2 Important Uses of Acupuncture and Trigger Points – PDP105

Jaz’s Introduction: Hello, Protruserati. I’m Jaz Gulati, welcome back to another Protrusive Dental Podcast episode. I feel like it’s been a long time since I had a PDP episode, we’ve had a couple of group functions, which I hope you really enjoy with Pav. Like I told Pav before I recorded those episodes, speak to me like I’m five years old, because like I said, in a recent Instagram post, I don’t know very much about implants. So that’s why I really enjoyed learning those basic principles from Pav and sharing them with you. And we had some great comments on YouTube asking for more of this kind of stuff, because it’s a confusing gray area, which Pav made very clear. Anyway, this episode is about acupuncture, and trigger points, and two really key uses of acupuncture in dentistry, even if you don’t proceed with actually implementing acupuncture into your care, then I think you’re still getting a lot of value from David Johnson, Dr. David Johnson did a fantastic job to explain the benefits of acupuncture but also how you can use something called acupressure to actually suppress the gag reflex on children and adults. So do stick around for that absolute gem of advice that he gives. And I think you’re able to gain even just from that. This area, you know, trigger points and acupuncture is yet another area, which is not really talked about much in dental school, especially trigger points, like the more I learned about trigger points, the more I’m like how do they not explain this in dental school? I can actually think back to patients at dental school, which were having issues around trigger points and referred pain. And we and the dental tutor and I as a student, we couldn’t figure out what was going on. But now I look back and I think yes, it must have been referred pain. And it makes so much more sense to me and you find it, once you know what you’re looking for, you can find it a lot more. I think on a monthly basis, I find patients who’d benefit from this. And I think the role of acupuncture is great two main functions of acupuncture that Dr. David Johnson explains. One is suppressing the gag reflex. And you hear all about that, including that acupressure pearl. And the other main one is trigger point therapy. So when people have trigger points, I’m not gonna ruin the podcast episode, I’m gonna let David Johnson explain what trigger point is and why they’re important, how they were discovered, how to palpate one, what relevance they have, and something that we should I think we all should know, as good general dentist specialists, we should know that.

So before we joined that, I owe you a Protrusive Dental Pearl. Now what’s going to make a whole episode about this topic, but I thought, let me know, let’s not drag it out, okay? Let me just give you this cool pearl, okay? Now, the pearl I want to give you is how I communicate an oro-antral communication, how to communicate an oro-antral communication. And notice how I’m sharing with you how I communicate, I’m not saying this is the best way to communicate an OAC. Because really, when I stick this up on social media and whatnot, I want to hear from you guys. How do you communicate OACs to your patients? Do you have a way that you’d like more than what I’m about to share with you? Now when I think back to things that are I create that original, which is like 1% of things, and things which I have plagiarized over time. This is probably within the plagiarize category, 90% out of things that I share with you guys, I’ve learned from people really clever, and mentors and whatnot. Now I can’t credit who I learned this from, I feel as those prejudices sometimes, you know, I think it could have been me, but it’s too intelligent for it to be me. So let me share with you the pearl. So when I’m communicating an OAC risk, so any upper, maybe sometimes second premolar depending on the radiograph or molar for sure. And the roots are anywhere near the antrum. Anywhere near, okay? I will always do the same thing, I will pull up the radiograph and show the patient, “Hey, do you see this white line over here? That’s your sinus.” And I point to my cheek and I say “Hey, you know we got two of those, we have two of these either side. And the roots of your molar are very, very close. In fact, can you see this X ray that overlapping. Now this doesn’t mean that the root is living in the sinus, it could just mean that it’s close and is overlapping. If your roots are living in the sinus, when I remove the tooth, I will take a look. And if I can see your sinus, if I can see into your sinus, I will do a few things to make sure you don’t get something called a communication, an oro-antral communication. Now what that basically means for you is you’d have a new party trick and the party trick would be is that you drink water through your mouth and it could come out your nose, okay?” And I just look at the patient and I make a like a kind of like a serious face but also like a wow, that’s kind of weird, right? And then usually get like a laugh or something. You know, I think most people tend to laugh at this and they say, they memorize it. And I think part of consent that’s powerful because it’s something that the patient will not forget. So even if an OAC does happen and does become something in the future and you see them again a few weeks later then they will remember, Oh yeah, Jaz warned me about this link, okay, because my roots were close to sinus and just to go back a bit when I’m sure showing the patients their radiograph. And I’m showing their roots, I say, your tooth, your roots and making them take ownership of their problems and their teeth and the anatomical considerations. It’s not my problem, it’s their problem. I’m just there to do a nice safe job for them. So anyway, so I will tell them, you’ll have a new party trick that’s very memorable for them, they laugh, creates a positive sort of interaction, and then say, and then I say, don’t worry to make sure that doesn’t happen. Once I remove the tooth, if I can see this sinus area, then I put a special stitch inside, and then we’ll see how you heal. And you know, sometimes people say that, Oh, if you give warnings like these to patients, then they might not have their tooth out. Or they might No go ahead with treatment X, Y and Z because you scare them away from treatment. Well, Lincoln Harris always taught me that that’s the whole point of consent, right? If your patient doesn’t consent to a risk, then they shouldn’t be having that treatment. So I don’t worry about if the patient is going to suddenly back out the extraction never happened to me. It’s important for them to know because the time that you don’t want them, that’s sods law, that’s what’s going to happen okay, so it’s not the end of the world and when I communicate an OAC, I’m you know, when I’m talking about it, I’m not acting all like scared and worried I’m like, you know, it could happen is your mat is your tooth is close to sinus. It could happen, don’t worry, I’ll deal with it. So I’m instilling them with confidence as well at the same time. So how do you communicate an OAC please do let me know, type it on the Facebook Instagram page app because of dental our telegram group or the protrusive dental community Facebook group, please let me know I’d love to know how you do it. And let’s see if anyone has a way that I like to pinch and steel and improve the way I communicate. Anyway, I will stop blabbering. And let’s join Dr. David Johnson, and all about the two important things you need to know about acupuncture and trigger points.

Main Interview:

[Jaz] Welcome, Facebook, welcome YouTube, welcome Protruserati to a very special live, you know, I get to do about four or five lives a year. So not that many. It’s an absolute pleasure to have you on the real day the dentist from Wales. Welcome to the show, my friend. How are you?

[David]
I’m very good. Very, very good. Thank you again for the invite. As I was trying not to do too much in the that little bit of chat that we do when we’re testing the feed earlier I am you know, a short time viewer I’ve only just discovered you about a month ago with some of the stuff that you were talking about with some patients you were to but yeah, I’m a big fan. It’s just that we are on the same page with some of the stuff that you were talking about. So your podcasts blow my mind. So for the fact that you have invited me along, you know, and I’ve given up a Friday night of sitting with the kids and having a movie to talk about some of those close to my heart is great. So thank you again.

[Jaz]
We really appreciate it and the community appreciates as well and I’m looking forward to learning from you a lot because trigger points is something that I haven’t been in this area of learning this arena for that long, really fascinates me and my trigger points of journey is very much up here and down here and now moving to the sternocleidomastoid but not so much trapezius and stuff so it’ll be interesting to know where how you think that plays into that but also the role of acupuncture and how I got to bring you on as a guest is we must give a shout out to Imran Suida, hope I’m saying his name right. His instagram handle and that his Instagram page is, and Imran I think you’re watching this because said you’ll tune in. Imram, your Instagram page is the worst page ever. And I mean the worst page ever, because it’s actually a fantastic page. It just makes me so damn hungry. Every time I go onto it. So come in barbecue with me and just clipping so good makes me hungry every time. And he suggested to speak to you about trigger points. And here we are. And I’m so happy to have this opportunity, Dave, tell us about how you got to know Imran, and then your origin story. How did you get into this world of acupuncture and trigger points?

[David]
So Imran and his good wife they came on one of my courses that I was asked to do by Health Education England up in the Leeds area. So they come on and Imran is you know and his wife, but he’s one of those delegates who you can just see absorbing this knowledge that just like a sponge, it’s just like, you can see the osmosis drawing out of you. And he just took it and as anyone who likes to teach sees that someone who just then flies with it, and that’s what he’s done because, you know, his background, he’s an oral surgeon. So this greatly relates to oral surgery, but a lot of our courses what we’re mainly I like to see, you know, what our main delegates are so if it’s a lot of oral surgeons as I’ve done. I’ve taught down in Taunton, huge amount of oral surgeons down there, whereas sometimes a lot of what we’re getting along is general dentists and that’s where we want this, we want this out in general dentistry this is as we talked about, it’s an extra tool in the toolbox. Yeah, in the same way that you know, you’d learn your background basics of endodontics, so you learn the root morphology, you learn the anatomy, you learn the disease that you’re treating. And you may have learned, you know, I have been graduated 20 years now coming into my 21st. So we’re talking hand files in my day. And once you’ve done a quota, you could then move on to doing profile. So it’s, you know, that background you’ve got that but what we’re adding is something extra to treat these conditions. So patients with a prominent gag reflex, patients with temporomandibular joint pain of muscular origin, in relation to that is headaches, migraines, and especially headaches, we know this one yet 60% of patients who have temporomandibular joint pain are getting regular headaches, we need to start coming away from it and moving as your stunts do down onto the neck because we know that most headaches are coming from muscles of the head and the neck, so yeah, so that’s how Imran was on the course. And that I, you know, I got interested into I was, so I graduated 2001 from Cardiff. I did a year’s VT in North Devon, and then came back to Cardiff as in those days, we call it GPT. And I think it’s now called DCT 1 because there’s DF, and then there’s DCT1, but we used to go to GPT. General personal training. And you spent some time in the hospital, time in the community. So my time in the hospital was an SHO in oral medicine and oral surgery. And one of the lectures, was just a very short lecture that we got to do was anesthetist came over from Marsden Hospital in Swansea and did some dental acupuncture for us. And I responded really well. I just thought this is really good. I love the way it makes me feel, make me feel very euphoric, and chilled out for I’ve got to find more out about this. So you think

[Jaz]
Isn’t the experience of learning or was he?

[David]
Not just that but yeah, the way it made me feel, it just made me feel really good. I went and had that with just chilled out lunch. It was like I don’t you know, like I’d had a really good glass of wine. But no, it was just the acupuncture and these were points that I don’t use these points now, there are some far better relaxation points. And I’ll come to them later. And they’re great for using on patients. So I thought well, I’m going to need to learn about this you think well why are you going to learn about dental acupuncture so you know the internet was about and you can find it is as good as it is now with stuff like this. So where do you go? You go to Sheffield. That’s where you went. You went to Sheffield and you learnt from..

[Jaz]
Dental School as well

[David]
Yeah, exactly. I have friends who are there. And I learnt from a consultant in medical acupuncture guy called Palle Rosted, who’s a Danish doctor, who’s working at the hospital there and had his own clinic and he used to at that point, he was the person who was teaching dental acupuncture courses. He’s now retired. So it’s got to turn to someone and I got asked by the British Dental Acupuncture Society many many years ago, if I would take over so generally if you see a course on dental acupuncture 90% of the time, it’s yours truly. But if you come to our courses we do in London, and with COVID many things we’ve slowed down a bit on those. It’s myself and my good friend Tom Fayer, who’s a consultant in oral surgeon and you get the two of us and we do these I think we’ve got one fingers crossed, all being well, Omicron wise then we’re looking I think it’s March, I’ll give you the exact date later on. So yeah..

[Jaz]
Send me the link and put it in the blog when this does get and put on. I’d love to have this link because people need to learn and people need to know and then to, like you said earlier before we actually went live someone from Australia once flew to attend one of your courses, now that you know that just tells you about the volume of training that might be out there in the future

[David]
That’s going to be difficult now with the COVID restrictions and stuff like that but yeah, we used to have guys and girls coming over from France, Spain, Portugal, my good friend Jose, again he’s like Imran came over really took this and flew with it. Riga in Latvia, we had a couple over from Canada. No one from Oh, yeah. One guy from South Africa. And Peter all the way from Australia, which he regarded a flight you know, and we I’d arranged it because I honestly thought that Wales, we’re gonna do a lot better than we did that year in the Rugby World Cup. We did better than England. But Australia in the final and I thought, well, maybe he’s coming for that. No, he honestly flew over just for the course. So you know, I’ve been teaching these courses for 15 years because again, as because I was an SHO in oral medicine and surgery when I got to do this. I got paid for the hospital, paid for out of our study grant. And then I went into community four days a week, I was asked to come back and do one day a week as an honorary clinical lecture in oral medicine. So I got to treat a lot of patients with head and neck pain. And one of the majority of things that I was seeing was patients with temporomandibular joint pain. Now you call it TMD. I’ll call it temporalmandibular joint pain because, you know, there’s different Schools of Thought. I mainly go with what Professor Renton from Kings says. She says, you know, what we’re seeing, if it’s not dysfunctioning, she says it’s muscular pain. So we should call it that, which was she gave it once in a pain symposium, I was teaching for the BDA. And I was sat there thinking, Oh, God, my slides will say TMD and TMJD, I best change slides quickly. But from what you said, I think, yeah, it’s in the same way but when they change the classification of you know, you call a white patch, or white patch, instead of giving it a fancy name, like leukoplakia, or something, call it what it is. So she says, We should call it temporomandibular joint pain, because the ones that dysfunction, that’s when we should put that D word in. But that’s…

[Jaz]
It’s nice to know these terms in there. You know, at the end of day, we know it’s an umbrella term, we’ve actually read the RCD, the Research Diagnostic Criteria, there’s many diagnoses within this umbrella term. And I encourage you all to look at that. And the one where, which is so important in terms of the muscular origin, just like you mentioned earlier, and the reason why I think we need to learn now. So we’ve obviously talked about all these people that come to your courses from all over the world. But now let’s give these nuggets and pass them on to the Protruserati tuning in right now, the very fundamental bits information, which is important because so much pain that we see is non odontogenic, in origin, and it gets completely misdiagnosed, completely missed. And whilst I am a big fan of no diagnosis, no treatment, I am making much less diagnosis of no diagnosis, if that makes sense? Because once I’ve done the usual checks for, Is this odontogenic pain? Is this from the sinus? No. And then I move on to the other areas in the muscles. And very often I’ll palpate a trigger point. And that recreates the familiar pain. And when I started to do that, it was brilliant, you know, whereas you think some of our colleagues out there might be doing unnecessary root canals, extractions and various other procedures. So let’s just start from the very basics if you don’t mind, Dave, what is a trigger point?

[David]
Yeah, so a trigger point is basically a well defined anatomical area within a muscle that upon stimulation, usually pressure and that’s the way that that you’d be doing it in your examination, palpation of firm pressure, and definitely physiotherapists, the firm pressure that they use, you know, my wife’s a physiotherapist, even my kids say she’s got thumbs of steel, but a…

[Jaz]
Physical terrorists

[David]
Physical terrorists, that’s the one and I’m so glad she’s in the other room. And that upon the stimulation gives a specific pattern of pain radiation. And that’s what you’re recreating. And you know, when you start to look at these maps. So we’ve got, I’ve got Palle Rosted, great book, which is Acupuncture for Dentists, and it’s got these great maps in and the crosses is, you know, it depends on how big your screen is. But you know, I’ll find one of the bigger pictures. But what it’s basically showing is when you stimulate that trigger point, that’s when that patient gets that specific radiation pattern of pain. I found one earlier, there we go.

[Jaz]
One I’ve been finding the most. Now before, this is me before now feeling moving on to the sternocleidomastoid and how important that is, like, it’s one of the only muscles that can refer pain to the contralateral side, which I learned about some months ago, which is fascinating as well, and how the trigger point on the right scm could actually give a headache on the left refer it from above.

[David]
Yeah, just above it just above like a small circle here. But what, the main thing that trigger point does, and there are four main trigger points in the sternocleidomastoid is C shaped pain around the eye. And that was something, this is one of the things that as I was building up my portfolio of cases that I was seeing, I saw a patient on the oral medicine clinic when I was starting out as a clinical lecturer and she had C shaped pain around the eye which was you know, had been diagnosed as atypical facial pain, okay? So I was asked, and she’d been offered different therapists, she recently I don’t want to give away too much, but she worked over in the main hospital on one of the clinics over there, okay? And so she had some background knowledge and she didn’t want to take some of the medications that have been offered her.

[Jaz]
Amitriptyline that kind of stuff, the usual.

[David]
The fact that she didn’t want to be offered those. So I got asked what I have a look at it and see if acupuncture would help. So just went straight back to the beginning of you know, tell me about your pain, and she said what it was well, from reading books like Travell and Simon and Peter Baldry’s book, Peter Baldry was one of the founding fathers British Medical Acupuncture Society, C shaped pain I’ve just went straight to the sternocleidomastoid but a few needles into some light fit light needling, you know, found these trigger points. Light needling pain went away, took the needles out, pain started to come back. But instantly I know that’s the thing. That’s the thing. So yeah, it took a course of treatment say weekly. And that’s what we’d like to do. Again, we pressure’s on the NHS and pressure’s in practice, it depends how you can fit it in. Now I’ll come to that way up, especially if you’re an NHS practice where you can fit things in so it doesn’t eat into your time. But yeah, that was one of the first ones I saw, you know, and he presents that way we used to have a SWAG, the South Wales Acupuncture Group, which was mainly for doctors and I was the only dentist there. So you know, I went to them I said, oh, so I had this case in and talked about it into the all of them knew what it was, they would have done exactly the same. But for me, this was a new thing. Because otherwise, wouldn’t have known because, we talked about…

[Jaz]
Medicines or different routes, neurologist or whatever. The routes that they’re these patients may end up but I think it’s important for all dentists, all every single dentist to have knowledge that these trigger points exist, how to palpate them to some degree, and you need to go through a course to really do it properly, so that you can make better diagnosis because the most common one I found before I now move further I’m excited to learn from you tonight further is temporalis giving pain in a lateral incisor region. And also insertion of the masseter giving pain to a lower molar. I’ve got some great videos of patients and say, “Oh, yes, raise my hand, I’m feeling the pain.” And when you start noticing these things, it’s just brilliant. It really completes your ability to be able to get a good diagnosis.

[David]
Yeah, because sometimes we learn all these muscles and it’s you know, spend that first year at university learning you know, all of these muscles and even coloring in the muscles in different colors. If you’ve got the you know, the anatomy coloring, one of my favorite ones to do. But knowing about how they can, never taught it’s never but then I’m not blaming dental school because to be honest, you know, there’s so much out there it is just getting you out there as a safe but a, you know, a safe beginner, safe learner. So there’s so much that’s the exciting thing about it, but there’s so much more to learn. I’m 20 years out and then still learning everything. You know, it’s fabulous. So yeah, we need more of that out there to learn certain things of different pain because we’re not just the teeth, we are the whole head and neck and especially when that pain refers into our and can affect our treatment. And you know it, yeah, we don’t want to cause over treatment, but we don’t want to under treatment because our patients can be in pain. You know, Palle who used to teach me when he was teaching in Denmark, they do it slightly different especially they’d set up for headache clinics, and they’d get a dentist along, a doctor along, a chiropractor along and they teach them also, they’d be like a mini MDT. But, you know, if you as a dentist, have, you know, done the appropriate courses, done the training and work through a portfolio, then a lot of this. Personally, I don’t think the patients just coming to us about headaches is really our remit. I think it’s more in relation to tempomandibular joint, I don’t like that gray area. And I don’t want to get you know, the GDC or anyone like that too excited. But as we know, like I said 60% of patients with TMJ pain are getting headaches. So yeah…

[Jaz]
That’s what it should be. Yeah, this is why we should be screening for headaches. But you’re right, there is a gray area where we can’t diagnose, we can’t actually diagnose headache, it’s really important to say that we can’t diagnose it. But and it’s the same way when I give it a patient’s appliances, because I don’t do, I don’t offer acupuncture yet. And when I give appliances to help them with their muscles, and then their headaches go away, I never tell them that your headaches will definitely go away. I’m managing the force of bruxism, I’m doing all these other things. But some of my patients have found that their headaches gone away. And that’s usually when I’ve been, I’ve done my muscle palpation and it’s getting a positive response. And I’m there and there about and in the ballpark. So that is important as part of your palpation to figure that information out before you do anything. But I guess the next step for me is looking to acupuncture. Now, you mentioned about what a trigger point is, how do these trigger points actually formed in these patients? What’s the etiology? Or the, you know, the pathophysiology of a trigger point?

[David]
So yeah, so trigger points are always there in muscles, and we ever say that they’re so like, on or off, or some people will call them on and latent, okay? And the way they were really discovered was we’re talking going back 5000 years in China, okay, with traditional Chinese medicine. And so if I take you back to my clinic 5000 years ago, and so you might come in to my clinic, and I noticed that you’ve got this main sort like focus of pain, okay, I’ll use modern terminology. That’s just hearing the trapezius and it’s radiating up your neck, and I see another you know, 50 patients, I’ve got the same and I keep good contemporaneous notes. So dental protection love me and I start to notice this pattern of these main patients with this focus radiating up their neck, but then I’ve got another 50 patients who have got this main focus just where yours is radiating up to, and that’s radiating into the temporalis area. But for some another 50, it may be radiating down. So I start to you know, and we’re in China 5000 years ago, and the Chinese weren’t dissectors of the body, what they were was very good topographical observation list. And they didn’t know about Melzack and Wall’s Gate Theory of Pain, they didn’t know about myelinated and unmyelinated fibers. But they were really good topographical observation lists. And when you look at sort of like head and neck mapping of acupuncture points, and there’s an 85% correlation between acupuncture points, and trigger points, because trigger points roles in muscles, but acupuncture points aren’t necessarily always a muscle. So that’s why it’s never going to be 100%. But when you look at the mapping of acupuncture points, and you see these points, and what the Chinese did was, they came up with these Meridian maps. And when you look at these Meridian maps, what they basically did is join the dots. And that’s when you look at Meridian maps of acupuncture, you’re looking at them, looking at musculoskeletal referral patterns of pain. And it’s phenomenal. When you look at it, you know, you see patients who you know, have pain for their masseter, and you’ll see that it radiates up into the temporalis or radiates down the neck or along the jaw. It’s just really good topographical observation lists, and that they’ve mapped these out. So that’s where, you know, we think, you know, theory of acupuncture comes from, from the mapping of trigger points.

[Jaz]
But what is the thing that actually, you may be coming to this, but what is it that turns a latent or one that trigger point that’s off, what brings it on? Is it the whole bad posture, our stress, the things that we, the naughty things that we do, the poor posture that we adopt? Is that the kind of thinking?

[David]
So it’s basically injury, overuse, improper use, so that, you know, that could be from you know, whiplash from a car accident, it could be digging in the garden wet, and you always go off, I found some muscles that I, you know, didn’t know I had, they were always there, but what you’ve done is you’ve injured them. And we’re, in our case with patients with temporomandibular joint pain that could be you know, that overuse that clenching, okay? Now, one thing we know from studies that came out of Sweden, looking at the Masseters and doing micro assays of micro arrays in these triggerpoint areas, what they were noticing was increased lactic acid products. And decreased oxygenation, but you’re going to get one with the other. So when we find these trigger points, and we’re sticking this needle in what the acupuncture needle is doing into that trigger point, you get histamine release. So whenever you stick an acupuncture needle in your nose, you get that so like red wheel, yeah. And you get histamine release. Well, we know that histamine release causes vasodilation. So you’re going to get increased blood flow to that area. So you’re going to get increased oxygenation, and increased perfusion. So you’re basically going to wash away more of these lactic acid products. But one thing we do notice, and this is why I say on all of my courses, and it’s one of those things that you come on an acupuncture course, and you’re really keen to stick needles in, that’s all you want to do. You want to stick needles in. But the most important thing is the examination of the patients, and especially with the form of acupuncture that I like do, which is it’s called, you know, trigger point acupuncture, muscular skeletal acupuncture. And that’s the stuff I really love. And it’s a real Western acupuncture.

[Jaz]
And so this is dry. This is dry needling, right? This isn’t getting any fluid, yeah?

[David]
Yeah. Dry needling. Dry needling is also not cause bleeding, okay? So that’s dry needling as well. But yeah, basically dry needling. So you really got to find that trigger point. That’s why the good examination, and if you get the needle right into the trigger point, what you get is a Twitch, and then we, I basically see it as like, there’s really tight fiber so that then just go and they just melt down, you’d can take the needle out then, it’s like when you get that Id blocks spot on. Yeah, you know, you barely need to put any lignocaine in there. So yeah, it just goes but mainly what acupuncture is doing, like I said, increased perfusion to that area, you know, there’s that whole Melzack and Wall’s Gate Theory of Pain, which is happening in the second and the fifth layers of the dorsal horn. And that’s what we call a segmental effect, but locally, that’s the local effect. And then with the acupuncture point, if you really, truly in the acupuncture point, that gating of pain, a sense up through and this is where we get into the heavy stuff up through the lateral spinal thalamic tract into the higher centers of the brain into the pain centers of the brain. And that’s where on things like fMRI, you see those areas lighting up on fMRI, difficult thing with acupuncture and fMRI, metal needles, world’s largest magnet, it’s never get you’re never going to get on with those but you can use non ferrous needles, you can use gold needles, and again, the other thing that makes it limited is there’s nothing new in acupuncture. There’s no big company behind acupuncture, you know, funding it. And it gets expensive. The biggest, most expensive thing is your time unless you’re going to start using an FMRI machine, and they get very expensive to rent, so, never rented one myself, we’ve got one of the best ones in Europe here in Cardiff. It’s called Cubric, the 3d scans it does my friend Jeremy, works with a team on it down there, and it’s meant.

[Jaz]
But in your day to day practice, when you use it, do you use it as per like, people refer to you as because they know you now and the fact that you provide acupuncture, you get referrals for people in facial pain, and then they suspect there’s a muscular component, and then you get to see them. And then you get to do your examination and figure out okay, there is some sort of correlation, there are these trigger points and then you’d carry out with therapy? Or are these patients that you are Have you ever list and then you’re just going the extra mile to diagnose these conditions and offering your acupuncture, how’s it? How do you work in terms of pain clinic?

[David]
Yeah, so my clinic, my background is I treat I’m a general dentist works in the community treating special needs kids and special needs adults. And I’ve been doing that for 18 years. And the more you do the more you know, specialized you become within that, but I’m not a specialist. I still like you know, I love the fact that you said and I say the same. I’m a generalist, but I work within that field. And it’s great. So we’re a referral only practice treating, you know, special needs kids and special needs adults. So but yeah, if a referral came in, then yes, but I generally I’m, I don’t promote that out because that’s not what I’m there for. I’m there to do treatment under sedation, general anaesthetic and do more complex cases, stuff like that people who can’t accept treatment within general practice, but if one of my guys that I see needs it, then yeah, I use it on them. You know, I used to use this, there’s some lovely points just on the top of the head around the crown, which are really good for sedation feel just a nice, relaxed, sedative effect. And I used to use them a lot. And I still teach them a lot. But I have better things now. You know, I have different gases. And if my gases and drugs aren’t good enough, then you know, my colleagues, Simon or Tom in the hospital who are anesthetist, then there’s a better, so but you know, for those before I built up my sedation portfolio, then I were using these a lot. And you know, and they’re fabulous, nice, simple technique, you know, five needles, so, you know, your overhead like a box of acupuncture needles like this, 100 needles, 10 pounds. So each needle 10 pence. So, you know, your overheads for acupuncture are extremely, you know, extremely low, your most expensive thing is is your time. So I’d say to anyone starting out doing acupuncture, you know, you want to be doing it say, you know, at the end of the session. Or at the end of the day. Especially if you’re using it for someone with temporomandibular joint pain, and you’re not going to be doing anything else, you might be doing the splint and stuff like that. Myself, I like to use acupuncture to get rid of the muscular pain, I just see it as these sort of like magic little, you know, arrows that get right to that pain that target. And that’s how manufacturers of like ibuprofen always like that they like show a bull’s eye. And that’s how I visualize it in my head. They do. We are really targeting it. You know, my wife’s a physiotherapist. I was into acupuncture before we got together and she’s doing acupuncture courses, but she still prefers getting the thumbs in, she likes that even though she’s not muscular skeletal anymore. But me, you know, with the knowledge that I’ve done, because the amount that you can use acupuncture for within the dental field is finite, you know, we’re to around here. Yeah, I wouldn’t expect patients to start stripping off any loan there. So I’m working on the top of the shoulder, you know, for headaches in relation to temporomandibular joint pain, but I still read around it and we get to do other courses. So once you’ve done a course like our one with the British Dental Acupuncture Society, there are some great ones with a medical acupuncture society on headaches, back pain or stuff like that. It’s not for us to treat, it’s great for yourself and the trigger point ones are great. So you know, for our I was getting some plantar fasciitis, some pain and at one point during the I think we’re on our second lockdown, it could have been a local lockdown that we had here in Cardiff, in Wales so you could only go about five miles so at the weekend, you know when you weren’t at work, the only thing you could do is be going out for walks with the kids. If you’ve got plantar fasciitis and that’s really hurt and making it painful to walk so some lovely, so you research around it, look through the text and some lovely trigger points just up on the calf. Sticks of needles in there. Did a treatment one day, does treatment next day, fine. I was fine to go walking..

[Jaz]
And it’s almost instant relief?

[David]
Yet near enough. With patients if I was doing more intense treatment I would do one day on, one day off. It’s up myself. I, you know, I really go at it with myself and also did some points right in. I wouldn’t recommend it. I was chatting with my friend Mike who is the director of the British Medical Acupuncture Society And he said, What you put it right in the arch of the foot. He said, that must have been painful. I said, I have no words for it. I said, it worked. The distal points, they’re the ones away from it. They worked really well. But I did do some local needling on I’m so glad I did. Because otherwise I wouldn’t be able to go out but it was. Yeah, when I put the needles in, it was like, my hand wouldn’t allow me to do it. It was it but it works. So you know, whenever I go away, we always take acupuncture needles, I’ve used them, you know, when I’ve been here, there and everywhere on different things when I’ve been on Expedition training and stuff like that, and someone’s bound to get a little bit of back pain. And you know, I’m not in the UK. You know, also I might do some manipulation with my fingers, but a physio and stuff like that, but understanding trigger pointing, and in those areas and just, you know, works really well, that’s the basis of musculoskeletal physiotherapy. So more dentists getting into it, and working down, you know, coming away from this area, examining muscles of mastication, especially the masseter, temporalis, lots of trigger points in the temporalis, fits in with a line called the gallbladder line, it goes back and forwards and now lots there. But moving down the neck, the main ones that we look at, especially in relation to headaches are trapezius, that’s the big one for us, especially, you know, in dentistry, that we all lean forward. And we all you know, round in and we’re at the coalface and then we come away, and at the end of the day, we most probably haven’t drank enough fluid. And we’ve done this, we’re going to get headaches in our profession, and especially if people are, you know, not wearing loupes. But that’s another bugbear of mine, you got to have,

[Jaz]
I would love to see a survey of dentists and see what percentage of dentists and dental nurses in the dental team suffer from headaches compared to the general population, that’d be a real fascinating study to do. And obviously, they usually muscular in nature. And on that point, most temporomandibular joint pain to use the terminology you said about tyrant. And most of that, let’s call this TMD, the umbrella term is muscular in Origins, ie 65%+ then there’s less intracapsular. And a lot of it is mixed. But even in those mixed cases, the muscular component should not be ignored, it’s often the bigger component. And that’s where I see the role of these trigger points and acupuncture. And that’s why I like to refer to really good physiotherapist, like my friend Krina Panchal, who’s doing great things. She’s taught me a lot about a trigger points, actually, what are the other main uses of acupuncture in dentistry? So I know, I read on these forums, from colleagues who do acupuncture, lots of dentists raving about the ability of acupuncture to help with the gag reflex. Can you tell us about that?

[David]
Yeah. So I on the course, I say, if you go away from this, and we aim the course at generalists. We aim the course at generalists, because there’s no point teaching everyone, some of the really, you know, rare stuff that’s going to come into general practice. Yeah, the stuff that’s more likely going to be in oral surgeon, in oral medicine. So the main things were temporomandibular joint pain anxiolysis, the point on that, but gagging and if there’s one thing, one thing alone that you’re going to use for and this is what’s great for the again, the DCP so the hygienists and therapists who come on the courses, as well, because obviously, a lot of practices are this patient gags send it to the DCP. Whereas me, I like to keep stuff like this. And in our practice, you know, we’re offering sedation, so that synergistic effect of sedation, you know, inhalation sedation, and the acupuncture. So the point is, basically, if you know, your lateral calf tracing, it’s point B. Yeah, that most inferior point, as the lip comes in, and the chin comes in, just in there..

[Jaz]
Mentalis muscle.

[David]
Yeah, just above it. So you look at the patient, like as an orthodontist would from the side, and it’s that most inferior, and even…

[Jaz]
Point B on the lateral calf.

[David]
Yeah, right there, the most inferior point in there, that most inferior point. And even on patients like us, you know, your beard is far superior than mine. And, but you palpate that area, and then it’s a very precise point down the midline. In it goes 15 millimeter needle, and it goes in until it stops. But that doesn’t mean you know, it’s basically just gently touches the bone, just okay, but it’s not in the sulcus, it’s below the sulcus. So you’ve never pierced someone through and through and that point is called conception vessels on the Conception Vessel Meridian that goes from the lower lip all the way down the midline, okay? And that comes, takes about five minutes to work, okay?

[Jaz]
And how successful is this? What percentage do you know either in the literature or from your own experience?

[David]
My experience, I’m quite persistent with it. And if it’s not working, then it might be that my aim is slightly off. So I will keep the original needle in, and then put another one alongside it. But yeah, you’re looking about 85-90%. You just got to give it a bit more time. But I don’t just use that one. And so what we teach is there’s a point just above the triggers. There’s just there’s this small triangle just in there. And it was rediscovered by Janice Fiske is one of the founders of Basically Special Care Dentistry. And it getting recognized as a speciality within dentistry. And she’s part of the Dental Acupuncture Society, just there. And we call that we named after her, the Fiske Point, and it has the advantage patients can’t see it. It doesn’t get in the way, even though it only gets in the way when, if I’ve marked up the rubber dam wrong. And there’s too much rubber dam here. But this one can with repeated opening and closing work its way out. If it does, you just reapply it. So CV24. The Fiske Point where we say bilateral Fiske points. And then there is another point and it’s one of the points on the wrisk that a lot of people so it’s the most distal wrist crease, and it’s three fingers down, which in an acupuncture measurement is called cun. Okay, three fingers is to cun. And it’s just that midline as PC6, pericardium 6, there’s a lot of research done on that one. Very good anti..

[Jaz]
And then we, Dentists, we can poke needles on the wrist?

[David]
Yeah. You know, it was one of the first points that I was taught, I think, you know, because you’re using it, I don’t think it’s in an area that to risky, an all risky, and you get right, by the way, so we’re not asking patients to strip off the chair, it’s a good distal point and an area of easily accessible, you know, unless people have got, you know, an aversion to showing their wrists in public then fine, but the local points are far better. PC6, pericardium 6 is what’s used with Sea-Band®. Those are acupressure bands for seasickness, travel sickness, but again, takes about half an hour, and who’s got half an hour. So we generally go with the local points, which are a lot quicker. There are also there was a guy called Bob who came out to one of our courses over from Vancouver. And there are some points on the air. And you can get these like little clips that just clip just behind the lope just around here. And he came on one of our courses because someone had told him about these clips, and he wanted to just understand how this works. So he you know, he’d used him in his practice, still didn’t understand how he worked. He came on my course. And I went, Yeah, auricular acupuncture is not really my thing, I know about it. I do bits, I said, but I can tell him that these points but you know, I said if it works, it works. Yeah, I said I don’t do auricular stuff or ear acupuncture, as it’s called, but the local one. Acupuncture is great for them. And that’s something that in our practice, because we’re being referred a lot of patients with excessive gag. You know, you can take someone with a GSI of four, Gagging Severity Index, from a four down to one…

[Jaz]
I don’t even know that existed.

[David]
Oh, the gags. Remember, in dentistry, there is a grading system for everything. And if not, someone’s working on one. But yeah, the GSI, The Gagging Severity Index is what the gag is like, before you’ve done anything. And then when you’ve done whatever you do, whether it could be hypnosis, it could be desensitization, I’m not insulting of the tongue, because we’d like to keep it low.

[Jaz]
I was going to ask you about that

[David]
That again, that most probably works on a similar neural pathway. But for me, I do acupuncture, or it could be just be doing inhalation sedation, or the two combined. And then there’s GPI, a Gag Prevention Index. So what you’ve brought that gag down to so it’s just a before and after measure, you can give it you know, it’s quite useful, it’s easier, you know, especially if you’re doing research on them. So my first line, I will always well I’ll generally jump in with acupressure, firm pressure.

[Jaz]
So I was going to ask, okay, what if you don’t have any needle at the moment and you haven’t been on your course yet? I’ve read somewhere that you can use acupressure. So is that as simple as just getting the patient or you yourself? Ramming your finger in that space just under the lip just by the mentalis, just by the point B as we said, and then giving it some time to work?

[David]
Yeah, I generally, when I was doing my research, for my you know, to complete my foundation training in dental acupuncture, I did research because at that point, my main patient basis was kids. So I was doing a needle free technique to reduce the gag on pediatric patients prior to taking bitewings. Because I want my wings on kids. because it helps improve my treatment planning. But you know, even with the size 0 film, it can stimulate that gag because the main areas for stimulating a gag, lateral border, the tongue, posterior palate, lo and behold, what does the bite wing collector do?

[Jaz]
And also the way they swallow is it makes it even more difficult by placing a bite wing. So that’s fascinating. So any guidelines as to how many minutes and how hard?

[David]
For my study, I did it for a minute, why a minute? Because it seemed about righ. How firm? Firm enough to cause blanching so a bit like, you know, when you do like peripheral perfusion test, yeah, so I’m on the, so firm enough to cause blanching, but not firm enough to cause bruising, okay? For a minute, now I was doing a set, it was a single blinded study. So I wasn’t telling the kids why I was doing it. But I knew why I was doing it, okay? Now, I tell the kids, this is the Ninja point. It’s a ninja. So I’m flying, I’m doing some ninja magic. And we’ll apply it to Ninja point for a minute. Most kids, you only need to do it once. But if you got to do it for a minute, prior to each bite wing, then fine. In some study, I did. So 90% success again, because it was a short amount of thing. But I also make sure whether you know, good techniques are making sure they’re in good position, they sat back, the chin is up, you know, and also instruct them what I want them to do close slowly and gently, not quick, like a crocodile slowly and gently. So yeah, so works very well. If that doesn’t work, then fine, then we need to move on to the needles, and that’s for kids and for grownups, especially with grownups. You know, in my time, I’ve only had three cases that I’ve not been able to treat with a combination of acupuncture and sedation, and these are men in their 50s, all three of them, men in their 50s previous heavy smokers, previous heavy drinkers, I don’t know why, I’d like to know more, I’d like to, you know, I can tell, there are characteristics. So if anyone out there goes, Yeah, that’s why I’ve had the same. And this is the reason why it doesn’t work. It’s like, Thank you, that explains it for me, because I really want to, but they’re three previous heavy smokers, previous heavy drinkers, not being able to do a thing with their gag, not being able to do a thing.

[Jaz]
So you’ve talked about the use of acupuncture. And we talked very much about trigger points, and how they’re related to myofacial or myalgia of the umbrella term of TMD, talked about acupuncture and the gag reflex, and you gave some great pearls about using acupressure and in children, I think that’s something that we can all do on Monday morning. So thank you for that brilliant tip. Any point, we just wrap up now and welcome any questions from the audience. Any other uses that you think general dentists are missing out on by not implementing acupuncture as part of that practice?

[David]
No, I think they’re the main things, they’re the main three things that we like, you know, start with the, you know, with the basic cases, and then after that, you know, start with temporomandibular joint pain. And once you’re moving from that, that’s when you start to come down onto the neck and everyone when they’re first put needles in into the masseter and the temporalis, they’re all a little bit weary. And we do it as a two day course over a weekend. And on day two, we move down onto the neck and I say to the delegates, once you’re down on the neck, and you’ve learned and you’ve been doing the big muscles on, on trapezius, splenius capitis then you just, everything pales into comparison, because you’ve had to, you’ve got to go on to the neck, you’ve had to lift the trapezius and hold it up, you’ve had to go in a different angle, very good safe technique, because that’s the most important thing, good examination and safe needling technique. And that after that, you know, the needling of the masseter. And if you want to do you know, there is a trigger point from the masseter that goes through to the pterygoid then you can do that most people you know, I don’t feel that I need to needle through to the pterygoid I think it’s the big muscles that causing those main problems. But if once I’ve turned them down, there’s still some, then it may be that there’s something a little bit deeper. But yeah, it’s that whole thing of building up your portfolio. It’s one of those things come on the course, build up your portfolio, the more you do, then just learning more as I say is, you know, learning more about musculoskeletal pain because it is a very interesting thing. You know, because

[Jaz]
I’m actually gonna, definitely committing to, I’m gonna join you on your course. We just had a question. Right. So, and actually one of the questions from the same person. So Sherry, hi, Sherry, Sherry Abu Turabi. So after one minute of pressing, so back to the acupressure, yeah, just for the gag reflex. One minute of pressing and do you see the effect immediately?

[David]
Well, the gag is reduced so I’m able to take the bite wing. So that’s a success what we’re talking you small amount of stimulation. There are some patients who are referred in And just to examine them, what I’ll do is, I won’t be able to use both hands. It’s that thing where, you know, it would have been nice if when we had that first COVID Jab that we grew that third arm because it would have been so useful because I could apply the acupressure. And then I could have the mirror and the probe. But yeah, so I often apply that, I generally like to apply the acupressure myself. But you can especially for patients who gag when they’re brushing, talk about them applying it, you know before they’re brushing, yes, but it fits in with that that whole thing. There’s lots of different tips, you know, the one of them is applying firm pressure. The other thing is, for some patients, I say, if you shower in the morning, brush your teeth while you’re in the shower, because when you’re bending over that sink, you’re already in that position getting ready to be sick. I said so just changing the press. And that because you can breathe better because you stood up, if you don’t have to worry when you spit it out showers gonna wash it away, but you know, good firm pressure for yourself, and helping, you know, we’ve been doing it in our house when we’ve been doing our lateral flows every day, and especially with the fact with the Omicron variant, you know, you’ve got to be swabbing the back of the mouth. And, you know, without so yeah, so we make sure that one finger on, and then back we go with that swab, but yeah, firm pressure, if it brings it down, so it doesn’t feel like when I’m swabbing myself that I’m gonna sick myself inside out, then that’s good, it’s done its job.

[Jaz]
Next time I do a lateral flow, I’m gonna give this a go as well…

[David]
Firm pressure

[Jaz]
Firm pressure. Well, I remember a patient I see about five years ago, and I felt really bad for him he actually hadn’t, it’s the most severe gag I’d ever seen. He’d make himself gag, every time he’d brushed to the extent that we actually had to remove, there are non functional but still remove the second molars which are to anyone else’s are very accessible only because of early decay. And the prognosis was so bad because there’s extreme gag to remove teeth under sedation, which is a real shame and to be able to teach that patient just like what you said, in the shower, and to use the acupressure is something that could really make a big difference. So I think that’s a very implementable,

[David]
Well, the other thing is also timing as well, because especially when you’ve woken up in the morning, your stomach, just not fully settled. And you know, when I, you know, we now say brush at nighttime, and one other time. The nighttime brushing being the most important, you are less likely to gag at night. Yeah, it’s that you know, your stomach small settled, you just, whereas first thing in the morning, and I speak from personal experience. And from chat with patients, that’s when they’re more likely to gag. So sometimes it’s just about, well, maybe wait till later on in the morning. There’s nothing wrong with taking a toothbrush to work and then just assume that five minutes, go off and brush your teeth. And if you’re less likely to gag and you’re able to get just work that into your day and just alter that time, we will get that brushing in but just later on in the day. And it means it’s less of a task, you know, I’m forever I’m to bring up sort of like altered brushing plans for carers who are brushing foot for Special Needs patients. And you know, if you’ve ever had someone else, brush your teeth, it’s a strange thing, having someone else do it. So I was trying to teach them that, you know, it’s, you know, it’s no wonder they might be pushing weights China is, you know, involve them in it. There’s different techniques we can use for that. That’s for another day. That’s off the subject.

[Jaz]
No, but that’s really something that we can implement in practice. And Sherry also asked, there’s a last question, and I was going to ask you anyway, is and I know you’re gonna send me brochures or links or whatever. Tell us about your course date. And you give us a website, maybe and then Sherry is really keen for that. And so am I. So please let us know.

[David]
Yea, I’ll look it up on my calendar. I live by my calendar. So if I don’t, so yeah, we’re looking at fingers crossed. Saturday, the 19th and Sunday, the 20th of March. So it’s a two day course. I think the price is around 450 pounds. But that’s for the total weekend obviously doesn’t include your accommodation, but it includes the…

[Jaz]
For a two day course that is phenomenal

[David]
For a two day practical course. And the main reason for that is the philosophy of those of us that are in the society, the society is there for the education, and it’s not about us making loads of money. So it’s there, we have to charge it at London prices because you know, we’re college and it costs more whereas if we did it somewhere else if we came to reading it might be half that.

[Jaz]
Well, I’m gonna have to host you in Reading because I can’t make that day because I’m in Dubai, hopefully all day as well.

[David]
We are most probably doing because we haven’t, we didn’t do one last year and we generally do them in October, but we haven’t done for the last two October’s, we all know why we haven’t done them. The only thing that we’ll be looking at is with anything flow before you go so we asked people to lateral flow before you know, they come in for the course, that’s fine, because that’s what we’ll be doing. Because obviously people are coming in this was out, you know, for the course and they’ll be coming from multiple practices. So everyone wants to know that after the weekend that they are fine to go back to work. So it’s that mutual respect thing. So yeah, so we’ll be looking at doing one, doubling up this year, and doing one, a couple of months later, we’re just sorting out the dates with regents colleagues

[Jaz]
Please do. I would like I said, I’m not just saying this, because you come as a guest, I generally want to come to this course, I think it’s the next string to my bow, in terms of the management of temporomandibular joint pain that I do. I do quite well with splints, and using physio techniques and referring to my physio colleagues, but I think I would love to have for just even just the gag reflex, and for a simple trigger point areas to help people with their facial myalgia, I think it’s a great thing to be able to

[David]
It’s that extra tool in the toolbox, that’s what it is, it’s that extra tool in the toolbox, and you can use it in combination, you know, with other therapies. So when you can approach it in the, you know, multifaceted way and you know, to get that and different cases will need different things. And also, you get some patients who, you know, needles are not their thing. So it’s not like, I go well, I can only offer you acupuncture, I want to get them pain free. So Fine. We’ll talk about acupressure, we’ll talk about firm massage in that area, you know, using something like bio oil, or just even just a simple you know, face cream and just giving themselves self physiotherapy in that area. You know, when I was a student, one of the Oral Surgery consultants used to talk about this stuff called Coal Tar paste, really thick, and you get the patients put a small dot of it over where we say the trigger point is, and you’d get them to massage it in. Well, this stuff was extremely thick, and they’d have to massage it in until it dissipated. Well, it took a decent amount of time. So by the time they’d finished, they’ve given themselves physiotherapy over that trigger point. You know, so we’re talking, you know, we’re maybe explaining things a little bit more scientifically. But you know, things go back, you know, way before them. You know, I spent a bit of time with the San Bushmen in Namibia on an expedition survival course, when we were looking at the women from from the San Bushmen, a lot of them to treat sort of headaches and facial pain, what they would often do is they take a small blade and just cut over that area, and then they would take ash from the fire and rub it in. And the way you could tell is because they had some sort of like tattooing in that area. And that’s how they would do, they would basically use a noxious stimulus, basically to help with the pain that they were having. And that goes back, you know, for them, most probably centuries, if not more. So you know, we’re just explaining things a lot more scientifically now, because we’ve got far better machines, better understanding of anatomy, neuroanatomy, and how thing all links in, but yeah, for looking at the courses, just Google British Dental Acupuncture Society, the BDAS. Yeah, British Dental Acupuncture Society.

[Jaz]
Amazing. Sherry says thank you very much. I find it very interesting. And even though it’s Persian New Year, she said she’s going to come. Sherry, I’m sorry, sorry, I won’t get to meet you because I’m not be able to make that date. But I’m going to be pestering Dave, for his other dates, especially at that fee is amazing deal. And I can’t wait to learn more from you actually, hands on. So really excited for that. Dave, thank you so much for giving up a Friday evening to be live with us, with the Protruserati and to teach us some things about trigger points, and how we can implement acupuncture in practice for temporomandibular joint pain and for the gag reflex. I really appreciate you coming on.

[David]
No, I and again, once again, thank you for the honor of being part of it. Like I said, when I saw your site, just Yes, he’s on the same page. He understands trigger point is,

[Jaz]
I am on the same page but I have so much more to go to be able to learn. I’ve got so much to learn from you. So appreciate you initially, I will say one so thank you.

[David]
Yeah, it is a great journey to understand muscular skeletal pain. My wife and I talk about this a lot. So what happens when people don’t understand it and she says, they walk about in pain for a long time. All they have to you know, from the rest of it, they have to alter their posture and stuff like that. But you know, this feeling with medical colleagues, they just say, you know, really the good health model would be to have the every general medical practice has physiotherapist who does acupuncture and something like that there because 70% of what comes in of pain is musculoskeletal pain and musculoskeletal pain response so well to acupuncture.

[Jaz]
And it’s the second most common cause of pain in the face. So after odontogenic, after you know tooth pain, it is the next most likely thing. So this is something that most dentists when they qualify they don’t have no knowledge of and I actually remember being in dental school and patients come in and the tooth to be there and I’d be there and we just don’t know why this patient’s getting pain for the molar, you’ve done your vitality testing, you’ve done your check TDP, you’ve done your probing depths, and you just can’t figure out why they’re getting pain. And then I truly believe the next step, which the tutor didn’t know about at that point, I definitely know by that point was to then actually look beyond the teeth and look at the muscles. And that would have given a huge clue or gonna get us closer to diagnosis.

[David]
And all it takes is just a couple of lectures just with some nice diagrams going. And if one thing it will show you, especially looking at the muscles on the neck, improve your posture because when you look at these trigger points, everyone will go. We most probably all like this, just midline of the neck, which is a point called bladder 10, and a half, on the bladder meridian. It’s named the head areas are none of them relate when you cover the course you’ll see how none of them relate to the underlying anatomy and I’ll explain why they’re given the names that they are, their medical names, and who came in and said, We’ve got to have something so we’re all working off the same terminology. So people don’t stick needles in the wrong place. But yeah, bladder 10 and a half, in between bladder 11 at the top, bladder 10 down the bottom. That’s where people like to be massage, that sort of area that you think, if I was a tiger cub, that’s where I’d like to be picked up on my neck. It’s just, ah, yeah, that’s the area you go. That’s just a few little needles in there. A few on the trapezius. The worst thing is the ones on the trapezius, you can’t do yourself. So it’s always good when someone comes along, you bring someone else from your practice. So you can do them, and they can do you. And when we do the course Tom does me and I do him. And we both like this afterwards, Oh so much better, it’s reset. It’s reset all that badness of the year.

[Jaz]
Excellent. I just want to say some more message coming through a Radner. Hi, Radner. I hope you’re well, she said thank you and Miles says thank you so much both of you. Ready for that course. Amazing Miles, I hope you’re well buddy, hope Movember went well, and I see your photos. David, this was absolutely brilliant. And thank you for telling us about these bladder points as well. I really appreciate your time once again, and have a lovely weekend.

Jaz’s Outro: And guys, thanks for joining this live. I’m going to be ending the live stream now. So thanks so much for joining. And this will be a properly produced episode on the main podcast very soon. If you want to listen to it again or watch it again. That’s coming soon. And for the YouTube guys again, thank you guys for tuning in as well really appreciate it. Oh, there we have it, guys. Hope you enjoy that with Dr. David Johnson. David, thank you so much for just being a brilliant communicator in this really helped make clear about the role of acupuncture and maybe you’ll be able to use acupressure on Monday morning to sort of get you started about tricky gag reflex patients. I hope that gem was useful for you. I’m actually looking forward to joining David on one of his courses because will complement the kind of work I do already with facial pain and TMD and I think to have acupuncture to my list of treatments I can offer will probably be good for my niche term development and hope some of you guys feel the same way and we’ll find somewhere local to you, no matter where you are in the world, someone who you can learn dental acupuncture from, and I hope this episode helped you to spark the interest in that journey. And thanks so much for listening all the way to the end. Really appreciate it always. Do hit that subscribe button if you’re watching on YouTube. And if you’re listening, give me some stars, okay? Spotify rating and Apple rating here and there means a lot to me. Thank you so much. Bye