Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1192 Samuel E. Cress DDS of Colony Dental and The Center for Craniofacial and Dental Sleep Medicine : Dentistry Uncensored with Howard Farran

1192 Samuel E. Cress DDS of Colony Dental and The Center for Craniofacial and Dental Sleep Medicine : Dentistry Uncensored with Howard Farran

5/17/2019 12:14:03 PM   |   Comments: 0   |   Views: 89

Samuel E. Cress, D.D.S., director of The Center for Craniofacial & Dental Sleep Medicine located in Sugar Land, Texas, received his Bachelor of Arts Degree from Austin College in Sherman, Texas. He completed his Doctorate of Dental Surgery from the University of Texas Health Science Center, San Antonio, Dental Branch. Dr. Cress also completed his residency in Dental Sleep Medicine at Tufts University School of Dental Medicine in Boston and his residency in TMD through the American Academy of Craniofacial Pain.


VIDEO - DUwHF #1192 - Samuel Cress



AUDIO - DUwHF #1192 - Samuel Cress



In addition to his practice specializing in dental sleep medicine, TMD, cosmetic and Full Mouth Rehabilitation, Dr. Cress is a clinical instructor in the prestigious Dr. Dick Barns Group where he teaches other dentists the benefits of Airway Conscious Dentistry as well as diagnosis and treatment of patients suffering from TMD. He has successfully treated OSA and TMD patients since 2009 and he is a featured speaker at industry conferences and educational seminars. Dr. Cress pursues ongoing advanced education in the field of Dental Sleep Medicine, TMD, Cosmetic and Full Mouth Reconstructive Dentistry and currently holds a duel patent on an oral appliance for the treatment of OSA and TMD, currently undergoing FDA clearance. Dr. Cress has several published articles in the field of Dental Sleep Medicine. Dr. Cress recently presented at the TMJ Bioengineering Conference in Barcelona, Spain.


Dr. Cress is a member of the American Academy of Dental Sleep Medicine, American Academy of Craniofacial Pain, American and Texas Dental Associations, the Academy of General Dentistry and the Greater Houston Dental Society. Dr. Cress has been in private practice in Sugar Land, Texas for 20 years and has been a family member of the prestigious Arrowhead Dental Lab since 1995. Dr. Cress and his wife, Kimberly Cress. M.D., director of the TMS Serenity Center for Depression, share their life with their son, Carter currently attending Hew Hampton School in New Hampshire.



Howard: It is just a huge honor for me today to be podcast interviewing Samuel E kress DDS the director of the Center for craniofacial and dental sleep medicine located in Sugar Land Texas he received his Bachelor of Arts degree from Austin College in Sherman Texas he completed his Doctor of Dental Surgery from the University of Texas Health Science San Antonio dr. Kress also completed his residency in dental sleep medicine at Tufts University School of Dental Medicine in Boston and his residency in TMD through the American Academy of craniofacial pain in addition to his practice specializing in dental sleep medicine TMD cosmetic and full mouth rehabilitation he is a Clinical Instructor where he teaches other dentists the benefits of airway conscious dentistry as well as diagnosis and treatment of patients suffering from TMD he has successfully treated oh I say obstructive sleep apnea and TMD patients since 2009 he is a featured speaker at industry conferences and educational seminars he pursues ongoing advanced education in the field of dental sleep medicine TMD full mouth reconstruction and currently holds a dual patent on an appliance for the treatment of OSA and TMD recently granted FDA clearance dr. Kress has published several articles in the field of dental sleep medicine as presented at the TMJ bioengineering conference in Barcelona Spain he's a member of the American Academy of dental sleep medicine American Academy craniofacial pain American in Texas Dental Association the Academy of General Dentistry and the Greater Houston Dental Society he has been in private practice in Sugarland Texas for 23 years his wife Kimberly kress MD is the director of TMS serenity center for depression they share their life with her son Carter currently attending New Hampshire school and New Hampshire we just had the honor to meet you we're both sleeping sleeping we were both lecturing at the American sleep and breathing Academy conference right here in Scottsdale I saw you what a couple of weeks ago.

Sam:  Couple of weeks ago yeah.

Howard: And we and I got to run into another guy he's been on the show David gergan with Gorgons ortho lab who has come over my house and done podcasts with NFL players sleeping with the NFL David Gergen was the one who started on convincing the NFL that you put all these money on these million-dollar athletes and they're not sleeping tonight they're sitting there grinding their teeth at night and he started doing NFL players the next thing you know he got the NFL to actually pay for because I mean imagine imagine if you paid a million dollars a year for this great great athlete and he comes to work and he comes on game day and he's all tired because he's not even sleeping well so every so the and everybody loved your lecture everybody was talking about you were they hit hit at the American sleep and breathing Academy so so in all honesty in all fairness of disclosure I am I graduated dental school in 87 and they never mentioned sleep one time in my entire curriculum when did this even become when did this hit the dental schools it wasn't there but it wasn't there when I was there when did sleep hit dental schools.

Sam: You know I'm not really sure about that answer because when I was in Dental School I don't even think that we even knew how to spell sleep and it really wasn't until I actually got out and it was kind of running around and now of course it's the big buzz topic its interesting I spent some time talking to some new graduates who are getting out and again they have very little exposure to sleep overall with the team world which kind of surprises me because again when you look at dentistry you look at comprehensive dentistry that should be on the forefront that should be the number one thing that we look at is how we exchange oxygen through our nasal and oral cavity.

Howard: Well what do they say you can go three months without food and maybe a week without water but only five minutes without oxygen.

Sam: Something like that we're all addicted to air and so we kind of want it as much as we can possibly get it.

Howard: Yeah so um I just think it's absolutely interesting that you go into dentistry where everybody thinks it's root canals fillings and crowns are I think and and your what percent of your practice is sleep and TMD.

Sam: Was interesting probably I would say across the board for everyone's practice it's probably right out a hundred percent but when you look at specifically treating those individuals I'm gonna say right now currently I'm a good 40 to 45 percent treatment of patients with sleep apnea and TM over my practice now it's not always been like that it's been a transition over the past couple years but when you become more knowledgeable about the signs and symptoms of individuals who possibly are you know suffer from obstructive sleep apnea you didn't start looking at things a little differently so your practice does take a dimensional turn if you would when you start integrating you start becoming educated on what to look for for patients with obstructive sleep apnea.

Howard: Your dental practice and Sugarland Texas is colony dental dot com where does that name come from.

Sam:  Calling you so it's interesting sure it's interesting so there is Houston is obviously relatively large six million people in the southwest corner of the city outside the city limits of Houston is an area called first colony it's our town called Sugar Land or suburb of Sugar Land and the actual development is called first colony and so when I was in dental school I actually built my office building during my senior year in dental school I don't know how many people would do that and I wouldn’t recommend it but anyway I was trying to come up with a name and one of my friends that was in school I said you know we're living in first colony he instantly said once you steam a colony dental associates so that's where that name originally came from.

Howard: Wow so is it.

Howard: Something more interesting is we're in Sugar Land Texas my office is on Sweetwater Boulevard and my last name is crest like toothpaste without a tea and I'm a dentist Wow.

Howard: And cotton candy was invented by a dentist hygienist absolutely Wow so um so you know the thing with podcast is um they're all young a court I always tell them people send me an email Howard at dental town comment tell me who you are where you live all that man a quarter or in dental school and the rest are all under 30 so so um your you opened up with this big statement that you know the sleep should be the first thing we Dentist look at and I just like man I get I just paid $400,000 for dental school and they didn't mention it so back up that claim what do you mean it's the first thing Dentist should look at.

Sam: Well you know when we look at dentistry went to my dish the actual restorative component of it we noticed that their restorations that don't last a very long time and a lot of that stuff happens to be with materials etc etc a way they were placed that sort of thing but if you step back and see what really takes the wear and tear why are we really tearing up our dentistry you know the number of times that our teeth are together throughout the day is minimal but at night time that's where most of that destruction takes place and so when you have a bridge or you have a crown or you have a filling or a class-five or whatever you want to look at a veneer pops off et cetera is it true your technique is it truly the materials is it truly you know the environment in which that restoration was placed or is it something more bigger than that something beyond us and well we have learned in the world of digitally in the world of sleep medicine it's actually are we're trying to protect our airway and there as a result something's got to give and so our dentistry and our teeth are the ones that take take the brunt and the beating of it and what I have learned what's kind of interesting what I’ve learned integrating dental sleep medicine to the practice is yes you can make a very good living at integrating that but where you really perform the best is restoring these individuals who have torn their teeth up as a result of obstructive sleep apnea once you get the apnea under control and you start restoring these individuals back to the form and function in which they should been me and you see just nothing but just all you have to do is claim I mean it really is it's people who I’ve gone back and restored over the past you know ten years or so we haven't done a dang thing on them with regards to dentistry.

Howard: So you think sleep is related to TMD.

Sam: Oh well we were taught in both the residences of programs that they are correlate their is a strong correlation between the two and if we can get to sleep under control and get the airway and most of the time the TM issues kind of dissipate any and go away now there's other things that that contribute and I'm not here to debate that what I'm saying is is that there's a direct correlation between the two and we I see historically in my practice and once we get the airway under control when we get these people stabilized through different you know phase two treatment that yes their TM subsides pretty quickly.

Howard: Okay so I'm what you're again focus these my audience is still in dental kindergarten school or they just they just graduated so when they get out of school before they can go do anything they need to figure out you know almost all the dentistry is on four or six year molars and it's a filling or a crown you know on a six year molar right they're gonna do one tooth dentistry for a couple years out of school is right as a restorative dentistry related to airway health.

Sam: Again from my practice my experience once I started integrating dental sleep medicine they answer the question is yes I’ve done numerous I mean ad nauseam number of cases that are full mouth reconstruction post airway management and I tell you what it's it really you see things from a different light and interesting comment you just made you said most of your audience are young individuals who are just in dental school and really are just kind of getting or kind of going to start out with if they were taught or if they would look at things through a different lens not look for a single unit truth to be true but start at the very back of the throat and look at the airway and look at the soft tissues look at the dentition look at the things that I’ve already destroyed you look at the clinical signs that the individual actually presents and you say A-HA there's something going on here that we need to look at a little bit closer and what you will find is it primarily is sleep disorder issues that need to be addressed and what's so skid addressed then your restorative peace kicks in and your restorations have some good life to them good longevity to them now.

Howard: I am one of the I was born in 62 so of course I don't even have my tonsils and adenoids a lot of these kids when you said look back in the throat a lot of times they're gonna see these really huge swollen tonsils and adenoid right like saying when I when I was a little kid I I think me and all five of my sisters had tonsils and adenoids taken out is that still.

Sam: The reason you do this you get the ice cream that's the only she did.

Howard: Actually my mom it's it's what of her most stressful story she always tells me she said that um they put me under they did it on since I noise she was in the room the whole time still there and then I'm she had to go to the bathroom or something but the one minute she left that's when I woke up and then when I walked in there I was all cried and all of sad because and I told that she leaved me and she promised me that she wouldn't leave me and she left me she said she felt so horrible but no you think the tonsil and adenoid removal rate has really gone down in the last 50 years.

Sam: Well it's interesting it's kind of a great cycle in fact I parallel myself with an amazing ENT a gentleman across the street and you've got to when you do dental sleep medicine you've got two parallel yourself with mds you can't do it on your own for a vast number of reasons primarily legally but anyway in fact that is the comment of the question that you made was the answer the question was yes that adenoids and tonsils removed when you and I were growing up cuz you and I are just about a year apart from each other at age that it was very common something to do then insurance companies kicked in and it started limiting that and then E start following with regards to well I really don't want to go through that process of trying to get adenoid tonsil case you know approved for insurance purposes so it kind of dissipated went away what's interesting is the ENT that I work with is also boarded and sleep and see things from a totally different perspective and so what he sees is his first line of treatment is you know removing adenoids and tonsils and opening up these kids Airways and again you see all the different issues associated with that you see better grades in school better behavior less you know ADHD issues etc etc by just giving these kids some oxygen exchange by removing the adenoids and tonsils so I see that the pendulum swinging back the other way where now that we're becoming more airway conscious not only on the dental side but the medical side that we are seeing ents who are seeing that removal of adenoids and tonsils or more I guess thumbs up you know a treatment option for sure.

Howard: Another um you know there's what were they call them trigger words where you say certain words you know it triggers them into some behavior like I'm Irish so if you say Jameson I just run out of the room and go giant dive on the bottle myofunctional therapy is about a controversial term as you can get in dentistry when someone says orthodontist I mean I’ve had or thoughts on this show that just dismiss the word myofunctional they don't want any part of it um why is myofunctional therapy such a buzzword first of all explain what it is and what your views on it and why is it such a trigger-happy word.

Sam:  Sure it's pretty interesting I have an incredible team that been with me my entire career I just don't have a big turnover and probably I'm going to say 10 plus years ago my lead hygienist and two other came to me and and brought that buzz word myofunctional therapy and and I'm sitting there thinking please don't ask me to spell it because I would definitely fail that one but they said this is something that we're interested in would you support it and I'm like absolutely I mean I'm all about educating education I don't think there's a better place that you can invest your money and your time being your own education so I obviously stepped up to the plate supported I sent all three of them to New York with Barbara Brown Barbara Green threw her for her program and then two of them took off went back a second time for level two and then one my lead hygienist took off and went to level three out in LA coming back guess who their first patient was was me and I think personally it's kind of if you don't mind how are like the steps I now come back to the myofunctional therapy but what's interesting about me is the only thing I have not done to myself in the world of Dentistry is dentures and did I need any of that dental work done answer the questions no jaw surgery you know everything from full mouth reconstruction to implant to root canals etc the reason I bring that to to the forefront is put myofunctional therapy back into it most of these orthodontists are these people who dismiss it or don't really understand it have not gone through it and if they would sit and go through them as a patient and understand the concept and see the benefits associated with then it wouldn't be a you know I dismiss if you would so back to myofunctional therapy we all learn to position our tongues in a certain way in order to speak swallow etc so our tongues are very trainable muscles and so what I have learned through the process and what I’ve seen in my clinical practice is that when you integrate myofunctional therapy you train the tongue to position itself where it needs to be when you finish talking etc etc you become less weary you're not a quite as tired when it becomes talking or eating or chewing the other thing that I personally think that every orthodontist should integrate is myofunctional therapy and all of their patients with regards to before they go into ortho you see a decrease in relapse etc etc so I'm really saddened when I hear that dentists especially orthodontists kind of dismiss it because again if they sit through it as patients and actually went through the treatment and went to the 14-week program they would see the benefits and their attitude would totally change.

Howard: Now you have two websites you're on for your patients your office is Colony Dental you talked about that you also have another website meridianpm.us what we're all that about.

Sam: So what's interesting about the Meridian by the way my website is Sam crestcom Colony dental was it but it got moved over to see impressed doc.

Howard: I know but if you if you um if you go to Sam crestcom right it goes right back to colony dental dock home.

Sam: Right so the day they crisscross but both of those are my clinical one and but the Meridian p.m. Is kind of an interesting little story so when I am with successive actually exit dentistry and go find something to do because I was becoming a little bit bored and I guess that the dentistry was becoming trite for me and I got it dental sleep medicine I noticed that or one of the things that you really have to be cautious of when treating patients with OSA using or appliance therapy is TM issues if the patients have TM issues you can exacerbate it or they don't you can create them so you kind of have to keep in mind the complexity and the how sophisticated that joint is so when I did the residency through the AACP we had seven different clinicians there who are educating and and they're and they're all great they're all I just I think all amazing and you were two parallel yourself with one that you reached actually had like their philosophy if you would and through that whole process I just figured that there would be an easier way to create an appliance where you could actually help patients with TM and pain issues that being said I got with a gentleman friend of mine by the name of Lamont Carpenter and we created an appliance or he helped me engineer appliance for treating TM and it's called and we just named it the Meridian and so I’ve gotten a tremendous amount of success with that the interesting component is it's very non-conventional it's an upper appliance it's made in a specific bite pattern so that we're as we close our jaws our jaws will forced into a specific pattern so because I did sleep I went back to Lamont and I said hey is there any way we can create a bottom orthotic if you would that would work in conjunction with the upper in order to create a sleep appliance and lo and behold we were able to it was a very it's a dorsal design which is pretty common the number one problem with dorsal designs is the lateral fins will break off with during bruxism etc and so we created or he created engineered a way of which that wouldn't happen and so that's what created a whole pattern component of it is to how do we keep these these dorsal wings from fracturing because the patients who actually have an oral appliance at the dorsal design and they become lateral ruptures you get failure fatigue they break and if take them away those patients are really in distress for a period of time until they get their appliance back and so that's what I was seeing in the sleeper world and so when I came up with this Meridian for TM we added the lower piece of it didn't we said what we'll just call it Meridian PM for night time and it's been a it's been a hit it's been very predictable and it's it's its incorporation of the whole thing happened to happen to be built around myofunctional therapy so if we could keep the jaw the theory behind the whole appliance itself the Meridian PM if we can keep the jaw in a comfortable position for the patient and train the tongue to stay forward opening the airway we've done the same thing that cpaps do by blowing air and pushing the tongue forward or any idea or oral plants whether via herbs or those types of appliances the taps that brings the jaw forward pulls the tongue forward opens airway why don't we just keep everything comfortable position compliance for patients make them happy don't put a lot of stress on the TM and train that tongue to say forward so that's where that whole thing came in - with regards to the Meridian and the Meridian PM.

Howard: Um that is a that's pretty cool because that site instead of calm its dot us what is a dot us.

Some guys just made the us but is the u.s. Is that the it's a country code for United States yeah us any.

Sam: You can have you know your own website dot us you could get that whatever you wanted to provide it's available but dot us you know is is the same level as calm and dotnet.

Howard: So let's see what uh yeah that is so causing that so when you when you go to when you go to Meridian p.m. Dot us you have a picture this is says Meridian PM treats primary snoring OSA and associated breathing symptoms the Meridian PM stabilizes the lower jaw maintaining a patent upper airway during sleep decreasing the frequency and duration of APNIC and hypotnic do I say right APNIC and hypotnic but I say all right yes you got right on events including respite or II effort related arousal zari are a as such a storing the Meridian p.m. Helps an oxygen exchange during sleep as well as health and social consequences associated restoring now this is dentistry uncensored so I always try to ask the tough questions you say in this country for just us if left untreated us obstructive sleep apnea can result in a growing number of health problems including high blood pressure stroke diabetes depression or heart attacks right what would you say to Dentist says our does not its quarterly when the every morning I make coffee and then the Sun comes up me making coffee did not cause the Sun come up um can you really link this to high blood pressure stroke diabetes depression and heart attacks.

Sam: When to the question of me personally can i link it just to research in the study not only in the medical but also in the dental world the answer the question is yes because think about this for a second if you're not getting the amount of oxygen and our bodies are pretty sophisticated we'll just start shutting down parts of it in order to give areas of our other bodies that have or need the oxygen levels required and as a result our heart has to work a little bit harder in order to circulate that blood faster in order to get that oxygen exchange so you're basically overworking the heart muscles and so again there's been you know ad nauseam amount of literature out there that supports the fact that individuals who have obstructive sleep apnea do have comorbidities primarily a cardiovascular disease regarding depression a little or mental illness if you would depression more specifically is that my wife is a psychiatrist and so she treats patients with what they call TMS transcranial magnetic stimulation.

Howard: Well you said that way too fast TMS hands for what transcranial magnetic stimulation.

Sam: TMS and so basically what that is it's a dental chair with a magnet that comes over the frontal cortex of the brain and the the waves go through the frontal cortex increased into production of serotonin which is missing the individuals who have depression refractory depression etc so before she puts them in treatment she always has sleep studies done to rule out obstructive sleep apnea because they go hand-in-hand with regard to some mental illness and depression and so that's kind of what got me started on this whole arena with regards to that so again there's tons of medical literature etc that supports individuals who have obstructive sleep apnea also had comorbidities of depression as well okay.

Howard: Well I'm a little slow TMS transcranial magnetic.

Sam: Stimulation.

Howard: Stimulation um well you're on that done it that is amazing and your wife it's like I you know what other dentists I know who's married to psychiatrists some of the biggest names in the country..

Sam:  Yes.

Howard: Who do you know?.

Sam: Mark Zuckerberg.

Howard: Mark Zuckerberg whose son will ed Zuckerberg the dentist his son mark is a grocer on Facebook but he is married to an MD and a t-bone tarun agarol who was like did so much for dental town and started the town team meeting and all that his wife is a psychiatrist and there's just a lot of dentists and your wife is I mean she's she's um I mean her her bio I mean she's an amazing person she even completed a Harvard Medical School in in this transcranial magnetic stimulation when I first read I thought what is transcranial magnetic stimulation and she learned up from Harvard Medical School that is.

Sam: She was originally what yeah she was really one of the pioneers about 16 plus years ago when it took off and now she's part of Greenbrook TMS just joined them and as medical director of numerous clinics and she in the Greater Houston area.

Howard: Wow dude does she um I’ve always asked what I'm having dinner with Edie and his wife's there I always asked you know you've been married to a dental I do think dentists have this more I when I asked t-bones wife that I said do you think Dentist I they always say yes does your wife I mean she's married to a dentist she says rinser do you think a lot of these dentists have depression anxiety disorders bipolar disorders mood disorders things like that do you think they're the same as the general public or do you think they might have a little more propensity to it.

Sam: I think they're the same as a general public I think that we may get the triggers or maybe exacerbated a little bit heavier just because our professions are so unique within themselves there's the amount of everyday grind and pressures and the multitude of hats that we have to wear throughout the day creates and can I can express some of the issues that we currently have I can't tell you my wife's a little bit unique and the fact that she doesn't talk about we don't talk about our practices when we walk out the door we're in the same building and so we always kind of tease each other that we do mental and dental in the same building we walk down the honestly we don't we don't communicate with regards to practices and patience and so forth so I really can't and we really haven't had that discussion with regards to mental illness or depression or things like that in the dental world although I’ll have to tell you a little funny story when I got ready to start to practice you know 27 years ago you go into the bank and you're asking for loans and they go you know Dentist just had the highest suicide rate and I said I got that coward I'm married to a psychiatrist so we're good but anyway I thought that's kind of humorous but that all being said you know mental illness is kind of a unique entity within itself but had had it not been for her and had it not been for her in the TMS world more than likely I wouldn't be sitting here talking to you because I was going to quit dentistry I was burned out I was tired and she encouraged me to look at the world and seek medicine and I ran across James Spencer who saved my career and he and I have been really good friends ever since.

Howard: Yeah we had him on the show he was an amazing guy but you know the one you know I'm obviously the men and women who serve that they have 26 to the sides a day so when it was so when Dentist are saying we have the highest suicide rate they need to call the United States Army they are the United States Army has the highest suicide rate in the world it's 26 people day but I always noticed even to this day when you're working on a patient I always know when they're feeling any discomfort or whatever because I feel my own breathing change or my heart rate or I start feeling tense and I'm 32 years I trained myself well well if you're if you're feeling tight and all this said that you're you're reading them I think when they're laying there asleep it's totally different when they're laying it when they're feeling stressed they're making you and the dental assistant feel this stress and anxiety.

Sam: You know and I think that's Howard that's what makes me kind of unique and special is because I’ve sat in that chair and I’ve had all those procedures done to me and so the empathy level is pretty high with regards to that so when a patient feels that way it doesn't resonate to me because I can relate and I can pick up on those I guess signs if you would and I helped him walk through it because like I said I’ve been through it so I kind of get that at the same time I really wish that more and more dentists would kind of follow my path if you would my lead in order to put themselves in the same world I’ve got a couple of dentists as patients quite frankly that I'm kind of surprised that you know they they're one of those individuals who don't don't walk the talk when I was getting ready to do the TM appliance and making the Meridian p.m. I have probably 20 plus appliances that are made for me and I’ve slept with every one of them have had sleep studies done with every one of them so that I could create the Meridian PM the things I like and don't like about appliances bring them all together the point I'm trying to make is is I think that if dentists would go to the next level and integrate themselves into their practice the way that they should be that you probably wouldn't see a lot of this stuff that's going on with regards to individuals especially didn't should get burned out I mean we all get burned out in our jobs I'm sure you do from time to time but it's constantly reinventing yourself that makes things exciting and I always look forward to the next day with regards to what my practice bring to me.

Howard: Right gosh I’ve had ed Zuckerberg of my I’ve had dinner with him and Karen and his daughter Ariel who my granddaughter thinks is the from The Little Mermaid movie or whatever come over the house but hey I I told Karen Zuckerberg and I'm and it's open to your wife and it's open to tbonz my think wouldn't that be cool to get your wife Karen Zuckerberg and tbonz wife on but but if she ever wants to come on and talk about stress because I’ve had all these practice management consultants on and they'll all tell you most of them off the record that um a lot of dentists who are having really big practice management problems their own personal houses aren’t in order and they're always saying you know a lot of times we feel like we're armchair psychiatrist and a lot of times you go in there and if you listen to everyone and the staff there just like know that the problem is doc is batshit crazy and so when they get these people to let like dentists are burned out well you know burned out might be some form of depression it might not be because it's a filling or a crown or a root canal all the things you think it is if your own brain isn't in order it's really gonna show up in in every time you do in life I mean I I tell people I'd rather have my foot amputated than my brain amputated I know there have something go wrong with my finger than my my my cerebrum you know and so it's really tough but but um so they're young they just got out of dental kindergarten they want to learn more there's I mean where do they learn it I mean there's the American Academy of dental sleep medicine a a DSM org there's another one the American Academy of craniofacial pain at aacfp.org their sleep apnea org there's a SBA dot not a mean I mean make it easier for she just got a dental kindergarten shooter he's what she says what's the first stair up the stairway to get to where you're at at the second floor you know decades later where does she even start to learn this journey like your immersion p.m. If I'm on your website and I am right now at Meridian p.m. Dot u s how would I even learn the Meridian PM appliance yeah where do I start all.

Sam: Right well actually that's that's a great question you know there's tons and tons of organizations out there teaching or trying to teach other doctors how to integrate or how to expose themselves but this way they're trying to expose dentists and new dentist in the area of sleep medicine and I personally think what's interesting is the way the approach that I take it is very textbook it's one plus one is two two plus two is four step by step by step and unfortunately I don't see a lot of organizations that do that clinical mastery series does it and it just is if you could get if the end of your kindergarteners if you would and I don't use that word that's that's your word I don't want to borrow that word from you but anyway the young dentist you're getting out a dental school they're interested in integrating it or getting more exposure to it I would look for a course that really taught one plus one is two two plus two is four measure these organizations and meetings will go off on and have individual lectures that lecture component of it but really never puts it all together never really connects the dots I’ve attended a lot of CEE and sleep and again that's kind of the ongoing path that you would or presentation if you would when I see across the board that this one will talk about appliances or this one will talk about you know screening or this will talk about billing or this will talk about you know some other component of it and no one ever goes through and puts together a step-by-step process other than clinical masteries which I think is an incredible organization that all being said if the individuals are really interested in I would probably start at a local level of you would maybe their local Dental Society and take a course or two to see if that's something that they're interested in I personally think that it should be kind of the forefront like I said earlier that this podcast it should be the understanding that airway and airway conscious industry is where it all begins and if you get that part a knowledge base of that part and understanding when you get to the restorative phase you will then start seeing how you can make these restorations in your dentistry lasts longer than they really should primarily because you've gotten there breathing under control you've gotten there TM issues out of you know under control and basically giving these people a better life that they you know deserve and of course a lot of it does play a role in in inpatient compliance and in patients understanding and letting them understand the value and what it is that you do.

Howard: Well you mentioned clinical mastery series on twice and I have to hone in on that because that's not that's right in my back yard that that's Pete Janicki and as an amazing wife Jen occasion yeah how's that um so to talk about them again I'm sure I'm sure once we have you talked about it for the rest of the show.

Sam: So clinical master serious is an organization that I was a blessed to run across about a year and a half two years ago when I met Pete Jenn and when I learned there their direction and their philosophy and how they made better didn't dentist better dentist by educating him and the level of education that they offer i said i got to be part of that group i want to be part of that group and so that being said i was able to bring to the the table if you would my area expertise in the world of dental medicine and the format in which we presented in and they were very accepting and brought me on as one of the clinical instructors for the organization and so that's what's really cool about it is they see the value in once you get to sleep under control you better have in your toolbox all of the education possible for restorative for cosmetics for all of that because those do go hand in hand I’ve done numerous course numerous cases I'm sorry where we've gotten individuals who've been diagnosed we've restored them for full mouth recon and we've gotten their index numbers and their sleep under control well that's where your value that's where your production that's where your limits come in to with regards to that so I always tell Doc's primarily seasoned docs that if they're going to integrate dental sleep medicine to the practice they better make an investment in their education with regards to restorative because they don't want that restorative a to walk out the door and be they're going to do such a great service to the patients because they've already built such a I guess or sold such a value and what they do by getting these people breathing better getting them sleeping better getting them out of pain with regards to their joint now go ahead and stabilize them and restore the back their proper form and function so that's kind of where all of that it blends in and what's great about the CMS group is they do have a whole Corps of courses from the occlusion courses to the full-mouth courses to cosmetic etc that all fit the pattern of what we were just talking about.

Howard: So so if someone let's learn more as sleep is your first go to I'm clinical mastery comm.

Sam: I would say I'm gonna be a little biased yeah I'd say yes because that's who our lecture with I'm a clinical instructor there and so what we talk about is again is screening diagnosing etc step 1 step 2 step 3 so that when you walk away from that two-day course there's absolutely no reason whatsoever you cannot integrate dental sleep medicine in your practice come Monday but be prepared because what you will see is you will didn't start looking at things differently and then have to restore these patients back where do you get the education to do that is going back to clinical masteries learning you know Ultimate oclusion one two and three learning you know full arch full mouth reconstruction those types of things a TM course all of that are all integrated into the overall package if you would with regards to it I'm not going to say I'm the feeder of the first but I do believe that once you start looking at things through a different lens and you start looking again at the back of the throat the airway the symptoms you know Mallampati score is the torah' excess so she sees all of those types of things you then start seeing things differently and once you get them under control patience you build a great reputation with him you sold a value of what you can bring to them from their overall health when it comes to selling in larger cases in order to restore them it pretty much is a kind of a slam-dunk if you would and I hand it all to the component of Jen and Pete pulling that together with regards to the clinical master series.

Howard: I think Pete is an absolute genius he he basically built dental town for me I mean when when I started dental town he helped me for the first decade and he's not.

Sam: He's not that old.

Howard: Well he did he worked for me he worked for dental down for ten years and I mean I it's funny because when he left to marry Jen and started all that stuff and it's just been amazing to watch but still to this day in seven years years years will say well Pete always said or Pete always said and I mean I I have so many pete-isms that I still I'm always say to my son so it's so grateful that guy when you lecture for them what what are you lettering are you lecturing on the Meridian p.m..

Sam: So know what we do on the lecture keep in mind we're not trying to be self-serving result promoting what we're trying to do is specifically teach individuals how to integrate sleep so the course is divided into two days first one is the first day consists of basically the science of sleep the screening you know the testing we talked about integrating with mds and how to work all that together then we actually run sleep tests with Itimar Itimar is a phenomenal company that does the watch Pat's so they participate….

Howard:  Slow down spanky. ITIMAR?.

Sam: ITIMAR .

Howard: ITIMAR sleep what?.

Sam: Just type in watch Pat WTCH PAT what's once Pat okay and then I’ll sum up so they they work with this the docs at first not get to do a sleep study home sleep study the next day we'd go over we would talk about incorporating or interpreting sleep studies the docs get to look at theirs and then we talk about appliance selection which appliances that you use of course we do mention the Meridian as a appliance option and we talk about that and then we also talk about from that point move forward about case presentations how you sell the cases what happens when you have things that go great and what happens when you have things that go they're wrong so in my course my lecture I give the good the bad and the ugly because you will be faced with one of those three on a daily basis and so how do you handle that and the other thing that's really cool about that organization is more specifically I'm going to say me is that you kind of get me as a mentor if you would we love to mentor Doc's when they have cases issues that sort of thing on my website if you tend it you actually get a passcode you can go in and download all the forms we don't want you reinvent the wheel I mean I can't treat every patient but if I'm able to help you as a dentist treat and learn screen and treat patients OSA I personally feel I’ve treated those patients as well and so I don't want you to spend the time reinventing that wheel I want you to spend the time learning about or screening patients and and and building a reputation if you would to become the sleep go to doc with regards to a sleep apnea you may or may not know that the cpaps Are kind of losing their their golden gold standard if you go if you would in the world of sleep medicine and so that being said dentists really need to be on board because the other alternative is besides surgery is oral appliance therapy and Dentist are the only ones who can make the oral appliances so that being said dentists really need to embrace dental sleep medicine not only from the overall health or comprehensive dental perspective but also from the perspective of they're the ones that are going to be the go choose if you would when individuals CPAP therapy or not even compliant with CPAP.

Howard: So ITIMAR medical out of Israel that is a that is a talks about a a medical device startup providing simple solutions to diagnosing sleep apnea & heart conditions Itimar medical is a publicly traded medical device company the develop some markets innovative diagnostic therapy solutions watch patch, watch pat the company's fda-approved flagship product is used for diagnosing sleep apnea in the home environment watch pat is an easy-to-use patient let alternative so so you're big on the on that.

Sam: Right there's several different studies you know Braeburn has one Aries has one there's there's several of them the out there on the market and and I always recommend even in my lectures that the watch pat may not be for you per se but you need to have some type of component where you can follow up for titration and that sort of thing and so the one that's been really successful for us has been the watch pat just because the ease of use love the company joel bliss who is the rep the dental wrap is is amazing to work with and so you know he's been very supportive in these courses and again it's not about the product whether it be the meridian or the watch pad or you know any of the medical building companies it's about the patient and you need some good armamentarium in your toolbox when you go after to help treat these patients and so the focus is really on on the course is really on integrating it and what can you do to to help your patients achieve a better lifestyle and better health.

Howard: And better health amazing so on dental town I’ve been a big fan of your post a lot of people I'm sorry I asked this I saw so a crude & rude should matter but it absolutely matters huge is this insurance free do I have to learn medical insurance so talk about insurance because money is the question what is the answer.

Sam: Right I love that money is the question that's pretty funny so you know.

Howard: It isn't no I'm sorry money is the answer what's the question? So I know my choice I know my homies like I did I'm a delta dental provider money's the answer what's the question is this covered by insurance do you take insurance do you do medical insurance talk about that.

Sam: Right so what's interesting is it is a medical condition so does fall under you need your medical insurance component of it and you know it's kind of a it really it's a lot simpler than I guess most people present in the fact that's kind of a flow chart and the flow chart is first of all do you have medical insurance and it's you do you just need to prove the necessity and so each insurance company usually falls underneath the same category as far as the checkboxes of is it a as it be as it C a D and if it's all those and yes you we do provide benefits associated with it you just need to know what the information is that they're requiring and obviously you want to produce the information correctly that being said you know you didn't look at the individuals do they have out of network benefits or in-network benefits and which category do they fall so once you go through this I guess a decision tree if you would or if you wouldn't and finally you get to the bottom line where there is medical insurance benefits available then the individuals usually move forward with the treatment and again it does fall under the medical you know again following the the necessity following you know the Rx for oral appliance et cetera if you follow their rules and regulations and their step-by-step guidelines more than likely you will give benefits with regards to us would you take insurance but we don't take it as assignment so we help individuals file for their insurance and we do get some reimbursement from anywhere from next to ten dollars all the way up to almost full fare it's never consistent across the board at all so it's kind of an interesting game we have one individual in our office who does nothing but that on the medical side not the dental side but the medical side and every day there's a new story every day there's an interesting category every day there's a new caveat that we have to dance around so it's it's really interesting when you start integrating medical insurance into your practice it is a different arena and there are different companies out there there's ds3 there's dental rider there's all these other companies out there that can help you guide you through each of them each and every one of those steps if you elect not to teach yourself but yes you want to make sure that you do get compensated for the treatment and it does fall under medical.

Howard: Okay um I’ve had some sleep people on my podcast before some of the ones you've mentioned and some of the flack email I got and on to dental town was that when some people said that anybody who you're treating for TMD should be screened for OSA and they said hey you got to him and then other people said that's just crazy crazy crazy and but I would I'm gonna tell you the this dentistry uncensored the brutal reality when I am in a bunch of dental offices or I'm talking to my friends if they got any kind of grinding or whatever all they do is see if their insurance covers a night guard and then the assistant comes in takes two algaecide that they make a night guard and then three days later they'll deliver it and maybe if you're lucky they might slightly adjust it but what what percent of TMD do you think is treated like that in the United States today.

Sam: Oh way to high.

Howard: But wait how high.

Sam: I'm gonna say I'm gonna go probably as high as 70 80 percent I mean it's.

Howard: It's 90 it's a 90 percent Oh talk to that guy right now he's like yeah I treat TMD if they if they're grinding or icy up fractions or teeth wore down my assistant will go in there and he'll take an impression and make him a night guard and we'll deliver it in two or three days and we're all done that's 90 percent of what's going on so talk to that guy right now he's an old guy you know talk to that guy.

Sam: So let's pull up the part we say the old guy so how much of your continuing education component have you invested in is that something that you learned way back in way back when to treat TM because how I was taught in TM and San Antonio is totally different from why I do it now I believe in standard of care I believe there should be follow-up I believe that any individual who comes in with TM issues you can do a quick screening on them to see what really going on I didn't put a patient on a t scan I also do a CBC T we get beam readers to look at the Condor elements of it we really kind of hone in on to that whole component if you would and then we look at developing an orthotic that fits them specifically for what we're going to treat in addition to that we just don't give it to him say see ya our protocol in the office we see in 24 hours we see you in one week and then we see in four weeks minimum knowing that we're on call something goes wrong or haywire we want to hear about it when we want to go back but interesting enough before I do any of that before I even commit them to an orthotic I have a sleep study done since I’ve been doing this in almost 10 years there's only been two patients who have had TM issues that we've done sleep studies that come back negative for OSA what does that tell you changed it back to the question that you asked me earlier on the podcast is there a correlation between the two and the answer to the question is yes we see it continuously so that being said I believe that the standards just mean I believe this is the standard of care for individuals who have TM you really should have a sleep screening done to see if it's OSA if it is you want to treat them appropriately with an orthotic for OSA not an orthotic for TM it comes back negative then obviously you want to treat them a little bit more conservatively with it with a TM orthotic and I think it's all camps and philosophies but when you integrate it and you do what I’ve done over the past 10 years you kind of develop your own philosophy can you see what works I really unlike you that the 90% that do that I this just mean me personally just I do not think that there is there's fairness to the patient in that type of treatment that type of treatment modality I think when it comes to TM the the integration with a patient and really learning the patient and follow them up with an orthotic to get them out of pain discomfort whether it be asleep orthotic or team of orthotic to me is the standard of care and I don't think personally that there should be any any waivers are alternatives associated with that.

Howard: I love the way you just called TM is that a thing I mean can you just call tempero mandible TM without putting a D or a J.

Sam: But I could put the D on the back of it makes you feel better.

Howard: But I believe ever heard that on this show from you or you're the only one I’ve ever heard called a TM.

Sam: Really.

Howard: Yeah but you know what because I have a problem with this you know if you say TMJ the dentist get all mad at that just well the I don't care what you think because all the patients call it TMJ it's kind of like the endodontists don't want you to call it a root canal they want you to call it endotherapy I'm sorry but I live in this little place called Earth and nobody they all call it a root canal same thing with the crown I had an older Dentist got mad at me because I called it a cap and he goes why would you say that it's like cuz I'm in Phoenix and they come in and say does that tooth gonna need a cap they don't say they're gonna need a full-coverage restoration you know so I liked TM because that solves the TMD verse the TMJ just called TM I like that you're the you're the first guy I’ve ever heard say that but.

Sam: But it's surprising I'm just saying it's surprising.

Howard: So you go on dental town it's all organized like 50 message board forms and the very last one is TMD occlusion sleep apnea and I'm looking at somebody's post and one of the questions that was stated it was some crazy guy named sleep doc oh my god it was you says for those of you that I have integrated dental sleep medicine in your practice what is the most common appliance that you prescribe and why people are talking about their herps appliance a saamne med herb said so so answer your own question other guy Kent Smith you talked about the who is the past president breathe economy he's talking about different deals but I want you to answer your own question on Dental town for those of you that have integrated dental sleep medicine into your practice what is the most common appliance that you prescribe and why?.

Sam: Most common appliance that I prescribe is the dorsal fin and I'm more specifically obviously the Meridian but the dorsal fin because it gives you freedom of movement you know the tap all the other ones of those are more locked in appliances I also look at the dexterity of the patients it's easier for them to get in and out the only negative that I’ve seen in the past not with the Meridian PM but in the past is the fracturing of the lateral wings there but that being said that to me is my appliance of choice my go-to just like anything else if you happen to be a runner people like a subset of shoes people like Nike tennis shoes and so forth you've got to find an appliance that you're comfortable with and not not one appliance works on every patient so you got to know your patients you've got to know what you're treating how you're treating it class 3 class 2 what do you you know what's going on with the cranial facial features you know again do they have TM issues etc etc so I think the appliance selection is based upon those those specifics but once you find something that you like something that works for you stick with it you know we always dentist a lot predictability and we don't like surprises and so if you happen to have some type of appliance that you use that you know what for example the herbes or something of that nature that you usually use on a regular basis and that's probably the direction I would go in dorsal has always worked well for me and I think it's because that I was introduced to dorsal when I did my residency at Tufts and I think that's kind of where my spin-off or my affection or attraction to that appliance system or design kind of spun off and I really I really liked it a lot.

Howard: Well you're not gonna believe I answered your own question on that did you know that.

Sam: I do believe after I recall.

Howard: I know I just did it right now okay and guess what I answered it with so I just answered your own question by I love on your website the Meridian PM us you have a PDF file and it's a usin you don't have talked about right that PDF file yeah so I just I just answered your own question I said um this is what Samuel L Cress you so I just uploaded your answer to dental town but uh so more um I'm gonna go back to more sleep questions and a lot of people are still I'm asking a lot about them you talk about the Meridian PM a lot of patients are on CPAP what would percent of patients do you think in America tried CPAP don't like it and should would be more comfortable with an oral appliance well versus what percent of CPAP people actually like it in fact one of the dentists on the thread says CPAP intolerant what's a big deal I love my CPAP and then everybody starts talking about you know some people love it some people don't like it so what were you at on this well what percent CPAP is happily ever after in what barrettes and I'm need to try something else I could be totally wrong but I'd say good 95 plus percent is just and of all the patients I’ve treated for sleep apnea which has been hundreds and hundreds and hundreds there's only been two that love their CPAP and so I never use.

Howard: Only two?.

Sam: In my practice but it's interesting is new CPAP you can get some you give compliance issues associated with it but the efficacy is is amazing or appliances a little bit on the converse side you can get compliance but you have to work again the efficacy and the working part from my perspective standard care is a follow-up of titrations we don't want our patients out the door until we get them to right where they need to be and then once we get them where they need to be they're comfortable the index numbers are comfortable we're all satisfied and happy then we push them off at six months and see them six months recall obviously if they're dental patients of mine they bring their appliance in when they get there re-care but if they're not we call them back every six months just to see how things are going so I do believe that if you're going to get into someone's health at that level that you really the standard of care needs to the dentist needs to integrate into it and you alluded to how these dentists make these TM appliances and just someone take some impressions and send them on and maybe adjust them and bye-bye to me that is not again standard of care and it's interesting my really good friend Jamison Spencer has said to me numerous times that me as a clinician I go way beyond treating patients with sleep and TM and more so than anyone that he's he's aware of and so I’ve heard that I’ve heard that comment numerous times but again I think it's just personal preference it's philosophies and it's just the way you want to treat patients in the way that you want to be treated as a patient.

Howard: So we have four let's see what are we so we have three courses on sleep medicine we're about to get the fourth one as soon as you make it are you are you gonna make it online sleep course.

Sam: Oh are you asking.

Howard: Yeah absolutely I think we have one on dental sleep medicine from getting started to billing another one sleep principles of oral appliance well we actually have two courses from Barry Glassman that's really our only sleep guy and then Mark Murphy but uh but I would I would I would love to have a course on there for you because again they come out of school and they've spent five hundred four hundred thousand dollars on student loans and they really don't want to start dropping a ton of money and so I did this with the pain cancer I said you know you're showing them an ad to go to to go to the pinyons here they're you're gonna have to cancel a week there have to fly all the way down there the tuitions expensive now that's a big jump to go from here's an ad and now I'm cancel in a week and flying in so I convinced them to take each one of those weeks and condense each one down to an hour to deconstruct the bridge so she's like uh what is this pinky continuum one then she can go dental town watch an hour on it and then if she decides yeah that's a that means lots of me I'm gonna go spend a whole week I I wish I I think you should tell Jen Jen Jen Jen janikki that's a that's a tongue twister iiii think I should do that with the with the your courses for for what for what she's doing though what is the the.

Sam: The occlusion courses and all the seahorse's.

Howard: Yeah III think it's it's gonna like this is what it reminds me because I took a hundred hours to see a year for 32 years I got my master Shen HD all this like that and the biggest association looking back 32 years of predictability of what separates a dentist's who live happily ever after and achieve their goals and those that are burned out fried and miserable I think the number one correlator is CE the dentists that kept putting and that's why I'm doing this thing I'm on podcast is that you're commuting to work you know hopefully you know you put enough information in their minds they start making right decisions they get happy they love dentistry and all the things like that but um but yeah I am but the the biggest commercial the biggest asset most people own is their house sitting there and doing a reverse mortgage instead of just dying and giving your house to your kids you can sell off your house and they'll give you an annuity because the charts know how long you're gonna live especially with women the average American woman lives almost so predictably about nine to eleven months longer than her mother now guys are all over the board because you know they they wrecked cars.

Sam: They bad habits.

Howard: Yeah they have dangers job might my son's my two oldest sons are cell phone tower welders they sent me pictures a thousand feet off the ground and they loved it because their number one sport was was rock climbing and and then they found out that nobody will work on a cell phone tower because it's so Frightening but anyway so um so how do they get you to do a reverse out me that the 60-second commercial is not gonna convince you to sell your damn house so the whole commercial is just to sell you to call them up so they can send you a CD and tell you based on where your house is located what it would be worth so they're just starting to start a conversation I think those hour-long online CE courses are the best marketing for these institutes in the world because they deconstruct the marketing process into I hear about it I’ll give it an hour and then in that hour you've got one hour to convince me I should come spend the weekend with you that's right so yeah so tell tell Jen and Pete that Howard's asking for a course from you on line for that stuff because sleep it's so uh it's so tough to it's so tough to go from zero to 100 miles an hour you know I mean on this.

Sam: Absolutely yeah absolutely.

Howard: So so yeah demonstrating since I want to ask you another brutal hard question I'm sleep got a very bad reputation right out of the gate in dentistry because everybody teaching you the course only had one incentive and that was to sell you a five thousand dollar machine to go and measure patience so the first thing I'm going to ask you is are these courses about selling a machine do they need to buy some some home sleep device did you agree with that that that was the beginning of dental sleep medicine in dentistry all the conventions we're selling you equipment.

Sam: Right I’ve heard that numerous times you know what I think is really great about especially about clinical masteries is they don't it's it's not about selling anything it's about educating and I think that's where you need to find and align yourself with an organization that does nothing about educating although we do have you know if you happen to want to go it down that road then we can definitely give you some experience based upon the the professor's or the the educators experience but back to your question with regards to do you need to buy all that the answer the question is no there are other organizations out there that can do HST etc etc where you can actually funnel all that out until you get your feet wet ion in the handle it's a little bit unique when I got out I'm an all-or-nothing guy and always have been and so I I got into all of that to find out what it is that works best for me with regards to sleep so yes I you do need to be a little cautious when you sign up for different courses what is their motive what if they're trying to sell what are they trying to get into who's got what in and that's what I think it's kind of interesting you know you had mentioned about the course the sleep course for the CM is it about Meridian no it's not it's about integrating and we only mentioned it once and if you want to give it a try go for it if you there's something else you'd like we support that as well and it's not about trying to to commercialize or integrate anything into that component of it and it saddens me when these Doc's walk away thinking they have to spend all this money in order to get into dental sit medicine and then I'm just been anything they just need to get educated lay back out they need to invest in your education but they don't have to buy any physical equipment in order to do that looking forward.

Howard: Okay we mentioned a lot about clinical sleep mastery because we're both in love with Pete Jannetty his wife Jen I mean it's a great team and I mean some of the people in that team are just unbelievable but you know in all fairness I want you to get a second recommendation so if you had to pick between the American Academy dental sleep medicine AADSM.org or the American Academy of craniofacial AACFP.org or the sleep the American sleep apnea Association sleepapnea.org or the final the ASBA.net of those for who would be second to clinical sleep mastery about joining us association today you're sure that.

Sam: That's a difficult question because they each have their own philosophies and the only way that they direct things a one that's or I guess you have to kind of figure out where you belong in that arena I’ve attended all of them and I’ve got association affiliation with two the three if to the four that you just mentioned there and so that being said it would really be tough I guess I think you have to understand what it is that you want out of an organization in order to become part of that organization does that organization feed you and supports you in a manner which it makes you what you need to be makes you a better clinician and so forth so that would be very difficult to say I am a member ACP and the AAA DSM but you know attend them find out what's going on find out what philosophies and direction that you like and if it fits your if it fits your personality.

Howard: Ok well the correct answer was ASBA.net because it's right here in Phoenix Arizona I don't even have to fly that's what we bet I totally think the Americans sleep and breathe Academy is the best one mainly because I can drive there in ten minutes so although second all those other ones that are in different cities you know they should have been in Phoenix.

Sam: Well those those lectures at that meeting couple weeks ago the lecturers were really good in fact you were one of them but the lecturers were really a good selection across the board and it was pretty pretty awesome I tell you another group that I absolutely just just recently just fell in love with is the DS3 group the dental sleep solution group and so they're amazing too because they are non-agenda they are non-political and it's just it's just an open forum where people can get together and exchange ideas I was just introduced to them and they're meeting in Clearwater Florida this past February and I’ve already signed up to be it to get to attend again and I’ve recently been asked to give a presentation there and there's their small forums so it's it's that's a really good organization the people I'm developing relationships and friends with in that group are pretty amazing and they're all down-to-earth are all very neutral so I would probably lean towards that one would probably my second choice now that I’ve we've been exposed to all of those that would probably be my second choice.

Howard: So you said the dental services group DSG?.

Sam: No ds3 the ds3 the number three.

Howard: Dental solutions ds3.

Sam: Right.

Howard: Okay ds3 don't see.

Sam: Guy Yaris and and Jason tyranny net that a group of a group of guys and gals Jodi Jack all those those people.

Howard: Is that dental sleep solutions.

Sam: Ds3 idea dental sleep solutions mm-hmm.

Howard: Okay let me see ds3 I got ds3 sleep.

Sam: Mm-hmm.

Howard: Is that them? What website did you say.

Sam: What what I'm sorry.

Howard: What website did you give for those was it ds3sleep.com.

I could hear what could be I don't know what exactly the website is but I just called them ds3 okay let me history is actually the software of the organization that supports and they're the ones to integrate the software.

Howard: So that that is the ds3sleep.com yeah it's funny I don't know all their names but yeah guy yaris yeah he's been on the show just a great guy and and who's that uh who's the smartest person they're whole group the one from Phoenix.

Sam: Jason tyranny.

Howard: Yeah I mean yeah that is a good group well I can't believe we went over an hour by ten minutes one more controversial deal the the kids at a dental kindergarten school get confused because you can go to a hundred different root canal lectures and no one talks about a camp you don't I mean you got to take every I mean I think the only controversy in pediatric dentistry is silver diamine fluoride otherwise they realize but occlusion you kind of got a decide are you gonna go CR or neuromuscular um it's like kind of like.

Sam: There's a skeletal a bunch of skeletal you will.

Howard: You're the man who said TM that was a new to me so TM and skeletal I like that yeah well if someone asked you an occlusion are you are you neuromuscular or CR what would your answer be that you're just.

Sam:  Are those the only two choices CR.

Howard: CR but but its skeletal is better but my question was when would I name those four associations you said I’ll kind of do things differently but you don't really see that in studying endo I mean you don't go to a root canal course they say well you know the other endodontists they're there they're from a different camp so is asleep like occlusion in that there's a bunch of different camps with a bunch of different philosophies.

Sam: I don't think there's I don't think there's camps I think there's personalities there's a little bit difference when you say yes camps are philosophies that they're teaching these organizations have different personalities and the personality where do you play play where do you find yourself at and of those are the ones that are out there the one that I just recently got exposed to I think that one fits my personality a little bit better because I'm a little bit more of a free spirit I got a big personality and they're very open to new ideas and new concepts and integrating relationships amongst a dental sleep Doc's they're very big on that and that really does resonate with me personally so you know again I think it's more of a personality and and and and what you're looking for versus a camp if you would know.

Howard: That's well put because it's simply with sports so many kids end up their favorite sport is just because they were exposed to all these different sports but they really gelled as a specific coach and like for me and and when I was in high school the the biggest personality in the whole school was the wrestling coach and he was just like this vortexes sucked all these kids in you know I mean and and I saw I saw that I mean someone if you so many people like though you know Dickerson change your life at Ovi or or gosh um or Dawson I mean I have I I'd say a third of my dentist friends and all would say Dawson just change their whole life so that's probably well but it's probably not the the science the math the algebra the calculus but just a personality leading this organization unto that fit right you all.

Sam: Right because you find someone you like someone you didn't develop a respect for my perfect example is Jameson and Spencer you develop a respect from you learnt learning a lot form and they're always a go-to person that if you happen to have in an issue where you need to bounce something off that would be the first person that comes to my mind would be Jameson and again it's an example just because we met at the at the TDA I set in his a lecture I set in his his a hands-on of course that afternoon and I instantly parallel myself with them and then obviously I’ve taken numerous courses with him in actually was kind of a funny story my very first lecture that I gave was a 3d lecture 30-day lecture I'm sorry and I am extended an invitation to him he showed up and then he and I have lectured a couple times together and so there's just a tremendous respect I have for him and so as a result of that I learned a much more open to the communication and what kind of learn from him and that sort of thing.

Howard: Well you know I'm gonna close with the but the first question I asked you is TMD and occlusion and sleep-related and what I think's very interesting on dental town is the same two guys Mark Murphy and Barry Glassman who did our sleep medicine online CE courses also did our TMD courses i think that is and then of course i i think one of the greatest seclusion course ever is michael melkor's who did nuts-and-bolts occlusion but tell you tell all these guys you're you're mentioning put an hour highlight show on the dental online CE so these kids can find out if you're the coach for them if your personality does it for them I mean I I can vouch for you I think you're very charming handsome and intelligent man and I really enjoyed know I'm serious I think think what you're doing is amazing big fan of you big fan of your course was there any question that you're wishing I asked and I wasn't smart enough to ask.

Sam: I don't think there was a question there I didn't go at the mind step for a question answer such as more of a chitchat back and forth that I think you've done a fantastic job and I really do enjoy you know you these these podcasts that you do and so forth so I don't think there's any specific question that you didn't ask or anything I specifically was say you were just trying to find out my ideas my philosophy my background my journey with regards to the appliance system that I came up with and so I think that was that's all been covered.

Howard: And was the FDA when you got that clearance were they just lovely to work with and you just recommend them to everyone or were they more proverbial pain in the ass. .

Sam: You got to have two things - money patience okay patience.

Howard: But yeah I am I am NOT a fan of the FDA because I live in a house where a person had brain cancer and an American company made a medication but it was under FDA approval and she couldn't get on the trial so she had to sell her home to me and moved to Scandinavia where she could get the prescription there and I talked to John McCain about that when he was still alive and I said you know it's one thing for the FDA to say we don't approve this drug we don't we don't know enough about it yet but dude I'm dining cancer i I'm not I'm on a different time schedule I I I want this drug now and I don't think you're a patriot I don't think you're an American when you block an American research scientist from giving you a drug when your only alternatives death and I told John McCain I wish they'd still do it you got all these Indian reservations that when you say okay we'll let him build casinos they need to have an FDA free zone right out here I mean you got Mayo Clinic y'all these hospitals and instead of these this crap trying to get on some FDA trial or whatever but you know I'm a I'm I may be seeing you because for at a you're on interstate 59 which goes straight to my four of my five grandchildren are in Beeville so I'm always down there and.

Sam: Right down the road.

Howard: How far are you from Beeville.

Sam: Prob about an hour and a half.

Howard: And that's all that is right there an hour and a half.

Sam: Yep.

Howard: Wow well I stopped.

Sam: I I I invite you stop by and I’ll take you to lunch or dinner depending what time you come through.

Howard: Wow well if I got my grandkids there there only can eat chicken nuggets and french fries so there there's.

Sam: I got a place for that.

Howard: You got a place that hey thank you so much for taking an hour out of your very busy day and sharing it with my homies.

Sam: You bet thank you so much for the opportunity and invitation.

 
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