Okay. So Russ, why don’t you sit down again? So well, no, I am going to keep your watch because I am going to have you come back in a minute. Now I have a watch, does it have a battery in it, Russ? Oh, wind up or is it – I have a hard time keeping my wind up, good. If it’s a Rolex, because the automatics work better. Okay. So now we rechecked the indicator muscle and you get a positive result, and that’s a weak response of a previously strong indicator muscle, it’s a positive test for the left ventricle. Now Russ within 4 seconds, 5 seconds went into strength again, you don’t have this slide, this is the preference pyramid, it’s in my book. This is a picture that’s been redone from the great Dr. [George Partal’s] work. Basically it’s important to think about this physiologically as well as philosophically, we only have one brain. We only have one heart, we only have one liver. We have 32 teeth, or some thereabout. We have lots of bones, muscles, skin. So the body will try to detoxify through a rash and get rid of toxins before it will impair the heart. The body will do anything it can, we can lose a tooth, but we can’t lose our heart, we can’t lose our stomach or brain, our more vital organs.

So it’s important to think about survival and how the body prioritizes in life. So often these vital organs are harder to therapy localize, harder to bring up because the body is protecting them. Now, so how do we test Russ? So what does he need now? [cocu] or magnesium, what does he – does he need for focal infection, what does he need to treat especially now that he’s gone into strength? Now we have the same problem, for example, if we are therapy localizing a tooth. If you do muscle testing and you’re therapy localizing a tooth and then you’re trying to put this product on and that product, this homeopathic and this herb, and keep that same position of that tooth, keeping it weak and seeing what two points, it’s difficult, it’s awkward, right?

So how do we handle that with heart to therapy localize areas or dynamic tests that are only positive for a few seconds? We only get to look at that left ventricle for a few seconds that issue. So this is another test that we’ve been doing for years for decades and decades. This came from Dr. [Alan Baer] as well as an osteopathic friend of mine in Austria and this is called the straight lock test and the reason it is the tooth is there is because we use it a lot for teeth. So if I am therapy localizing a tooth, I’ve got a strong indicator muscle at therapy localized number 30, it’s positive. I can lock this weakness into the whole system and then the whole body is the tooth. It works, we’ve been doing it for years and the way you lock it in, as you have the patient, you keep that ischemic grip, keeping the patient weak with that positive TL and you have the patient closed their eyes, open their eyes, just rub that forehead from the glabella to the hairline twice, eyes closed. The brain stand proprioceptive information, eyes opened, frontal cortex, this particular maneuver works all the time, it makes it so much easier in practice.

So when you do that, then you can two-point the treatment because the right treatment will cause a global strengthening in all those weak muscles, if am all number 30, it’s positive, then any muscle I test that helps that tooth, arnica or some kind coenzyme Q10 for the gums or whatever is needed, some kind of antibacterial will cause a two-point. Many of you know this, you do muscle testing all the time. So what do we use for the heart? Lots of things, Ubiquinol actually throughout my coenzyme Q10 it was so impotent compared to Ubiquinol, Ubiquinol is also much more active form of coenzyme Q10 and it works much more effectively, much more assimilable. This is information from Steve Sinatra, one of the — a few holistic cardiologist in the country, hasn’t gone mad about statin drugs. He’s a great — great cardiologist, great lecturer.

So many products to test, patient may need Ubiquinol, patient may need magnesium. Magnesium is excellent for relaxing the heart muscle, like Magnesium CitraMate from Thorne, D-Ribose, Corvalen M, very good sugar that helps feed the glucose, helps give the patient energy especially in the heart, very good for heart conditions, L-carnitine, fish oil is very good, anti-inflammatory, of course, you don’t want the patient taking the fish oil before surgery because it’s a blood thinner. Okay, so we can use all those but Tolle Causam, right, we like to treat the cause. So in most of our patients the issue with the heart is due to the teeth or tonsils, and that’s usually due to bacteria — bacterial infiltration and infection of the heart valves. So treating the root cause, again going upstream to the tooth will more deeply affect the heart. So again the patient comes in, to us, then complain about the wisdom tooth they have this left shoulder problem all the time.

All of us as doctors and practitioners very well know that ipsilateral rule, everybody know the ipsilateral rule? Some familiar with that, if a patient comes in, they say I have the right hip pain, I have right shoulder pain. I’ve got Writer’s cramp, tendonitis, it’s all on the right side. What’s the first thing a good biological physician or practitioner should do? Check on the right idea, yeah, exactly. Check the teeth, check the tonsils, especially the teeth, this whole one-sided thing, great diagnostic tool. Most the time you’re going to find a dental focal infection on that same side, some kind of problem with the tooth can be a million different issues.

Okay, so if we want to consider most of the time that these are caused from underlying silent focal infections, then I would like to talk about notatum — notatum 4x now, got to state that I don’t get any kickback or remuneration or any kind of money from these companies for talking about their products but if we want to be master carpenters, we’ve got to have the very best hammer and drill, screwdriver that we can possibly have. So I am always testing to try to find out the very best quality, the best product you can use. We will be talking about that a lot in my second lecture. So notatum is a natural anti-inflammatory, natural antibacterial, isopathic remedy, I have been using it ever since it’s been available in this country for about 12 to 15 years, tested it in Germany from the naturopath that developed it, it tests well there too. So it works. Remember not through killing and splattering those endotoxins all over the body into tissues, it works through the wisdom of immune modulation, it activates natural killer cells and macrophages so they can go in and kill and neutralize the bacteria and then eat up the toxic byproducts of that whole war that’s going on in the system.

So these are indoline products, right, these are based on professor — indoline products but they don’t contain cell wall antigenic material which cause healing crisis and disturbance in the system. So I just used to use [sonum], I used to have a microscope and all that too but as soon as the SanPharma came out, I will just plug them quickly, it tests hundred percent of the time better than the [sonum]. So do consider SanPharma and you guys have this in your — did you get sonum — you didn’t get any in your – he was supposed to give us a sample. Don, can you check with Mike and see if he has samples of notatum? Oh, Mike, how many samples do you have? Can you just place them at the end of the table? I am sorry.

Okay, so it’s a very effective therapy, inflammation, antibiotic type therapy without the healing crisis. I use this all the time, I use it for cavitation surgery pre and post, I use it on an inflamed tooth, that somebody’s threatening a root canal, they don’t need a root canal at all, I just laser it in perforatically, I use it on cuts, bruises, use it after dental drilling, use it after even dental cleaning to use to reduce the bacterial metastasis in the bloodstream to these different focal infections in the body. Yeah, they have injection formula too, they have sets. You don’t? oh, okay, so that’s why. Okay. Well, as far as using this Chairside just orally or giving it to your patient, it works great. Again like I said you can drop on the tooth or tonsils. You can snore it up nasally to the sinuses, you can rub on the elbow crease. The Germans, the Swish, the Austrians, they just rub it vigorously, (inaudible) vigorously on the elbow crease. Of course, the left elbow crease is excellent – excellent way to directly communicate with the heart. It’s a very highly vascularized area. And so therefore, you’re just getting a whole holistic systemic treatment and an immune system response and protection.

So after you do that, the weak muscles should now test strong and the grip test should not elicit weakness again. If not, you can test another remedy. Maybe they need ubiquinol, ribose, magnesium, something like that. Okay, so we’re going to practice, but let me bring Russ up here again. Let me demonstrate. Now it’s important to remember that if somebody – if we’re going to workshop, if somebody in your group is in weakness, is in parasympathetic [atonia] — 15 more minutes — you can’t do this test. Okay, because if they already start out weak and then you have them squeezed, you can’t tell anything.

Okay. So we will hand out these, so people can test. Okay, so we’re going to do the test again, hold this arm up, hold tight, now we’re using the left arm, it’s good to let them use their dominant hand for the grip test. So he’s nice and strong. Now we can use a dynamometer or you can use your tooth. All right. So I get my timer. Okay, Russ, squeeze moderately hard. Now moderately hard. Okay, now close the eyes, open the eyes. So if you know your patient is positive, you want to lock in that weakness right away and then what you’ll find, hold his arm up, hold tight, he will be weak everywhere. Okay, so his left ventricular weakness here is systemic, really neat thing to do. It works very well. Now we can therapy localize a treatment, so you can put this on his energy field, you have to put it in your pocket and just see if we’re on the right track. Hold tight. He goes super strong and then you can take out your product, go ahead and drop it on. Let’s do the left – elbow crease here. Such a direct relationship but inguinal crease is also highly vascular. So we use either.

Okay, so now you can have him retest, so hold on. So everything is okay. So tell him — squeeze moderately hard, oh, strong up to 40. Usually people stay about 20 or 30, okay, stop. All right. Then we test again, hold tight. And that no longer causes stress in his left ventricle. Okay, so that’s the way you test, he’s strong. Now of course, so let’s consider notatum, I’d also want to go into the heart relationship again to see if there’s other issues, check to make sure since it was the notatum which is an antibacterial that helped him to see if that’s any kind of focal infections in the mouth, but I doubt it but maybe a tonsil, maybe something else. Lot of us dentists and doctors have problems with the very thing that we’re working on. So, okay Russ, thank you.

All right. So let’s — very good job – so we have 10 minutes to very quickly break up into groups, doctor, patient, teacher. Doctor will test the strong indicator muscle, have the patient do the grip test, squeezed the ball. If it’s positive, then do it again and then quickly lock it in and then test to see if the notatum tests positive if that’s a good treatment for you and then repeat the grip test, it should not weaken the indicator muscle.

Okay, so let’s break up, you got like seven minutes. Quickly.

I have some more. Here you guys, here’s – squeeze, it doesn’t matter which hand, yeah.

Okay, all right. Let’s have a seat and we will wrap up. Thank you, so I thought everybody had a sample in their pocket. Okay, so first of all, good enthusiastic group here, we’re actually running on schedule. Okay, some comments about the muscle testing and the test. One of the main things that was missing is people. I went through this too fast quickly lock in this weakness. So you know the patient has some kind of left ventricle issue, they went weak, have them redo it again. As soon as they finish that 15 seconds close the eyes, open the eyes and their all left ventricle, just like their all tooth, every muscle in their body is weak that left ventricle is displaying. Then you can see how to help them be a better athlete or find a focal infection or test for particular products, do all kinds of diagnosis and treatment at the time.

There were some tests to talk about, it’s difficult sometimes to test a strong indicator muscle, use a big shoulder muscle or use a more specific muscle like the supraspinatus 30 degrees in front of the body, that’s what the applied kinesiologists do and they are such excellent muscle testers. So it’s a more specific muscle, more precise, more able to see obvious strength versus weakness. But overall everybody caught on really well and I saw some great testing.

So conclusion, rheumatic disease, illnesses of streptococcal origin are still quiet pandemic, but they’re just not diagnosed except through us. Dental cleaning, dental drilling, extraction obviously causes transient bacteremia. Is that a big deal? Well, yes, if you have underlying dental and tonsil focal infections or heart disease, and it can worsen these areas or any part in the body that’s a disturbed rheumatic field. What’s a rheumatic field? An area where strep bacteria likes to reside.

Sustained grip test is an excellent dynamic test to reveal underlying cardiac abnormalities. It can help you determine the natural therapeutic supplement. You can get a pre and post dental cleaning, drilling, injection, like I said it’s on my five dental cavitation surgery protocol now. Everybody uses notatum drops and other therapeutic supplements to help support that surgery. And the naturopathic prophylaxis again, notatum 4x to help to reduce and prevent pathogenic bacteria, post-cavitation surgery, mercury amalgam removing – removal, even post cleaning. You can use Chairside or give to the patient to take home.

All right. So again the point is the reason I named my book Radical Medicine is radical actually means getting to the root or the origin or the cause of disease. Many, many diseases are caused by these chronic underlying silent insidious dental and tonsil focal infections and we’re the ones to diagnose that and to propagate that through our colleagues who know more about that.

Okay, So I’m done. Thank you.

Wіthоut knоwlеdgе оf thе humаn bоdу, wеіght lоѕѕ саn bе dіffісult tо асhіеvе. Thе рrоblеm wіth mоѕt реорlе іѕ thаt thеіr dіеtѕ аrе еxtrеmеlу рооr. Thе Stаndаrd Amеrісаn Dіеt іѕ nutrіtіоnаllу іmbаlаnсеd.

In оrdеr tо асhіеvе wеіght lоѕѕ, уоu muѕt соnѕumе fеwеr саlоrіеѕ thаn уоu іntаkе. Thеrеfоrе, уоu muѕt соunt рrесіѕеlу. If уоu dо nоt соunt, уоu wіll lіkеlу fіnd уоurѕеlf еаtіng tоо mаnу саlоrіеѕ. Thе mіѕtаkе реорlе mаkе іѕ, thеу dо nоt undеrѕtаnd hоw tо соunt саlоrіеѕ.

It іѕ nоt оnlу іmроrtаnt tо соunt саlоrіеѕ, but tо соunt whеrе thе саlоrіеѕ аrе соmіng frоm. A рrоblеm wіll оссur іf thе mајоrіtу оf thе саlоrіеѕ bеіng соnѕumеd аrе соmіng frоm рrосеssеd fооdѕ. Thіѕ іѕ bесаuѕе уоur bоdу nееdѕ аmрlе nutrіеntѕ аnd vіtаmіnѕ іn оrdеr tо funсtіоn рrореrlу.

Enter Protein Shakes. Most of us know that a good protein shake in conjunction with exercise can be a powerful combination. But finding the correct protein supplement for your system is crucial.  Best Protein Shakes is a site dedicated to helping you find the correct one for your body and lifestyle.

A рооr dіеt wіll rеѕult іn а lоwеrеd mеtаbоlіѕm. Yоur bоdу wіll nоtісе уоur lасk оf nutrіеnt іntаkе. Thеrеfоrе, уоur bоdу wіll trу tо соmреnѕаtе аnd mіnіmіzе thе wоrk lоаd bу ѕhuttіng dоwn. Thіѕ іѕ thе рrіmаrу соntrіbutоr tо unrеаlіzеd wеіght lоѕѕ.

In оrdеr tо асhіеvе wеіght lоѕѕ, mоѕt оf уоur саlоrіе іntаkе ѕhоuld соmе frоm рrоtеіn, соmрlеx саrbоhуdrаtеѕ аnd fаt. Prоtеіn ѕоurсеѕ саn іnсludе; bееf, ѕtеаk, lаmb, fіѕh, сhісkеn. Whеrеаѕ, соmрlеx саrbѕ саn іnсludе; саrrоtѕ, рерреrѕ, рumрkіn, ѕquаѕh, ѕwееt роtаtо. Of course the purest form of protein will be from aforementioned best protein shakes.

Whеn уоur bоdу hаѕ rеаdіlу аvаіlаblе ѕіmрlе саrbоhуdrаtеѕ оr ѕugаr, іt wіll utіlіzе thіѕ fоr еnеrgу. Whеrеаѕ, іf уоur bоdу оnlу hаѕ рrоtеіn аnd fаt tо utіlіzе, іt wіll bе fоrсеd tо соnvеrt thеm іntо еnеrgу ѕоurсеѕ. Thіѕ rеquіrеѕ mоrе wоrk оn уоur bоdу’ѕ bеhаlf, аnd thuѕ, іnсrеаѕеѕ wеіght lоѕѕ. Yоur bоdу wіll tаrgеt уоur fаt сеllѕ аnd uѕе thеm fоr еnеrgу.

Yоu muѕt dеvеlор, оr hаvе ѕоmеоnе dеvеlор а fіtnеѕѕ рlаn. Thе fіtnеѕѕ рlаn ѕhоuld bе tаіlоrеd tо уоur ѕіtuаtіоn. If уоu аrе аblе tо run, уоu ѕhоuld іnсludе ѕрrіntіng. If уоu аrе unаblе tо run, уоu саn bаѕе уоur fіtnеѕѕ rоutіnе іn thе рооl, оr аrоund wаlkіng. Thе роіnt іѕ уоur fіtnеѕѕ rоutіnе muѕt bе rеаlіѕtісаllу асhіеvаblе fоr уоu.

In оrdеr tо еnѕurе рrореr mоtіvаtіоn, уоu ѕhоuld сrеаtе gоаlѕ fоr уоurѕеlf. Thеѕе gоаlѕ muѕt bе rеаlіѕtіс аnd аttаіnаblе. Mаkе ѕurе уоu ѕеt ѕmаll gоаlѕ аnd а bіg gоаl. Thе ѕmаll gоаlѕ wіll аllоw уоu tо ѕее ѕtеаdу рrоgrеѕѕ аnd еnсоurаgе уоu tо kеер gоіng. Onсе уоu ѕее ѕmаll рrоgrеѕѕ, уоu wіll lіkеlу ѕее whаt іѕ роѕѕіblе frоm соnѕіѕtеnсу.

Thе mоѕt іmроrtаnt fасtоr thаt wіll соmе іntо рlау іѕ whеthеr оr nоt уоu саn bе соnѕіѕtеnt. Cоnѕіѕtеnсу іѕ thе kеу tо асhіеvіng аnу tуре оf fіtnеѕѕ оr wеіght lоѕѕ gоаlѕ. Yоu hаvе tо bе соnѕіѕtеnt wіth уоur dіеtаrу іntаkе аnd fіtnеѕѕ rоutіnеѕ. Othеrwіѕе, уоu wіll lоѕе mоtіvаtіоn аnd dесrеаѕе thе роѕіtіvе rеѕultѕ.

A gооd wау tо rеmаіn соnѕіѕtеnt іѕ tо fіnd аn ассоuntаbіlіtу раrtnеr. Thіѕ wіll bе а раrtnеr thаt іѕ іn thе ѕаmе роѕіtіоn аѕ уоu оr hаѕ ѕіmіlаr gоаlѕ. Yоu саn hоld еасh оthеr ассоuntаblе аnd uѕе еасh оthеr fоr рrореr mоtіvаtіоn.

Have you ever considered taking paediatric first aid courses? If you work with babies and small children, it’s important to know how to react in case of emergency. There are many benefits of paediatric first aid training, especially for parents, teachers, nannies and other professionals who work with kids. These classes teach participants how to treat an unconscious baby or a child, how to prevent cross infection, how to administer CPR, and what to do in case of seizures or chocking.

What Are Paediatric First Aid Courses?

Paediatric first aid training focuses on the most important aspects of dealing with medical emergencies. These courses are designed for people who care for babies and children, such as nursery workers, child minders, and school teachers. Participants learn to treat common injuries, handle first aid situations, and perform resuscitation on infants and children.

This kind of training will teach you a range of first aid skills to deal with common health problems such as severe allergic reactions, raised temperature, head injuries, bleeding, seizures, unconsciousness, burns, diarrhea, and strains. It’s recommended to take a fully certified course. A qualified instructor will show you how to carry out the procedures detailed in the course programme and develop new skills.

The Advantages of Taking a Paediatric First Aid Course

Knowing what to do in case of a medical emergency can help you save a life. Paediatric first aid training will give you the necessary skills to deal with infant chocking, broken bones, meningitis and other health problems. You will also learn how to record accidents and incidents, treat spinal injuries, and apply the right treatment for asthma, epilepsy, diabetes, and hypovolemic shock.

Most companies that offer paediatric first aid training provide students with certificates on successful completion of the course. For optimal results, it’s recommended to refresh your skills every 12 months.

For Paediatric first courses visit First Aid Safety

Lоѕіng wеіght іѕ mоrе thаn јuѕt ѕhеddіng thе роundѕ. Yоu nееd tо kеер іt оff аftеrwаrdѕ. Thіѕ mеаnѕ уоu nееd tо mаkе сhаngеѕ tо уоur lіfеѕtуlе. Hеrе аrе fіvе ѕtерѕ уоu nееd tо tаkе fоr аn еffесtіvе wеіght lоѕѕ.

Burn Mоrе Cаlоrіеѕ thаn Yоu Cоnѕumе

Enter Garcinia Cambogia, which helps reduce hunger and calm emotional eating. Thе оnlу wау tо lоѕе wеіght іѕ bу burnіng mоrе саlоrіеѕ thаn уоu еаt. Yоu nееd tо wоrk оut hоw mаnу саlоrіеѕ уоur bоdу nееdѕ thrоughоut thе dау аnd hоw muсh уоu еаt frоm уоur mеаlѕ. Thіѕ rеquіrеѕ ѕоmе саlсulаtіоnѕ, some supplements,  аnd trасkіng but іѕ wоrth іt tо ѕее thе wеіght lоѕѕ. Onсе уоu lоѕе wеіght, уоu саn іnсrеаѕе уоur саlоrіеѕ ѕlіghtlу ѕо уоu burn аbоut thе ѕаmе аѕ уоu еаt.

Eаt а Nutrіtіоnаl аnd Bаlаnсеd Dіеt

Nо-саrbоhуdrаtе dіеtѕ аrеn’t gооd fоr уоu. Yоur bоdу nееdѕ саrbоhуdrаtеѕ, рrоtеіn, fіbrе аnd еvеn fаt tо ѕurvіvе. Hоwеvеr, уоu nееd tо fосuѕ оn thе саrbоhуdrаtеѕ thаt оffеr nutrіtіоnаl vаluе. Sіmрlе саrbоhуdrаtеѕ, ѕuсh аѕ thоѕе frоm саkеѕ, bіѕсuіtѕ аnd mоѕt brеаd, brеаkdоwn іn thе bоdу quісklу аnd саuѕе blооd ѕugаr lеvеlѕ tо ѕріkе. Cоmрlеx саrbоhуdrаtеѕ brеаk dоwn ѕlоwlу аnd rеlеаѕе еnеrgу оvеr а реrіоd оf tіmе, оffеrіng mоrе nutrіtіоnаl vаluе.

Plаn Yоur Mеаlѕ Ahеаd

Plаnnіng аhеаd fоr аn еffесtіvе wеіght lоѕѕ аvоіdѕ gіvіng іntо thе tаkеаwауѕ аnd hіgh-fаt fооdѕ. At thе ѕtаrt оf thе wееk, рlаn whаt уоu wіll еаt аnd mаkе ѕurе уоu hаvе еvеrуthіng уоu nееd. Plаnnіng уоur dіnnеr аnd mаkіng іt ѕоmеthіng ѕіmрlе tо mаkе іѕ іmроrtаnt аѕ thіѕ іѕ whеn уоu’rе mоrе lіkеlу tо gіvе іn fоr ѕоmеthіng quісk аftеr а lоng dау аt wоrk.

Mаkе Surе Yоu Gеt All thе Nutrіеntѕ Yоu Nееd

Yоur bоdу nееdѕ сеrtаіn nutrіеntѕ, ѕuсh аѕ іrоn, thе dіffеrеnt vіtаmіnѕ аnd саlсіum. Thеѕе nоt оnlу hеlр tо сrеаtе а hеаlthу bоdу but thеу rеduсе thе hungеr раngѕ аnd bооѕt thе mеtаbоlіѕm. Fосuѕ оn fооdѕ thаt аrе full оf thе nutrіеntѕ уоu nееd, еѕресіаllу dаіrу рrоduсtѕ (іn mоdеrаtіоn), fruіtѕ, vеgеtаblеѕ аnd lеаn mеаt, роultrу аnd fіѕh.

It’ѕ Mоrе Thаn Juѕt Dіеtіng

Yоu саn’t јuѕt dіеt tо lоѕе wеіght. Yоu nееd tо dо ѕоmе еxеrсіѕе. Thіѕ іnсrеаѕеѕ thе аmоunt оf саlоrіеѕ уоu burn, wіll еnсоurаgе fаt lоѕѕ аnd tоnе thе bоdу. Buіld уоur еxеrсіѕе uр tо іf уоu’rе nоt uѕеd tо іt ѕо уоu dоn’t іnјurе уоurѕеlf. Garcinia Cambogia can help here as well, as it will target your belly fat, and you burn calories.

Another that I like is genchi genbutsu.   Now, this term literally means “boots on the ground”.  So, I’ve changed my position, and I feel like we’re right more than we were.  I used to say that I wanted the dentist to come into the office and they’ve got all their systems set up and never ever have to worry again about managing anyone.  I think I was wrong about that, and I’ll admit it now because periodically, even the higher up Japanese CEOs do this, periodically, they will get their feet on the ground in a Japanese factory and get in there and fix a problem. You cannot completely, 100% fix a problem and always fix everything.

Obviously, you can’t always be there and fix a fire, but it is a very, very important thing that we teach that you should not be putting out fires daily.  You should always be able to plug in and do your dentistry without worrying about all the little micro things in the office, but certainly, occasionally, maybe once a month, go in there to see what’s going on.  If there’s a problem, fix it the best you can.  So, everyone stays on target knowing what you want.  That’s the concept that you really need to consider doing.  So, the point I’m trying to make here is yes, it’s good to do that occasionally once or twice a month.  No, it’s very, very bad to try to get in and try to micromanage everything in a dental office.  If you came to my practice, you would see I personally do very little except dentistry on Mondays, Tuesdays, Wednesdays.

Alright here’s a good one, nekku.  Now, nekku means “a blockade”, a blockage, a road block, a narrowing.  Now, where in your practice can you find a blockade?  We’re going to go through in a minute a flow sheet. A term that I came up with which I’m sure is not the right terminology for management, but a nekku in our practice had always been the diagnosis because who read Dental Town this month or last month?

When I get my Dental Town magazine, I immediately read the Howard Speaks section.  Howard Farran is a good friend of mine.  Besides being a friend, he’s like a hero of mine.  I always love the guy, and I agree with him a lot.  He said 20% or 30% is what the average US dentist has for case acceptance.  Now, I did not know that. I have always been looking for this magical number is for what the average American dentist has for case acceptance percentage because we’ve measured ours for 10 years.  I’m proud of ours.  We’re up about 75% of case acceptance.

Long ago, some management practice person said that 76% was what we should out for, and I’ve always shoot out for that.  Ours has always been a little below that, but it’s still good.  According to Howard, it’s great, but that had always been one of our blockages.  How could we get more treatments scheduled?  So, we came up with a very simple three phase diagnosis that I’m going to talk to you about later to solve this blockage.  Be serious and think about yourself.  Spending a day and a half thinking would be a very profitable exercise for everyone on this call, just think about, “Where in my practice could things be better?”  Sit down, draw out a blueprint, draw a process map, and make it better.

Now, I always have people guess what this word means.  So, we get all kinds of answers.  People always say, “Stop watch.  Time.” Those things are close, but muda actually is a Japanese word for “waste”.  We’re going to talk about the seven deadly dental wastes that I’ve interpreted from the seven deadly wastes of just plain, old Japanese manufacturing, but time, in my opinion, is the biggest waste in a dental office.  So, that’s why I put the little stopwatch here.

The next one.  This is a good one, muri.  When I speak or when I go into a dental office, initially, the dental staff bristles up.  Their hair stands up on the back of their neck.  They absolutely hate to see me coming because they think that I’m about to give them a whole bunch of stuff to do, but if you could just be enlightened enough to be at our practice or read some of the testimonials from the people that we’ve helped, we do give people stuff to help them.  In the end, the end result is a lot less work.  So, this work actually means “overburdening”.

This is something that I’m constantly vigilant to avoid because you don’t want to charge in and give the staff or the team members a bunch of extra stuff to do.  They’ll balk on you.  They’ll never do it.  It’ll never work out.  So, you always want to be conscious to add a little bit, to get it working good, and then add a little bit more.  If you’re headed towards a goal, Rome wasn’t built in a day.

The point is don’t just throw a bunch of change on your team or your staff overnight.  Plan it out and make it go as smooth and as simply as possible.  Never overburden them.  If you’re getting in there and you’re doing too much in your practice, if you’re staff’s making you do things that they should be doing, they’re overburdening you.  There has to be a balance, a balance between the load the team is carrying and the load the doctor is carrying.  Okay?  We’ll talk about that again in a minute.

Here’s a good one, jasuto in taimu.  I’ll tell you what it means.  It’s very simple, “just in time”.  Just in time is very important when you’re building a car because you don’t want inventory stacking up all over the factory.  You want the bolts to be continually coming to the person putting the tires on.  Always just have a few extra, but not a bunch.  So, we’ve always done this seriously.  In ordering our system, we’ve run out of stuff right before it’s time to order again, run out before items actually come in.  So, there’s actually a little bit of an overlap but not much.

We had an assistant one time who used to order for me, and she would get these show specials and monthly specials.  It took me nine years to use up all the number 4 round burs that she bought back in 2001, just as an example, but as we go throughout the day, we would like for the dental chairs to become available, ready for patients just as soon as a patient is available for it because you don’t want to be in a situation where you’re all blocked up and people are waiting, getting mad.  You want a nice, natural flow of things where chairs are being constantly turned over and ready to be sterilized, and there’s just a nice flow in the office and not just this big flurry and nothing to do, flurry and nothing to do.  That’s what you want to avoid.  So, just in time is a concept we want to have.

Heijun ka, this is scheduling.  Now, scheduling is very important.  It’s a skill.  It’s an art. It’s all those things put together.  You need a good person to be a good scheduler.  You also have to give them the tools and the ability.  I don’t know if there’s any scheduler in the world who can schedule appropriately if you’re not consistent with the amount of time it takes you to do a procedure or if you give them absolutely no indication on how long it’s supposed to take.

How are they supposed to know?  Are they supposed to look at a set of procedures that you’re supposed to do for a patient and just get it right on how long it takes?  No, that’s crazy, right?  You need to have a system to give them the information they need to make their scheduling more effective, and if they can be more effective, it makes everyone happier.

The clinical staff will not get stressed out.  They will not get overburdened.  They will be happier.  If they’re happier, the front office people would be more confident for fitting in the procedure so you have higher production in a day.  You can’t have higher production if you can’t do more procedures unless you raise your prices sky high, but is that really going to work in this economy?  I don’t think so.

So, you have to go give your scheduler the tools they need to do a good job.  Then, expect them to schedule appropriately.  Do you think some people, right here, this schedule looks crazy busy?  Other people might be looking at this and saying, “Boy, Dr. Griffin.  He’s not working hard at all.” I don’t know.  This is a pretty reasonably good example of an average day at my practice.

Okay, now, like I said, we’re going to talk about the seven deadly dental wastes.  I am pretty much taking it interpretatively from the seven deadly wastes found in manufacturing.  So, let’s get into it.  Number one, perishable inventory.  We talked about it earlier.  You don’t want to be one of those people that orders too much stuff from your supplier.  What else is important in a dental practice?  Is time important in a dental practice? Absolutely, time’s important in a dental practice.  So, if you think of time, chair time is an important inventory.  Every second of every day that a dental chair sits without a patient in it, you have lost inventory. It is gone away, never to come again.  There’s nothing you can do about it.

You cannot stack time in a warehouse, and you’ll get it when you need it.  If you’re working and your overhead’s running and you have a dental chair sitting there needing a patient or needing a doctor or needing an assistant or hygienist or someone to man that patient and it does not get used, that is lost inventory.  You cannot get that back.  So, all the systems we’re going to talk about, using a color-coded template and everything else, those are designed so you lose as little of that special inventory as much as possible.

Chair side, a little bit more clinical, wasted motion.  Now, a good example here.  Here is a picture of me doing a root canal.  You can see in the background, you got me holding a hand held wireless endo hand piece.  So, I little part in one of my lecture where I explain the proper way to hand endo.  So, we have a mannequin here in the office, and we have doctors that come here sometimes.  We have them sit down with the mannequin, and they drill.  We watch them. I’ll tell you, some dentists will sit down, and they’re confident.  They just boast through those mannequin teeth, and they’re pretty fast.

The other people are not all fast, and they could take a procedure that should take five or ten minutes, like drilling a crown on a mannequin that’s obviously not going to yell and scream if you hit a nerve.  They do that, and they take 30 minutes doing it.  Now, as you watch, we film these things and break it down like John [35:14] on TV.

So, what do you think happens?  The bur is on the tooth a reasonably close amount of time when the guy is drilling 5 minutes and when the guy is drilling 20 minutes.  What’s the difference?  The guy that drills for 20 minutes, he’s drilling about 3 or 4 seconds, stopping, look at the mirror to see what he did is perfect, putting the hand piece down, drilling for 3 or 4 seconds, looking, putting the hand piece down, picking it back up.  That’s what he does or she does.  That’s what they do.  That’s why it takes so long.  We have to coach it out of them.  When they get home, we don’t know if they still do it or not, but, at least, when they’re here we try to coach it out of them, get them where they need to be.

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http://www.youtube.com/watch?v=PdIFcVdpwiY

Lisa Pruitt: Okay. We will kick off lecture today. We’re going to move onto dental tissues and their replacements. It’s actually probably a good timing following up on Professor Ritchie’s lecture where he talked about bone fracture and moved that into the role of fracture in teeth. Actually if you read the College of Engineering LabVIEW notes this month, the article featured actually is on Professor Ritchie, I think you will find that interesting, he talks a lot about how it’s moved from fracture of ceramics and engineering materials into fracture mechanics of bone. So it’s a nice short article that I think you’ll find quite relevant.

Okay. So we’ve got a few examples with us today that we’ll go through as we get to the end of class but we’re just going to start with just a basic overview of dental tissues and their replacements and so the first slide just really is an overview, talk a little bit about the structure of a tooth, we’re going to look at this in cross-section in terms of structure. So again this builds on what Professor Richie talked about in terms of the constituents of occlusals and how they’re oriented and how that plays a role in the basic mechanical properties. Then we will look at what it takes to actually replace a tooth. So obviously there’s a cross-section, you can see the screw threads here. This is not a real tooth, this is a man-made replacement. And then we’ll look at just titanium and osseointegration and then we will finish up with TMJ implants and look at some of the issues there.

And one of the things that you will hopefully see as themes that a lot of the dental issues and dental materials very much so are like orthopedics. In fact, the two fields go hand-in-hand. We borrowed some things from them. Bone cement is namely the primary material we borrowed from their community. So the dental adhesive that many of you have probably been exposed to is really the same basic chemistry that gave us bone cement for the connection between the metal implant and the bone.

So dental issues, when we think about orthopedics it’s easy to think about total hip replacements, total knee replacement, shoulder replacements or something afflicting the elderly with osteoarthritis. We can get a little more close to home with athletes when we talk about ligament tearing or tendon rupture, or even talking about meniscus tears of the knee. And so then the athletes start to have some relevance. But when you talk about dental, it’s right down to childhood. So you can start to talk about dental decay and loss of teeth right down to a small child who actually has an appropriate tooth protection. And a lot of this has been channeled by the use of fluorine in our water to actually change the solubility of the enamel and also to improve some of the mechanical properties. So lot of people today in this culture don’t experience some of the dental decay that had been experienced in previous decades.

Periodontal disease, so again this is disease where you look at the loss of the bone in the gum line, which then becomes supporting structure for your teeth and so as we lose bone, whether it’s due to by a mechanical loading or whether it’s due to disease or biochemical factors, that becomes a support structure for the actual tooth itself. How many of you have worn braces of some sort? Okay. So here we go, there’s a relevance. Orthodontics, so we won’t really spend a lot of time in here on that but understand that that’s an enormous concept and of mechanical loading of moving teeth. So it’s moving teeth, but it’s also remodeling the bone and actually movement of the supporting structure around the tooth structure itself. So a lot of remodeling has to occur. So again there is a lot of linkage to orthopedics when we talk about orthodontics, and we’ve got two guest lecturers coming up, one from Nitinol Device company and he may not only talk about nitinol as a material for cardiovascular issues and stents but he may actually bring up the use of nitinol as a good material for braces or orthodontics because you could have low force control material because of super elasticity.

And then restorative treatments, and restore treatments can be anything from actually putting on a ceramic crown or just actually doing a reblend of the tooth structure. Something we’re going to see in dental materials that we don’t really see anywhere else are thermal expansion issues and hopefully that makes sense, right, I am sipping here on a hot cup of tea and right before I had my cup of tea I was drinking a cold cup of water. So immediately you start thinking about your temperature differentials that you put in your mouth, right? So every time you’ve had a nice ice cream cone and followed up with hot chocolate you’ve run your tooth through a large delta teeth. So. Delta teeth is really something we don’t tend to think about in the body right, we tend to think a 37 C operational temperature for physiological conditions and plus or minus a degree or so depending on what the situation is but that’s about it. You start talking about dental applications and you could easily have a swing of 50 degree C. So thermal expansion issues are there, and they are there cyclically every day.

So remember we talked about fatigue issues, we said well, fatigue was due to cyclic loading of material, where you can cyclically load due to mechanical issues but you can also cyclically load because of total expansion issues. So every time you put a filling in, you need to be thinking about what the thermal expansion of that material is relative to the tooth surrounding it. So you load up internally with stresses just with the things like amalgams and resins just because of temperature fluctuations.

Fatigue and fracture, so again large mastication forces, so we chew and most of us chew more than a couple times a day, right. So we’ve got large cyclic loads, you can have forces as high as 900 Newtons acting on a tooth. So you get pretty high stresses and you get large levels of fatigue loads. So fatigue issues are important. And fracture, it’s a fracture of the tooth, not many of us have probably fractured a tooth but certainly fracture of a tooth is an issue. It’s more – I think as we talk about aging and disease with dental is more that we have loss of the tooth structure, so that the loss of the jaw bone – so we will talk a little bit about that today, but you could actually need to rebuild the joint structure for movement, but you can actually have loss of the bone that actually supports the structure around the tooth itself. So this is an indicator here just the tooth loss because of poor bone support. And once that process starts, it’s like everything else in orthopedics. You can change the biomechanical loading, once you lose one tooth you’re setting yourself up to lose multiple tooth, so it’s not a singular event. So it’s one thing to lose your tooth in a bar brawl, it’s another thing to lose it because of biomechanical loading.

So you probably have seen this in your dentist’s office, like how to brush your teeth. This actually – I think a pretty nice schematic, there’s two in the posted slides, one that comes out Dr. Sally Marshall’s paper, which I think is a nice read, it gives you a little bit of structure on dentins that’s the PDF that was posted. Again a lot of that work becomes collaborative with Professor Ritchie’s work so that they have teamed up to look at the role of all these constituents on the fracture behavior of these materials. So again you’ve got different structures acting here. So enamel probably just from Trivia you realize is the hardest material in the body. It’s a material that provides great resistance to damage to the underlying structure. Its role is really important because enamel is the bearing surface, it’s the one that comes in contact with other teeth, it’s the one that when you’re chewing gum, it’s being subjected to the continuum mastication and the chewing forces, as you’re eating food, it’s always in contacts. So high abrasive forces, so all the same things we had to think about for the hip and the knee suddenly come into play for the loading of the teeth, right?

So if we just think about this for a moment, and we just back off for the image of this tooth we can expect high compressive forces, we can expect shear forces, most of us, it’s right after lunch right, we kind of think about how we chew we also have it out of plane motion, right? So we probably also get a little bit of a torquing motion on that jaw. So you get high compressive axial loading, you get shear just due to the motion of the teeth and then you can also go little bit of out of plane because our jaws actually have out of plane motion as well. So you’ve got high, high levels of stresses and these stresses also have contact. So we don’t just think about forcing on the tooth itself, so we’ve got this enamel structure. We think about its counter bearing, so there’s another tooth that comes in and meets the structure. So you’ve also got contact tissues, so you’ve got dental contact and suddenly it’s not looking so different from orthopedics, is it? So suddenly it just looks just like it could be a knee joint, we still have high compressive loads. We still have actions of shear. We can still have out of plane motion. So we can essentially have the rolling sliding type combinations that we had in the knee and we remember when we talked about orthopedics that every time we had contact, then we also had stress distributions that build up due to contact, right? We also remember that we’ve got stress profiles that build up under these contact zones.

So we’ve got compressive forces, we’ve got shear, we’ve got torsion, we’ve got contact. We have cyclic loads. So immediately we need to be thinking about where, we need be thinking about fatigue, and we need to be thinking about fracture. And so these types of stresses as overloads can give us a fracture scenario. So that when we talk about materials that go in and try to replace the dental tissues, we have to remember what they are being mechanically subjected to. This is just the mechanical aspects, and then we have to remember that inside this situation unlike the joint we’re also going to have a delta T component. So we’re going to have a strain that’s going to develop as a function of our thermal expansion coefficient and a temperature range. So we’re going to see strain buildups that can occur just because of thermal expansion and thermal expansion mismatch when we talk about fillings.

So that the stress states when we talk about dental our — again very similar to what we see in orthopedics added with that the thermal effects. Okay, so let’s just look at the tooth again. So in terms of enamel, the role of enamel is really to provide wear resistance, it’s to prevent fracture and fatigue in the sense that — again we’re going to go back to what we learn in orthopedics, anything that we can do to prevent the initiation of a flaw is going to be good for fatigue, propagation and it’s going to be good for initiation and propagation and it’s going to be good for fracture toughness. So anytime we have good mechanical integrity of enamel we’re setting ourselves up for the good protective shield. Most of us know or have experienced at some level, what can happen with loss of enamel. So loss of enamel can come about through resorption abilities, so relative changes in saliva, pH or fluoride treatments can make the enamel more porous, more susceptible to damage. You can have mechanical fractures of the enamel itself and you can have just loss of the enamel over time just because you literally wear it away.