniofacial Pain (AACP)

- & American Academy of Sleep Medicine (AASM).

Howard: It is just a huge honor for me today to be podcast interviewing Dr. Prabu Raman DDS, MICCMO, LBIM, FACD. This guy is a legend. He’s practiced dentistry in Kansas City since 1983; is an alumnus of William Jewell College for undergrad, UMKC Dental School class of ’83, the Las Vegas Institute Advanced Dental Studies where he served as clinical instructor and featured speaker. He currently teaches lectures on live patient courses on aesthetics and TMD treatment sponsored by Myotronics: manufacturer of Bioelectronics Instrumentation for Neuromuscular Dentistry. His Kansas City practice-the Raman Centre for advanced dentistry, focuses on four areas of excellence; Neuromuscular dentistry Temporomandibular Dysfunction, Aesthetic Dentistry,Complex Restorative Dentistry, Neuromuscular Functional Orthodontics, and Sleep Breathing Disorders- Oral Appliance Therapy. He has achieved mastership status of the International College of Cranio-mandibular Orthopedics, and mastership of Las Vegas Institute of Advanced Dental Studies; is also a Fellow of the American College of Dentists, and a Fellow of Pierre Fauchard Academy.

Dr. Raman has lectured on TMJ,  TMD in Argentina, Australia, Canada, Germany, Italy, Japan, Russia, and the U.S.A. He was selected by the American Dental Association Council on scientific affairs as a TMD expert to participate in the Science Forum at 2011 ADA Annual Meeting. He was also selected by the Journal of the California Dental Association to be invited author to contribute to its August 2014 TMD issue. Dr. Raman currently serves as President of the Missouri Dental Association, as a delegate to the ADA House of Delegates; member of the ADA Council on Dental Education Licensure; Chair of Recognition of Dental Specialists and Interest Areas in General Dentistry Committee; is also the Vice President of the International College of Cranio-mandibular Orthopedics; past President of the International Association for Comprehensive Aesthetics; and past President of Greater Kansas City Dental Society. His other memberships include: International Association for Orthodontics; American Academy of Craniofacial Pain; and American Academy of Sleep Medicine.

My God! You are amazing! And you said you showed up here from India at age 20 with only five dollars in your pocket and look what you’ve accomplished.

Prabu: I have a little more than five in the pocket now.

Howard: Yeah, are you up to a ten dollar bill now?

Prabu: Yeah, somewhere around there.

Howard: You said that Missouri Dental Association is a hundred and fifty one years old, you said?

Prabu: Yes, sir.

Howard: You’re the President, and you’re the first President who wasn’t born in the United States and non-white. Congratulations on that. I think that is– just you just made my day telling me that.

Prabu: Thank you.

Howard: I mean this entire country was completely built on immigration. I mean, that’s all it was and it seems like every time, I mean, I have a list that I follow, of the Fortune 500 companies that were built by a first to second generation immigrant, and it’s half the list. If you’re born in America, you’re not hungry enough to do what it takes to start a great company like that. I mean, Google, Sergey Brin, Russian. I mean, the list just goes on and on, eBay, all these guys. So, congratulations, thank you for immigrating in the United States and for all your accomplishments.

So, there’s so many things that we can talk about today, but I want to start with the four thousand pound elephant in the room that no one ever wants to talk about. If I interviewed a hundred endodontists, they’d hardly disagree on anything; if I interviewed a hundred pediatric dentists on a chrome soak crown, there probably wouldn’t even be an argument; my God if I interviewed a hundred people in TMJ, every single one of them would have a different thought. Do you agree with that? TMJ or TMD is almost like a religion whereas a root canal is more just physics and biology. Do you agree with that or disagree with that?

Prabu: Oh, no. I totally agree with you and that is the reason why the California Dental Association have that issue that was referenced earlier because there is so much confusion, so many differences in opinion and it’s confusing for dentists. What do you do? and one of the things I think a lot of earlier, I think you mentioned about how I talked about TMJ, what I did not learn in dental school, and you and I went to the same school, and unfortunately, they are still teaching the same thing, Howard, what they taught us way back when, and some of those things simply are not true, and yes, there is this aspect of what do you believe but IT really shouldn’t be. It all should be scientifically based and more importantly, what works? What is bottom line? They keep exchanging paper versus paper and all those kind of things. Clinical dentists don’t care, they’re kind of like, “Hey, what can I do to help my patients? What can I do it in a predictable way? This is not going to be something so esoteric, only a certain people can know how to do this.” This whole idea of romancing the mandible, you have to have this touch or else you can’t do it. No, if I can do it, anybody can do it, it is teachable thing but this California Dental Association journal picked four people and what is very unique about that particular one was this: before, they wanted to pick four experts and the deal was, the other three will get to read your paper. Not like the usual stuff where you send it off, you don’t know who’s reading it, it’s all anonymous. I mean, I’m a reviewer myself for a peer-reviewed journal, I don’t know whose paper I’m reading, they don’t know who’s reading theirs, that is the usual case. This one is pretty open and transparent so the deal was, they will get to read it— the other three experts, they know the stuff, they get to critic mine, I get to critic theirs, and then we get to respond one time, and there are so many words we had to use like economizing the words. That is a great little concept— you’re respectful of each other, we respect each other, but we’re able to critique each other’s paper and then got to respond one time and they got their award for that. So, if somebody looks it up on that California Dental Association journal—

Howard: What year was that? That was—

Prabu: 2014, I think, 2014.

Howard: 2014. That is a very pioneering journalistic method.

Prabu: Yeah, they got an award for that. It’ll be excellent for any controversial subject, making it open. I have done debate since ’01 but that was much better, and one of the things I want to point out was, I didn’t spend too much of my time talking about my paper works, your paper, I actually showed real examples, talk about how it is done. One of the things that I always say is, “Where the river meets a road, you can get the patients better predictably, and, if you can’t do that, then you need to kind of pay attention to that one.” And that’s all I do every day, that’s all I have done for a couple of decades now and I must be doing it right for me to be continuing to do this every day.

Howard: One of the things, I really wanted you to go to this website, because so many— your website is amazing. First of all, you have a Youtube video of a patient who’s telling you that she had migraines and TMJ for five years, and when I go to a dentist’s website, I mean, you’re lucky that there’s even a picture of the dentist it usually looks like a mugshot for being arrested and here you have beautiful, smiling faces, your beautiful face, but you have a video of a human patient telling you their pain, so, I mean, you must have a very busy practice and I give you an A+ on your website.

Prabu: Oh, thanks.

Howard: So many of these people that have problems and they’re not going to the yellow pages that you and I grew up with in the 80’s, they’re going to Youtube, they’re going to Google, and they see five people with treating TMJ and just nothing, mugshot, nothing, mugshot, and then they go to your site and you’re going to see live patient testimonial videos, so, kudos to you on that.

So, what would you tell someone who watch these testimonials of these people in pain and were in pain for five years and you’re getting out of pain? Let’s just start one by one. How do they learn more about your four areas of excellence? Let’s start with just Neuromuscular Dentistry Temporomandibular Dysfunction. How does someone learn more about that? What should they need to know about that?

Prabu: You mean, what is Neuromuscular Dentistry, is that what you’re asking?

Howard: Yeah, and Temporomandibular Dysfunction.

Prabu: Great question. Basically this: what we were taught in dental school and they are still teaching these days, TMJ meaning the joint, right? Joint good, joint bad, as a matter of fact, if the jaw joint didn’t pop and click and hurt, you don’t have TMJ. Well, that’s not the whole story. The analogy that I often use to explain to people is this: say, if you go to a hotel room, you try to close the door, the door is just a little bit off, it doesn’t quite close at right, how would you shut her (inaudible 0:09:45) Once it is slammed in too hard, slammed hard and shoved into place, would anyone say it’s a perfectly fitting door? No, it’s not. It’s been shoved in. If you keep shoving it in long enough, thousands of times a day, what’ll happen to the hinges over time? Come apart? Get loose? Got to get stuck? Get out of track? Any of those things, right? When that happens, now we have a hinge problem, right? Well, let’s look at this analogy of the jaw. Upper jaw’s like the door frame, lower jaw is like the door, what moves it is the muscles. No matter what happens, the jaw muscles controlled by the jaw nerves of course, (inaudible 0:10:23) teeth to come together so they can’t put your teeth together-- chew and eat and function well, that’s what you call occlusion. Occlusion is nothing more than where the teeth fit. Teeth fit is where the door has been shoved in, so to speak. Well, no one will say that is ideal, but do people get away with it? Absolutely! We have a lot of adaptive capacity, that’s a good thing otherwise, we can’t do dental work. So, a lot of people get away with it in the sense; they manage to use some nerves, control the muscles, neuromuscular, that’s where the neuromuscular comes from, get the teeth to come together, jaw muscles pull them in so the teeth fit together. Yeah, I can chew and eat a matter of fact, where do we keep the jaw? Most of the time, close to striking distance, pretty close to where the teeth fit. We know we call them a “freeway space”, one or few millimeters away from where they touch. We’re not going to stay way over here and come back a couple of thousand times a day, we’re going to keep them close. If you do it all day long, what happens to the muscles? They’re going to get tired, fatigued, do they all have pain? Not necessarily, but lot of time, people get away with it because they have adaptive capacity. When you get over that bond, when you no longer (inaudible 0:11:34) your adaptive capacity, now we have symptom, now we have pain.

Most of the pain does come from the muscles, we call them Myogenous TMD but, it is all the same. Temporomandibular Dysfunction just means things are not fitting right, they’re not functioning properly. The term that I really like to use better is not very common, it’s Craniocervical Mandibular Dysfunction, CCMD. It hasn’t taken off yet because it’s a longer one, because what happens to the jaw affects the neck, you really can’t ignore that one, and I...

Howard: Say it again, what is CCMD stand for?

Prabu: Craniocervical-- head and neck, Mandibular Dysfunction. It’s actually a more accurate term, but TMD works because that’s more commonly known. TMJ’s a little too narrow, it’s just a joint. It’s one part—

Howard: But the sad thing about the terminology is, with the people, the patients, they’ve already branded it TMJ and root canals and then the dentists want to say, “No, it’s TMD and endodontic therapy.” But it’s kind of like we’re already— it’s too late, we’re behind the eight ball because they call it TMJ and root canals—

Prabu: Quite okay. It’s just a way of communicating, right?

Howard: Right.

Prabu: I mean, it’s like saying, “I have a knee,” but knowing well I have a knee problem, right? So, I get it, but one thing that people make a comment of is, how come your website says, “Midwest Headaches”, how come it does not say, “Midwest TMJ?” How come it doesn’t say, “Kansas City TMJ?” Well, the answer is very simple. It’s now I give credit to my wife for that one. She says, “People don’t know why they have a problem, but they know what they’re experiencing, right?” If you have a headache, you know you have a headache; you don’t know where that is coming from. By the way, headache is probably the number one symptom of poorly aligned jaw; number two maybe neck, number three maybe ear pain; those are the top three. Never them directly to do with the teeth, are they? So, we picked the term “Midwest Headaches” because I was thinking big in those days, all the way around Midwestern cities in Kansas City which is funny, it’s almost like— I’m sure you know the story about IBM, the guy that came up with the IBM name, International Business Machines way back when, they just have adding machines, he was thinking big. So, I was thinking “Midwest Headaches” thinking all around Midwest but in fact, I have treated people from pretty much all over the U.S., currently treating a kid all the way from Texas, and new Orleans, and so on. Also from overseas, but that is why we came up with the “Midwest Headaches” and she was also— give her the credit for how did this organize. When you go to the homepage, it has all the symptoms and the people go there for one reason and they go, “Oh! I have that too. I have that too” and they click on it and they’ll learn more about it, there are few case histories. So, my primary purpose really, Howard is to be a source of good information. Whether they come to me or not, I don’t really care, but really it’s important for me that they get good information.

You mentioned about going to Australia, I have lived there before also, I had a couple of emails. I think maybe last year or so, one woman saying, “Thank goodness I ran into your website! I’m not crazy, I have all these symptoms. Do you know somebody in this area?” I send her somebody there. Then a week or so later from Sydney, the sender lady, very similar email that saying, “I’m not crazy, I’m feeling all these. Do you know somebody?” I know two people, Fred Taylor and Fred Calabasas, I gave them two names. So, my purpose is to just be a good source of information so they go to somebody they can get really good help because very too often, they get the runaround.

Howard: You just had six thousand American dentists graduate last month and one of the first questions they ask on Dentaltown is, “I want to learn more about occlusion and it seems like there’s two main camps of occlusion: CR and Neuromuscular.” Does it matter which camp they got to? What is the difference between CR and Neuromuscular? Do you really think they need to pick a camp first or just start learning all they can about occlusion?

Prabu: Well, let me be blunt. As a matter of fact, I wrote something for Dental Town years ago called, “Occlusion Confusion” It was published on Dentaltown, because I was giving a course and—

Howard: Can we find that link, Occlusion Confusion. That sounds awesome.

Prabu: It’s in Dental Town few years ago and I kind of compared the various philosophies, and one of the reasons why I don’t think it’s such a great idea to have a TMD specialty is this: it’s a fundamental philosophy, how does it all work? Right, because that has to be another laying philosophy for the whole thing, no matter what you did. So, to answer your question, I think it absolutely makes difference which paradigm that you wanted to use. Paradigm is a model, right? How does it all work? So, I talk in simple terms about a door and a door hinge and all that, so at CR, let’s be honest about it, it’s all about joints. I have actually treated people that have a crappy joint or hardly any joint at all, so where does the CR come in? So, if the philosophy is based on a joint position, they can argue about where there used to be up on back, then up, now down and forward, whatever that might be it doesn’t matter, but this is a bigger one. In other words, look at the nerves, look at the muscles, the physiology of how things move, and the jaw is not much different from any of the part of the body, right? That is like a fundamental way of how we function, so to me, I have absolutely no doubt I think this makes more sense, and one of the questions that I want in my favorite quotes is from Thomas Jefferson, that says something— I’m paraphrasing probably, something to the fact to question everything and to question everything, even if they’re to say, existence of God, question that one, if there be a God? That God would probably more appreciate the fact that you’re questioning Him rather than just going by blind faith or something. So, by all means question, if it doesn’t make sense, ask people.

Howard: So, if someone wanted to learn about neuromuscular dentistry, where would you send them?

Prabu: Well, I teach them and other people that teach for myotronics and they can look through myotronics and that is the—

Howard: I mean, do you teach over the shoulders at your office? How will they learn from you?

Prabu: The first step would be probably the introductory course, two days, and I teach some and Dr. Mike Miyazaki teaches a lot of those too and that is usually in a hotel location because you don’t need a clinic for that.

Howard: But how would they find out where those courses are?

Prabu: Go to


Prabu: It’s on the front-- first page I think they’ve shown their C.E. offerings. That’ll be a good place to start.

Howard: How much is that machine these days?

Prabu: Which machine?

Howard: The myotronics machine where you measure the bite that there—

Prabu: Probably the very basic one to start with, which would be the principle behind getting the jaw on the right places. They used the term, “myomonitor”, it is an ultra-low frequency tens and that is all you basically need to begin with. That one is like a couple of thousand dollars, not much—

Howard: How much?

Prabu: About two thousand or so, I don’t know the exact number, I think it’s about—

Howard: Okay. So, if you go to, you can see series one, series two of where these are at. There’s a course coming up in Los Angeles, Calgary, and then you’re teaching one in Kansas City September 14 to16 so that’s a three-day course, and then October 5 to 7. That’s nice. Then you’ll also be in Seattle, then Washington D.C. So yeah, so go to But you said the—

Prabu: That’s where they’ll start.

Howard: That’s where you recommend they start?

Prabu: Yeah.

Howard: The basic machine you say is only how much money?

Prabu: Two thousand five hundred or something like that. I don’t know the exact numbers—

Howard: Twenty seven hundred dollars?

Prabu: It’s not very much but I think they’ll be referring to the K7 computer, that is a more expensive one and let me address that a little bit because sometimes people think it’s all about selling machines, it’s all about expensive stuff before you ever get in, there was a critics some time ago, “Oh, you don’t need all of that, why do you need all that expense?” I spend my first I-Cut machine that’s like pretty near $200,000 and two (inaudible 0:20:10) and people buy the Xerox machines and the similar machines. Don’t give me a big grief about something that cost maybe $30,000 or so, but my point is: don’t jump until you don’t need it. The analogy that I use, I’m not a pilot, are you a pilot, Howard?

Howard: No.

Prabu: Okay. Well, pilot speaks—

Howard: I was going to be, but when I found out that you can’t drink beer while you fly, I said, “No.”

Prabu: Well, my point is, on clear rather, most pilots are just going on visual flight drills, they can see where they’re going, they fly for fun or what not, right?, but when you get to something a little more complicated, go over the mountains or something, everything is upside down, they don’t know where they are, then you need all the avionics. Then you also need to know how to read it, right? That’s kind of what the case of a machine is, you don’t need them unless for those cases— like I use it every day, I have three of these but my point is, you don’t need to jump in there and spend all (inaudible (0:21:06) money. Start off with: does it makes sense to you? Go to one of these courses, does it make sense? It has to. That is, don’t ever go by faith; it has to make sense and then start off with something like an ultra-low frequency tens machine. Learn how to do it, you’ll do it in the first course, go home and try it out. That is how I started way back when.

Howard: Well, what I want to do is again, the online C.E. is mostly millennials. For me, if I want to learn the most information in the shortest amount of time, I always read a book. I mean, a text book, a dental textbook. I mean, you’ll watch some program on TV and it’ll be, say, it’s on The Great Barrier Reef and it’s like, you can watch an hour program and only write down like maybe, three things that you learned. But if you got a textbook on The Great Barrier Reef by a PhD, in the same hour of reading, you would have four pages of notes, but the millennials like podcast and online C.E. So, you’re talking to a bunch of kids and here’s the specific question: some patients are all fine and then you do something as little as a single unit crown or you just did one filling and you just set off the whole damn thing. How can you keep these young kids out of trouble? What would (inaudible 0:22:28) so they don’t think, “Oh, a broke tooth, crown, no big deal” now thet’ve throw someone all the way into TMD and all that.

Prabu: It’s a wonderful question. That’s exactly what I‘m going to be talking about in this program and when I do it an ADA. That’s at—

Howard: Are you going to put it online on DentalTown? Put the lecture online—

Prabu: (inaudible 0:22:46) All that I really care about is to get this information out. My point is this: you don’t see what you don’t know. Would you agree with that statement?

Howard: Absolutely.

Prabu: Right. The biggest part is learning enough that you don’t even need to teach this, you don’t need to choose to do it all the time. Learn enough to recognize a problem when it walks in, “Oh, this isn’t good.” If nothing else, a good conversation can happen. You could be, “Hey, I see lots of signs, things aren’t quite okay. You have the signs, but not really symptoms.” They’re saying, “I don’t have any symptom, I don’t have any pain, what are you talking about? I’m good.” “That’s fine, but I see all these signs and I could at least inform you of it if things aren’t okay.” They could say, “I don’t care, doc, just fix this crown.” Okay, then you could’ve at least have them informed, have been informed, could then say, “I have done giving them information.” Okay, the other thing that could happen would be when this conversation happens, “Oh, as a matter of fact, I have lot of symptoms. I’ve been going to this doctor, I’ve been going to that doctor, I’ve been to a neurologist, I’ve gone to the ear, nose, and throat”, it happens. Then they could say, “You know what, you might want to go to somebody like me, go here and check it out”, and maybe, they’ll thank you for sending them the right way, that could happen. The other thing would be, people that don’t have symptoms all the time, once in awhile, “Well, I just have it occasionally, then I’m good otherwise.” Then there are people that are all the time, persistent TMD, they actually think of it like a pyramid-- the bottom is lots of signs, if you know enough you can see it, if you don’t see it, you go in right back. The analogy that I use is: you and I go to a crime scene— we don’t see it and a crime scene investigator find these little bit of things that are clues for them, that’s all I’m talking about. Showing the signs, learn enough about the signs to recognize, that’s the first one. They are the people that have subclinical TMD— there are signs but no symptoms yet. The next level is Transient—once on a while, if I do this, fell over do this then I have pain, otherwise, I’m good. The third will be Persistent TMD. Those are stages if you will, and the sole idea, the adaptive capacity, what your body will put up with, Oftentimes, they’re right about the edge, they don’t know it, you don’t know it, you do something, everything blows up and now it’s on you, right? That is really what I would like to avoid for dentists. I have seen cases, simple as a single filling, single crown, lumineers, that’s not supposed to change your bite or orthodontist just barely start it of course orthodontist says, “There’s absolutely no way that could’ve caused it.” Well, he’s right in a way saying he must have done thousands of cases, they don’t cause it so it cannot be it, but my point is it’s like this straw that breaks a camel’s back. That last straw didn’t do it but, the last straw gets too much credit or too much blame depending on how you look at it. So, to answer your question, the way to start would be: learn enough about it; learn the signs; what you are to look for; and the first course would be enough to do it and I may be put on a course with you, what all to look for so that you’ll recognize it like, “Whoa! Whoa! Whoa! Something isn’t quite right.” And have a conversation, and if you have a conversation that patient were to choose to say, “I’m cool with that, leave it alone” and you’ve choose to go, that’s okay at least let them be informed. This analogy is not so weird, think of it like a heart problems: there are a lot of people walking around with half of their coronary artery closed up; they don’t know it, right? These are also people that have coronary artery 80% blocked up, the only time they have problem is they go up about four or five flights of stairs otherwise they’re good. Then you have somebody have a full blown heart attack. Did that happen overnight? No, it’s been going on for a while. Unless you do some tests, you will never know. That’s kind of what the case of the computer that I talked about is useful for, I can actually measure things and that doesn’t mean everybody needs to have it, but we do have the technology to be able to measure that and yes, this technology has been approved forever and I know there are people they’re saying, “Oh, you don’t need all that, no.” No, you don’t need it? It’s just like saying, “You don’t need all the avionics in an airplane.” Yeah, you’re right; there are planes that don’t have any of that, but you better not be taking cross-country flights on that one, right? You might get in trouble. Hope that makes sense.

Howard: Yeah, you should’ve talked to John Kennedy Jr. before he took that night flight.

Prabu: Exactly. You got it, yeah. Do not only have the machine, know how to interpret and use it too. That’s also important.

Howard: That was a great— so, aesthetic dentistry complex restorative dentistry. How do they learn more about Aesthetic Dentistry Complex Restorative Dentistry?

Prabu: Well, the second course, we did talked about the smile design, how to do that now, but then more importantly—

Howard: One was the proper course, and then one was the C.E.

Prabu: Yeah, and the idea there is: you want to have the functional part and you also want pretty teeth. You can have both, it’s not either/or and more importantly, it’s really, really important for people that do aesthetic dentistry, veneers, and so on to know enough about it. They don’t make people that use to be symptom-free, put them into symptoms. I often used to tell people; when somebody coming to me with disabling symptoms, if I get half of them better, they’re happy, right? They’re better than they used to be. What if somebody walks in that absolutely have no symptoms at all, but then after some treatment they have symptoms? They have every right to blame you, right? They’re like, “I was perfectly fine until you did the XYZ.” So, it is in a way even more important to learn what to avoid if you would, what are those things that are waiting to blow up on you in a way.

Howard: So, this is Dentistry Uncensored, I don’t like to talk about anything everyone agrees on. So now I’m going to get you in trouble, I’m going to throw you under a bus right now.

Prabu: Go right ahead.

Howard: A lot of dentists, when they’re learning TMJ or TMD and occlusion, they’re very confused because they say, “Look, we send our so many millions of American children to the orthodontist and they’re pulling first bicuspids and wisdom teeth, they’re leveling out the curve of Spee, the curve of Wilson and when the kid’s done with the orthodontics, they don’t even think the kid’s occlusion was finished off. Do you think orthodontists—there’s over ten thousand orthodontists in America, do you think they do a good job with occlusion? Or do you think it’s more of a mass mill and they have this very adaptive capacity that just works for most kids and doesn’t work for a few? What would your general rant assessment of the American orthodontic factory that we all send our children through?

Prabu: You did say you’re going to throw me under the bus, didn’t you? You’re not kidding, no. Let me back up and see, what do orthodontists do most of the time—give me pretty teeth, straight teeth, nice looking front teeth, right? If that is your goal, they do a great job. Do they do a good, efficient way job of doing it and get people nice and fake teeth? Absolutely, yes, that happens, right? The other thing is also a truth: four out of five people that I meet have had braces before; they often had been complimented on nice-looking teeth, nice-looking occlusion, meaning where the back teeth fit.  This may be a time for me to bring up a story which I thought you might ask. Why the hell did I get into this TMD business? Why? Because I was making a nice living, I had six ops, eight people working for me, making more money than I am now, but this is why: right after I was out of dental school, I took my own wife to a local orthodontist— good guy, one has straight teeth. You went to UMKC, how much did you know about orthodontics when you came out? Not a whole lot.

Howard: 0.000 and when I asked my instructors, “Are we going to learn anything about ortho?” He said, “Howard, if you’re going to learn anything about orthodontics, you need to go to ortho school.” And I thought, “Well, half the class is going back to rural Kansas and Missouri where they don’t even have a specialist.” Yeah, anyway—

Prabu: Same school I went to, I had similar kind of experience as well. I didn’t know anything so I took her to local orthodontist. Now that I know what I know, that would have been an easy case. I didn’t know, so one of the first thing he did was, when you get four bicuspid (inaudible 0:31:38) minimal crowning in the front, that’s about it. I have an old picture of her somewhere, but I followed the advice, have four bicuspid taken off. I didn’t want to do it because it’s my own wife, I hang on to her hand, we took her to the surgeon, and I’ve used sedation to get that taken out and the wisdom tooth. Everything was cool, and as she was getting toward the finishing part of her orthodontic treatment, she became a migraine patient. We took her to the physician, they said, “Oh, she has migraine there’s a medicine.” I think it’s at that time, some kind of triptans medicine and she couldn’t tolerate it and she would only take it if she couldn’t take it anymore. It is so bad and she said-- she’s from Korea and there’s a whole story there about how she defied her family to marry me, they’d be asunder and yet I’m doing this to her? I feel so guilty so I’m going to find a solution for this. I just did not believe the physicians, this migraine is a coincidence during braces. So that is really where I started learning with the Jon Witcik, he has passed away. That’s one of my first forays into this, just talking about functional orthodontics made a lot of sense, then I took a lot of courses for the whole lot of courses for the Jay Gerber, that is really where I started and that is where I learned about neuromuscular dentistry, the aesthetic part came later. So now, I do both, but to answer your original question: do all orthodontists harm patients? No, that’s not a fair thing to say, it’s a very, very broad stroke. Do they sometimes do treatment that puts people on their path to have more problems? Absolutely, absolutely, it happens all the time because four out of five people that I treat have had braces before. Some of these people have had more than once; many of these people had braces specifically to have a better bite; and I’ve also had referrals from orthodontists, one orthodontist said— A couple of years ago, I had a call from her, the patient said this orthodontist referred so I called her, say, “Thank you.” I should call the referring doctor about half of her patients come from internet, half from other doctors that refer, I don’t need any of their advertisement kind of thing. So, I called and asked her to thank her, she goes, “She’s not really my patient.” “Oh, she’s not? It says here, you referred.” “Oh, I had referred. She came to me for a third opinion.” I said, “Really?” “Yeah, she’s been to two other orthodontists, she has a perfect bite, perfect teeth, the last orthodontist said made her splint her back guard, but this girl has a lot of jaw pain. I don’t know what to improve; she has a perfect bite, perfect teeth, maybe you can help her so I referred her to you.” So this girl comes in, are you referred— I should call people before I meet them. So, I started asking questions and so on and I asked her, this is the way I ask a question, it’s an odd way to ask, “If you could have any health related outcome, anything at all, just like a genie’s wish list, what’ll be number one?” She said, “Anything at all?” I said, “Yeah.” “Migraine.” I said, “Really? I thought you’d come in for jaw pain?” “You said anything at all.” I said, “Yeah, tell me about it.” She’s in her late 20’s, (inaudible 0:34:43) person, she’s been on a migraine medicines since she was in eighth grade, she’s in so much medication that every time she calls a neurologist it says, “Up the dose.” I said, “If I take anymore dose, I can’t function. I just put up with it. So, if you could get through—oh, heck! I could put up with the jaw pain.” “What’s your number two, Callie?” that’s her name. “Neck pain, I’ve a lot of neck pain.” I said, “Okay, what’s your number three?” “I have a shoulder pain, upper back pain.” Number five was jaw pain.” That is what she thought she is coming to me to see jaw pain but really, that turned out to be number five and she had many more (inaudible 0:35:17). The interesting story was even though her teeth looked pretty, the bite looked good, they are all interdigitated, they’re in the wrong place, those muscles were constantly working. Once I figured this out, put where the jaw should be, let her live it in a few weeks, all of her symptoms run away including her jaw pain, off the migraine medications, now she’s married, she’s having a baby, she’s pregnant right now with her young husband. All of those could’ve not have happened, I don’t think if she’s still with migraine taking all those medications. So, that’s what the cool part about this one is, back to connecting orthodontics and so on, not all orthodontics cause problems, many of them inadvertently do-- they are taking out the teeth at the cost of function. If you don’t look at the muscles, if you don’t know how everything else lines up, sometimes you get it right, many times you don’t and the patients don’t have problems until much later so they often don’t connected. So, (inaudible 0:36:10) am I under the bus completely or still am I under the bus?

Howard: Nice answer but I got to go back, so did you meet your Korean wife in Kansas City or did you meet her in Korea?

Prabu: No, I meet her in school, Bilingual College and Liberty.

Howard: Oh, an undergrad?

Prabu: Undergrad. She came here, she’s supposed to go back home and I was from California, I was supposed to come here and go right back to California. We met, and my family didn’t like that idea, her family didn’t like that idea, they all have different plans so they both disowned us and she would not go, she never did listen to me even then. I said, “You know what, maybe you should marry that doctor that they picked for you.” She said, “Nope.” So that is forty years ago, we’ve been married forty years now.

Howard: So, who would pick the guy? Who had the arrangement, your wife did? They wanted her to come back to Korea?

Prabu: Yeah, they wanted her to come back to Korea, as a matter of fact—

Howard: Did they have an arranged marriage for her?

Prabu: Not arranged so much but tried to find a match, there’s a nice doctor in I think it’s in Louisiana or somewhere, Korean background and both of their family they are looking for a nice Korean girl, but the son wanted somebody that is new American. He was already going to school, this is perfect. They all thought it was perfect, she didn’t want to and my family wanted me to marry a nice Indian girl, neither did I so here we are.

Howard: So, what did your wife end up becoming?

Prabu: Oh, she’s an accountant.

Howard: An accountant, very nice. Yeah, it’s funny because I’m a product of (inaudible 0:37:34) because my dad and mom’s family disowned them because my mom was Irish Catholic and my dad, his family was Episcopalians—

Prabu: Oh my God! How could they possibly—

Howard: I guess back in late ‘30’s, the lowest thing you could do in Kansas is many an Irish Catholic and they disowned them. So then they got married, they had two daughters–my two older sisters and still no communication, but then when they had their first born son, me, that’s when the grandpas they wanted to see their first born son, and that was the icebreaker to get them back together. I thought it was so—

Prabu: If we can imagine in your case, to me from my perspective, like that there shouldn’t be a problem, right? But obviously that’s a big problem in their culture and I can’t imagine two different countries and two different cultures and so on, they just, oh, they can’t do that in here. We have three beautiful girls, daughters and heck, they’re going to be grandparents this December.

Howard: Right on, right on. Congratulations! So I want to ask you another extremely controversial question—

Prabu: Please do.

Howard: Pharmacology has some TMJ people; TMD people use a lot of pharmacology; and other people don’t think there’s a place for–they think it’s more mechanical and do your treatment. So what are your views on pharmacology? No matter what you say, half of the people listening will disagree with you.

Prabu: I get it. Now, let’s talk about pharmacology here. Most (inaudible 0:39:03) medical were a list on pharmacology, right? That’s where billions of dollars are made, right? So pharmacology, if you can think in terms of their adaptive capacity, I often use a cup analogy. I like analogies, if you haven’t figured that out already. If you have a cup, lots of things fill it up. How did jaw fits there 24/7? How the neck and the posture fit there? That’s where the airway comes in. If the airway isn’t good, your planet make up for the neck is forward, the back is messed up, posture is bad. On top of that, you have biochemistry, diet, medications and so on, are you for in hormone changes? They all are built on top of that. On top of that if you can think of it would be the stress— comes and goes, we blame stress a lot, it is often the precipitating factor, so now, back to your original question about this pharmacology. When you give a medicine, let’s talk about migraine as an example, when you give a medicine, what are you really doing? You’re finding some way of symptom relief, right? To me, it’s almost like finding some way yet, say, you have a check engine light comes on a car, you’re driving along. Most people would take the car to the dealership to figure out what’s going on, find out what it is, diagnose it, and fix it. What if you could find a way to just reset the check engine light every three or four hours? Are you cool? No more symptoms. So, that’s kind of what pharmacology that is most times, then of course somebody else might even go to the next level, if I can find the wire that is coming to the little indicator light, man that indicator light will be gone for good. There are some surgical procedures that are doing just that, cut off the nerve where the pain is coming from. To me, back off! First find where they’re coming from and see if you can figure that out– see if you can fix it. This maybe a good time for me to bring this up, I never tell anybody that I treat migraines. I never tell anybody I treat fibromyalgia. I never tell anybody I treat cervical dystonia, any of those things because I’m very clear about what I did. I’m a dentist, what I’m good at is getting the jaw and neck alignment; I know exactly how to do that from right. So, I very much follow the ADA parameters and TMD parameters of care, but what I also know is when the jaw and neck are properly aligned, many, many of these symptoms go away. Like the girl I’ve mentioned about, Callie. Much more symptoms including migraine went away, but I’m very clear with what I’m doing— I’m doing velvet on my scope of practice, correcting the jaw alignment, by the way, always correcting the jaw and neck. Back to your pharmacology, I’m okay with using pharmaceuticals as a short term and I also use trigger point injections, again as a short term, those were all things to give some temporary relief while you’re facing the real problem. As for as having that as a long term solution, somebody is set on it, I pretty much tell them I’m not the doctor for you. I say. ‘I’m not a pain management doctor; I’m a pain resolution doctor.” Depending on what you want.

Howard: Okay, I ask you to throw the orthodontist under the bridge and tell you what you thought of them. Now, I’m going to throw my own homies under bridge, I’m going to throw 95% of all the general dentists under bridge. This is reality, I mean, this is total reality—in 95% of total dentists offices, when you come in and you tell them you have any of these symptoms; any TMD, anything going on, 95 out of hundred dentists just take the upper and lower impressions, send it to the lab, make a night guard and say, “You’re cured.” Agree or disagree?

Prabu: That’s not a bad way to start as a first step, what do you got to lose? It is a management strategy nothing wrong with that, right? You can manage or you can fix a problem. I’m not saying management is a bad one but, especially if you’re using something like a medication then you could’ve put in chemicals on your body forever and ever, that is worse than putting a piece of plastic. Again, if the person is more in the transient stage, meaning they have one in a while problem put a piece of plastic so they can slide around in their nighttime and they’re doing good afterwards, happy, what’s wrong with that? That’s a pretty conservative way of doing it, right? You know I’m not doing any harm, what’s the worst thing you can do put a piece of plastic? You cost a few hundred dollars for the patient if they do, but if that is the only tool you have in your toolbox then I would have problem with that. There are actual people they’re called, again, you started talking about throwing me under the bus I’m going to throw myself under one here— there are people that are orofacial pain specialists and what do they really do? Let’s get to the bottom line. What do they really do? They do a lot of diagnostic part, fine, cool, then what? He puts a piece of plastic you already talked about. Wouldn’t a second year dental student know how to do that one? Do you really need a dental degree and a specialty to be able to put a piece of plastic? No, you don’t. He could give a lot of medications. Well, do you really need a dentist to give medications? There are plenty of physicians. Nurse practitioners give you medications or you can send him to psychological therapy, oh, there are plenty of psychiatrists and psychologists. Where do you really do? What do you do unique here, right? That’s the kind of question I have for them. So, back to the piece of plastic— nothing wrong with that, that is not a cure, it’s a management strategy and if the management is enough to keep the patient get through their life, fine, nothing wrong with that. So, I don’t really think I throw anybody under a bus on that one.

Howard: Another big, scary thing that—again, I’m trying to aim this at these young millennials that are coming out. They might be getting to their first full mouth rehab case or first big complex aesthetic case and they’ve heard all these nightmares that you don’t want to open the bite. If you open the bite, all hell is going to break lose. What’s the story on opening a bite?

Prabu: Okay, that’s a very good question. Let me talk about what we mean by opening the bite. What you’re really talking about is opening the bite you’re thinking vertical, right? It opening the bite so much and how many thousands of dollars have you all spent on articulators? Thousands, right? I had a fully adjustable (inaudible 0:45:17) and something else, I have a couple of (inaudible 0:45:20) bunch of thousands of dollars. Most of them based on this fundamental concept if you would, one of those many lies that are taught to us, I’d use the word “lie”: first twenty millimeters you’re just opening as a pure hinge, haven’t you heard that? Did we learn all that? What else moves like that? Your articulator, nothing else, not real person so, when we think in terms of vertical opening, how many opening, that really is a misnomer. If that were true, first twenty millimeters is more than enough for two teeth, right? Height wise, more than enough. If that were true, why do they get this all done, let them do whatever CR whatever method they have to figure out where the bite should be, send them off to have the crown done or multiple crowns, and they put them back in the mouth, how many of them don’t adjust? They all adjust, why? They didn’t exactly fit the same way if the mouth doesn’t chew the same way the articulator chewed. No, because that’s an absolute truth, that’s not how it works. Let’s go back to the joints. I’ve had a CT scanner since 2006 as I’m on my second one now. I have imaged every single patient that I’ve treated, jaw joint. No two condyles are exactly the same, not a single tooth and there is no average, they’re all over the place, so the jaw doesn’t exactly open the exactly the same on the left and right let alone fifteen people. So, what it really means is, we need to figure out how the jaw really functions in— you know, when I talk about the neuromuscular concept, relax the jaw muscles, neck muscles, figure out where that is, what you often find out is– I’ve measured them every single case by the way, sometimes, the front my open say, four millimeters back is four, five here, what then happened? Jaw came almost straight down, so how would that work in an articulator? No, it doesn’t, so you really need to figure out the physiology and so on. Back to your question about what would a person like that, a young dentist taking on a big case? Probably the best advice I would give them would be: be very clear you’re not changing the bite because if you’re changing the occlusion, changing the way things come together, then you better be very careful that you preserve it correctly. And if you’re doing a one [0:47:38 inaudible], depending on why they’re doing it, if they’re doing it because a bunch of teeth are broken down they need to fix them anyway, do them in stages so you’re maintaining the best you can, so at least you didn’t make them worse because 99% of the dentistry get done are on the presenting occlusion, right? They walk in with something, you do one tooth, two teeth, or quadrant, whatever you do then you don’t really change them, hopefully that’s kind of what I’ll talk about on this CE course. I’ll do for you then I’ll also be talking about ADA about what are some strategies you can use so at least don’t make the patient worse, so the whole thing. Above all else, don’t do any harm to the patient, right? So, if you can keep them from changing arbitrarily, then you’re better off. The worst thing that you can possibly do, I can tell you this much, open the (inaudible 0:48:27) millimeters, on the articulator? It does happen, wouldn’t you agree?

Howard: Yes.

Prabu: People (inaudible 0:48:33) “I need more room, open.” Where did they come up with that one? It absolutely has no relation to reality and just opening like this. The only reason they do it is because they were talking in dental school, “for the first twenty millimeters, it is all pure rotation you can’t just open it up.” It doesn’t actually work in a real patient, live patient as first twenty millimeters and rotation, no, it doesn’t. You can’t make them. I can actually grab them and make them rotate, but if they’re actually moving on their own, rotation translation all happens simultaneously, lots of studies to show that.

Howard: She’s a twenty five year old dentist, she’s working in corporate, she has worked at Aspen and the mom, she’s doing a hygiene exam on the mom and the mom says, “My three year old daughter sleeps with me at my bed at night and she just grinds her teeth, I mean, you can hear clear across the room.” What should the dentist say to—how do you respond to that question when mom says that about a three year old, four year old?

Prabu: Yeah, lot of times, by the way, lot of times, the grinding like that happens because they have ear issues. They may have plugged up ears, you know the Eustachian tube if it is plugged, when you clench and saw one move the jaw, it feels better. That’s the reason why we chew gum on a flight, because the same nerve, trigeminal nerve, that controls the masseter or the medial pterygoid, there’s a branch in the medial pterygoid going into the tensor veli palatini and tensor tympani. Tensor veli palatini is a little bit of muscle that controls the Eustachian tube, so if it feels itchy, if it feels plugged, they grind so it feels better. So, maybe what they need to do is to get them to the primary care or ENT to see what’s going on. Maybe they have some kind of ear problems, allergy problems that might be the reason they grinding not because of bite is soft.

Howard: Okay, this one’s an intra-office controversy—

Prabu: Okay.

Howard: Abfractions. The hygienist is telling all your patients it’s because you’re sawing your toothbrush back and forth, and then the dentists are listening to veterinarian saying, “Hey, these animals out in the Serengeti, they have abfractions and they don’t have toothbrushes.” What causes abfractions?

Prabu: Well, it is a flexure, it’s basically bending. One of the things– I don’t have it handy, one of the things I often showed to people is when they have a lot of abfractions, some TMD patient coming to me, but they have had a bunch of composites right up the gum level because every time they go to the dentist, oh they have one more to fix. Some of them are below the gum and I always ask them, “Did you just brush that one tooth harder than the front teeth?” Not really, and how many times did you see abfractions, Howard, that they go below the gum, and you have a tissue sitting here, did they get the brush in there, brush it hard, but not touch the gum? Give me a break, and again the hygienists, unfortunately probably is repeating what she has heard or he has heard. But it is really from flexure, too much pressure on them, and if you get a little paper, roll it up then put it in your hand taking out, if you bend it, you’ll bend right where you’re holding it and immediately patient’s eyes open, “Oh that makes sense to me.” It is a physics phenomenon; it’s a too much pressure biting, clenchers more than grinders by the way and to have more of an abfraction. Why do people clench? That’d be our next story.

Howard: Well, why do people clench?

Prabu: Now that you asked, most people say, “Clenching is because of stress.” Stress does increase clenching, absolutely true. You know when you’re getting ready to punch somebody, you got to clench and stabilize your jaw before you throw a punch. So when you clench, it increases your stability temporarily, it’s almost like holding on to something for more stability. People that have postural problems, now this is jaw, jaw connects to the neck, the neck connects to the rest of the body, one of the many things that I check when I meet somebody for the first time, check their posture, check their gate when they’re walking up and down, how are they and so on, if there’s a lot of problems with that, I don’t fix anything below the neck. My area of expertise is right here, my license is right here so I’m very clear about it but I’m aware of the rest of it. You see, if things are not okay, which one came first? I can do a balance test easily and I’ll show that when we do the CE course for Dentaltown. It is easy to do that one to see where that might coming from, what we find out is a lot is a large number of them, not all of them, large of them is because of poorly aligned jaw. If the jaw’s poorly aligned, it affects the neck, it affects the whole thing, and why would this be the first one? Why is this so important? The jaw is the right place; it is one end of the postural chain, right? Bottom of the foot all the way to the head it is one end of the chain, but this chain is more important than the other end because this is the end we feed, we breathe, this is a really important end (inaudible 0:53:37) so no matter where the jaw fits, it will come together so we can chew, eat, and live, and all that other stuff and if you need more airway, bring you your neck forward, we’ll do all that, but there’s a price to pay. So people that have poor jaw alignment oftentimes have a postural alignment problem, when they have a postural alignment problem, oftentimes they clench. So, we have to find out why, and we’re not going to make them all perfect, if we can get her to the original problem if that is the case, then doing things like physical therapy, yoga, those are all good strategies long term to maintain.

Howard: Okay, now I’m on to more controversies, more throwing you under the bridge.

Prabu: Okay.

Howard: I mean, again, these are millennials listening and she’s hearing some pretty outlandish claims and some of the stuff is on Dentaltown that there are people who sleep, who do sleep apnea, sleep breathing disorders then say that it is absolutely malpractice to make anybody an appliance for grinding their teeth until they’ve had a complete sleep breathing disorder work out and that’s end of story. What do you think of that claim that it is malpractice to give someone a night guard for grinding if they haven’t had a complete workout for sleep breathing disorders?

Prabu: You mean, one of the things that I mentioned is sleep breathing disorders on my list of things, but I don’t do a lot of that for this reason: it is really insurance driven and I don’t do insurance, they need to pay me upfront before we do them. That’s a different conversation in itself why I do that and all that and because I don’t do a lot of it, but I had lot of interest in it early on because I do a lot of full mouth reconstruction, when I sedate them with oral sedation and I’ve done it for many, many years long before docs came along and I often notice people in the middle of the procedure, they kind of stop breathing and I had to wake them up and of course they are being monitored, they have the pulse socks and everything else, but it made me wonder how many of these people are stopped breathing in their own home, nobody ever knows. That is where my interest came from way back when I’m a member of the American Academy of Sleep Medicine, not on Dental Sleep Medicine, I just want to know about it, be on top of it, to say it is malpractice to put anything in the mouth unless you do full blown steady and then do sleep treatment. I think that it is perhaps in my opinion, oral blown important sub dental area [0:56:00 unclear]; I do many things including that one. It is true, anything you put in the mouth can affect, but that’s like saying, “Nobody should ever do orthodontics unless they go do a full case of a work up to figure out where the jaw should be.” Would that work? Would that be malpractice do orthodontics and misaligned if you don’t know exactly how the joint is how the muscles are? That would be analogous saying that, “If you don’t do full blown and sleep study, you cannot do a bite guard.” to me is analogous to what I claim I just made.

Howard: You are an amazing man and I could listen to you for forty days and forty nights, I mean, is there anything else you wanted to talk about that I wasn’t smart enough to ask?

Prabu: No, you’re plenty of smart. Well, let me put enough plug in for ADA. I’m very much part of ADA, I know people complain much about ADA and this do and do that, we all can have our complaints ,but that’s only one we have and there are about 68% or so are members of ADA and you probably know AMA is somewhere in the teens, not even in the 20%. As a matter of fact, I’m also a delegate to the American, ADA House of Delegates. About five years ago, I came up with a resolution. All that it said was this, Howard, very simple. It says, “There are people that are promoting army, navy, and all those kind of thing; there are people promoting corporate practice; there are people that are promoting public health; who’s promoting private dentistry, private practice?” Nobody. So all that, my resolution asked for, is for ADA to spend some effort in promoting this as a model and I thought I was doing something good thing, I thought it’ll be like motherhood and apple pie. That resolution got shut down at the ADA House of Delegates, like I was surprised to hear that, like “Why would you be against this?” because if the private practice area dies, so does ADA because that is exactly what happened with the AMA because I was looking, doing study in preparation for that solution, I asked AMA, “What is your market share?” They would not tell me. I said, “Really?” So I called ADA person and thinking that colleagues calling each other bottom Chicago, ADA membership person asking AMA membership person they thought they’ll all tell them, they were surprised that AMA person would tell the person what their market share was, that how proud they are of that one, so we can only go on indirect evidence and so on, somewhere in the teens. Why did that happen? Because private practice went down, there was a time, you probably know this most docs own their own practices, right? How many of them own their practice these days? Not very many, they are just about all owned by hospital corporations and so on, AMA to a large extent, many of them, they are all doctors but they don’t own private practice doctors, they may have worked for insurance company, they may have work for a hospital owning corporations, and a number of things. None of my kids are into dentistry, this is not for me, I’m talking about the young kids coming up after us. I want ADA to be the champion to maintain private practice dentistry as a viable option and we can only do that if we all hang together, we can have our differences, but it’s better to be a part of the conversation, be part of the good instead of paying outside and thrown dark sided, so one thing that I would end with it to be; become part of your local dental society, dental association and be part of the solution instead of just complaining about it. So, that’s what I would end up but it’s not controversial, nothing to do with TMD, but to dentistry for sure.

Howard: Well, I think it’s a— I’ve been a due paying member since day one, I always pay my dues and it’s so funny on Dentaltown you’ll hear someone complain about the ADA so they’d quit paying their dues, I’m like, “Dude, you have more complaints about your own parents than you do the ADA.” I mean, I have four boys and one of those four doesn’t even think I’m perfect, imagine that.

Prabu: Howard, I don’t believe that.

Howard: So, the bottom line is, I mean, when you graduate from dental school– when I was in UMKC my mom and dad cried, and if you want, I mean, it’s a sacred, sovereign profession and they’re the only team fighting for your profession and if you don’t fund and support the only team fighting for dentistry, you’re an idiot. I mean, you’re an idiot and the other thing is that there’s, I think of the ADA is a very federal part, Chicago, for Washington DC, but then there’s fifty states. You’re the president of the fifty states and these dentists don’t know about all the little legislative battles that are going on every day in every state all day long and they think that that doesn’t need supported? I mean, there’s so many issues and I was telling, I had my local executive director on a podcast, Kevin Earl and I was telling Kevin Earl that the only complain I have about the ADA is that they don’t market well enough for all their doing because every time I have lunch with Kevin, I hear all about the bullshit going in the legislator and then I’ll be watching the football game with the [1:01:37 unclear] dentists and they don’t know any of this stuff and so the only thing I would say to ADA is they just got to get a better job of getting out all these crazy battles, I mean they’re the only ones fighting for you and I’ve had a couple of presidents’ son of the ADA on the show and I’ve had the executive director on— who’s the current president of the ADA right now?

Prabu: Gary Roberts, you should get him on. He’s a great guy.

Howard: We’ll fix this up. Email him and CC me, and my son and we’ll move him to the front in line because my gosh, if no one’s fighting for it, this profession and the thing that worries me the most is look at health care— is it all the dentists work for Wall Street and all the physicians work for corporate, who are Americans going to go to when they need a doctor? When you’re baby is sick, you don’t want to go to a Wall Street executive, you don’t want to go to an insurance salesman, you don’t want to go to an MBA, you want a damn doctor who wants to do what’s best for your child and if all the doctors are employees and then what do we have to do?  Where do we have to go back to the Eastern hemisphere to find a real doctor?

Prabu: Well, they are doctors, they just– their decisions are often overseen by somebody else and controlled by somebody else, that’s a problem, right? It may have—

Howard: But these kids tell me they work in corporate dental offices in America and an office manager, she has no training says that every pocket that’s greater than five millimeters has had the periochip in there and she can’t find one periodontist in her town that agrees with that and then they say things like, “Well, 30% of your new patients need perio.” That’s like telling a physician that, “30% of your new patients have Chlamydia, I mean, I thought you only have Chlamydia if you have Chlamydia, I didn’t know that 30% of your new patients had Chlamydia.” I mean, it’s just, it’s crazy and that’s where I’m very skeptical of these laws that non-dentists connote dental offices because who built the first great car? Henry Ford, he was an engineer, you know what I mean? I think the guy in charge of the dental office, I think she should be a doctor of dental surgery, I don’t think she should be an MBA from Wall Street.

Prabu: Now, I’ll get a hold of Gary Roberts, good guy. He’s from Louisiana, very dental, straight-forward, straight doctor; it’ll be great for you to get together on that podcast.

Howard: Yeah, and tell him that the most fun I ever, I could tell you my Louisiana story and you wouldn’t even believe us. So, I went down there and lectured in Lafayette and I took all of my four boys and then when we’re done, we drove two hours South to where the roads ended then switched this flat bottom boats, and went an hour around the Gulf of Mexico, red fishing and when we’re coming back, we found like a, you can’t make this one, it’s like a twelve-foot long alligator bloated almost dead, obviously he got lost in the sea so we tied him back, we trolled him all the way back to the shore and then my four boys were all sitting on him like a horse and we’re taking a picture of it with these four boys sitting on like a horse, there must have had, between all the dentists’ kids, there must have been ten kids (inaudible 1:05:04). So when we then all went upstairs, we cooked fish, we all passed out, and when we woke up the morning, the alligator was gone. So it obviously got well enough to crawl off in the middle of the night, but yeah, I love—

Prabu: A lot of big memory—

Howard: I love Louisiana; I’d love to talk to the president of ADA; congratulations on being the president of Missouri Dental Association; congratulations on being the first non-American born non-white to be, that’s so cool; and I just love that—

Prabu: One more thing that I want to bring that up is there were never any barriers, I want to make it clear, nobody ever kept anybody else from going to this level, nobody tried. So to me, one of the biggest thing I hope that I do is, just  when they see me doing that one, “Hey, he can do it, I can too.” That’s basically there are no barriers, nobody went out their way to recruit us either, it’s up to you. So, all that I want to make a point of that one is; that there are no barriers, no one actively recruited somebody that is not white, but now that I am there, just an example would be like, “Oh, if he can do it, I can do it.” Hopefully that’ll bring more people that are— we are mixed ethnicity here, so that’ll be only good for the country and good for the association.

Howard: Well, thank you for all you do for dentistry, it was wonderful talking to you for an hour and I hope you have a splendid day.

Prabu: Thank you so much, Howard. I appreciate it and I’ll get a hold of Dr. Roberts for you. Take care.

Howard: Okay.

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