Facts from the National Youth Sports Foundation for Safety

• Dental injuries are the most common type of orofacial injury sustained during participation in sports; the majority of these dental injuries are preventable.
• An athlete is 60 times more likely to sustain damage to the teeth when not wearing a protective mouthguard.
• The cost of a fractured tooth is many times greater than the cost of a dentist diagnosed and designed professionally made mouthguard.
• Every athlete involved in contact sport has about a 10% chance per season of an orofacial injury, or a 33-56% chance during an athletic career.
• The cost to replant a tooth and the follow-up dental treatment is about $5000.
• Victims of knocked out teeth who do not have a tooth properly preserved or replanted may face lifetime dental costs of $15,000-$20,000/tooth, hours in the dental chair, and the possible development of other dental problems such as periodontal disease.
• It is estimated that faceguards and mouthguards prevent approximately 200,000 injuries each year in high school and college football.
• The stock mouthguard which is bought at sports stores without any individual fitting, provide only a low level of protection, if any. If the wearer is rendered unconscious, there is a risk the mouthguard may lodge in the throat potentially causing an airway obstruction.

http://www.sportsdentistry.com/

Seems like a silly question, doesn’t it? If I had to boil it down to one concept that has made NTI therapy successful, it’s the acknowledgement that most chronic migraine and headache sufferers don’t (or won’t) admit that upon waking in the morning, having some degree of discomfort above their shoulders in completely “normal” for them. Not just headache or even full blow migraine. It could be the facial/forehead and back-of-the-neck combination pain, sore and stiff jaw, or “sinus” headache.

In comparison to the migraine episodes they experience, their morning headaches are somehow “manageable”, and therefore in their mind, not worthy of including in their complaints to their health care provider.

They’ve seen plenty of doctors for their headaches. They’re asked specific questions regarding the degree of pain that alters their normal function like, “When you get your worst headaches…”, and “What makes your headache worse?”, or “How many times per week/month do you have a migraine?”. Rarely, if ever, is a chronic migraine or headache sufferer asked, “Exactly when DON’T you have any degree of headache, even the slightest?”.

There are two simple questions to ask in a interview of a headache patient.

Question 1: On a scale of 0-10, with 10 being the worst discomfort above the shoulders that you could imagine (includes neck, jaw, sinus, headache or migraine pain), and 0 being no pain at all, how many mornings per week do you wake with a ZERO, that is, you feel fabulous?

That last part needs to be emphasized. To anyone else, not having pain upon waking is normal. Sure, you can still feel tired, but a lack of pain isn’t remarkable to the normal person. For the chronic headache and migraine pain sufferer, a degree of pain IS normal. For them, having no discomfort at all would be, well, fabulous. Perhaps unintentionally, the chronic headache and migraine pain sufferer avoids that acknowledgement.

Most chronic headache sufferers will hesitate with their reply, and then begin to rationalize their their answer before they provide it. They’ll begin by stating, “Well, when I get my really bad headaches…”, or, “Nobody ever really feels fabulous”, or some justification as to why it’s “within normal limits” for them to have discomfort upon waking. The practitioner must press on, and confirm how many mornings per week that the patient wakes with ZERO pain.

Experienced practitioners will soon find that being pain free is quite rare for the chronic headache sufferer, especially upon waking. The practitioner can remind the sufferer that waking daily with, say, liver pain, or kidney pain, is certainly not normal, and so it is with chronic headache pain. They can’t be helped to the fullest extent if their entire presentation is not understood.

Question 2: On those days that you don’t wake with a ZERO (that is, you have “a number”), what’s the average “number” that you have?

Now the practitioner will have a clearer picture of the patient’s condition and likelihood of the presence of nocturnal jaw clenching. Waking 5 days per week with a level 4 headache, to some chronic sufferers, is not worthy of reporting. They have learned that they must deal with the discomfort and reserve their complaints for the degree of migraine pain alters their daily lives. They are wary of being labeled “drug overuse” patients, because in some practitioners minds, constant headache, especially upon waking, could only be due to medication overuse.

The chronic sufferer figures that their worst headaches and migraine attacks are far more important to try and manage than their chronic “normal discomfort” existence. Besides, no one has been able to diagnose and alleviate their normal discomfort, anyway. However, to the practitioner, this information is critical in the assessment of the cause and/or perpetuation of their patient’s condition.

This is not to suggest that chronic nocturnal masticatory parafunction (ie, intense jaw clenching) is the lone cause of chronic headache or migraine pain. On the contrary, it is better considered as being a primary complicating factor and/or perpetuating influence on chronic headache and migraine pain. Better stated, habitual nocturnal jaw clenching cannot, by itself, cause chronic headache or migraine pain, but chronic headache and migraine pain cannot be completely managed in the presence of un diagnosed and uncontrolled nocturnal jaw clenching. In fact, without controlling nocturnal jaw clenching, traditional medical management of chronic headache and migraine pain typically less that satisfactory of falis altogether. As Andrew Blumenfeld, MD, likes to say, “Controlling chronic jaw clenching doesn’t cure migraine, but it can help reduce the frequency of migraine attacks…sometimes to zero”.

Following the first month of NTI therapy, the practitioner can re-ask the two question above. Although the patient might first proclaim, “I’m still having headaches” (as if no improvement had occurred), the practitioner may discover that the patient is now waking less frequently “with a number” and that the level of that number is reduced.. Continually using the two questions above is a handy tool to follow a patient’s progress.

-James P. Boyd, DDS, Developer of the NTI therapeutic protocol.

When listening to Dr. John Wilson, you are startled by the humble and self-effacing nature of this popular Vancouver Island dentist. With his patients he uses a “you’re the doctor, i’m the technician” approach to his dental practice. He doesn’t consider himself ‘special’ or ‘above anyone else’; as a consequence, he has developed sincere compassion for his many loyal patients. He believes that this philosophy is sometimes lacking in a small number of the younger dentists of today who see their dental career more from an investment perspective.

Dr. Wilson’s advice to young dentists is “become the best dentist in the world” and all else will follow. He urges them to spend the time necessary to master their dental craft, take the courses to improve delivery and learn how to communicate effectively with staff and patients. He encourages dentists to practice in small town environments where he feels the rewards are greater, both professionally and personally. However, he qualifies this belief in saying that the small town should be close enough to a ‘big city’ to allow for the benefits a large cosmopolitan centre can offer.

John possesses a ‘green’ side that is prevalent in many west coast Canadians. He is currently planning to build a cob house to improve his lifestyle and lessen his impact on his natural surroundings. Modern cob houses still use ancient building techniques and materials like bricks made of mud, sand and straw and harnessing natural energy sources such as passive solar heating. To these older wisdoms are added the latest in today’s technological thinking; the result is an environmentally friendly accommodation and living style. While these homes might not appeal to all, they are highly efficient, cost effective, sustainable and low maintenance ‘green’.

Growing up in Gananoque, Ontario, the son of steel worker, he had two choices: work in the steel mill or go to university. He is thankful he was born and raised in Canada and praises his parents for a ‘normal’ upbringing that allowed him freedom and choice. He has tried, with his wife Sylvia, to provide a similar upbringing for his own children.

One of John’s children, Jannah, is a surgical resident entering her final year of residency. Like her father, she works hard – very hard at her chosen profession. A typical week at the Ottawa Hospital involves a minimum of sixty hours and sometimes, the hours served are twice that amount. Jannah loves the pace of hospital life. She enjoys thinking on her feet, calling on her manual and mental skills to solve the never-ending problems of providing quality medical care for her patients.

Prior to medical school, Jannah worked in Methadone clinics on the east side of Vancouver. She taught a Youth at Risk programme for troubled teens.  She considered and explored careers in both sociology and law enforcement. She thought about a career in physiotherapy and worked as a fitness trainer at a rehab hospital. What drives this energetic young professional? She freely admits she is an adrenalin junky looking for a challenge and the high she gets from her work on a day-to-day basis. She learned perseverance (a word she uses often) from both her sister and her father. Her sister overcame a hearing disorder from birth through sheer determination and hard work. Jannah grew up looking up to and out for her older sister. Her father asked his children to strive harder at whatever they did and he himself lived the credo he encouraged in his children.

The possibility of following in her father’s pathway as a dentist was never rejected. While her father never encouraged any one career, including dentistry, he did ask Jannah to think hard and long before becoming a doctor. The endless, demanding hours that a career in medicine entails were his central concern. Ten years down the road, Jannah hopes to have worked as a locum in hospital settings in at least three provinces. Educated in French Immersion classes, she wants to perfect her fluency in French and become truly bi-lingual. She loves the natural setting and lifestyle of British Columbia and hopes to practice in the northern regions of that picturesque province. As a child growing up in Timmins, Ontario, she acquired a soft spot for Ontario, especially its cottage country. For now, Jannah looks forward to another year of perfecting her surgical skills and procedures. Her perseverance and patience coupled with her desire to problem-solve and volunteer as an international aid worker keeps her humble and balanced.

Dr. John Wilson credits his wife and family for his being grounded, open and caring. Jannah concurs with her father. The unconditional love provided by her mother, her interactions with her siblings and the respect for others that her parents instilled, usually derived from dinner table discussions, was crucial to her development. Her sister’s early hearing struggles taught her about human vulnerability. She laughingly related that her ‘brat’ brother taught her that patience was indeed a virtue. Both John and Jannah fondly recall family dinner chats, when everyone related the events of their day. It became a time of sharing feelings, debating ideas and reflecting on everyday issues both big and small. John and Jannah understand the need for a personal life and vacation time. They are active and physically fit, enjoying skiing, sailing and hiking. Jannah loves sports, travel and is happy riding her motorcycle whenever possible. John, in his spare time, is content to be busy planning and building a cob house. Both live life to the fullest.

Bottom Line: This article relates the lifestyle and interests of two health care professionals who just happen to be father and daughter.

Article originally published in Profitable Practice Magazine – Dental Edition – Fall 2012

Follow-up article Profitable Practice – WestCoastLifestyle