Whether you are a clinical dentist, dental student, manual therapist, another healthcare practitioner, dental lab technician, or just a curious individual interested in what some dentist wasn’t taught in dental school, you might be wondering what this book is about. It’s about the knowledge and clinical skillsets I acquired after leaving dental school that helped me to effectively and successfully care for patients who had multifactorial complex conditions affecting the structure and function of the components of their stomatognathic system. A complex condition is a medical term that refers to: ‘physical disorders involving a combination of more than one system of the human body,’ such as including a combination of portions of the skeletal, muscular, and nervous systems. Complex conditions, in this case, are those that involve structural and/or functional disorders that patients have with their craniofacial-cervical neuromuscular system, certain craniofacial-cervical bones including the sphenoid and temporal bones, maxilla, and mandible, temporomandibular joints, and contents of the neurocranium in addition to disorders involving their teeth, periodontal tissues, oral mucosa, salivary glands, tongue, and other structures of the oral cavity.

While I was in dental school many years ago, I was taught the fundamental knowledge and rudimentary clinical skillsets which were necessary to provide basic dental care to patients; how to repair, remove, and replace teeth, but not to how to restore, reconstruct, realign, and replace the dentition, all 28 teeth functioning as a complete unit. Some of the professors and clinical instructors did talk about occlusion – the way the maxillary and mandibular teeth come together, but they didn’t teach us students about the dentition, how it was best configured, aligned, and functioned, or how to analyze, diagnose, and fix it when it was broken. For me this was one of those mysteries of clinical dentistry that sat on the shelf for many years. I knew it was there, but during dental school and my primal years in clinical practice it didn’t matter. Then after providing basic dental care for about 15 years after graduation I began to realize that it did matter and there must be more to practicing clinical dentistry than what I was taught in dental school.

I am curious by nature. I’ve always wanted to know how things worked and why they worked that way. When things didn’t work, I also wondered why they didn’t. So, I began my journey acquiring additional knowledge from my patients and numerous experts from in and outside of the field of dentistry. They became my new professors. Through them, I realized I knew a great deal about how to fix structural disorders of individual teeth and treat periodontal tissues but knew almost nothing about how all the teeth were supposed to occlude, articulate, and function together along with the lips, cheeks, & tongue during speaking, biting, clenching, chewing, and swallowing. I knew hardly anything about the normal function of the craniofacial-cervical skeletal muscles and nerves and the temporomandibular joints that made the teeth, lips, and tongue move or the oral-craniofacial-cervical bones they were attached to. Nor did I know anything about the effects that disorders of the stomatognathic system could have on other parts of the human body.

It may seem unusual to some readers, but I started my journey to learn about the configuration and alignment of the dentition by studying the structure and function of the components the stomatognathic system, not about how all the maxillary and mandibular teeth should fit together. I began studying about the structure and function of the temporomandibular joints, oral-craniofacial bones, contents of the neurocranium, the oral-craniofacial-cervical skeletal muscles and nerves, and then about how all 28/32 teeth are supposed to be physiologically arranged and aligned to function as a complete unit. I learned this without attending any seminars or continuing education courses regarding occlusion. It was a gradual process, without much input from any of the so-called occlusion experts who wrote or lectured about it during that time. It was through trial and error as I treated patients, discovering what was supposed to work, what did work, and what didn’t work. Most of the time I kept asking the question why, knowing I didn’t know what I didn’t know.

The focus of my clinical practice soon expanded to treating all 28 teeth arranged and aligned functioning together as a complete unit, the facial bones they were attached to, and the oral-craniofacial/cervical skeletal muscles and nerves, and temporomandibular joints that made them move. During that time, I also coined the phrase, the four pillars of occlusion which I wrote about and for several years taught to other dentists and dental lab technicians. Then, without realizing it, I slowly matured, and became aware of the bigger picture that turned out to be the stomatognathic system.

During that time, I also discovered that there were quite a number of my patients who had other disorders involving the structure and function of the contents of their neurocranium, jawbones, jaw-joints, jaw muscles, nerves, and tongue in addition to disorders involving their teeth and periodontal tissues. But I didn’t have the necessary knowledge nor the clinical skillsets to effectively and successfully take care of them. Then opportunities began to knock on my door. I heard about, and then attended numerous meetings, seminars, and continuing education courses regarding the structure and function of the cranio-maxillomandibular-cervical structural complex and neuromuscular system, temporomandibular joints, neurophysiology of the brain, the central and peripheral nervous systems, and a great deal more. I learned that the structures and function of the stomatognathic system were not only connected to teeth but were interconnected to other neuromusculoskeletal parts of the body as well. With this newfound knowledge I began a journey into the unknown. During that time, I was taught by many other healthcare practitioners and patients how the stomatognathic system functioned, why at times it became dysfunctional, and how to fix its components. This newfound knowledge was what I needed to effectively help those patients who had complex multifactorial disorders that were adversely affecting the quality of their lives. These were situations caused by more than disorders that only involved their teeth, and I needed the additional knowledge and learn new clinical skillsets to effectively take care of them. Through my studies I learned the reasons why patients were having their problems. This newfound knowledge changed my professional life. Unfortunately, this knowledge and information was not and is not generally taught in dental schools in America and Canada.

I got hooked and went down the rabbit hole seeking to learn how to solve the puzzle of patients’ complex multifactorial disorders. I also learned I needed a new clinical method of caring for these patients, that turned out to be comprehensive oral-craniofacial patient care. From my journey’s experiences I believe I can provide a few guidelines I discovered and valuable lessons I learned to effectively and successfully care for patients who have complex multifactorial disorders involving the structure and function of the stomatognathic system. I found there were common denominators in these experiences that became the maxims I learned to follow as I cared for them. I learned as I cared for these patients that I needed consistency, and the maxims provided the guidelines I needed. The concepts I have put forth in this book are for those dental & non-dental clinical healthcare practitioners who wish to transition beyond considering the oral-craniofacial-cervical neuromusculoskeletal system, temporomandibular joints, and teeth to consider what influences the structural components and functions of the stomatognathic system have on structural components and functions of other parts of the body.

The book is 86 pages long, contains numerous illustrations, and is divided into five sections.

• My Professional Journey – from dental occlusion to the stomatognathic system; from basic dental care to comprehensive oral-craniofacial patient care
• The Bigger Picture – comprehensively caring for disorders of the stomatognathic system
• Guidelines for Success – those I discovered to successfully provide comprehensive oral-craniofacial patient care
• Lessons I Learned – those I found to be true, however not taught in most dental schools
• Epilogue & My Legacy – my advice and recommendations and some of what I introduced into dentistry

My hope is that the guidelines I developed and the lessons I learned during my professional journey will help dentists and other health care practitioners take better care of their patients by helping to solve their mystery disorders. I invite you to take a look inside. You too may become curious and venture down the rabbit hole. Maybe I’ll see you there. – Dr. Carlson