How did you become interested in PRI® and when did you attend your first course?
I first became aware of PRI through a dental TMJ study group – as Visiting Faculty at the Pankey Institute, we instructors are interested to learn more than we know to teach, and created the Acorn Study Group, led by Herb Blumenthal DDS. At one of our initial meetings, a PRC named Kathy Johnson was invited by Herb to attend and to give us her input on our musings. We spent our time sharing presentations and seeing study-patients clinically, and during one of those clinical times Kathy invited a patient to read a paragraph backwards – the patient was able to touch the floor after not being able to do that for 40 years! The patient also had more neck and shoulder range of motion afterward. Needless to say this caught my attention and I was hooked. Kathy recommended me to meet Mike Cantrell MPT PRC, which I later did. My enthusiasm for understanding how this thing called the body affected my thing called the jaw was powerful, and so with Mike as my tutor, I began doing home studies right away. The first course I attended was the newly designed Cervical Revolution course, in March 2014 in North Carolina. My head was spinning – literally!
How do you integrate Postural Restoration Institue Concepts within your practice ad how has your practice changed since you were introduced to PRI?
Wow – When I do an initial assessment of a patient I see for either jaw pain, bite change, or neck issues, I try to use the history to determine if this is an orthopedic problem or a neurosensory problem or both. I use PRI testing of TMCC and BC regions in this assessment; if the limitations follow the patterns taught in PRI, and a simple occlusal intervention frees those limitations quickly and completely, I know I will need to refer the patient for PRI therapies, usually in conjunction with splint therapy. That said, there are occasionally patients whose bite issues began only after another clinician used a segmental bite splint (resolving their TMJ pain issues but creating another issue with a different pain pattern) for whom the bite distortion is minimal, and I feel we can treat him by removing the other appliance and PRI therapy without making a new appliance.
The best part for me as a dentist is the confidence I have in the restorative phase of dentistry – having had a PRI therapist validate my findings, the patient is more easily able to accept his human tendency to revert to his patterned ways. The conversations with the patient about what he is feeling on his teeth are ongoing and non-confrontational. Prior to this, conversations about why the bite feels different while reclined in the dental chair and upright have been frustrating.
I know that you also have a passion for writing and teaching, how do the concepts that you learned through PRI affect those two portions of your life?
You can’t put this genie back in the bottle! In its simplest form, I invite and challenge dentists to look beyond what they have been taught in dental school. In lectures, I advise them to position pillows and props under their patients’ knees, and to situate the articulating head rest to give support for EVERY patient. I say, “even if you can’t explain the why behind this like I am attempting to with you, you can explain that you do your best work on a relaxed comfortable patient, and get immediate patient buy-in!” I also ask them to look at what they consider a balanced bite – is it simply balanced for the teeth? If you were aware that you could help a patient’s neck, vision, back or knees, would you be willing to learn more about how the sphenoid affects the neck?
I have also begun developing my own curriculum to more uniquely allow me to share these findings, without limitation of an institution’s historical understanding of the bite and how dogmatic beliefs authoritatively limit new learning. To assist me in that venture, my sister Dr. Melissa Caughey PhD and I have designed some preliminary studies to ultimately support (or refute!) the concepts I teach, and to put this into the dental literature.
What would you say to dentists who are considering taking a PRI class?
Awesome! Be prepared to take it four or five times before you get this in your tissues. It would work best if you could take the course with other people from your dental study club, as well as with the PT you know.
Who have been your mentor(s) in your career?
Most recently, Ron Hruska, who encouraged my willingness to get completely consumed with this material. I previously mentioned Herb Blumenthal, who has taught TMJ extensively and quietly taught some osteopathic and craniosacral concepts, for he was who opened my eyes to their being more to the bite than teeth. Mark Piper MD DMD, a TMJ surgeon who has brilliantly described the types of TMJ orthopedics previously less well understood – because most significantly for me, he introduced me to the role of sympathetics and neck pain in TMJ. Don Rozema DDS, Rich Green DDS, and Buzz Raymond DMD, for the three of them taught me to hone my craft in creating a smooth bite splint, which I personally experienced the importance of in my own care. And above all others, my mother Ginny Caughey, with the promise that my career would become what I wanted it to be, by following my own interests.
How do you go about mentoring others in your profession?
I have recently joined a new study Spear study club in Atlanta, with most of the dentists under 30, and it is good for me to be around people struggling with what I now consider some basic concepts, for that helps me to remember the complexity of my own learning. I also have been offered (and continue to look for new) opportunities to speak to small learning groups about this material.
Who have been your mentors within PRI?
Most importantly Mike Cantrell! Prior to my understanding the why behind his advice on how to adjust a bite splint, he was able to communicate what he wanted me to do differently without putting my knowledge on the defensive; he had just the right degree of deference to me as a learned professional, yet challenged me to change how I adjust bite splints. He countered his serious request with, Hey if it doesn’t work you can just adjust it back. What a wordsmith!
What activities do you enjoy doing in your free time?
In general, anything with my 5 year old son! But on my own, I am enjoying rediscovering tennis and golf – while wearing my bite splint and Coffin PRI orthotics! I can’t get enough of the instant feedback these rotational sports give me when I’m managing my body well.
What would you recommend to PRI therapists who are looking to integrate with a dentist (any specialty certifications, courses etc)
Find a general dentist who has an interest in occlusion and at least 2 years’ experience making hard bite splints, as a starting point. If the dentist also has some experience with orthodontics, that is a major plus, because ordering and adjusting ALFs can be difficult without that. From there, be confident and persistent – continue to frame what you want to see happen in a positive way, giving their current way of seeing things as being valid for all the patients for whom you have not evaluated! But regarding this patient you have evaluated, your charge is to advocate tirelessly for what is in his best interest!!
If the dentist has taken courses at the Pankey Institute, chances are good he has had some experience with what you need. As far as I know there are no certifications available for this kind of training, so no need to look for that. Dentists who are very interested in cranial and facial pain may be a good resource, but be aware they may have their own ideas about how to solve what problems they see, which may not be compatible with the issues you see – in that case, agree to jointly examine the patient and to then jointly prioritize the cranial versus cervical issues, etc. and to come up with solutions that run less risk of causing more issues.
Most importantly, realize the relationship is a dance – you take turns leading, and try not to step on each others’ toes!
