Are you considering the airway in your treatment planning?

Could centric relation (CR) be compromising your patient’s breathing?

When you open the vertical dimension, are you making the airway better—or worse?

Welcome to another AES 2026 series episode, this time with LEGEND Dr. Jeff Rouse as he joins Jaz in this eye-opening episode to explore how airway, aesthetics, and function are deeply interconnected—especially in prosthodontics.

They discuss key clinical scenarios like vertical dimension changes, examining how your choices may impact the airway—sometimes in ways you didn’t expect. With practical insights and examples, this episode will help you make smarter, airway-conscious decisions that elevate both your functional and aesthetic outcomes.

https://youtu.be/-Ut-qme7Vcg

Watch PDP229 on Youtube

Protrusive Dental Pearl: Plan your breaks 12 months in advance to avoid burnout and ensure quality time with your loved ones. Prioritize rest and connection before reaching exhaustion—your body, mind, and heart will thank you.

Need to Read it? Check out the Full Episode Transcript below!

Key Takeaways

Airway health is crucial in dentistry, impacting aesthetics and function.
Understanding airway issues can lead to better treatment outcomes for patients.
Breastfeeding plays a significant role in childhood development and airway health.
Interdisciplinary approaches are essential for effective adult treatment.
Aesthetics and function are key factors in airway prosthodontics.
Most patients are unaware of their airway issues until they are addressed.
Early intervention in childhood can prevent future airway problems.
Combining orthodontics and prosthodontics can enhance patient care.
Airway management is crucial for overall patient health.
A great bite is not just about teeth alignment.
Pathway wear can indicate deeper dental issues.
Vertical dimension changes can negatively impact airway.
Understanding joint positions is essential in treatment planning.
Continuous education is vital for modern dental practices.

Highlights of this patient:

02:22 Protrusive Dental Pearl
04:34 Interview with Dr. Jeff Rouse Begins
09:05 Understanding Airway Prosthodontics
15:58 The Role of Cone Beam CT Scans
17:58 Treating Children and Early Interventions
24:50 Addressing Adult Airway Issues
29:43 Multidisciplinary Approach in Dentistry
31:46 Patient Transformations and Airway Focus
34:42 Understanding Pathway Wear
41:32 Impact of Vertical Dimension on Airway
48:55 Exploring Different Occlusion Philosophies
51:34 A Sneak Peek at AES 2026: Dental Wear Patterns Of The Airway Patient
55:25 Upcoming Events and Resources

Explore the world of sleep disordered breathing with Prof. Ama Johal in PDP033: “Airway – Dentistry’s Elephant in the Room.”

🎓 Join the world’s leading organization dedicated to occlusion, temporomandibular disorders (TMD), and restorative excellence — the American Equilibration Society (AES).

🗓️ AES Annual Meeting 2026 – “The Evolution of the Oral Physician”
📍 February 18–19, 2026 · Chicago, Illinois
Don’t miss Dr. Jeff Rouse as featured speaker, presenting on “Dental Wear Patterns Of The Airway Patient”

🎓 Learn more with Dr. Jeff Rouse on The Spear Education Online

#PDPMainEpisodes #CareerDevelopment #BreadandButterDentistry

This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.

This episode meets GDC Outcomes A, B and C.

AGD Subject Code: 730 ORAL MEDICINE, ORAL DIAGNOSIS, ORAL PATHOLOGY (Sleep medicine)

Aim: To deepen clinicians’ understanding of airway prosthodontics and empower them to recognize airway-related dental issues across all age groups.

Dentists will be able to –

Differentiate between anatomical airway dysfunction and sleep-disordered breathing, and understand the unique role of dentistry in addressing each.

2. Explain the principles of Airway Prosthodontics, including the significance of tooth position in facial space and its impact on breathing.

3. Recognize signs of airway compromise in both pediatric and adult patients, including atypical wear patterns, bruxism, reflux, and chronic fatigue.

Click below for full episode transcript:

Teaser: They don't want us playing in that world either. They don't. Their world is completely different than ours. And you as a dentist, you don't want to be in that world. It's an ugly, ugly world and most physicians would love to be dentists nowadays, 'cause we have so much more freedom to change and to act and to care for our patients than they do. Most people don't know what they don't know. They just call it normal.

Teaser:
A woman I was visiting with earlier today had had orthognathic surgery and she said, I didn’t really realize that I never was able to breathe and I never slept until I had the surgery done. People that are constricted in their bites like this, their maxillas are constricted.

And if their maxillas are constricted and their nasal cavities constricted, they can’t breathe well through their nose. And so if you go from giving a small piece of cheese or beef jerky or a peanut to chew, they can manage their airway, have ’em bite into a sandwich with a bunch of bread and a bunch of stuff in it. They can’t, so their chewing cycle will move forward and they’ll hit their front.

For me, airway is just established the aesthetic position of the teeth first and the functional position of the teeth. If you get those things normalized, then we help the patient normalize what they do, which is close the mouth and breathe through their nose.

That’s dentistry and the success of that treatment is does the patient have a beautiful smile and a great bite? That’s success. Not did I reduce the apnea level? We’re treating 26 month old as the youngest I’ve ever heard, done Invisalign first to expand, start expansion early, but at four you can start to see if you’re leaving them in a constricted pediatric arch that the permanent teeth are gonna erupt outside of the housing of the bone. So the orthodontist never moved the teeth outta the bone. They were never in the bone to begin with.

Jaz’s Introduction:
How does the airway relate to aesthetics and function? Interesting concept ’cause we think about aesthetics, we think about function, but are we necessarily thinking about the airway when it comes to our treatment planning?

Related to this is a scenario like, let’s think of complete dentures. When we deliver complete dentures, the joint position that we usually select is centric relation or seated condyle position. Now the question is, is this position adversely affecting their airway? i.e. by moving their condyles in into centric relation, which usually means they’re moving their jaw a little bit further back. Is that necessarily worsening their airway?

Well, we answered that in this episode. And how about when we’re opening someone’s bite? Well, in prosthodontics, when we open someone’s bite, there are some scenarios where you are at risk of making the airway worse and other scenarios where you’re probably not gonna make the airway worse.

And you’ll learn this episode exactly what those two distinctions are. I’m joined today by the Dr. Jeff Rouse absolute giant in our profession. What a lovely guy he is. Author of one of the best dentistry textbooks there are Global Diagnosis. He’s also a very prominent educator with spear education and the impact this man has made in airway and dentistry and prosthodontics is just absolutely amazing.

So it’s real privilege to host him today as part of our AES takeover. See, Jeff Rouse is one of the speakers at the AES Conference, 2026 in February, and that will be held in Chicago. And we’re trying to shine a light on this conference because it’s based on occlusion, right? It’s related to occlusion, but it’s so much more than occlusion.

In fact, the theme of the AES conference next year is the Evolution of the Oral Physician. Let me say that again. The Evolution of the Oral Physician. So it really looks more than just the occlusion. When I attended a few years back, they really are a comprehensive, holistic group that brings together all the occlusion camps and me and Mahmoud Ibrahim, have the privilege of being able to speak there.

But we are a small piece of it. You know, some of these giants, like Dania Tamimi that we had on previously, Lukasz Lassman, Jeff Rouse, who you’ll hear from today, is gonna make a really great conference. We’re shining a light, so check out aes-tmj.org, that’s aes-tmj.org to learn more about this conference in Feb 2026.

Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. Every PDP episode, I give you a Protrusive Dental Pearl, and quite often the pearl I give depends on my mood and my context and what I’ve been doing that day or the few days beforehand. And whilst this episode’s being published, probably six to eight weeks later, it’s actually Easter Monday today.

And so Spank Hall in England, I’m just reflecting on this Easter break that I’ve had. And honestly, it was just very, very special. For those of you who’ve been listening to every single episode, you may remember I had pneumothorax, a spontaneous pneumothorax. My lung collapsed in February. It canceled our family holiday, like a first world problem.

Yes, it was not nice. It was devastating actually. But there’s a reason for that. For me and my wife holidays are very, very special. It’s really quality time with our kids. It’s a time where I switch off and so we couldn’t go away in February. And so I was really nervous about flying in April and thank goodness, I survived and everything’s fine.

And honestly, it had just the loveliest 10 days away in the sun with my wife and two kids, and I’m feeling really great. And I guess the pearl is, please make time to rest. If you have a young family. And if they’re at school age, then yes, school holidays are expensive time to go away. But even if you don’t get away, just having that time to reset and connect with your family and making time for that is so special in my opinion.

And the reason I’m having to mention this is too many times I’m having conversations with dentists and they’re burnt out. And I always ask ’em, when was your last holiday? And they keep saying to me, ah, you know what? I’ve been meaning to book something, but I never get round to it. And I get to a point where I feel like I need a holiday right now, but I can’t actually book anything because of practice commitments, blah, blah.

So something I’ve said over and over again on the podcast, and I make no apologies, do you plan your breaks 12 months in advance? So I do. It’s why I’m able to be so organized in my diary. I know exactly when I’m taking a break from teeth, paying attention to family or things that are important to you.

And the next thing is really quite celebratory. Like for the first time in probably 20 years, I managed to get eight hour sleep for about 12 days straight. That was absolutely transformational for me. So Protruserati, please make time for your loved ones. Plan those breaks well in advance so you don’t have to wait until you’re burnt out to book a holiday.

You always have something to look forward to. So I’ve said it before, I’ll say it again. Look after your body, look after your mind, and by spending more time with loved ones, look after your heart. Let’s join the main episode now and I’ll catch you in the outro.

THE Dr. Jeff Rouse. Absolute pleasure to have you on the Protrusive Dental Podcast. How are you, sir?

[Jeff]
I’m wonderful. Thank you. Thanks for having me here.

[Jaz]
I’m so stoked. I told you this before we hit the record button. Your reputation, what you’ve done, your contribution and dentistry already just been phenomenal and I’m so excited that you’ll be speaking. You are such an established educator, your work with spirit education, your own stuff you do and you’ll be speaking AES as well.

It’s gonna be amazing. And as part of the buildup and excitement of that, it’s so great to talk about some key themes today. But for those younger colleagues who perhaps haven’t heard about you, tell us about you, your journey and what inspired you to take the route that you did take?

[Jeff]
It’s strange you asked me that question, Jaz ’cause and by the way, thank you for having me on. I know the Protrusive podcast is worldwide and so it’s such a treat to actually get a chance to talk to you. It’s strange you asked me that question ’cause I was, today, I was sitting around thinking like, what a weird route I’ve taken to get to where I am.

How some of the things that happened to me, if I had made a different decision, there’s no way I’d be in the position I’m in right now. So for all those people out there that were horrible and undergraduate and dental school, there’s hope you can actually make it to a podcast one day ’cause I was terrible in school.

I had no passion for it. I didn’t really understand what dentistry was all about. I went into dentistry because a friend of mine wanted to be an orthodontist and I lost my desire to go to medicine. And I say lost desire. I would’ve probably never gotten into medical school. But I didn’t want to get into medical school, but I didn’t know what else to be.

And so a buddy of mine said, you want to go to dental school? And I said, yeah, whatever. And I must have done well on the exam ’cause I got into dental school somehow ’cause my grades were horrible. Got to dental school, the guy there said, C equals DDS. And so I just said, well, that’s easy enough. I can make Cs.

And so I did. And the last year in school I met a professor, Bill Robbins, who I later ended up working with and writing a textbook with. But I met him and he showed me the dentistry could be more than what my local dentist was doing. And that there was science to it and there was an art to it, and that allowed me to go to a residency.

And so I did a two year GPR came back and went to general practice, practice as a general dentist for 14 years. And once again, Bill and I were working together. We were writing textbooks together, we were lecturing all over the world. And I knew there was something different or something more that still I was passionate about.

And so I had an opportunity where I could work my practice and go to prosthodontic residency at the same time. So it took me four years to do it, but I did, and I became a prosthodontist. And after that, then I had opportunities that would’ve never happened had I not taken that, which is I got to work with Greg Kenzer and Frank Spear up in Seattle.

And from there ended up teaching at Spear. So a handful of decisions of just saying yes to hard work and saying yes to the fear that was accompanying it and it paying off. So I think we get comfortable and I’ve always gotten anxious when I’m comfortable. And so for those of you that think there’s more, there is, you just have to be willing.

Like I tell my kids, you have to be willing to take a deep breath and take that leap, even though it’s scary. And in many ways I got lucky, but in a lot of ways, it was just being able to say the word yes, I’m gonna do that. So that’s how I ended up getting here.

[Jaz]
Wonderful way to start the podcast. Richard Branson says, if an opportunity comes along that just really, really good, say yes and then figure out how you’re gonna do it later. And so this is the same Bill Robbins that I think spoke at AES two years ago on global diagnosis.

[Jeff]
Yeah. That’s what we wrote here.

[Jaz]
And I met- and that was all work together. And what a charismatic chap he is. What a lovely human being. And just his charisma. It’s just oozing, it’s just pleasure to see him.

[Jeff]
There are very few people in the world that you’re better, you as a person are better off having been around him. And he’s one of those people that just being around him and being in his presence creates such a benefit to you. Like the energy coming from him just feeds you. And yeah, I was lucky enough to work with him for four years and he’s my best friend in dentistry for, I don’t know, 30 years now. So it’s awesome.

[Jaz]
What a story. And yeah, that was definitely palpable when I met him a few years ago. Today’s topics we’re gonna take lots of little detours and stuff because to do a topic like this justice, you have to kind of like build the context into it. And I want to help dentists understand a few key things related to airway based prosthodontist.

Some people may be thinking that’s a new term for others who maybe done your classes and stuff, they may be more familiar. But what I was thinking was when we do our restorative dentistry, let’s say. We can do something that may affect the phonetics, and we think about that. We think about the tooth length and thinking, oh, that might affect the phonetics.

We plan our restoration. So we think about the cleansability. You know, we often opt for certain designs, so there’ll be cleansability, but sometimes perhaps we may be guilty in dentistry of not thinking about how our dentistry, obviously more and more with your good work, people are becoming more aware of this, but how might our dentistry affect the airway?

So I guess I’m gonna let you really lead the direction on that. But when it comes to the decision making and the kind of dentistry that we deliver, what kind of situations where may we be impacting the airway without perhaps realizing?

[Jeff]
Yeah, good question. Let me back up a step so that everyone is clear. The biggest confusion that I run into when I’m speaking today is when you used the word airway and you used it properly, in my opinion. The issue that I run into is people, at first when you would go to lectures would say, my patient has sleep apnea, or My patient has a sleep problem. And then myself and other people kind of following the same course started utilizing the word airway to differentiate it.

And now if you go to a lecture, you’re gonna hear people say, my patient has an airway problem. But the next thing out of their mouth is they went in for a sleep study and their apnea level is 24. So they’re using the term incorrectly. Airway, the way that you were using it was about anatomy or changes to anatomy that could affect your ability to breathe.

Tooth position, vertical dimension are some of the things that you were outlining. And that’s where we start. So back in the day, I came up with the term airway prosthodontics, just to differentiate it from sleep dentistry. So we were clear, but it still hasn’t become clear. So let me see if I can create some more clarity to it.

[Jaz]
Because what I’m thinking immediately is will not, the first part, will not, the airway based prosthodontics that will also impact our sleep. And so they are connected in a big way, right?

[Jeff]
They are, but I would go to an easier step because if you connect it to sleep and say sleep apnea, let’s say, the moment you connect it to a medical problem, your markers for success change dramatically. The minute you say my patient has sleep apnea, in order for you to be successful, you have to make that go away. Right? It either has to, success is reducing the apnea level by half and being under 20, cure is under five and the apnea hypopnea index, right?

So the minute you establish the standard for care or your metric for care as apnea, you’re playing in the medical world. I don’t wanna play in the medical world. I don’t want anything to do with that. And to be honest with you, I had a physician in my office, an ENT in my office for five years, and they don’t want us playing in that world either.

They don’t. Their world is completely different than ours and you as a dentist, you don’t want to be in that world. It’s an ugly, ugly world. And most physicians would love to be dentists nowadays because we have so much more freedom to change and to act and to care for our patients than they do. So with that in mind, that was my original goal, was how can I use this to integrate medicine and dentistry for the first time, let’s work together as a team.

And the more I did it, the more I figured out we don’t wanna do that because they’re gonna take over. And if we are treating to the apnea level, it’s medicine. And medicine then wins and every decision. And I don’t want to be there. So came up with the term airway prosthodontics, which actually could impact the apnea, but doesn’t focus on the apnea.

That’s not our central theme. Our central theme is doing the two things that we’ve taught at either in global diagnosis or facially generated treatment planning in the spear world, which are where do the teeth belong in the face and how do you get ’em to function correctly? Those are one and two of every system that’s ever been developed that you’re using for treatment planning.

So when we look at aesthetics, there are three main areas of aesthetic tooth positioning that happen on a wax rim before you ever set a tooth, which is you’re gonna get the transverse dimension correct. You’re gonna get the AP dimension correct. You’re gonna get the vertical dimension correct. So you get all those three things established, and then you start setting the teeth into ideal position.

The vertical, the transverse, and the sagittal dimension and position of the upper arch are all key airway factors. And so if any of those anatomic factors are irregular, you will have more difficulty breathing during the day and at night when you go to sleep. So aesthetics in the maxilla is number one, not only the way we’ve always thought about treatment planning, but it’s number one for airway because it’s connected to the nasal cavity and changes in those dimensions.

Orthodontically, orthopedically, orthognathically will make you breathe better. How much better? We don’t know. No one will ever be able to tell you in advance, but we know it makes you breathe better. The second is function. By the way, function used to lead back in the day when I learned it, function was the leader.

It was all occlusion. It was a lower arch dictated treatment. And even in ortho, lower arch dictated treatment. Tweed orthodontics take teeth out, put the lower interiors over the ridge, move everything to it. Lower arch gnathology, Pankey-Mann-Skyler, everybody was lower arch. The upper arch just sort of sat there and you worked around it.

Today, if we established a maxilla first, the aesthetics first, and then do the lower arch the same way we would do a denture when we get the lower arch in the proper location to inter interdigitate, the airway is also better at that point. So are there other factors beyond that?

Yeah, sure there are. There are soft tissue issues or tongue ties, large tongues. Adenoids, tonsils, deviated septum, which actually come from constricted maxillas. There are lots of things that could be added onto that. But the two main factors that make you breathe better during the day and at night are aesthetics and function.

They’re exactly what we need to do in treatment planning. So for me, airway is just establish the aesthetic position of the teeth first and the functional position of the teeth. If you get those things normalized, then we help the patient normalize what they do, which is close them mouth and breathe through their nose.

That’s dentistry, and the success of that treatment is does the patient have a beautiful smile and a great bite? That’s success. Not did I reduce the apnea level. So that’s the big difference between the two.

[Jaz]
When you’re assessing that in a patient in the medicine world, they use the, yes, apnea hypopnea index as a marker. You said that aesthetics and function, are you also using cone beam CT scans and they look at the volume of the airway? Is that a metric that you use as well in terms of, okay, by doing our prosthodontic intervention, we’ve improved the airway by volumetric percentage?

[Jeff]
Yes, but I don’t treat to a number that way. Do I look at it? Yes. You know the interesting thing about cone beams, the thing I look at most often is we now know that if you do a cone beam and do slices at the first premolars, so we’re doing AP slices first, premolars, then go back to the first molars and do the same thing. Measure from bone to bone on the palate.

We know the widths that you need to be healthy so I can take a CT of you or any of your patients. And I can cut it and go, you’re too narrow. You’re gonna be sick. And you look at me and go, well, I don’t snore, I don’t have this, I don’t have that. I go give it 10 years or 10 pounds. And you’re gonna, so why would you wanna wait around the way medicine does until you’re sick?

Why don’t you treat it in advance ’cause we know you’re gonna be sick. And the closer you are to that number, the more risk you’re gonna have. We also know, if we look from the side, sagitally, we know that distance. We know that from porion, which your ear hole, if you drew a vertical line off it, an a point which is up under your nose, if you drew a line measuring between those two points, 97 millimeters is a number, you have to be greater than if it’s not greater than 97 millimeters, your odds go up dramatically with or without obesity.

Your odds go up because cranial facial is more important than weight. And we also know that vertical, people that grow vertically, VME patients. Those are airway patients. They’ve always been airway patients. We’ve called them adenoid faces forever. We called them that for a reason. So we know if your anatomy is off, you’re gonna be off.

So yes, I do use cone beam and I use it that way. I like cone beam even in children because I can see the nasal cavity, I can see any deviations, any issues in the nose. I can see the adenoids. I can see the tonsils in 3D. So we get a nice view of those structures also. So if I can get even really, really little kids, they have those quick cone beams, the four second versions, if you can get one of those, then even like four year olds, it’s awesome ’cause you can see anatomy you wouldn’t otherwise be able to see.

And in fact, we now know another, there are many reasons why you wanna treat kids very, very young. We’re treating 26 month old as the youngest I’ve ever heard, done Invisalign first to expand, start expansion early. But at four you can start to see if you’re leaving them in a constricted pediatric arch that the permanent teeth are gonna erupt outside of the housing of the bone. So, the orthodontist never moved the teeth outta the bone. They were never in the bone to begin with. So.

[Jaz]
Well, that was actually gonna be my question. My next question is that, okay, based on what you’re describing, what percentage of your dentistry is for children, and then what percentage is for adults, let’s say someone in their forties who seems to have minimal dental issues, but you’ve made these diagnoses and you know these metrics and they’re gonna run trouble. At that point for an adult, it’s very much, I’m guessing, gonna be surgical orthodontic or a combination of both would be the mainstay of treatment, would you say?

[Jeff]
All right. Let me answer the first part, which is children. Children are absolutely the key. I ran a family practice before I went back to pros. I don’t enjoy treating children anymore. I did ortho on kids. I did all that. It just wasn’t something that I enjoyed, and so I stopped. If I had to do it over again, I would continue. It was, the reason I stopped is I had one case that the patient went away for six months and the wire was active and I didn’t know how to recover from it. And so in my mind, I was like, I don’t know how to deal with that, so I don’t wanna do anymore.

And so I gave it up. I just gave it all the orthodontists. In hindsight, I should have just said, I don’t know enough. I need to learn some more. And instead of thinking, I knew it all, you know, right up front, and if I did, I would still be treating kids and I would have a bigger impact on my community because I would be treating young.

That’s where the problem needs to be dealt with. The problem needs to be dealt with in newborns. Newborns that are tongue tied. And having difficulty breastfeeding if you can’t breastfeed as a child, if growth discrepancies are huge. So breastfeeding is absolutely the best thing you can start. And if the mother doesn’t want to do it, that’s fine.

But what I find and just hate to see is when the parents come in and I look at the kid a little older and their tongue tied and lip tied, and I ask ’em about breastfeeding, they go, yeah, they weren’t good. They didn’t latch well or it hurt, or whatever it happened to be, well, they wanted to do it, but there was this anatomic restriction, which now we’re having to play ketchup because they didn’t get to grow normally as a kid.

So breastfeeding, what they eat, how they eat, lots of things that we can do to make kids grow and we start intervening way earlier. We getting ENTs involved to look at tonsils and adenoids in an earlier level. We don’t require apnea before those things are removed. We require symptoms, attention deficit, grinding their teeth, reflux, wetting the bed, thumb sucking beyond early years, moving around in the bed, sleep, talking, sleepwalk, any of those things.

Start promoting the idea of getting tonsils and adenoids out, and then also expanding arches. And so, yes.

[Jaz]
This is very relevant to me, Jeff. So I’m sorry to intervene, but just to let you know that my son’s gonna be two tomorrow. He’s gonna be age two tomorrow. But since he’s never been a good sleeper, since he was born and I knew something wasn’t right ’cause I hear snorting and sometimes he would stop breathing and I knew something wasn’t right. And we have so many healthcare challenges around the world and getting diagnoses and stuff in the UK in particular. So I managed to see the right person that got this sleep test and lo and behold, he was diagnosed with moderate sleep apnea at age 18 months.

And he’s on the list for eventual when he’s like healthy enough for adenoidectomy, which actually my elder had as well. So I’ve seen firsthand why my interest grew in this ’cause I wanted to help my own son and he was breastfed. And he was breastfed fine. In fact, my wife made it to one year. And interesting stat is that in the UK, and I dunno what the US or rest of world stats are, but in the UK only 1% of mothers are breastfeeding at month six, only 1%. So my follow up question will be, do you think this has been a huge player in terms of the why we are seeing so many more of these issues?

[Jeff]
Yes, there was a perfect storm of problems that happened in the late fifties, early sixties. Antibiotics started being used instead of surgery for tonsils and adenoids. Part of it was, it used to be if, like, if your brother got his out, you got yours out, which is wrong. So they were overdoing the surgeries.

Then they went completely the other way. Women went back into the workforce at really high numbers. And so breastfeeding went way down. Gerber introduced soft foods and mushy baby foods instead of the natural course was six months minimum breastfeeding, and then introduction of solid foods after that.

Gnawing on solid foods grows your face. There’s crap in the air, crap in the water. I mean, there’s all kinds of different stuff in our food, right? Everything plays a little bit of a role in what we call epigenetics. And so it’s environmental factors that are altering natural growth and development.

In addition, and this is totally a guess, there is some science to this, but not enough to be causative at all, but somewhat correlational, folic acid in prenatal vitamins, decreases neural tube defects, but the tongue ties are neural tube issues, so they close earlier than they should have. And so we get a lot more tongue ties than we used to in the past.

So yeah, it was a perfect storm of bad things that happen. Interestingly, I think it will be interesting to watch that percentage because at least in the states, people are starting to take an approach of what can I do to be healthier? Can I have clean foods? Can I do supplements? And in the space of taking care of children, there’s a refocus on breastfeeding I think. So we’ll see if that number grows, but that would be a good thing if it does.

[Jaz]
Absolutely. I mean, it’s much high in some of the Scandinavian countries, like 33% and whatnot. But yeah. Interesting. Six months. It was 1% in the UK so well done to my wife. But yeah, sometimes not possible and stuff, so I wanna make this about, make anyone feel guilty and whatnot.

But no, I think as a fact we know that if you can, you are able to breastfeed your child. Yeah, it’s the best thing. I mean, a stat I had at the time was something like 20 times less likely to have some sort of orthodontic issue properly to do with your palate dimension, I imagine.

[Jeff]
Absolutely decreases sleep disturbed breathing issues and it reduces malocclusions prematurely born children are absolutely gonna have sleep disturbed breathing issues ’cause they’re so far behind in growth and development and breastfeeding is the best way to catch them up.

‘Cause you can almost get them caught up to normal kids growth and development through breastfeeding. The nice part for, to sort of file away for people is whatever time you do it is good. If you breastfed for a month, the numbers are significantly better at eight years for your kid. So whatever you do is good. Your question then was about getting the older patient, the 40-year-old-

[Jaz]
So that scenario described where you take a CBCT and then you notice that the dimension from first molar to first molar and the palatal bone and it’s not meeting a minimum number. And they say to you they don’t have any issues because they’re now an adult, they’re fully grown. What kind of treatment interventions are available to these patients?

[Jeff]
Part of your question that’s interesting is they say, I don’t have issues. But most people don’t know what they don’t know. They just call it normal. Woman I was visiting with earlier today had had orthognathic surgery. And she said, I didn’t really realize that I never was able to breathe and I never slept until I had the surgery done.

And she said, you told me that about all this stuff, but I did it ’cause I didn’t like my profile and so aesthetically I thought it was gonna be a nice change. And she said, I just didn’t realize it. And now like it’s a different world. So part of our job as dentist is to, well, airway, like I said, airway’s just putting the teeth where they’re supposed to be is for aesthetics and function.

So if a person says, I don’t have a problem, I don’t necessarily have to argue with them about it. If we can come to some agreement, your teeth are in the wrong place and your bite is off, and that’s all I’m doing, then I know I’m gonna make your airway better and I don’t have to focus on it ’cause in the end, what success you have a pretty smile and you have a good bite, so, I don’t need you to believe you’ve got an airway problem.

The time it becomes important to get you to believe you have an airway problem is if you have ugly teeth and a bad bite and you’re not really wanting to do a whole lot about it, but you know that there’s an airway problem and a bad smile and a bad bite, the airway problem is the one that you can have a conversation about easier than any of the other ones.

I find it extremely difficult to have a conversation with people to say, oh my God, you’re ugly. Right? I mean. You don’t walk into a room and go, oh man, look at that. That’s hard. Even when it is like they got a crown on a central and you go, wow. Like, whoa, we can make those look like teeth nowadays.

I don’t know if you knew that. So you see that, or you look at their bite and it’s just totally messed up and they’re chipping teeth, breaking teeth. Oh no, I do fine. I eat right. Those two things for me are really hard to talk about, but if I can talk about health and link all of those things together, now I give them something they’re interested in, which is being healthier for a lifetime than they are right now, or would be in the future without any care.

But I get, what I get from it is I get to do all the cool dentistry I always wanna do, which is put the teeth where they’re supposed to be, rather than camouflage it with ceramics and stuff, put ’em where they’re supposed to be and then make ’em beautiful. And then, you know, put the bite together. And a lot of times I do less dentistry.

I mean, huge advantages from a dental perspective, great smiles, great bites, maybe less dentistry. Maybe if I have to do the same amount of dentistry. At least it’s the right shapes of teeth. I mean, they’re anatomically correct rather than warping teeth around and stuff. So what do you have to do?

And you’re right, typically orthodontics plays a big role in this, but it doesn’t necessarily have to jump all the way to to orthognatic. There’s a middle piece nowadays that is surgical based orthodontic therapy. And the surgical base, orthodontic therapy is not orthognatic in nature. The two main ones are, well, I’m gonna lump into surgery for a second, but it’s really not surgical.

The two main ways of expanding arches are surgically facilitated orthodontic therapy where we make corticotomy and cuts in the bone and add bone. That’s like adding base plate wax, so you get a little change in the anatomy, right? The other one is MARPE, so, so mini implant assisted rapid palatal expansion.

Now, I said you have to do a surgical intervention. That’s a non-surgical intervention, but it is an intervention, right? You have to put Tads in the palate and expand off the tads. Today, I’ve kind of gone the whole route on this. The original MARPE that we used was MSE, so four Tads, small, little tiny screws and such.

Today we’re using custom MARPE, so we’re using 6, 8, 10 long Tads, big solid MARPEs. And so we can split anyone open up to the age of 70. So you walk in my office and you need expansion and some AP, we can do all that non-

Interjection:
Hey guys, it’s Jaz with an interjection. So we’ve got two interjections for this episode. Let’s talk about dual bite. Okay, so dual bite is basically a scenario whereby you have a patient who when they bite together, their teeth fit together well. Right. So they have their dental home, their maximum intercuspal position. The relationship between the teeth. Now this patient, right when you seat their condyles, their jaw drops right back like distalises, and they also have a bite in that position.

So this patient is said to have a dual bite, okay? They have a bite where they have like a dental home, and then they have the bite where they have a skeletal home, i.e. the condyles are in the Fosse, or I like say the balls are in the cups and in this position, their teeth also have a bite. So they have a bite that’s further forward and a bite that’s further back.

And this is a dual bite patient. If you routinely start to check your patients for where their centric relation contact point is, or where their stable condylar position is, whether you deprogram your patient or use a leaf gauge or whatever, then you’ll start to identify these dual bite patients who have this very large slide. So that’s what we mean by a dual bite patient.

[Jeff]
Surgically, and then orthognathic comes into play only in my office when non-surgical expansion with MARPE and SFOT on the lower ’cause the lower dictates how wide I can make the upper go. That doesn’t resolve whatever the problem is. My smile doesn’t look good, my bite doesn’t look good.

But the main one is I’m still don’t feel good. I’m still grinding my teeth. I still have reflux, I still have TMD issues, I still whatever. And in that case, we’ve gotta move forward and any big protrusive movement in particular mandible has to occur surgically. So orthognathic comes into play at that point in time.

[Jaz]
So what you do is very, a lot much multidisciplinary, right. Orthodontics, oral surgeons, what you do is very much a team-based approach.

[Jeff]
Yep. I’ve got a practice where the first visit I ought to have like a rotating front door ’cause they come in, they see me and they go right back out to see other people. It’s just in and out from other consults. So I have most of my new patients that are interdisciplinary in nature.

[Jaz]
That’s really the whole-

[Jeff]
But you know, if I was, like I said, if I was smarter back in the day, I would’ve stayed doing ortho and I could have done a bunch of this ’cause I would’ve, the skills at this point in time to do for sure 50% of it, if not 75% of the stuff I’m talking about. I don’t think I would’ve ever taken on an orthognathic surgery case. I think that would’ve always scared me to deal with those cases. But I actually personally did the SFOT surgery and I put MARPEs in so that I can expand. So I’m expanding people.

[Jaz]
So you’ve had all this done to yourself?

[Jeff]
No, I had the SFOT done to myself, but I do it to other patients now.

[Jaz]
Okay.

[Jeff]
So I just, the other day, I always get this question in the classes, which is, where do you find somebody that’ll do that? Like, I don’t have any in my community. And the answer always was, well, if the guy that’s doing it right now doesn’t do it, go find someone.

Go find a younger guy, that’s hungry and has some new knowledge and such, and would like to establish his practice based on this and get a chance to work with you. I bet they would love to do it, but a lot of the people I teach, the orthodontist comes in once a month and does ortho in the town.

Right? So if that orthodontist says no, who are they supposed to go to? And so I got to thinking about that, like I’m spoiled by working in San Antonio and I am spoiled by having so many great teammates. And so I’m speaking from this position of well just go down the street and find another one, right?

And so it hit me one day and I was like, well do it yourself. And then I thought, well, if I’m gonna tell somebody to do it themselves, then I better be able to do it myself. So, I started doing a few and it’s not that hard. So.

[Jaz]
What kind of changes have your patients experienced that you look back? A lot of my colleagues that I look up to that have been practicing for years, they say, the full mouth rehabs they did when they come back, 15, 20 years later and everything’s working well and it makes ’em really happy and dentistry and their smile looks great and whatnot. That’s the kind of stories I’ve heard. With your focus on the airway, what kind of changes have you experienced in your patients?

[Jeff]
All right, so first thing is your colleagues are lying to you. Nothing looks good at 15 years. It’s still in the mouth and it’s not broken in 15 years.

[Jaz]
Yes.

[Jeff]
Ceramic ages. It always, you look at it go, ugh. So yeah, I don’t get much of a thrill at seeing rehabs. I always tell the story. Back when I was in dental school, people were so grateful. They’d like, you’d put these ugly crowns that you made and residency or in dental school, you’d put ’em in and, and in hindsight you go, man, those were ugly.

People were crying, they were bringing you presents. They’re like, oh my god, my whole life I’ve always wanted white teeth and you gave me, there is just like the greatest day ever in dental school, right? And then you get out and you charge a fair fee for it and they start like, wow, what about that edge right there?

I don’t really like that. So they complain a lot. The nice part about the airway is if you do it the way I am suggesting is you are transforming their lives in multiple ways. You’re giving them a great looking smile. You may be giving ’em a great looking face, right? You send ’em out for orthognathic.

By the way, if you do that, custom MARPE, their face will look better as well ’cause they’re midface will fill in because you’re actually expanding the whole maxilla up under the eyes, the zygoma everywhere. So you give ’em a great smile, a great face, you give ’em a great bite, they can function wonderfully and they feel good.

And then you give ’em this great airway. And the way they know great airway is whatever the thing that triggered you to say, you probably have a bad airway like bruxing, reflux, TMD headaches. Those are gone. And because it takes a while to get ’em through the whole treatment, a lot of times they forget. And so in the end I have to remind them, hey, you still get those headaches? And they’re like, no, those have been gone for a while. Oh, that’s so good. So yeah, it’s very cool.

[Jaz]
I manage TMD patients there, Jeff. And what I also realize is they kind of forget where they were. And so at the very first few appointments I get them to mention all their issues and give it a score out of 10 about how much it affects their life. And then oh, as we go through, they’ll score it.

And then when they’re down to like a two or three as like, oh, that’s interesting. You were a seven. No, like eight months ago, whatever. So it’s very, very true to that point you raised. It’s amazing what the impact you’ve had on these patients through thinking in this way, but this level of knowledge that we need to upskill and we need to open our eyes to this and you’ve done great contribution education.

I’ll ask you and again at the end, where can we learn more from you and whatnot. So it’s our duty to upskill. But two things I want to just talk about for our younger colleagues. One thing is you mentioned a great bite, so what are some features that you look for? You look at a bite and say, that is a great bite. What constitutes a great bite?

[Jeff]
Well, are you talking about a restored bite or because a restored bite for me is gonna be in a seated condylar position ’cause that’s what I work to. A great bite doesn’t have to be the teeth all in the right location either. It can be a bite that the patient is so adapted to that there’s no damage to the teeth.

I had an 85-year-old lady in not too long ago, and there were nowhere on her teeth at all, and they weren’t what you would call a dentoform perfect teeth. But yeah, that’s a great bite. It functions without damage. That’s perfect. now, that actually leads me to talk a little bit about one of the topics I’ll have at the AES meeting and its pathway wear or envelope of function would probably like, or envelope of dysfunction. People call it all kinds of different names. You have posselt’s diagram.

[Jaz]
Well spotted.

[Jeff]
So once again, just for younger people, I don’t know what term they use or where they’re in the world or where they’re in their education, but I’ll describe what we at Spear Education would be a person that actually comes in and we call it pathway wear.

Pathway wear. So pathway wear is that as you chew your lower teeth, nick the lingual surfaces of your upper teeth. So the lower anterior teeth will wear at an angle, so they’ll be higher in the back, lower in the front. They typically will create a shiny wear facet there. So if you took a photograph, you’d see the light reflecting off of this shiny area, and then the upper lingual surfaces will be hollowed out and they can be hollowed out in different paths.

They can kind of come in a lot from the side, or they can be tighter paths, but they can’t kind of just eat out the lingual without really taking away the length of a tooth. So the tooth still remains long. You just eat the backside out and as the backside goes away, tooth erupts. Not only does it erupt straight down, but it also erupts in.

So it keeps getting tighter and tighter over time. And with that tooth loss, sometimes at the very end, it’ll chip at the edges and you can almost see through the enamel ’cause they’ve hollowed it out so much. Very difficult case to take care of because we want to do everything restoratively.

That’s a huge flaw in how we’ve been taught as restorative dentists to work when teeth wear they move and if they move you need to move them back. And so we should always think in terms of orthodontics first. So a wear case walks in your office, you figure out am I gonna move them back or is the orthodontist gonna move ’em back?

But somebody’s moving these teeth back where they used to be before I fix ’em ’cause you can fix ’em so much more conservatively that way. The only other option you have is open vertical dimension, in which case you’re doing all the teeth upper arch or lower arch or both arches, right? So huge amount of dentistry and most of our patients don’t need it and or can’t afford it. So we need to learn to integrate orthodontics in that regard as well.

Alright, back to the topic, which is this pathway wear, where the teeth are getting worn out. So we have for years said, that’s what happens. And people just nodded and said, yeah, that’s what happens. They hit the backs of the teeth and they can’t be restored there.

And so then we talk about orthodontically moving the teeth and here’s you have to put ’em back in the right. But we just made the assumption that happens, and I have this weird thing that I do, which is if I ever have a question, I go to the literature and if I go to the literature and can’t find an answer, I do experiments on my patients.

Now, I don’t tell ’em really. I just ask. I got this new toy you wanna play with it. And I got a lot of patients that are really fun, been around forever, so they love being involved in that stuff. So here’s what happened to me. I heard it from a lot of people. I heard those patients being called, like they chewed like rats.

So they just keep chewing. And I just wasn’t convinced that people would run into their teeth ’cause I never honestly banged into my teeth when I chewed. So I wasn’t convinced. So I went to the literature and then, you know what the literature says? The literature says that if you give people that have tight bites like that, so class two div two type patients.

You give them food and they chew, they never touch their front teeth. They’ll do anything in their power including mess up their joint to stay away from their front teeth. And I’m like, well those two things don’t work together ’cause I’m being told by really famous people that they do bang their teeth.

But I’m also being told by the research that watches ’em chew that they don’t touch their front teeth. So I went in and did the experiment on my patients to mimic what they did in the laboratory and I found that no one touched their front teeth. So started looking for different answers like. You know, what could it be? What could it be?

Well, now airway has entered my world, so I’m now in this airway world and I kind of lose focus on this chewing pattern thing. And one night, about three in the morning, I wake up and I’m like, I wonder if those two things are related to one another. And I got on the internet and I’m searching through the literature on PubMed, and I found a group that actually did a study where they did exactly the chewing study I was talking about, and found that no one hit their front teeth.

And then they said, what kind of sandwich do you want to have? Because if you think about it, all the people that break stuff in your practice, they break when they’re eating a sandwich. It always has bread involved in it somehow.

[Jaz]
Always a soft one.

[Jeff]
Yeah. So occasionally it’s hard foods, but almost all the time it’s like tuna fish salad sandwich, right? Something soft. And it has bread in there. And so this study did exactly that. What they found is that during a chewing cycle, you have to be able to manage your airway. You have to be able to breathe through your nose. People that are constricted in their bites like this. If their maxillas are constricted, and if their maxillas are constricted, then their nasal cavities constricted.

They can’t breathe well through their nose. And so if you go from giving a small piece of cheese or beef jerky or a peanut to chew, they can manage their airway, have ’em bite into a sandwich with a bunch of bread and a bunch of stuff in it, they can’t. So their chewing cycle will move forward and they’ll hit their front teeth.

In addition, apnea patients make their soft palate numb to holding a food bolus, and so the food wants to slip early on them and so they actually get out of normal chewing cycles a lot. So airway explains a lot of the reasons for tooth damage that we never had an explanation for in the past. We always just called it, this is what they do. They just do that. And we never knew why, and now we know.

[Jaz]
That was brilliantly explained. Absolutely love that. And it makes so much sense. You also talked about, when I asked about the great bite, you mentioned a seated condyle position and you also said that, okay, well, in that hypothetical scenario where you have someone who has a restricted envelope function or constricted or basically a lack of overjet, deep bite, and if you open the vertical dimension, then again, perhaps overkill, where ortho is needed and just bringing all those themes together.

Do we have a concern in dentistry that when we are doing a rehab type case or when we are choosing to use a repeatable joint position, i.e. stable condyle position, seated condylar position, centric relation, call it what you will, that we are making the airway worse. But from the bulk of this discussion so far, I like how you’ve been addressing it from the maxilla and you’ve been talking about the maxilla predominantly.

Whereas quite often in my learning as well, I made a mistake of perhaps being a bit too focused on the mandible. And so what do you think about, if someone’s got a huge slide or they’ve got a long way to go back and that could be making the airway worse, what advice would you give to dentists? When we look at the joint position, when it comes to the airway?

[Jeff]
Two things. One is you’re talking about a dual bite patient. A dual bite patient will have greater than three millimeters between their maximum cuspal position and their seated condylar position.

Interjection:
Okay guys, interjection number two. What are TADS? So TADS are Temporary Anchorage Devices. They’re also called mini screws. And I’m gonna explain it very briefly like this. Imagine you are extruding a broken down premolar and the way you’re going to extrude this premolar, and actually this topic is on my mind at the moment ’cause I’m going on a course next month exactly about how to do more of these kind of cases where you take like a broken down premolar and you extrude it orthodontically.

Anyway, imagine you are extruding this and you are relying on the two teeth next door to extrude. Now imagine that as an unwanted consequence. Yes, the premolar extrudes but the two adjacent teeth, let’s say the canine and the other premolar, they end up intruding. So the premolar that’s broken down, we extruded orthodontically and the other two teeth, they intruded.

You could say that you lost anchorage or you didn’t have enough anchorage. Now imagine if the two teeth next door to that broken down premolar were implants. If they’re implants, they’re kind of like fused to the bone. And what then happens is the premolar extrudes. But nothing happens to the implants because the implants give you lots of anchorage.

And this is how clever ortho folk, they use these mini screws and temporary anchorage devices to do all sorts of crazy movements because it gives them skeletal anchorage. It reduces those unwanted movements. Back to the episode.

[Jaz]
I’m happy to talk about that, but also just generally, like, we know that for most patients, their seated condyle position will be further backwards, further distal. So how do we know which patients can be making worse?

[Jeff]
But not much. So my take on this and to my knowledge, there hasn’t ever been a study, so I don’t know of a study. So I’m gonna base this on my opinion ’cause I don’t know of literature. My opinion is that the patients that you and I deal with routinely, that all we’re doing is seeding and equilibrating to and keeping the vertical essentially the same.

Those patients that has no impact on their airway at all, the patient would do a dual bite. Absolutely is gonna have an impact ’cause you’re gonna drop ’em back significantly. But the one that people forget is, you were talking about doing a rehab, I would assume you were describing doing a rehabilitation in a seated position at an open vertical dimension.

[Jaz]
Usually yes, we need the space. Teeth are worn right.

[Jeff]
So when you open the vertical dimension, it will absolutely have an impact. And it’s usually negative.

[Jaz]
So I guess what you’re trying to say also then is, sorry if I’m putting words in your mouth, but you know, correct me if I’m wrong here, is it’s the opening of the vertical dimension that is the sinner rather than the seating to a seated condyle position.

[Jeff]
Yes, unless you’re talking about a dual bite patient. Okay, so if we take that case out of play, then yes. It’s the opening of the vertical dimension that is the problematic part of it. And unfortunately it hasn’t been studied a lot, but there have been three studies and every one of them shows when you take patients with mild to moderate apnea.

And you make ’em night guards and we’re talking just a classic one to two millimeter opening posteriorly, five millimeter open anterior, the one everybody makes that at least 50% of those patients are gonna get worse. And it’s usually somewhere between 60 and one study at a hundred percent of the patients.

Now the a hundred percent didn’t get much worse, but they got worse. So if you have a class two patient and you open their vertical for whatever the reason happens to be, there are airways already constricted anatomically, and now you, doubling up on, ’cause they’re actually down the arc already and you’re even like really gets bad fast.

Class two even worse than class one patients. So the vertical is the killer. Bill McCor taught me resolution before reconstruction. So McCor is a big gnathologist, lectured at AES and his idea was you need to get the joint healthy before you actually reconstruct. And so he would make orthotics before he would do reconstruction.

And his logic was that if opening the vertical dimension was a bad thing, then the patient would react badly. Well, that logic has gone away a hundred years ago. I mean, it just, no one believes that anymore. ’cause that if a person comes in in pain, you make ’em an orthotic and you open the vertical and so you’re making the thing to make ’em better that he thinks might have made it worse, but now that we have this airway data, you go, well, maybe there is something to it. ‘Cause maybe we go old school on this and make an orthotic at a proposed vertical dimension and see how they react to it. If they’re grinding really aggressively on the orthotic, you just made their airway worse.

If they get headaches, if they, whatever. I haven’t gotten there. I actually now watch my provisionals more than I used to in the past. I don’t trust my provisionals up front. I tend to stay with them longer if I’m opening the vertical a fair amount, so significant opening of the vertical dimension or more class two type of patient that I’m opening. I stay in provisionals longer just to see how they react ’cause I know I’m gonna probably be messing with their airway.

[Jaz]
One school of thought that’s been shared to me is in those patients potentially with a dual bite or those who are, you are opening up significantly. So your vertical dimension increases quite significant due to the level of wear and compensation that’s happened.

And because you are opening up so much, there is a concern about the airway. And then therefore you may then not be choosing to use a repeatable condyle position, a seated condyle position. You’re using what they say, an arbitrary position, which could be further protruded or the mandible be set further forward. Do you have any concerns about using such a joint position, which many people with a dual bite may function on?

In terms of stability? Mostly in terms of stability ’cause I always think, okay, you build them there, but what’s gonna keep ’em there long term? Is that a way that you’ve managed your patients? What would you recommend to people who who’ve heard that advice?

[Jeff]
Okay, so you had a lot of things in there. The first is people that had a lot of wear, they can either lose vertical or they don’t lose vertical, they just lose tooth structure, right? So if a person doesn’t lose vertical, just lose tooth structure, and then you open the vertical, now you’re impinging on the airway. If the person loses vertical and you open vertical, you’re actually just making ’em normal again.

[Jaz]
You’re reestablishing what they had.

[Jeff]
Potentially. You’ve normalized anatomy rather than altered anatomy. The dual bite patient, I tend to work to the bite, to the MIP position, and I remember having this epiphany and I had two denture patients in a row that had an old denture in like a class one setup that were all worn out, and I was making ’em a new one, and I put ’em in centric relation and they fell way back.

I was like, holy crap. And so I started trying to make their denture in that position and they go, I don’t like it back there. I don’t go back there. And I’m like, well, I mean, I was cocky.

[Jaz]
I’ve been to this exact same thing, one year outta dental school. I remember this exact patient and how much he hated it and it was a huge slide. So yeah, definitely been there.

[Jeff]
I’m the dentist. I know it was fast. I can’t control your occlusion unless I worked at this position. It was horrible. And finally, I remember in the end there were two patients in a row. It was weird ’cause it was like God was smacking me twice. You didn’t learn. Here there’s another one, there’s another, all these, keep sending ’em.

And I finally learned, right? The second one, I remember one day going, just bite wherever you want. And so she bit down and I made her denture there. It was fine. So I then like went, okay, I don’t need to work to a seated position. I can work to their maximum intercuspal position. What disadvantages are there when they chew hard foods?

The chewing data. Remember I said I kind of got into this looking at chewing data. The chewing data on hard foods says they seat their condyles, and so that’s where you damage second molars a lot is they put a piece of beef Turkey in their mouth. They have to load through the food, they will seat their condyles, they’ll hit posteriorly.

And so I try to mount them in the seated position and see if I can adjust that on the articulator. But I worked in the MIP position, so I just see if I can provide myself a little bit of a lack of interference in the seated position. But everything else is focused up front. The other one that’s interesting is since I got into the airway part that kind of feeds into this as well, is I went and took some courses in neuromuscular dentistry.

And so I started using. A TENS unit on patients that were those rat chewers, the pathway wear people that needed freedom-

[Jaz]
Class 2 Div 2 type.

[Jeff]
Yep. And then I married that information with MRIs on them, and what I’m finding is that the cases that work really well for neuromuscular dentistry are actually disc displacement cases where the condyle is back and down and the disc is slipped forward and is crowding the condyle out.

And if I either tenses them or I can just relax ’em on an orthotic, either way they tend to get to the same spot. But we’re not working down and forward on the eminence. We’re actually centering the condyle by giving ’em the freedom to go there. So, I don’t know, the airway stuff’s kind of opened up a lot of really cool different avenues to look at for like why things work.

Because you know, there are too many people that I think are smart people that do things differently than me that I just can’t understand why you would do that. And like, that’s not how I was taught. That can’t possibly work, but they’re smart people and they’re running good practices and I can’t believe they would just like do it wrong.

There’s gotta be something to it and airway really feeds a lot of answers or at least can. And so little things like that, like the neuromuscular people got such a bad wrap over here and were just berated every time they did anything. And I was like, those guys, they just can’t be wrong on everything. I do think they overuse it, but I think in the right cases it’s great. It works out perfectly. So I’ve done a few cases like that as a proof of concept.

[Jaz]
What you said is very validating for me personally as someone who’s always wanting to learn from the different occlusion camps. And it ties in very nicely what AES is about nowadays in terms of bringing everyone together, sharing knowledge, different camps coming together, if you like.

And I always say that listen to everyone, but do what feels right to you. One of my listeners actually sent me that advice and I always like to share it. And so I always find that certain cases, some of the principles I’ve learned from the course of philosophy, they work really well here. Some things that work in this philosophy really well.

Just like you notice that okay, certain patients, what you’ve learned from neuromuscular dentistry can be applied well on those patients and I really admire that we can learn from everyone and then pick the right time to use that skill where it makes sense to you the most.

Jeff, we’re coming to the end of the time, I just wanna say, wow, that was just absolutely packed full of stories and interesting anatomical explorations. We focus a lot on the maxilla, which was very good for me. This is all learning for me as well, which is fantastic. Can you give us a flavor of what you’ll be talking about at AES in Feb 2026? I’ll put the links and everything below obviously.

[Jeff]
Yeah, I’m gonna build on the idea almost exactly what we ended up with, which is questions you’ve always had in your practice that airway might explain and sort of a medical dental connection that the airway could be the component that we’ve been missing all along.

At least in my dental school, we didn’t study how people chew. We studied how an articulator moved around, right? So we forgot the biologic part of it. And we talked about my patient, bruxist, but we forgot there’s might be like, why? Why would they do that? And we really didn’t spend a ton of time, we talked about how to make a splint, right?

My patient bruxist is let’s make ’em a splint like we always are jumping to how do we fix something rather than asking why. Because if I can figure out why I might have all kinds of cool ways of dealing with the situation. So we’re gonna ask a lot of why questions. Why did this patient do this? Why did this patient do that?

And obviously because of the topic and the title, the answer’s gonna be airway. So if at any point I ask the audience like, well, what do you think? Just answer airway, you’re gonna probably be right.

[Jaz]
That sounds amazing. And over the years, what does the AES mean to you and why should some of our younger colleagues around the world visit this conference in Chicago?

[Jeff]
I have to get ’em to add it up. I’ve at least lectured five times, maybe way more than that. I probably have lectured there more than anywhere else in any big conference. And so I’ve gotten to watch it evolve over time. If I was to kind of give you an idea, actually you summarized it really well, it’s because it looks at the broader scope.

It’s not exclusionary to any different perspective, even some that you would consider sort of out there. Neuromuscular has been at this conference a lot. Like the best people in neuromuscular have spoken a bunch at this conference. And the other beautiful thing about is they’ll put ’em on panels with people like you were talking about today.

We talked a lot about the maxilla. Well I was on a panel with Jim McKee and Mark Piper, they’re the mandible. And so I just kept saying, you gotta get the maxilla in the right place. You know, the mandible follows the maxilla. And so we have this debate and then the audience gets to be involved in that debate.

So I don’t know of any other conference that allows that unique of a format and breadth of information. Like AES. So if I was, coming to Chicago, absolutely, the AES starts the week. So it’s a Wednesday, Thursday conference, and there’s no better way to start the week than at the Equilibration Society.

[Jaz]
And most importantly, Jeff, where is the place to eat when they’re in Chicago?

[Jeff]
So this one’s one that it’s, you need to save for a long time. Alinea is the best restaurant in Chicago, and it’s gonna cost you so much money. It’s crazy.

[Jaz]
But it’s all tax deductible. It’s fine.

[Jeff]
Alinea is phenomenal. It’s a, actually everyone needs to have one of those kinds of experiences and then go back to your practice and try to make your practice like Alinea, because it’s just service at a higher level and thinking about every detail instead of, you know, like I walk into my practice and every day I enter from the back, but I try to go to the front and walk through my practice as if I’m walking through as a patient.

And I’m looking at everything. I’m looking at it as a trashcan full. We need to get rid of that. Is anything dirty? Is there a book out of place? Is there I looking, is there anything that a patient might see? And then I listen constantly to how do my staff talks to people and Alinea does a beautiful job. So that would be-

[Jaz]
There we are another learning experience through that. Thanks for that share. I’ll make my reservation well in advance before people listen to this podcast and it’s oversubscribed on that Wednesday night. Jeff, for those who are hungry to learn more from you, I know you’ve got so much, you’ve contributed in terms of, in the form of education, so many programs that you deliver. Where’s the best place to book some of your courses and learn more from you?

[Jeff]
So it’s my main place to lecture about this is at Spear Education. Spear education’s in Scottsdale, Arizona. It’s a beautiful teaching institute, and the seminars are two days long. The workshops are three days long. But for a lot of your listeners, that’s gonna be quite a bit of traveling to do.

And me personally, I’m cheap. And so, although I just told you about expensive dinner, but I’m really cheap if I’m trying to make a decision about continuing education or whatever I want to know, I’m gonna have value when I get there. One of the things you can do is go to Spear Education and get in the online platform, in which case you’ll see all the videos, we produce all the courses, and you can actually watch some of the stuff in advance of coming to Spear and you’ll see the value behind the education that we give you at Spear.

So that’d be the introduction I would have if I was living somewhere else. If I was in England, I would watch the online platform and go, okay, that’s something I want to do. Or, I mean, we’ve got courses and everything, so if you happen to be working tomorrow and you’ve got a horizontal root fracture and you want to know what to do about it, we’ve got courses that you just pop on, like a YouTube video and you’ll find out in five minutes what to do with that particular case. So we’ve got all kinds of things, but airway is part of it.

[Jaz]
Amazing. I can definitely vouch for the quality of educational videos on Spear Education website as well. So I’ll put the links on there, especially to your stuff on there as well.

[Jeff]
Oh, you know what else I got coming? Oh Jaz, I forgot about this, that global diagnosis textbook I wrote with Bill? We got a second edition coming. It’ll have airway in it.

[Jaz]
When’s it coming out?

[Jeff]
Oh, I don’t know. Whenever I finish writing my chapters, he just yelled at me last night about it. I’m thinking probably the end of the year. So Quintessence and handles it and so they’ll Bill announce it.

[Jaz]
Amazing. I can’t wait to get a copy and I’ll get signed by you personally when I see you in Feb. Awesome. I’m very excited to meet you in person, but thanks for giving up the time to speak about something that’s so dear to your heart. And I think we can all just learn more about this because the impact, like you said, will have on our patients will be so great.

And anyone out there in a position of which way to pivot their career, the early in the career, which way to pivot, then what a wonderful direction to go in, with a health focus and the ability to help children in all ages actually. But such a positive influence you can have. And I think that’s something definitely I’ve picked up today. So thanks so much, Jeff.

[Jeff]
Oh, you’re welcome. Thanks for having me.

Jaz’s Outro:
Well, there we have it my friends, thank you so much for sticking all the way to the end. Some really great points that Jeff raised there, how the airway is there to explain so many things that are almost unexplained or unanswered.

So I’m really looking forward to his talk next year. Also, highly recommend his textbook Global Diagnosis. I know the second edition will be coming out probably, I think at the end of the year. But I’ll put a link to his excellent textbook. If you have access to it, please do check it out. If you’re like a student and you have this book in a library, then please get it.

If not, then tell your librarian, you need to get this book. It is phenomenal. Once again, this was an AES takeover episode, so please do consider coming to join us in Chicago in February, 2026. It’s on the Wednesday and Thursday. That’s the AES conference, 18th and 19th of Feb. And it’d be great to to see you there. Come and say hello. If this podcast is the reason you ended up at the AES, please do come and say hello.

Now, just to wrap up for those Protruserati who are subscribers to Protrusive Guidance. Thank you so much. This episode is very much eligible for CE Credits or CPD. We are a PACE approved education provider.

As you’re watching in the app, just scroll down, answer the quiz, get 80%, and our CPD Queen Mari will email you a certificate. In fact, what we do is every quarter we’d email you your personal dry folder with all the certificates that you’ve collected from the podcast episodes and our mini courses on the Protrusive Guidance platform.

More than the education, it’s about the people. Now we’ve really attracted the nicest and geekiest dentist in the world. The reason I specify that is I’m trying to attract people who listen to the podcast, but who identify themselves as nice and geeky. And for those who don’t, they stay away. And that’s amazing ’cause I’m trying to build a special group of people, people who can share failures with each other, be a little bit vulnerable, and it is very much a protected space.

We have to manually verify each person who applies to come on Protrusive Guidance. So if this sounds like your bag, then check out Protrusive app that’s www.protrusive.app sign up, and it’d be great to see you there. Whether you want to get the CPD or just join the community, it’d be nice to have you.

Thanks for listening, watching, or wherever you’re tuning in from today. Don’t forget to leave a review. I read every single one, whether that’s on Spotify or Apple Podcasts, wherever you are checking this out today and a thumbs up button on YouTube. Thank you. Once again, Protruserati. Catch you, same time, same place next week.

Bye for now.

Episode 193: Finding Low-Cost Capital To Boost Your Amazon Business With CJ Gianatiempo