This conversation is SO CONVOLUTED AND CONFUSING right now...Sure wish it was on ACE Dental World so I could follow along so much easier and know who was saying what to whom????
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Dr. Mike Maroon
Founder & Fellow Academy of Comprehensive Esthetics
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On Sat, Mar 2, 2013 at 9:21 AM, John Nosti <tmjcenter@aol.com> wrote:
Tad-- thanks for continuing to play along. Sorry it took me a day to get back to you, I was waiting for some of the guys who were on this thread to comment as well,
See my answers below
John,
I will give you some quick thoughts from the view of a new TruDenta provider. I focus my TruDenta on the headaches at this point and not so much from a tmd perspective. That may change some when I have more experience but there are so many factors with tmd that I am fine with just going with the headache angle at this time. But, I am sure I will get some tmd patients that are looking for help so I need to be ready. I will try to give more info tomorrow but I am tired and ready to go to bed. So.....
1. Can you expand more on the pain? Where, how often, how long has it been present, what triggers it, etc......When you palpate the Temporalis muscles the patient responds with "that is my pain is" or "That is where my headache is". "It has been present for a while now". "Nothing in particular triggers it. Sometimes I wake up with it, sometimes it is at the end of the day".When you palpate the masseters the patient tells you "that feels a little sore".
Any other muscles tender? How long has the pain been present.......is "a while" a couple of months or years? Is the under the care of a physician for this pain? What meds does she take and how effective are they? Joint sounds and pain? What does the T Scan say as far as force distribution? Tooth wear and if so where?No other muscles on your examination are tender. If you were taught to palpate the medial or lateral pterygoids by either TruDenta, Dawson, or another continuum, I disagree with the ability to due so. Ironically this came to my attention while taking a dissection course by Henry Gremillion at .... the Dawson Center. The pain has been present for a few years now. The patient doesn't know when it started or why it started, but Patient A has been dealing with it "for some time". Patient A talked with her physician about it before and has had an MRI done that was negative. Patient A takes 2 tylenol, or Advil and it is somewhat effective, but still is bothersome.JVA or K-7 show recipricol clicking indicative of a partial disc displacement. If you "load" the joint there is no pain on either Patient A or Patient B. Remember both patient A and patient B have the same finding on JVA/K-7. Both Patient A and PAtient B have a 65/35% force balance. Both patient A and Patient B have very little tooth wear. The tips of the canines are slightly worn. Under close examination Patient A (the patient with pain) has slightly more incisal wear, but Patient A's teeth don't hurt, aren't sensitive, and there are no caries.
2. I think some patients can adapt better than others...
This is a good point. But what about the fact Patient A and Patient B had similar findings on JVA/JT, EMG, T-scan, or K-7? PAtient A has pain, PAtient B does not.
3. No. At this time I only do the TruDenta workup on patients that are interested in the process. They are usually patients that have been checked out by the medical side and had the MRI's and scans and are still looking for relief.Okay...without giving away TrudDenta secrets, what are you looking for in the TruDenta workup that tells you that you can help this patient? What bells go off that makes you say ... SLAM DUNK, typically classic case of " ".
I am interested in their history of headaches, muscle palpation, T Scan results, range of motion, maximum vertical opening and also lateral movement or restrictions of the mandible.If the pain is sudden acute pain that recently showed up I am leery of helping them. When I evaluate each of my interest listed I put it all together and decide if I can help them. I love patients that are under the care of the neurologist, have had chronic pain, tenderness to palpation, limited vertical opening, limited lateral movement, poor force distribution noted on T Scan, results of range of motion evaluation showing limitation. I never promise to get them headache free no matter what I see. I can with confidence say we can help them if they are a candidate for TruDenta.
From the previous email- we have two patients where the muscles are unbalanced, the occlusion time is long, the disclusion time is long and the patients have a partial disc displacement, both have a maximum opening of 45mm, both have lateral excursive movements between 9-13mm... Patient A has pain, Patient B does not.
I will add that on t-scan when you perform a "multibite movie"- it consistently shows a 65/35 force balance distribution.
Tad John Tad John
On Wed, Feb 27, 2013 at 5:01 PM, John Nosti <tmjcenter@aol.com> wrote:
Thanks for playing along... and Dennie thank you for all the compliments!!Trudenta guys play along....The first thing I want to review is the question I asked regarding the research the Bob Kerstein is doing on disclusion time. He has reported in his literature that extensive disclusion times (those over .4seconds) co-incide with patients having facial pain and headaches.The question I ask regarding this is--- When does disclusion time matter? (this isn't to say I don't agree with Dr. K....)Next- if we invest in EMG, JVA/JT, Sonography, K7, Trudenta- what ever is your diagnostic protocol (I am a Bioresearch guy so I use JVA/JT, M-scan) and the information tells us that we have two patients where the muscles are unbalanced, the occlusion time is long, the disclusion time is long and the patients have a partial disc displacement, both have a maximum opening of 45mm, both have lateral excursive movements between 9-13mm... Patient A has pain, Patient B does not.Questions-1) What further information do you want to know to base your treatment rationale on? (play along and ask me and I will provide you the information).2) If it is necessary to have short occlusion times, short disclusion times, balanced muscles, and no joint vibration/sounds, what does patient B have no pain?3) Does anyone here complete a full NM workup, Trudenta Workup, or Bioresearch Work up on all of their New Patients... both the ones in pain and the ones asymptomatic?To: djsmiledesign <djsmiledesign@aol.com>; tmjcenter <tmjcenter@aol.com>; curtis <curtis@cooltodrool.com>; tshewman <tshewman@insight.rr.com>
Cc: gkodish <gkodish@gmail.com>; riccoker <riccoker@gmail.com>; ACEsthetics <ACEsthetics@googlegroups.com>
Sent: Wed, Feb 27, 2013 4:24 pm
Subject: Re: [ACEsthetics] Barry Glassman's take on TruDenta
I appreciate being compared to a politician (smile!) but the fact is if you want to treat TMJ patients you better pay attention to everything otherwise you can get yourself in trouble. Remember many times these patients have gone through seeing many docs and therapists before they find you. You best pay attention because success is defined as how happy the patient is and were their expectations met and that doesn't always match up with this game that you want me to play along with. FWIW,
Shahin Safarian DMD, MBA, LVIF | Irresistible Smiles
Carmel Valley/Del Mar 858.755.8993 | Chula Vista/Eastlake 619.656.6785
WEBSITE | FACEBOOK | LINKEDIN | YOUTUBE | THEBATTLEGUARD
-----Original Message-----
From: Dennie Jenkins <djsmiledesign@aol.com>
To: safariandmd <safariandmd@aim.com>; tmjcenter <tmjcenter@aol.com>; curtis <curtis@cooltodrool.com>; tshewman <tshewman@insight.rr.com>
Cc: gkodish <gkodish@gmail.com>; riccoker <riccoker@gmail.com>; ACEsthetics <ACEsthetics@googlegroups.com>
Sent: Wed, Feb 27, 2013 1:17 pm
Subject: Re: [ACEsthetics] Barry Glassman's take on TruDenta
Come on Shahin, Play along. That answer sounded like one of our politicians. Keep it simple, I think John has a valid point to make for us.djDennis J. Jenkins DDS
Designing Smiles, PSC
Director, Greater Louisville Aesthetic Masters
812-246-3386 office-----Original Message-----
From: safariandmd <safariandmd@aim.com>
To: tmjcenter <tmjcenter@aol.com>; curtis <curtis@cooltodrool.com>; tshewman <tshewman@insight.rr.com>
Cc: gkodish <gkodish@gmail.com>; riccoker <riccoker@gmail.com>; ACEsthetics <ACEsthetics@googlegroups.com>
Sent: Wed, Feb 27, 2013 4:11 pm
Subject: Re: [ACEsthetics] Barry Glassman's take on TruDenta
Remember John you don't need the equipment to do NM dentistry. Ok now having said that I really don't do well with hypotheticals because the fact is that not every case is the same. Hence we can go into a puzzle here and have this big discussion but yet they are two different puzzles presented as the same. Gender, Genetics, Tolerance, Coping capabilities, Lifestyle, Personality, Stress, Motivation, Financial statues, Med Hx, Dental Hx, Medications and so on come to mind to make you aware that it might seem like the same but in fact it is way different.
Shahin Safarian DMD, MBA, LVIF | Irresistible Smiles
Carmel Valley/Del Mar 858.755.8993 | Chula Vista/Eastlake 619.656.6785
WEBSITE | FACEBOOK | LINKEDIN | YOUTUBE | THEBATTLEGUARD
-----Original Message-------
From: John Nosti <tmjcenter@aol.com>
To: safariandmd <safariandmd@aim.com>; curtis <curtis@cooltodrool.com>; tshewman <tshewman@insight.rr.com>
Cc: gkodish <gkodish@gmail.com>; riccoker <riccoker@gmail.com>; ACEsthetics <ACEsthetics@googlegroups.com>
Sent: Wed, Feb 27, 2013 12:22 pm
Subject: Re: [ACEsthetics] Barry Glassman's take on TruDenta
OK--- so here me out for a second and let's go back to what Barry discussed regarding the invesment on equipment.Just in the most basic sense of the equipment- If we took 2 patients that had near identical information from the equipment- both had a Partial disc displacement, both had unbalanced muscles, both on T-scan showed long occlusion times and long disclusion times... but one had facial pain and one didn't...Why would we see this?If it is important to "fix" the bite on patients with pain... then why doesn't the patient who has the equally bad bite not have pain?Don't get into a heated discussion, don't throw rocks at me yet.... I am just throwing this out there.John-----Original Message-----
From: safariandmd <safariandmd@aim.com>
To: tmjcenter <tmjcenter@aol.com>; curtis <curtis@cooltodrool.com>; tshewman <tshewman@insight.rr.com>
Cc: gkodish <gkodish@gmail.com>; riccoker <riccoker@gmail.com>; ACEsthetics <ACEsthetics@googlegroups.com>
Sent: Wed, Feb 27, 2013 2:02 pm
Subject: Re: [ACEsthetics] Barry Glassman's take on TruDenta
No. If I was an exclusive NM practice then I would but with my set up it would be impossible. Hence why i stated that i do most of my dentistry in CO.
But I do know where you are going with this and the answer would still be the same NO TX. Remember when we do NM tx we need to also listen to the patient, look for Signs and Symptoms and many other factors are involved not simply looking at K7. Hope this helps.
Shahin Safarian DMD, MBA, LVIF | Irresistible Smiles
Carmel Valley/Del Mar 858.755.8993 | Chula Vista/Eastlake 619.656.6785
WEBSITE | FACEBOOK | LINKEDIN | YOUTUBE | THEBATTLEGUARD
-----Original Message-----
From: John Nosti <tmjcenter@aol.com>
To: safariandmd <safariandmd@aim.com>; curtis <curtis@cooltodrool.com>; tshewman <tshewman@insight.rr.com>
Cc: gkodish <gkodish@gmail.com>; riccoker <riccoker@gmail.com>; ACEsthetics <ACEsthetics@googlegroups.com>
Sent: Wed, Feb 27, 2013 10:51 am
Subject: Re: [ACEsthetics] Barry Glassman's take on TruDenta
Shahin-Let me make sure I am asking the right questions- Do you perform NM exams on all of your new patients? (meaning K7 evaluations)John-----Original Message-----
From: safariandmd <safariandmd@aim.com>
To: tmjcenter <tmjcenter@aol.com>; curtis <curtis@cooltodrool.com>; tshewman <tshewman@insight.rr.com>
Cc: gkodish <gkodish@gmail.com>; riccoker <riccoker@gmail.com>; ACEsthetics <ACEsthetics@googlegroups.com>
Sent: Wed, Feb 27, 2013 1:36 pm
Subject: Re: [ACEsthetics] Barry Glassman's take on TruDenta
Pt. comes in with no pain, no wear and perfect muscles. We don't treat. Remember if muscles are happy we are happy and in this case it doesn't matter where the teeth are. Hope that answered the NM concern. I will say this has been very rare in my practice to see all 3 but again I do most of my dentistry in CO.
Shahin Safarian DMD, MBA, LVIF | Irresistible Smiles
Carmel Valley/Del Mar 858.755.8993 | Chula Vista/Eastlake 619.656.6785
WEBSITE | FACEBOOK | LINKEDIN | YOUTUBE | THEBATTLEGUARD
-----Original Message-----
From: John Nosti <tmjcenter@aol.com>
To: curtis <curtis@cooltodrool.com>; tshewman <tshewman@insight.rr.com>
Cc: gkodish <gkodish@gmail.com>; riccoker <riccoker@gmail.com>; ACEsthetics <ACEsthetics@googlegroups.com>
Sent: Wed, Feb 27, 2013 10:23 am
Subject: Re: [ACEsthetics] Barry Glassman's take on TruDenta
Barry is someone who practices with JVA/JT/EMG and T-scan, he is also someone who practiced NM dentistry.It seems some of their previous posts didn't really register as to why the have issues with teaching about "occlusion" being the issue.They ask questions like- If you did a CR examination on every patient in your practice, how many patients are truly in CR? (feel free to answer this one CR docs out there).For the NM docs- how many patients come to your office for a NP exam and don't have any pain, no wear, yet your diagnostic protocol reveals that their bite is off and their muscles are in perfect balance? (feel free to answer this one too)Let's forget Don and Barry for a minute and focus on T-scan guru Bob Kerstein. Bob is continuously doing research about disclusion time and it's effects on muscle pain.Can someone care to volunteer and answer the question- when does someone's "disclusion time" matter?John-----Original Message-------
From: Curtis Westersund <curtis@cooltodrool.com>
To: tshewman <tshewman@insight.rr.com>
Cc: gkodish <gkodish@gmail.com>; riccoker <riccoker@gmail.com>; Ace <ACEsthetics@googlegroups.com>
Sent: Wed, Feb 27, 2013 12:52 pm
Subject: Re: [ACEsthetics] Barry Glassman's take on TruDenta
Just be sure to bring your Spirit Guide with you on your trips--
On 2013-02-27, at 10:46 AM, tshewman wrote:
but they are the best kinda mushrooms. goes along with the new cooking hobby.From: Curtis WestersundSent: Wednesday, February 27, 2013 12:38 PMSubject: Re: [ACEsthetics] Barry Glassman's take on TruDentaTodd, you need to lay off the magic mushrooms buddy. They are affecting your memory. I know they are "natural" but you are starting to hallucinate without them.Don is the king of ask for something just to ask for something. Not the king of "Oh hey, that makes sense"I have been on enough of his rips personally and you were right there egging us both on as a spectator sport.And now we are further digressing from the topic.--On 2013-02-27, at 10:17 AM, tshewman wrote:
Don generally asks for evidence (esp on sleep etc). Haven't seen specific rips, but to say there aren't holes (like with many things) may also be a focus but obviously;y can't speak for him.From: Curtis WestersundSent: Wednesday, February 27, 2013 12:08 PMTo: tshewmanSubject: Re: [ACEsthetics] Barry Glassman's take on TruDentaYesAnd yet he rips LVI NM approach???? Or at least his instructor Don Mazilla does.--Please explain Todd as I don't get it.On 2013-02-27, at 10:01 AM, tshewman wrote:
Has a hate on for techno TMD guys? Not sure I understand (seeing he does use some technologies). He's also a member/fellow of ICCMO.From: Curtis WestersundSent: Wednesday, February 27, 2013 11:57 AMCc: riccoker@gmail.com ; AceSubject: Re: [ACEsthetics] Barry Glassman's take on TruDentaBarry has a hate on I feel, for the techno TMD guys.One thing I do want to stress though Gary is that never stop looking for more. Join ICCMO www.iccmo.org and find out the don't know what you don't know stuff.There is so much I don't know yet. And so much I have been told but cannot press playback on my brain to regurgitate. Keep searching for you will find that the Trudenta materials will not solve all of what you need. No one system does. This is truly a multifactorial problem.Curtis--On 2013-02-27, at 8:28 AM, Gary Kodish wrote:
I have the up most respect for Barry. I've been to several of his courses and have learned a great deal from him. I think that he is missing the point on the equipment that is used in trudenta. The t-scan and the the range of motion unit are used help in the diagnosis and classification of the patients symptoms in order to determine the extent of the treatment. When used with the diagnostic skills that are learned it helps quantify what is going on. No one is claiming to be a neurologist. We are using skills learned in the course and for me after many hours of CE. It is then used to help determine the success of the treatment. I would say that the majority of the patients I see for this therapy have suffered for many years with headaches, migraines, and TMD pain. Have been to every kind of doctor to get relief. Have been to dentists who have made them mouth guards. Nothing has helped them. Most are going chiropractors and physical therapist for some relief. Once our therapy starts they get better. We encourage them to continue with their chiropractors and tell them they should now get better quicker and remain stable longer. In fact that is what happens. Like I wrote previously, because the patients are having therapy in office and it is more in our control, we are finding greater success.
On Wed, Feb 27, 2013 at 9:43 AM, Rick Coker <riccoker@gmail.com> wrote:
I copied this from Dentaltown!Dr. Barry Glassman, DAACP,DAAPM,FICCMO, FADI
Vice President of Education and Training - Therapeutic Solutions International, Inc.
Diplomate of the American Academy of Dental Sleep Medicine
Diplomate of the American Academy of Craniofacial Pain
Diplomate of the American Academy of Pain Management
Fellow of the International College of Craniomanidbular Orthopedics
Fellow of Dentistry International
www.DrBarryGlassmanSeminars.com
Medical Staff - St. Lukes Headache Center
Resident Instructor for the Lehigh Valley Hospital in Craniomandibular Disorders and Sleep Disorders--
Dr. Rick Coker, DDS, FACE
Director, Academy of Comprehensive Esthetics
www.tyler-smiles.com, www.tylersleep.com
http://www.google.com/profiles/riccoker.
903-581-1777--
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