The Future of Dentistry Is Airway-Focused

What if the future of dentistry has very little to do with simply fixing teeth  and everything to do with understanding breathing, sleep, facial development, and long-term health?

In this episode of the Airway Nexus Podcast, Dr. Mark Cruz and Dr. Richard Stevenson break down why airway-focused dentistry is becoming one of the most important shifts happening in modern healthcare and dental education today.

They dive deep into the concept of the “airway spectrum”  from pediatric airway issues and facial growth development to sleep apnea, TMJ dysfunction, worn dentition, gummy smiles, clenching, grinding, and full-mouth rehabilitation. The conversation challenges traditional dental thinking and explores why many treatments today may only address symptoms rather than root causes.

If you’re interested in airway dentistry, sleep health, orthodontics, facial development, functional medicine, TMJ, or the future of comprehensive patient care, don't forget to follow.

To learn more about Dr. Mark A. Cruz, DDS. visit:
https://www.MarkACruzdds.com
Dr. Mark A. Cruz, DDS. 
32241 Crown Valley Pkwy #200  
Dana Point, CA 92629  
949-661-1006 

Transcript

Mission And Big Picture

SPEAKER_02 0:00

There's no way we're monetizing this to become rich. We're doing this because this is what needs to be done in our profession, and I wanted to make it happen. This is a huge commitment for us.

SPEAKER_00 0:12

At the intersection of airway, sleep, dentistry, and whole body health, three leading experts come together for one evidence-driven conversation. Dr. Barry Raphael, integrative orthodontist, and co-founder of the Airway Collaborative. Dr. Richard Stevenson, award-winning educator, author, and authority in restorative dentistry. Dr. Mark Cruz, respected lecturer, clinician, and contributor to national dental research, where science meets clinical insight. This is Airway Nexus.

SPEAKER_01 0:48

Hey everybody, welcome to another episode of the Airway Nexus. Hey Rich, how are you doing?

SPEAKER_02 0:54

I'm doing great, Mark. How are you doing?

SPEAKER_01 0:55

Good, good. Really excited to talk about our topic today. Super excited about it. So uh what's up, man?

SPEAKER_02 1:06

Well, you know, uh we we have come up with an amazing curriculum, and uh we call it the Airway Nexus, and I think it's important for us to talk a little bit about why we think it's so so important that this kind of education exists today. And I I think probably one good way good way to you know kind of break the ice is to to ask you, and you've said this many times, that you know, we don't treat sleep per se, but we we we basically help sleep when we treat breathing, or basically another way uh thing that we said is you know, every smile begins with with a breath. And I think um, you know, you need to clarify that a little bit because uh I think most people listening probably don't really have a good handle on what we mean when we talk about airway-focused atistry. I just don't think they do.

SPEAKER_01 2:02

Yeah, no, I agree, and and and and we can actually define what that means, but I think let's just kind of give it a dental

Every Smile Begins With Breath

SPEAKER_01 2:10

context versus you know the foundational concept of the medical indications for dental treatment, which we'll talk about. But something that I think every dentist would relate to and the public at large is you know uh smile design, right? Just digital smile design, aesthetic smile design. Well, when you really understand the concept of airway-focused dentistry, you're really treatment planning that smile by understanding the facial skeleton, right? So every smile begins with a breath because the facial skeleton, one of its main moment-to-moment roles is breathing, right? The caliber and size of that airway. So nice broad smile, great arc of smile, beautiful facial structure. That is synonymous because form follows function with you know, good airway phenotype, if you will. Obviously, it's more complicated than that, but patient comes to you on Monday and wants to have a beautiful smile because they've got a worn dentition. Well, with an airway focus, you really look at the patient and the conversation is very different than the traditional, all right, let's go ahead and do a diagnostic wax up, let's go ahead and do our photogrammetry, let's go ahead and uh understand archivosmile, display, proportion, arrangement, all those things, pink and white aesthetics that have been taught in the last 15 to 20 years. Very different. Those are that's a subset, if you will, of the underlying foundational concept of an airway-focused approach. Makes sense?

SPEAKER_02 3:51

Uh absolutely it does. So, I mean, uh to me that makes sense anyway. I mean, I think that you know, when most people think about airway, I think they're they're just stilling it down to

Why Weekend Courses Miss The Mark

SPEAKER_02 4:05

the the what their role is in sleep dentistry slash sleep apnea. And I think that's that's one great big camp of people that are out there looking for courses, you know, like uh, you know, what's my role in this? Can I make a living doing this? What what kind of compensation can I have? Can I really help people? How do I make these devices? What's the best company? What am I looking for? How do I get paid? Should I take Medicare? Should I work with a physician? You know, how's it all work? And there's that whole huge industry that is this, you know, this end stage of this illness that's out there. And then also certainly emerging uh and growing in in popularity is the expansion orthodontic mindset, and those courses are filling up and people are taking them in droves. But what I'm hearing is that people take the courses, they understand the concepts about expansion as part of the puzzle, but I don't really think that they've been even given the pieces to complete the puzzle. They don't even know what the puzzle is even supposed to look like when it's completed. So it's it's a little bit of uh it looks good and you're seeking something that you think is going to help you, and then you take the course and you kind of go, huh. Yeah, even if I could expand, what am I really trying to do here? I mean, it seems like maybe I should just refer to the orthodox. I mean, that's what they're that's what their specialty is. And so I have encountered these two huge groups of people, then also at the same time, I'm getting uh the message that there are some courses that are more than that, that somehow uh pick up a lot on the mini residency that used to conduct for you know well over a decade. You and Barry Rayfeld did that, and um and they they have a lot of that built into it, which sounds interesting. Some of those courses are out there, but you know, I I think they're missing the a huge piece that the airway nexus is going to introduce, and I don't know, I just I I'd throw that back to you and comment on on what my perspective, if if that fits with what you're seeing, and then what you see as uh the missing piece or the pieces that would help a clinician truly transform their practice and open their eyes to another whole uh way of looking at their patients.

SPEAKER_01 6:50

Yeah, no, it there's there's a lot there, and we'll get into the details of but I've got the bullet points in my head here. So we'll get into the brass tacks of, if you will, on on um the curriculum that ends up um with a fellowship. Basically, uh you become a diplomat. Now, let me make this very clear. This is not sleep dentistry. There's like you said, there is that camp, the AADSM, the American Academy of Dental Sleep Medicine. This has very little to do with that. Has very little to do with sleep apnea, other than the fact that, you know, you do will see patients that have that end stage diagnosis, but it's really not, I mean, as I say, that's the tip of the iceberg. We're really actually dealing with the base of that iceberg in airway, and that's really what's missing. I'm not interested, nor was I ever interested in appliance therapy, a management, if you will. So you solve one problem short term and you create another. We have a whole generation of patients that were dealing with that, whether it's chondral position or changes due to uh using mats, uh uh mandibular uh repositioning appliances, um and they're focusing on just one segment of that whole spectrum.

SPEAKER_02 8:15

And and let me can I stop you there real quick?

SPEAKER_01 8:18

Yeah.

SPEAKER_02 8:19

Most people don't understand as a spectrum. Honestly, they don't think of it as a spectrum, and yet I do, you do, we know that's what it

Airway Problems Across The Lifespan

SPEAKER_02 8:30

is. So can you just talk a little bit about what that is? I mean, let's look at the long arc of the airway, you know, disease, if you want to call it, or it's not really a disease per se, but it's you know, it's just it's a structure, function, behavior um construct that starts really early and goes all the way to the end of life. And patients that have sleep apnea today probably could have been helped a long time before, earlier. There are ways to recognize who will ultimately end up in these end stages and catch them much earlier, more preventive. And um, I think that's where people there's a lot, there's a lot of misunderstanding, or maybe they're just frankly, they don't they don't understand that that is even a possibility.

SPEAKER_01 9:22

Yeah, no, no question. And first of all, let me just um backtrack just a little bit because you are an educator and you have you know you your teaching institution, you were the uh department chair of the restore department at UCLA, you have your fingers on the pulse of what the provider, the dental provider, is doing in the way of continuing education out there. I mean, you know, because you you live that day-to-day more so than even clinical dentistry, as fine a clinical dentist as you are. You know, your focus is uh on really understanding education. You've been an educator, and you're that rare combination of an educator that actually can do it as a clinician. So I'm just gonna say that because you have your fingers on the pulse and understand that uh I have a respect for that and understand exactly what you're saying, that people are thinking that it's about appliance therapy and it's just another weekend course you can learn, or if you want to become a diplomat in dental sleep medicine, uh, I think that's a mistake. Uh that is an absolute mistake, and there are lots of reasons for it, and it's no different than what medicine is going through now, where the specialty of sleep medicine is a dying specialty for the same reason. Um but to go back to the spectrum of sleep disorders, let's just say that what we talk about in the airway nexus is the entire timeline from that first breath when you're born all the way to the end stage when you die, right? So each of that, in the entire timeline, there is a spectrum of degrees of severity and progression, but also there is a spectrum of age, right? So it's it's a couple of things. So if you're a pediatric dentist, you're gonna be dealing on that epoch, if you will, of the spectrum in pediatrics. If you're, say, a prostodontist or someone that focuses on temperamental disorders, you might be more towards the end stage or middle to end stage of the spectrum. And I think that's a mistake intellectually, because that means you really are not understanding the problem of an airway-focused problem. And this is what why the airway nexus curriculum is the solution, because it really gets into understanding the entire spectrum from the innocent snore in pediatrics to uh which is quote unquote innocent, um, to full-blown end-stage severe sleep apnea, all of which uh will give you uh information diagnostically as far as prognosis, as far as um morbidity, um, as far as what the um um interventions that you would take and the team that you would put together. All the things that we'll get into maybe a little bit more detail in a little bit, but I think what's exciting is that we're actually talking about something that no one is right now. I guarantee you, I I just as much know as you do of what's out there. And yes, there are courses that are bringing in, they might bring a sleep token sleep physician to talk about it, or they might talk a little bit about skeletal expansion because it's a widget and you can monetize that, right? On Monday. Is it intermolar width? Really? Because oh if they're not wide enough, what's the number you expand to? So those are I think those are all really missed, in my opinion, misguided uh understanding of what's going on, and yet that's where everyone's jumping into it. So I think we need to be careful uh about that. So to answer your question, I I I think that that's um what you know what the issues are, is that there is a spectrum, and everyone is focusing just on the end stage. And even at that, sleep medicine and medical insurance is reticent to really deal with it. And if you go into health care to really help your patients, but let's just say it's your neighbor, your friend, your spouse, your kid, you're gonna take it very seriously for them in addressing this for the rest of their life, right? You're gonna get early intervention, you're really gonna understand why they're so symptomatic when they're it's early onset, versus while they're not so symptomatic when it's late stage because there's been so much damage to the brain. So the signaling that uh in the autonomic nervous system that's been hammered is not working, so you have this false sense of security that it's not that big of a problem. Uh, a little bit of snore, I just sleep in a different bedroom. But um, that's where we get into the the the course, and what's exciting as just a regular dentist is that how you see the patient and and really read

Rethinking Gummy Smile Treatment

SPEAKER_01 14:45

what wear patterns, where it's in the anterior, in the posterior, whether it's uh muscle temper mandibular, uh uh probably related to the muscle or a franc capsulitis in the joint, or whether there's erosion, um, why they have a reverse smile line.

SPEAKER_02 15:06

Um about a gummy smile, Mark. A gummy smile. Okay, I mean, I I I just got off uh a 30-minute Zoom consult with uh a patient that wants to have veneers and highly educated uh a patient that uh got referred to me, lives in a different state, and so it's common for me to have these uh initial meet and greet um you know conferences. And uh she believes that the solution to her gummy smile is a combination of Botox, crown lengthening, and veneers. And and yet has uh uh you know the obvious phenotype of somebody that's suffering in in in in a that we we we learn in our course. And the interesting thing is I would have uh you know, even as maybe even a year ago, I would have entertained her proposal. Said, yeah, we can do that. Uh but today our discussion veered a different direction where we actually uh we're we're talking about you know identifying she was she was coming to terms with identifying her own problems uh and uh admitting to what she sees when she looks in the mirror, um, and uh was contributing her own symptoms that would alert us to to a person that's uh you know that needs some assistance and needs our help.

SPEAKER_01 16:39

Well, could I tell you right there? Yeah. Okay, so here's the interesting thing is that you only know what you know. You only see what you know, and so what's happened is we've conditioned as a profession our patients that increasingly are becoming educated by going on uh social media, Instagram, YouTube, um, talking to influencers and short snippets of you know, two-minute discussions of you know, you could use Botox for the hyperactive lip to deal with that gummy smile, or um, yeah, veneers and and this combination, especially now with what we talk talked about uh in the past is looks maxing, for example, people are really more consciously aware of, but they just don't understand, and neither does a provider, because that's what we were taught, right? You know why? Because we didn't understand that of what we could do in controlling the foundation of the what houses the teeth, as I say, treating the patient attached to the teeth rather than just focusing on the teeth attached to the patient. That's how we were all trained, right? So when you have a patient like that, I look and say, I understand, I mean, I would say the same thing, and then you start asking questions that the answers to what you already know with the narrow focus, where the patient starts coming back and going, Wow, um, I get that, I understand. Well, how did you know that? And then they almost lead you. They, you know, you can more properly co-diagnose, and they start understanding that the problem that they're looking at, that they want to fix, is just one sign, if you will, or a symptom of a deeper problem that had they known that it was connected, they'd be more motivated to fixing, which is their ability to breathe through the nose, keep the lips together, um, sleep deeply, wake up energetic, regulate metabolically, keep their blood pressure, all those things that also cause dental problems, clenching, grinding, Temp D. So as you start going through that, um, that patient now goes to where the veneers and the Botox and all those things, they may be tools there, tool chests for sure, but they might be put off after you've addressed the root cause or the foundational things. You maybe expanded, maybe you um uh did some corticodies, clear aligners, or whatever mechanics that you want to increase uh oral volumes of the breathing and sleeping better, the tongue is not obstructing them as as much, you're dealing with the myofunction and the behavior and all those things. And then at the end, depending on how severe the case is, how old the patient is, how healthy they are, you still may use some of those tools, but now they're gonna be more precisely used with better prognosis. And and so spend a whole um podcast just on what we didn't know about with the typical gummy smile diagnosis, right? VME, dental extrusion, hyperactive lip that is now really changed dramatically. So, as a dentist, if you're listening, but that's antiquated, it's it's stale information because we have more information, right? So that patient you talked about. Does that make sense?

SPEAKER_02 20:05

Oh, it does, you know, and it's like the the the diagnosis of the gummy smile, the seven possible diagnoses. I look at every one of those diagnoses, they all have a a common uh yes uh you know source, and it's absolutely the phenotype of the air, it's an airway-related issue, no matter which one you're looking at. Anyway, I think that's really interesting. I wanted to talk a little bit about

Inside The 32-Day Fellowship

SPEAKER_02 20:30

uh our the architecture of our course and why it's different. Yeah, and um I'll say a few things. First of all, in and as an educator, I really believe that um I've come to terms with you know the right amount of education and not over not, you know, we always talk about over-treating the wrong problem. We want to we don't want to over-educate the the the dentist, and so but but we also don't want to leave things um behind. So we we really thought about this a lot, and um I I'm just ex this is really you know, there's a movie called you know Mr. Holland's opus. This has got to be you know Dr. Cruz and Stevenson's opus, because this is the 32-day plan that I think you and I have just always well you have, but more recently for me, uh thought that would really be the right number of days to commit. You know, you go to the I'm a graduate of the COIS Center, that's 27 days, uh, and not one day of that when I took it had airway involved. Um we're talking about a 32-day course that uh covers you know in depth the identification, stabilization, the mastery, all the widgets too. By the way, we love widgets, Mark. Widgets are cool, they're cool. I mean, I like designing them, I like placing them, I think Marpe's are are amazing, and I I think knowing how to use them is. A great skill set and everything else. It's not like we're not including that.

SPEAKER_01 22:03

But including, by the way, mandalive advancement devices, we still use those two absolutely one tool in a big tool chest with the proper indications. Yeah, you got it on. I'm sorry.

SPEAKER_02 22:14

Yeah. No, and it's like we we we have a 256-hour program. I mean, this is serious. And you know, going all the way from the initial identification where you know nothing, all the way to the most complex uh surgical interventions, working with allied health uh, you know, individuals, um, rehabilitation, all of that would be included in the thing that um that makes it really different, different, and that's something that you and I know very well, is that study group component to it where we are including clinical care of patients over almost like a it's like a mentored year of clinical clinical dentistry, uh, where we provide all the patients in a really wonderful state-of-the-art facility, uh, and you get to actually learn through treating patients. And that's not all, because every single, and I've never heard anything like this, Mark, but every part of the course, every pillar, if you will, has two follow-up Zoom meetings where we meet with everybody and we talk about what we learn, any questions. I mean, who's doing stuff like that?

SPEAKER_01 23:39

I mean, that's amazing, but it's required to keep people on task because everyone's a clinician, they've got their wives, they go home to families, we get that. And I just have to say, Rich, you know, one of the things that's wonderful and how we got back together as classmates, and after many years, um, you mostly in education mean more mostly in clinical practice, although we both have dabbled in the other uh other realm, is that you know, for now we're well over 15 years, I think I was uh actually it's closer to now 18 years, where I was giving these courses when no one was really giving any of these courses. It was very, very small, and then it started growing, and and and Barry and I started giving them the mistake that we made, if you will, was we focused on the theory, giving all the different aspects of it, credible growth and development, epigenetics, looking at medical comorbidities, dental comorbidities, looking at the use of the importance of allied health and function. We had all these 12 chapters that we brought together over uh well over uh 100 hours of continued education that was in the classroom, if you will. But when all was said and done, everyone saw it and they were very excited about it. But what we didn't do is really provide a concrete way of translating it into real-world practice on Monday. And a lot of these were made, and actually it's what ceded and gave rise, I'm confident, in a lot of what you're seeing out there right now. Because I know the people that are out there that are doing this, and that's great. I mean, one of our uh one of our tag lives was secondary goal of teaching the teachers, which is you know what's happening. Barry and I were talking the other day of saying, see, this is what's happened. We've taught the teachers, and they're out there, and they've influenced other people, and this is exactly what we wanted. We wanted to be open source, to raise the awareness that we weren't crazy about it, and that the orthodontic specialty was more and more increasingly feeling the pressure of not doing business as usual and just straightening teeth out. Okay, so um, I think what's what's different here is that you went through that program when you when you asked to learn more about it, you had already kind of had some background in it, and then you went through it twice. And with your eyes as an educator, you're able to help develop a much better curriculum that allows the dentist on Monday to start translating into real world practice, um, getting patients scheduled for treatment right away for evaluations, um, and and be able to actually increase the the spectrum of uh services, if you will, for the patient that makes them healthier as you're going through it. So it wasn't something that you'd have to go through two years and then you start doing that. Well, that was a mistake. No, that was a mistake, right?

SPEAKER_02 26:53

Oh, right away. You know, and um, you know, it's it's there's still a fair amount of classroom work, but there's always clinical relevance, uh, translational discussions. Um uh you're constantly bringing up cases, you know, in the in the in the uh world-class, world-class presentations that you give, Mark. Uh, we have patients that we bring in and do demos on. In the even in the identifier and stabilizer, the pillar one and two courses, we still will bring in patients and show exams and question the Q ⁇ A part, photography and stuff. But but it's basically to introduce those concepts and then the mastery series after that. Either these two or three-day uh uh courses that get added on allow the clinician to pick up on those whenever they can, you know, because we're also super busy. So, but those take a deeper dive. For example, going into you know, uh cornitology course with surgically facilitated orthodontic treatment, uh, another course on on you know the uh the orthotropics and pediatric area. Right. I mean, so if you if you think about it, I mean here's the here's what I and I appreciate um you your your um compliments and and and also recognizing uh that the synergism of our two experiences of the world and dentistry and healthcare have really made for a much bigger uh volume of of potential that we could have done individually, and you know, summative. I mean it's it's it's kind of an exponential thing. And you know, I I um I thought to myself, what would I personally want? You know, um what would I want if I was one year out of dental school? What would I want if I were 10 years, 15, 20? So, and I thought you gotta make it uh it's gotta be accessible, we gotta figure out a way to to make it very translational. Um, and people almost, I mean, I would love to say the tuition for the course could be paid for with just the patients they'd start seeing almost immediately. You know, it's not like, oh, it's gonna happen two years from now or whatever when you graduate. No, I mean you're already seeing the benefits of of this right away. I mean, for example, I I ran residency programs, right, at UCLA. When we accepted a resident, they would get super excited about working on patients and doing all this kind of stuff, and and they would start producing for us. They would start producing for the clinic, and we needed them to produce for the clinic. And so it it didn't, they didn't have to wait till they finished the program to start working on patients. That was part of you know the whole process of learning. So I just am really, really proud of this because this is this is gonna allow people to engage in patient care immediately after just six days. After six days, boom. You're in the clinic and take engaged in patient care and then take a well like a residency or or a fellowship, right?

SPEAKER_01 30:15

Hey, have you ever seen the uh the series The Pit, HBO series, the pit? Oh, yeah. Yeah, yeah, right. It's it's a little bit like that. You know, you're in the emergency room, and then you've got uh, you know, the uh interns, and then you've got uh first year, second year residents, and then you've got the attendings, and you've got this hierarchy, and then you've got all hell breaking loose, and everyone's gonna go in there, and you're you know,

Mentored Clinic And Learning By Doing

SPEAKER_01 30:40

uh first-year resident, you're a place placing a chest to, right? The first one that you put it it's like you cannot do that unless you've got an experienced provider that's there to help you to do your first one and you learn. Well, the thing that I'm excited about in our program, and it would have been great if I would have had this myself, um, and certainly did in our hands-on restorative uh study groups that I was in, where we were seeing patients and we had a mentor, and uh helped tremendously even after you know years of practice where they you know it wasn't like you were still just out of dental school, you still you still had a mentor kind of giving you some things that really accelerated your learning curve, efficiency, diagnostic skills, and all that. But if let's say you want to do learn how to do ALF or uh bioblock orthotropics, just as an example, you actually will be able to learn by doing it after a lecture, actually seeing a patient and seeing that patient all the way through. There isn't anywhere in the country that you do that. There are many residencies where you go and you watch someone else do it and talk about it, but Monday you've got to go in there and say, Well, how do I adjust that class? You know, same thing with the ALF. You watch other people do it, you kind of learn it. Well, this is actually what you do. Same thing. I mean this marketing, placing your pads the first time you're actually doing it. If you want to do surgery for corticotomies, right, we're gonna teach you that because we've got a faculty that looked so that's what I'm excited about.

SPEAKER_02 32:19

Yeah, I mean, and I and I know what other courses run financially, and I don't want to get into the finances too deeply right now, but I do want to just say that you the clinical involvement in this program is significantly less of investment than and you're treating the patients versus one where you actually watch watch someone do the work and you pay more. So it's like, wait a minute, well, there's a little disconnect there. Um, we we're we just understand that the way to really jump through to the next level is to to truly have a hands-on experience. And just telling people to go do it in your practice and let us know how it goes and show us your cases, that's fine. But if you have if you came to a center and you were assigned a patient and you had to work on that patient, but you did it under a mentorship situation where you and I and the other incredible faculty that we have will be and will be engaged in the in the person uh uh learning and the whole experience and getting the getting the patients um committed to the work. And I'm the patients love the experience because they just know it's it's very transparent. Patients love this because they're like, oh my gosh, there's there's nowhere I can go to get this work where there's a group of people that are check it's it's like this second, third, and fourth opinion all built in, it's all part of the treatment. Um there's nothing like this except for the the study clubs, and there's very few of them in the world.

SPEAKER_01 33:53

Or dental school residencies. Right. And they're struggling because they they uh are going out to community centers. But the the the thing is is, and you know this is my pet peeve, and and why I'm excited because this is a solution, is even faculty that I've had before that knew a lot, because let's say they had gone through uh the curriculum, uh they knew a lot, but they never really treated a patient. And they could talk like an expert on what device, but they never actually have to troubleshoot any. What happens when you're placing your first uh Marpey? You went through a weekend course, and the head strips as your placement. Who's gonna be there to help you troubleshoot that in real time? So you're gonna do one of those and then you're gonna say no more. The thing is, you've got to make some mistakes in the clinical setting, and we're there to help because we know what those mistakes are gonna be before they happen, and so we uh guide you through. And the other thing is that you get the confidence that on Monday you're now treatment planning them on your own patients, and we have case reviews like on the Zooms to answer those questions and to help troubleshoot. But you first have to have your hand, your gloves, if you will, uh wet. And and that's what I'm excited about. And this is a solution, Rich. Honestly, um, this this um you know, you you you only learn by doing it, you know, in academics you get very smart people, but you know, if I'm gonna have my chest cracked open, I'm not necessarily gonna go to that ivory tower clinician that did a lot of research on it and knows a lot about it, but has only cracks the chest open once every two months. I'm gonna go to the guy in Dallas at that, maybe university-based teaching hospital, but he's got a kind of practice that he's doing all the time. Maybe that's not a good example, but we get into things like planning maxillomandibular advancement surgery. I argue that every dentist should know what's involved, how to decompensate in preparation for that, treatment planet, and be an integral member of doing that. Not that they're necessarily going to do the uh the the LaFort cuts, but they should be in the OR at least a few times to see it if they get interested and want to go down that path. Now, if you're treating kids in early intervention, that's a different population. And that's the nice thing about this program. No matter where you are in that spectrum, pediatrics, full complex pros with implants or surgery or surgical track, we cover those bases. But everyone learns from everybody else because if you're treating adults, you got to know where the problem begins, and if you're treating kids, you got to know where it's gonna go if you don't treat it. So that's what I like about it, if that makes sense.

Who Benefits Across Dental Specialties

SPEAKER_02 37:00

Yeah, I you brought up that last point about you know, you kind of alluded to who could benefit from learning this, and I'm gonna tell you right away that if I'm a pediatric dentist, and and I you can tell I'm respectful of my colleagues that are pediatric dentists, because I don't call you a pedodontist, because that's not respectful, right? You're a pediatric dentist. And if if if you don't understand airway, you're you're kind of missing the main reason, probably, why you became pediatric dentist. I mean it. It's so huge. If you're an orthodontist and you're you're stuck in the white paper mentality, and then you're worried that that there's another opinion, and it's this there's a lot of uh confusion. The dust is the dust is definitely um you know it's being uh plumed everywhere.

SPEAKER_01 37:55

It interferes with your financial model, your practice model about it. Oh, yeah, for sure.

SPEAKER_02 38:00

And then you mentioned about about, I think, you know, if you're oral facial pain person and or you're the you know a new specially trained OFP oral medicine and and you don't understand this, oh my gosh, it's so huge that you're missing one of the most important aspects of your practice. If you're a prostanist and you start doing pros on patients with extra with wear, because that's what you do, you treat the worn dentitian, that's a lot of what you do in pros, and you don't understand why it happened, and you believe it was just, oh well, you know, no one knows, it's just erosion, it's detrition, it's a bruxism, blah, blah, blah. And you understand what's behind it, your cases are gonna fail sooner. I I absolutely know that to be for sure gonna happen. You're not gonna get the kind of longevity out of your cases. Um, so I mean, I I just think that uh the general dentist, the pediatric dentist, the orthodontist, the prostodontist, uh, the the oral facial pain. Am I missing anybody? I mean, you know, paridontist, by God. I'm sorry, paridont. Of course. Huge, huge part of this. So I mean it just seems like the look, we're not gonna, Mark, here's the deal. There's no way we're we're monetizing this to become rich. We're doing this because this is what needs to be done in our profession, and I wanted to make it happen. This is a huge commitment for us. The amount of time that we have to put into this is mind-boggling. The the planning, the staff involvement, I uh your staff, my staff, we're constantly on top of this, developing teaching materials, carving out the space in our busy lives to make it happen, making sure the facility is in perfect condition, getting everything in gear. We we can't take more than a cohort of us. We can't take a huge cohort for it for this. We're not filling a lecture room for this. This we're talking about you know, 12 to 16 people in the in the clinic, maybe up to 24 or 28 people or something listening to the the lecture modules or the breakout modules, but you know, the mastery modules, but for the clinic part of it, it's very uh highly uh the you know mentored in in a high level, you know. Okay, Rich.

SPEAKER_01 40:21

Let me make a prediction. Um I believe that this model, so it's it's think of it, this is not a CE, this is actually a model that is the future that dental schools will eventually uh have a program like this. And the problem why it cannot work right now in dental schools is because the way the education is so siloed, you've got you know the orthodontists in one place, you've got the periodonists in the other, you've got the prosidonists, no one's talking to each other in their education. You've got their attendees, and and that's all fine and good to do this. Plus, you don't have the current you don't have the faculty that understands and transcends who's trained, yeah, not trained. Right.

SPEAKER_02 41:10

No way.

SPEAKER_01 41:10

And and so we're gonna bring our cumulative 80 years of of uh plus of of of practice and the seasoned um uh faculty, world-class faculty, both in medicine and dentistry, by the way. Right? Oh, I would agree. In this program to rock your world, and I think more importantly, your community's health, the health of the your community

Medical Indications Drive Case Acceptance

SPEAKER_01 41:35

that you're in. And one last really important point that needs to be cleared. One of the very important foundational concepts is the medical indications for why you would do dental intervention. So let me just use an example for a MARPE, a skeletal expander. If you take a weekend course and you learn how to do it, and you're a general dentist, and you go back on Monday, um your treatment planning based on a phenotype, you're looking at intermolar width, oh, this person's uh, you know, narrow, and you could talk to the patient about it, and the patient may or may not buy in and want it. But when you understand and ask the right questions on the medical indications, what you're not doing now, and that the reason why you would do a MARPY has to do with the breathing and the sleep and the comorbidities and all those complaints that are being treated in isolation by the physician, either with anxiolytics, proton pump inhibitors, antidepressants, hypertensive drugs, that they start understanding that they can get off of those medications or greatly ameliorate it and feel better. They're gonna want the MARPY, not because they want the MARP, but because they want to be healthier, and the MARP is just a tool, right, for them to become healthier. The discussion and the acceptance of the treatment goes very differently than, yeah, I just want a wider smile. It looks better. And I think that's really important that of something that no one's really talking about. I mean, they give it lip service, you know. Maybe you start your stop your snort if you're using a um, you know, uh a mandibular advancement uh uh appliance. Okay, fine, but that's not really people are lukewarm about that. What I love is it's transformational for your practice because people are not lukewarm about it. They're like, I'm all over this. Now you're gonna treat my spouse, I've got my kids, my neighbors, and it really builds your practice in such a meaningful way, um, where you're doing increasingly complex treatment in an interdisciplinary fashion that's super professionally satisfying, way beyond the fee. And I think that's why we went into healthcare is I mean, you know, um honestly. If I had a line out the door to do full mouth rehabs and veneers, I'm like going really, I mean, I'm I'll do as many as I can, and I'm gonna be beat up at the end of two years. And at the end of it, what have I really done? Maybe I'm funding my 401k, but I've not moved the needle in the health of you know my community, you know, and maybe I've got this reputation for doing some, you know, really nice uh white smiles that's already out there, it's worn. You know, um, this is very different. It's a completely different path that really pulls us back into the mainstay or main path of health and wellness. And that's what the program is all about. You get the foundation, and then depending on where you are, you start taking all the courses, and one last thing about the curriculum in the second pillar, is we also teach those basics, right? Um optimal scanning, um, the optimal photographic setup and photography. There are a lot of courses on it, but it's gonna be different with the gallery that you take for airway, you know, the extra, the intra oral, um, because that's also gonna help you with your planning of your simulation for your clear aligner. So we're gonna teach you all those things, even if you're very seasoned, I will guarantee you you will learn a lot. And um, and so I agree. I I think it's exciting for for everybody. And um uh thank you, Rich, for you know, taking your expertise as just such a respected educator because I didn't see it. I didn't have the wherewithal, I'll say I didn't have the wherewithal to really understand what was I mean missing because I got it, right? And I was practicing it, right? But I could never scale, you know, for a colleague. I could get on a zoom here or there, but I could never really scale, even though we had courses on medical billing and and and consulting on how to set up things, it just wasn't scalable. And and you were able to help provide the solution in this amazing fellowship that, by the way, when all is said and done, there will be a written test, there will be a practice, but you're gonna need that to feel super confident, and by the way, also to help teach it yourself. We want to do it in a much deeper way than someone that published one or two papers in some university, but at the end of the day, you're still doing dentistry, even if it's within a specialty. I think this is very different.

SPEAKER_02 46:46

Yeah, I mean I see I see a future where our graduates are are educators running uh you know similar programs in other locations, or maybe working out of our lake location. You know, but I I kind of I know you're a big you're you're a big thinker, and uh you know you're seeing how this can be um into the devil of the country and the world, if you know, and uh it's gotta start somewhere. I you know, one of the things that people ask me is about how much does it all cost, and like I said, I mean we'll let's put it this way if if you want to do this, it there's a way to make it work because we're it's like you know, you even when you buy a nice car, you don't just plop down the whole amount at once. There are ways to work it out, and we're we're building this one person at a time, Mark. And one of the things we're doing is that the the the doctors who are interested in becoming members of this were taking very seriously. And I I you know it's it's a little bit of we want to know what your motivation is as much as you're asking us what they're gonna receive because it's a two-way street. Um we want winners that are looking to be fully committed, um, and we will talk to them on the phone before uh we green light them to even enroll in the course. It needs to happen that way. This is um a very important way for us to start uh the airway nexus. It's not new to us. That nothing in this course is new in terms of content, it's already textbook, by the way. Yeah, it's not your textbook, it's it's IP. I mean, we've we've got the intellectual uh property, we've got we've got all of this, all and the responsibility of them treating patients, right?

SPEAKER_01 48:42

I mean, so yeah, we we we can't remediate, spend any time remediating.

SPEAKER_02 48:48

We need serious people that are gonna look to get this thing done in somewhere between one and three years. We're not even letting people take longer than three years. You you have to commit to it and get it done. So maybe one year you you you take the two courses, you and then you start the the the mentored year of working on patients, and then throughout the next year and a half uh you continue to take these uh mastery modules along the way. And as long as you complete everything and you complete an examination, you presented your cases, then you can be a graduate, you can be a fellow.

SPEAKER_01 49:24

Well, one other thing, Rich. Also, uh well, two other things that are super unique and uh features of the program that no one has also is we actually have a very robust uh course curriculum on how you actually translate in real world practice for sure to workflows, um, to uh verbal skills to train your staff because we believe this is real world. This is not like you go ahead and do all this curriculum and then it's interesting, but how do I actually make it work? And that's what the mistake I made for so many years is I I wasn't able to really uh solve that part of the problem. Well, we've solved that, number one. Number two is we actually have an electronic platform that houses all our lectures, all our videos, all the case reports.

SPEAKER_02 50:15

Yeah, you're talking about the platform.

SPEAKER_01 50:18

So you've got your cases on Monday in between in between the the sessions, you're gonna be posting those sessions those cases in a HIPAA platform, like an EMR, if you will, and we're and you're gonna have a whole community chiming in and talking about it. Um, and so no one else does that. And that is necessary, by the way, if we're gonna do this, unless you stop and take a hiatus of two to three years, like a sabbatical, and then go full-time academia, fine, you could do that. We know that we're we're really working with people that are working full-time and have families, but still provide a rigorous, um, robust curriculum. So I just want to say those are the last two to go along with it. Um, but with that, I mean, I think we've, you know,

How To Get Started And Contact

SPEAKER_01 51:10

we could just conclude by saying, wow. And I would say, how do people find out about it, Rich? And then we'll enter our podcast.

SPEAKER_02 51:19

You know, um, honestly, the the um the Aray Nexus is going to be live uh very, very soon. Uh the the um the portal is uh gonna be ready very very soon. Uh until it is available, you can take advantage of going on to the Stevenson Dental Solutions website and checking out the um the pillar one and pillar two courses.

SPEAKER_01 51:49

Um requirements of the everyone. Oh, they're required anyway.

SPEAKER_02 51:57

They can start on that and then continue on the take them now, and then when the uh when the nexus is fully online uh in 2027, you will have already completed the first two pillars of a four-pillar program. So I think you know, uh that's what I would do. Um, anybody interested can can go there, they can reach out to me at my email, which is RGS at Stevenson Dental Solutions.com. I'd be happy to engage in conversation with you, uh, get on the phone, uh, and and help you understand a little bit better about how the whole thing works. You know, Mark, I'll tell you something. Uh I you're right, I teach a lot of courses in in just good restorative dentistry, and I mean I even have a course starting tomorrow, a two-day course, which is sold out. And every every course that I teach, I talk about the importance of understanding the concepts of airway and how it is um a modifier of everything. Uh and um the interest in doing an airway course is enormous. And interestingly, a lot of them are asking me, so Dr. Stevenson, what what course do you think I should take? I hear I heard about this course, I heard about this course, I heard this course. And you look at them and go, take our course. You know, we have a course. They go, oh, you do, you know. So it's I think it's kind of interesting. Uh they really want to do this. I mean, if for look, it you don't nobody wants to jump around and take a bunch of courses that don't add up to something that's translatable to your practice. You need to be able to make this work for you. You know, it needs to you need to see a proof of concept. And so what better way to do that than have uh all in one, one stop, this is it. And go to OG. Yep. Uh, you know, it's kind of like if you had to build a house, you know, and you had to you you had to take care of all the subcontractors yourself and all that stuff. I mean, come on, you go you go to a builder that knows what they're doing, and an architect and a builder, and they they take care of the house for you. They understand how to do this. You don't go around and go to Home Depot and buy the materials. You you you know, my goodness, you you get professionals to help you to the point where you can pop out the other end and and have the the credentials that you have worked hard at that have been given to you in a very clear way. And I think that's that's what this does for people. And it's to me, it's a no-brainer.

SPEAKER_01 54:34

Yeah, no, great, Rich. Thank thanks um for that. And we'll continue uh talking about our other um airway topics that we talk about in this podcast. But I I I was really excited about this particular podcast. Talk about really, you know, because we need more people that are properly trained, way beyond schlepping widgets, uh, to comprehensively diagnose and treat the patient with interdisciplinary care. So we'll continue that conversation. But thanks um you know for sharing that information. Thanks to you for really um putting so much of this together in such a meaningful way. So, with that, um thanks everybody for joining us on another podcast, and we'll see you at uh the next one.

SPEAKER_03 55:24

See you next time, guys.

SPEAKER_01 55:25

Bye. Take care.