Rickster-
I opened her by several millimeters and brought her forward so that she was moving forward in the pathway where she was grinding...it was forward with a slight deviation away from the pathological joint. On Sun, Apr 28, 2013 at 11:05 AM, Rick Coker <riccoker@gmail.com> wrote:
Or a Herbst or something like that? It sounded more like he held it there.One thing that rings true to me is that often people DO get better when they can move their jaws comfortably more forward and often have issues when they are pushed back distally. Whether it is orthodontic sequelae, restorative iatrogenics or simply growth issues.Certainly the TENS and NM mode of thinking would not want to exceed the NM Trajectory too much, but there are some unknowns as to tensing time, etc, but it is certainly possible that a place could exist that was therapeutic and not on the NM trajectory.We always want to know the reasons- is it jaw position, is it tongue space, is it the full moon, but Bob moved her forward and her symptoms went away, which is a good thing to know, a good tool to be utilized.What if he had moved her to the left five mm? or the right? Or just opened her?What if her symptoms were the result of excessive parafunction, in a pathologic position? What if he had botoxed her and her symptoms went away? Where would you be then?Tell us more, Bob.RickDr. Rick Coker, DDS, FACEOn Sun, Apr 28, 2013 at 12:43 PM, Curtis Westersund <curtis@cooltodrool.com> wrote:
Bob, I am not clear. Did you put her in an orthotic to position her more forward?On 2013-04-28, at 11:16 AM, Bob Perkins wrote:
on a similar note...I had a patient come in last week with strong clicking in the left TMJ, strong muscle discomfort on the left side...I put her on the tens and didn't really like where her jaw ended up...not enough difference. I then put her more forward based on some criteria I was focused on..(from hanging out with Bill Hang I felt confident that I didn't have to stop with the tens), anways, after two days I called her...all of her pain is gone...most of her clicking noise is gone...AND, her GERD is gone...she had reflux constantly but hasn't noticed it since....
Could this have been triggered by her tongue being postured too far back in her throat? Is the increased tongue space the reason for this relief?On Sun, Apr 28, 2013 at 10:12 AM, Bob Perkins <turkeysturkeys@gmail.com> wrote:
good points, deacon Curtis!--On Sun, Apr 28, 2013 at 9:36 AM, Curtis Westersund <curtis@cooltodrool.com> wrote:
Can I bring it back to dentistry and the people we are seeing?In my area, gone are the mouths of babes full of cavities. The more urban environments seem to have stopped the flood of decay. Modern hygiene, the decrease in cigarette use, paid cleanings have decreased the pathetic hygiene patients from 30 years ago.So what is left? Well, I see malocclusion has not changed? There is still only 5% of the population that I see, in a very urban environment, that have an ideal occlusion. And none of them were post ortho. Oh, we get good wide arches and nice vertical from some of the ortho cases, but there is still A/P issues or neck/posture issues or Trigger Point issues or latent airway issues with most of the post-ortho patients I see.Now many of these patients are "asymptomatic" or have no diagnosed disease. But the absence of a "disease" is not health. Health is Health. These people are still going to the Chiropractor once a week, seeking massage therapy, going to the doctor for pain control, taking over the counter NSAIDS to deal with pain. They are not "healthy". It is just that no one has given them a diagnosis.So in my opinion, you should think about learning how to recognize and treat these patients. There is a lot of them around and they just need to find a place that can help them. And they will reimburse you for your efforts. That may change the nature of your practice greatly. Right Mac?CurtisOn 2013-04-28, at 7:05 AM, mchenry lee wrote:Dentistry has certainly changed in the last decade. Insurance is running just about everything, including the behavior of the patient, public, dentist and team. The model I started with, i.e. wait until they call or come in, see what you can get out of them, make it as cheap is possible, etc was a pretty free flowing business model that has changed in my opinion. Modern dentistry has such a wide range of wonderful choices which even makes things more confusing and very complicated. Modern dentistry is expensive. The government, the insurance companies and the lay public want cheap.
The real question for all of us to ponder is where do you think you are going to be or where will your office be in 10 years. Are you going to be in control or be controlled. Is there a fear factor with either choice?
The younger you are, the more important the question and your decision is; again, my opinion.
Example, it takes a hell of a lot of guts, business savy, the right team, the right circumstances, the right clinical ability and reputation, the ability to look at yourself, etc to make the decision to become insurance free doesn't it? If you don't plan to drop insurance in the future, what do you think your business model will look like?
Food for thought after reading some of Seth Goodwin's material.
Mac--
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