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Re: [CORE-Discussion] Re: bad dream

Comments (0) | Tuesday, September 2, 2014

I am so loving where this conversation is going.  You can see how our thinking has progressed from concentrating on the end-stage apneic patient to looking at the continuum of airway compromise that starts at birth, if  not before.  If we can look at this whole airway phenomenon as a condition to which only modern man has been subject and that each patient lies somewhere along this continuum, we'll have a much better handle on the big picture. Then its a matter of figuring the balance of prevention:remediation and also balance between form:function approaches (that form AND function, mind you, no OR).

Jeff, thanks for the nod.  Kevin and I are prepared to share what we know.  I, for one, am exploring as many different approaches as I have time for and applying them in the way best for the individual mouth/person/family.  Each technique has strong and weak point of course, but the common thread is much like what you and Tom have been talking about:  Breathe through your nose, lips together, tongue on the palate and swallow without using your facial muscles.  After that, it's just about undoing the damage already done, if possible.

Though the orthodontists have been much maligned by the integrative community in the past, I truly believe that once we sink our teeth into this subject (pun intended) that we will have a ton to contribute to this endeavour.

When the orthodontists are ready to learn, I'm ready to help.

Barry


On Tue, Sep 2, 2014 at 1:26 PM, 'Jeff Rouse' via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com> wrote:
I like everything your doing. You are ahead of me with the breathing training. My myologist has her own practice in my space so I have to make appointments which is limiting. Your protocol is like Barkley's hygiene instructor. I had one of those for years. I do want to add that having an ENT in the office has allowed me to watch him examine and work on patients. I think that resolving anatomic issues along with instruction can be important to our success. It is amazing what he detects during a scope and what a difference it can make. I have said repeatedly...if I was an orthodontist today, I would share space with an ENT. There is an amazing synergy in childhood and adult care. 


Jeff Rouse


-----Original Message-----
From: Tom Colquitt <tcasoulet@gmail.com>
To: core-dentistry-discussion <core-dentistry-discussion@googlegroups.com>
Sent: Tue, Sep 2, 2014 12:14 pm
Subject: Re: [CORE-Discussion] Re: bad dream

Jeff-  I agree with the Mytap-tape initial tx. However, we talk about tongue position and function first and show them how their nasal airway can open/close due to tongue position -- so they're thinking about this before we start any tx. Then we have them tape at home, first during the daytime to show  them they can do it without panicking  and that their noses will decongest.​ 
Then taping at night. Then followup oximetry to see if only taping and recruit their tongue improves things.  If it's better, then I'm thinking they can recruit their tongue and they can breathe through their noses, so  I'd be thinking more bout OMFT and B. Breathing than an ENT referral.

Then when we give them the TAP they're already precondition to a consciousness of tongue position and I think this allows the TAP to not have to do so much heavy lifting by itself.
 
hope we gat the chance to get together and b.s.  maybe IN longview - don' want to barge in but the Macks have repeatedly asked us to come over some time.
 
t


On Mon, Sep 1, 2014 at 3:02 PM, 'Jeff Rouse' via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com> wrote:
Thanks Tom. Forgot adults in the discussion. I think the key is the myTAP and tape. If I can get them resolved with minimal protrusion or tape alone, it signals to me that their autonomic nervous system is still responsive. That to me signals ENT surgery, ortho, SFOT, or orthgnathics. If they require a significant movement then I still discuss options to improve but they are probably always going to be damaged goods.

Loved hearing about your Homeoblock journey. I have been reading a bunch on craniofacial development and will have a post soon for you and Scott along with a critique of the DNA article that was posted. Just went through SFOT surgery #2 to allow the final torque and expansion. When we flapped I had a ton of hard, live, bleeding bone around the roots where there was very little to none before. Roblee says it is the rule of 2's. two times faster, two times more expansion. I would add 2x thicker bone and tissue. It can alter phenotypes. I am feeling great and sleeping great with tape. Off of allergy meds. GERD med for tequila and Tex-Mex only. Problem is there is a huge issue with my data...I lost 28 lbs so far. It could simply be that we have both dropped weight and nothing to do with the expansion. Might think about selling this through Jenny Craig or Weight Watchers.

Final observation: I am a horrible dental patient. I gag on impressions and have to swallow every two seconds even when there is very little in my mouth. I find it difficult to open my mouth and breath through my nose.  My heart begins to race every time I need to swallow as if I will never breath again. I hate working on people like me!!! During my surgery Friday, it dawned on me that I never had that urge. They were even covering one or both nostrils and I never fought the reflex. Lisa just added some Invisalign buttons and Jake suctioned (poorly). It did not bother me. Learning to breath through my nose makes me a better dental patient. The reverse is probably diagnostic of airway issues. Your horrible patients need to be counseled on sleep and airway when they finally stop pointing to the f*****g suction!


Jeff Rouse


-----Original Message-----
From: Tcasoulet via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com>
To: core-dentistry-discussion <core-dentistry-discussion@googlegroups.com>
Sent: Mon, Sep 1, 2014 8:08 am
Subject: Re: [CORE-Discussion] Re: bad dream

Jeff-  Interesting stuff.  thanks for describing the proper future of orhodontics in such simple terms.
 
t colquitt
 
In a message dated 8/31/2014 11:39:11 P.M. Central Daylight Time, core-dentistry-discussion@googlegroups.com writes:
John:
Thanks for jumping in the fray. I am trying to develop airway-based orthodontists in my town. They are talking the talk but their tools and timing need to be improved. That is my challenge.
I held a Chicago Salon last weekend (Salon based on the French gatherings to discuss issues of the day- Nader named it since it was way beyond a Texan). I was lucky enough to recruit great restorative dentists from neuromuscular, Piper joint-based, Pankey/Dawson, Spear, Kois and gnathology to attend. The goal was to find harmony between occlusion, TMD, and airway. Really amazing weekend that I will begin reporting on shortly. The outlier (and star) was Kevin Boyd, a pediatric dentist who does ortho with a focus on airway given his anthropology background. He is promoting early intervention just as Barry Raphael has tirelessly taught. That includes on-demand breastfeeding ideally (but not realistically for 3 years), baby lead weaning to promote harder foods earlier and thus more muscle activity. Both activities push the premaxillary suture. Early expansion (4yo or earlier) both transverse  and A-P to get the anterior teeth out of the way of the developing mandible and to push them into a more ideal position rather than the typical retruded maxilla found in most patients. The time of use and the type of appliance is different than my orthodontists do. They need to change but are not comfortable yet. Secondly, Herbst style of appliances are devices that my practitioners were also taught. They typically have a retractive effect on the maxilla. If we are treating for an ideal maxilla, then holding back growth doesn't work within that formula. Finally, your greatest orthodontic tool is the tongue. Numerous studies have shown that if craniofacial changes are occurring and the airway is resolved (T&A typically), the tongue will change growth to a normal pattern. Get the kids to close their mouths and position the tongue correctly EARLY and the face will improve. Problem is we miss the 4yo and you get them too late, that is why you have to help with T&A and ortho in most cases.

So my two-cents...you cannot be effective in helping these kids with the timing ad tools you were taught in ortho residency. Just the same way I cannot help prosthodontically with the old tools I used. Change is required and some of those tools have not been developed yet...exciting times.


Jeff Rouse


-----Original Message-----
From: John Esterkyn <esterkynortho@gmail.com>
To: core-dentistry-discussion <core-dentistry-discussion@googlegroups.com>
Sent: Sun, Aug 31, 2014 1:13 am
Subject: Re: [CORE-Discussion] Re: bad dream

Thanks guys!
John

Sent from my iPhone

On Aug 30, 2014, at 8:21 PM, Barry Raphael <dralignmine@gmail.com> wrote:

You know, just before you said "subdue your ego", Tom, I thought, "Boy I'm going to have to be honest with physicians about what I don't know while at the same time carrying the banner with some amount of confidence" (my actual thought was not nearly so coherent).  But that is exactly what we have to do.

Br'er Orthodontists, let's start with this: We have to begin with abandoning treatment planning by the lower incisor and begin treatment planning by the upper incisor.  Then we must realize that the upper incisor is retrusive in nearly every malocclusion, even in Class II cases.   Before you say anything, just sit with that thought for a minute and reflect, if that were true, what would it mean for our treatment mechanics, even the so-called Class II correctors.   If after you sit with that for awhile, and you want to hear more, please ask.

Barry 


On Sat, Aug 30, 2014 at 8:17 PM, Tom Colquitt <tcasoulet@gmail.com> wrote:
Nader- we have two seasons here, summer and christmas.

tc


On Sat, Aug 30, 2014 at 5:37 PM, 'M. Nader Sharifi' via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com> wrote:
hope everyone has a great  last weekend of the summer.

t colquitt

Don't you live near Texas? Doesn't your summer end, like on...never?

Nader.

> On Aug 30, 2014, at 5:33 PM, Tcasoulet via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com> wrote:
>
> hope everyone has a great  last weekend of the summer.
>
> t colquitt

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--
dr. barry raphael
the raphael center for integrative orthodontics
the raphael center for integrative education
1425 broad street, clifton, nj 07013
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--
dr. barry raphael
the raphael center for integrative orthodontics
the raphael center for integrative education
1425 broad street, clifton, nj 07013

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Read More......

Re: [CORE-Discussion] Re: bad dream

Comments (0) |

I like everything your doing. You are ahead of me with the breathing training. My myologist has her own practice in my space so I have to make appointments which is limiting. Your protocol is like Barkley's hygiene instructor. I had one of those for years. I do want to add that having an ENT in the office has allowed me to watch him examine and work on patients. I think that resolving anatomic issues along with instruction can be important to our success. It is amazing what he detects during a scope and what a difference it can make. I have said repeatedly...if I was an orthodontist today, I would share space with an ENT. There is an amazing synergy in childhood and adult care. 



Jeff Rouse


-----Original Message-----
From: Tom Colquitt <tcasoulet@gmail.com>
To: core-dentistry-discussion <core-dentistry-discussion@googlegroups.com>
Sent: Tue, Sep 2, 2014 12:14 pm
Subject: Re: [CORE-Discussion] Re: bad dream

Jeff-  I agree with the Mytap-tape initial tx. However, we talk about tongue position and function first and show them how their nasal airway can open/close due to tongue position -- so they're thinking about this before we start any tx. Then we have them tape at home, first during the daytime to show  them they can do it without panicking  and that their noses will decongest.​ 
Then taping at night. Then followup oximetry to see if only taping and recruit their tongue improves things.  If it's better, then I'm thinking they can recruit their tongue and they can breathe through their noses, so  I'd be thinking more bout OMFT and B. Breathing than an ENT referral.

Then when we give them the TAP they're already precondition to a consciousness of tongue position and I think this allows the TAP to not have to do so much heavy lifting by itself.
 
hope we gat the chance to get together and b.s.  maybe IN longview - don' want to barge in but the Macks have repeatedly asked us to come over some time.
 
t


On Mon, Sep 1, 2014 at 3:02 PM, 'Jeff Rouse' via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com> wrote:
Thanks Tom. Forgot adults in the discussion. I think the key is the myTAP and tape. If I can get them resolved with minimal protrusion or tape alone, it signals to me that their autonomic nervous system is still responsive. That to me signals ENT surgery, ortho, SFOT, or orthgnathics. If they require a significant movement then I still discuss options to improve but they are probably always going to be damaged goods.

Loved hearing about your Homeoblock journey. I have been reading a bunch on craniofacial development and will have a post soon for you and Scott along with a critique of the DNA article that was posted. Just went through SFOT surgery #2 to allow the final torque and expansion. When we flapped I had a ton of hard, live, bleeding bone around the roots where there was very little to none before. Roblee says it is the rule of 2's. two times faster, two times more expansion. I would add 2x thicker bone and tissue. It can alter phenotypes. I am feeling great and sleeping great with tape. Off of allergy meds. GERD med for tequila and Tex-Mex only. Problem is there is a huge issue with my data...I lost 28 lbs so far. It could simply be that we have both dropped weight and nothing to do with the expansion. Might think about selling this through Jenny Craig or Weight Watchers.

Final observation: I am a horrible dental patient. I gag on impressions and have to swallow every two seconds even when there is very little in my mouth. I find it difficult to open my mouth and breath through my nose.  My heart begins to race every time I need to swallow as if I will never breath again. I hate working on people like me!!! During my surgery Friday, it dawned on me that I never had that urge. They were even covering one or both nostrils and I never fought the reflex. Lisa just added some Invisalign buttons and Jake suctioned (poorly). It did not bother me. Learning to breath through my nose makes me a better dental patient. The reverse is probably diagnostic of airway issues. Your horrible patients need to be counseled on sleep and airway when they finally stop pointing to the f*****g suction!


Jeff Rouse


-----Original Message-----
From: Tcasoulet via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com>
To: core-dentistry-discussion <core-dentistry-discussion@googlegroups.com>
Sent: Mon, Sep 1, 2014 8:08 am
Subject: Re: [CORE-Discussion] Re: bad dream

Jeff-  Interesting stuff.  thanks for describing the proper future of orhodontics in such simple terms.
 
t colquitt
 
In a message dated 8/31/2014 11:39:11 P.M. Central Daylight Time, core-dentistry-discussion@googlegroups.com writes:
John:
Thanks for jumping in the fray. I am trying to develop airway-based orthodontists in my town. They are talking the talk but their tools and timing need to be improved. That is my challenge.
I held a Chicago Salon last weekend (Salon based on the French gatherings to discuss issues of the day- Nader named it since it was way beyond a Texan). I was lucky enough to recruit great restorative dentists from neuromuscular, Piper joint-based, Pankey/Dawson, Spear, Kois and gnathology to attend. The goal was to find harmony between occlusion, TMD, and airway. Really amazing weekend that I will begin reporting on shortly. The outlier (and star) was Kevin Boyd, a pediatric dentist who does ortho with a focus on airway given his anthropology background. He is promoting early intervention just as Barry Raphael has tirelessly taught. That includes on-demand breastfeeding ideally (but not realistically for 3 years), baby lead weaning to promote harder foods earlier and thus more muscle activity. Both activities push the premaxillary suture. Early expansion (4yo or earlier) both transverse  and A-P to get the anterior teeth out of the way of the developing mandible and to push them into a more ideal position rather than the typical retruded maxilla found in most patients. The time of use and the type of appliance is different than my orthodontists do. They need to change but are not comfortable yet. Secondly, Herbst style of appliances are devices that my practitioners were also taught. They typically have a retractive effect on the maxilla. If we are treating for an ideal maxilla, then holding back growth doesn't work within that formula. Finally, your greatest orthodontic tool is the tongue. Numerous studies have shown that if craniofacial changes are occurring and the airway is resolved (T&A typically), the tongue will change growth to a normal pattern. Get the kids to close their mouths and position the tongue correctly EARLY and the face will improve. Problem is we miss the 4yo and you get them too late, that is why you have to help with T&A and ortho in most cases.

So my two-cents...you cannot be effective in helping these kids with the timing ad tools you were taught in ortho residency. Just the same way I cannot help prosthodontically with the old tools I used. Change is required and some of those tools have not been developed yet...exciting times.


Jeff Rouse


-----Original Message-----
From: John Esterkyn <esterkynortho@gmail.com>
To: core-dentistry-discussion <core-dentistry-discussion@googlegroups.com>
Sent: Sun, Aug 31, 2014 1:13 am
Subject: Re: [CORE-Discussion] Re: bad dream

Thanks guys!
John

Sent from my iPhone

On Aug 30, 2014, at 8:21 PM, Barry Raphael <dralignmine@gmail.com> wrote:

You know, just before you said "subdue your ego", Tom, I thought, "Boy I'm going to have to be honest with physicians about what I don't know while at the same time carrying the banner with some amount of confidence" (my actual thought was not nearly so coherent).  But that is exactly what we have to do.

Br'er Orthodontists, let's start with this: We have to begin with abandoning treatment planning by the lower incisor and begin treatment planning by the upper incisor.  Then we must realize that the upper incisor is retrusive in nearly every malocclusion, even in Class II cases.   Before you say anything, just sit with that thought for a minute and reflect, if that were true, what would it mean for our treatment mechanics, even the so-called Class II correctors.   If after you sit with that for awhile, and you want to hear more, please ask.

Barry 


On Sat, Aug 30, 2014 at 8:17 PM, Tom Colquitt <tcasoulet@gmail.com> wrote:
Nader- we have two seasons here, summer and christmas.

tc


On Sat, Aug 30, 2014 at 5:37 PM, 'M. Nader Sharifi' via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com> wrote:
hope everyone has a great  last weekend of the summer.

t colquitt

Don't you live near Texas? Doesn't your summer end, like on...never?

Nader.

> On Aug 30, 2014, at 5:33 PM, Tcasoulet via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com> wrote:
>
> hope everyone has a great  last weekend of the summer.
>
> t colquitt

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--
dr. barry raphael
the raphael center for integrative orthodontics
the raphael center for integrative education
1425 broad street, clifton, nj 07013
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Read More......

Re: [CORE-Discussion] Re: bad dream

Comments (0) |

Jeff-  I agree with the Mytap-tape initial tx. However, we talk about tongue position and function first and show them how their nasal airway can open/close due to tongue position -- so they're thinking about this before we start any tx. Then we have them tape at home, first during the daytime to show  them they can do it without panicking  and that their noses will decongest.​ 
Then taping at night. Then followup oximetry to see if only taping and recruit their tongue improves things.  If it's better, then I'm thinking they can recruit their tongue and they can breathe through their noses, so  I'd be thinking more bout OMFT and B. Breathing than an ENT referral.

Then when we give them the TAP they're already precondition to a consciousness of tongue position and I think this allows the TAP to not have to do so much heavy lifting by itself.
 
hope we gat the chance to get together and b.s.  maybe IN longview - don' want to barge in but the Macks have repeatedly asked us to come over some time.
 
t


On Mon, Sep 1, 2014 at 3:02 PM, 'Jeff Rouse' via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com> wrote:
Thanks Tom. Forgot adults in the discussion. I think the key is the myTAP and tape. If I can get them resolved with minimal protrusion or tape alone, it signals to me that their autonomic nervous system is still responsive. That to me signals ENT surgery, ortho, SFOT, or orthgnathics. If they require a significant movement then I still discuss options to improve but they are probably always going to be damaged goods.

Loved hearing about your Homeoblock journey. I have been reading a bunch on craniofacial development and will have a post soon for you and Scott along with a critique of the DNA article that was posted. Just went through SFOT surgery #2 to allow the final torque and expansion. When we flapped I had a ton of hard, live, bleeding bone around the roots where there was very little to none before. Roblee says it is the rule of 2's. two times faster, two times more expansion. I would add 2x thicker bone and tissue. It can alter phenotypes. I am feeling great and sleeping great with tape. Off of allergy meds. GERD med for tequila and Tex-Mex only. Problem is there is a huge issue with my data...I lost 28 lbs so far. It could simply be that we have both dropped weight and nothing to do with the expansion. Might think about selling this through Jenny Craig or Weight Watchers.

Final observation: I am a horrible dental patient. I gag on impressions and have to swallow every two seconds even when there is very little in my mouth. I find it difficult to open my mouth and breath through my nose.  My heart begins to race every time I need to swallow as if I will never breath again. I hate working on people like me!!! During my surgery Friday, it dawned on me that I never had that urge. They were even covering one or both nostrils and I never fought the reflex. Lisa just added some Invisalign buttons and Jake suctioned (poorly). It did not bother me. Learning to breath through my nose makes me a better dental patient. The reverse is probably diagnostic of airway issues. Your horrible patients need to be counseled on sleep and airway when they finally stop pointing to the f*****g suction!


Jeff Rouse


-----Original Message-----
From: Tcasoulet via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com>
To: core-dentistry-discussion <core-dentistry-discussion@googlegroups.com>
Sent: Mon, Sep 1, 2014 8:08 am
Subject: Re: [CORE-Discussion] Re: bad dream

Jeff-  Interesting stuff.  thanks for describing the proper future of orhodontics in such simple terms.
 
t colquitt
 
In a message dated 8/31/2014 11:39:11 P.M. Central Daylight Time, core-dentistry-discussion@googlegroups.com writes:
John:
Thanks for jumping in the fray. I am trying to develop airway-based orthodontists in my town. They are talking the talk but their tools and timing need to be improved. That is my challenge.
I held a Chicago Salon last weekend (Salon based on the French gatherings to discuss issues of the day- Nader named it since it was way beyond a Texan). I was lucky enough to recruit great restorative dentists from neuromuscular, Piper joint-based, Pankey/Dawson, Spear, Kois and gnathology to attend. The goal was to find harmony between occlusion, TMD, and airway. Really amazing weekend that I will begin reporting on shortly. The outlier (and star) was Kevin Boyd, a pediatric dentist who does ortho with a focus on airway given his anthropology background. He is promoting early intervention just as Barry Raphael has tirelessly taught. That includes on-demand breastfeeding ideally (but not realistically for 3 years), baby lead weaning to promote harder foods earlier and thus more muscle activity. Both activities push the premaxillary suture. Early expansion (4yo or earlier) both transverse  and A-P to get the anterior teeth out of the way of the developing mandible and to push them into a more ideal position rather than the typical retruded maxilla found in most patients. The time of use and the type of appliance is different than my orthodontists do. They need to change but are not comfortable yet. Secondly, Herbst style of appliances are devices that my practitioners were also taught. They typically have a retractive effect on the maxilla. If we are treating for an ideal maxilla, then holding back growth doesn't work within that formula. Finally, your greatest orthodontic tool is the tongue. Numerous studies have shown that if craniofacial changes are occurring and the airway is resolved (T&A typically), the tongue will change growth to a normal pattern. Get the kids to close their mouths and position the tongue correctly EARLY and the face will improve. Problem is we miss the 4yo and you get them too late, that is why you have to help with T&A and ortho in most cases.

So my two-cents...you cannot be effective in helping these kids with the timing ad tools you were taught in ortho residency. Just the same way I cannot help prosthodontically with the old tools I used. Change is required and some of those tools have not been developed yet...exciting times.


Jeff Rouse


-----Original Message-----
From: John Esterkyn <esterkynortho@gmail.com>
To: core-dentistry-discussion <core-dentistry-discussion@googlegroups.com>
Sent: Sun, Aug 31, 2014 1:13 am
Subject: Re: [CORE-Discussion] Re: bad dream

Thanks guys!
John

Sent from my iPhone

On Aug 30, 2014, at 8:21 PM, Barry Raphael <dralignmine@gmail.com> wrote:

You know, just before you said "subdue your ego", Tom, I thought, "Boy I'm going to have to be honest with physicians about what I don't know while at the same time carrying the banner with some amount of confidence" (my actual thought was not nearly so coherent).  But that is exactly what we have to do.

Br'er Orthodontists, let's start with this: We have to begin with abandoning treatment planning by the lower incisor and begin treatment planning by the upper incisor.  Then we must realize that the upper incisor is retrusive in nearly every malocclusion, even in Class II cases.   Before you say anything, just sit with that thought for a minute and reflect, if that were true, what would it mean for our treatment mechanics, even the so-called Class II correctors.   If after you sit with that for awhile, and you want to hear more, please ask.

Barry 


On Sat, Aug 30, 2014 at 8:17 PM, Tom Colquitt <tcasoulet@gmail.com> wrote:
Nader- we have two seasons here, summer and christmas.

tc


On Sat, Aug 30, 2014 at 5:37 PM, 'M. Nader Sharifi' via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com> wrote:
hope everyone has a great  last weekend of the summer.

t colquitt

Don't you live near Texas? Doesn't your summer end, like on...never?

Nader.

> On Aug 30, 2014, at 5:33 PM, Tcasoulet via CORE Dentistry Discussion <core-dentistry-discussion@googlegroups.com> wrote:
>
> hope everyone has a great  last weekend of the summer.
>
> t colquitt

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dr. barry raphael
the raphael center for integrative orthodontics
the raphael center for integrative education
1425 broad street, clifton, nj 07013
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