{
  "text": "Going to start off by just looking at your posture. Look straight at me and straight at eye level. That's great. And the posture is good. [PERSON_NAME], put [MEDICAL_PROCESS] [MEDICAL_PROCESS] down towards your chest. As far down as you can. Inflection. He's full at zero. Lean your head back as far as you can for me. Extension. He's full at 180. Look at me. That's great. Now turn [MEDICAL_PROCESS] [MEDICAL_PROCESS] over your shoulder. He's going 90 degrees left. Let's go to the right. As far as you can. Going 90 to the right. Now I'd like you to put your ear on your shoulder. Leave your shoulder down though. So let's just start again. Just relax and just let your head drop. That's good. And in lateral flexion left, he's 40 degrees. Go to the right and to the right. He's 40 degrees and look at me. I'm going to compress a little. Any pain? No pain in compression. I'd like you to just nod your head up and down gently. I'm just going to look at the position of movement. Move up and down a little bit more. Great. Now put [MEDICAL_PROCESS] [MEDICAL_PROCESS] all the way down again. That was occiput on atlas. Movement was good. This is atlas upon axis. That movement's good too. And just look straight ahead at me. And now I'm going to reach and get a straight level just to see what your posture is. Anterior head posture. And your anterior head posture is about 9cm, so it's slightly head forwards posture. And the last thing I'm going to do is just check the transverse process of atlas. Slide [MEDICAL_PROCESS] [MEDICAL_PROCESS] forwards. Does it hurt you on either side? A little bit [MEDICAL_PROCESS] [MEDICAL_PROCESS] right. Okay. So the transverse process of atlas is tender [MEDICAL_PROCESS] [MEDICAL_PROCESS] right and it's rotated to the left. Okay, [PERSON_NAME], I'm going to ask you now if you would to sit on this chair facing the television screen. And I want to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] muscles [MEDICAL_PROCESS] [MEDICAL_PROCESS] head and neck. Okay, you're comfortably seated. Now what I'm going to do when I press is, is ask you if it bothers you. Now I want to know if it's [MEDICAL_CONDITION], [MEDICAL_CONDITION] [MEDICAL_CONDITION] severely tender when I press and also if it sends or radiates pain anywhere. Okay. And I'll tell you the muscle as I [MEDICAL_PROCESS] [MEDICAL_PROCESS] it. This is the infraspinatus. This is [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] rhomboid. Anything painful? And I'm trying to push with about 2kg of force going to the levator scapula. Nothing. And now pressing [MEDICAL_PROCESS] [MEDICAL_PROCESS] upper trapezius. With a pincer motion. And now the supraspinatus. Nothing bothers him on that side. So we're moving over to the right side now. And these are the rhomboid areas. Levator scapula, upper trapezius supraspinatus. I want to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Nothing [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Which area? Okay. Right around the thoracic spine as it turns into the cervical spine. And is it still referring. And it goes to [MEDICAL_PROCESS] [MEDICAL_PROCESS], like right here. Okay, so paraspinals. You can put mid paraspinals going to the left [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] splenous capitis, semispinalis, cervicis. And the other side. Nothing. Okay. And I'm just going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] scalene muscles. Nothing too bothersome, huh? Very good. Okay, I'm going to ask you to sit on this chair now. And that way I can take a look at the anterior neck muscles. Doing all right, we're going to give you a bib. And while we're at it, we're going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Sit your head forwards for me. We measure around the cricothyroid cartilage area. And he is [PERSON_AGE] [PERSON_AGE] [PERSON_AGE] [PERSON_AGE]. Okay, let's check a few more muscles. This is the sternocleidomastoid muscle. Just checking. Longus coli. That's when you swallow. This is [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] medial pterygoid. Nothing too bad there. I want you to open your mouth just a little. And I'm going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] masseter muscle. This is the deep area at the zygomatic arch and at the angle [MEDICAL_PROCESS] [MEDICAL_PROCESS] mandible. Nothing bothersome. Okay, open your mouth a little. Like to put the muscle on a stretch when we test it because that gives us a more accurate reading. So that was the temporalis. Didn't bother you? We're [MEDICAL_PROCESS] [MEDICAL_PROCESS] masseter [MEDICAL_PROCESS] [MEDICAL_PROCESS] right side. Open a little. And anterior temporalis. Okay, now I'm going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] joint itself. Does that hurt you? No. That's the lateral [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] tmj. And now the dorsal. And still nothing painful. And [MEDICAL_PROCESS] [MEDICAL_PROCESS] right. Not painful. Open for me. And close. And open. And close. Not painful at all. Okay, so I'm going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] internal muscles inside your mouth. Open just a little. Not quite so much. Now I'm going to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] area adjacent to the lateral pterygoid. Little sore. Mild, [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION]? Moderate. Okay. Can you put that down, [PERSON_NAME]? So this is the left lateral pterygoid. This is actually the Temporalis tendon and the medial pterygoid area. That doesn't bother you? Let's go to the other side. Same thing. Moderate. Okay, Open temporalis tendon, medial pterygoid. Nothing much there. Okay, let me take off this glove. We get another one and let's move on. Now with [MEDICAL_PROCESS] [MEDICAL_PROCESS] you. So let's start off with some simple stuff and let's see if your eyes can track my flashlight. Very good. And now let me check pupil response to light. Just look at me. This is the ipsilateral. And now the contralateral. Perfect. Okay, I'm going to check hearing the tuning fork. Can you hear anything? Yeah. Both ears as far as you can tell? Yes. Okay, can you hear anything there? Not really. Okay, let's try it again. So we're touching [MEDICAL_PROCESS] [MEDICAL_PROCESS] mastoid process behind the ear. Tell me when the sound is gone. Starting to leave and it's gone. Can you hear anything? Yes. Okay, let's check the other side. Do you hear something? Yes. Tell me when it's gone. It's gone. Can you hear anything? Yes. This is a 128Hz tuning fork. Okay, now I'm going to move on with some other things. I want to check and see you do some facial movements. I want you to smile, big as you can. Now, I want you to frown. Lift up [MEDICAL_PROCESS] [MEDICAL_PROCESS] muscles. Here, watch me. Perfect. Okay, relax. I want you to puff up your cheeks. Relax. Stick your tongue [MEDICAL_PROCESS] [MEDICAL_PROCESS] cheek. Push it [MEDICAL_PROCESS] [MEDICAL_PROCESS] cheek. In this cheek, please. Middle [MEDICAL_PROCESS] [MEDICAL_PROCESS] cheek. Good. Stick your tongue out as far as you can. Okay. Put your tongue back. I want you to scrunch up your eyes really tight. I'm going to try and open them. Good. You have good strength that way. I want you to shrug your shoulders up [MEDICAL_PROCESS] [MEDICAL_PROCESS] air. Good. Now turn your head this way and back into my hand as hard as you can. Good. This way. Back into my hand. Fantastic. Now I want you to squeeze my fingers really tight. Really tight. Go for it. Go for it. It's your chance to get even. Good job. Okay, so I'm looking at range of motion. You've got good strength and you have normal flexibility. You can't [MEDICAL_PROCESS] [MEDICAL_PROCESS] thumb all the way back to your forearm. Also, look at your hands to make sure there's no signs of any arthritic changes [MEDICAL_PROCESS] [MEDICAL_PROCESS] fingers. Okay, you can put your arm down. Now, what I'm going to do is do some [MEDICAL_PROCESS] [MEDICAL_PROCESS]. And there's two things I want to do. See if you can first discriminate pin Prick and light touch on your hand. That's pin prick and that's light touch. Can you discriminate? Yes. Okay, close your eyes. Now is that sharp or dull? Sharp. Sharp or dull? Dull. Sharp or dull? Dull. Sharp. Dull. Sharp. Sharp. Dull. Sharp. Dull. Very good. Now we're going to do the light touch specifically. And you can feel this [MEDICAL_PROCESS] [MEDICAL_PROCESS] back [MEDICAL_PROCESS] [MEDICAL_PROCESS] hand. A piece of paper. This is 10 micron mylar paper. Okay, close your eyes. Can you feel that on your face? I'm going to compare it to that side. Is it about the same? A little bit less. Okay, if this is a [MONEY_AMOUNT] in touch, what number would you give that? [MONEY_AMOUNT]. Okay, if this is [NUMBER_SEQUENCE], what would you give that? If you. This was a [MONEY_AMOUNT], what will you give that? Very good. Okay, now let's take a look inside your mouth and we're going to just check and make sure you have a normal response with your tongue. Say ah. Ah. Okay, very good. That's got a normal gag response. Okay, [PERSON_NAME], if you'd start reading out some stuff for me, we'll go through the rest [MEDICAL_PROCESS] [MEDICAL_PROCESS] database. Okay, so he has a nice complement of teeth. I see wisdom teeth [MEDICAL_PROCESS] [MEDICAL_PROCESS] bottom, not [MEDICAL_PROCESS] [MEDICAL_PROCESS] top. And they're somewhat crowded and you could do with a [MEDICAL_PROCESS]. [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Okay, so normal nasal valve. Okay, I want you to close your mouth. Breathe through [MEDICAL_PROCESS] [MEDICAL_PROCESS] as much as you can. Great. And relax. Okay, that's good. Okay, so I'll look for the septum. I'm going to look straight down from behind. And he's pretty good. He deviates just the tiniest bit to the right. Okay. Turbinates were normal. They aren't large. And I'm looking inside [MEDICAL_PROCESS] [MEDICAL_PROCESS] [OCCUPATION] I'm just looking for any blockage. And he looks pretty clear. There's actually a little bit of extra turbinate [MEDICAL_PROCESS] [MEDICAL_PROCESS] left middle turbinate area. Okay. Okay, open for me. Hard palate is high but not vaulted. Uvula is present and not enlarged. So normal. Soft palate is normal. Say R. Stick your tongue out for me. So his. I would say his [PERSON_NAME] score is 3 and his [PERSON_NAME] [PERSON_NAME] is 2. Tonsils are not visible. Did you [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]? No. No. Okay, they're just small. So he has a tonsil size of 1. So from 0 to 4 he has a 1. Okay. Occlusion. Okay. Bite your teeth together. Bite on your back teeth for me. Okay, so his occlusion is. Okay, we'll get into the [MEDICAL_PROCESS] [MEDICAL_PROCESS] stuff in a minute. And he has [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION]. One [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION]. Mucosa. Mucosa is a little inflamed. And that's because he's overdue for his home care. His skin tone is good. Neuro we just did is fine. No lymph nodes. Palpable. And tongue. And tongue size. Let's see. Open for me is. I'd say it's medium. And it's just above the occlusal plane. Yes. A slight scalloping of his tongue. Okay, let's go to the second sheet. How you doing? All right. Okay, so now we're going to look at range of motion stuff. So the [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] was fairly normal. There really wasn't anything significant there. So let's look at range of motion. I want you to open as much as you can without it hurting. So his inter incisal distance is 51 millimeters. Bite your teeth together. His midline is 1 millimeter to the left. His mandibular midline is to the left. Slide [MEDICAL_PROCESS] [MEDICAL_PROCESS] as far as you can to the left. Keep going, keep going. He goes to the left. Nine millimeters. With tremor. Come to this side. He goes to the right. 10 millimeters. Keep going to the right. He's got a slight tremor that way. Okay, and protrusive. Bite together. Come as far forwards as you can. Further, further. Six. And close down. Let me give you the rest. Bite [MEDICAL_PROCESS] [MEDICAL_PROCESS] back teeth. Six and three. So he's got a total of nine in protrusive joint noises. Let's just see. Open for me. Close, open, close. Let me load the joint. Open, close, open, close. And open, close. And I'll listen with a stethoscope and see if there's anything specific because I can hear next to nothing on you, [PERSON_NAME]. You have the quietest joints. That's a good sign. Okay, and open, close, open, close, open, close, open, close, open, close, Open. Joints are good. No noises. Let's go on to the next step. Okay, so let's do a couple of things where we provoke snoring. Try and snore. Okay, and again. Good. And now I want you to bite your teeth together. Slide them forwards. Try and snore. Okay, so it's a double positive. It does stop the snoring. Okay. And I'm going to do one other thing. I'm going to just spread your nares from underneath. I want you to try and snore now. And that's also a positive result. So both things seem to help reduce snoring. Next question. On opening. Okay, bite your teeth together normally at the back. And I'd like you to open and close and open and close. And now just protrude [MEDICAL_PROCESS] [MEDICAL_PROCESS] forwards and back. Okay. There's no deviation on opening or on protrusion. Cervical spine we saw as normal [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Let's go over to the second page. I don't think there's any other questions there. Right. Okay, so now we're going to look at specifics on occlusion. Okay. Bite your teeth all the way together. He has a cross point of tooth number 21 and 30. His anterior posterior relationship is canine class one, both sides. He has some lower crowding of his teeth. Let [MEDICAL_PROCESS] [MEDICAL_PROCESS] loose. Loose as you can. He has some [INJURY] [INJURY] [INJURY]. I'm looking for evidence of [INJURY] [INJURY]. I don't really see that. While I'm at it, I'm looking also for any [INJURY], [INJURY] or bumps. And I'm going to grab your tongue and look underneath your tongue too. So if you stick your tongue out for me, it's a bit of a slippery fish. So I'm going to grab it that way. Turn this way. And he's good that way. Okay. Tongue is normal. I don't see [MEDICAL_PROCESS] [MEDICAL_PROCESS] third molars. Did you have anything [MEDICAL_PROCESS] [MEDICAL_PROCESS]? No. So the chances are they're [INJURY]. We would have to look and see on an [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Bite your teeth together, slide sideways and the other way. I see some chips, but they don't line up with any facets from grinding. The chips are on number 23 distal and number 28, mesial. Okay. Okay, open for me. So I'm just going to touch the gum now, [PERSON_NAME], in several areas and I'm going to see if there's any heavy bleeding or any pockets greater than 4 millimeters. That would be an indicator to me that you need some [MEDICAL_PROCESS] [MEDICAL_PROCESS] and maybe [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Okay, so there's no pockets over 3 millimeters. He's good that way. Only has a little [INJURY] occlusally on tooth number 32. Smaller clues also on number 31. Okay, look at the top. I do see the upper wisdom tooth poking through [MEDICAL_PROCESS] [MEDICAL_PROCESS] upper right side. And [MEDICAL_PROCESS] [MEDICAL_PROCESS] upper left side I see them just starting to poke through. So you have all four wisdom teeth. Chances are you're gonna need those guys out. You lucky guy, you. Okay, what else? Okay, lift your tongue up for me. Up, up, up. Normal [INJURY] [INJURY], no evidence. Tongue small, medium, large, medium, plus scallops. Yes, we already went through that. Uvula, normal [PERSON_NAME] and [PERSON_NAME] [PERSON_NAME]. We've done [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Average. He is average. No. Okay, all set. Okay, champ, one other thing we're going to do, and that's just [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. So I'm going to use that same very fine piece of paper and we're going to see. You can hold your teeth together. Close down, Bite. Open. Close. Open. So he's got contact. 18. 19. Close. Open. Close again. Open. 20. Close on your back teeth, right? Regular. All right, [PERSON_NAME], we've gone through the exam and I wanted to summarize all my findings and give you some recommendations. Now, first of all, we do not have the [MEDICAL_PROCESS] [MEDICAL_PROCESS] back yet from [ORGANIZATION] [ORGANIZATION]. So I can't interpret what that is and I can't read the [OCCUPATION] report. So I don't know how significant the [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] is, whether it's just snoring, primary snoring, or whether you have [MEDICAL_CONDITION], [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION], whether there's any [MEDICAL_CONDITION] [MEDICAL_CONDITION] versus [MEDICAL_CONDITION]. And the differences are? [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] is when you can't breathe. There's something blocking your airway up here, [MEDICAL_PROCESS] [MEDICAL_PROCESS] airway, and it's like. Or you can't breathe. A torch. And you go at a certain period of time. That's sort of an [MEDICAL_CONDITION] [MEDICAL_CONDITION]. Now, a [MEDICAL_CONDITION] [MEDICAL_CONDITION] is when you stop breathing [MEDICAL_PROCESS] [MEDICAL_PROCESS] brain is not telling your body to breathe. There's no effort from the chest. So if you had an obstruction, you're going to try, you're going to try in this effort. If you have no effort, it means the brain is not telling your body, your diaphragm [MEDICAL_PROCESS] [MEDICAL_PROCESS] intercostal muscles to breathe. So we need to see that because that makes a difference as to whether an [MEDICAL_PROCESS] [MEDICAL_PROCESS] is indicated. But let's say that the [MEDICAL_PROCESS] [MEDICAL_PROCESS] comes back, that an [MEDICAL_PROCESS] [MEDICAL_PROCESS] is an appropriate therapy. Well, I can understand that being a good choice for you because you're a [MARITAL_STATUS] guy and you may be looking for a lifelong partner. I can see you saying there's just no way you would accept the [MEDICAL_PROCESS] like you had explained to me. So in that particular case, an [MEDICAL_PROCESS] [MEDICAL_PROCESS] is a very good option. But let me give you every option so you can decide what, which is the right thing for you. First of all, there's [MEDICAL_PROCESS] [MEDICAL_PROCESS]. And when we look at [MEDICAL_PROCESS] [MEDICAL_PROCESS], there's two types. There's [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] and [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. The [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] are mainly done by [OCCUPATION], [OCCUPATION] [OCCUPATION] [OCCUPATION] [OCCUPATION]. And what they do is they will [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Perhaps they need to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] or [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS], polyps or even some turbinates, which are bony, incidentally. And the other option would be that the [OCCUPATION] would do a [MEDICAL_PROCESS], a [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. They can [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS], they can [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. In your case, I don't see much blockage that way. I don't think they would make an improvement. And the [MEDICAL_PROCESS] are not necessarily long term successful for people. So [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] particular case doesn't seem that reasonable. And, and certainly if you had trouble breathing through [MEDICAL_PROCESS] [MEDICAL_PROCESS], I would address the nasal blockage, but you don't seem to have that. [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] are done [MEDICAL_PROCESS] [MEDICAL_PROCESS] jaws themselves. So a [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] could be [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] because your tongue's anchored to the inside [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Another [MEDICAL_PROCESS] could be to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS], [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Now that kind of a [MEDICAL_PROCESS], the [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] is called an [MEDICAL_PROCESS] [MEDICAL_PROCESS], is quite a successful approach and could be considered a curative approach. Somebody at your young age, you might consider that because you've got so many years of treatment. The other way, and I mean by that is that if you decided that [MEDICAL_PROCESS] was not the right choice for you at this point, you could do [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] or [MEDICAL_PROCESS]. If [MEDICAL_PROCESS] is not doable because it's just going to keep you a [MARITAL_STATUS] guy too long, then we're looking at the [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Now, you had one before and it worked well for you. But for me to make you another [MEDICAL_PROCESS] [MEDICAL_PROCESS], I'm going to need to get a prescription from your [OCCUPATION]. Legally, I'm required to have a prescription [MEDICAL_PROCESS] [MEDICAL_PROCESS] [OCCUPATION] needs to know what's going on. So I'm going to show you some different oral appliances so you can see how they work. But typically there are two types. One is a tongue guidance or positioner or retainer. And another would be a jaw repositioner called a mandibular. That's [MEDICAL_PROCESS] [MEDICAL_PROCESS] anteriorization forward device. So a MAD device or a mandibular repositioning device. And there's different designs on them. In fact, there's many, many different mouthpieces, oral appliances out there. Now to address [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION]. In fact, one [MEDICAL_PROCESS] [MEDICAL_PROCESS] appliances also, it does something to raise and spread [MEDICAL_PROCESS] [MEDICAL_PROCESS]. And I noticed when we were testing you, that seemed to help you as well to breathe better. So we're going to look at [MEDICAL_PROCESS] [MEDICAL_PROCESS] those devices, and I think an [MEDICAL_PROCESS] [MEDICAL_PROCESS] is a good idea. However, every treatment has some downsides or side effects. So this is an informed consent form that I'd like you to read through and be able to ask me questions. And I will highlight any issues when we go through the next sort of stage of treatment for you so that you know what the risks are and you can weigh them into the consideration of which treatment you prefer. Now, these were the findings that I had [MEDICAL_PROCESS] [MEDICAL_PROCESS] exam. First of all, I [MEDICAL_PROCESS] [MEDICAL_PROCESS] the range of motion [MEDICAL_PROCESS] [MEDICAL_PROCESS] head and neck and it was fine. I [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] and [MEDICAL_PROCESS] [MEDICAL_PROCESS] that way, and you were fine that way. When I pressed [MEDICAL_PROCESS] [MEDICAL_PROCESS] muscles [MEDICAL_PROCESS] [MEDICAL_PROCESS] head and neck, great. No tenderness of significance. One area that was a mildly tender, not really dramatic, and that was [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] back, [PERSON_AGE] [PERSON_AGE] couple of spots inside your mouth that were moderately tender, mild to moderately tender. So from that perspective and from the [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS], which was entirely normal, I think that you're a good candidate for [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. The issues that we would have that restrict us from moving along with that are, first of all, we do need the prescription from your [OCCUPATION]. We need to review your [MEDICAL_PROCESS] [MEDICAL_PROCESS], but also you need a little [MEDICAL_PROCESS] [MEDICAL_PROCESS] done. Your wisdom teeth should be addressed, although you don't absolutely have to have them [MEDICAL_PROCESS] [MEDICAL_PROCESS] for us to do [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS]. Long term, there's not enough room for them. You have a couple of [INJURY], those need to be dealt with. And certainly if you had [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS], they might find a few more [INJURY], and those would need to be addressed. And then there's also the issue [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_CONDITION] [MEDICAL_CONDITION]. You've got some [MEDICAL_CONDITION] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_CONDITION], and it seems like it's been a while since they've been cleaned. So those things have to be addressed. But once those things are addressed, if we get all the other things lined up, we can move along and get you [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] started. So in that light, let me show you a few different appliances and then we can talk about what the pros and cons would be for you choosing one or more of these different devices. So I have here a little box of a few different ones, and I'm going to highlight just a few different ones so you can look at them and what the pros and cons are the different appliances. Okay? And I have a few more appliances too. There's one that is not out [MEDICAL_PROCESS] [MEDICAL_PROCESS] table here, which is called a tap appliance, and it has several different models. And I'm going to show you a few more appliances at another time, but I don't want to overwhelm you, so let me just show you a few times. First of all, this is one type which is called a tongue retaining device. The tongue goes into this bulb, you squeeze the air out, you put your tongue in, and that holds your tongue. Now, these are not as reliable as the other appliances, and I'm not recommending it for you. Now, if you had no teeth or you had some problem with [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS], we could consider it. There are other types of devices that also will push [MEDICAL_PROCESS] [MEDICAL_PROCESS] tongue to guide it forward. And those things may or may not be useful for somebody that has [MEDICAL_CONDITION] [MEDICAL_CONDITION] and cannot tolerate a repositioning device. But if we were to look at the research, we would find that the repositioning devices work the best. And they [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] by anchoring the top and the bottom together. And, and by anchoring them together, they can use some sort of mechanism to have the [MEDICAL_PROCESS] [MEDICAL_PROCESS] guide the [MEDICAL_PROCESS] [MEDICAL_PROCESS] forwards. This particular mechanism is sort of a modified herbst. You can see it's got a cylinder and piston, and you can see little washers that can be added to bring [MEDICAL_PROCESS] [MEDICAL_PROCESS] further and further forwards. Now, I like these appliances because they allow for movement, and it's nice if you have movement that way [MEDICAL_PROCESS] [MEDICAL_PROCESS] doesn't feel locked in. And if you were trying to move [MEDICAL_PROCESS] [MEDICAL_PROCESS], just. You don't necessarily get [INJURY] [INJURY]. One [MEDICAL_PROCESS] [MEDICAL_PROCESS] downsides of this kind of appliance is if you have sensitive cheeks, these bumps can be irritable. Now, for people that perhaps do not have such strong teeth, we sometimes use something that's a little bit more flimsy. And this is an [MEDICAL_PROCESS] appliance. And this one can fit [MEDICAL_PROCESS] [MEDICAL_PROCESS] top and the bottom. This one tends to have less ability to adjust. Let's say you [INJURY] [INJURY] [INJURY] and you needed to fix it. There isn't much play that I have in these appliances as opposed to these where I can repair or change them a lot easier. But it does the same thing when you use different size elastic bands. And they're a little bit more forgiving because they're rubbery versus metal. Now, if you were to use an appliance that was a one piece. These things are made, and these can be fit and can work as well. The downside to them is that they do not allow for the same kind of movement. In other words, you can position the two pieces in different positions for further forwards and back. But unfortunately, once they're connected, you can't move, you're stuck. And so for somebody that likes to move their teeth at night, it's not so comfortable. The other thing is any of these appliances can have a soft inside. If you have very sensitive teeth or you feel like your teeth are fragile, you could have this soft liner as opposed to a hard liner. The downside to a soft liner doesn't last as long. The upside side, spongy, cushy, it's a little bit more comfortable. In the morning, we sometimes will have you wear an appliance that allows you to bite your teeth together. Because all these appliances tend to [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] forwards and hold them forward for that period of time that you're asleep, it might be [DURATION] [DURATION] [DURATION] [DURATION]. So for other people it could be [DURATION] [DURATION]. You sleep less than most people. So [MEDICAL_PROCESS] [MEDICAL_PROCESS] morning, if [MEDICAL_PROCESS] [MEDICAL_PROCESS] feels like you can't [MEDICAL_PROCESS] [MEDICAL_PROCESS] teeth together, yes, you can certainly try to wait it out and try to push [MEDICAL_PROCESS] [MEDICAL_PROCESS] back or chew some gum. But sometimes I'll give you a morning positioner which gives you little bumps that you can bite on and that helps to bite down and helps to bring [MEDICAL_PROCESS] [MEDICAL_PROCESS] back into position. Most of these appliances I've showed you so far are connected. A more recent appliance is one here, which is a repositioning forward appliance called a somnomed. And there are other types just like it. And this one does not have necessarily a connector from the top and the bottom. And what happens is these particular spikes or fins tend to guide [MEDICAL_PROCESS] [MEDICAL_PROCESS] forwards. So what happens is the fins fit [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] this piece fits [MEDICAL_PROCESS] [MEDICAL_PROCESS] upper. And as you close your mouth, the fins guide [MEDICAL_PROCESS] [MEDICAL_PROCESS] forwards. And of course, you can see the adjusting screws on both sides. And that brings. Brings forward this block, and this block pushes the fin further forward. So that's another appliance. If you didn't want to be able to keep your mouth closed, I think it's better if your mouth is closed. If your mouth is closed, you tend to breathe less through your mouth. And I think that tends to help you with heating or humidifying the air as you breathe in. So these are repositioning kind of appliances, and these are some. And next time, I'll show you a few more, but this is the design. And then we have to go through what the pros and cons would be. Now, at this point, our steps are going to be for you to be able to get us the [MEDICAL_PROCESS] [MEDICAL_PROCESS]. We'll try to do that. For us to be able to send the report to your [OCCUPATION] and also ask for an approval for [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS], you'll need to sign this informed consent. And you'll also have to give us an affidavit as to why you will not use [MEDICAL_PROCESS]. Once those things are all completed, we can move on with the next step. We'll need to find out from your medical insurance how much is covered and how much your co payment will be, and my [OCCUPATION] [OCCUPATION] will help you do that. However, before you move on to the next step of having [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] made, I want you also to check in with your [OCCUPATION] and get that [MEDICAL_PROCESS] [MEDICAL_PROCESS] done. Okay? So that takes care of us for today, and we'll look forward to seeing you. And I'm going to pass you off now to my [OCCUPATION] [OCCUPATION] who will take care of you. Thank you so much.",
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