Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1104 Airway Centric Dentistry with Michael Gelb, DDS: Dentistry Uncensored with Howard Farran

1104 Airway Centric Dentistry with Michael Gelb, DDS: Dentistry Uncensored with Howard Farran

10/23/2018 2:47:04 PM   |   Comments: 0   |   Views: 336
Dr. Michael Gelb is a highly rated author and speaker on TMJ, sleep apnea, sleep disorders and chronic headache treatments. After graduating from Columbia University with a DDS degree, he received his MS degree at SUNY Buffalo in Neuromuscular Research.  Dr.Gelb went on to become Clinical Professor at NYU where he directed the TMJ and Orofacial Pain program. Dr Gelb provides solutions for dentists to incorporate Airway and Sleep into their practices. He is also the cofounder of The Foundation of Airway Health and it’s Airway Summit. Dr.Gelb is the coauthor of GASP: Airway Health- The Hidden Path to Wellness and maintains a private practice in NYC and White Plains. He has pioneered AirwayCentric Medical and Dental education and recently developed the ACG Day Night Appliance System.

AUDIO-DUwHF #1104 Michael Gelb, DDS

VIDEO-DUwHF #1104 Michael Gelb, DDS


Howard: It's just a huge honor for me today to have one of the biggest TMJ legends that ever lived on my show, it's Dr. Michael Gelb. He's a highly rated author and speaker on TMJ sleep apnea sleep disorders and chronic headache treatments. After graduating from Columbia University with a DBS degree he received his MS degree at Suny Buffalo and neuromuscular research. Dr. Gelb went on to become clinical professor at NYU where he directed the TMJ and orofacial pain program. Dr. Gelb provides solutions for dentists to incorporate airway and sleep into their practices, he is also the co-founder of the foundation of airway health and it's airway summit. Dr. Gelb is the co-author of Gasp, airway health the hidden path to wellness which you can purchase on Amazon. He also maintains a private practice in New York City and White Plains he has pioneered airway centric medical and dental education and recently developed the ACG day-night appliance system. When I started this show a thousand amd 90 days ago you were one of the first people I emailed and I took three years before you finely blessed our show but thank you so much. So I just want to start with one rent and I didn't want to interrupt and only to you with it, when I talk to Millennials or when I talk to dental suits probably a quarter of our listeners they are still in dental school and all the way under 30 we're probably the two oldest guys that ever listened to a podcast ever they always say the same thing to me and they're say this is her this is there a question not mine there's a man if you listen to ten endodontists lecture they don't argue they there's no controversies, you listen to you know ten guys making a denture they do they don't argue listen to ten oral surgeons you know there's almost no arguments and then you listen to TMJ and occlusion and then you'll it's like 20 different world religions. Why do they feel this way after like you you got a MS in neuromuscular you know how controversial today you know losing camps are neuromuscular versus CRC so my question is why is it so confusing is in controversial and complex?

Michael: Yeah that's a great question it's great to be here Howard. I'd say that it's because it was a religious cult type thing because they really didn't know very much was all based on dogma. So they would argue about we're centric relation where should the jaw be shouldn't be up and back should it be down and forward is never muscular those guys were bums and there's no good and the CR guys hated them the neuromuscular guys and then there was my dad and it got very very controversial and I think one of the greatest kind of accomplishments or greatest things I've seen in dentistry is that you know was the Hatfields and the McCoys. It was my dad again Pankey my dad against Dawson and now I become good friends with whit Wilkerson from Dawson and I become friends with Mark Murphy from Pankey and the only way that we've come together which is so exciting is we unify it's the unifying theory of Dentistry it's about airway. The only thing we all agree upon is that everyone deserves an open airway every patient should have an airway and our feeling is the guys from Pankey, Dawson, LVI, Kois, Spear, airway trumps everything else in dentistry. Airway trumps everything else so whatever you're learning whatever you like you really should learn it should know a little bit of that airway because if you're gonna do a full mouth case and we can talk about this, you got to start with the airway first the last thing we look at is teeth. So I'm gonna make some controversial statements but one thing that you're gonna get agree upon and I never saw if you have Kois and spear and Pankey and Dawson and LVI all agree on something and I would hope the dentaltown people it would be that airway is pretty darn important and start looking at it and maybe it'll makes things. So you know here's my thing once I started looking at airway it did away with a lot of TMJ problems then the TMJ was enough so important anymore and so the CR guys they had to time stop talking about CR because the guys that were pushing drugs back we just got a position paper from their American College of Prosthodontist, you can't keep doing the same bike or that you and I learned thirty years ago when I graduated Columbia 50% of the night guards that are being made every day in this country are actually closing the airway and I think it's more like ninety percent. So there's a lot there's a lot there.

Howard: Well I'm so old my great dream dental school the Dead Sea was just sick and hey when you're listening to Dr. Gelb I want you to know I mean this guy I mean he's been on ABC News, CBS, Chicago Tribune, CNN, L, Fox, Fox News, Village, New York Times, The Atlantics. I mean I don't think I think there's any one can agree on anything in TMJ it's that all American media agrees that you're the expert so

Michael: Thank you

Howard: I mean all those people you listen to Kois, Spear, Pankey, Dawson not any of them have been on one third of that list. So in all seriousness so when I graduated from University of Missouri Kansas City in 1987 not one time did anyone mention airway. I mean well I never even heard the word.

Michael: No we never heard it no one talked to me no he didn't know we didn't know there was an airway I mean it was there but it was an empty space right Howard it was an empty space, it didn't matter it was empty. So when you did your Anatomy exam it was hard to put a tag on the airway cuz its air and we just never realized that the tongue was so important. So Howard Hindon and I we wrote this book Gasp and we talked about airway centric because I like the concept we always talk about centric, centric relation but this concept of airway centric is a new way of thinking in dentistry okay it's not a thing it's really something that we can teach it's a device and so I love talking about airway I love talking about airway centric.

Howard: Well I'm talking about Gasp, is that a gasping for air tell me what you have to learn if they buy you a Gasp airway health the hidden past the Wellness a gazillion five-star reviews with you and Dr. Howard Hindin.

Michael: They're gonna learn that airway issues start in the first year of life. So preemies we're gonna start with kids everything's evidence-based we've got references on everything you're gonna see that most preemies anyone born before at 34 weeks 35 weeks anyone early early birth preemie will most likely be a mouth breather and as a high likelihood of developing in the airway problem mouth breathing, snoring, sleep apnea and you're gonna learn early on that it's probably responsible for 60% of people or patients kids with add and you want to talk about getting kids of off of add medication and something they probably never needed. We we talk about all that and I think the kids part is particularly I'm passionate about that and it affects a lot of us it affects a lot of our kids our grandkids and we all know kids that are on meds for that so it starts with that and then it goes on to fatigue performing that this is all lifestyle Howard this is what I like talking to I talk to anyone but it's about how you feel every day how's your memory, how will you performing today, how's the mood of your kids having anxiety and children having anxiety and college students. So we've got into subjects that I never in a million years thought I'd be talking about anxiety, depression, panic attacks and insomnia, performance of all kinds, fatigue. You know stuff that's really relevant to how you feel and so Gasp takes you through all of that and then it takes you into older age with you know dementia, Alzheimer's and it links everything back to sleep in the airway and when what you can do about it as a dental team and by the way the dentist and the dental team the assistance and the hygienist is run by the dental team and no one does it as well as we do it you can't the ENT can't do what we do it the pulmonologist can't do what we do. We love working with the team but you really need to dentist involved and we even talk about aesthetics in there as well.

Howard: Let's throw a big reality blank yeah I mean I know my homies there's two hundred eleven thousand Americans living today with the active license to practice dentistry and when someone comes in with anything to do with TMJ all they do is the assistant comes in takes up her own alginates they sent to a lab they make it mine guard they're cured they're done next patient. Do you wrote thank you what percent of American dentist treat TMJ like that what would you guess?

Michael: 90%

Howard: Absolutely, so that means nine out of ten  and then what's even tougher if you're talking all these 30 and under dentist right now and about a third of them are going to go back home and practice with mom and dad they think their mom and dad and their mom's the best dentist in the world their dad's best dentist in the world anything to say that I've done it this way for 30 years that's what we do next patient. How does how does she go home and tell the love of her life her mom who's a dentist said yeah there's more to it than a night guard units for 90% of all TMJ treatments in America today?

Michael: Yeah well that's a great question, so today we have things that we didn't have 15 years ago we have comb beam right, we've got home sleep testing. So first of all just knowing that half the night guards that you've ever put in at least half or the night guard that you may put in tomorrow or maybe after this podcast I hope to kind of ruin their thinking or they I want to disrupt the way they think I don't want them putting in that night guard that they used to put in because they know I'll ask you a question is that night guard open in the airway or close in the airway and if I told you that at the people that rocks have a sleep apnea or a snoring condition and maybe their sleep condition is what's making them burx remember years ago Howard that was equilibrate if you were bruxzir you had to balance CR the balancing the working lay the patient back minor collaboration or god forbid a full mouth rehabilitation and that was the treatment we actually believe that equilibrate in the mouth full mouth equilibration would stop clenching. Well we've come a long way from since then and we know that it's a stereotype movement disorder we know it has to do with sleep we know there's arousal and so the American College of prosthodontics has published a position paper which everyone should read and they're saying when you get a patient that has clenching that as bruxism it would behoove you and beyond that to avoid liability you should be investigating whether this patient has snoring, mild apnea and moderate apnea and maybe take a look at their airway and so we talked about the airway as something that you carry with you 24 hours a day. So if you're going on with your millennial say before I make that nightguard what am I really why am I making it and if I'm putting in is it opening the airway or is it closing in the airway if you don't know don't put it in the mouth.

Howard: So how does she listen to you and go to the next level? Give her a stair step. First of all she's $400,000 student loans especially if she went to NYU what's NYU a year now?

Michael: Probably 125, 100

Howard: She borrowed the whole thing, its 500,000 in debt she can't afford to just walk out with five hundred thousand dollars in student loans she can't afford to go to Kois, Pankey, Spear, Dawson and Dickerson.

Michael: Exactly

Howard: So give her a stair step, how does she go from I'm 25 my mom just takes algae nets and sticks in a night guard and how do I end up being like you someday?

Michael: I think it starts with you know we're doing a course now a million-dollar airway, you know we're doing a five and a half hour course across the United States you know we're not doing a ton of them but you get started you go to a study club you go to a lecture there's more and more stuff online you and I are gonna do one online we'll do an hour an hour course where they can learn something about story and sleep apnea and then you know you have to I guess online learning is the way to go. I mean I think that's what you and I have been talking about they come and they spend a day with me they do a two-day hands-on course I mean I think that's the best way to learn because Howard you don't learn this in dental school unfortunately even though it's the right thing to do they're still not teaching this in dental schools right now. So you've gotta learn from someone that you like that you trust and just start start reading I'll tell you though the book Gasp it's a good it's a good start just get this book all of my patients get this book and then I can recommend other books after that.

Howard: Well first of all I want to thank the 25,000 dentists and follow me on Twitter and I know that 85 percent of my listeners are commuting to work right now. So what I do to help them is I retweet my guests tweet so I'm just retweeted your last week on he is on Twitter he is @thegelbcenter and his last week was the mouth is the entry point not only for food but also for bacteria that end up in your gut and both small large quantities, so it was the only two dentists is a family you and your dad?

Michael: Yeah yeah absolutely yeah my daughter was working here for about a year helping us with new patients phone treatment coordinator and hopefully she'll be back in a few years with her own practice.

Howard: That is so cute I love that and you know all the media talks about that fortune 500 companies all day long every day they don't even employ twelve percent of Americans and then small family business twenty five employees or less 85% of the economy.

Michael: Love that

Howard: and it's the family-owned wheat farm pig farm dental office that runs America.

MIchael: I'm with you.

Howard: So you think all the camps are now come together because of sleep but you say some things that I know they're not gonna understand you say airway Trump's everything in dentistry mind and body medicine in dentistry day and night sympathetic and parasympathetic so what happens is when you stop breathing at night your body's saying to itself I'm not getting any oxygen I'm building up co2 I'm gonna something Bad's gonna happen and so what happens is your sympathetic nervous system picks up you get an arousal you wake up your release cortisol and you're just ready to go mean you have to be you have to be revved up because your sympathetic nervous system fight-or-flight is keeping you from dying and so what happens in the morning you get up and you're so revved up and your blood pressure goes up you develop cardiovascular disease. So they see what we're saying is that if you want to integrate mind-body medicine if you want to integrate your everything everyone talks about the vagus nerve parasympathetic people are meditating people are taking or during yoga the way that you can get your nervous system to slow down is just to slow down your breathing.Sso if you go Howard you and I are breathing 16 to 18 times a minute right now if we would go to 6 to 8 times a minute to breathe if we would slow our breathing down for in-laws 4 to 4 out and just take a deep breath while you're driving out there while you're listening to is take a deep breath and what that'll do is that'll help your heart rate variability and almost stimulate your parasympathetic nervous system. So people are reporting to us that after they open the airway after they're wearing one of these devices at night it opens the airway they're a lot calmer they're better focused, so I took about the nervous system I took about the airway day and the airway at night so I talked about it's as important sometimes to open the airway during the day and that's why you know the gillip appliance is probably the number one appliance in the US as in daytime appliance. Maybe all along it it's use really was for the airway and not what we thought was so much it being a just primarily TMJ appliance. So that's what we're talking about we're talking about mind and body because when you get deep sleep you repair the body when you get deep sleep when you're not snoring the body releases human growth hormone, so if you want to actually feel younger younger you get better sleep and it repairs the body and then it rem sleep we consolidate memory and we help repair the mind and we've got into things like we're talking about dementia we're talking about Alzheimer's because airway treatment and open the airway is part of reversing Alzheimer's and reverse and dementia.

Howard: By the way if you want to get a degree on Dr. Michael Gelb, dentaltown has 270,000 dentist who have posted six million times.We have a search engine on the app and the website if you just type in Gelb some of the most amazing threads come up by everyone talking about it try to teach it to each other blow their mind if you'd get on there and start answering okay if you post well first of all you couldn't post in every thread that had the word your name in it because you would have to quit your job and do it for at least a week or so but it is I just love it and I'm so honored to get you on this thread because like I say you just don't see these long arguments and debates and endodontics. I mean no one's talking about going back to sarjenny no one's talking about silver points you know I mean exactly the endodontists figure something out and move on and that's just not what we see in TMJ, occlusion Alliance therapy and I wish you'd put some courses online.

Michael: I will do it, I'm telling you I'm gonna do it I'm committed to it.

Howard: There's something in the market. Another popular question is when they see people grinding and bruxing their teeth the sites that have them deal with airway or teeth or whatever or there are other variables involved like their brain psychic stress or their diet or their gut microbe or their exercising or any of those factors are those secondary tertiary factors or secondary?

Michael: Yeah secondary so I'd say alcohol consumption and sleep apnea the two top things odds ratio, those the two top things you put in stress caffeine alcohol and sleep apnea. So sleep apnea is really the number one in terms of it's like 1.8 in terms of odds ratios how likely are you to clench and brux. So that's why the American College of prosthodontics is saying if you have a patient that's a bruxzir are maybe a good place to start is to evaluate their sleep get a sleep study because in these chronic bruxzir the people that are just you can't stop them they're exhausted in the morning we can they're men they're thin women they're petite women they had big tongues they have small Airways you would never in a million years think that that was going to be a candidate there you really are helping these people once you evaluate their sleep problem once they start sleeping better you open the airway it really comes down their bruxing they awaken more refreshed they awaken in a better mood and I had a woman come in today she came in for weight gain she goes you know what I don't have those cravings anymore. So here's the thing ever you wake up in the mill night are you gonna reach for a pint of that hot in US coffee or chocolate or are you gonna maybe take a carrot or take a slight a piece of celery. So they did a study at Cal Berkeley people would wake up and the center of their brain that handled cravings would go way up if they had sleep apnea and their decision-making skills would go down, so they have a craving and their executive function or their decision-making is poor so they're gonna make the wrong decision they're gonna go for the pint of ice cream and the carbs are just going to feed that they're hungry and they're they're cortisols is out of balance. So what we're saying is you sleep better you'd feel more satiated you're not as hungry and it works very well and your cravings go down.

Howard: Talk about the American College of prosthodontics put out a paper on oral appliances, what did you think of that paper?

Michael: Yes, I absolutely loved it I think it's one of the best things they've done and I think they're gonna look a lot more at Airway now. I think it's a game changer you know I could say it but when the American College of prosthodontics comes out with that and they're saying before you do a full mouth rehab a before you do a crown I tell dentists you ever work on tooth number 18 you ever work on 30, 31 well if you contour that tooth too too thick too heavy lingually you're affecting the airway people say well I don't want to get into air well you're an airway doctor right now Gary Catis says your master the airway we all treat the airway Howard we just not aware that we do it so when the American College says you know what you better look at it and by the way there's liability out there that if you're closing peoples airway we took a Hippocratic oath, do no harm. If we're closing someone's airway we're really suffocating that patient we do it slowly and I say no one notices right you're killing the patient but we're doing very slowly so they can't pin it back to us we have a good alibi but we really it's like a me-too movement in dentistry you really have to start looking at the airway or we'd advise that you do and you know you're an airway doctor right now whether you're a superhero for good or for evil, that's you know that we can't really say but that that position paper if you google and American College of prosthodontics paper on oral appliances they've got a lot of good literature it's all evidence-based and I think it makes a ton of sense.

Howard: and that was with Dr. Jeanne Woo, Nancy Devoy

Michael: Yes it's a game changer

Howard: Yes, it is a game changer. So what is airway centric?

Michael: Airway centric is a way of looking at dentistry, it's a way of reframing everything that we do so that if we see a scalloped tongue if we see where if we see acid reflux the first thing we think of now and we see acid reflux and we see that appearance of a tooth that's washed away it's flattened out we think airway because the pressure the negative pressure pulling the acid out of the stomach we think hey I better treat the airway. It's when I look at a scalloped tongue I think airway when I look at someone who has retro nasiha if I look at someone that can't breathe through their nose I'm thinking not TMJ like I used to thinking this patient probably has an airway problem. If I hear about a kid with ADD I'm gonna make for sure make sure their tonsils and adenoids are have been looked at and by the way 80% of ENT's really don't get this yet pediatricians don't really get this yet so we're only 25 years into this airway movement and probably only 10 or 15 and to really talking about airway, sleep apnea was only invented by you know Colin Sullivan and DeMint and teaming up probably 25 30 years ago. So we're still relatively new at this and when you talk about airway centric it's a new way of looking at dentistry that really focuses first on the airway and then Howard what it does you're doing dentistry for wellness reasons. So if you start with the airway you know what we talked about epigenetically a lot of us have receded jaws narrow jaws narrowed palates and occlusions are getting worse with time so starting with kids and what you see in your dolts if you start looking at things in the airway centric fashion it really changes everything you do in dentistry and it starts it really should start with kids.

Howard: Did you see about that all of that ancient child they found the other day that was inside of a bird?

 Michael: No I got a look at that amazing

Howard: Oh my god they kind of prehistoric huge bird with the fossilized baby human in its stomach could you imagine birds but the reason I would want to think about that is the one thing that I love going outside or dental bubble and talking to other people whenever you meet them whenever you sit by some guy on a plane on a five-hour flight you find out he's something different it's fun to just download his brain but it's funny how the anthropologist were the ones educating us first before the orthodontist that all these malocclusions they pretty much just popped up a couple hundred years ago and when you go to ASU where they have Lucy who's 1.6 million years old these anthropologist say we'll all these malocclusions and everything they just recently popped up a couple of centuries ago and they're thinking and changing diet softer foods I mean instead of throwing your two-year-old granddaughter a Mastodon bone and having her chew on it or die so you know there's she's eating Puri stuff out of a jar as soon as she has any difficulty nursing they switch to a bottle and a sippy cup out and so my question is why arent the orthodontist talking about this I mean how can I don't see all the local awards are named hey if you're pregnant come to my orthodontic office on the first Tuesday of every month and we're going to talk to pregnant mothers about how they can change diet and nursing and all this stuff so you're not gonna breed all that you know I have all these environmental factors that lead to 12 years later needing a bunch of teeth extracted and $6,500 worth of ortho. So my question is or the what letter grade would you give the orthodontic community on airway centric airway breathing?

Michael: You want to be honest I'm gonna get probably between a C and D they're probably the most disappointing profession to me and I do applaud the American College of prosthodontics for coming up with this but the orthodontist you know they had some good teachers right they have Linda Aronson and big and Ricketts and Solo and tallgrand they had Harmibal with those monkey studies. It's in their literature but something got lost in translation and it became a very attractive and year for bicuspid extractions. So Howard we had this bad situation right we went through me and Ruth all where they had these big jaws and they had it at no snoring no sleep apnea you described it beautifully and then here comes Homo Sapien small retractor jaws the work of Lieberman at Harvard and what do we do well we used to equilibrate we don't do that as much anymore but now we take out teeth and we use headgear and we want to pull everything back when a camouflage cast is you know McNamara said 85% of all maxilla isn't too far back so I just really feel so bad I feel bad from the orthodontic profession but I'm really happy for the general dentist who have gotten into orthodontic who are doing things we could talk about clear aligners in a second that's all another subject but I'm so happy with the general dentists that have gotten into ortho and I think the orthodontists it's really time for them to wake up but they want to keep their ground they want to do things just the way they've been doing them and I'm frustrated with them I kind of and at least second or third generation and that my dad felt the same way and I just I don't get why they wouldn't want to jump on this bandwagon and probably what they'll do in another 10 15 20 years oh yeah we do that all the time but..

Howard: and they think their issue is Invisalign I posted last night I don't know if you saw it yesterday The Motley Fool came out the article says better to buy align technology versus DENTSPLY Sirona which one of these stocks is likely to bring smiles to investor faces and Motley Fool was just talking about that basically I mean you're in New York where they're going buy the Apple Genius bars and align technology owns a iTero scanner and Invisalign and they're going right next to these I mean Steve Jobs was the only thing you know Steve Jobs I mean he would have programming wasn't a tech guy he would mean he was a marker he was a master in genius marker and when everybody was getting out of retail it's a it's going online he said hell no he's to open all these Apple genius bars repair all of his products in the front 25% with a bunch of people but it was nice nice locations and and buying apples like buying a mercedes or a Ferrari. I mean if you walk into a bar and we both go out clubbing and you got a samsung and I got an iPhone I'm the guy I would get to dance and now align technology is doing the same thing you can go to place our noone in dentistry some girls and used to work in a makeup booth who's pretty in heels and knows how to sell and close and next thing you know she's scanning and sending back on a dykon file to Costa Rica they're making trays sending it right to the right to the patient at home and how do you think that's gonna affect orthodontics in Airway when you're having makeup ladies doing the diagnosis treatment plan and scanning and they're sending you the trays from Costa Rica do you think that's gonna work have any red flags do you?

Michael: Oh yeah well I think absolutely it's gonna work it may put the orthodontists out of business I'm not sure that it shouldn't there's a problem though so if you only want to have alignment of teeth and if that's really what the orthodontists are doing there really should be an orthodontic profession but if you're just one alignment of teeth and you're not looking at airway and you're not looking at TMJ you're missing the boat. So you know we see patients come in that if had just alignment teeth may look nice but aren't the jaws in the right position and did you take any account of their airway see what happens is with clear aligners the last two or three trays they want to make it so you could floss right so they close the spaces they narrow the spaces they close and in many cases when they close the spaces I wrote an article with Bill Lang on this when you retract remember what I'm saying that retraction if you're gonna retract those spaces and you're closing things down Howard you're closing the airway so I'd be very careful I think it's great it's a price point is great and those girls that are scanning you who's ever in there they're doing a nice job and it's very cost-efficient but you know we want to talk about this as a medical profession dentistry we're physicians of the mouth Howie Hindin likes to say and we'd like to see dentist going and more in that direction where we're a part of medicine this is really the best way to integrate medicine and dentistry and the get us aligned it's the unifying theory of Dentistry. So it'll take a look some people are longer than others to get into it it's also happens to be very fulfilling and it's something that's really run largely by the dental team. So the women in the practice get it better than the the male dentist the female dentist may get it better even the male dentist.

Howard: Okay let's move from orthodontist to pediatric dentist I've been a little disappointed like three exact times in the last year so where you'll be at a friend's house and I'm in Ahwatukee and this is clear over in Queen Creek and the five year old is sleeping on the couch and just grinding is like like marbles just grinding and I said I said you hear that, she says that and then I try to explain here about all this and she goes well I go to the best pediatric dentist I said okay well I want you to make another appointment and I want you going there just not because this is a six-month cleaning but because he's grinding his teeth at night and you can hear it across the room. You know what he told her?

Michael: What?

Howard: Their baby teeth are gonna fall out he's fine don't worry about it

Michael: Right that's a big problem we have I totally agree with you another big disappointing group Howard the Academy of pediatric dentistry yeah there was a big conference that Steve Carstensen set up at the ADA last month a lot of my friends went out there and the American Academy of pediatric dentistry didn't see any need the center representative out there so they are definitely not on board with this airway thing and I'm saying they're there now it almost as bad as the orthodontist. So we want the pediatric dentist to get in there before five Kevin Boy who's one of my good friends and does a lot with the epigenetics and out in Chicago he says less than five and when we heard Karen Banach we're now even getting in there with healthy start or myobrace we're advocating getting in there at two and a half three years old it's about you know what orthodontics is about brain development, orthodontics doesn't have a lot to do a teeth it's about opening up the structures opening up the airway and saving these kids lives, changing kids lives, the time to do it is when the bone is soft and Howard yeah I'm with you on it the pediatric dentist I guess they're doing very well to spend on teeth. So I think we've regressed in certain ways you know there's a percentage of the of the people out there that really get it and want to save lives and get kids off of medication change behavior make kids a little bit more clear headed and there's others that just like you said their only baby teeth.

Well Big Pharma is very big and when you watch any of the news stations if you want CNN Fox News MSNBC what percent of all those commercials are Big Pharma?

Michael: Right I'm with you on that.

Howard: It's either Big Pharma or the lawsuit and what's so funny is half the time it's a big pharma and then and then the big lawsuit is about a class-action lawsuit but on some medical device or whatever it's like

Michael: Or a drug

Howard: Yeah so I don't think America when when you're news stations are publicly traded on the New York Stock Exchange profit is the motive it's really hard to get good information because they want to say I'll never forget when the military did an amazingly I mean who could do a bigger study than the military about psychiatric medications and post-traumatic stress disorder and if some of the biggest thing drugs out there I forgot the it was the biggest one and then they said they saw nothing zero effectiveness they're just trying to get out of it they're you know they're not standing behind our soldiers they don't want to pay for all it's like dude no one in the military didn't this say that that's their own try they're not trying to throw their own charter bus their own tribe doctors are saying we don't see a difference with these psychiatric pills for this treatment and I saw it across the board all publicly traded news companies the talking point was the Pentagon's trying to get cheap on the vital medication that our soldiers need today it's like anybody thought that maybe maybe it just doesn't work. So I want to switch to another profession we beat up orthodontist pediatric dentist let's go to a professional I'm not even sure if it exists exists yet geriatric dentistry it sounds like the courts starting in Texas have basically said there's no such thing as a legal special if the American Dental Association they didn't care what their club called mine specialties there was about an implant case and the Texas Court said is your practice limited they implanted he said yeah so you know Sato then what's your problem you're a club if you kick him out of your club keep mine of your club but he's not fraudulent he says it's the only does implant it means an implantologist get over it. Well geriatric profession I'm a little bias about that because I'm out here in Phoenix and I mean within two miles of my dental office I swear guy it's forty percent people who retired if they're east of the Mississippi River they home in Florida and if they're what's the Mississippi River they all come to Phoenix and so how is sleep apnea tied to dementia and Alzheimer's?

Michael: It's a great question let's see if I at my book here but there's a book by Dale Bredesen but we've known for a long time that it usually takes two paths in chin kids and and middle-aged adults older adults sometimes it affects the little kid you know there used to be the fat kid little lethargic kid he's he's a little bit overweight and then there's the thin kid who's running around is hyperactive right so it takes two different paths. Well we always knew that neurocognitive aspects of this could be one of the ramifications so in other words you could be irritable or you could like forget things you could have a poor memory now that's the hippocampus that then involves into cognitive impairment which evolves into dementia which evolves into Alzheimer's. So Anita Guard did a great study at Rochester he found that when you got into deep sleep that's when the toxins were removed from the brain and he discovered this thing called the glymphatic system not the lymphatic the GL the glymphatic and that's when our brains get scrubbed that's when the housekeeping occurs that's when the toxins get removed spaces open up and toxins get removed from the brain. So UCLA did another study and they said when you don't sleep well your blood brain barrier opens up and that's when we start talking about this oral systemic stuff mouths get dirtier you get Treponema you get PE gingivalis what that's what they're discovering the brains of Alzheimer's patients. So it's kind of Prince prudent that before we get to that geriatric number like maybe in our 30s 40s or 50s we're trying to get people to prevent it but if you want to talk about reversing Alzheimer's, Alzheimer's is number one and disease of inflammation and well what's the most one of the most potent causes is systemic inflammation sleep apnea so if you want to get into anti-aging dentistry if you know what I will if you want to take a drive with me to Las Vegas one day we can fly-in their this whole anti-aging this whole wellness phenomenon I think it starts with airway more than diet diets very important exercise extremely important and you can cut dementia by 50% with just exercising but there's a huge proponent of the inflammation dementia Alzheimer's that has to do with getting a restful night's sleep that's when your brain gets recreated that's when you form new synapses. You know I learned something from Dale Bredesen if you talk about synaptic blastic activity you know like the the osteo class and osseous and snyap through new synapses that's called anti-aging you know what they call synaptic plastic activity that's called Alzheimer's so when you start losing synapses you're getting that dementia and Alzheimer's. So if you want to live longer if you want to be healthier if you want to keep your marbles in your memory you got it you know you can't ignore it so you know you get to be my dad's age they don't want to do anything about it you get to be 93 or 90 or parents doing things and we have to start doing things in our 60s and our 50s.

Howard: Do you see I mean you're you know you're in Manhattan you teach at...

Michael: I'm in Manhattan I'm in the city I'm in 59th in Madison right here.

Howard: So you have more people and density than anyone, are there any full-time geriatric dentist in private practice in Manhattan that market I'm selves geriatric guys?

Michael: I used to hear that when I was at Columbia I heard that I I don't know I needed a geriatric.

Hoard: Well I think geriatric dentistry it could be a huge thing because these retirees that they got money and he had broken his leg I wouldn't heal he was 85 they said well that's just how it happens in 85 year olds and he was in a wheelchair so he was so pissed off his wife was about ready to hit him on the head of the frying pan and sent him on his way and one of his neighbors said well you know if you tried to palm strings they got a life extension Institute down there so he made the drive down there and they tested on needs to just basic things if you have no testosterone you have no human growth hormone yeah so he just pumped him up on testosterone cream and human growth hormone which were always focused on trying to catch the athlete that's doing it no one cares no one cares if you won the race or made the touchdown because you have a cream on your arm who cares what I care about is the fastest-growing segment of the American population is people over a hundred second is ninety two hundred third is eighty to ninety the fastest decreasing population is childbearing you know they're having less and less kids. So within so he but he had sat in that wheelchair for two years six weeks of doing that he was out of that wheelchair when he came back to my office for a recall he got down on the floor and did eight push-ups and was telling me tell me that this religious mindset that oh you're cheating you're taking steroids he's like he said what are they legalized all that stuff because while you're cracking down on all these steroids and all this stuff for athletes you guys have you ever thought about maybe the steroids that the Olympic athletes are taking might help your 85 year old grandmother resume her normal life and the other thing the Mayo brothers they were the first one were the Mayo brothers even said they said you know when you're 85 years old you've had a small grains wheat farm your whole life and they get cancer and they say grandma's gonna die ever you yeah she's 85 shes had a good life let her die Mayo Clinic said are you out of your mind they will sell the entire farm the whole thing to save grandma and you look at Grandma and say well she's 85 you're not gonna sell the farm to save grandma that's not how humans, ask any woman with a two-year-old say if your baby who's gonna die tonight and the only way you could save her you sell your house car iPhone all your money fly to Scandinavia and take this little bitty white pill would you do it and she'll say yes every time. So I think this anti-aging should be exploding there should be people out there in Manhattan and Phoenix and by every Mayo Clinic only had two satellite offices they went to Phoenix well it's in Scottsdale and then they went down to Florida that's where all the rich money people are and they don't realize that these people don't want to settle for gum disease and losing all their teeth and if you can do other things and improve their sleep and diet did you know you know Mayo Clinic is now doing fecal matter transplants

Michael: I love that I love it.

 Howard: to rejuvenate the gut microbiome

Michael: I think that's a hot area you know we want people to do that but they have to have C-diff I want more people to have fecal transplants I think that's a huge area that's gonna if the government maybe lightens up on a little bit that's a huge area where people can only get help you know without having to suffer for years.

Howard: Well they just didn't they just pass a law though that if you're terminal you can get the medication if it's on trial someone someone just told me they finally did that did you hear about that?

Michael: I didn't hear it but I think it's gonna loosen up my friend Larry Brandt at Montefiore has done a lot of the research in the US on fecal transplants and it's in a pill form now it's getting it's getting easier to get it so we I would have everyone follow that I'm with you.

Howard: Well the last straw for me in having any faith in health care in this government of ours was when I bought my house this house and I'm living in raised my four boys this decades ago, poor woman had to sell her home and moved to Sweden because of a drug invented in America she had brain cancer and she couldn't get the drug because it wasn't FDA approved so she had to move she has she's an American they come to be making the drugs American and she had to move to a foreign country because our government I mean I'm a libertarian I'm a Milton Friedman economics I I would I would I think Milton and his wife rose to the greatest economist of all time. How did we get to a point where a government aids it when you say look I'm dying I'm dying I mean can I just have the pill no we have not approved in it. I mean it's one thing to say well I'm the FDA and I'm telling you we don't have any research on this decision it's your American freedom to say well what are my alternatives I mean what I'm also going to do you know Essential Oils I'd like to try this obviously the scientists that made this believes in it obviously the the pharmaceutical companies going to spend millions of dollars I mean I had no alternatives and then wouldn't that speed up their R&D; process that we did a clinical study of 30 but 3,000 volunteers bought it with their own money and this is what happened on them so yeah the government the government is too big and they need to get out of health care. I remember when the Senator McCain I had a fundraising dinner of him Senator John McCain you passed away I share the same birthday over Senator John McCain August 29 and and I told him I said well you know you got these any reservations and they're you know they exempt them from they let him gamble so why don't you have a deep FDA free zone on the reservations we're good pain Americans can just come here and try what they want without Washington DC 3,000 miles from here regulating everything and he said oh my god he goes like you know I wonder how the big pharma would talk about that. All right my only final question last question...

Michael: Sure

Howard: Why the heck did you go on CNN, ABC, CBS and Fox before Dentistry Uncensored

Michael: It was a mistake

Howard: but hey oh I'm sorry one last thirty second question

Michael: Sure

Howard: You were also have been written up in Woman's Day, is it true that women have more of these issues than men?

Michael: Typically men have the issues until women get to be menopausal age they catch up with us but there's a group of people women very thin maybe they've had a kid in their third trimester and there's other very thin women that have something called upper airway resistance syndrome they have trouble getting into deep sleep they don't have apnea they don't have oxygen issues with their brain you know how the women after they've had a kid or two they're always up listening for the kid and then your kids driving you never really sleep the same way these women's brains never get down they're very fit they're very thin they they're exhausted in the morning they got pain all over they clench all night they have irritable bowel they have cold hands and cold feet that's what we'll talk about that in the our segment but a lot of women Howard this is we've been taught the wrong thing over the years there's tons of women out there legitimate good women they don't sleep well their looking for sleep aids they're exhausted in the morning and they just they can't find what it is and then a lot of it we can help as a dental industry and the dental team. I'm excited.

Howard: Just don't ever publish one of those magazines that it's caused from the stress of their husband.

Michael: I will never say that.

Howard: Okay thank you again so much for coming on the show.

Michael: Okay thank you, great being here.



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