How Many Practicing Dentist are Expert Dentists?

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According to the U.S. Department of Labor, Occupational Outlook Handbook, 2016-17 Edition, there are 151,500 Practicing Dentists in the United States. I believe conservatively speaking 80% are involved with the following:
* Preventative care – Restore, reconstruct, replace, redo, alter, extract, maintaining.
* Limited understanding of the importance of the bio- physiology of occlusion/ practice management of their practice.
* They have very little to no understanding of TMD issues.

Approximately 22,725 Dentist in the U.S. (15% at best, again a conservative number, giving them a benefit of doubt) are involved with the following More Advanced forms of dentistry such as:
* Recognize some of the musculoskeletal occlusal signs & symptoms.
* Masticatory dysfunctions disorders.
* Joint derangement problems
* Temporomandibular pain problems.

Now this leaves a remaining 5% approximately 7,575 Dentists in the United States who may consider themselves as “expert” dentists (again a very conservative and generous number for the benefit of any to doubt…these expert dentists should be able to do the following:
* The ability, skills to treat, recognize and see the occlusal/TMD problems.
* Able to treat the masticatory dysfunction, pain and TM Joint derangements effectively.
* Ability and knowledge to address the cervical dysfunctional TMD problems
* Ability and knowledge to address the TMJ primary problems, Class II division 2 retruding jaw problems and or retruded maxillary problems.
* Ability, skills and knowledge to treat the anterior open bite TMD pain problem cases
* Address the CNS – autonomic (parasympathetic and sympathetic) responses of the TMD patient.

Question: Where are these 7,575 Expert Dentists in the United States, let alone in this world where our TMJ/TMD discussion group of patients can go to access these doctors? I want to know…where are they if they exist in this country.

Consider this…<1% of the total number of dentists in the United States is the remaining number of 1, 515 Dentists possibly available at best to address this list of problems I mentioned above (these are the concerns that most of these internet TMD layfolks on these forums have as their concerns). I don’t think what I have stated was over exaggerated or out of line at all. How else can one explain the predicament that many here are on in?

[A TMJ/TMD Discussion forum member] stated his interpretation and posted his opinion above as: “The arrogance of stating that only 1%, of health care providers agree with the current #TMD #CNS model. Then stating that 99% are wrong, is in addition outrageous.”

I don’t think what I stated was wrong neither outrageous…..I actually stated the following: “This is where we see 99% of the profession fall short from their lack of understanding the GNM issues.”

What I posted above in this thread was based on this type of data and information. You can all decide base on state data…not on some biased opinion.

There are no more than 230-250 dentists who have actually come to get trained in GNM here in Las Vegas at Occlusion Connections. Not all have gone through the Levels 1-7 and ortho/orthopedic training in total. You all can do further the math!

GNM is such a small entity in the bigger picture of things, yet for some reason it has become a significant focus of attention around the world for some odd reason amongst many TMJ and TMD forum groups. GNM dentists are just dentist trying to do what is right and do good things for our TMD patients. Is that a bad or outrageous thing to do?

– Clayton A. Chan, D.D.S. – Las Vegas, NV

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How Many Practicing Dentist are Expert Dentists?

Where are your studies to back your talk up Chan?

Nick Yiannios Where are your studies to back your talk up Chan? We are still waiting… You’re sounding like a salesman for Myotronics.

Clayton A. Chan

Clayton A. Chan Nick, where have you been all these years? 15 years ago and even earlier in the early 1970’s this NM battle was ragged (read: http://nmdfacts-battles.blogspot.com/) among our profession regarding occlusion and the neuromuscular concepts validity to which I practice. Scientific facts rather than opinions was Dr. Bernard Jankelson basis for his further investigative studies as a trained prosthodontist who practiced in the state of Washington. Let me take a moment to update you on some past history. (if you have time to carefully read).

“In 1986, the American Dental Association Council on Scientific Affairs recognized Myotronic’s neuromuscular instrumentation. [To keep the record straight I am not a paid a salesment by Myotronics nor have any financial interest with them like some others…I am just an end user who realizes its value and sophistication very well].

In July 1995 House Commerce Oversight Subcommittee on allegations of FDA retaliation that the FDA’s Office of Internal Affairs found Roland Jankelson’s testimony so compelling, the credibility of then FDA Commissioner David Kessler’s testimony to the Committee regarding the Myotronic’s issues so lacking and the evidence of FDA cover up so powerful that the criminal investigation was transferred to the Inspector General, Department of Health and Human Services. The two year investigation concluded “In 1994 the Dental Products Advisory Panel of the Center for Devices and Radiologic Health (CDRH) assessing a Myotronics Inc. dental measuring device was indeed rigged.” The probed resulted in discipline and dismissal of certain FDA employees, including the author of the 1988 ADA Draft Status Report.

(I do not believe your Bio colleagues had the guts or stamina to stand up to such scrutiny and convictions…even to this day….if so where have they been during those early pioneering years and even after during those years when many criticized NM instrumentation, its validity and its concepts, where have they been when it was needed to stand up, voice their belief’s, convictions in order for you to enjoy the things you are professing today?). Where have they been? Hiding? Just watching on the sidelines to see who is the winner?…without putting any conviction of thought or effort into really find the truths about how the masticatory system works physiologically, or are they just selling equipment to the dentists with no occlusal philosophical belief.

Dr. James Garry, past President of ICCMO, Dr. Barry Cooper, President of ICCMO, Dr. Larry Tilley, President of the TMD Alliance, Robert and Roland Jankelson (son’s of Bernard Jankelson) who possessed the courage and tenacity of Dr. Bernard Jankelson (father of Neuromuscular Dentistry) along with countless others gave their time and energies to overcome seemingly insurmountable adversaries who were skeptical about the validity. Yet, time after time the disciples of Dr. J have prevailed and the pigeons of Zeus retreat, only to reappear. Their venues change, but their agendas remain the same. The neuromuscular devices, principles and protocols have the ADA Seal of Acceptance and recognition of the FDA. The neuromuscular devices I and many of my GNM colleagues use clinically have the lowest priority classification as per the Advisory Council, which have been granted in 1994, and are recognized as safe and effective by the FDA.

An overwhelming amount of scientific evidence was produced to both the ADA and FDA’s scrutinizing councils years ago so to produce that here would be unproductive. But if you want you can do your own research as I have done years ago to read up and find those supportive papers as I have done in times past giving you reference link for your perusal on your own time. (see above and the related links in those links).

Through the years since the early 1970’s there has been a resistance of anti-instrumentation critics when the present methodologies were challenged with scientific credibility. Although the CR concepts has been the gold standard for years it has been unsupported with scientific evidence. In 1988 the political battlefield shifted from occlusion to TMD. A small group identified with the gnathological occlusal paradigm joined a small group from the American Association of Orofacial Pain (AAOP), to exert political pressure upon the ADA to rescind the Scientific Council Seal of Recognition for neuromuscular measuring devices. As time evolved the K7 users across this continent and internationally (university research departments, etc) also see: http://occlusionconnections.com/…/k7-system-used-in…/, advanced protocols and techniques have been developed beyond the classical NM teachings over these past 15 years at OC. Testing these protocols and ideas has been done amongst many astute and very clinicians of at least 10-21 years of clinical experience regarding EMG fatigue analysis and various clinical studies regarding efficacy of occlusal outcomes. GNM teachings sprouted out from the foundations of NM to further advance the concepts and teachings beyond the classical NM teachings.

Interestingly the Bio folks including you and your colleagues are riding on the good will of dedicated hard work of others you seem to fail to acknowledge the often unrecognized NM predecessors who pioneered and developed the foundation of CMS, EMG, ESG and TENS technologies to which you are privy to know in limited forms (whether more advanced than K7 is to be questioned clinically and philosophically).

Dr. Norman Mohl was retained by the ADA to review the scientific safety and efficacy of these devices as aids in diagnosis and treatment of TMD. The draft Report concluded that “Expert for devices have been developed for electromyographic biofeedback, none of the other devices intended for treatment of TMD have the scientific evidence required for their recommendations.”

Ultimately it could not hold back the tide of scientific evidence that exposed the Mohl Report as a adhominem politial diatribe, not a reasoned scientific document. Myotronics submitted a voluminous review of the scientific literature supporting the efficacy of surface EMG, jaw tracking and low frequency TENS for diagnosis and treatment of TMD to the ADA Council on Scientific Affairs. After unprecedented scientific scrutiny these devices were ultimately awarded the ADA Council on Scientific Affairs Seal of Acceptance.

“Manuscripts submitted to scientific journals are reviewed for validity in the same way as granted requests. And who is better qualified to judge an article than those same eminent experts with their laurels to guard?”

It is based on this science and the work of many of my colleagues, our studies, clinical experience from years of practice and analysis from various perspectives and philosophies being in the trenches of dentistry and using our K7’s properly and completely and prudently both nationally and internationally that we at Occlusion Connections follow and implement the physiologic occlusal and neuromuscular principles we call GNM at an advanced objective level.

I am not sure if you have time to study these objective measuring concepts to the depth that many of us OC doctors have studied over these 15 years, since we too are a group of analytical and skeptical clinician’s who are very interested in TMD and occlusion, etc., desiring to positively assist in understanding the demises of TMD issues and effective remedies. That is why we ask you the questions and will continue to do so to encourage a rational debate of clinical and treatment effectiveness for the sake of our TMD lay folk members understanding.

 
NMDFACTS-BATTLES.BLOGSPOT.COM

– Clayton A. Chan, D.D.S. – Las Vegas, NV

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Where are your studies to back your talk up Chan?

Understanding Principles: More than Technology

An Emphasis of IMPORTANCE – PRINCIPLES over Technologies

What all dentist need to learn and understand are the PRINCIPLES of what this type of technology is discovering and unveiling. If they understand the principles the dentist can then modify their traditional occlusal and TMD philosphies as well as modify their clinical methodologies to fit and be in better align with the biophysologic science. It doesn’t mean they all have to have these kind of technologies but they do need to learn what these technologies are unveiling…the technology definitely does not support a mechanical occlusal philosophy like centric relation methods when recording bite registrations, as example…. the technology shows that the bio physiologic neuromuscular concept is the right direction to go.

That is what all TMD treating clinicians need to realize…and from this kind of data and information adapt their protocols to better fit the neuromuscular bio-physiologic protocols that better helps patients. It is simple as that. Who says every dentist has to have K7 and J5 TENS. Learn the principles!

– Clayton A. Chan, D.D.S. – Las Vegas, NV

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Understanding Principles: More than Technology

Here is My Story…

by Clayton A. Chan, D.D.S. – Las Vegas, NV

Here is my short story…

I have been practicing routine general dentistry for years in California…it was good dentistry. After some years I realized some of my patients were having TMD problems…but I couldn’t seem to help them resolve the issues…and it really bothered me. I tried many ways but they were not working for them or me…. I almost decided to quit dentistry because things were not working like it was taught in dental school. After feeling frustrated for some time as a dentist not getting the results I knew were possible….I decided to do something about it. I wanted a change…. so I decided to look for answers…I had a lot of questions about dentistry and the way it was being done that had to be answered. So I started to search…

I took continuing education courses across the country…listening and gathering ideas, information, searching for ways that made the most sense…. over time I started to formulate ideas and eventually got some answers that made sense…but not without disrupting audiences, lectures and programs…oh yes,..I am noted for doing such and asking the difficult tough questions to the profession…why? Because I am a dentist and I got tired of doing the same routine of drill and bill dentistry. I wanted answers that made sense and answers that were practical.

Well, here is the “pitch”…. there is another way dentist can do things if they really want to….if they pride themselves in the work they do… or are they just dental technicians doing piece meal work (doing fillings, crowns, extractions, root canals, dentures, implants)…or do they really care about getting patients healthy…looking at the bigger picture being physicians of the masticatory system?

I decided to slow my dental practice way down…purposely over the years…I got tired of cattle herding folks in out of my operatories with large number of employees to perpetuate the typical dental process, doing it fast, and quick and short visits… but over time I realized a dentist has to make choices….do routine care or he/she can do quality healthcare both are needed but only one way will meet the needs of the 20%ers who are in greater need.

As I got older and experienced in my career I decided quality of care to me was valuable then the quantity of care. Quality of heath is valued to me more than the quantity of care. Quality of function is valued more than dysfunction and bodily impairments…

So I continue to search for that fine balance in life as a dentist…to help those I can…dentist who understand this plea, tired of the rat race of dentistry and patients desiring a different way.

This is the journey for us all. Change is necessary for some of us… or we put up with the status quo. I chose to change and do what I can to help make that change in my life with purpose. It is all possible…if there is a will there is a way.

Last thought… I believe in Prayer! When things look impossible and bleak….offer a sincere pray to our Heavenly Father we don’t see…but He listens to all his crying children on earth. That is what I do when I have difficult challenges in life. Prayer is amazing. It’s free and no strings attached.

 

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Here is My Story…

Patient Testimonial How GNM Saved My Life: No Sales Pitch

Diana Roland O’Brien – Anderson, Indiana, U.S.A.

Sales Pitch…. hm… Well let me tell you how GNM Saved my life.

My Story starts out with having headaches and sensitive teeth. I was put into a Splint (Gelb) and instantly the pain became worse. Tight neck muscles, tight facial muscles,tight band wrapping my head, headache intensified, tingles down my arm and fingers, eye pain. jaw cracking, jaw pain shooting down the center of my jaw, I locked 2x on it after having it for only 4 months. Only thing the dentist could do is continue to flatten the plane and then build it back up taller than before. When I continued to get worse, he would take it and build it up more vertical. I would wake in horrible pain; I just knew I was getting worse. Some days just getting out of bed just to curl into a ball because of the headache and other pains, was all I could do. I would beat my head into a wall for a few seconds of relief of pain. I would go back to my Dentist every couple days and we would do it again, then he started with pain pills and muscle relaxers, and would tell me how I wasn’t listening to him just so I could continue with what I felt like was a bit of life left trying to do my job at work. I did everything he said to a T, why? I wanted to get better. We even did braces because he said it would help!! I couldn’t eat real foods, all soft mush, or shakes. My jaw hurt, my jaw cracked, it always sounded like glass in my joint area. You have no idea how many times I just wanted to ram my car into oncoming traffic because MY Dentist wouldn’t listen to ME. I was dying I was in so much pain.

My family was watching me wither away. I didn’t want to live anymore, the pain had consumed me. 32 ibuprofen a day on top of pain pills and muscle relaxers, I wanted to be numb and nothing worked. I constantly hurt. My Dentist was having me double up on the pain pills and even that didn’t work anymore; I am surprised I have organs left at all. I saw a Chiropractor he recommended who cracked me, put weights on my neck, next thing I know I had an over curve in my neck when I saw the new X-rays and it became a huge red flag. Did the Chiro say anything was wrong? NO. I stopped treatment with him. Started seeing an A/O, I eventually switched to a NUCCA.

Fast forward I gave up, enough pain after my Dentist yelled at me one day saying I wasn’t listening to him. He made me cry right there in his office. All my pain was my fault. He told me my only answer was surgery. I told him we were done, (he had me in Phase 2 saying the braces would fix my jaw, except I had teeth piling on top of one another, he had no idea how to align teeth.) So I started looking for help elsewhere.

I found Dr. Gregory Yount Dmd on Dr. Clayton A. Chanwww.OcclusionConnections.com page. He has taken all of Dr. Chan’s courses, so I contacted him right away and asked for help. From there I have been in the best hands ever. He takes his time and is so thorough with everything he does. It’s not a simple in and out visit. We tens, we check the bite, and then the fun begins. The K7 comes out and the scanning begins. We do not stop until we have that bite as perfect as we can get it, paying attention to all the little details. We go through a lot of articulating papers, and wax to get where we need to be, we don’t stop and say ok looks and feels good. No, it’s not guess work. Lots of training and in the end I am doing so much better than when I was in the other unmeasured acrylic Flat Plane. I have full contact, balance. Strength tests prove it. My muscles are happy. My Joints are happy. My Shoulders are no longer tight; I no longer have tingles running down my shoulder into my fingers. No eye pain, I do not Clench/Grind (Brux) on my GNM Orthotic as if I am eating it all night long. I do not wake with jaw pain, or other issues, no tight band wrapping my head. My ROM has increased dramatically. The Scans show this, my body shows this. I am now in phase 2, and moving along!

Patients can have more issues and it can take a while to get the whole body in balance. This is why it is recommended that you see a Cervical Chiropractor, and PT while seeing your Dentist. You have to work on the whole body. It might take you a few Chiropractors until you find one that works for you, Whether it is a NUCCA, Or A/O, No, I am not talking about a “back cracker”. NUCCA / A/O’s check the Cervical structure which can throw off the entire body, just have it go off a couple degrees to one side and you will now lean off to one side. Imagine what it will do to your head, jaw, shoulders, hips, knees, and feet. All CONNECTED.
All of this has been a life saver literally for me. So when I can I will help others who need it, I will always learn when I can. I have been through hell and made it. For that I will always fight for what I feel is something I believe in, and this is something that works, it’s not an overnight fix. You are not going to be better in 2 weeks, 1 month 4 months, you will feel better, yes, but you didn’t get TMJD overnight, and you will not heal overnight. Other Patients go through the same thing and they feel the same. How can a piece of Acrylic change the way a person feels? When Dentists have proper training, using all testing possible like the K7, listening to the patient, and having patience! Like I always say “It is a whole body issue.” Facts do not lie. How much more evidence does someone need?

Sales Pitch….. No…. Life saving technique…

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Patient Testimonial How GNM Saved My Life: No Sales Pitch

What Does the K7 Do?

by Gregory Yount, D.M.D. – Mattoon, IL (OC Levels 1-7, Ortho 1-3)

“The K7 only helps us to “see” what we cannot see and aids in the overall evaluation and process. I think where many may get confused like everyone else is the difference between the myomonitor (tens) and the duotrodes which are part of the K7 measuring EMG activity.

The actual device that aids in the trajectory issues which we are discussing is the “array” that sits on your head. It is an extremely sensitive device which measures the magnetic field in 6 dimensions in conjunction with a magnet that is place on the front of your lower jaw just below your incisors. Each of these parts of the K7 has a part to play in displaying the overall function through the various scans that are run. Some show velocity, some show trajectory, some show EMG’s, and some show joint sounds just for starters.

It is putting all of this information together with other sources of information such as CBCT images of the joints, MRI’s, cervical spine x-rays, and all the rest that help the doctor discover what is actually going on with the patient. I think many people get the idea that we just put on some electrodes, many of which are actually sensors and those things determine the bite !! Not so as you yourself can attest.

Paying attention to all of the various factors and listening to the patient goes a long way to figuring things out. You are right especially in your last sentence………..machines are just machines, and if they are not used correctly will spit out tons of useless information which is not even worthy of trying to interpret…………….”

 

 

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What Does the K7 Do?

Sleep and Airway Considerations from A Dentist who Does Sedation Dentistry

 

As you know, I do a fair amount of sedation in my practice and I see (and create) a lot of obstruction. Thus, I am very familiar with opening & managing airways… For 90+% of my sedated patients, even the deeply sedated patient, managing airway is very simple and takes a very small amount of manipulation to the jaw or tongue; I can usually open an airway by just turning the head slightly or simply by closing the mouth, i.e. putting the patient into MIP (maximum intercuspal position).

  • The only time the patient obstructs or snores is when their mouth is open.

“Do any of you feel that all these sleep appliances being advocated more recently than the past 15 years are only necessary because there is no orthotic appliance that is  properly adjusted?  Because of the effects of gravity the mandible wants to retrude when a person is supine and, when compared to the normal (sitting/standing) manidbular physiologic rest position, this retruded position would put stress/restrictions on the airway and jaw muscles/joints.”

It seems to a few dentists that the optimized bite position would be more “restful” for the supine patient… minus nasal oral pharyngeal insufficiency (deviated septum, turbinate abnormality, hypertrophic nasal tissues and hypertrophied tonsils that effect tongue position ) a properly adjusted GNM orthotic should allow the patient to sleep with their mouth closed and teeth touching, right?

So, based on the assumption that the closed mouth position is more restful than an open mouth position, the reason people sleep with their mouths open is because the bite is more stressful? – that is, the bite is not optimized ?

A question I would ask is:

  • Is the reason patient’s continues to sleep with their mouths open maybe because they do not have a properly optimized the bite (like retrusive interferences maybe existing with the various occlusal appliances used)?
  • Would the patient benefit more if the dentist takes time to properly detail and adjust the orthotic rather than conclude all these various grinding and bruxing night time issues is in need of a sleep appliance that may only mask the underlying issue?

Clinical Thoughts and Observations by a Dentist Who Does Sedation Dentistry

It’s interesting because what got me thinking about this topic wasn’t the patient who wanted the sleep appliance, but two patients I had this week. The first one was a TMD consult I had earlier in the week and the second was a sedation patient that has many of the musculoskeletal signs and symptoms (but not interested in TMD treatment). One of the questions on the TMD questionnaire (which I copied from your handouts) is “Mouth breather at night?” I had never really considered this question, but for some reason, as I was reviewing my notes, I started to wonder why this question was on the questionnaire. I decided that a mouth breather might have nasal issues so I should look for nasal insufficiency if they said yes.

Then, the next day as I was working on this sedation patient that had all the signs and symptoms, it hit me – people breathe better when their mouths are closed! My sedation patient, diagnosed with OSA and with almost every clinical sign and symptom of TMD, obstructed when her mouth was open, but was not obstructed when she was in MIP. The entire 2 hours under sedation I would work until her saturation started to drop and then just close her mouth – no head tilt, no jaw thrust, no tongue pull, just closed her into MIP. All her vitals (heart rate, O2 saturation, CO2 waveforms) were so much better when her mouth was closed. That got me to wonder, if this patient’s vitals and airway are so good when her mouth is closed, why doesn’t she just sleep with her mouth closed?… she would no longer have OSA! Then I had my epiphany, it’s because her bite is terrible and is more stressful for her to stay closed than open!

– Thoughts of Dr. Paul Chung, DDS, – Portland, OR (A dentist who practices GNM dentistry)

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Sleep and Airway Considerations from A Dentist who Does Sedation Dentistry