Nuts & Bolts Foundations with Dr. Melkers

Occlusion, Occluding, Communication, and Pain CE

As for most of us coming out of dental school (I graduated UNC-Chapel Hill School of Dentistry ’98), my understanding of occlusion was extremely limited.  I thought that getting someone’s “bite right” would somehow stop people from grinding or clenching, stop jaw pain, stop broken teeth and restorations from happening, and more.  After practicing for a few years, plenty of CE, doing some big cases, and seeing unexpected failures, I learned that wasn’t always the case.  Through discussions on DentalTown, I was exposed to people and ideas that helped me understand why.  Of those, Dr. Michael Melkers was one of the first and most influential for me, and he continues to be so today.

Course Description and Details

As described on Mike’s FB page: Nuts & Bolts Foundations – Study Club II

This program will be an evolution of the original Nuts & Bolts Occlusion program which will meld communication, occlusion & treatment planning.
Content will customized and attendee driven to best meet the group needs. Key concepts will include patient centered treatment planning, occlusal instrumentation and records as well as orthotic therapy.
Overall goals will include understanding, implementation planning and application in attendees practices.

  • Tuition: $2750
  • CE Hours: 20
  • Attendees: Limited to 6 per course
  • Dates: March 14-17, 2013
  • Location: Hanover, NH at Mike’s office, near Dartmouth College

 A Brief Introduction

As with most of my other reviews, this one begins with  I first met Mike Melkers there back in 2002; Mike was an extensive contributor on TMD and Occlusion with his discussions of parafunction.   This was my first introduction to the idea that people do crazy things at night with their teeth, and introduction to the NTI-tss as a means of parafunctional analysis and pain relief in conjunction with restorative treatment. At that time, I was most interested in learning how to use the NTI in my cosmetic/restorative treatment plans to avoid early failure, but I also had an interest in helping patients with jaw pain and headaches.

The first course I attended with Mike was the Nuts & Bolts of the NTI , held in Boston, MA back in 2003.  Just 1 long day, it was a powerful introduction to the NTI.  In 2004, I attended one of Mike’s first Nuts & Bolts of Occlusion courses in Spokane, WA, where he practiced for many years.  Over the following years, I heard Mike speak at the Townie Meeting, the NC AGD meeting, and other places I don’t even remember.  Through all that, Mike and I became friends.

Why Take the Nuts & Bolts Again?

In the intervening years, however, my practice evolved and changed a lot, and much of what I’d learned slowly seeped out of the daily practice, and I wasn’t happy about it.  In 2012 and into 2013, as we grew at a rapid pace, we realized it was time to refocus on what our most important services would be, as we simply couldn’t do it all any longer.  And while treating pain patients is not something I want as a primary focus of my practice, we do want an increased focus on comprehensive and multi-disciplinary care, and THAT requires a higher level of communication, and THAT is why I chose Mike’s Nuts & Bolts Foundations seminar.

So……was it worth taking again after so many years?

Five-Star Dental Continuing Ed

Yeah yeah, I know….another top-notch course.  LOL  But as I’ve said, I’m picky to begin with, so my expectation of every course that I attend, is that it will be worth rating 4 or 5 stars.  As a matter of fact, there is only one (1) CE that I’ve attended in the last several years that wasn’t that good.  So what made this course so good?  There were 3 aspects that made it so worthwhile for me:

Part 1: We Experienced It as We Learned It

In what was one of the most interesting course formats I’ve ever attended, Mike literally demonstrated how his course materials works during the flow of the course itself!  We didn’t truly realize it until 1/2-way through, but Mike used his “methodology,” if you will, to teach us what we were learning to do.  Once the light bulb went off, we realized how effective it was.  I will say, however, as we practiced on each other, it’s not nearly as easy to DO as it is to HEAR.  The tools of communication are so simple, really, we dentists often have difficulty accepting them.

Part 2: Touchy-Feely

Ultimately, the biggest barrier most dentists have trouble overcoming in patient communication, is the almost irresistable urge to explain EVERYTHING.  Very often, however, what patients really need, is someone who will LISTEN, and by LISTEN, I mean REALLY REALLY REALLY REALLY LISTEN.  The second biggest barrier goes right along with the first – dentists assume they know what the patient means when they make a statement or ask a question, but often there is a hidden experience or meaning that must be brought out before we can adequately answer.  With numerous real-life cases, Mike demonstrated how inadequate our usual patient questions are, and how easy it is to miss the real needs our patients have – ESPECIALLY the most difficult ones.    With those same real-life cases, Mike demonstrated how the simple determination to, “Stay in the question,” and keep asking, “Tell me more about that….” brought out what he really needed to know to treat those patients.

Part 3: Hands-On

While the NTI has been my “go-to” appliance for treating pain patients and managing parafunction since first learning about it on DentalTown, Mike introduced us to a different kind of anterior midpoint stop deprogrammer called the DAASA, or Dual-Arch Anterior Scribe Appliance, which is a variation on the theme of the NTI.  Admittedly, it takes more work to fabricate, but with a little practice, I foresee it becoming our “go-to” appliance as well for both parafunctional and pain management.  We all went through the labwork to make one for our partner, and since getting home and wearing mine (I’m a big-time clencher with occasional migraines and jaw pain/tension), it is the most comfortable and effective appliance I’ve ever worn.

For the nitty-gritty details:

  • Location: Admittedly, it was not easy for this Southerner by choice to enjoy the lovely cold weather of Dartmouth, NH in March, but it’s a beautiful area.  The office that Mike joined after moving from Spokane has all the facilities necessary for this intimate, small-group seminar.  My only complaint besides the cold, was it took a 3-hour bus trip from Boston airport to reach them.
  • Dr. Melkers as Lecturer: Mike is a very low-key, easy-going, but passionate guy who is one of the best dentists I know at what he does clinically and in communication.  He’s been presenting this material for years and is simply superb.  He demonstrates the very skills he teaches throughout the course, and is very encouraging.  In addition, he is incredibly available for follow-up and assistance long after the course.
  • Course Materials/Take-Home: while there is a 3-ring binder that comes with the course, the real meat of the course is in the communication skills taught, and that’s not something that you can put in a binder or on a DVD.  The tools taught are simple and easy-to-use, all you have to do each day is remind yourself to use them!  While it takes a bit to build the habit, once you start experiencing the difference in patient response, the material becomes self-reinforcing.  Mike also creates a private Facebook group for each group of attendees, which allows for private conversations, case discussions, brain-storming, and encouragement.  And the last part of the course is goal-setting, in which each of use created a small but precise list of tasks to do once we got home.

In short, this course was exactly what I needed as we focus our practice on providing more comprehensive and multi-disciplinary care, especially because such care is often for patients who’ve been through many dentists and many negative experiences, who may be jaded or scared, etc.  Only 5-6 weeks after the course, I am already finding that these simple tools are among the most effective I’ve ever learned, and have helped me add numerous $5-15,000 cases to the schedule, often willingly prepaid, in just this short time.  Not a bad ROI, is it?!


Leave a Reply