tips on using the mrc pre-ortho trainer in myofunctional orthodontics
DESCRIPTION
Some tips and tricks on using the MRC pre-orthodontic Trainer in practice, presented by a practicing orthodontist.TRANSCRIPT
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Some tips and tricks for using MRC’s pre-
orthodontic Trainer By
Dr. Barry [email protected]
Part of a presentation for MRC At the Rancho Cucamonga training center in Sept. 2011
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The Process: Myofunctional Ortho
Light Wire Expanders•To undo damage and make room for the tongue
Trainers• To get the tongue on the palate
The Goal: To get the tongue on the palate
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The Process: Trainers
Appliance Delivery Comfort check Routine visits Training Sessions Exercises
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The Try-on
Trainers: Appliance Delivery
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The Try-on“The Four Things”
Bite DownLips togetherBreath through your noseTongue on Tag
“The Two Things”Lips togetherTongue on Tag
Trainers: Appliance Delivery
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Trainers: Appliance Delivery
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The Try-onThe Two ThingsWearing Schedule
1hr/day plus sleepingNo “Two Things” while Sleeping
OK to Ramp up
Trainers: Appliance Delivery
5 min 10 min 20 min 30 min 60min60+slee
p5 min 10 min 20 min 30 min5 min 10 min 20 min5 min 10 min5 min
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The Try-onThe Two ThingsWearing Schedule
1hr/day plus sleepingNo “Two Things” while Sleeping
OK to Ramp upChoose activities and make calendarOK to Split time
Sun Mon Tue Wed Thu Fri SatActivity
1 TV Homework
Homework
Ride to Soccer
Homework
TVMovie
Activity 2
Gaming
Reading
Gaming
Reading
Laundary
Trainers: Appliance Delivery
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The Try-onThe Four ThingsWearing ScheduleScore Card
Trainers: Appliance Delivery
q
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The Try-onThe Four ThingsWearing ScheduleScore CardWarnings
Don’t chewDon’t let Dog chewFee to replace
$85-200
Trainers: Appliance Delivery
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The Try-on“The Four Things”Wearing ScheduleScore CardWarningsSend them home
Trainers: Appliance Delivery
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So, how does it feel? Is it comfortable?
Buccal gingiva, especially around erupting
teeth
Retromolar pads
Incisive papilla
Doesn’t fit over BWS
Unexplained apthous ulcers
Allergic Reactions
Trainers: Comfort Check
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Comfort check1. Comfort: Common irritations
Buccal gingival, especially around erupting teeth
Retromolar padsIncisive papilla
Unexplained apthous ulcers
2.1.2) Protocols: Trainers: Comfort Check
Buccal Gingiva blanching
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Comfort check1. Comfort: Common irritations
Buccal gingival, especially around erupting teeth
Retromolar padsIncisive papilla
Unexplained apthous ulcers
Trainers: Comfort Check
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Comfort check1. Comfort: Common irritations
Buccal gingival, especially around erupting teeth
Retromolar padsIncisive papilla
Unexplained apthous ulcers
Trainers: Comfort Check
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Comfort check1. Comfort: Common irritations
Trainers: Comfort Check
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Comfort check1. Comfort: Common irritations
Buccal gingival, especially around erupting teeth
Retromolar padsIncisive papilla
Unexplained apthous ulcers
Trainers: Comfort Check
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Trainers: Comfort CheckRetromolar Pads
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Trainers: Comfort CheckRetromolar Pads
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Trainers: Comfort CheckRetromolar Pads
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Trainers: Comfort CheckIncisive Papilla
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Trainers: Comfort CheckIncisive Papilla
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Trainers: Comfort CheckDoesn’t Fit over BWS
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Trainers: Comfort CheckDoesn’t Fit over BWS
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Trainers: Comfort CheckDoesn’t Fit over BWS
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•Not related to contact with trainer• Use oral ointment• Restart use when sores gone• Ramp up time
Trainers: Comfort CheckApthous Ulcers
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Trainers: Comfort CheckAllergic Reactions
3 Days of wear
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Trainers: Comfort CheckAllergic Reactions
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Trainers: Comfort CheckAllergic Reactions
Next: T4K Hard
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2. How is your daytime wear?• Great! Here’s my card• Too Busy• Not Linking to other activities• Excuses
• I was sick• I told her she didn’t have to wear
it.• We had a family blah blah
• Sad Puppy Eyes• Can’t Breathe, Gagging
Education
Trainers: Comfort Check
(Bite your tongue)
SunMon
TueWed
Thu Fri Sat
Activity 1
TVReading
Homewor
k
Ride to Soccer
Homework
Spongebob Mo
vieActivity 2
Gaming
Gamin
g
Reading
Laundary
Encouragement, Offer
alternatives
Airway training
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3. Nighttime wear
• Normally takes time
• Can’t fall asleep
• Falls Out At Night (FOAN)
Trainers: Comfort Check
Delay starting
15 Min before sleep,
Airway training
Check Daytime wear,Airway training
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4. Motivation
• Attitude check
• Looking for results
• Encourage Patience
• Talk about alternatives
Trainers: Comfort Check
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4. Motivation : The bicycle speech
7 out of 7
Trainers: Comfort Check
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4. Motivation : The bicycle speech
5 out of 7
Trainers: Comfort Check
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Check scorecard
Video and Mirror to review
exercises
Comfort and Troubleshoot
Adjust BWS
Prescribe new exercises
Plan next Trainer or BWS
Trainers: Routine Visits
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Trainers : Training Sessions
• 1/2 hour• Up to 8 patients/hour• Assure proper wearing• Exercises to boost progress• 3-4 sessions• Extra sessions if needed
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Patient FlowActivity Area
Workbook Session
Doctor Visit
Progress Records and
Notes
1.3 Trainers : Training Sessions: Training Sessions
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Their “one hour” of wear
Activity Area
Trainers : Training Sessions
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Activity Area
Trainers : Training Sessions
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Activity Area
Trainers : Training Sessions
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Activity Area
Trainers : Training Sessions
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“So how ya do’in?”
Workbook Session
Trainers : Training Sessions
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“Here’s your password…”
Trainers : Training Sessions
Workbook Session
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“Don’t put these on the furniture….”
Trainers : Training Sessions
Workbook Session
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Trainers : Training Sessions
“No, you can’t share it with the dog”
Workbook Session
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Trainers : Training Sessions
“So how ya do’in?”
Doctor Visit
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Trainers : Training Sessions
“How’s your wire thingy?”
Doctor Visit
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Trainers : Training Sessions
“S’comfortable?”
Doctor Visit
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Trainers : Training Sessions
(The Look)
Doctor Visit
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Trainers : Training SessionsProgress
Records and Notes
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Trainers : Training Sessions
Progress Records and
Notes
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Trainers : Training Sessions
Progress Records and
Notes
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Trainers : Training Sessions
Progress Records and
Notes
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Trainers : Training Sessions
Progress Records and
Notes
10/1/10
Was talking the entire time. Told to be quiet while wearing
trainer.
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Doctor-time Scheduling
Code
Appt ActionAsst Time
Dr Time
Total Time
640 spacers Spacers 10 0 10
604 BWS insert Band, cement, fit 35 25 60
605 BWS adj Remove, adj, replace 0 10 10
606Trainer insert
Instruct, check
15 5 20
607Trainer check
Coop/comfort/progress 10 10 20
608 Activities Workbook/video/practice 10 0 10
609Group
ActivitiesWorkbook/video/
practice 30 0 30
860 Progress Photos Pictures only 20 0 20
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Trainers: Exercises
•MRC Activities Workbook•Groups 1,2,3, extras
•www.trainerkids.com
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Trainers: Exercises
• Practice with and without trainer• Phantom Trainer• 5min on, 5 min off• do the “two things” without
Trainer• Decrease daytime wear
• ramp down • down to 5 minutes for daily “warmups”
• Give Nighttime “vacations”
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Trainers: Exercises
• From Rogers• Jaw Stretches • Neck Stretches• ( 5sec x 5 reps x 3
sessions/day)
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Trainers: Exercises
• From Kondo•Tongue Lift (with gum)
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Trainers: Exercises
• Additional Exercises• From Rogers
• Jaw Stretches• Neck Stretches
• From Kondo• Tongue Lift (with gum)
• TicTac hold (From Joy Moeller)• Hold it on the spot ‘til gone.• 5x/day
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Trainers: Exercises
• Additional Exercises• From Rogers
• Jaw Stretches• Neck Stretches
• From Kondo• Tongue Lift (with gum)
• Tongue Spot• Hydrocolloid bead pressed on
“Spot”• Lasts for 2 hours• Practice “Quite Face swallows”
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Trainers: Exercises
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Trainers: Exercises
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Trainers: Exercises
• Additional Exercises• From Rogers• Jaw Stretches• Neck Stretches
• From Kondo• Tongue Lift (with gum)
• From Flutter/Buteyko• 3M Micropore tape
If you show these to If you show these to anyone, I’ll kill you...anyone, I’ll kill you...
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Trainers: Exercises
• Additional Exercises• From Rogers
• Jaw Stretches• Neck Stretches
• From Kondo• Tongue Lift (with gum)
• From Flutter/Buteyko• 3M Micropore tape
• Nasal rinsing