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Changing Lives Through Neuromuscular Dentistry

Patrick Im



  • October 28, 2011
    3:00 PM
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also thank you very much and unborn on the throne is for this opportunity to share with you I think it was yesterday when I can someone asked me inside Reagan besieging William the lecturing about nicely while I think I'm not didn't want to sharing with you what I've been learning in the past forty five years am understood general dentist what finger dentist doing the day-to-day dentistry like a lot of you here and about ten years into my career I found myself I'm getting burned out and I started to experience what I heard about from veteran dentists and dentistry start to things get pretty routine things get very predictable speaking specifically about restorative dentistry and for the first ten years of my career I was pretty much just doing the bare minimum continuing education requirement to keep my license up and I and I recently heard out long ago that that comprises over eighty percent of general dentist I think the same thing may have invited physicians as well so there's only a small percentage of dentists who are going above and beyond continuing education to really stay on the cutting edge of knowledge to continually learn new knowledge and to apply the knowledge into new skills that can for the betterment of the patient's health these are my three kids of our Daniel and Christian they could be with me this weekend a lot going on and on they had grandparents day today so by the time to get out of school and drive over here with all the traffic in Atlanta and would just wasn't feasible for them to be here here's my wife my better half and she's been extremely supportive to the years and especially being very encouraging to continue my education are you guys enjoying dentistry good good I think there's a lot of things I don't want to do and even on our worst days I think there's still better than some people 's best days so as and before we get started I just wanted out sure where prayer with you because I'm introducing a topic that I feel is very broad and comprehensive by no means am I an expert in this field I just started my journey maybe four years ago in this field of neuromuscular dentistry I find it extremely challenging very time-consuming but extremely rewarding I think all the sacrifices are professionally have made it at created a real paradigm shift in the way I approach patients the way I treat patients and ultimately the way I view patients in my clinical care with sensitive deposit before work for after father just want to thank you so much for how you'd lead my life for rejuvenating my career with neuromuscular dentistry I just pray that our hearts and minds will be open to the intricacies the complexities that amazing your amazing creation the human body and how we has dental help healthcare providers can can be more attuned to that and to be earnest seekers and very curious about how we can obtain knowledge and skills that will help our patients achieve better health to get them off their medications and for them to enjoy the health that we enjoy to be with us as we share in Jesus appellation more than thirty three percent of the elderly people have lost all their teeth the highest rate in a survey of forty six US states and also in Appalachia the burden of coronary heart disease is greater than in the entire United States chiefly like cause and we also went to our move the lower jaw can be repositioned the lower Johnson and strengthening muscles ligaments muscles nerves bond and to John joins to which it is attached the forces of chewing page changes and many dental treatments can affect his positions and job position for better or for worse synergies and save or extend your life the dental function as a single significantly associated with better brain function vision hearing lung volume heart volume muscle strength bone mineral content less heart attacks and longer life very interesting study nonspecific medical complaints as related to job position a twelve year study conducted by a fifteen member research group of GHD 's physicians and dentists of the children's medical Center in Osaka Japan showed a high correlation between John and balances and varied medical problem since nineteen eighty three over twenty thousand patients were studied for various medical complaints that had no definite diagnosis for the underlying cause these maladies included headaches asthma allergies postural problems Parkinson's disease respiratory problems epilepsy gynecological problems iPhones facial neck pains each patient was treated with a dental orthopedic appliance which reestablished a corrected job position and sixty six percent of the patients treated there was either a reduction in symptoms or total resolution of their problem no other form of treatment other than the dental correction of a job position was utilized remember that number sixty six percent were messy that number again in a different study it nearly ruined my life it's an incredibly painful condition I couldn't see what had several headaches and muscle spasms in my face neck and back I lost my job nearly lost my husband for two years the doctors and know what was wrong with me I was suicidal because of the pain and was even sent a mental health facility as far as not being able to sleep with an appliance in the mouth consider the alternatives how'd you like me to refer the patient to your office five years ago I would've out is not known what to do with her or him physically on now I can honestly tell you that I look for the patients like this it's it's really interesting in my dental journey I was like ten years and smart dental journals like getting cases like this come into my office comprehensive like format issues and I'm looking at this going what I start now obviously the previous works failing but look at the look at the misalignment of teeth this lady came to me unhappy with her smile suffering from severe temporomandibular disorder musculoskeletal disorders on my TMJ screening form she pretty much check everything in machine where he began how can I best help this person where you begin with this now obviously this patient needs a new bike but where do you start with that note recently I was just I got my old Dell school anatomy Atlas announced so I especially had a nice session and just reminded what an amazing the intricacies that make physiologic the physiology going on between muscles and bones ligaments where the blood supplies coming from and how to use in the position of the jaws affects muscle position and how that all plays together the oral cavity what we what we refer to as the bony box and how the teeth come together forming the inclusion how does that effect on position how does Tom position affect breathing how does it affect swallowing and all these things look at all the muscles there how does composition affect airway how does air weigh affect your heart is job position affect the sinuses and so forth how does it affect the cervical vertebrae five years ago I would have known how to answer the questions I still am learning systematic method triad noticed that that word it's such a big word and see the word tomato and I just puzzling well tomatoes okay it's easy to remember Jason Domine joints and muscles are forced to accommodate just a theme I want to introduce to you as we go along here how to determine the healthiest occlusal position restored to the existing inclusion the patient has warned that might for years it must be comfortable and functional or is it and this was advice given to define older last that I thought for some advice a dentist that I consider like a mentor when I presented this case Tom is my hands were up in the air this patient came to me wanting something Harris and as I looked at this case I was like I mean there and have to be metal reinforcement out of old severe Bronx or history of clenching and grinding that all the fractions and is Dennis I said how do you do how do I find my position how to reestablish a healthy bite position in a dentist with me just while I thought Jason had several cases like this I just eyeball it I build up of quadrant one composite see how the patient responsibilities are comfortable I build up I restored outside and I just do a quadrant at a time until the whole mouth is not all about you but that didn't sound to me that just I will not couldn't I couldn't run without one you know I'm not eyeballing something this complex just to resonate with me if you can't be measured it suggests it can be measured it's a fact and I think we has dentists we do the same thing over and over again expecting different results I think I'm from my own experience as a clinical dentist icing things fail and I've seen things work but a lot of times it's very repetitive and I think Albert Einstein was onto something here curiosity is one of the most permanent and certain characteristics of a vigorous intellect in our impressive view of ten years in my career I was I guess I was kind of in a room and now I wasn't curious I was a great chief carpenter and I wasn't looking much beyond just to and I believe the Lord was speaking to me in our Daniel chapter one the Daniel and his three friends God gave them knowledge and skill in all literature and wisdom in all matters of wisdom and understanding finding them ten times wiser I think God wants us to do something more with their profession with our degrees in character and how we witness but particularly in the area as well God wants to bless us with knowledge and skill and as I have taken all these choruses and interacted with people very brilliant in the field of neuromuscular dentistry and I see how secular you know the lives are conquering the manner conversation outside of all this wonderful science I realize that God is not there and there's another opportunity for witness to my my secular colleagues that don't know that don't know the Lord now think about it this way as medical missionaries must as dentists starting to win souls for Christ when we go to continuing education seminars and making friends with people who don't know the Lord with a beer in her hand you know our glass of wine is a wonderful opportunity to say you know that talk about the wonderful science creative power of God from their God wants to use this not why Jim JD is the second most commonly occurring musculoskeletal condition resulting in pain disability after chronic low back pain affecting approximately five to twelve percent of the population about half to two thirds of those with TMJ disorders will seek treatment among these approximately fifteen percent will develop chronic TMJ game Roger Sperry better than ninety percent of the energy output of the brain is used in relating to the physical body and its gravitational field the more mechanically distorted person is the less energy available for thinking metabolism and healing and the more I get the more study into this area I think this statement is pretty true when I talk more about how the jaw joints how this is the highest posture Lincoln is in the musculoskeletal system and so when there is no alignment disharmony here it translates down the circle spline neuromuscular dentistry understands that the etiology of head and neck pain can relate to numerous pathologic conditions especially the relationship of the mandible to the maxilla and including mechanism teeth are not set in stone there is a dynamic relationship between two position arch shape and mandibular posture we all have the ability to exist and accommodated pathologic position when the pathologic position exceeds our accommodative capacity patients begin to complain either of pain discomfort or aesthetics so today when I define no muscular dentistry workman review basic anatomy of the TMJ talk about tends how much of my auger fee computerized and if you are scanning electro sonography is touch on those introducing to you what to talk about the HIG plane ambulance I said that the plane how it is an anatomically correct a starting point in diagnosis and treatment of TMJ the Sprint talk about golden proportions in the health and with some actual casework hopefully I'll know if we have will have time for some questions neuromuscular dentistry is the science of dentistry that embodies accepted scientific principles of pathophysiology anatomy form and function it objectively evaluates the complex relationships between two joints and the masculine muscles in order to achieve an solution that is based on the optimal relationship between amendable and the skull neuromuscular occlusion the goal is to relax the muscles controlling job position to establish a true physiological rest position upon which treatment considerations are based the science of occlusion encompassing not only the teeth but the objective evaluation of the status and function of the job muscles and joints before during and after treatment to achieve results occlusion is the foundation of dentistry it is of key importance in the success of every major dental procedure occlusion is affected by a triad of factors the chief muscles and joints traditional dentistry has focused on achieving and you know basically I can testify to this and I think a lot of you can too I mean it was there a lot of talk about how to achieve perfect job position and how that influences muscles and how that affects the jaw joint I didn't learn a lot about that in school at least I don't remember what you do a lot of things by the book and yet still have unsatisfactory results and no going back to the case I showed you earlier the case that got this whole journey started for me this am and by the way he moved away and I actually referred him to that dentist who sure that guesswork treatment plan with me he never followed up within either I think it was too frugal to want to spend any money muscle hypertonicity authors who have reviewed the TMJ literature generally agree that muscle hyper function is the principal cause of myoclonus TMJ disorders there is general agreement among both clinicians and investigators that masturbatory muscle activity is greater in symptomatic patients as compared to subjects so are neuromuscular Dennis Hart providing a closer relationship to the mandibles and isolate that minimizes need for muscle accommodation and provided and includes a relationship that allows for normal decompression of neural and vascular intervention or tissue and associated connected and this is our goal is illogical rest physiologic rest is that mandibular position in which the various mandibular muscles are simultaneously other resting length and imbalanced honest with one another it is always defined from and only valid from the upright postural position is that position in space were all the masturbatory muscles including all antagonistic muscle groups such as elevators and oppressors are in a state of minimal electrical activity necessary to maintain postural rest and I'll show you later on we discuss electromyography how we measure muscle activity think all of us are very familiar with muscle over accommodation classic example is a walk-in issue if I were to if we were to go down to the beach this afternoon and I asked you to take off twenty issues on the rock and there is okay let's go for a walk with walk several miles how would you be walking not very comfortably right this is what I tell my patients who say that they can't find their buyer that Mike doesn't feel comfortable or are there have a lot of tension headaches in and were bringing them back to their malocclusion I told him if the bottom of your foot is a sensitive your brain is not quick to discern a pebble in your shoe or in your sandal how about a bad contact between two of the goals of experience the patient comes back saying student sensitive listener chart oh I just did some work in get out the contact paper just feel so much better right muscle will for accommodation it happens in the mouth and just as the central nervous system can pick up the rock and the shoe and picks up a sign that picks up and influences the muscles of mastication postural muscles in the head and neck and the effect of working to discuss your just a few minutes so once again to dominate joints and muscles must accommodate the disc and condyle should move synchronously maintain a spatial relationship adequate disk space synchronous non- hypertonic musculature and just to go over a couple of things the this is the superior lateral head of the lateral pterygoid by concave disk virtual physical tissue and this is the year canal excuse me can anyone tell me what Fisher is back here what the name of that is there's a prize after prize for the person who guesses the anyway touch primary I was with you at but that tympanic Fisher and behind that area we have the overkill of temporal nerves and also the superficial temporal artery in the slide it shows how I reached through the condyle okay Richard a condo going posteriorly will reduce circulation to the TMJ 's and the head and retreated condo compresses the nerves of the temporomandibular joint arugula arugula temporal nerve and its branches is so mean a lot more as we go into our sites that this radiograph shows that if any of you are familiar with the work of Doctor Dell he established with all his clinical research that the four seven window he divided up the glenoid fossae and two eight spaces and discovered that there was a common theme running through patients who were working treated for TMJ and that their medical symptoms triggered by jaw misalignment and they were position in the four seven position that they first medical symptoms started to be resolved and in this tomography here you see in the CEO position the spacing around the head of the condyle here and rest position try this with me one with you let's gone with Phyllis and discussed in the that's rest because your lips your teeth are touching with your lips are together into their slightly apart COAs when you keep them together and habitual buying so our goal a lot of a lot of these TMJ patients have condyle center posterior display posteriorly displaced and pressing on the retro fiscal tissues and against your canal here and we'll talk about tinnitus and dizziness in your palms turned just a few minutes so just more tomography to show that people 's patients when they're in their sealed by that the spacing bacteria is that they have a malocclusion is typically very compressed sometimes we even same I've even seen the condyle 's incident contact with the posterior longer care so you can imagine how painful that must be the person is in that position a synergy of distant condyle can be the result of mechanical infringements or muscle spasms that results and uncorrelated this movement I want to share short film and neuromuscular circles this is affectionately called to join film annual Yorkshire why is it done by a couple of researchers which is in Sweden and really cool accent but they got dissected some cadavers and showed different healthy TMJ and so forth saw one to share this with you should show this film with you on sixty minutes I'm just in a fast-forward to the actual excuse in case it needs in a superior position that you sent this assisted in between the two human beneath the nation in the little anymore translation you need to do this I is selected since this is an okay person since his death he will take them up I think this is the and posted it online at maximum in the first however a small information we send all the things doing is getting them that his patient a little while in the translation and Yahoo Isle of Man reputation of thinking is going to be the yearly location of the preparation for the same within all things is definitely unusual in going to leave the disk displacement it is our experience that preparations for the government take in Memphis to test and knocking me these are when the economy said he suspected down will probably have a information can be loosely and destroy the Disney sensibilities thanks and he begins on opening with the students demonstrate specifically thinking which he lies thinking you are opening forward by clicking your claims the disc is he a game to place the consideration of the joint 's course of study wedding and was seen on all bands and observations so this is the thinking uses the sign on the abuse with WinFax for interesting quantities tends to you sometimes it is transcutaneous electrical neural stimulation no muscular dentistry begins with the use of times true relaxation of muscles it's a widely used term but in neuromuscular dentistry we get is more properly called ultra- low-frequency electrical muscle stimulation can wear stimulating the facial seventh and mask a Tory fifth cranial nerves is a nurse controlling the muscles of mastication and facial expression the muscles that are most involved in inclusion here's the J five-mile monitor HH Dixon an internationally recognized muscle physiologist at the University of Oregon demonstrated many years ago that exercise produced by gentle repetitive electrical muscle stimulation below one hertz once per second allowed muscle tissue to restore itself for over forty years Doctor Jacobson and Doctor Thomas have further scientifically validated the muscle relaxing capabilities of ultra- low-frequency tens with the established six seven hertz is the frequency for the G5 my monitor so why should we use hands and relaxing the muscles of the head and neck muscles of the face and neck are often programs are proprioceptive to control head in mandibular position in a way posture in a way that accommodates occlusion even though that particular occlusion may be less than ideal neuromuscular dentistry wants to relax these often tense muscles to find their true resting state and establish the inclusion at that position it is extremely difficult to voluntarily overcome this proprioception sentences used a secondary use of low-frequency stimulation is to achieve junk from free pain relief of pain of muscular origin so how does it relax the muscles a muscle in chronic spasm has impaired circulation and in a cumulation of waste products of metabolism the gentle repetitive electrical stimulation pulsing on the muscle creates a pumping action this causes a gradual increase in blood flow and subsequent washing away of stored metabolic waste products as a muscle returns to a more normal physiologic state the fibers lengthen and the muscle relaxes this is why it generally takes forty to sixty minutes of stimulation to achieve a relatively healthy relaxed state of the muscles being stimulated pain of the head and neck is commonly a component of TMG or TMJ very often the pain is at least partially related to muscle spasm as mentioned earlier muscles and spasm suffer from poor circulation and buildup of waste products of metabolism so that's why we use them I'll monitor to to pump away those waste products the lactic acid buildup and get the patient nice and relaxed one when I'm stimulating a patient in an tensing them frequently they're pretty much and reclined position but at times will put a blanket over them turn off the lights and forty five minutes to an hour later that's when I'll see them upright and take measurements for my registration closes this is what it looks like here's a patient testimony on the effective times this lading even came to me seeking relief from severe headaches ringing errors and jaw joint pain after my first visit I left the office without any pain in my head or jaw joints Doctor Anthony was an orthotic to realign my bite and since have improved much more I now have little or no gene jaw joint noise or pain and headaches are almost nonexistent I'm looking forward to continuing my treatment for even better results than I've already received when this lady came to me her face was literally quivering and she was in tears and I could hear my my staffer saying Doctor M I can hear her job hopping from across the waiting room and reception areas that allow and and so I was just thrilled that I could help her why is evaluation of physiologic function important member house going back to my mind is the statement if it visits if it can't be measured is just a guess right it can be measured it's the fact we need to to be objective in our evaluations of these patients the state of the teeth of the joints very often cause muscles to accommodate evaluation the hard tissue alone does not provide insight into the true status of the occlusal system this is why no muscular dentistry uses objective scientific documentation methods in a comprehensive evaluation of inclusion through the use of jaw chucking electromyography and join sound recording a complete analysis of the function or dysfunction of the masturbatory system is accomplished so the case of an evaluation system does anyone out here on the case based on how I explain each of these two jaw tracking is one of the modalities used in a muscular dentistry to precisely identify the relationship of amenable to this call and to study mandibular movement dynamically utilizes a tiny magnet affixed by wax to the labial and mandibular incisors so that it does not affect function the sensor array of four ounces is so light as to not interfere with mandibular function is free of interference and introvert and inadvertent patient movement so this is what it looks like four ounces and it's just extremely light until the patient this is like a GPS for your jobs and wisest so valuable first it permits us to study mandibular action dynamically by recording and replaying traces representing rep representative of the mandibular path of opening and closing this can reveal and highly precise fashion a number of anomalies otherwise difficult to discern second it records the relationship of the mandible to the skull with great precision information useful and in the diagnostic process and in taking a neuromuscular bite registration third the records and verifies that patients closure to centric occlusion is on a neuromuscular physiologic trajectory is a magnet we attached to the lower incisors by wax and of course you know we met we want to make sure that everything is nice and parallel to the floor the patient is seated in the upright position this is a letter milder for you surface electromyography this is the study of the muscle status activity using surface electrodes EMGs pickup tiny signals coming to the skin that are representative of the average of multiple flavors of a given muscle the data is obtained to the surface electrodes must much EKG electrodes amplified and sent to the computer where it is displayed the EMG permit study of up to eight channels simultaneously from anterior to the roster upon masters massacres and by gastric muscles I tell my patients this is like measuring muscle activity in the head and neck is like a cardiologist with measure your heart is sort of looks like so what do we need a lecture my out if he is the only way that a dentist can accurately measure and record muscle status and function palpation is subjective at best has little consistency from one dentist to another and provides no objective documentation EMGs allow the dentist to measure and record objective data concerning muscle status information can be invaluable as an aid in occlusal diagnosis and is highly useful in patient education it also enables studies of muscle function showing precise timing and activation patterns of various muscle groups this information is adjunct into the occlusal diagnosis and is not otherwise available authors of the definitive clinical EMG text in the medical field chose the Mann Chinese EMG technology in the above introduction to surface electromyography and these are the dual trellis that we attached to the patient's face measuring the temporalities massacres digesters and sternocleidomastoid bilaterally this is what an EMG scan looks like scan in the upper is the same forgot to reattach the mic after the yelling zone patient's EMG readings before intends in a normal occlusion and the patient's injuries after tens with a new neuromuscular by the place you can see here that LTA is exhibit browses these of the massacres these are the S SCM 's abuse of the back and can see here to point a to point a to point out these are what we would consider normal healthy muscle readings you can see this patient is just off the charts lots of pain there after times in a neuromuscular thought it was quieter patients feeling so much better that's when the real healing takes place that's when the inflammation starts to dissipate and Odyssey most commonly called sonography or joint vibration analysis that utilizes computer-based vibration sensitive transducer technology that quickly and noninvasively records joint sounds and vibrations originating in the TMJ patient wears a light weight headset that positions to sensors over the joints and we have them opening closing we are able to record those joint sounds in those four openings opening and closings this is what it looks like this tell my patients is like a electronic stethoscope for your jaw joints and working on record some information why should we use sonography on transmission of sound is so rapid that unilateral study of joint sound with a stethoscope may not even discern which side of the sound is coming from further sound studied in this manner are subjective and not documented data captured by means of sonography not only record joint sounds from both TM joint simultaneously the information can be played back at will the dentist can then analyze this recorded information in a number of ways that may yield additional insight regarding joint status and joint function here's an actual patient I'll show you this case later this is before treatment this is after treatment the quieter the lesson on the line means that's a healthy client join these big jaggy lines on the right side is when the patient's opening and one on the left side as lender closing secant see this patient on the left joint has a lot of sound clicking popping on the right upon opening and then on closing couple more sounds so it measures the left and right join at the same time you think this patient's feeling a lot better significantly better now how do we mount the cases okay the question I had referring back to that case that got this whole journey started for me is how do I stop where do I begin to build the buying wears a healthy bite position and when I learned about the HIG plane it just really resonated with me it just makes perfect sense the HIG playing as an accurate horizontal reference plane to have your incisive papilla plane Cooperman and will it say ten thousand schools from nineteen fifty five to nineteen sixty discover the nature 's plan of occlusion parallels HRP playing Cooperman wrote the HIV plane is used as a diagnostic aid and related medical problems such as syndromes of the head and neck and when used as a transit line playing discloses the degree of diced the disease occlusion in the natural dentition and in prosthesis so here's a HIV plane as you can see the handler notch both left and right sides and insights of the fellow when you draw a line through that that line is always parallel to the floor and so were able to use the stratus articulators or the oculi articulated to reproduce the exact orientation of the maxilla to the base of this call so here you see I've marked on this model incisive patella and a two handler notches the plane of occlusion should be at right angles to the forces of occlusion it is a basic premise in nature it produces stability when forces are correctly find a dental materials last longer and don't share off benefit help stabilize overall physiology of the body in other words bone teeth nerves muscles and the central nervous system are optimally affected when the plane of occlusion is at right angles to the forces of occlusion it produces stability said in all areas of dentistry plan conclusion should be at right angles I got cut off to the forces of occlusion here we see a patient's model on the occlusal plane analyzer and these you can see it's kind of hard to see that the surface of it was a plan analyzer but can you see how weak the way the pattern of the buying see how there's not many cheap meeting contact with their parallel surface this patient had a lot of head and neck cervical issues right shoulder issues water chiropractic a lot of acupuncture water massages could never find relief but just try to picture with me the mandible trying to bite at a right angle to that roller coaster and the effect on the musculature over and over and over again is it any wonder why this patient is suffering so much so the plan occlusion needs to be parallel at a ninety degree angle six orientations of occlusion as seen in a maxillary arch mounted to the HRT landmarks so are concerned about horizontal vertical anterior posterior pitch your enroll someone where Tenzing when I'm tending a patient and I'm taking a bite registration relax muscles will help and ultimately the bite registration will give me the will give me the right orientation of parallelism and another way to look at this if your pilot any pilots in the room the maxilla is what's determining mandibular position because the manual is fixed to the base of the skull is not moving mandible is the one who understood stating the obvious but if the maxilla is pitched if it's turned rotated of its roles it's cannot have an effect this is really interesting the three-dimensional orientation of ahead in space is dependent on four planes the orthostatic balance of the cranium and cervical spine is best maintained when the occlusal plane over the plane and by pupillary planer kept parallel if any of the three horizontal planes are not horizontal adaptive position will be made over time by the rest of the spinal column to restore these planes to level the drive to level these three planes is so strong that if the buy pupil area and occlusal plans are not parallel and horizontal a gradual warping of the face will occur resulting in facial asymmetry Mario rock bottom if the plaintiff conclusion is distorted or alter certain muscular activity can occur to cause postural adaptation to maintain orthostatic balance postural adaptation can cause biomechanical dysfunction in the head neck and shoulders Doctor Robert Bono is a world-renowned physical therapist who truly understands craniofacial disorders and trains both dunces and physical therapist to collaborate together and helping these chronic pain patients so here we have the bike people are going on a plane and occlusal plane they must be parallel member that comment back about the Noble prize Doctor Sperry about the body fought using so much energy ninety percent of the energy try to fight the gravitational field so how do we best determine occlusal position to be restored to the existing by position eyeballing guests or I was thrilled when I was taught that we use the neuromuscular dentistry uses the golden vertical the golden vertical based on fine I don't want to get too bogged down the stairs I want to have enough time for the cases that basically five was used by the ancients all the Greek Parthenon all the beautiful things architecture that we see around the world and in nature we see it Leonardo Fibonacci discovered this mathematical sequence that after forty is at the forty numbers in the series it's accurate to fifteen decimal places so unfortunately that I couldn't get this video to working here but did you ever have I would begin your e-mail and reported to you is an amazing short little video clip that shows the Fibonacci sequence in examples in nature like the model shall sunflower seeds and so forth all based on this amazing ratio Golden proportion examples for arm to the hand how this is one six one eight to one ratio we find it in spinal divisions toes human heartbeat the DNA spiral is a golden section measuring thirty four angstroms long by twenty one angstroms wide and so forth are so many examples even and this was really interesting extremely low frequency research and development they track radiation on earth the array of antennas they state the following finding we have found an extremely low frequency signal at five or one six one eight hertz these signals appear with no clear relationship with any known source they do varying amplitude or intensity and are irregular with their timing the signals had been detected on a global scale and are of extreme interest is it any coincidence friends that this amazing ratio is found not only throughout nature but in and in the radioactive waves that surround our planet and it's an amazing opportunity to see it in the face perfect faces one just one six one eight seed in the teeth if you were to draw a rectangle around to prevent central incisors is a perfect rectangle is exactly one one one six one eight credit cards one to one six one eight thank you so anyway I don't want to get bogged down with the methylated to the cases but and I'm not a mathematician but using golden proportion were able to extract away a guide and this is the measurement guide and it's only a guide a starting point please because ultimately low muscle measurement activity is what this is what we ultimately used to use measurement of time and then compare with him the muscle ratings and with those two were able to get the optimal by position so what we'll do is one measure a patient's existing vertical portion by seeing will measure the width of the central and using the table I just showed you find that the patient is deficient and vertical measurement so let's say this patient measures thirteen and the width of essential incisors show us that seventeen and three quarters would be a healthier vertical relationship for this patient okay we use that as a starting point I'll just fascinated because in Romans one eighteen to twenty says the wrath of God is revealed from heaven against all ungodliness and unrighteousness of men who suppress the truth in unrighteousness because what big what may be known of God is manifest in them for God is shown it to them for since the creation of the world his invisible attributes are clearly seen being understood by the things that are made even his eternal power and Godhead so that they are without excuse but there was a really interesting basically in the interest of time my running of time couple minutes of family go through this this is just talking about how sugar the modern diet is causing a lot of malocclusion 's patients limited to him some other cases here on this is a patient that came to me with a lot of old Dell work you can see the dark lines will give fans shed tension headaches tinnitus dizziness lower neck pain difficulty sleeping prisoner treatment plan Sergeant that would go over with you if she is professionals fish is covered porcelain opposing a lower fixed orthotic my lab is able to take my bite registration are muscular by registration wax it make it look like teeth and here she is getting healthy achieving maximum medical improvement fishes all finished and porcelain just real quick all tension headaches fully resolved all Gary issues result lower neck pain result numbness in hands over fifty percent improvement number clenching improved function fifty percent sleep improvement or relax full body and she just basically is saying you have made I'm so thankful for the changes you made in my life both medically and aesthetically this is a midwife nurse came to me in extreme pain she's biting together and her existing Bartlett of the look of the distortion interface can you see that amazing is not pain when chewing she said she had always flat if she ever ate sandwiches she had to flatten them as much as false could barely open her mouth limited range of motion bilateral chocolatey and popping chronic tension headaches for taking eight hundred milligrams Motrin three times a day and Flexeril these were her EMGs suit account in her by she also by the way had cereal for bicuspid extractions and orthodontics earlier on as a teenager here's a joint sounds six months into orthopedic stabilization no pain when chewing job hopping clicking resolve able to buy the large sandwiches with ease meeting five dollar foot longs that in shoulder pain tension headaches result stopped taking her Motrin and Flexeril out when she came in and told me that I was just thrilled absolutely thrilled you can see that her EMCs so much more relaxed right with their time sounds quiet much more quiet she's in her provisionals these are all temporaries that's what it was a monochromatic bleach white shade she's just waiting for porcelain delivering headaches and migraines there's so much to share with you if any of you are interested in reading this I'll be happy to share with you but some of you might know this guy Doctor Chung is my brother-in-law and Averitt averaging forty five debilitating migraines since the age of thirteen this is before EMG malocclusion 's triggering migraines for thirty seven years and migraines resolved migraines resolved by the way medication when you touch it and I remember driving into the ER one time over ninety miles an hour concerning adults and two zero seven one of those episodes is really debilitating so you see here guys neuromuscular dentistry can equip you and me to help people like this I'm not just sit to this fund is looking here at this time on this thing here Davidson fifty three minutes now okay okay all right well I didn't really cover alive but this one a thank you all for your attention and and for listening to this presentation and vicinity want to see more cases on behalf of show that to you but I does when things were rewarded when the word or will this weekend was using my audio verse four amen and his medical management known you'd like to learn more about me then please visit www. a man and I thought you might was more free online service please visit www. audio verse one


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