Tips on using the MRC pre-ortho Trainer in myofunctional orthodontics

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Some tips and tricks on using the MRC pre-orthodontic Trainer in practice, presented by a practicing orthodontist.

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  • Now that you have a way of thinking about this process, you have to design a protocol that matches your personal style and your practice. Here is a bag of pearls you can use to help you design your own protocols
  • Tips on using the MRC pre-ortho Trainer in myofunctional orthodontics

    1. 1. Some tips and tricks for using MRC’s pre-orthodontic Trainer <ul><li>By </li></ul><ul><li>Dr. Barry Raphael </li></ul><ul><li>[email_address] </li></ul><ul><li>Part of a presentation for MRC At the Rancho Cucamonga training center in Sept. 2011 </li></ul>
    2. 2. The Process: Myofunctional Ortho <ul><li>Light Wire Expanders </li></ul><ul><ul><ul><ul><ul><li>To undo damage and make room for the tongue </li></ul></ul></ul></ul></ul><ul><li>Trainers </li></ul><ul><ul><ul><ul><ul><li>To get the tongue on the palate </li></ul></ul></ul></ul></ul>The Goal: To get the tongue on the palate
    3. 3. The Process: Trainers <ul><li>Appliance Delivery </li></ul><ul><li>Comfort check </li></ul><ul><li>Routine visits </li></ul><ul><li>Training Sessions </li></ul><ul><li>Exercises </li></ul>
    4. 4. <ul><ul><li>The Try-on </li></ul></ul>Trainers: Appliance Delivery
    5. 5. <ul><li>The Try-on </li></ul><ul><li>“ The Four Things” </li></ul><ul><ul><li>Bite Down </li></ul></ul><ul><ul><li>Lips together </li></ul></ul><ul><ul><li>Breath through your nose </li></ul></ul><ul><ul><li>Tongue on Tag </li></ul></ul><ul><li>“ The Two Things” </li></ul><ul><ul><li>Lips together </li></ul></ul><ul><ul><li>Tongue on Tag </li></ul></ul>Trainers: Appliance Delivery
    6. 6. Trainers: Appliance Delivery
    7. 7. <ul><ul><li>The Try-on </li></ul></ul><ul><ul><li>The Two Things </li></ul></ul><ul><ul><li>Wearing Schedule </li></ul></ul><ul><ul><ul><li>1hr/day plus sleeping </li></ul></ul></ul><ul><ul><ul><ul><li>No “Two Things” while Sleeping </li></ul></ul></ul></ul><ul><ul><ul><li>OK to Ramp up </li></ul></ul></ul>Trainers: Appliance Delivery 5 min 10 min 20 min 30 min 60min 60+sleep 5 min 10 min 20 min 30 min 5 min 10 min 20 min 5 min 10 min 5 min
    8. 8. <ul><ul><li>The Try-on </li></ul></ul><ul><ul><li>The Two Things </li></ul></ul><ul><ul><li>Wearing Schedule </li></ul></ul><ul><ul><ul><li>1hr/day plus sleeping </li></ul></ul></ul><ul><ul><ul><ul><li>No “Two Things” while Sleeping </li></ul></ul></ul></ul><ul><ul><ul><li>OK to Ramp up </li></ul></ul></ul><ul><ul><ul><li>Choose activities and make calendar </li></ul></ul></ul><ul><ul><ul><li>OK to Split time </li></ul></ul></ul>Sun Mon Tue Wed Thu Fri Sat Activity 1 TV Homework Homework Ride to Soccer Homework TV Movie Activity 2 Gaming Reading Gaming Reading Laundary Trainers: Appliance Delivery
    9. 9. <ul><li>The Try-on </li></ul><ul><li>The Four Things </li></ul><ul><li>Wearing Schedule </li></ul><ul><li>Score Card </li></ul>Trainers: Appliance Delivery q
    10. 10. <ul><ul><li>The Try-on </li></ul></ul><ul><ul><li>The Four Things </li></ul></ul><ul><ul><li>Wearing Schedule </li></ul></ul><ul><ul><li>Score Card </li></ul></ul><ul><ul><li>Warnings </li></ul></ul><ul><ul><ul><li>Don’t chew </li></ul></ul></ul><ul><ul><ul><li>Don’t let Dog chew </li></ul></ul></ul><ul><ul><ul><li>Fee to replace </li></ul></ul></ul>$85-200 Trainers: Appliance Delivery
    11. 11. <ul><ul><li>The Try-on </li></ul></ul><ul><ul><li>“ The Four Things” </li></ul></ul><ul><ul><li>Wearing Schedule </li></ul></ul><ul><ul><li>Score Card </li></ul></ul><ul><ul><li>Warnings </li></ul></ul><ul><ul><li>Send them home </li></ul></ul>Trainers: Appliance Delivery
    12. 12. <ul><li>So, how does it feel? Is it comfortable? </li></ul><ul><ul><li>Buccal gingiva, especially around erupting teeth </li></ul></ul><ul><ul><li>Retromolar pads </li></ul></ul><ul><ul><li>Incisive papilla </li></ul></ul><ul><ul><li>Doesn’t fit over BWS </li></ul></ul><ul><ul><li>Unexplained apthous ulcers </li></ul></ul><ul><ul><li>Allergic Reactions </li></ul></ul>Trainers: Comfort Check
    13. 13. <ul><li>Comfort check </li></ul><ul><ul><li>1. Comfort: Common irritations </li></ul></ul><ul><ul><ul><li>Buccal gingival, especially around erupting teeth </li></ul></ul></ul><ul><ul><ul><li>Retromolar pads </li></ul></ul></ul><ul><ul><ul><li>Incisive papilla </li></ul></ul></ul><ul><ul><ul><li>Unexplained apthous ulcers </li></ul></ul></ul>2.1.2) Protocols: Trainers: Comfort Check Buccal Gingiva blanching
    14. 14. <ul><li>Comfort check </li></ul><ul><ul><li>1. Comfort: Common irritations </li></ul></ul><ul><ul><ul><li>Buccal gingival, especially around erupting teeth </li></ul></ul></ul><ul><ul><ul><li>Retromolar pads </li></ul></ul></ul><ul><ul><ul><li>Incisive papilla </li></ul></ul></ul><ul><ul><ul><li>Unexplained apthous ulcers </li></ul></ul></ul>Trainers: Comfort Check
    15. 15. <ul><li>Comfort check </li></ul><ul><ul><li>1. Comfort: Common irritations </li></ul></ul><ul><ul><ul><li>Buccal gingival, especially around erupting teeth </li></ul></ul></ul><ul><ul><ul><li>Retromolar pads </li></ul></ul></ul><ul><ul><ul><li>Incisive papilla </li></ul></ul></ul><ul><ul><ul><li>Unexplained apthous ulcers </li></ul></ul></ul>Trainers: Comfort Check
    16. 16. <ul><li>Comfort check </li></ul><ul><ul><li>1. Comfort: Common irritations </li></ul></ul>Trainers: Comfort Check
    17. 17. <ul><li>Comfort check </li></ul><ul><ul><li>1. Comfort: Common irritations </li></ul></ul><ul><ul><ul><li>Buccal gingival, especially around erupting teeth </li></ul></ul></ul><ul><ul><ul><li>Retromolar pads </li></ul></ul></ul><ul><ul><ul><li>Incisive papilla </li></ul></ul></ul><ul><ul><ul><li>Unexplained apthous ulcers </li></ul></ul></ul>Trainers: Comfort Check
    18. 18. Trainers: Comfort Check Retromolar Pads
    19. 19. Trainers: Comfort Check Retromolar Pads
    20. 20. Trainers: Comfort Check Retromolar Pads
    21. 21. Trainers: Comfort Check Incisive Papilla
    22. 22. Trainers: Comfort Check Incisive Papilla
    23. 23. Trainers: Comfort Check Doesn’t Fit over BWS
    24. 24. Trainers: Comfort Check Doesn’t Fit over BWS
    25. 25. Trainers: Comfort Check Doesn’t Fit over BWS
    26. 26. <ul><ul><ul><li>Not related to contact with trainer </li></ul></ul></ul><ul><ul><ul><li>Use oral ointment </li></ul></ul></ul><ul><ul><ul><li>Restart use when sores gone </li></ul></ul></ul><ul><ul><ul><li>Ramp up time </li></ul></ul></ul>Trainers: Comfort Check Apthous Ulcers
    27. 27. Trainers: Comfort Check Allergic Reactions 3 Days of wear
    28. 28. Trainers: Comfort Check Allergic Reactions
    29. 29. Trainers: Comfort Check Allergic Reactions Next: T4K Hard
    30. 30. <ul><ul><li>2. How is your daytime wear? </li></ul></ul><ul><ul><ul><li>Great! Here’s my card </li></ul></ul></ul><ul><ul><ul><li>Too Busy </li></ul></ul></ul><ul><ul><ul><li>Not Linking to other activities </li></ul></ul></ul><ul><ul><ul><li>Excuses </li></ul></ul></ul><ul><ul><ul><ul><li>I was sick </li></ul></ul></ul></ul><ul><ul><ul><ul><li>I told her she didn’t have to wear it. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>We had a family blah blah </li></ul></ul></ul></ul><ul><ul><ul><li>Sad Puppy Eyes </li></ul></ul></ul><ul><ul><ul><li>Can’t Breathe, Gagging </li></ul></ul></ul>Education Trainers: Comfort Check (Bite your tongue) Sun Mon Tue Wed Thu Fri Sat Activity 1 TV Reading Homework Ride to Soccer Homework Spongebob Movie Activity 2 Gaming Gaming Reading Laundary Encouragement, Offer alternatives Airway training
    31. 31. <ul><ul><li>3. Nighttime wear </li></ul></ul><ul><ul><li>Normally takes time </li></ul></ul><ul><ul><li>Can’t fall asleep </li></ul></ul><ul><ul><li>Falls Out At Night (FOAN) </li></ul></ul>Trainers: Comfort Check Delay starting 15 Min before sleep, Airway training Check Daytime wear, Airway training
    32. 32. <ul><ul><li>4. Motivation </li></ul></ul><ul><ul><li>Attitude check </li></ul></ul><ul><ul><li>Looking for results </li></ul></ul><ul><ul><li>Encourage Patience </li></ul></ul><ul><ul><li>Talk about alternatives </li></ul></ul>Trainers: Comfort Check
    33. 33. <ul><ul><li>4. Motivation : The bicycle speech </li></ul></ul>7 out of 7 Trainers: Comfort Check
    34. 34. <ul><ul><li>4. Motivation : The bicycle speech </li></ul></ul>5 out of 7 Trainers: Comfort Check
    35. 35. <ul><li>Check scorecard </li></ul><ul><li>Video and Mirror to review exercises </li></ul><ul><li>Comfort and Troubleshoot </li></ul><ul><li>Adjust BWS </li></ul><ul><li>Prescribe new exercises </li></ul><ul><li>Plan next Trainer or BWS </li></ul>Trainers: Routine Visits
    36. 36. Trainers : Training Sessions <ul><li>1/2 hour </li></ul><ul><li>Up to 8 patients/hour </li></ul><ul><li>Assure proper wearing </li></ul><ul><li>Exercises to boost progress </li></ul><ul><li>3-4 sessions </li></ul><ul><li>Extra sessions if needed </li></ul>
    37. 37. <ul><li>Patient Flow </li></ul>Activity Area Workbook Session Doctor Visit Progress Records and Notes 1.3 Trainers : Training Sessions : Training Sessions
    38. 38. <ul><li>Their “one hour” of wear </li></ul>Activity Area Trainers : Training Sessions
    39. 39. Activity Area Trainers : Training Sessions
    40. 40. Activity Area Trainers : Training Sessions
    41. 41. Activity Area Trainers : Training Sessions
    42. 42. <ul><li>“So how ya do’in?” </li></ul>Workbook Session Trainers : Training Sessions
    43. 43. <ul><li>“Here’s your password…” </li></ul>Trainers : Training Sessions Workbook Session
    44. 44. <ul><li>“Don’t put these on the furniture….” </li></ul>Trainers : Training Sessions Workbook Session
    45. 45. <ul><li>“No, you can’t share it with the dog” </li></ul>Trainers : Training Sessions Workbook Session
    46. 46. <ul><li>“So how ya do’in?” </li></ul>Trainers : Training Sessions Doctor Visit
    47. 47. <ul><li>“How’s your wire thingy?” </li></ul>Trainers : Training Sessions Doctor Visit
    48. 48. <ul><li>“S’comfortable?” </li></ul>Trainers : Training Sessions Doctor Visit
    49. 49. <ul><li>(The Look) </li></ul>Trainers : Training Sessions Doctor Visit
    50. 50. Trainers : Training Sessions Progress Records and Notes
    51. 51. Trainers : Training Sessions Progress Records and Notes
    52. 52. Trainers : Training Sessions Progress Records and Notes
    53. 53. Trainers : Training Sessions Progress Records and Notes
    54. 54. 10/1/10 Was talking the entire time. Told to be quiet while wearing trainer. Trainers : Training Sessions Progress Records and Notes
    55. 55. Doctor-time Scheduling Code Appt Action Asst Time Dr Time Total Time 640 spacers Spacers 10 0 10 604 BWS insert Band, cement, fit 35 25 60 605 BWS adj Remove, adj, replace 0 10 10 606 Trainer insert Instruct, check 15 5 20 607 Trainer check Coop/comfort/progress 10 10 20 608 Activities Workbook/video/practice 10 0 10 609 Group Activities Workbook/video/practice 30 0 30 860 Progress Photos Pictures only 20 0 20
    56. 56. Trainers: Exercises <ul><li>MRC Activities Workbook </li></ul><ul><ul><li>Groups 1,2,3, extras </li></ul></ul><ul><li>www.trainerkids.com </li></ul>
    57. 57. Trainers: Exercises <ul><li>Practice with and without trainer </li></ul><ul><ul><li>Phantom Trainer </li></ul></ul><ul><ul><li>5min on, 5 min off </li></ul></ul><ul><ul><li>do the “two things” without Trainer </li></ul></ul><ul><li>Decrease daytime wear </li></ul><ul><ul><li>ramp down </li></ul></ul><ul><ul><li>down to 5 minutes for daily “warmups” </li></ul></ul><ul><li>Give Nighttime “vacations” </li></ul>
    58. 58. Trainers: Exercises <ul><ul><li>From Rogers </li></ul></ul><ul><ul><ul><li>Jaw Stretches </li></ul></ul></ul><ul><ul><ul><li>Neck Stretches </li></ul></ul></ul><ul><ul><ul><li>( 5sec x 5 reps x 3 sessions/day) </li></ul></ul></ul>
    59. 59. Trainers: Exercises <ul><ul><li>From Kondo </li></ul></ul><ul><ul><ul><li>Tongue Lift (with gum) </li></ul></ul></ul>
    60. 60. Trainers: Exercises <ul><li>Additional Exercises </li></ul><ul><ul><li>From Rogers </li></ul></ul><ul><ul><ul><li>Jaw Stretches </li></ul></ul></ul><ul><ul><ul><li>Neck Stretches </li></ul></ul></ul><ul><ul><li>From Kondo </li></ul></ul><ul><ul><ul><li>Tongue Lift (with gum) </li></ul></ul></ul><ul><ul><li>TicTac hold (From Joy Moeller) </li></ul></ul><ul><ul><ul><li>Hold it on the spot ‘til gone. </li></ul></ul></ul><ul><ul><ul><li>5x/day </li></ul></ul></ul>
    61. 61. Trainers: Exercises <ul><li>Additional Exercises </li></ul><ul><ul><li>From Rogers </li></ul></ul><ul><ul><ul><li>Jaw Stretches </li></ul></ul></ul><ul><ul><ul><li>Neck Stretches </li></ul></ul></ul><ul><ul><li>From Kondo </li></ul></ul><ul><ul><ul><li>Tongue Lift (with gum) </li></ul></ul></ul><ul><ul><li>Tongue Spot </li></ul></ul><ul><ul><ul><li>Hydrocolloid bead pressed on “Spot” </li></ul></ul></ul><ul><ul><ul><li>Lasts for 2 hours </li></ul></ul></ul><ul><ul><ul><li>Practice “Quite Face swallows” </li></ul></ul></ul>
    62. 62. Trainers: Exercises
    63. 63. Trainers: Exercises
    64. 64. Trainers: Exercises <ul><li>Additional Exercises </li></ul><ul><ul><li>From Rogers </li></ul></ul><ul><ul><ul><li>Jaw Stretches </li></ul></ul></ul><ul><ul><ul><li>Neck Stretches </li></ul></ul></ul><ul><ul><li>From Kondo </li></ul></ul><ul><ul><ul><li>Tongue Lift (with gum) </li></ul></ul></ul><ul><ul><li>From Flutter/Buteyko </li></ul></ul><ul><ul><ul><li>3M Micropore tape </li></ul></ul></ul>If you show these to anyone, I’ll kill you...
    65. 65. Trainers: Exercises <ul><li>Additional Exercises </li></ul><ul><ul><li>From Rogers </li></ul></ul><ul><ul><ul><li>Jaw Stretches </li></ul></ul></ul><ul><ul><ul><li>Neck Stretches </li></ul></ul></ul><ul><ul><li>From Kondo </li></ul></ul><ul><ul><ul><li>Tongue Lift (with gum) </li></ul></ul></ul><ul><ul><li>From Flutter/Buteyko </li></ul></ul><ul><ul><ul><li>3M Micropore tape </li></ul></ul></ul><ul><ul><li>Nasal rinsing </li></ul></ul>

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