Signs of Airway and TMJ Disorders

Welcome to The Dr. Phil Klein Dental Podcast. I'm Dr. Phil Klein. Today we'll be discussing the most common signs and symptoms related to sleep, airway, and TMJ disorders. Our guest is Dr. Jon Caulfield, who owns and operates Epic Dentistry in Littleton, Colorado, specializing in the areas of sleep, airway, and TMJ. He is an instructor at the Vivos Institute and leads the clinical advisory and advocate program at Vivos Therapeutics. In fact, he's actually doing this podcast from the backseat of his automobile because where he was originally, which was in a coffee shop, was a little bit too loud. So Dr. Caulfield, thanks for being so versatile here and getting into your car to do this podcast. Phil, I could say the same for you. Thanks for having me and for being a little flexible. I'm glad we got it worked out. So this is really exciting. that you're a dentist you're involved with sleep airway and tmj treatment and um just to begin as a dentist how did you end up specializing in sleep airway and tmj disorders yeah you know that's a great question because our careers can take us down so many paths but uh as i started fixing teeth which is what we all go to dental school for right we think about teeth and all the many things we can do to help patients with their teeth I started realizing that I was fixing teeth in a broken system. I was like, I keep fixing these teeth, but they keep getting broken, right? Like, what's the problem? It wasn't usually decay or periodontal disease. So I started asking myself some more questions. You know, why are these teeth breaking? Why do teeth that we fix continue to break, right? Our porcelain chips, our composite leaks, we get all these restorations that don't fully restore the tooth and restore the health the way I wanted them to. So I started in about 2004, 2005, looking for some answers. And I found a lot of it within neuromuscular occlusion, TMJ or TMD treatments. When I started fixing the biting system, when I started fixing the occlusion, now I started having great results. My dentistry was holding up. And lo and behold, my patients were telling me they were getting less headaches. Their necks felt better. They were feeling like their lives were just getting easier. They had less muscle tension. less problems. And so as I started going down that journey, the only patients that weren't responding the way that I was hoping to, I was getting joint noises to recede and be better. I was getting people feeling better and functioning better. But a lot of my, like 25% of my patients were saying, you know, I still wake up with a, you know, like this brain fog or this kind of low grade headache. I'm still exhausted during the day. You know, I feel better, but I still feel tired. I started seeing a whole nother set of symptoms that were coming through. And then I started hearing stories like, you know, I never used to snore and now I'm starting to snore. My bed partner, my spouse is telling me that I'm snoring now and I never used to do that. And so ironically, I was helping people with their TMD and relaxing their muscles, but causing now the jaw and the airway to collapse and causing some sleep issues, causing some sleep disorder breathing. That's when I started looking at their airway. And then once I started realizing I could help their airway, fix the airway, that would help them sleep better. And then also help prevent or treat a lot of the TMD that I've been seeing. So basically you had a practice that had a good number, a swath of patients that had TMD and you treated them. So you were treating those patients. And what were you treating them with that you think subsequently caused the snoring and the sleep problems? Yeah, so I was using a neuromuscular approach. So I'd use a TENS machine. It's a medical grade TENS machine that would actually relax the muscles, decompress the joint, allow the lower jaw to go to a more comfortable, less stressed, less muscle spastic position. And as they started getting to this better position, it helped relax their headaches, relax their central nervous system. It started just, you know, in general. getting more jaw relaxation, getting more joint decompression. But because of that, when they'd lay down, now they used to clench and grind all night to keep their airway open. And all of a sudden, their jaw would start to relax. They'd sleep and get into deeper levels of sleep, go unconscious, and the jaw and the tongue would fall back and start to block the airway or obstruct or at least cause some airway resistance through their sleeping and breathing. Wow, that's very interesting. So then you went ahead to learn more about airway obstruction. Right. Tell us a little bit about that. Exactly. Yeah. So then now I had a whole set of problems, right? Like, okay, I've got their jaw better. I got their joints better. And now we've got snoring, sleeping, breathing, sleep apnea issues that were starting to come up. And so I started looking into a device that could actually hold the jaw forward, grow the teeth, grow the intraoral tongue space, expand the palate, expand the intraoral tongue space. Give the tongue a better place to go than back into the airway. What are the most common signs and symptoms that you see in your practice of airway obstruction and also the related TMD stuff, the TMJ disorders? Yeah, and I'm going to just apologize right now to all the listeners because what I'm about to describe is going to start people really thinking about what they're seeing, you know, in their practice the next time they go in. But what we're looking for, what we typically see would be the number one would be like the scalping of the tongue. That is an indication the tongue is trying to get out of the airway. It's pressing so hard on the teeth to get out of the airway that we're literally leaving marks on it that last all day long until they come into your office. We would see inflamed and red swollen uvula, tonsils, narrow pharyngeal arch, narrow throat and palatal tissue. Linea alba, like this line along the outside of the cheek where the teeth are suctioning up against it as they're, again, fighting to keep their airway open, fighting to breathe while they sleep. We start to see wear on the teeth from the clenching and the grinding that allows the airway to function better and to get more air. Abfractions, recession, those are all really key indicators that we've got somebody who's struggling to breathe at night. And then typically, ironically, these are some of the same TMD signs and symptoms that we see as well. You found a really exciting kind of sector of practicing dentistry. You still do the restorative stuff. Absolutely. Okay. So you haven't changed your focus of your practice as far as restorative dentistry. You're a general dentist? Yep. I do implants. I do restorative. I do all kinds of things. What percentage of your practice time is dedicated towards the sleep disorders? Yeah, I mean, at this stage of my practice between the TMD and the sleep, you know, about 60 to 70 percent of my practice is designated for those treatments. And then I'm in the process of looking at some associates to come in and do more of just the general dentistry. But yeah, a lot of my day is focused on really seeing less patients, but seeing them more comprehensively looking at airway, looking at sleep, looking at their jaw health. and really getting each person back to their maximum medical or dental improvement. You know, you kind of branched off into this, and then I guess you grew that part of your practice because from word of mouth, and then are you getting referrals from other general dentists? I am. I'm getting a lot of the general dentists in my area know that I, you know, when they get TMD problems, TMJ problems, airway and sleep, they know that this is something that I've done a lot of research with, have a lot of experience with, and I'm also getting referrals from my ENTs. I'm getting referrals from... sleep physicians now that know that I'm able to help their patients with an oral appliance that can actually grow the jaw, grow the tongue, grow the space for the airway space. And so I'm getting a whole level of both. professional and then obviously personal too. We're getting, you know, patients bring in their child or their spouse and they say, wow, you're helping them. Could you help me? Or I know someone else that needs this help. And so the word of mouth is really kind of catching like a wildfire. And all of a sudden, you know, it's all the friends and family of everybody you treat start to realize that we're treating a bigger issue here than just a tooth or even than just a joint. We're really treating the entire health system, the entire human system. And helping people breathe better and sleep better is probably the most important thing you can do for someone. Yeah, it sounds like it's very satisfying to you. Absolutely. Yeah, how you've moved in this direction. And from the time you first started doing this kind of treatment, how many years has it been for you to get to this level of being 60% of your workload right now? Yeah, so I started with TMD and the neuromuscular back in 2004, 2005. And then in 2008 and 2009, I started looking at the... jaw and growth and development of the airway. And so I would say, yeah, over the last 15, you know, 15, 14 years, it's been slowly escalating. In the last three or four years, it's really blossomed to where I'm teaching other dentists how to do this. I'm teaching other team members how to do this. I instruct for a company called Vivos where people can come and learn. how I've done these techniques, what kind of results we've gotten, see cases that have been successfully treated and start to see that they could do this in their own practice, see this in their own patients and do similar life-changing and life-saving treatments like this. What is something a dentist can incorporate into their practices like right away to start addressing these signs and symptoms of sleep, airway, TMD, if they're not already doing so? Yeah, and that's a great question because we we want to help right and the first thing you can do is just to see it right if you don't see it you can't treat it um and i would say too my hygienist is indispensable to me because she spends more time in the mouth more time with the patient gets to ask some some deeper questions that we weren't always asking and so you know better screening process both in you know asking some different questions do you snore do you ever wake up choking or gasping You know, finding out if the patient has any sense that they may have a problem with their sleep. And then again, letting the hygienist look for some of those dental clues we talked about, the scalp tongue, you know, the linea alba, the way that the tongue looks too big for the mouth instead of the mouth looking big and developed, like the tongue should have done. And so starting there, but knowing that, you know, when we put something in a mouth, we can actually take away tongue space. And so, you know, really being careful about. A lot of dentists want to just do a night guard. They say, you know what, I'm going to put a guard in there, protect the teeth. And although that can be a very helpful thing for the teeth, it can actually take away tongue space. Much like I was helping people to become snorers and sleep apnea, you can actually turn off their clenching and grinding, but let them fall back and start having more obstruction and more issues. So to get the proper training, the proper education is one of the things that I'm really big about because. Once we learn more, we can know more and we can do more. Tell us about Vivos Institute and Vivos Therapeutics and in relation to how dentists can learn more about this. And, you know, what do you recommend as far as learning about a multidisciplinary approach to treating sleep apnea? Yeah, that's, again, a great question because we want to talk about what are the resources? Where can I get this information, this education? And Vivos was formed about three or four years ago here with technology from Dr. David Singh. And utilizing this technology, we've been able to not only hold the jaw forward and the tongue forward with a manual advancement device, but also grow the intro tongue space, grow the possible airway that that patient has available to them to get the tongue out of the airway and to keep the airway open all night. Vivos is... What's powerful about it is it's a product, but it has a process attached to it. And so what I love about it is that they actually work with my team, that each of my team members, whether it be my hygienist, my assistant, my front desk people, you know, people using medical billing, questions about that. They're a constant resource and a constant partner in this process so that we can diagnose patients correctly, design the treatment objectives and the treatment plan correctly. and then deliver that treatment so they've really kind of packaged the whole process up into a nice package where any dentist can bring this into their practice and do it as much or as little as they'd like to do vivos by the way uh and i'm just talking to the audience now is v-i-v -o-s that's v-i-v-o-s totally different than viva for viva learning which is what the program you're listening to now um vivos therapeutics what does that name represent Is that the name of a company? Yeah, that's the name of the company. It's actually on the stock market now. It's actually, they went public here last fall. And so the VVOS, I think, is the ticker symbol. But yeah, it's a public traded company now because they're seeing all this hope and all this improvement and what we're experiencing for our patients and for... their families and the kind of changes that we're making. And so Vivos Therapeutics was formed. They took the technology that Dr. Singh had come up with and said, we have got to get more dentists doing this. And they were able to take sort of a business model of his scientific process and really combine the two so that it can become highly adaptable and highly implementable for dentists to bring it in in sort of a packaged state to the practice. And really get the right education, get the right support, get the right sort of team members. There's clinical doctors that work with other doctors to help them answer tough questions. There's appliance design team members that help explain how to design the appliance to accomplish the goals of the treatment. And then there's also these practice advisors from Vivos that will come in and say, hey, let's find other doctors in your network. Let's find an ENT. Let's find a sleep physician. pulmonologist. Let's find a pediatric doctor. Let's get some people to understand what you're doing, make some more networking and connections for you so that we can all work together to help these patients sleep better and breathe better and be better. Yeah. So again, talking to the audience, vivoslife.com is the website, vivoslife.com. So what's the timeframe for a dentist who decides, you know, I'm ready to get this education. And along with his education, there's a system that I could incorporate for someone who's done a little bit of this stuff in their office, whether they just use a night guard and they just do the basic stuff. What are we looking at as far as someone who's ready to start implementing some of this technology and protocol into their practice? Yeah, well, good news. There was a positive effect of COVID. Because of COVID, we've all had to shift and pivot. high complements for this. They were able to, you know, they brought in, we started to record all the training, record all the learning, record the basic courses so that somebody at the comfort of their own home can start that process. And then, you know, another thing about, you know, opening up is that we're going to begin doing live training again. So a lot of the core education, the core information can be consumed and observed and learned in their own time. And then we all, live courses again out of a large training center that's being completed right now in Denver so that dentists can then come hands-on and actually either be a patient or bring a patient to start learning this process and walking their first case with the entire Vivos team, with clinical doctors, with some of the business management and business team leaders, with their team. They can bring assistants and hygienists. office managers, so that everybody can learn together in cooperation their roles and responsibilities to how this can become highly successful so the whole dental practice can participate and the whole dental practice can help their patients. Yeah, phenomenal stuff. I mean, there's no question that something like this requires very keen, focused education in a very... organized manner. Apparently, Vivos Institute has figured all that out. You're singing to the choir about education. That's our whole business, Vivo Learning. Exactly. Yeah. And we do it all on the internet. We don't have a live venue yet. We're thinking of actually doing some sort of symposium maybe once a year now that the pandemic is certainly waning to an end. But this is very exciting stuff, Dr. Caulfield. It sounds like you have got to the point where you have this passion for treating these kinds of conditions, which worldwide is over a billion people suffer from airway disorders. And this is according to your website, which I looked at briefly before the podcast. And so I'm sure there are plenty of dentists that would be interested in this and really want to take it to another level. And I think your operation over there that you're involved with is just perfect for them. So I'm glad we had the opportunity to do this podcast. And thanks so much for doing it out of the backseat of your car. Is that a rental car or is that your own car? No, it's a rental car, but it worked. It did the trick. I didn't know that this was going to be one of the aspects, right? Of being able to rent this car and be a little bit of a mobile studio. Yeah, amazing. I really appreciate you, Dr. Phil, for what you're doing. I'm sure you get the Dr. Phil thing quite a bit, right? Yeah, sure. But I love that you've got listeners that are taking their time to educate themselves, to find out more. I will say that what I love about Live is that we get so many great questions. so many great um you know cases that get presented that are that we've not seen as much of and so there's so much more back and forth and talking about you know what do we do here and how would you handle this and so sometimes it's that live interaction that's so powerful so it's great when we can have a hybrid right where we can learn so much on our own but then coming together is so much stronger and i love that you've got so many listeners that are working together hearing this information being able to then spread that out and you know i was helping hundreds and hundreds of patients in my practice and now helping all these other doctors to help other hundreds and hundreds of patients i think about the amplification of what you're doing and what we're doing where we can meet reach so many more people exponentially and help so many more people exponentially by doing this so thank you for having me on today and doing what you're doing Yeah, our pleasure. And keep us up to date, Dr. Caulfield, and how things go down the road. We'll have you on a future podcast so you can update us. And have a great weekend, and thank you very much. Thank you very much. You as well.