Airway ortho 8 intervening function

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A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics.
Chapter 7 : Some ways of changing the Function side of the facial growth and adaptation equation.

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Airway ortho 8 intervening function

  1. 1. Airway OrthodonticsA lecture series prepared byDr. Barry RaphaelOf theRaphael Center for Integrative OrthodonticsClifton, NJ.www.alignmine.comwww.myobracenj.com“Intervening Function” - 20131Thursday, June 6, 13
  2. 2. •Animations are not included in this archive and mayaffect the meaning or intent of the slide•As the information in these presentations isconstantly evolving, please consider the date of creationwhen reviewing the material.2Thursday, June 6, 13
  3. 3. Airway-focused Orthodonticsfor the OrthodontistMay 31, 2013Dr. Barry Raphaeldrbarry@alignmine.comwww.alignmine.comPart 3:The SolutionIntervening Function3Thursday, June 6, 13
  4. 4. Intervening Function• Establishing Nasal Breathing• Myofunctional Orthodontics• Oral Myology• Ortho-Postural Training• Behavioural Modification4Thursday, June 6, 13
  5. 5. Establishing NasalBreathing5Thursday, June 6, 13
  6. 6. Nasal Lavage•Blow the nose•Saline Mist•Saline Rinse•Squeeze bottle•Neti Pot•Use Distilled Water6Thursday, June 6, 13
  7. 7. Nasal ClearingHold your breathAnd shake your headThen breath through your nose7Thursday, June 6, 13
  8. 8. Medications• Comply with MD’s Rx• Use prn for acute problems•Try to avoid Chronic use.8Thursday, June 6, 13
  9. 9. Remove Obstructions• Polyps• Septal Deviations• Swollen Lymphoid Tissue (T&A)• Lingual Frenectomy9Thursday, June 6, 13
  10. 10. MyofunctionalOrthodontics•The Myobrace System10Thursday, June 6, 13
  11. 11. Recommended AgeGroup: 10 - 15+ yrsSimultaneous archdevelopment andmyofunctional training.Arch Development inconjunction with theTRAINER System™11Thursday, June 6, 13
  12. 12. PRIMARY DENTITION MIXED DENTITIONDEVELOPING PERMANENTDENTITIONPERMANENTDENTITION12Thursday, June 6, 13
  13. 13. STAGE 1HABIT CORRECTIONSTAGE 2ARCH EXPANSIONSTAGE 3FINAL ALIGNMENT& RETENTION13Thursday, June 6, 13
  14. 14. MYOBRACE FOR KIDS™ - K1Made of flexible silicone to adaptto any arch-form and poorly-aligned teeth.Its flexible naturemeans that it offers improvedretention for night-time use.Breathing holes assist thetransition to correct nasalbreathing.Extended lip bumper discouragesstrong, overactive lip muscles.14Thursday, June 6, 13
  15. 15. MYOBRACE FOR KIDS™ - K2Features Dynamicore™ with aFrankel Cage which assists indeveloping the arch-form andimproving the dental alignment.Tongue tag, guard and elevatorstrain the tongue to positionproperly.Extended lip bumper discouragesstrong, overactive lip muscles.15Thursday, June 6, 13
  16. 16. 16Thursday, June 6, 13
  17. 17. MYOBRACE® INTERCEPTIVE CLASS III17Thursday, June 6, 13
  18. 18. 2.1) Protocols:Trainers1) Appliance Delivery2) Comfort check3) Routine visits4) Post treatment maintenance18Thursday, June 6, 13
  19. 19. 1.The Try-on2.1.1) Protocols:Trainers:Appliance Delivery19Thursday, June 6, 13
  20. 20. 1.The Try-on2.“The Four Things”1. Bite Down2. Lips together3. Breath through your nose4. Tongue on Tag3. “The Two Things”1. Lips together2. Tongue on Tag2.1.1) Protocols:Trainers:Appliance Delivery20Thursday, June 6, 13
  21. 21. 2.1.1) Protocols:Trainers:Appliance Delivery21Thursday, June 6, 13
  22. 22. 1.The Try-on2.The Two Things3.Wearing Schedule1.1hr/day plus sleeping1.No “Two Things” while Sleeping2.OK to Ramp up2.1.1) Protocols:Trainers:Appliance Delivery5 min 10 min 20 min 30 min 60min 60+sleep5 min 10 min 20 min 30 min5 min 10 min 20 min5 min 10 min5 min22Thursday, June 6, 13
  23. 23. 1.The Try-on2.The Two Things3.Wearing Schedule1.1hr/day plus sleeping1.No “Two Things” while Sleeping2.OK to Ramp up3.Choose activities and make calendar4.OK to Split timeSun Mon Tue Wed Thu Fri SatActivity 1 TV Homework HomeworkRide toSoccerHomeworkTV MovieActivity 2 Gaming Reading Gaming ReadingHomeworkLaundaryMovie2.1.1) Protocols:Trainers:Appliance Delivery23Thursday, June 6, 13
  24. 24. 1.The Try-on2.The Four Things3.Wearing Schedule4.Score Card2.1.1) Protocols:Trainers:Appliance Delivery24Thursday, June 6, 13
  25. 25. 25Thursday, June 6, 13
  26. 26. 26Thursday, June 6, 13
  27. 27. 27Thursday, June 6, 13
  28. 28. 28Thursday, June 6, 13
  29. 29. 1.The Try-on2.The Four Things3.Wearing Schedule4.Score Card5.Warnings1.Don’t chew2.Don’t let Dog chew3.Fee to replace$85-2002.1.1) Protocols:Trainers:Appliance Delivery29Thursday, June 6, 13
  30. 30. 1. The Try-on2. “The Four Things”3. Wearing Schedule4. Score Card5. Warnings6. Send them home2.1.1) Protocols:Trainers:Appliance Delivery30Thursday, June 6, 13
  31. 31. So, how does it feel? Is it comfortable?1.Buccal gingiva, especially around erupting teeth2.Retromolar pads3.Incisive papilla4.Unexplained apthous ulcers5.Allergic Reactions2.1.2) Protocols:Trainers: Comfort Check31Thursday, June 6, 13
  32. 32. Comfort check1. Comfort: Common irritationsBuccal gingival, especially around erupting teethRetromolar padsIncisive papillaUnexplained apthous ulcers2.1.2) Protocols:Trainers: Comfort CheckBuccal Gingiva blanching32Thursday, June 6, 13
  33. 33. Comfort check1. Comfort: Common irritationsBuccal gingival, especially around erupting teethRetromolar padsIncisive papillaUnexplained apthous ulcers2.1.2) Protocols:Trainers: Comfort Check33Thursday, June 6, 13
  34. 34. Comfort check1. Comfort: Common irritationsBuccal gingival, especially around erupting teethRetromolar padsIncisive papillaUnexplained apthous ulcers2.1.2) Protocols:Trainers: Comfort Check34Thursday, June 6, 13
  35. 35. Comfort check1. Comfort: Common irritations2.1.2) Protocols:Trainers: Comfort Check35Thursday, June 6, 13
  36. 36. Comfort check1. Comfort: Common irritationsBuccal gingival, especially around erupting teethRetromolar padsIncisive papillaUnexplained apthous ulcers2.1.2) Protocols:Trainers: Comfort Check36Thursday, June 6, 13
  37. 37. 2.1.2) Protocols:Trainers: Comfort CheckRetromolar Pads37Thursday, June 6, 13
  38. 38. 2.1.2) Protocols:Trainers: Comfort CheckRetromolar Pads38Thursday, June 6, 13
  39. 39. 2.1.2) Protocols:Trainers: Comfort CheckRetromolar Pads39Thursday, June 6, 13
  40. 40. 2.1.2) Protocols:Trainers: Comfort CheckIncisive Papilla40Thursday, June 6, 13
  41. 41. 2.1.2) Protocols:Trainers: Comfort CheckIncisive Papilla41Thursday, June 6, 13
  42. 42. •Not related to contact with trainer• Use oral ointment• Restart use when sores gone• Ramp up time2.1.2) Protocols:Trainers: Comfort CheckApthous Ulcers42Thursday, June 6, 13
  43. 43. 2.1.2) Protocols:Trainers: Comfort CheckAllergic Reactions3 Daysof wear43Thursday, June 6, 13
  44. 44. 2.1.2) Protocols:Trainers: Comfort CheckAllergic Reactions44Thursday, June 6, 13
  45. 45. 2.1.2) Protocols:Trainers: Comfort CheckAllergic ReactionsNext:T4K Hard45Thursday, June 6, 13
  46. 46. Encouragement2. How is your daytime wear?• Great! Here’s my card• Too Busy• Not Linking to other activities• Excuses• I was sick• I told her she didn’t have to wear it.• We had a family blah blah• Sad Puppy Eyes• Can’t Breathe, Gagging2.1.2) Protocols:Trainers: Comfort Check(Bite your tongue)Sun MonTue WedThu Fri SatActivity 1TV ReadingHomeworkRide toSoccerHomeworkSpongebobMovieActivity 2GamingReading GamingReadingHomeworkLaundaryMovieEncouragement,Offer alternativesAirway trainingOral Myology46Thursday, June 6, 13
  47. 47. 3. Nighttime wear• Normal, takes time • Can’t fall asleep• Falls Out At Night (FOAN)2.1.2) Protocols:Trainers: Comfort CheckEncouragement15 Min before sleep,Airway trainingCheck Daytime wear,Airway training47Thursday, June 6, 13
  48. 48. 4. Motivation• Attitude check• Looking for results• Encourage Patience• Talk about alternatives 2.1.2) Protocols:Trainers: Comfort Check48Thursday, June 6, 13
  49. 49. 4. Motivation : The bicycle speech7 out of 72.1.2) Protocols:Trainers: Comfort Check49Thursday, June 6, 13
  50. 50. 4. Motivation : The bicycle speech5 out of 72.1.2) Protocols:Trainers: Comfort Check50Thursday, June 6, 13
  51. 51. 1. Check scorecard2. Video and Mirror3. Comfort and Troubleshoot4. Adjust BWS5. Trainer Activities6. Plan next Trainer or BWS2.1.3) Protocols:Trainers: RoutineVisits51Thursday, June 6, 13
  52. 52. Patient FlowActivity AreaReview ActivitiesDoctorVisitProgressRecords andNotes1.3 Protocols:Training Sessions52Thursday, June 6, 13
  53. 53. 1.3 Protocols:Training Sessions• 1 hour• Up to 8 patients/hour• Assure proper wearing• Exercises to boost progress• 3-4 sessions• Extra sessions if needed53Thursday, June 6, 13
  54. 54. Their “one hour” of wearActivity Area1.3 Protocols:Training Sessions54Thursday, June 6, 13
  55. 55. Activity Area1.3 Protocols:Training Sessions55Thursday, June 6, 13
  56. 56. Activity Area1.3 Protocols:Training Sessions56Thursday, June 6, 13
  57. 57. Activity Area1.3 Protocols:Training Sessions57Thursday, June 6, 13
  58. 58. “So how ya do’in?”Workbook Session1.3 Protocols:Training Sessions58Thursday, June 6, 13
  59. 59. “Here’s your password…”1.3 Protocols:Training SessionsWorkbook Session59Thursday, June 6, 13
  60. 60. “Don’t put these on the furniture….”1.3 Protocols:Training SessionsWorkbook Session60Thursday, June 6, 13
  61. 61. 1.3 Protocols:Training SessionsReview Activities61Thursday, June 6, 13
  62. 62. 1.3 Protocols:Training Sessions“So how ya do’in?”DoctorVisit62Thursday, June 6, 13
  63. 63. 1.3 Protocols:Training Sessions“How’s your wire thingy?”DoctorVisit63Thursday, June 6, 13
  64. 64. 1.3 Protocols:Training Sessions“S’comfortable?”DoctorVisit64Thursday, June 6, 13
  65. 65. 1.3 Protocols:Training Sessions(The Look)DoctorVisit65Thursday, June 6, 13
  66. 66. 1.3 Protocols:Training SessionsProgressRecords andNotes66Thursday, June 6, 13
  67. 67. 1.3 Protocols:Training SessionsProgressRecords andNotes67Thursday, June 6, 13
  68. 68. 1.3 Protocols:Training SessionsProgressRecords andNotes68Thursday, June 6, 13
  69. 69. 1.3 Protocols:Training SessionsProgressRecords andNotes69Thursday, June 6, 13
  70. 70. 1.3 Protocols:Training SessionsProgressRecords andNotes10/1/10Was talking the entire time.Told to be quiet while wearingtrainer.70Thursday, June 6, 13
  71. 71. 2.1.4)Protocols:Trainers:Post-treatment• Phantom Trainer• Practice with and without trainer• 5min on, 5 min off• do “two things”• Decrease daytime wear• ramp down• down to 5 mintues for daily “warmups”• Give Nighttime “vacations”71Thursday, June 6, 13
  72. 72. Pt Education CD72Thursday, June 6, 13
  73. 73. RESEARCHWHY IT WORKSMYOFUNCTIONALORTHODONTICSWHAT IS MRCCASESPATIENTEDUCATIONTHE PROBLEMTHE CAUSES OFMALOCCLUSIONCURRENTORTHODONTICSHOW TOSTARTDr Education CDwww.myoresearch.com73Thursday, June 6, 13
  74. 74. Oral Myology•The study of normal function of the muscles of themouth•Tongue•Masticatory muscles•Facial muscles•Protocols• Group Therapy• Individual Therapy74Thursday, June 6, 13
  75. 75. OroMyology Therapy•Neutral Rest Posture•Normalized function•bite, chew, and swallow•Eliminate noxious behaviors•Planning: assessment, examination, diagnosis, treatmentplanning, implementation of a therapeutic process•Evaluation of outcomes75Thursday, June 6, 13
  76. 76. Neutral Rest Posture•Tongue rests lightly on palate or slightly away• Dental Freeway space is open• Minimal masticatory muscular tension (contraction)• Minimal pressure or tension within TMJs• Facial muscles relaxedThe position from which allfunctional movement can begin76Thursday, June 6, 13
  77. 77. Noxious Habits•digit sucking•tongue thrust•Forward•Lateral•clenching•Bruxism•Incidental enamel attrition•muscle bracing•Leaning habits•Nail biting•Sleeping postures77Thursday, June 6, 13
  78. 78. Physical Limitations•Facial and skeletal deformity (malocclusion)•Frenum limitations (ankyloglossia)• Muscle coordination issues•Adapting to macro- or microglossia• Flaccid and weak musculature78Thursday, June 6, 13
  79. 79. Co-therapy with...•Orthodontist : reduce abnormal resting and functionalforces on the teeth•ENT : reestablish patent airway and nasal breathing•TMJ : reduce aggravating movements to the joints•SLP : reduce oromotor incoordination79Thursday, June 6, 13
  80. 80. Does OMT move teeth?•Assumption: Tooth movements are influenced by resting andfunctional forces•OM is about returning to normal function.•Movement of the teeth may occur as a result in change of resting orfunctional forces•Correcting the musculature corrects the balance of forces (in spaceand time)80Thursday, June 6, 13
  81. 81. Does OMT help TMJ?•OMT places both joints into neutral postures/positions•Allows the joints to function as nature intended without adaptive,redirective, or inappropriately applied pressures or forces.81Thursday, June 6, 13
  82. 82. “It is a sad state of affairs thatfor every 100 orthodontists inthis country there is only oneoral myologist when it shouldbe the other way around”- Dr. Bill Hang, 201382Thursday, June 6, 13
  83. 83. Trainer Activities• Purpose:To apply Oral Myology principles on a broadscale.•Assumption: One on one OMT is impractical on alarge scale.• Must be done in conjunction with Myobrace wear.83Thursday, June 6, 13
  84. 84. 84Thursday, June 6, 13
  85. 85. Trainer Activities•MRC Activities Workbook•Groups 1,2,3, extras85Thursday, June 6, 13
  86. 86. Trainer Activities•MRC Activities Workbook•Groups 1,2,3, extras•www.trainerkids.com86Thursday, June 6, 13
  87. 87. Trainer Activities• From Flutter/Buteyko•3M Micropore tape•1/2 inch, 1 inch•Demonstrate abiltiy to bust open•Start daytime, work up to 1 hour•Then start sleeping•Anticipate up to 3-4 weeks for mouthbreathersIf you show these toanyone, I’ll kill you...87Thursday, June 6, 13
  88. 88. Trainer Activities• From Kondo•Tongue Lift (with gum)88Thursday, June 6, 13
  89. 89. Trainer Activities• Additional Exercises• From Rogers• Jaw Stretches• Neck Stretches• From Kondo•Tongue Lift (with gum)•TicTac hold (From Joy Moeller)•Hold it on the spot ‘til gone.•5x/day89Thursday, June 6, 13
  90. 90. Trainer Activities• Additional Exercises• From Rogers• Jaw Stretches• Neck Stretches• From Kondo•Tongue Lift (with gum)•Tongue Spot•Hydrocolloid bead pressed on “Spot”•Lasts for 2 hours•Practice “Quite Face swallows”90Thursday, June 6, 13
  91. 91. Trainer Activities91Thursday, June 6, 13
  92. 92. Trainer Activities92Thursday, June 6, 13
  93. 93. Trainer Activities• From Rogers• Jaw Stretches• Neck Stretches• ( 5sec x 5 reps x 3 sessions/day)93Thursday, June 6, 13
  94. 94. Ortho-Postural Training• Roger Price• Sydney,Australia•The Edgecliff Respiratory Centre• Respiratory Therapist• Phyisiotherapist• Dentist (Sleep Dentistry)• Physician (Integrative)• Background•Pharmacy•Buteyko94Thursday, June 6, 13
  95. 95. Stress and the Modern World• Physical Stress• Birth Trauma• Bottle Feeding• Poor Posture• Poor Breathing mechanics and dynamics• Ingestional Stress• Grass/grain/cereal• Manufactured foods• Genetically Modified Organisms• Chronic inflammation• Emotional Stress• Chronic autonomic activation• Breathing Disordered Sleep95Thursday, June 6, 13
  96. 96. Roger Price’s “Toothberg”Change this......bychangingthis96Thursday, June 6, 13
  97. 97. “Sleepberg” Change thisByChangingthis97Thursday, June 6, 13
  98. 98. Stress leads to Mouthbreathing• If correction requires the tongue to be on the palate….•Then the lips must be closed•And Breathing done through the nose (which ishealthier anyway•BUT, if the child is overbreathing and hypocapnic•Then closing the lips will beVERY uncomfortable•They will feel CO2 rise quickly•And sense they are out of breath•Therefore, the FIRST step in therapy must be•Clearing the nasal airway and…•Ortho-Postural TRAINING98Thursday, June 6, 13
  99. 99. Ortho-Postural Training• Better Breathing• LowerVolume and Rate• Diaphragmatic• Better Posture•Sitting, Standing, Sleeping• Better Nutrition• Real Food• Harden the Diet• Better Oral Rest Posture and FunctionNothing changes unless something changes99Thursday, June 6, 13
  100. 100. Ortho-Postural Training1. Staff Training2. Airway Assessment3. Patient and Parent Workshop4. Home Education Kit5. Web and mobile app support6. Follow-up100Thursday, June 6, 13
  101. 101. Ortho-Postural Training• 1. Staff Training• For Para-dental personnel• Education, not therapyThe entire program is run by auxillary staff101Thursday, June 6, 13
  102. 102. 102Thursday, June 6, 13
  103. 103. PEOPLE WITH FUNCTIONAL BREATHING:COPYRIGHTRoger L PriceOctober 2012Functional breathers103Thursday, June 6, 13
  104. 104. PEOPLE WITH DYSFUNCTIONAL BREATHING:COPYRIGHTRoger L PriceOctober 2012Dysfunctional breathers• Asthma management• Posture and Breathing Mechanics correction for Snoring and Sleep Apnoea• Correcting mouth breathing and tongue posture in adults and children• Addressing anxiety/panic attacks• Managing chronic tiredness• Eliminating bed wetting in children and multiple night-time toilet trips in adults• Stress management• Enhancing sports performance• Managing hypertension104Thursday, June 6, 13
  105. 105. Ortho-Postural Training• 2.Airway Assessment• Medical and Airway History• Posture Pictures• Capnography• Baseline• Relaxation Imagery• Challenge• Supine/Diaphragmatic105Thursday, June 6, 13
  106. 106. COPYRIGHTRoger L PriceOctober 2012106Thursday, June 6, 13
  107. 107. COPYRIGHTRoger L PriceOctober 2012Forward head posture Forward head positionDropped left shoulder Pronounced kyphosisSimian knuckle stance Hyper lordosisDistorted midline Laterally out of plumb107Thursday, June 6, 13
  108. 108. BREATHING REGULATION IS ALL ABOUT CO2*CAPNOMETRYis an essential tool in being ableto determine functionaldynamics and mechanicsthe system used should bequick simplenon-invasive painlessaccurate visualmeaningful low costCOPYRIGHTRoger L PriceOctober 2012Vitally important108Thursday, June 6, 13
  109. 109. Dysfunctional BreathingFunctional Breathing* CHARTING PROGRESS OBJECTIVELY &VISUALLYBEFORE ANDAFTERCOMPARISONSare extremelyimportant to be ableto show eitherprogress orregression in anobjective way andnot rely on thepatient’s subjectiveappraisal orevaluationCOPYRIGHTRoger L PriceOctober 2012Objective scientific measurement109Thursday, June 6, 13
  110. 110. Ortho-Postural Training• 3. Home Education Kit•Workbook•Stopwatch•Tongue Tip Tags•Tape110Thursday, June 6, 13
  111. 111. Ortho-Postural Training• Home Education Kit•Workbook•Stopwatch•Tongue Tip Tags (cellulose)•Tape111Thursday, June 6, 13
  112. 112. Ortho-Postural Training• 4. Patient and Parent WorkshopDr. John Flutter112Thursday, June 6, 13
  113. 113. First learn sit-up-straightandstand-up straightin the correct sized chair113Thursday, June 6, 13
  114. 114. Identify the diaphragm and feel itmove.114Thursday, June 6, 13
  115. 115. When placed in the correct positionthe can should rock with every breath115Thursday, June 6, 13
  116. 116. 116Thursday, June 6, 13
  117. 117. Taping the lips at night117Thursday, June 6, 13
  118. 118. Ortho-Postural Training• 5.Web and mobile app support118Thursday, June 6, 13
  119. 119. Ortho-Postural Training•Web and mobile app support119Thursday, June 6, 13
  120. 120. Ortho-Postural Training• 6. Follow-upBREATHING WELL PTYLIMITED3a/2 New McLean StreetEdgecliff NSW 2027SYDNEY AUSTRALIA(02) 9363-1970BREATHING WELL LLC3600 Cerrilos Road #734Santa Fe NM 87507505.820.3376www.breathingwell.com.auenquiry@breathingwell.com.au120Thursday, June 6, 13
  121. 121. Behavioral Modification121Thursday, June 6, 13
  122. 122. SuperBetter.com122Thursday, June 6, 13
  123. 123. Game:FACEthe raphael center forintegrative orthodonticsbreathing well workshoprecorded january 2013by dr barry raphael123Thursday, June 6, 13
  124. 124. Game:FACEAddressing the Causes of Crooked TeethCertain habits cause the face to growpoorlyIf you change these habits….The jaws and teeth grow properly124Thursday, June 6, 13
  125. 125. Game:FACEWorkshopsAddressing the Causes of Crooked TeethBreathingNutritionPostureSleep125Thursday, June 6, 13
  126. 126. Game:FACEPowerUPs: things you do that make you BetterVillians : things you do that make you worseAllies: people and things that help youQuests: Challenges to meetEpic Wins:All the Ways in which you get BETTERWe teach:126Thursday, June 6, 13
  127. 127. Game:FACEHandoutsPowerUP listReferences for ParentsTissuesOrganic Bread TiesLip SticksTapeStopwatch127Thursday, June 6, 13
  128. 128. Game:FACEPowerUPs and Rewards ProgramParent Worksheet1. Set Budget2. Determine PointValues = (2000/3000/4000)/budget3. Choose Rewards4. Earning Points5. Celebrating Epic WinsPoints Worth/ptPrizeValuePrize #1 Prize #21002505001000128Thursday, June 6, 13
  129. 129. Interdisciplinary Treatment129Thursday, June 6, 13
  130. 130. •Early Feeding, Nutrition and muscular development•Tight Frena and Early Nutrition•Posture, musculo-skeletal-cranial stress and facial growth•Breathing, Airway and Apnea•Soft Tissue Dysfunctions, Habits and malocclusionBig-Picture Issuesrelated to(Mal)OcclusionContext: Dentistry is Medicine130Thursday, June 6, 13
  131. 131. Context: Dentistry is Medicine• Multi-Disciplinary Effort: Various dental, medical, and supportspecialties will find a common thread in preventing and treating airwayissues.Big-Picture Issuesrelated to(Mal)OcclusionGP Allergist Oral myologistOrtho Pediatrician Chiropractic/PTPedo (Pediatric) ENT HygienistOral Surg Pain Medicine EducatorsProstho Sleep Medicine Breathing Therapy131Thursday, June 6, 13
  132. 132. •The separation was political andeconomic, (for good reason) but isnow coming to an end•The dentist as oral physician•Broaden your view.....Context: Dentistry is Medicine132Thursday, June 6, 13
  133. 133. My Next Dream Practice• Full Time Staff• Director/Orthodontist• Oral Myologist with training in OPT, Buteyko, Sleep• 2 Health Educators•Admin• Part Time Staff• Chiropractor/Physical Therapist/Cranio-sacral/AK• ENT with training in Sleep•Allergist with training in nutrition• Nutritionist with training beyond the Pyramid• Referral• Oral Surgeon with training in mid-tongue release• Private practices of parttime staff• Pediatrician with Integrative background133Thursday, June 6, 13

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