This audio recording of a CDA convention provides the dental provider with tools and concepts to consider adding TMJ, TMJ, CMCD, OSA care into their practice.Read More
Obstructive Sleep Apnea may result in obscure symptoms that can be hard to diagnose. At Chase Cranialorthopedic Center, we see that everything is connected. We look to fix the root of the issue rather than merely treating symptoms. This interview is from such a scenario. The vertigo she experienced was from several key factors that we were able to uncover during her treatment process. We were thorough in treating each root issue, and we were dedicated to restore wellness into her life from beginning to end.
As I lecture, I realize that dentists continue to view their professional world from their time in dental school. What I view as important gets left behind as student clinical requirement pressures take over and those hurdles become the top concerns.
This leaves the dentist working from a point of view of fixing the tooth. However, that's like an orthopedic surgeon setting the bone. Though that is the CPT code and how insurances and patients view the issue, it is not the main service.
Dentists mostly treat movement disorders. What you really provide is for the patient to eat better, talk better, smile better, swallow better, and breathe better. These movements and their dysfunction are functional disorders and often involve critical functions as just mentioned. Not counting general pathology cancer infections, dentists treat the patient to restore and/or improve function. It is much larger than the 'set the bone' or 'fix the tooth' thinking.
We are now entering an era of oral systemic linkage which takes us into an additional area of function in non-movement processes. We will now treat and resolve general physiological functional disorders and hopefully before they cause pathology.
We're not confident yet in the medical world on what is happening in this area. But we see the issues and treatment or service is coming soon as we develop protocols.
Oral Systemic Solutions is working with healthcare providers to implement such protocols. So the next time you go to the dentist or you treat a patient, remember the goal is to restore function as we improve our lives.
Come join the conversation. With oral solutions for wellness, I'm Dr. Doug Chase.
For those that want clinical issues solved and do not want philosophy please ignore this academic wandering. For those that love this educational journey and how it affects you and your patients here are some thoughts. Many of you have take countless courses and are the wiser, more excited on your skills and are working to make not only your practice better... but the field and indeed humanity better... albeit for different reasons. We are all thankful for the past and current leaders; daring enough, vision enough, commitment enough, and moral enough. `The Possible’s slow fuse is lit by the Imagination’ , (Dickinson 1960:688± 689), but there are no single views of the possible, any more than there are ways of measuring what it signifies in anyone’ s imagination. Imagination summons up visions of a better state of things, an illumination of the deficiencies in existing situations, a connection to the education of feeling, and a part of intelligence. Mary Warnock (1978: 202± 203) evokes Derek Walcott’ s view of the enlargement of experience and the need for more than one horizon: The belief that there is more in our experience of the world than can possibly meet the unsuspecting eye, that our experience is significant for us and worth the attempt to understand it . . . this kind of belief may be referred to as the feeling of infinity. It is a sense that there is always more to experience and more in what we experience than we can predict. Without some such sense, even at the quite human level of there being something which deeply absorbs our interest, human life becomes perhaps not actually futile or pointless, but experienced as if it were. It becomes, that is to say, boring. In my opinion, it is the main purpose of education to give people the opportunity of not ever being, in this sense, bored; of not ever succumbing to a feeling of futility, or to the belief that they have come to the end of what is worth having.
As Maxine Greene said... "I am what I am not yet," said Maxine Greene on a snowy morning last winter about her retirement. Her existential theory of retirement is the same as the one she has maintained for her theory of her career: she is always in pursuit of herself.
My point is that education at any level provides your mind and so your body a needed nutrition. In fact more than a simple enjoyment of the process the act of knowing and understanding there is even more, is not futile, but actually liberating to the soul. It is expressly human. So yes, take that next class... give back and make your wisdom know. Interact and create new knowledge. The process of learning will always... "being on the way" and that the question is still not answered. I ,like Greene, "want students to love the question and the wonder and mystery of it."
|The butterfly counts not months but moments, and has time enough. ~Rabindranath Tagore|
Dentists mostly treat “movement disorders”. What you really provided was the patient to eat better, talk better, smile better, swallow better, and breath better. These movements are “functional disorders” and often involve “critical functions” as most mentioned in the first sentence. Not counting general pathology (cancer, infections etc), dentists treat the patient to improve and/or restore FUNCTION. It is way bigger than the “set the bone” or “fix the tooth”.
To this we are now entering an era of oral systemic linkage which takes us into an additional area of function in non-movement processes. We now will treat and resolve general physiological function disorders. Hopefully before they cause pathology. We are not competent yet in the medical world on what is happening in this area… but we see the issues and treatment/service is coming soon as we develop protocols.
So next time you go to the dentist or treat a patient, remember the goal is to restore function as we improve our lives.
I work in a world different from most dentists. Many of my patients are treated for a constellation of systemic issues including: Obstructive Sleep Apnea, Vertigo, Tinnitus, headaches, dysphagia, cervical dysfunction/pain, TMD’s, and a host of connected pathologies such a Rheumatic diseases ,Bell’s palsy and Multiple Sclerosis to mention a few. Science and technology is supporting the dentist’s role increasingly being more authoritative for a greater range of care to these interconnected systemic health issues. Interconnected to what? To our occlusion, to our head posture, to our cervical relationships, to our jaw positions, to our airway; indeed, all the way down to our feet. Biological testing will be knocking on our door as the medical world requests we test for various cancers, disease markers, and biometric data for medical referral. I lecture on these topics at the University of the Pacific Arthur A. Dugoni School of Dentistry and lecture locally, nationally, and internationally. The medical world and the public’s perception of dentistry is changing and we are entering the “third wave” as Danny Bobrow, MBA states in a recent article.  There are a number of dental researchers and academics that are saying the same thing. I like Mr. Bobrow’s essay as he is a lay person. Yes, even the people outside clinical settings are recognizing the trend.
The public has gone through the first wave where dentists were the ones to get them out of pain. This was the “Feel Well Dentistry”. Then a second wave developed more recently with patients getting care in improving their appearance as well as keeping them out of pain. This was the “Look Well Dentistry”. The phrase “cosmetic dentist” was created.
Presently a third wave is underway. This third wave perceives dentists connecting to a patient’s comprehensive health and wellness. For many dentists, this was not known about or taught in their dental schools. We are in transition as more physicians, dentists, and the public come to see the dentist as truly an oral physician. When dentists offer integrated care for diagnosis, treatment, and prevention to a multitude of systemic illnesses; then interdisiplinary and interconnected care will be afforded and “Be Well Dentistry” sought. Dentists will have to become comfortable in charging for their time and not just for procedures.
Currently training for such a wider scope of practice is difficult. Though membership is booming in various special topic areas; we as dentists do not yet have the academic support we need. Change is hard and progress slower than one would wish. I often ask patients, “How healthy do you want to be?” after treating their chief complaint(s). The question I pose to dentists is “How much health do you want to offer your patients?”
 EF Wright, Otologic Symptom Inprovement Through TMD Therapy, Quitessence Int. 2007, Oct. 38(9): e564-71
 A Bjorne, Assessment of temporomandibular and cervical spine disorders in tinnitus patients, Progress in Brain Reasearch, 2007: 166:215-9
 Ana Franco, Migraine is the Most Prevalent Primary Headache in Individuals with Temporomandibular Disorders, Journal of Orofacial Pain, Vol 24, 2010
 A Monaco, R Cattaneo, etal, Prevalence of atypical swallowing: a kinesiographic study, European Journal of Pediatric Dentistry, 2006 Dec 7(4): 187-91
 Edward Reiman, TMD Diagnosis and Treatment Handbook, Medical Scope Publishing Corp, 2005
 P Rosted, and Dr Woolley, Bell's Palsy following acupuncture treatment--a case report, Acupuncture Medicine, 2007 June: 25(1-2): 47-8.
 Tammarie Heit, DDS, Neuromuscular Orthotics in the Treatment of Craniomandibular Dysfunction and the Effects on Patients with Multiple Sclerosis, Cranio, Vol 1 , January 2011
 Pereira Magalhaes, etal, Influence of Maloccluson on Masticatory Performance, Angle Orthodontics, Unincor, 2010
 PJ Strini, NA Machada, MC Gorreri, etal, Postural evaluation of patients with temporomandibular disorders under use of occlusal splints, Journal of applied Oral Science, 2009 Sep-Oct 17(5): 539-43.
 Danny Bobrow MBA,; Are you ready for the next wave in dentistryDental, Products Report, November 2010
The field the cranial mandibular cervical disorders has undergone tremendous growth in the recent years. As software improves and research continues to deliver new information we are constantly pressured to implement this new knowledge into clinical practice. Medical graphics often provide stunning visualizations of complex processes. Intoxicating as these images are, practicing healthcare providers need to reserve judgment and not to draw conclusions quickly from over simplification of more complex and deeper structures. As we delve into a deeper meaning of physiological and anatomical processes; technological equipment such as bio-instrumentation, cone being volumetric tomography, electronic acupuncture, digital occlusal force devices, and infrared cameras; we have a conundrum. On the one hand, we have data that leads us to conclusions to provide diagnosis and treatment. On the other hand we have data that is so rich in new content and at such large volume that we do not have time to process and confirm its global application and accuracy within a given bio-system.
Clinicians are becoming increasingly bombarded with information from a variety of sources both in the commercial world and the academic world. In evaluations of this knowledge we lack randomized controlled trials and lack strong statistics that indicate improved patient outcomes and cost effectiveness. New knowledge is often difficult to generalize and do not provide the scope of detail necessarily to provide informed decision-making.
An example of this is the modern imaging technology screening healthy people for signs of incipient disease. Such noninvasive diagnostic capabilities may be as much a curse as a blessing. Patient's like clinician's often get excited about the prospect of early diagnosis of life-threatening conditions. However, medical researchers and organizations are beginning to understand the potential downside of screening- false positive test results and treatment are either ineffective or not necessary. The approach of early screening provides also a large new database that with more and more imaging, will find more disease. Some patients may benefit from early detection, but a lot may not. Studies on these early findings of potential disease have yet to be quantified and analyzed for actual productivity and benefits to society and then the individual. Disease often is poorly understood in early stages and no database currently exists as we did not have the technology. Early detection screenings may provide us with a great deal of data but will take years of research to understand the actual meaning of the data and how to apply it to treatment and integrate with other diagnostic tools.
This issue of gathering data without context proves to be a similar problem in such areas as functional MRIs , understanding the Cosmos, the human genome project, and bio instrumentation that is currently used to try to understand cranial mandibular cervical disorders.
Karl Popper was a British scholar and professor at the London school of economics and is widely regarded as one of the greatest scholars of the 20th Century. He argued that scientific theories are abstract in nature and can be tested only indirectly, by reference to their implications. He held that scientific theory and generally human knowledge is irreducibly conjectural or hypothetical, and is generated by the creative imagination in order to solve problems that have arisen in specific historico-cultural settings. Essentially logically, no number of positive outcomes at the level of experimental testing can confirm a scientific theory, but a single counterexample is logically decisive: it shows the theory, from which the implication is derived to be false. His writings "All life his problem-solving", Popper sought to explain the apparent progress as scientific knowledge that is our understanding of our world seems to improve over time. In 1934 proper wrote of the search for truth is "one of the strongest motives for scientific discovery." Indeed Popper once divided the world into two categories: clocks and clouds. Clocks are neat, orderly systems that can be solved through reduction; clouds are at a epistemic mass "highly irregular, disorderly, and more or less unpredictable." Modern science and indeed neuromuscular dentistries mistake is to accept everything as a clock, which is why we get seduced again and again by the false promises of brain scanner, image generators, gene sequence and bi- scans. We want to believe that if we find the right widget we will understand nature but this approach is doomed to failure. We live in a world to be understood as clouds and not as clocks.
Neuromuscular dentistry understands the concept that is all connected. The anatomical and physiological processes are by definition interconnected and inter-related and must support each other for function, durability, and comfort. However our understanding via instrumentation scans is both shallow and relatively new. Though antidotal reports of success are plentiful and research that is somewhat related is available, there remains much to be done from confirming research.
It is not a sense of hopelessness that we should take from understanding that the world is more like a cloud than a clock. Instead, it should give us strength in knowing that our search for truth is a path with many turns and forks. Our understanding does grow through the discoveries of new information, the disproving of old theories, and our fundamental need to understand the truth.
I just spend my Sunday with Anil Makkar who is the Founder and President of Makkar. He was amazing as he lectured to a number of certified neuromuscular dentists on how PPM takes the technology and techniques we use so often to help with various head and neck pain and dysfunction; and puts it to work with "healthy" athletes to make them perform better. They just released a new Key appliance which is simpler to construct and deliver. This adds to their higher professional versions. The mouth piece uses your existing muscle skeletal status and adds though better alignment of your frame improved flexibility, balance, power, and range of motion. I cannot think of a sport that does not use these parameters. I cannot be more impressed and hope to bring what I treat so often in a disease state into providing advance athletic performance. Your jaw posture is so important. How it affects central nervous system and muscle skeletal is complex and I will not go into it here. I will in future posts talk about the parts of the solution. Here is link if you want more.... or email me at firstname.lastname@example.org Makkar: Pure Power Mouthguards
I updated my techniques and reviewed data of the results that a number of high level sport individuals have obtained. You can go to the site to see more. Obviously I provide this service here in Santa Rosa and also in San Francisco at the Pacific Center for Orofacial Disorders at University of the Pacific Dental School. However, I can direct you to the closest dentist by having you go to the site and have them direct you to such providers . Tell them I sent you. So bottom line it is not the money .... it is the great direction we are going to not only get healthier but actually find our best performance in sports we so enjoy in our life.
This is my typing in an ad lib manner. I have chosen this medium to try to connect to a wider world. Care in Craniomandibular Cervical Disorders CMCD is developing at an amazing rate. I hope that this Blog will help some, create questions for others, and along the way I hope to learn more, communicate more and give more. I have grand plans. They all start with a single step. That step is today. Enjoy. Doug Chase, DDS, FiCCMO