Every time someone speaks about tea the first thing or the first sensation that comes through my mind is the word relaxation. Either you’re at a meeting or in a public place, a cup of tea can make your day sunny. The production of tea has grown considerably in the last couple of years, and the benefit of consuming tea is that your body is wrapped in all the nature’s help that you can get in order to stay healthy and to live well.

What is good to know for your own knowledge and the idea to find out more things about the products that you drink is that the tea occupies the second place in the category of the most consumed drinks on the surface of the globe, of course after water.

As a second detail, it is useful to find out that the green tea among other types of tea like the white one, or the black one come from the same plant that makes them so tasteful and rich in many curable elements, the Camellia Sinensis.

The base that makes all these types of teas so different is due to the different and various processing methods. For example for the green tea leaves are less processed, this indicating a high level of antioxidants. In the case of the black tea, the processing method assures a process of being highly fermented. The great news is that the antioxidants are vital elements that help your body in the process of skincare and much more. The antioxidants that are found in the green tea can assure the protection of the skin against the sun burns and a process of combating the skin cancer. These elements have a high contribution in the process of the cell renewal.

In general even the appearance and the taste vary. Tasting a tea has become an art that has grown to become as important as the art of tasting wine. When you taste green tea or any other tea you’re looking for some specific characteristics. We look for characteristics that can mainly be found in the flavors, the tannins and of course the two main senses: the mouth and the nose that are used to discover the best qualities in the tea.

But if you consider what makes it be a good tea or how you can choose the best of green tea, here are some advices that will help you decide. For this, you’ll have to look at the shape of tea leaf, because each type of tea has a certain shape that makes it have the best quality. For example when looking at the Dragon Well (a certain type of green tea), its leaves should look like a needle with a surface that is flat and straight.

Another idea is to look at the color because the types of tea that exist have different colors before and after the process of brewing. For example, the green tea leaves before the brewing process have a fresh green color. When it comes to smell, good tea should leave a long lasting aroma of natural essences.

And the last thing when choosing a tea is the taste that guarantees the unique perspective of the flavor. Each type of tea has its own characteristics that help you live every moment from when you’ve tasted your first cup of tea. In the case of green tea, the taste should be pure and fresh.

The green tea remains one of the products that are highly preferred in the Chinese culture and many provinces, but also in the Japanese culture. Yet the British prefer to consume the black tea much more. Black tea is a product that in order to be preserved while being in the cargos that were shipped from China is first put through a process of withering, rolling, fermenting and then in the end firing up the leaves.

When it’s about remedies or fighting a disease or cold, the best way to start is to drink a cup of tea. Its natural selection and the careful processing methods will help you overcome the sickness and feel much better. Another method that is applied in such cases is using the herbal infusions, also called tisanes.
Enjoy every single cup of green tea!

Introduction: ladies and gentlemen our next speaker for this morning is Dr Thom’s Culprits. Dr Thomas Culprits received his dental degree from Washington University dental school and his IMD at Capital University of integrative medicine where he was Professor Emeritus. Dr Culprits is a member of the IOMT and he has a private practise is Tulsa Oklahoma. Please welcome to the podium Dr Culprits.

Dr Colpitts: so what I’m going to be talking about today is a three dimensional cat scan. I’ve been in practise for almost forty years. This is probably the most important technological toll that I have seen since I’ve been in practise. It virtually changes the way that I look ta patients and   it helps us find things that I couldn’t see before. I rich, I said “this is pretty important I would over to be able to do a small presentation”.

There’s two things that I’m going to do. I’ll go through a PowerPoint presentation talking a little bit about the technology, a little bit about h what it can do, some case studies. When we’re done with that I’ll be able to pull up a cat scan on the computer and I’ll go through on how you can actually manipulate it.

One of the things that I’ll talk about here is this is just a tool and it give us one piece of the puzzle. In and of itself is not going to make us great biologic dentist but it is going to give us a tool that is unsurpassed. One of the things that I always worry about is how do we document in the standard of care what we know is true and I struggled with that for a long time.  There’s things that I knew inherently were a problem in terms of infections are concerned.

I sometimes thought I know it’s here but I can’t really document it if I want to take it to the board of governors. So how do I practise still saying within the standard of care. Somehow I was able to do that I never had a conflict with the board since I’ve been in practise but that kind of relieves that.  I have seen one dental patient who came in with cancer in the last fifteen years that didn’t have significant dental treatment that was done. I don’t think that was a coincidence.

I’ve studied a lot with Dr Omega   who is a MD and   his belief is that all disease including cancer is simply an infection. That still seems true to me. I have not seen anything to tell me that’s it’s not true. If that’s true then one of the things they need to do is to find where the infection is and what’s going on and the CAT scan is just an incredible tool to do that. I  don’t know how much technological  tools you have in your office  but I’ve got a bunch, we have a  ceric and we have the cat scan. Every week something goes down and you’re fooling with it trying to get it to work. infect I was talking to somebody and they asked if I was a little nervous about speaking and I said” a little bit but you really worry about is the electronic stuff, is it going to work or not” right now it’s not working.

I’m a clinician not really a scientist but this is what I’ve seen. This is a great book. I used to teach practise management for a little bit. I’ve always been a little bit intrigued with it. This is a very interesting book by Jim Collins, Companies That Went from Good to Great, it talks about passion. I thought it was worthwhile to introduce myself a little bit. I’m passionate about my family, this is my family in Colorado. I live in on a ranch and we have  11 house but you got to go to Colorado  to get everybody together on a horse. These are eight of my grandchildren. at this pint of my life  there’s not a week that comes by that I don’t think that I’m bless that I got to see my children grow and my grandchildren grow up.  Faith is important to me, country is important to me. I fly the American flag. Toby Keith in his song red, white and blue he says “my daddy was in the army he lost his right eye, flies the flag in the earth to the day that he die” well I fly the American flag, the green corps flag and the POW flag. I was not a POW but I serve in Vietnam and it reminds me humbly that there is always   people that paid more than I have paid whether it be in dentistry or for the country.

We just went to new your city this week.  actually it’s my wife’s birthday today and  part of my family and she is part  of the reason I’m here doing what I do because she support me but the statue of liberty reminds me ,  I’ve travelled to ever continent except one and I’ve seen people who never had a chance. Those of us who are here are blessed that we are born with an opportunity. It doesn’t matter how smart you are, how motivated you are, if you are born in a situation that a lot of people are INS omen countries the most that they can hope for is just survival and many of you don’t do that.

This is the flag that flew in little base in Vietnam. The ranch is a big part of our life. We’ve only been on the ranch for about ten years but I really learnt a lot about physiology and I’ve learnt a lot about medicine at the ranch. This is one of our Clydesdale    and little POA called mac and mac almost died from arsenic, mercury poisoning and that’s another  story .these are some of the things that I learnt on the ranch and I think they apply to what I’m going to talk  to you in a little bit. Soils and living organism, stress on animals and health, I’ve studied with one of the best animal movers in the world Bud Williams, 80 years old. He thought us how to move animals gently with ought to stress now why is that important? When he took over a food line in Canada the year before the vet bill and the pharmaceutical bill was 130, 000. Within 1 year that same bill was $15 000. What did he do? All he did was to take the stress off the animals. If they came in and they were depressed got him up and got him walking, if they were hyper he got them walking and calmed them down.

I often think tats the relationship for us as human is stress. I could be better about getting stress out of my life sometimes but I’ve learned a lot. I’ve helped  birth cattle , goat , I’ve buried a lot of them  , our burial is above ground  but we have a lace that we take  them too their happy hunting ground. I’ve really learnt a lot emotionally about this life cycle that all animals are in. they are holistic rangers and farmers that are out there, Stock My Grass Farmers are great source for that. This is me just a month ago, we raised a red Angus grass fed beef past organic. This is me and one of our guard dogs, he guards out house he doesn’t really guard much of anything else. We just got this part of the facility enlarged. These are a couple of guys getting our grass fed beef     ready to take for sale.

Staff sometimes say to me “tell them the goat story” so you guys get the goat story. Goats have a problem with parasite. They are not really designed to come to Oklahoma and live in 200 acres. They are designed to live on hundreds of acres. once  a goat gets parasitic infection and  you don’t catch it early, I’ve seen many times  I’ll see the  goat lying on the ground and I see where it can’t get up or can’t walk and I think not a problem I will get it in the stall , I will give it my natural medicine. I would do all the things and never one of them survived and yet they looked really healthy last week. What happened is the parasite finally destroyed so many red blood cells   that they are so anaemic. The only way that you can tell is if   you pull they’re eyelids down or look at their gums and if they’re very pale you know that they’re in trouble.  We worked goats two weeks ago, now we have a smaller herd of about 60 animals and we really got or herd doing well.

The other thing to go back to the cattle, we do not do vaccinations, we never do antibiotics and out herd is healthy.  This is one of our guard dogs. The guard dogs stay out there and lives with the goat 24/7. one of the things that I’m passionate about an unfortunately feel like I’m obsessed with  and my wife has been a great example without criticizing showing o me how to balance my life a little bit better with the tether things that I do. The Outliers is a great book. It talks about people that are successful, it talks about the ten thousand hours. Everybody that is really successful that he has found had to put in their ten thousand hours and that’s why we’re all here. Even the Beatles, the Beatles played in a bar in Frankfurt, Germany 7 nights per week, 8 hours per night.

This is the CAT scan that I’m looking at my office. If you decide to get one and I hope you do one of the things I didn’t say is that I had no financial interest in any cat scan. I have a Serena Galaleos but I’m not here to promote the brand of CAT scan I have. If this is something when I’m done that you think will interest you do some research, talk to me I’ll be help. when I looked at it I thought carefully two years ago  that things are going to change but I’m  not here to promote a particular brand whether you buy a Ford or a Chevy it doesn’t matter to me . We do a lot of nutritional testing.

The objectives for today: why do I have a cone beam? What is a 3D cat scan? What can it do? Some clinical cases and my opinion of the financial advantages from this? Why did I purchase the CAT scan? Two years ago in January I had a physician send me a patient with cancer. The patient was on the way to Germany for a cancer treatment and the physician said make sure there is no infections. I took formal digital eletrorays. I looks at a mouthful of PMMs and didn’t like that but didn’t see any infection, didn’t see any part of it. I had just heard about 3 dimensional cat scan about among ago and I mentioned to this couple I said ” there is one cat  scan in Oklahoma that you would be interested in ” they  jumped on it and went and  get the 3 dimensional cat scan and the doctor called me and said  their three abyss teeth .  I went back and looked at my digital x rays and I still didn’t see them. It then became a moral issue for me. if I had patients  come in and particularly if they were referred  by the  good nature pathetic physician or the holistic  physician and they say get rid of the infections and I know in my heart  and also intellectually that there’s  a tool out there that is better than what I have I was stuck.  I moved on and within three months we had one at the office and of course they’re expensive. From a business perspective this goes back to Jim Collins book. He talks about the hedgehog concept and it’s based on the essay by Asia Berlin and the fox knows many things but the hog knows one big thing. I would like to think that we at the IMOT look at health like the hedgehog.

Fluorosis is the disease that occurs due to prolonged intake of high doses of fluoride. The
consumption of water containing fluoride most often affects the content of the element in the bones.

Mississippi Dentists: “The treatment of dental fluorosis is virtually impossible. A lot of modern dental clinics conduct researches and provide recommendations to limit the amount of fluoride that enters the body of the child.”

Fluoride is also present in foods and even in toothpastes, but there it is not absorbed in such amount as the fluoride in the water. Therefore, fluorosis is endemic, that is, the disease typical for a particular area, where the water is saturated with fluorine. Children and adolescents who have not yet erupted the permanent teeth are most susceptible to endemic fluorosis.

Fluorosis in children manifests not only to the scarcity of minerals, it also shows their excess. The lack of fluoride arises certain dental health problems in children: the tooth enamel becomes thinner, poorly protects teeth and dental caries of deciduous teeth begins, as well as developing the hypersthesia of teeth, that is hypersensitivity. Therefore, most toothpastes contain fluoride in an accessible amount. Besides, for both adults and children the fluorination procedure is offered to strengthen the enamel of the teeth and prevent tooth decay.

The daily requirement of fluoride at this age is 2-3 mg, which the child receives from food and water. For the development of the disease the maximum concentration fluorine in water is 1.5 mg per liter. Young children, at least until the school age, you cannot brush teeth with the toothpaste for adults, as it often contains a lot of fluoride, which for a young child is much higher than the permissible dose, and the excess of fluoride in the body can be even more dangerous than its deficit. If the child’s body during the dental germ formation and the tooth growth receives too much fluoride relative to the weight of the child, dental fluorosis develops. The disease is manifested by the appearance of white spots on teeth (in its mild form) and brown spots, and the discoloration of enamel in cases of intense excess of fluoride. The enamel becomes uneven, rough and ugly. Cleaning the teeth becomes impossible.

If the teeth are too unpleasant to look at, there are a number of aesthetic dentistry techniques to correct the defects. For more detailed information on these techniques, visit http://reviewfordentists.com/dentists/nebraska to find your local dental expert.

http://www.youtube.com/watch?v=-2SP-SSww5g

Trish Howser: you guys are emailing me and I’m getting emails all the time and you’re sending information in. And if there’s anything wrong with my teeth, please let me know and I will let Joyce know and she can make sure she gets it taken care of. So there’s always someone to fix something in this world, isn’t there in the day of technology which is – I was talking to — I’m always asking Dr. Joyce questions. So I had her come on so that she could answer all my questions. So I’ll be rambling and going on and on and on about my mouth and of course, I did get a few questions from other people that had emailed me on questions they want me to ask Dr. Joyce and maybe you’re afraid to ask your dentist. My dentist is open.

So let’s — first thing I want to do is find out how did you become a dentist? And how she became a dentist because I just can’t imagine looking in people’s mouths all day and I might have — some people have bad breath. So that’s one of the questions that came to. My question is, how do you have to sit there and smell bad breath all the day? But maybe it’s not. Maybe that’s why they have you wincing constantly. Every time I turn around, it’s rinse, rinse, maybe they’re saying something about me. So let’s go ahead and ask Dr. Joyce. How do you become a dentist and how did you become a dentist?

Joyce Kasunich: Well Trish, I went a different way of becoming a dentist, usually go four years of college and you can go right into dental school. I, however, took a long about way of getting there. I took five years off after high school. I worked as a dental assistant for a doctor in Pittsburgh. And he actually was my basketball coach at the high school. So I worked with him and he taught me a lot. I was going to go to a school similar to like a boutique out this area back in Pittsburgh. And he’s like you know, just come with me, work on the job training. So I worked with him for about two years and unfortunately, he got ill. So I was looking for another job, and I worked for a dentist in Shadyside and I worked there for about three years. And I thought to myself there were these girls there and doing a different type of job that when I went to the dentist. I always had the dentist clean my teeth and things that way.

Well, here they were dental hygienists and I thought to myself, oh, I could — I can do that. So I started taking some classes at that community college, local community college and applied myself and I got accepted into the University of Pittsburgh Dental Hygiene program back in ’88, graduated in ’90. But once I was in hygiene school, I knew then I am going to be going to dental. So after that, I had to take some more classes to get myself prepared for the dental school level. And it took me about three years and then I was in the 1993 class at Pitt and I graduated in 1997. So – but usually like I said, the normal four years college, four years dental school and then if you want to go on after dental school, you can become a specialist and a doctor that does root canal is an endodontist or a doctor that does braces is an orthodontist. So there’s oral surgery, there’s different specialties out there that branches off after four years of dental school.

Trish Howser: This is kind of off the subject but you see all those advertisements for Botox and all that. Now –

Joyce Kasunich: Yes.

Trish Howser: Are many dentists getting into doing that?

Joyce Kasunich: There are a few that I can — I think of, there are a lot of CE courses out there that are available for the dental professionals. The guys that I work with and myself, we have not gotten or into that quite yet. Actually this funny thing is, is next week there is a webinar through the Academy of General Dentistry that I am taking and it’s all about Botox and dermal fill. So picking an interest but I have not or we have not been able to get — to get into that.

Trish Howser: Yeah, I don’t know, I mean it’s funny because you see some of these movie stars that have had that gone. And it’s just not pretty. I mean they look like clowns. I think really – and I just wonder what specialty you did and is it just plastic surgeons that are doing more of it or a lot of dentists or —

Joyce Kasunich: Or there is dermatologists and then different – there’s a group of different types of doctors that can do, the Botox and things that way. So I don’t know if there’s a particular — it’s not just one doctor that’s allowed to do that.

Trish Howser: Because – those specialized in the face and those muscles and how all that works?

Joyce Kasunich: And that’s kind of like, what they are thinking is why always aren’t the dentists – can, should be able to do that, and do that which some of them obviously do. There is classes all over there. So there’s a group in Miami, I believe, that’s called the dental spa and that’s all they teach is Botox trying to get your practice into more of a relaxing because people are so nervous when they come in, type thing, to do Botox and spa, or massage and things that way. So it’s out there.

Trish Howser: Are they dentists? Is all that stuff covered on my dental insurance?

Joyce Kasunich: No. All will not be covered.

Trish Howser: Because I tell you what, I really want to know how to get that massage, that’s it.

Joyce Kasunich: I am liking that but – now, I don’t think that’s covered. So –

Trish Howser: It’s interesting, this is a little off the topic but I was talking to someone about what you pay for and all the extras and they were saying about — we’re talking about hourly rate on cars, to get your cars repaired, get this done, get that done. And he said yeah but you’ve got to think about if they’re washing your car, because a lot of people say oh, I am very happy if they have a Lexus or Mercedes, or Volvo, BMW, I guess I don’t know if Honda does that, I don’t know, Ford, who does it but they’re washing your car, they’re doing this, they’re giving you the – he said that they’re not giving you any of that stuff. He said they have to pay for their business.

Joyce Kasunich: That’s right, the business.

Trish Howser: So you might be paying a hundred dollars in the labor charge compared to seventy dollars on labor charge. But it’s kind of like you just said with the — if you’re going in and you’re getting the massage, you’re getting this and that.

Joyce Kasunich: They are paying for it, that’s exactly right. I’d say that’s exactly right. So –

Trish Howser: You got to pay your bills, not the government.

Joyce Kasunich: It’s not the government.

Trish Howser: We don’t have to pay our bills. So that is interesting. I like the massage and – to put that as a little –

Joyce Kasunich: I like to know how Tuesday – how the webinar goes?

Trish Howser: Well, I just wonder you know because like I said, my only measure is seeing a lot of movie stars and I’m sure there’s a lot of regular people walking around out there with it. But I just wondered because I thought Joyce knows the face and knows the muscles and I think it’s a cash crop –

Joyce Kasunich: Yeah, it could be here – yeah, plus it would be like I said it’s not covered under insurance. So if patients are willing to pay for it, then I just will learn to incorporate it into the practice. I have had patients asked. So and I know there’s an interest, it’s just how much of an interest is there in your county? So –

Trish Howser: And how much can you make? And you – you want to tell us where you are located and who all —

Joyce Kasunich: Sure. We are at — address is 1447, East Market Street, York, Pittsburgh, Crossroads of East Market, it’s a corner lot there. They have been there quite a few years. The first doctor was Dr. [Lee Park] and I believe he was on King Street, I might have that wrong, many, many years ago. And then he joined with Dr. Hess and they practiced together. I am not exactly sure when I say the wrong dates but then he moved to the East Market location. I mean now Dr. Hess and Dr. Lee Park are both retired. Dr. Bronley Walker is our senior partner and there’s Dr. Jeff Pugliese I am in with Dr. Paul Kruth and myself. So gees, Dr. Walker’s been here, oh gosh, I can’t even – yeah, I don’t want to say much here, Trish.

Trish Howser: Dr. Pugliese is about thirty years and I think Dr. Kruth is about fifteen and I’m now thirteen. Time flies. How do you look in mouths all day? I mean (inaudible)

Joyce Kasunich: I often wonder that row the teeth –

Trish Howser: Now obviously I came and I am just picture perfect.

Joyce Kasunich: Yes, you are. There is not thing wrong. Nothing wrong.

Trish Howser: You know, flossing, and that’s a thing that’s funny, I think everyone goes — the day they go to the dentist, they’re thinking oh, my gosh, I have to make sure I brush my teeth. I’m taking my toothbrush, I am taking my toothpaste, I can brush my teeth before I get in there. Better make sure I floss, it’s kind of like they want to make it look good. Then they won’t do with the rest of the 60 full days – one day I got their – insured, everything is done. And they can – like, are you doing this?

Joyce Kasunich: Yeah, yeah, some patients say that to us, oh, yeah I flossed two times a year when we see you. O my God, that’s good. So but I don’t even think of it that way is they come here for us to help them and that’s we try to do it every day to the best of our ability to help patients. Some patients are unfortunately for whatever reason have some bad teeth. And you just got to teach them, you got to educate them, you got it, nutrition is a big thing. What are the kids and adults, not kids, I mean even now with the fluoride (inaudible) and sealants that are out there, there’s still the decay that we see. A lot of it has to do with drinking with Mountain Dew or drinking pop and sugary candies and everything, they are not taking care. So just education, nutrition to try to get them back to healthy mouth as possible because there’s such a relationship with the mouth — health of the mouth throughout our system of our body. It’s – you lose teeth, you don’t eat food properly, you don’t digest properly, everything works together. Everything has to work harder. So the mouth is a very – teeth are very important for over well — overall health.

Trish Howser: Even just how you — when you speak, you think of the young child that loses their two front teeth, they are bad. And you listen to them, talking, always laughing, right to have them say things to you because it’s cuteness. But the adult that loses their front teeth, they have to talk to you, not quite a lot it — and how do you (inaudible)

Joyce Kasunich: I know, and I’ll tell you our days were so fortunate that we have – kids, we have the primary teeth and we become adults, have the – and then now there’s dental implants which is almost like a third set of teeth, if you do something does happen to have our primary teeth you can replace them with dental implants now.

Trish Howser: Dental implant, how does that work? Like what’s the difference? Why would I do dental implant instead of popping the teeth out and popping them back in?

Joyce Kasunich: Well it’s — dentures are very difficult thing to wear.

Trish Howser: Thank you. Dentures I should have let you all know dentures but —

Joyce Kasunich: Or parcels, anything that’s — are officially made is so much harder to wear in our mouth. And the dental implant is just a simple – patients that have lower dentures and upper dentures but the lower denture, it moves around a lot. It doesn’t have anything to hold onto. So patients are using that the paste in the creams and the Sea-Bond or whatever they are to try to hold them in. And if they have enough bond, there are different things for measurements we would have to take but if there’s enough bond, you put two implants in the lower jaw and it helps the denture snap on to and it gives it some stability for the lower denture. Upper dentures are a lot easier to wear. You got some suction to help hold that in.

Trish Howser: What’s suction?

Joyce Kasunich: Suction is when the denture is in and it has a grip, it has some hold to it that it doesn’t move. You don’t have the suction –

Trish Howser: So you can use like polygrip.

Joyce Kasunich: Right.

Trish Howser: Cement that baby up there.

Joyce Kasunich: Right, and patients tend to use it more in the lower because you have — you don’t have as much retention on the lower.

Trish Howser: I would think that would be harder trying to fit that in with your tongue there tough?

Joyce Kasunich: It is. It’s a hard thing to wear.

Trish Howser: That would be.

Joyce Kasunich: So dental implants, we — you complete at least two, I mean when a patient comes in I basically try — it’s the standard of care now, to treatment plan in upper and the lower denture together if I have to make them but incorporate at least try to get two lower implants to help stability for that lower denture. Because it’s not fun to wear, it just moves around.

Trish Howser: You said pop it in, so you can — when you have implants, are you saying they are not permanent?

Joyce Kasunich: You’re taking the denture in-and-out and –

Trish Howser: So I can’t –

Joyce Kasunich: You can but it was – but it snaps on to the implant to give the denture some stability when you’re talking and when you’re eating. But you’re able to take it out and clean it and then you can put it back in.

Trish Howser: See, this is only going to show my ignorance. But I’ll share, I thought when you said implants, you put each individual two things so that it was actually like having the real teeth where you stick them in.

Joyce Kasunich: You can, you could replace each tooth with an implant but that’s going to be costly. So when a patient has a little lower budget they have to work with, two is sufficient, four would be great but two is something that — for a lower denture to put in the bone to help hold that lower denture in. And it’s snapped on top of the implant.

Trish Howser: Okay. How about — on that subject, if some people get all their teeth capped?

Joyce Kasunich: Yes, that’s something different.

Trish Howser: If you have bad teeth and you still have the tooth that you can get – do you get like a root canal?

Joyce Kasunich: Every situation is different. For example if say, I try to tell patients couple of reasons why teeth die and need a root canal, the never dies and the tooth, you’re hitting the mouth trauma.

Trish Howser: I am going to give you more example. I was on swan teeth. And I was doing backstroke and a girl that was going on free got into my lane and punched me in the mouth. And I had braces at the time. But I still have like a dark spot which I have showed to you — shared with you. And I do remember, I ended up having to get my tooth capped because it got dark, brown –

Joyce Kasunich: Exactly. That’s what happens. Trauma for your teeth over time, the never will die, the tooth will darken and that’s one reason why patients sometimes need a root canal. Another one is cavity. Cavity gets – you let it go too long, it gets too deep and the nerve gets infected and then you have to have a root canal done.

Trish Howser: Is that abscess?

Joyce Kasunich: That’s abscess, yes. Some sort of infection starting, patients [commendable school] and things that way. So if you do the root canal, and with that time you take the nerve of the tooth out. The tooth stays but the nerve comes out.

Trish Howser: You can’t get out.

Joyce Kasunich: There’s a procedure that’s where the root canals go in. I try not to use the words, yank it out.

Trish Howser: I might not have shown up if you said, you will yank it out –

Joyce Kasunich: It’s so, we gently remove, how is that? No doubt, and you go in and you do the root canal but when you do that, you’re removing the nerve and nutrients in the blood vessels of the tooth. So the tooth becomes brittle. So to protect the tooth you have to put a cap parked round over that to make the tooth a lot stronger. So that’s another reason whenever a patient that has a root canal, a crown should be put over top of that. But if you for any rhyme or reason say, you break a tooth and the tooth does not have a root canal. Don’t always have to go and have a root canal, you can just put a cap on top of that. I have a crown and my tooth is not root canaled. But usually whenever you have the root canal because it’s brittle, it’s best to protect it with a crown.

Trish Howser: If you don’t, at some point it’s going to crack or like –

Joyce Kasunich: Yes.

Trish Howser: Especially front tooth.

Joyce Kasunich: Especially front tooth. Yeah.

Trish Howser: You said about – how do you think about the nutrients? What kind of nutrients — you know how they’re always saying take vitamin C for a cold, vitamin D for this, vitamin K for that, medicine for this, melatonin, I mean – sleeping. Then you go into a pharmacy, or drugstore or Walmart anywhere, I just stand there, my daughter wanted – she had a cut or something, so we need vitamin E to put on something, scar, I don’t know. She’s like pick me up. I am walking like – my good God, there are so many – what do you take –

Joyce Kasunich: And patients come in with such, a list of medications. And the side effects are unbelievable, just on the interactions and things that way but the big – one of the big things with dentistry is the dry mouth (inaudible) medications. And the patient’s saliva decreases and that’s never good because then bacteria in the mouth starts to grow, the bad bacteria and starts to cause more cavities. So that’s why when we know patients that are on radiation or chemotherapy or medications and we may give them a fluoride treatment to take home and protect their teeth that way, or there’s a fluoride toothpaste that’s a little stronger at the prescription we may recommend, at that time anything we can do to protect their teeth, especially going through certain situations like that. But really it goes back to the basic toothpaste, we hear all the time what type of toothpaste, what type of toothbrush, anything with fluoride and anything that was recommended when going through all the American Dental Association testing is good to use whitening – whitening toothpaste they’re all out there (how to whiten teeth).

Trish Howser: What is – well, let me ask you that, so all the toothpaste if it has American Dental Association, ADA correct?

Joyce Kasunich: Yes.

Trish Howser: Okay. So if that’s on it, you know that it has been tested and it’s recommended?

Joyce Kasunich: Right, correct.

Trish Howser: And I really haven’t looked because I know now and once again you go, you stand there — anymore you’re standing, you look, you could spend — sometimes one has to say, what the hell – what the heck do you do all the time? I literally will read labels. Also the [reality of toothpaste] because I had — it was Crest Kids and it sounds all – I mean you know there’s door, there’s all these people, there’s Star Wars, Spider-Man –

Joyce Kasunich: Anything to get the kids to brush and use.

Trish Howser: Exactly. And I am just like, my father said, gets you in there, brush your teeth. I don’t care what you’re using it and I can remember using peroxide and –

Joyce Kasunich: Baking soda?

Trish Howser: Yeah.

Joyce Kasunich: That used to be back when — years ago when I was just starting out in dentistry, we used to call it Keyes technique and they would use it for periodontal disease was baking soda, peroxide and salt. And they would mix that together.

Trish Howser: Wouldn’t the salt take in the enamel of your teeth?

Joyce Kasunich: Baking soda, it’s abrasive as well. So you really got to be careful and look at your health. But back then they would use it. Nowadays they — I still have some patients that will use baking soda. But I try to get them not every day. You got to back off on that.

Trish Howser: I am Irish and I’m a tea drinker. I drink tea and I know it stains my coffee cups. So I know how that stains my teeth, also probably I think you mentioned red wine –

Joyce Kasunich: Red wine would do that, Trish.

Trish Howser: And that’s I don’t do –

Joyce Kasunich: Okay, coffee, tea, red wine –

Trish Howser: Coffee, tea, red wine, what else?

Joyce Kasunich: Those are the big ones. Green tea every now and then – but smoking, chew, patients that chew.

Trish Howser: Now there is cancer, correct?

Joyce Kasunich: Yes.

Trish Howser: I actually saw some of it and they are like ground their teeth down.

Joyce Kasunich: There’s a lot of patients that can grind and they are due to their biting stress and things that way, can do a lot of damage. But yes with those, if you’re smoking and they are in coffee and the red wine, patients want to bleach or something like that.

Trish Howser: Well, and that’s where I went back to, I was reading everything and I know you had told me, I can’t use a lot of those bleaches because I have a capped tooth.

Joyce Kasunich: You got to be careful, your capped tooth is on the front that does not change.

Trish Howser: Yes, that’s what you said.

Joyce Kasunich: Everything else is enamel and your teeth, that will all come up but that crown will stay the same.

Trish Howser: So I will have all these white, white teeth.

Joyce Kasunich: You’ve got to pay attention.

Trish Howser: One that has my teeth stained?

Joyce Kasunich: Right.

Trish Howser: That’s why – see that’s why I got certain thing – if I used the peroxide and the baking soda and scrubbed that, probably then I can use all those things that just shine this mouth up. Because it is nice, you see these people that have these bright white teeth and it is distinct when you look at, you’re like wow –

Joyce Kasunich: Now bleaching will bring you up a couple of shades. It won’t bring you to a bright white. If you’re looking for something like that more cosmetically is the porcelain veneers, or crowns, caps, depending on what your situation is.

Trish Howser: You can’t like depending on where the rest of your teeth are, like have – I like to change your shoes, you color your shoes, you have one cap that you put on one day –

Joyce Kasunich: Now well you can do — there’s a thing that’s called a Snap-On Smile now.

Trish Howser: Snap-On Smile.

Joyce Kasunich: I am telling you Trish, there are so many things that are out there, it’s actually, if you’re missing some teeth or if you don’t like the color of your teeth, veneers and crowns are a little bit more on the higher end of cosmetics. It’s actually — I brought a model for you to see but it’s something here that you can replace this, it snaps right over your existing teeth.

Trish Howser: Wow, that reminds me of Halloween.

Joyce Kasunich: Halloween, yes. But that’s it. And the holes on the one side are so — if you make it on the top, you can still bite. We can chew with them in. You can – you take them out, you can brush your teeth, underneath there’s – you can see that the patient’s missing some teeth on the left side.

Trish Howser: Oh, I see that. I don’t know –

Joyce Kasunich: Of course, you know.

Trish Howser: Wow, they just — that’s really neat. So now, of course I just went straight –

Joyce Kasunich: I could make you one of those and we can put — I can make it any color.

Trish Howser: See I was thinking fashion right on –

Joyce Kasunich: Leopards, maybe hot pink for summer –

Trish Howser: Two smiley faces – so when you smile – I am telling you, I think we have a business here. I need to patent that, I hope to get like the producer to hurry up and get that patents somehow, you hop on the computer. So I could actually have two smiley faces.

Joyce Kasunich: Yeah, I have some patients that have little tattoos made on –

Trish Howser: Only one – me already.

Joyce Kasunich: Well that’s never a bad idea, Trish.

Trish Howser: Thank you, Joyce. Well, that’s interesting. That’s why we don’t see more of that. How – like a lot of people – now is this something we can have the gold teeth too?

Joyce Kasunich: It’s something like that –

Trish Howser: Or is that an individual thing?

Joyce Kasunich: It’s more like – more of an individual, you can. I have made pro dentures that the six front teeth they wanted more gold outlined, so I was able to do that. There’s a lot of things design wise that can be done. Now I am telling you, that’s my hidden talent.

Trish Howser: My gosh, and I have seen the granimals – so granimals for the mouth.

Joyce Kasunich: That’s right.

Trish Howser: I am seeing that. So we don’t have a lot of time, so we’re going to be breaking. So I will – give me just — highlight is gold more expensive than the porcelain or the enamels or when you’re doing all that, are those I guess silver, what — I have so many different things in my mouth right now. My mouth is probably as much of my life insurance but –

Joyce Kasunich: You know, that’s a hard question. Gold in our office, the goal and the porcelain crows are the same fee. There’s pros and cons to each individual material that you use. Obviously most patients don’t want the gold in the front, it will be more porcelain. But gold is a very good product, I have it in my mouth. I have gold in my mouth, I have silver in my mouth and I have composite in my mouth, just kind of like you.

Trish Howser: My husband said that, and when I pass away he’s taken everything out of my mouth and going to one of those jewelry parties where they buy gold and silver now, weigh everything and give you a little check, I don’t know, so depressed and burned out, his life will be over. So I guess it’s worth him getting everything out of my mouth and — knowing that he will buy good beer with it, shopping, I’ll take everything out of his mouth and shop, buying another pair of shoes just to irritate him just to fill the closet up.

Joyce Kasunich: That’s right.

Trish Howser: But yeah, I just off to know probably ask you more about that, then when we come back but that to me is fascinating what you do with all that stuff in your mouth and –

Joyce Kasunich: Dentistry is always changing. There is so much – you got to keep up with it. You got to keep up with it, materials and products and equipment. So yeah –

Trish Howser: Yeah, I know how it’s just changed over my short lifetime. As I live longer and longer – I don’t know, Joyce. Well, I just want to thank you for coming. Really we go ahead and take a short break and you can see what you think my mouth is worth. I will ensure that. And Trish with Illusions will be right back.

[Break…]

So, doing an endo hand off, if you have loops on like most of us wear for endo, is it beneficial for you to be putting the endo piece down changing your field of vision, or would it be better to lock those loops in around where they need to be on the mouth mirror and you just trying to put the wireless piece in your hand exactly at the right position each time and all you have to do is she hands it to you, you put it on the tooth. She hands you another one, put it in the tooth, another one.  We have two cordless handpieces when we do endo.  That’s just the way we do that.

So, wasted motion is a big deal when you’re talking about chair side time. Doctors think they’re slow. It’s not slowness. You can look at it two ways: It could be a lack of confidence on their stroke, maybe, with the bur, or they’re just very conscientious and they don’t want to mess up.  Whatever it is, if you’ve been in the industry any length of time, chances are you’re very good.  You’re a very good clinician.  Just learn to be good with your dentistry and don’t spend a bunch of time checking, checking, re-checking.

The number three deadly sin of wasted time is waiting time.  Now, there are four ways you can have waiting time in the practice.  You can have patients waiting.  That’s bad when the patients are just in the waiting room and they’re staring at the receptionist or whoever’s at the front window and they’re just all upset.  That’s a combat position in the practice.  When you’re running behind in the back, those people are catching the glares and the angry stares and everything else.

There’s staff waiting.   Sometimes, the staff have to wait on the doctor, believe it or not. Hopefully it doesn’t happen much in my practice, but how many people know about the hygienist that waits at the door waiting on a hygiene chair?  That’s staff waiting.  That’s not good.  By the way, if we have a chance, we’ll talk about the route board.  It is my opinion and my belief that the route board, when properly done, eliminates completely on the hygienists waiting on the doctor to see their patient 100% of the time.  It works in my practice.  I guarantee it will do in your practice if you implement a system something like that, and I’ll tell you the trick to it as we get a little closer.  There’s a trick to it, and for some reason it’s hard to grasp.  Once it’s grasped, it solves the problems.

Doctor waiting.  That’s what we talked about with the templates.  The doctor doesn’t need to be waiting.  If the room is set up completely, the doctor doesn’t have to wait.  The doctor shouldn’t have to wait. If you’re in a culture in your practice where you’re constantly waiting on someone to go get something once or twice a procedure, that’s ridiculous.  You don’t need to be doing that.  The staff shouldn’t be waiting on you.  You shouldn’t be waiting on them. Everyone should do their job in a proper flowing system.

Of course, the old room waiting like we talked about in the perishable inventory.  It’s what we absolutely try to avoid.  Obviously, if you’ve got six or seven chairs, unless there’s the doctor plus all the hygienists plus all the assistants they could do something legal, there’s going to be occasionally a chair waiting with nothing to do, but you need to minimize it as much as possible.

Number four, the waste of procedure processing time.  Now, we talked earlier about giving your scheduler the correct tools to be able to schedule properly.  One of the first steps to doing that, by the way, is learning how long it takes you to do something.  So, here’s one of the forms that we use, on the side, in one of my coaching programs.  We try to get people when they’re in our programs to just spend a couple of weeks to get to know how long it takes them to do something.  Some people are gung ho about finding this out.  Some people are not that interested.

The truth is this is what we did, and I didn’t invent this.  I got this from Scott Perkins 12 years ago or whatever it was.  This is an idea that he had.  This is my form, but his idea was the timed procedures.  I just took it to the next level.  If you look at a procedure, I think there are really about five components of time that need to be measure.  So, one of them is what we call reset time.  That’s how long it takes you to take a completely dirty room and get the room back to completely pristine, clean condition ready to be sitting in a new patient.

Then, there are other times.  Anesthesia time is important.  We find that doctors take different amounts of time numbing folks up.  Some people take 30 seconds to give the same number of injections that take me 3 minutes.  Thinking about that, it doesn’t hurt the patient as much.  However, in my experience, I’ve seen those patients that get the 30 second injections wince a lot more than the ones that are given the 3 minute injections.  If you give them 5 to 10 minutes that’s too long right?

Doctor procedure time.  We need to know how long it takes that doctor to do stuff.  The doctor may not believe it.  They may think the team are the ones that are slow.  It’s really the doctor a lot of time.  The doctor procedure time.  That’s how long it takes them to do their time, and, of course, total time.

If you want to use a tool, if you have Windows, you can go to a thing called online-watch.com, and you can pick the jumbo stopwatch in five different windows, minimize it to where they all fit on your screen at once, and then, go through and start them at those different times for five times.  Do that for each procedure two or three times, and you will have a good idea of how long it takes you to do something.  It’s going to help every single part of your practice, and guess what?  Just measuring it is going to make things move a lot faster, and that’s just the way it is.

The fifth deadly dental waste sin, defects.  Defects.  I got a cheerleader saying, “First and 10, do it again,” but you can’t afford to do something fast and do it crappy.  If you’re going to do it fast, it needs to be quality, or you need to go slow enough that you can do quality where you don’t have defects.  We don’t have a lot of defects.  We don’t have a lot of redos in the practice.  Some people do redos and charge for them.  I don’t do that.

If I have a redo for a reasonable amount of time, I’m just going to do it for free, but I don’t like doing that.  So, the way I get around it is I just try not to have defects. If you have a bunch of defects, there’s an issue somewhere.  It may be your problem.  Maybe someone on your team’s doing something wrong.  Maybe the lab’s the problem.  Whatever it is, you need to cut down on defects, and that’s just like any manufacturing place in the world.  They have the same issue.  They’ve got to cut down on some defects.

Here’s a good one.  Number six, opportunity cost.  Opportunity cost.  How many missed new patients are there in the practice?  So, let’s think about the time.  You got a person up there.  They’re answering the phone. If you think about a factory, a factory is made up of people that work on the floor that put the cars together, there’s a management team, and then, there’s a sales team.

Now, the people in the front, they’re answering the phone.  What are they, really, in that?  Are they the ones making the cars?  No, that’s the assistants.  That’s the hygienists, the assistants, not the doctor.  They are the ones making the cars.  The people selling the cars up front, that’s your front people. They’re the ones answering the phone, and what are they selling?  They’re selling chair time.  They’re selling time.  That’s why it’s so tough for a good chair assistant to make that transition to the front desk and vice-versa.  That’s why we learn.

I used to believe in cross-training, and I do. To a certain degree, I want to cross-train a little bit, but the truth is different personalities are for different positions in the office.  There’s no reason why you should have somebody up front that cannot answer the phone well enough to get somebody in the office. You’re missing opportunity.  You’re missing those new patients.  You’re missing those emergencies.  That’s where you get all your work.  Don’t do it. Get the right people there.  Unaccepted treatment plans.  We’ve talked about diagnosis being important.  That’s also opportunity cost if you don’t get those in.  That’s a big waste.

Number seven.  This is my wheel house.  Inefficient systems.  Inefficient systems are here’s an example.  We used to have 13 different checklists in my practice.  Is that very efficient? These are things that can’t fit on a template, right?  They’re like lock the chairs, fix the glove, mass stocked.  So, what I did was I sat down one day, and I took all 13 checklists.  I squeezed them on one sheet of paper using the same concepts as you have an algorithm in ACLS.

See I got IV certification a few years ago, and we’re learning IV and all the algorithms that go with ACLS.  I’m like, I can make all my checklists into that. I sat down and did this at night in Birmingham, Alabama, learning IV.  That’s what we did to make our systems more relevant in that regard.

So, this brings us to seven ways that I think you can make sure your practice is still relevant three years from now.  I’m not saying everyone’s practice is going to go away in three years, but it’s just that most of the ADA research is showing a slow decline. I do believe in our practice it’s harder to produce the same amount of money just because we’re having to see more patients.  Fewer people are accepting crowns.  More people want extractions.  That’s just the way it is here and all around America, North America.  I’m hearing the same type of things.  So, here’s what I think are seven things that you can absolutely do to make sure your practice is still around and thriving in three years.

Number one, you need staff excellence.  Now, it’s easy to say that, but the truth of the matter is some people get lip service of this.  Other people really take it to heart.  They try to give people that are talented, more qualified.  They pay more if they need to keep happy, and then, they do a lot of the heavy lifting for them.  Guess what?  If you have a good staff and you have targets and they hit them, do stuff for them.  We do cruises for our staff every now and then, send them to New York once.  Try to do fun things periodically, but if you don’t have a good superstar staff, then, it’s hard to do that because you’re not going to be hitting those targets like you’d like to be.

Accept human nature.  Now, this is going to be a tricky one for a lot of you.  A lot of you are not going to like this so let me just go ahead and throw this one at you.  I got this idea from the airlines.  Now, why do I hate the airlines?  By the way, I hate the airlines.  Why do I hate the airlines?  I think it is so unjust that you could have a ticket to go a certain place on a certain airline flight and get bumped or get your seat taken away from you, have them to put pressure on you to take a later flight.  I mean, it’s awful, but in our practice, our biggest problem, I’ll be honest with you, is not cancellation.  It’s no shows on the hygiene side.

So as we bring that process away we lose some of our protective barrier. Underneath this we have dentin and so we’ve got a dentin structure that provides for us, again you’ve got a number of these occlusals that are oriented in different directions, so they take an orthogonal profile but they take all different orientations as we move through the dentin. And that provides for us a highly tough material, but an anisotropic material because these all take profiles and so they are – in this configuration underneath the enamel and as we rotate around the pulp it actually starts to spiral around, so it becomes orthogonal by the time we get to the root. And so these perform different functions, we tie into the periodontal membrane and the bone below and so again very much like cartilage where we actually tie-in we become orthogonal in this direction here and then as we’re up here these periodontal structures actually take the perpendicular to the enamel. So they actually scale themselves as needed relative to load and structural support.

The pulp from a bio standpoint, again very important is our blood supply, it’s the nourishment. So we have to remember that we’ve got a lot of cellular turnover just like we have in bone. So we actually rely on structural remodeling of this material. We have a periodontal membrane, so again we’ve got a structure between the bone itself, so we’ve got our bone, we’ve got cementum layer, professor Ritchie talked little bit about this, we’ve got a periodontal membrane and then we’ve got our vascular and nerve supply, which is why if any of you’ve actually gone through a large temperature range, you probably hit strains in your tooth that in some instances gives you sensitivity, that’s the nerve endings. So anything that does that — anything that we can do that actually brings about nerve response you’re going to feel it, right?

So on my cartilage this is very similar to bone in terms of nerve supply and blood supply. So you’ve got an interesting anisotropic structure that provides for you some unique properties. This is taken out of the paper that’s posted, so it’s the Journal Of Dentistry, again it’s a structural paper. [The Marshall group], UCSF School of Dentistry, they’ve teamed up with professor Ritchie, they’ve done a lot of fracture mechanics works. They’ve also done a lot of nanoindentation work. So they’ve done a lot of nice work where they’ve taken these structures in cross-section and only looked at them micro-structurally which is part of that paper, but they’ve also proved them with a nanoindentation technique. So you can take this in cross-section and then you can actually probe about what the harness is as you move from the enamel to the dentin and through the junctions and this ties in nicely with looking at fracture mechanics issues which are micromechanics based. So you can look at the actual orientation of your occlusals, you can look at the relative mechanical properties and you can break it down to a nano-scale.

So this is a big challenge not just for teeth but all biological materials, when you have a higher RQ like this, whether it’s bone or whether it’s a dental tissue, how do you actually get the mechanical properties of something complex like this? So just going back to what we know about mechanical testing back to our E 45 days, you’re not going to machine this into a little tensile dogbone, right and just go pull on it, get a modulus. You could but what does it tell you? It’d give you some globally averaged tensile modulus. So you could machine this into a little plug and you can load it up in compression and again you could get a globally averaged parameter but I wouldn’t really tell you about what the different constituents contribute and the same issue with fractures, it’s really complicated to try to break apart the fracture process. But if you could have a technique that can come in and actually probe out mechanical properties at these microstructural levels you can get a better understanding of what each of these contributes, which is why nano and microscale mechanical testing is really important for us today.

Questions? (inaudible)

Lisa Pruitt: Well you can do it. Okay. So you can do it in few planes, right? One would be that we’ve taken in this plane here, so we could have dentin and a lot of times you want that, right? Because you want to move through the enamel dental junction. So you’ve got dentin, you’ve got this structure here. So if I can have it in cross-section and then pot it top down, I can come in and let this be my nanoindenter tip, I can come in, in cross-section, so now if I look at this inside profile I’ve got this mounted in cross-section, I can come down with a small tip, and I can actually march across and measure low displacement behavior as I move through different junctions. Question?

(Question Inaudible)

Yeah, that’s right. So okay, okay – so then you bring up – so the question is. That’s okay when we’re talking about enamel, but actually, even with enamel, because — the assumption with enamel is because of its crystalline structure and the scale of the crystalline structure that is a more isotropic structure altogether. So we just assume that you got isotropic behavior, which means we can approach it from any angle and the properties okay. So one way to handle that would be you could do different cross-sections, which is what we do a lot of our tissues. So you could take different cross-sections almost – you had your histology lecture? Okay. So in histology we take a very thin section of tissue, you could take different sections in different orientations and so this could be cross-section in this plane, we could then do cross-sections this way, right? So we could do something like this and then we could do top-down indents, so we could march across this way and get that direction.

But what these techniques allow for is for you to dissect the problem. So it allows you to look at different orientation effects, it allows you to come into the tissue in this orientation and then it allows you to take a different cross-section and come out of it from these sides. So you look at different effects of orientation. And the comment being if I just tried it to load the whole structure instead of taking cross-sections or are looking at very tiny parameters, a globally averaged, and so I can’t look at the role of orientation of a tubule, I can’t look at what happens to dentin by itself is maybe you changed a drug, something that didn’t come up with Professor Ritchie’s lecture, he talked a little bit about pharmaceutical treatment. There is a lot of work in bone right now, where if you look at pharmaceutical treatment, question is what happens to the quality of the bone? And again if you try to macroscopically characterize the mechanical properties you might miss out what goes on at the microstructural levels. So that’s where combinations of imaging with things like micro CT coupled with nanoindentation and modeling become very powerful tools.

So some of the classic mechanical testing protocols that we learned in E45 that worked really well for steels, well for engineering materials probably miss we have these highly complicated hierarchical structures. But that’s a challenge, how do we learn from biology and also it teaches us because it lets us ask the question of how can we better design engineering materials to give us this type of wear resistance and this type of fracture resistance? Most of us would love to have tooling materials that would have the same wear resistance as enamel, right? We put diamond like coatings on carbide or carbide treated steel to get better machining properties and reality is we don’t even come close to what we get out of biology. So there’s a lot — it works both ways, we can learn from tissues to understand disease but we can also learn from healthy tissues to better engineer materials.

That’s a bizarre looking plot, huh? So the concept of what I was trying to teach here, we should probably have a lecture on nanoindentation one day but the idea is that we would come in with an indentured tip into this structure. It would make an indent into the material and we can get low displacement behaviors. So we can monitor load and displacement and from that we can back out of unloading stiffness, and we can get a representation of the elastic modulus. And so the nice thing about doing to set nanoindentation scales is we can change out that tip geometry to be anything from a diamond pyramid tip on nanometer length scale all the way to a spherical tip that span several microns. So you can start to probe out with this technique nanometer length scales all the way to micron or hundreds of micron length scales, that becomes important because then you can start to see well, what are the cellular contributions, what are the trabecular orientation contributions, what are all the sub-structural contributions? So there’s not one biological tissue that isn’t built on hierarchy of these constituents. And so if you really want to get clear about the mechanics you have to start asking the deeper question because if we just go to this idea of well, we will make a little dogbone and we will load it up and get stress strain behavior, well that’s fine but it globally averages everything. And so we miss on all the constituent elements.

And same thing if we were to do a little compression test, we could still get a compressive modulus, we could still get compressive yield but we’re globally averaging everything that goes on. So we have no way to deal with size scales in that context.

So again this is — if you’re interested in that type of work in dental, this is a good group to watch for. The Marshall group has done a lot of work on looking at nanoindentation and how it plays a role on the basic mechanical properties and then recently they’ve coupled as I said with Professor Ritchie’s group looking at how the microstructure plays a role in fracture mechanics. So it’s a good combination, always when you can get your biological groups together with your mechanics groups. And hopefully you’re trying to learn out as we go through the course, right? There are some benefits to both, there’s benefits of understanding biology and structure and there’s benefits to really understanding mechanics and if you can bring the two together you’ve got a lot of power.

Okay. So again just different constituents, you’ve got enamel, so again very unique material and offering wear resistance. So it’s our hardest substance in the body, it’s calcium phosphate salt type crystals, they are large hexagonal type structures. Again nanometer length scales, so again that’s that whole nanostructured material, dentin composed largely of type 1 collagen fibrils, so again you’ve got a lot of fibrous tissue and you’ve got it blended with nanocrystalline apatite mineral. And then as Rob said very similar to bone in its microstructure. So that’s another thing you want to think about, every time we’re studying these materials we want to ask ourselves where can we learn from, so the literature from orthopedics offers us a lot of insight to dental and vice versa.

Dentin, the dentinal tubules radiate from the pulp. So we saw that in that one image. So we get radiation of these tubules and again they’re just marching around in a radial orientation. So they’re taking different orientations depending on where we are whether they’re tying into the jaw, whether they’re supporting below the enamel. The pulp is again almost like our bone marrow, it’s what provides for us a lot of the elements of vascularization and blood supply, it’s innervation, it’s a very important structure and so we talk about root canals, you get a lot of work into what happens at the pulp level.

Cementum, so again this is -coarsely fibrillated bonelike substance, again Rob made a comment about this in terms of the cementum line at that juncture and providing good mechanical properties. You may recall that it was actually that juncture that provided to your fracture toughness of the material. And so when you enter the dental enamel line to the cementum, see if we’ve got picture of this again, you’ve got your enamel, you’ve got your dentin, but you also have the cementum structure. And so the cementum structure actually marks you as the transition zone between them and so this place is where you stop cracks and this becomes a source of how you actually create (inaudible) lot of toughness. So mechanistically very similar to what we see in our bone materials.

Wе lіvе іn а nаtіоn оf grоwіng оbеѕіtу. Stаtіѕtісѕ іndісаtе thаt оbеѕіtу hаѕ dоublеd ѕіnсе 1980. A 2008 rероrt ѕhоwеd thаt 1.5 bіllіоn аdultѕ wеrе сlіnісаllу оbеѕе аnd оvеr 45 mіllіоn сhіldrеn wеrе оbеѕе. Thеrе аrе соmрlісаtіоnѕ соnnесtеd tо bеіng оbеѕе. Aррrоxіmаtеlу 3 mіllіоn реорlе dіе уеаrlу frоm dіѕеаѕе brоught оn оr mаdе wоrѕе frоm оbеѕіtу. Thеѕе dіѕеаѕеѕ іnсludе dіаbеtеѕ, hеаrt dіѕеаѕе аnd саnсеr.

Prасtісе Prеvеntіоn: Thеrе аrе mаnу thіngѕ уоu саn dо tо соntrоl уоur wеіght аnd рrеvеnt оbеѕіtу. It іѕ fundаmеntаllу а ѕhіft іn hоw уоu thіnk. Yоu muѕt rеаlіzе thаt уоu hаvе а grеаt dеаl оf роwеr оvеr уоur оwn hеаlth. Cоnѕіdеr thе fасt thаt уоu іn раrt, саn соntrоl hоw уоu аgе аnd hоw уоu саn mаіntаіn gооd hеаlth thrоughоut уоur lіfеtіmе. Of соurѕе dіѕеаѕе саn оссur tо аnу оf uѕ. Hоwеvеr уоu саn grеаtlу rеduсе уоur rіѕkѕ wіth а hеаlthу lіfеѕtуlе.

Phуѕісаl Aсtіvіtу: Exеrсіѕе іѕ а vеrу іmроrtаnt раrt оf аnу hеаlthу lіfеѕtуlе. Exеrсіѕе wіll ѕtrеngthеn уоur bоdу аnd уоu wіll bеgіn tо buіld muѕсlе. Yоur mеtаbоlіѕm wіll іnсrеаѕе bесаuѕе muѕсlе hаѕ а hіghеr mеtаbоlіс rаtе thаn fаt. Sо аdd ѕоmе ѕtrеngth trаіnіng rоutіnеѕ tо уоur еxеrсіѕе рrоgrаm. Yоu саn іnсоrроrаtе 2-3 ѕtrеngth trаіnіng rоutіnеѕ wееklу. Onlу 15-20 ѕеѕѕіоnѕ саn hаvе а hugе іmрасt оn уоur рhуѕісаl ѕtrеngth аnd hеаlth. Yоu wіll bеgіn burnіng fаt аnd thеrеfоrе lоѕе wеіght.

Gооd Fаtѕ vеrѕuѕ Bаd Fаtѕ: Thеrе аrе hеаlthу fаtѕ tо аdd tо уоur dіеt. Thеѕе іnсludе оmеgа fаttу асіdѕ ѕuсh аѕ thоѕе fоund іn frеѕh fіѕh. Sаlmоn іѕ hаѕ оnе оf thе hіghеѕt lеvеlѕ оf gооd оmеgа fаttу асіdѕ. 2-3 ѕеrvіngѕ wееklу соuld bе vеrу hеаlthу аnd hеlрful tо уоur wеіght lоѕѕ. Rеѕеаrсh hаѕ ѕhоwn thаt mоnоunѕаturеd fаtѕ аrе vеrу еffесtіvе fоr wеіght lоѕѕ. A gооd fооd tо аdd tо уоur dіеt іѕ аvосаdоѕ. Althоugh nоt thе lоwеѕt іn саlоrіеѕ, аvосаdоеѕ аrе еxtrеmеlу nutrіtіоuѕ аnd hіgh іn mоnоѕаturаtеd fаtѕ. Trу аddіng ѕоmе аvосаdо tо а ѕаlаd оr mаkе а guасаmоlе dір tо еаt wіth vеggіе ѕtісkѕ ѕuсh аѕ сеlеrу аnd саrrоtѕ. Othеr hеаlthу fооd сhоісеѕ fоr gооd fаtѕ іnсludе grаѕѕ fеd bееf аnd еxtrа vіrgіn оlіvе оіl. Olіvе оіl hаѕ numеrоuѕ hеаlth bеnеfіtѕ. It hаѕ bееn ѕhоwn tо іnсrеаѕе thе fаt burnіng rеѕроnѕе іn thе bоdу аѕ wеll аѕ lоwеr іnflаmmаtіоn lеvеlѕ.

Sugаr: Sugаr іѕ ѕоmеthіng уоu dеfіnіtеlу wаnt tо еlіmіnаtе frоm уоur dіеt, раrtісulаrlу іf уоu аrе trуіng tо lоѕе wеіght. Whеn уоu соnѕumе tоо muсh ѕugаr, thіѕ ѕіgnаlѕ уоur bоdу tо uѕе іnѕulіn tо bеgіn burnіng іt оff. Aѕ а rеѕult, уоur іnѕulіn wіll ѕріkе. Whаtеvеr іѕn’t uѕеd wіll bе соnvеrtеd bу уоur bоdу іntо fаt. Trу tо lіmіt уоur ѕugаr іntаkе tо nо mоrе thаn 10 реrсеnt оf уоur dаіlу саlоrіе іntаkе. Sо fоr еxаmрlе іf уоu соnѕumе 1500 саlоrіеѕ dаіlу, ѕugаr ѕhоuld соmрrіѕе оnlу 150 оf thоѕе саlоrіеѕ. Alwауѕ bе оn thе lооkоut fоr hіddеn ѕоurсеѕ оf ѕugаr ѕuсh аѕ thоѕе fоund іn ѕоdа аnd јuісеѕ.

A Hеаlthу Brеаkfаѕt: Whеn уоu аrе ѕlееріng уоur mеtаbоlіѕm gоеѕ іntо mоrе оf а rеѕtіng ѕtаtе. Thіѕ іѕ rеfеrrеd tо аѕ “саtаbоlіѕm”. In оrdеr tо turn іt оn аѕ еffісіеntlу аѕ роѕѕіblе, уоu nееd tо еаt а gооd brеаkfаѕt. Hаvіng а рrоtеіn wіth brеаkfаѕt іѕ hеlрful аlоng wіth whоlе grаіnѕ. A gооd brеаkfаѕt сhоісе mіght bе а vеggіе оmеlеt wіth whоlе whеаt brеаd. Or ѕоmе оаtmеаl tорреd wіth frеѕh fruіt аnd а рrоtеіn bаr. And rеmеmbеr tо ѕtаrt thе dау wіth drіnkіng ѕоmе frеѕh рurе wаtеr tо hуdrаtе уоur bоdу.

Eаtіng Stуlеѕ: Eаtіng ѕmаllеr “mіnі mеаlѕ” іѕ а vеrу еffесtіvе wау tо hеlр уоu lоѕе wеіght. Eаtіng уоur mеаlѕ аt соnѕіѕtеnt tіmеѕ іѕ hеlрful. Eаtіng еvеrу thrее hоurѕ durіng thе dау іѕ а gооd wау tо kеер уоur bоdу соnѕіѕtеntlу fuеlеd wіth еnеrgу. These healthy snacks wіll аlѕо kеер уоu frоm оvеrеаtіng. Mаnу реорlе оvеrеаt bесаuѕе thеу ѕtаrvе thеmѕеlvеѕ аll dау аnd thеn thеу bіngе оn а hugе dіnnеr. Thе whоlе kеу tо kееріng wеіght оff іѕ tо kеер уоur mеtаbоlіс rаtе аѕ hіgh аѕ уоu саn. Skірріng mеаlѕ асtuаllу lоwеrѕ уоur mеtаbоlіѕm.

Rеwаrd Sуѕtеm: Evеrуоnе оnсе іn а whіlе уоu rеаllу nееd tо јuѕt rеwаrd уоurѕеlf. If уоu аrе tоо rеgіmеntеd іn уоur еаtіng hаbіtѕ аnd nеvеr аllоw уоurѕеlf а lіttlе іndulgеnсе nоw аnd thеn, оnе оf twо thіngѕ wіll hарреn. Eіthеr уоu wіll еnd uр bіngіng оr уоu wіll quіt аnd bеgіn tо gо bасk tо уоur оld hаbіtѕ. It іѕ wеll knоwn thаt whеn уоu аrе tоо rеѕtrісtіvе іn уоur dіеt уоu wіll uѕuаllу bіngе wіthіn а mоnth аnd роtеntіаllу gаіn еvеn mоrе wеіght.

Suрроrtіvе Rеlаtіоnѕhірѕ: Bеіng wіth lіkе mіndеd реорlе whо tаkе саrе оf thеmѕеlvеѕ wіll rеаllу hеlр уоu. If уоu аrе wіth рееrѕ whо аrе оvеrwеіght аnd hаvе nо mоtіvаtіоn tо gеt іn ѕhаре уоu wіll рrоbаblу dо thе ѕаmе. Wе tеnd tо mіrrоr thоѕе wе аѕѕосіаtе wіth. Sо іf thіѕ іѕ уоur ѕіtuаtіоn, whу nоt lооk tо brоаdеn уоur hоrіzоnѕ аnd mееt nеw аnd іntеrеѕtіng реорlе. Yоu соuld јоіn а gуm, оr а lосаl mееt uр grоuр thаt dоеѕ wаlkіng, hіkіng, ѕwіmmіng, dаnсе, еtс. Thіѕ wіll сhаngе уоur оutlооk оn уоurѕеlf. Bеfоrе уоu knоw іt, уоu wіll іnсоrроrаtе nеw аnd hеаlthу hаbіtѕ іntо уоur оwn lіfе аnd bе оn уоur wау tо ѕuссеѕѕful wеіght lоѕѕ.

Elіmіnаtе Junk Fооdѕ: Gо thrоugh уоur kіtсhеn аnd еlіmіnаtе аll оf thе unhеаlthу јunk fооdѕ аnd рrосеѕѕеd fооdѕ уоu hаvе аrоund. Yоu wіll bеnеfіt уоurѕеlf аnd уоur fаmіlу bу dоіng ѕо. If уоu hаvе еаѕу ассеѕѕ tо јunk fооdѕ, thе оddѕ аrе уоu wіll еаt іt. Anуtіmе уоu fееl ruѕhеd оr uрѕеt аbоut ѕоmеthіng уоu wіll rеасh оut tо thеѕе tуреѕ оf fооdѕ. Fосuѕ іnѕtеаd оn fіllіng уоur раntrу wіth hеаlthу, whоlеѕоmе fооdѕ. Kеер ѕnасkѕ ѕuсh аѕ frеѕh fruіt аnd nо ѕugаr уоgurtѕ іn уоur hоmе. There are even some innovative companies with alternative snacks; to meet your cravings, while maintaining your waistline (check out Fresh Healthy Vending Machine).

Wаtеr: Wаtеr іѕ vеrу іmроrtаnt tо уоur gооd hеаlth. Yоu nееd tо ѕtау hуdrаtеd. If іt іѕ hаrd fоr уоu tо drіnk wаtеr, аdd frеѕh lеmоn оr lіmе. Trу drіnkіng 4 tо 6 glаѕѕеѕ реr dау оf wаtеr. Drіnkіng wаtеr іѕ hеlрful tо wеіght lоѕѕ bесаuѕе іt kеерѕ уоu fееlіng full. An еаѕу wау tо gеt уоur wаtеr іntаkе іѕ tо brіng а fеw bоttlеѕ wіth уоu tо wоrk tо hаvе rеаdіlу аvаіlаblе tо уоu. Thіѕ wіll lеѕѕеn thе tеmрtаtіоn tо соnѕumе ѕоdа оr fruіt јuісеѕ thаt аrе hіgh іn саlоrіеѕ аnd fіllеd wіth ѕugаr. Rеmеmbеr, whеnеvеr bеgіnnіng аnу dіеtаrу оr lіfеѕtуlе сhаngеѕ, аlwауѕ соnѕult wіth а mеdісаl рrоfеѕѕіоnаl, раrtісulаrlу іf уоu аrе tаkіng рrеѕсrірtіоn drugѕ оr ѕuffеr frоm аnу dіѕеаѕе оr аіlmеnt.

Thе Iѕѕеlѕ Mеdісаl Cеntеr іn Sаntа Bаrbаrа, Cаlіfоrnіа іѕ а wоrld rеnоwnеd аltеrnаtіvе саnсеr trеаtmеnt сеntеr. Thе Iѕѕеlѕ Trеаtmеnt іѕ аn Intеgrаtіvе Immunоthеrару рrоgrаm wіth а 50 уеаr hіѕtоrу. Fоundеd іn 1951 bу а ріоnееr іn іntеgrаtіvе саnсеr mеdісіnе, Dr. Jоѕеf Iѕѕеlѕ, MD., а Gеrmаn оnсоlоgіѕt, Thе Iѕѕеlѕ Mеdісаl Cеntеr іn Sаntа Bаrbаrа, Cаlіfоrnіа trеаtѕ раtіеntѕ wіth аll nаturаl nоn tоxіс thеrаріеѕ fоr а vаrіеtу оf hеаlth соndіtіоnѕ іnсludіng саnсеr.