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1:52

Hey everybody, Chris Kresser here. Welcome to

1:54

another episode of Revolution Health Radio. I've

1:57

done a few shows in the past with dentists and

1:59

periodontists.

1:59

is exploring the connection between

2:02

oral health and

2:04

the structure of our jaw and

2:07

face and nerves in

2:09

that area and our overall

2:11

health. I would say there's

2:13

been a

2:14

pretty dramatic shift in understanding

2:16

in these fields over the past few decades

2:19

where when I was growing up, the

2:21

dentist was just a place that you went to,

2:25

you'll see if you had any cavities and get those cavities

2:27

filled, maybe get a crown or something

2:29

like that. We now

2:31

know that the way our

2:34

face develops from birth into

2:37

adulthood and even in

2:40

utero actually,

2:41

the structure of our jaw and our dental

2:44

palate

2:45

affects everything from how

2:47

we breathe to how we sleep,

2:49

you can be a major

2:51

contributor to apnea and snoring, to

2:54

how we move our physical posture, problems

2:59

in the jaw and in the facial

3:01

structure can cause pain throughout the body,

3:04

cause digestive issues, can cause immune

3:07

problems. And there's

3:10

just so much to learn here. It's

3:12

such a rich area for exploration.

3:15

And I've seen some pretty miraculous changes

3:18

in overall health, sleep, musculoskeletal

3:22

issues, chronic pain, et

3:24

cetera, from people working with functional

3:27

dentists or doing dental

3:29

orthopedics or various names that are used

3:32

for this kind of work. I've benefited

3:34

tremendously from this kind of work

3:36

myself, as have my

3:38

wife and our daughter and many other

3:40

family members and patients. So

3:43

I'm really excited to welcome Dr. Paul Peterson

3:46

as my guest today. He is

3:48

a dentist that I encountered

3:50

in Park City, Utah, where we were

3:53

living at the time. And

3:55

I worked with him for a couple of years. My wife

3:58

also worked with him and our daughter worked with him.

3:59

And we all had pretty remarkable results.

4:02

So I wanted to have Paul

4:04

come on and share a little bit about his

4:07

approach and the

4:09

way he looks at dentistry from

4:11

a functional perspective. I

4:13

think you'll really enjoy the show. Let's

4:16

dive in.

4:18

Dr. Paul Peterson, welcome to the show. A pleasure

4:20

to have you on. Thank you, Chris.

4:22

Happy to be here. So, um, I'm

4:25

just, I'm so excited about this conversation so much

4:27

we can cover and I'll probably have to be a couple

4:30

more conversations after this one. Um,

4:32

cause there's no way we can cover everything in a

4:34

time that we have. But before we jump

4:36

in, uh, I'd love to just hear

4:39

a little bit about your background. You

4:41

know, you're trained as a dentist. Um,

4:43

how did you get interested in what

4:47

we might call non, you know, it's certainly

4:49

not traditional dentistry that you're doing

4:51

now. Um, so how did you get

4:53

from, you know, dental school to where

4:55

you are at this point?

4:57

Yeah. Uh, so I did grow

5:00

up in a dental family, so I

5:02

don't really have a normal

5:04

childhood in that regard. I joke with people that

5:06

my, my perspective is,

5:09

is different because, you know, I grew up hearing

5:11

it talked about at the dinner table. And

5:14

then when I was 16, my mom went to work for my dad.

5:16

And so all aspects of the, the,

5:19

the practice of dentistry, the patients

5:21

and the interactions was, was just something I grew up

5:23

with, but I knew I wanted to go into medicine

5:25

and healthcare. Um, I didn't know till I was

5:27

older, um, tells in college that I didn't

5:29

start considering dentistry to that point. Um,

5:32

and I got in my dad's office and I saw the

5:34

great relationships he had. And I

5:37

really wanted that in whatever, whatever healthcare

5:39

profession I went into. So in school,

5:42

um, I was fortunate

5:44

that I was able

5:46

to do deal with a lot of complex cases

5:49

more so than, than most of my classmates. So

5:52

I spent a lot of time and with

5:54

the professors and the clinics that kind of specialized

5:57

in

5:57

implant reconstruction and,

5:59

you know, Instead of doing a crown here and a filling here, I was

6:01

doing multiple

6:04

teeth at a time, 10, 12, 20 teeth at a time.

6:07

And it kind of gave me a taste for that. And following

6:10

dental school, I started a prosthodontic

6:12

residency, which would have been a three-year program, but

6:14

I spent a year in that program and

6:17

got a lot of great exposure and

6:20

decided that entire three-year program wasn't

6:22

where I wanted to go, but it

6:24

did set the tone for my career where

6:27

I got out and I started practicing and

6:29

I worked for an experienced dentist and

6:31

I was learning and watching from him

6:33

and I got involved with him vis-a-lin very early and

6:36

just found that even though I wasn't in school anymore,

6:38

I had a hunger to continue to learn.

6:41

I don't think at that point I realized

6:43

how much there was to learn and how little

6:45

I knew. I probably didn't

6:47

fully grasp that to a few years ago, but

6:50

it just gave me a hunger to learn.

6:54

I enjoyed that part

6:56

of it. I enjoyed looking at my patients and trying

6:58

to get the root of the problem and those

7:01

observations throughout the early years

7:03

of my career led

7:04

me to ask more questions

7:07

and then I had

7:09

patient experience and I had personal experiences

7:11

and they led me to do more than

7:14

the simple continuing education.

7:16

I started studying appliances

7:19

just for snoring and kind of accidentally

7:21

ended up in a wonderful course

7:25

that was multiple days long and taught

7:27

by a brilliant sleep tech and

7:29

she really got into the science of sleep and

7:32

sleep studies and what's going on

7:35

and that was kind of accidental, but

7:37

that was probably one turning point in

7:39

my career when I started understanding

7:41

that component as

7:44

I did more and more complex

7:47

restorative cases

7:48

than I wanted to understand

7:52

how do people get in this condition? Why

7:54

is one person's dentition

7:56

more damage to another

7:58

compared with another person?

7:59

teeth, you know, why, why

8:02

is someone grinding their teeth so bad? And

8:06

those answers are out there. They're not necessarily

8:08

widely discussed or emphasized enough, in my

8:10

opinion, or it wasn't in my education. So

8:13

going down that road, right,

8:14

got me

8:16

where I am doors gets you curious and you

8:18

keep pursuing those interests.

8:21

Definitely can relate to that. Let's

8:24

actually use snoring and breeding

8:26

and amnio as an entry point here, because

8:29

that's how you, you know, how I met you.

8:31

My wife was already working with you and

8:34

daughter actually and we

8:36

can perhaps revisit that later in the

8:38

conversation. But I came to see

8:40

you because

8:43

after we moved from the Bay

8:45

Area, which is more or less at sea level

8:47

to Park City, which was 6,500 feet,

8:50

I noticed that I was snoring more, which is,

8:53

you know, not

8:54

typical for me. And I did, you

8:56

know, we did an at-home sleep test and I was having

8:59

some

9:00

moderate sleep apnea, which I'd never had

9:02

before. I'd had sleep studies before,

9:05

like in the lab and I'd never had apnea.

9:07

I had some transient low oxygen events,

9:09

which were sort of below the

9:11

apnea threshold or what they would typically classify

9:14

as apnea. I think most

9:16

people today, when they

9:18

are diagnosed with apnea or they hear about apnea,

9:21

they don't make a connection immediately

9:23

in their brain to their jaw.

9:26

And, you know, the common prescription

9:29

of course is a CPAP

9:32

machine if it's, you know, severe

9:34

enough to warrant one, but many

9:36

people struggle with those and don't enjoy

9:39

wearing them for obvious reasons.

9:41

They're very cumbersome, difficult to travel

9:44

with, etc. And certainly

9:46

like, I'd say there's some growing

9:48

awareness that there are like, you know, basic

9:50

mandibular advancement devices or things

9:52

you can do. But in my

9:55

practice, for example, very few patients even

9:57

knew that that was an option until

9:59

I brought it up. So talk a little bit

10:01

about what's happening there for a lot

10:03

of people who are experiencing apnea with

10:06

their jaw and how their jaw

10:08

can play a role in causing

10:10

the condition and how resolving that

10:13

jaw alignment issue can help.

10:15

Yeah, absolutely. And I should

10:17

probably start just by saying I have

10:19

seen plenty of patients that get

10:21

a CPAP machine and do great

10:24

with it. Is it the lesser percentage? Absolutely.

10:28

In all fairness, there are some that get those

10:31

in it, addresses

10:33

their apnea. I don't know

10:35

if treatment is quite the right word

10:38

and hopefully that'll become clear as we talk about

10:40

it. But you know, they don't fail

10:42

all of the time. But on the flip side,

10:46

often they make improvements. One of the

10:48

things that isn't discussed is where

10:50

were you when you started with any treatment, whether

10:54

it's CPAP or

10:56

some other alternative treatment, where

10:59

were you when you started and where are you now and what does

11:01

that mean? And those are discussions that

11:03

I've found, I guess was about 2010

11:05

when I first did that really good

11:07

in-depth course. And I've been doing home

11:10

sleeps tests ever since for my patients. And

11:12

I found as through all those years of talking

11:15

with patients that so often that discussion

11:17

is never had with the patient from the provider, wherever

11:19

they are. The

11:22

other thing to bring up now

11:24

is that when

11:27

we talk about if we use a term functional dentistry,

11:29

for lack of a better

11:32

word, almost encourage me to use.

11:34

And I've given that a lot of thought since our discussion when

11:36

I saw you last in the office and it really has made

11:39

more and more sense to me terminology

11:42

wise. And I think it's something that people relate to, but it's

11:45

one component of

11:47

that is understanding where

11:49

these problems are coming from. And I think one

11:52

of the big gaps, whether we're

11:54

talking about apnea, head, neck

11:56

pain, jaw pain, or a whole host of other complications

11:59

is. the public awareness and

12:01

the medical and dental awareness of

12:04

the foundational issue just isn't there. And what is

12:06

that issue? It's that

12:08

the human head just is not growing

12:10

the same. And the

12:12

things to books like Breath by James

12:15

Nestor, there is more and more awareness.

12:17

We have people come in almost monthly or multiple times

12:19

a month sometimes that have read this

12:21

book and then they're looking for a healthcare

12:24

provider or a dentist that understands these

12:26

concepts. But for

12:28

tens of thousands of years, all

12:31

of the skulls that are dug up and looked at by

12:33

the anthropologists and the physiologists and the anatomists,

12:35

they're very similar and how

12:38

the upper jaw sits in relation to

12:40

the cranial base or to the rest of the head.

12:43

So if you just kind of think about your face that you look at

12:46

in the mirror, how does that grow and develop

12:48

from the time you're born?

12:50

But that's changed because without

12:52

getting too deep into that discussion, that's changed because

12:54

of the environment that we're in.

12:56

So with that

12:58

understanding, it changes

13:01

your perspective on

13:03

airway.

13:05

If that upper jaw is growing differently,

13:08

if any bone in the head, all these

13:11

different bones that are in the middle of the head, the

13:13

jaw bones, the plates of the head, if

13:15

one of them's out of position, everything else has to shift

13:18

and adapt.

13:19

What happens with breathing is if the

13:22

upper jaw doesn't grow out and forward,

13:24

it should go 80% out and

13:26

about 20% down from the time you're

13:28

born as an infant. Then if

13:31

that happens, you have a

13:33

big wide palate, you have room for your

13:35

tongue to sit up and forward. Not

13:37

only that, but the floor of your nasal

13:40

cavity is out, it's

13:43

wide

13:44

and you can breathe very easily through your nose,

13:47

not just when you're sitting and talking, but

13:49

all of the time. Your

13:52

soft palate isn't

13:54

a narrow space between where your soft palate hangs

13:56

back and the uvula in the back of your mouth to the

13:58

back of the throat. your

14:01

tongue moves forward. If the upper jaw

14:03

is forward and out, then the lower jaw, the way it fits

14:06

is out and forward also. And in this scenario,

14:08

we don't need orthodontics.

14:09

We have our teeth come in with

14:11

plenty of room. There's no extractions. There's

14:13

gaps between our teeth, our wisdom teeth come in.

14:16

And in many cases, there was room for a whole other

14:18

set of teeth. And

14:22

this was even observed even after

14:25

so much of the quote unquote civilized world

14:27

was dealing with crowding teeth

14:30

and all these and starting to have bad posture and all these

14:32

problems.

14:33

Well, when we found populations or study,

14:35

you know, Native American populations, Amazonian

14:37

populations, the Aborigines, they had

14:39

these beautifully developed faces. They stood up straight.

14:42

They had room for their teeth,

14:43

not only that, but there was due to diet

14:45

and breathing, you know,

14:48

they didn't have the decay issues that we have. The

14:50

minute you start breathing through your mouth, you're decaying everything. And

14:53

they weren't brushing their teeth or flossing three times

14:55

a day either. Right. No fancy

14:58

toothpaste, right? No super special floss

15:00

or water picks or anything like that. So hopefully

15:02

I made the point that

15:04

the jaw development is then

15:06

proper jaw development is opening airway. Right.

15:09

So what happens when let's say, let's say someone's

15:12

snoring,

15:13

what's happening there? Like what, when

15:15

they're laying down, what's going on to cause

15:17

that problem?

15:19

Good. And let me add real quick, one more thing in

15:21

the nasal cavity. This is interesting. We see so many

15:23

deviated septums and people think it's trauma.

15:26

They're almost never outside the face. This deviations

15:29

internally in the nasal cavity, because

15:31

the nasal cavity didn't develop fully. Then we have

15:33

all these deviated septums and you're not breathing well.

15:35

So snoring, what's happening,

15:37

it could be multiple locations. It's

15:40

not always the soft palate, the uvula.

15:42

It's sometimes it's the tongue. Sometimes

15:45

it's coming from the nose. So when you're treating

15:47

it, you also need

15:49

proper tools and diagnoses to identify

15:51

the area where the flat is it, then nasal

15:54

friend or airways, the oral friend joy

15:56

way behind the tongue. Is it down? Is it lower?

15:58

Are you having a,

15:59

a collapse

16:01

lower than the area of the tongue. So

16:04

what's happening and what cools

16:06

can help? Right. So

16:08

like in my case, my airway was, in

16:12

my neck was plenty large. That was

16:14

not the issue we had. The

16:16

problem was that if I recall,

16:19

correct me if I'm wrong,

16:21

some of the tissue

16:23

in the entrance, it's,

16:26

you know, around the entryway had become

16:29

slack over time, which happens

16:32

with aging. So we did something, you

16:34

can explain that a little bit, but then also

16:36

just the position of my lower jaw, like

16:39

if I'm laying on my back was receding

16:42

or was moving backwards and closing the entrance

16:45

to the airway. So it didn't matter how

16:47

large the airway itself was, if

16:49

the lower jaw is not staying

16:52

forward and in place, then it closes

16:54

the airway. And so we used

16:58

an appliance nighttime, which I'm still

17:01

wearing at night, which corrects that

17:03

problem. So talk a little bit about

17:05

those different interventions because that

17:08

speaks to what you just said. It's not the same

17:10

for some people, it might be the airway itself that

17:13

is compromised. Whereas for me, that was

17:16

a different issue.

17:17

Yeah. And we can see large

17:19

airways, but if you have trouble breathing

17:21

through your nose or you never established the proper

17:24

neuromuscular coordination

17:27

to hold your tongue up in the roof of your mouth and your palate,

17:30

maybe you just had really bad allergies as a kid,

17:32

you don't have them anymore, but you got in the habit

17:34

of reading through your mouth.

17:36

Well, then the whole lower on your back,

17:38

the whole lower jaw can fall back. When it falls back

17:40

and the tongue goes with it, it can push on

17:42

the soft palate, it can close the airway.

17:45

When you have any

17:46

sleep

17:48

disorder breathing, the larger, the

17:50

more severe the obstruction, the longer amount

17:53

of time, the more wear

17:54

and tear it can have on the tissues of the throat. But

17:56

those tissues are very friable.

17:58

They're, they're, they're... mucosal

18:00

tissue, they're thin, they're soft,

18:03

they get inflammation easily. So if

18:06

your airways closing, think of a hose

18:08

and you're tightening it to make the water go faster,

18:10

right, like out of the hose to squirt it.

18:13

Well, when the airways collapsing and you get

18:15

that, that more

18:17

friction of the air and the closure, you get

18:19

swelling. And then it's

18:21

a self feeding loop because now

18:24

you have more swelling and the airway closes more,

18:27

you know, with more ease, and

18:29

it continues to swell. And like

18:31

you said, with age, there's a natural, you

18:33

know, breakdown in elasticity or collagen

18:35

or elastin in the tissue. So there

18:38

are we've seen amazing results. We since 2016,

18:40

we were the first ones

18:44

in the state to start using this technology.

18:47

And I'm happy to say there's a lot of people using

18:51

it throughout, throughout Utah now.

18:53

But

18:54

we've seen really amazing results with

18:56

the night lace technology from photon laser.

18:59

And it's, you know, it's a special wavelength

19:01

of light that's fractionated

19:04

and micropulsed. And it's

19:06

used in multiple areas of medicine. It came

19:08

from other areas of medicine. This company's in dermatology

19:10

and gynecology, but they we can

19:13

tighten tissue,

19:15

and we get surprisingly good results. So that's

19:17

one tool. The mandibular advancement device

19:20

is an amazing tool.

19:22

And when I first started learning about them, we already

19:24

had 15 year studies on some of the

19:27

early good appliances

19:29

that are no where as quality is what you're using.

19:32

And they said, for

19:34

mild to moderate sleep apnea, you can get as good

19:36

of a better result with a mandibular

19:38

advancement device

19:40

than a CPAP.

19:41

With a lot less intrusion, you know,

19:44

for you and whoever you're sleeping with.

19:46

Yeah. Yeah. And then it comes to compliance,

19:49

right? So it's easier to wear for

19:51

the majority of people.

19:53

And you're the consistency of where

19:56

the insurance guidelines

19:58

to be successful to keep pain for the CPAP machines

20:01

are really lacks with, I don't know the

20:04

exact numbers off the top of my head. I've heard them before, but

20:06

you know how many days a week or how many hours of the night?

20:08

Well, you put your CPAP on and you take it

20:10

off four hours into the night. You have more severe

20:13

events in the later hours of the night anyway. So,

20:15

and if you're on the wire four nights a week for half

20:18

the night and it qualifies

20:19

for insurance, keep paying for it. Really,

20:21

how well are you taking care of that human

20:23

being, right? Really, how well are you treating

20:26

the sleep disorder breathing and all the associated complications

20:28

of it?

20:29

The sad thing is

20:32

that the mandibular

20:34

advancement appliances didn't get more traction.

20:36

And I believe, I have to guess

20:39

the reason is for two reasons.

20:41

There's a lot of inexpensive appliances

20:44

out there that they may be working

20:46

okay at first, but they're more cumbersome. They're

20:48

not as comfortable. They break. If

20:51

something happens in two years, you got to remake

20:53

one and no one wants to pay for it again. You don't

20:56

have warranties on them. They're not well made, but

20:59

also it's about if

21:02

you, again, it comes to understanding the foundational

21:04

issue and identifying the problem. While

21:08

it's true that the majority of people, if you move that

21:10

job for it and you hold that tongue out of the way,

21:12

it's going to help them. That's not everybody.

21:16

I've had people that got answers nowhere

21:18

and we put breath right strips

21:20

on them and their sleep totally changed. They

21:23

didn't even have surgery with the ear, nose, and throat

21:25

doctor.

21:26

You have to be able to look at everything. So I'm a huge

21:28

believer in

21:30

the combing CTs first,

21:32

looking at the area and the problem.

21:34

But the other issue is in dentistry,

21:36

there is not enough

21:39

instruction, understanding on

21:43

the joint. So we talked about the jaws don't come out

21:45

and florible. Then the joints, the victim of that, if

21:47

you just start randomly moving these teeth

21:50

around, in other words, if you go to

21:52

most general dentists

21:54

and they may have been to some good courses

21:57

on how to make these things, but

21:58

quote unquote, good courses. there's

22:01

not enough foundational understanding of what you're doing.

22:03

What have you done to that jaw joint? What

22:05

have you done to the muscles? So so many

22:07

people, even if they have a decent appliance, just

22:10

the way that you move the jaw, the position you put

22:12

it in, it hurts.

22:14

So if you don't know where the patient is starting, you don't know how

22:16

to assess it,

22:17

you don't check it before you make an appliance.

22:19

When we went through the process, we started

22:22

with a CT. We knew where your joint was. We

22:24

analyzed the obstructions. We formulated

22:27

a plan based on that. We didn't just say, I'm

22:29

not sleeping good, make an appliance, because I don't

22:31

want to wear a CPAP machine. And

22:33

we did follow up studies and we checked the

22:35

position of your joint after, before I

22:37

even had it made. I took a bite registration

22:39

instead of taking models

22:41

of your teeth, not

22:44

relating them in any way, sending to

22:46

a lab and saying,

22:47

build me something that moves their jaw forward.

22:50

Which in simplicity is what's being

22:52

done. So people aren't comfortable

22:54

in these things. And it's unfortunate,

22:57

because they work really well if they're done well. And

22:59

I can attest to that. Sorry for my long rant on that. No, that's

23:01

fine. But it really is a frustration of mine. And it's

23:04

not that I'm doing anything super difficult or magical,

23:06

it's just that

23:07

my career has led me to research

23:10

these things and understand them. So now I can make something for

23:12

you that you love and you can use. Yeah.

23:15

It's much more complete. It's

23:17

analogous to the difference between functional

23:20

medicine and conventional medicine, where

23:22

it's like,

23:24

in the conventional approach, oh, do

23:26

a blood test, your cholesterol is high.

23:28

Now we're gonna give you a statin that's gonna

23:30

lower the cholesterol on the follow-up

23:33

blood test. Problem solved. Well,

23:35

not really, because why was

23:37

the cholesterol high? In the first place, what's

23:41

going on under the hood that's leading to that problem.

23:44

And if you do a little bit more digging up front,

23:47

you find maybe a way

23:49

of addressing the problem at the root so

23:52

that you're not using a drug to just

23:54

suppress the symptoms. And

23:56

with the CPAP machine, okay, what's

23:59

the problem? problems low oxygen. So

24:01

you give oxygen. Okay, well that, you

24:03

know, that makes some sense in a way,

24:06

but you're not answering

24:08

the question, why is the oxygen low

24:10

in the first place? And so what

24:13

you're, you know, what you're doing is analogous

24:15

there where the first step is

24:17

diagnosing the problem. So like,

24:20

Where is the obstruction? Where is the obstruction?

24:23

The what's the right? And for those that aren't familiar

24:25

with the terminology, the 3D cone beam scan is, is just

24:28

a much more comprehensive

24:29

way of imaging the structures

24:32

in the head and the neck and It's a 3D x-ray

24:34

that doesn't have the high radiation that you'd get

24:36

out of hospitals.

24:38

Yeah. And so, and I've, I had

24:40

this in the Bay Area, you know, when I, when

24:42

I was having some issues with sleeping,

24:44

I did some my research

24:47

and I, you know, I can just look in the mirror

24:49

and see my jaw is narrow. I'm

24:51

a classic industrial

24:54

Western civilization face versus,

24:57

you know, if you read Weston, Weston A. Price,

24:59

nutrition and physical degeneration, like you

25:01

referred to earlier, you see the comparisons

25:03

of people living in the industrialized

25:06

world with very narrow jaw,

25:09

narrow dental arch, lower part

25:11

of their jaw is further back than it

25:13

should be all the classic signs. And so

25:15

I suspected that my jaw

25:18

misaligned, you know, malocclusion

25:21

was contributing to my problems.

25:23

And I went to a dentist and who was

25:26

just listed as someone you know, I think

25:28

I went to the mandibular advancement

25:31

device website and then they had

25:33

like a directory of dentists that were using it.

25:35

And I went there and it was exactly what you described.

25:38

You know, they took mold of the teeth.

25:40

They made an appliance that was based on

25:42

that. It was super uncomfortable.

25:44

It was bulky. It, it

25:47

locked my jaw in what felt

25:50

like, you know, it did, it did the

25:52

job in the sense that it mechanically

25:54

moved my lower teeth forward,

25:57

but it was not something that was sustainable.

25:59

I forgot to consider that these teeth in

26:02

this model of your mouth is connected to a human being.

26:05

The rest of the body. You can't just put it into

26:07

some random position.

26:09

Exactly. Yeah. And

26:11

then, so working with you, we had the better,

26:14

much more sophisticated appliance that there

26:17

was a night or two of discomfort just getting

26:19

used to it, but that quickly passed

26:21

and now I

26:23

sleep

26:24

with my mouth taped shut with

26:27

the appliance in and I wake up

26:29

with the tape still there. So I'm 100%

26:32

sure I'm not breathing through my mouth at

26:34

night. I'm breathing through my nose the entire

26:36

night and I feel more

26:39

refreshed and rested

26:41

and, you know, don't wake up

26:44

with headaches or anything that was happening with

26:46

the apnea before. So it's a pretty

26:48

big difference. And with the nightlays, that's

26:53

helped a lot, but it also, as you suggested

26:55

it might, helped even with like

26:58

my B02 max and

27:00

oxygen availability when

27:02

I'm exercising. You know, I was living

27:05

at 6,500 feet and

27:07

often exercising at 9 or 10,000 feet. So

27:10

the ability to get oxygen

27:12

when you're breathing through

27:14

your nose is, yeah, it's tough

27:16

and it's important, right? Because there's a lot

27:18

less of it. And I would notice, you

27:21

know, from, I'd also read James Nester's

27:24

book and he talks about

27:26

some training that he was doing where, you

27:28

know, just trying to breathe exclusively through your

27:30

nose, even when you're doing

27:33

pretty rigorous cardiovascular,

27:35

you know, type of activity. And so I would be

27:37

like riding my bike up the

27:40

Armstrong Loop, you know, ham

27:42

Armstrong Loop in Park City and just

27:44

trying, you know, with tape on my

27:46

mouth, trying to breathe

27:49

exclusively through my nose. And I was

27:52

able, you know, not immediately, it took a while

27:54

to build up to it, but I was able to do that. And

27:56

I think the nightlays helped because

27:58

it created more. space,

28:01

you know, more, more ability to breathe because

28:03

those tissues pulled together and tightened

28:05

instead of being sort of slack and obstructing

28:08

the airway.

28:10

Yeah, it's really cool.

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31:13

Let's shift gears and talk about TMJ because this

31:15

is like a whole another window into

31:18

how a lot of issues that we've already

31:20

been talking about, a kind of maybe

31:23

short-sighted or narrow view that

31:26

the conventional medicine or

31:28

dentistry takes a TMJ

31:30

and then what a more kind of holistic

31:33

way of looking at this is. And I know,

31:35

I mean, this is a huge issue. So many people

31:38

suffer from this. I mean, this

31:40

issue was the rabbit hole that changed

31:43

my career and my life.

31:46

In dental school, I remember

31:49

being in the clinic and going to get instruments.

31:51

And there was a lady working there that

31:53

apparently

31:54

we had a specialist

31:56

in the dental school. No one ever saw him. We didn't get

31:58

any lectures from him. But

31:59

but he saw people there. And so we saw

32:02

this lady that we talked to almost every day

32:04

when we were in the clinic seeing patients as students.

32:07

And one day she had this crazy bunch

32:09

of acrylic in her mouth, right? And everyone's

32:11

asking, hey, what is that? What's going on? Tell

32:14

me about it. Who is this

32:16

doctor that's treating you that happens to be here

32:18

at the dental school that's never a lecture to us? You

32:20

talk about our traditional view and

32:22

I don't know, there's ever been a good one. One

32:25

of the really sad realities of dentistry

32:28

in modern dentistry, I don't

32:30

even know how many. There's been

32:33

six or 10 different definitions of

32:35

how the joints should sit

32:38

in the faucet. What is that? So

32:40

the temporal bone is the bone on the side of your head,

32:43

the bottom of it forms the roof of the joint.

32:46

And dentistry has always been very

32:48

mechanically minded about where

32:50

should it sit? Should it sit up and forward? Should it sit

32:52

up and back?

32:54

So there's been all these techniques over there where you

32:56

grab the jaw and you try to force it into

32:58

a position if you think there's a problem or

33:00

you're doing something. You're manhandling

33:03

it into some position based on some definition.

33:05

Well, the dental school that you went

33:07

to on one side of San Francisco

33:10

is teaching it different than the one on the other side of San

33:12

Francisco. And so

33:15

historically it hasn't been well taught

33:18

to anybody. And

33:20

then there's been surgical interventions that

33:22

sometimes they work and sometimes they don't. Nothing's

33:24

been really great.

33:27

And again, you're missing the point. Like I said in the beginning,

33:30

if you understand the foundational cause, you look

33:32

at it differently.

33:34

If you understand that

33:36

it's clear as day that

33:39

all the anatomists and the anthropologists and they

33:42

agree the face isn't growing the same. And

33:44

if you understand that, and if you understand the upper jaw

33:47

is in a different position and now the lower jaw has to adapt,

33:50

the trouble with the TM joint is it's bilateral

33:52

and the lower jaw is victim to where the upper

33:54

jaw ends up,

33:56

which is a victim of the industrialized

33:58

world. And so

34:00

the lower jaw gets moved back, it changes

34:02

position, the joint gets compressed and

34:04

the desk, the disc gets kicked out.

34:07

I mean, I guess a traditional definition is, is

34:09

that disc is popping and clicking. That's a

34:11

dislocating disc and people don't even think about

34:13

it like that.

34:15

And dentistry has never talked about

34:17

functional space, you know, you talked in orthopedics,

34:19

you talked to a physical therapist, they understand joints need

34:22

functional room.

34:24

And, but if you have a corrupted skeletal

34:27

development, then the musculature is going to be off and

34:29

this joint gets really

34:31

victimized because your teeth still have to fit together

34:33

and the muscles still contract. And

34:35

there's just this huge cascade of symptoms

34:38

that,

34:38

that result to lots of inner ear issues, lots

34:40

of head and neck pain, you know, trigeminal

34:43

is nerve is in this hyperaroused

34:45

state all the time. But then if it's

34:47

affecting your airway too,

34:49

then it's affecting your, not just through pain

34:52

in the area of the joint or the head

34:54

and neck and the face,

34:56

let alone the neck. Cause now you have forward head posture

34:58

from your bad job position.

35:00

But if you're not sleeping, right? Well, what

35:02

now you have disrupted sleep,

35:05

you may have apnea and now you're at risk for heart attack

35:07

and stroke. You, you may just

35:09

have upper airway resistance syndrome, which is hugely

35:12

overlooked, which is just on that spectrum

35:14

of sleep disorder breathing.

35:16

And so you'll go get a sleep test and they say you're

35:18

normal because you don't have this high apnea

35:20

number or they call it mild, which is crazy, but

35:23

you have lots of disruptions and you feel crummy.

35:25

Well, if you're disrupted in your sleep

35:27

all the time and you're in fight or flight

35:30

all night long,

35:31

you know, the other functions,

35:34

hormone and metabolic functions, your body are thrown

35:36

off and now you're going to be even more sensitive to pain.

35:38

So you can't, there can't be

35:40

a disconnect between them. They're both so interrelated

35:43

and the numbers that I've been taught are, you

35:45

know, around 80,

35:46

85% of people that have,

35:49

you know, TMD have sleep disorder breathing

35:51

or vice versa. So why?

35:54

Well, we said it multiple times

35:57

because that is the same cause the majority

36:00

of the time. It's the same reason.

36:01

Someone's morbidly obese, you might have a perfectly fine

36:04

joint. But

36:06

that's also a big misnomer, not to circle

36:08

back around and sleep. But I see large

36:10

airways on thin people. I see tiny

36:12

airways on thin people. You can't tell

36:15

from the outside what it's like on the inside.

36:18

We talked about how

36:20

nutrition and other influences

36:22

in the modern world are leading to differences

36:25

in facial and jaw development and

36:27

how that relates to breathing and apnea.

36:29

I assume that's

36:32

a similar pattern with TMJ

36:35

and some of the joint issues. Yeah,

36:37

exactly the same. And one

36:40

complicates the other. Exactly.

36:42

In the case of my wife, she didn't have

36:45

TMJ, but she had pretty

36:48

intractable pain

36:49

in her neck and upper back

36:52

that

36:53

she had for 25 years.

36:56

And she's a Feldenkrais practitioner and

36:58

a somatic awareness practitioner

37:00

and has a very developed

37:03

refined body awareness. So

37:05

it certainly was not from lack of trying

37:08

to resolve and unwind

37:10

those patterns. And the thing that

37:13

eventually made the difference to

37:15

the point where she could be

37:18

without pain in those parts of her body

37:20

was fixing her jaw. It was re-doing

37:22

the work with you. I mean, she started with

37:25

a couple of other dentists who

37:28

were helpful in some ways, but were not able to

37:31

bring it across the finish line. I guess I

37:33

would say, I think there was

37:35

some awareness there for sure of how

37:37

the jaw was contributing and where the jaw

37:39

needed to be for her to

37:42

not have pain. That was actually

37:44

her first experience

37:47

of not having pain was after her

37:49

jaw was adjusted, but they were

37:51

not able to keep it in the right place

37:54

and without the appliance

37:57

being there anymore.

37:59

What's happening there

38:02

where just the alignment

38:04

of the jaw can cause such severe

38:06

and widespread pain in other areas

38:09

of the body?

38:13

There is no one answer for one patient and

38:16

this is why you need thorough

38:18

diagnostics and comprehensive evaluation

38:20

and you need a team. That's

38:24

why as far as I've come in

38:26

the last decade, I still feel like there's

38:28

always more to learn.

38:29

There are people that have been working

38:32

with patients longer than I have and

38:34

I go to meetings and I learn from them.

38:38

Why is there so much pain? How

38:41

many problems? Well, there's

38:43

a lot of energy expended when your body is

38:45

not in alignment. There's

38:48

one way to look at it.

38:52

Pain can come right from

38:54

the joint. There's not popping and

38:56

clicking but if the joint

38:58

is not sitting properly, there are nerves and blood

39:00

vessels in there that can be compressed. There's tendons

39:02

that connect to the inner ear that can cause problems.

39:05

The breathing and the

39:08

dysregulation of the autonomic nervous system

39:11

as a result of that is so interrelated.

39:15

But there's the trigeminal

39:17

nerve going to all the structures of functional

39:21

structures of the face also is just this

39:23

superhighway and

39:25

just like chronic pain anywhere else, the

39:28

sensitivity can be after long periods

39:30

of chronic pain

39:32

can become extra sensitive.

39:34

Some of the techniques are

39:36

some of the results that people get are based

39:38

on normalizing the muscle

39:41

position and

39:42

downregulating the neural

39:44

activity. One

39:46

of the really useful tools that

39:48

I don't think is wide enough known is

39:51

sphenopalatine nerve block. I'd have to go

39:53

back and see if we utilize that with the LAMB. It

39:55

is really beneficial. I've

39:58

had teenagers. My

40:00

youngest was 13 years old. This pore goal came in

40:02

and she started having horrible migraines. And

40:05

we did, and we just, you run,

40:07

you got to know where to put it, of course. But yeah, I mean, it's,

40:09

it's simple, 2% lidocaine. You put it in

40:11

the right place, run it into the nasal

40:14

sinus. You hit this nerve bundle that's not far

40:16

separated from the gingolin. And, and

40:18

you can calm down the, the, you know, the hypersensitivity

40:21

that

40:23

that's happened in that nerve pathway,

40:25

just like nerve blocks are used in pain anywhere in the body.

40:28

They're super useful, super easy to do, not

40:30

expensive.

40:31

I've had people that have suffered from migraines

40:33

for years and years and years. So it really is, it's

40:36

a complex answer because every patient

40:38

is different and every, some patients you're

40:40

able to get better really quickly. Some take more time.

40:43

There's not just muscle, but the fascia that's included,

40:47

improper breathing is a big player in

40:49

this and how sensitive people are to pain.

40:52

And so, you know, one of, one of the things that we've,

40:54

we've added to our repertoire is I have a

40:57

physical therapist that

40:59

works for me. And he, he works with preparing

41:01

people for me to do, you know, oral

41:03

tether releases like tongue ties and lip ties.

41:06

Some people have had really big relief

41:09

by just addressing

41:11

a tongue tie and how that's interconnected

41:13

to the hyoid bone and all those structures. But

41:15

it, the point I'm getting at is, is the

41:17

fascia. So we do the same thing with dry needling.

41:20

We can get into muscles and help

41:22

with the fascia. And I have a soft tissue

41:24

specialist that comes in and works on that too. So it's

41:27

not just my dental tools.

41:29

It's not just what I'm doing. I've

41:31

tried to bring in a team

41:34

to help these patients find

41:37

the things that are most relevant and most, and most

41:39

helpful.

41:40

And, and, and so now it's nice not to have two

41:43

tools in your toolbox. It's nice to have half

41:45

a dozen, and I hope in two years I'll have, you

41:47

know, I have half a dozen, you know, it's nice to have a dozen or

41:49

two, and then I'll have a half a dozen more.

41:51

Yeah. Did

41:54

I get to your question? Yeah, it's this, it's, it's,

41:56

I mean, I think what, what's, what's challenging. Just

41:58

not a simple answer.

41:59

Exactly. That's what's challenging in

42:02

general about this is if

42:04

you, you know, functional medicine

42:06

has come a long way since the early nineties.

42:09

I feel like function, let's just use for,

42:11

for lack of better term functional dentistry

42:14

is kind of at the stage that

42:16

functional medicine was 20 years ago where

42:18

there's,

42:20

there's less awareness, but it's growing.

42:22

And I think growing quickly. Yeah.

42:25

There's no established residency

42:28

or board certification for, for

42:30

this. There's, there's

42:33

not even really any form as far as I can

42:35

tell, there's not really even

42:37

any formal training programs.

42:41

I mean, they're like, that are like start

42:43

beginning middle end, you know, go through this

42:45

whole thing and you'll get this whole curriculum

42:48

and program. It sounds like you've done more of like

42:50

the Mr. Miyagi style kind

42:52

of apprenticeship, you know, finding

42:55

people that teach some part of it that you really

42:58

respect and learning from them and then going

43:00

on learning a different piece from someone else.

43:02

And I think that's, I mean, that's

43:05

fantastic. You've been able to put that together. And

43:08

I think what will might, my sense

43:10

is what will, it's also what

43:12

makes it frustrating for patients and frustrating

43:15

for dentists who want to get more training like

43:17

this, you know, it's cause if someone

43:20

writes it, here's this show and they're like, awesome,

43:22

I want to do this kind of, you know, I want to work

43:24

with somebody like this. There's no directory

43:26

that you or I can send them to that has

43:29

a list of people that are combining

43:31

all of these things in the way that

43:33

you are. And you know, of course

43:36

I'm very familiar with this problem. That's why I started

43:38

my adapt practitioner training program

43:40

in 2016. But

43:42

it is, you know, it's almost, we talked,

43:45

we chatted about this before we decided to do

43:47

the podcast. I'm almost reluctant to do

43:49

podcasts like this just because I know

43:52

people are going to hear it. They're going to get excited. They're

43:54

going to want to be able to, you

43:56

know, access this kind of care, which of

43:59

course is. perfectly logical

44:02

and understandable. I was there myself and

44:05

if they're near you or

44:08

can travel to you and can afford

44:10

to do that, I would highly recommend that. So

44:12

I'll in a second here let you give

44:15

your information. But for many

44:17

people, that's not going to be possible or feasible.

44:20

And so that's something you

44:23

can do anything about personally today

44:25

or I can. I

44:29

do take some solace

44:31

in the fact that this is really

44:33

different field even five years than

44:36

it was five years ago. And I was surveying

44:39

this landscape. It seems like there are

44:42

changes happening there and there's a lot

44:44

more going on now.

44:45

Yeah, there's more collaboration

44:48

of groups. And

44:50

AOMT, which

44:52

is a Myofunctional Therapy Group, they're doing brilliant

44:54

work and great education and lots of multidisciplinary

44:57

collaboration. The Breathe Institute

45:00

is doing great things. There's more and more

45:02

appliances that are based around addressing

45:05

these issues that are dental and nature for

45:07

expansion of one form or another. It's

45:10

growing and there's a growing understanding. And historically,

45:12

the problem has been a lack

45:14

of that, a lack of training, a lack of knowing.

45:17

As things like this developer

45:20

in this period where I feel like there's

45:23

people that are practicing on one thing

45:25

or another and I'm sure they know many

45:27

things that I have yet to learn. But

45:30

when I listen to them speak and I participate

45:32

in their trainings, I see gaps

45:34

in their understanding based on my experience.

45:36

And so we still have a long ways to go, but

45:39

I agree with you. I think your observation is accurate.

45:41

It's much different than it was five years ago. And

45:43

so it is promising that

45:46

in five more years, it'll be much better. But it's

45:48

challenging what you said about

45:50

how much it takes

45:52

to get this understanding and study.

45:55

It's very true and it

45:57

self limits because there isn't a result.

46:00

residency for this. And

46:02

I feel like based on what you learn in dental

46:05

school or in a specialty, you don't understand, at

46:08

least at the time that I went through, it's been

46:10

a minute. And to be honest, it's been almost 20

46:12

years, but you didn't

46:15

understand the importance of it.

46:17

You didn't understand the significance and

46:19

how profound the problem

46:22

is and how much people are suffering. So there's probably some

46:24

change there, but

46:25

it really, if you're gonna treat and

46:28

treat well, I mean, there was a point

46:30

that I was a few years into this and I had

46:32

to make a decision. Am I gonna continue to spend,

46:35

to forego family vacations and spend so

46:38

much money educating

46:40

myself and time away from family

46:42

and work to continue doing this? Because

46:45

that's, I had to get a couple of years in

46:47

to realize how much there was to learn.

46:50

And that's only grown because,

46:53

which is good, there's more interdisciplinary,

46:56

multiple groups sharing information,

46:58

but it's really hard to, as much

47:00

as I try, if you're a full-time

47:03

clinician, it's hard to keep up with it all. It's a

47:05

challenge.

47:06

Absolutely. Well, thanks for

47:08

your contribution. I really

47:10

appreciate your multidisciplinary approach and

47:13

that's definitely my orientation and what I think

47:15

is often necessary, especially in complex,

47:18

chronic cases. So where

47:20

can people find out more about your practice

47:23

and your work, especially

47:25

if they're local or

47:27

wanna come travel to see you?

47:30

Yeah, like you said, we're in Park City, Utah.

47:32

Our website is

47:35

advancedcosmeticdentistry.com

47:37

and you can look up Dr. Paul Peterson and

47:40

you will find that. We're launching here

47:42

in the next couple of weeks, a new site that hopefully does

47:44

a

47:45

clearer job of getting this message

47:47

forward. But for now, the

47:50

URL will probably be the same. By the time

47:52

this comes out, it'll probably be past that.

47:54

So that'll be great. Yeah, yeah, that should be great. We have

47:56

been working, so that'll be good and they'll

47:58

even be able to see. a

48:00

land on there and some of her her

48:03

changes. Yeah, she's been kind enough to say

48:05

you can use my before and afters and it

48:07

really speaks to what

48:08

can be accomplished. Absolutely. Yeah.

48:11

Well, thanks again, Dr. Peterson. It's been a great

48:13

conversation. Thank you, Chris. Thanks for what

48:15

you do.

48:16

Yeah. Thanks everyone for listening. Keep

48:18

sending your questions to chriskresser.com slash

48:20

podcast question. We'll see you next time.

48:24

That's

48:24

the end of this episode of Revolution Health

48:26

Radio. If you appreciate the

48:28

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48:31

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48:34

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48:37

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48:39

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48:41

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48:43

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48:49

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48:51

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48:54

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48:58

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49:00

do throughout the week there that never makes it to

49:02

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49:04

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49:07

Thanks so much for listening. Talk to you next time.

49:20

you