Mike Hoefs, DDS, FAACP, FADI
Give us a brief history of your background. How did you get involved with the care you provide today?
It started with orthodontic training in 1980. I learned functional orthopedics as well as straight wire technique. This was mostly with the US Dental Institute. We received good diagnostic training as well. I pursued as much orthodontic training as I could find through the 80’s and much of it included treatment of the TMJ. Starting in the 90’s I noticed more TMJ dysfunction that I didn’t understand how to treat, which lead me to seek out more TMD training. In the last eight years I have seen that the missing link (for me) between the two is the cranial connection. That also helped explain many of the relationships with pain in the rest of the musculo-skeletal system. My association with PRI trained physical therapists has further enhanced the treatment of chronic pain patients.
Who have your mentors been over the years?
In order of influence: Brendan Stack, Steve Olmos, Barry Glassman, Gerald Smith, Harold Gelb, Terry Spahl/John Witzig, and Jay Gerber. There are many more, but the Academy of Craniofacial Pain has been an important part of my development.
Whose work do you most often reference?
Brendan Stack, Gerald Smith, Harold Gelb. I have nearly a hundred textbooks accumulated over 29 years on orthodontics, orthopedics, and craniofacial pain/TMD.
How is your practice different from other dental practices in the surrounding community and throughout the country?
Other than spending nearly 100% of my time treating craniofacial pain patients (which less than 1% of dentists do), I would imagine it’s the incorporation of cranial principles into the TMD/ortho treatment. This directly influences the musculo-skeletal system from occiput to sacrum and all dentists affect this through their dentistry whether they realize this or not. Unfortunately these concepts are yet to be recognized by the dental community as a whole, so obviously are not taught or discussed at the academic level. Maybe in my lifetime...but probably not.
Are there other dentists around the country that practice similar to you?
I know of maybe 200 dentists that utilize these concepts, and our numbers are increasing. The osteopaths and chiropractors are recruiting dentists to learn these concepts. Ron Hruska’s vision with PRI is doing this and he has graciously asked me to be a part of the process, for which I’m honored.
In our area of practice we find it necessary at times to integrate with other professionals such as dentists, optometrists and podiatrists. Who do you find it helpful to integrate with and why?
It’s imperative to do integrative treatment with all of these disciplines. No single discipline can treat all of the problems. Chronic pain can become its own disease entity so pain specialist/neurologist may be needed at times. Plus we don’t have the diagnostic, let alone the treatment skills outside of our areas of expertise. So the unresolved issues can compromise the progress you will make and your ultimate success in treatment.
Over the last few years, you have had several PRI trained therapists refer patients to you. When is it appropriate for a therapist to refer a patient to you?
When the therapist finds that they reach a plateau in treatment that can’t be explained, they have influences from a related dysfunction. That quite often is a cranial/TMD problem. One of the most important points here is determining which of these dysfunctions the patients ’brain’ is recognizing as the primary dysfunction. The ‘brain’ will protect that injury at the expense of another part of the anatomy—it’s a survival mechanism. The head (face, jaw, eyes, ears, etc.) is the most important part of our survival, so it certainly is not hard to figure out what the primitive reflexes will protect first and foremost.
What do you appreciate the most from a PRI trained therapist who is working with a patient at the same time as you are?
Treatment is faster, and more effective—synergy! That’s usually the case for both of us.
Coming in March, PRI is hosting its first Interdisciplinary Integration course that includes you as a guest speaker. What do you plan on covering at this course?
I will discuss my treatment philosophy, treatment modalities, and integrative treatment. We will try to show as many cases (treated, and in treatment) to demonstrate this. I will discuss diagnostic protocols, different philosophies and treatment. When, where, why and how takes many years and a lot of hard work…I’m a 29 year overnight success. But I think we can train dentists to do this type of treatment with a concentrated effort in a few years, not decades.
We are often asked for our recommendation of dental courses that relate to PRI concepts, theory and practice. What continuing education courses do you recommend?
I would start with the Academy of Craniofacial Pain’s mini-residency program called the Craniofacial Pain Institute. This wasn’t in existence until several years ago and will concentrate on the necessary knowledge needed and taught by outstanding and experienced clinicians. From there you can find courses from the individuals I mentioned earlier if they are still teaching, to expand and enhance your knowledge base. I plan to do in office training as well if there is sufficient interest, but it will be the more ‘advanced’ concepts I use. Wherever the training is from, you need hands on treatment with live patients (preferably your own) to really see how this works. That’s when you really learn to tie all of this knowledge together.
How does the future of gnathological orthopedics and the integration of PRI look to you?
If we can get the word out and educate as many dentists as possible, this integrative treatment will grow exponentially—because it works. Ron and PRI trained physical therapists can relate to many instances that this co-treatment has helped patients when nothing else has worked. Many of these patients have seen dozens of health care professionals, a lot of time and money spent with little benefit. The key is proper diagnosis, followed by proper treatment. This has always been true in medicine and always will be, but not always done. Part of being successful is knowing when to treat, when not to treat and when to refer. These are the ongoing questions Ron Hruska and I continue to work on. This process will always be unending.