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1 in 7 of Your Patients Will Experience This Hidden Dental Disaster! And 80% have No Clue! · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:05
  back,
• 0:06
  my
• 0:06
  friends,
• 0:06
  to
• 0:06
  another
• 0:07
  episode
• 0:07
  of
• 0:07
  Pearls
• 0:08
  and
• 0:08
  prep.
• 0:09
  Npz.
• 0:09
  Here,
• 0:10
  your
• 0:10
  preceptor
• 0:11
  in
• 0:11
  your
• 0:11
  pocket,
• 0:12
  your
• 0:12
  go
• 0:12
  to
• 0:12
  place
• 0:13
  for
• 0:13
  pearls
• 0:14
  that
• 0:14
  prep
• 0:14
  you
• 0:15
  to
• 0:15
  practice.
• 0:16
  We
• 0:16
  have
• 0:16
  a
• 0:17
  pearl
• 0:17
  drop
• 0:18
  today.
• 0:18
  You
• 0:19
  all
• 0:19
  know
• 0:19
  I
• 0:19
  love
• 0:19
  these
• 0:20
  pearl
• 0:20
  drops.
• 0:20
  And
• 0:21
  today
• 0:21
  I
• 0:22
  have
• 0:22
  a
• 0:23
  really
• 0:24
  important
• 0:24
  one,
• 0:25
  my
• 0:25
  friends.
• 0:26
  So
• 0:28
  here's
• 0:29
  the
• 0:29
  pearl.
• 0:30
  One
• 0:31
  out
• 0:31
  of
• 0:31
  every
• 0:31
  seven
• 0:32
  of
• 0:32
  your
• 0:32
  patients
• 0:34
  starting
• 0:35
  an
• 0:35
  antidepressant
• 0:36
  will
• 0:36
  develop
• 0:37
  new
• 0:37
  onset
• 0:38
  bruxism.
• 0:39
  Now
• 0:39
  that
• 0:40
  is
• 0:40
  flashy.
• 0:41
  One
• 0:41
  in
• 0:42
  seven.
• 0:42
  Oh,
• 0:42
  you're
• 0:42
  talking
• 0:43
  14%.
• 0:43
  That's
• 0:44
  a
• 0:44
  large
• 0:45
  chunk
• 0:45
  of
• 0:46
  your
• 0:46
  patients.
• 0:47
  If
• 0:47
  you're
• 0:47
  a
• 0:47
  full
• 0:48
  time
• 0:48
  clinician,
• 0:49
  you're
• 0:49
  going
• 0:49
  into
• 0:50
  practice
• 0:50
  this
• 0:51
  week.
• 0:52
  You're
• 0:52
  gonna
• 0:52
  have,
• 0:52
  I
• 0:53
  don't
• 0:53
  know,
• 0:53
  anywhere
• 0:53
  from
• 0:54
  15
• 0:54
  to
• 0:55
  30
• 0:55
  patients
• 0:55
  on
• 0:56
  your
• 0:56
  panel
• 0:56
  this
• 0:56
  week.
• 0:57
  Okay?
• 0:58
  Well,
• 0:59
  that
• 0:59
  could
• 0:59
  mean
• 0:59
  at
• 0:59
  least
• 1:00
  two
• 1:00
  to
• 1:00
  four
• 1:01
  of
• 1:01
  them
• 1:02
  are
• 1:02
  going
• 1:03
  to
• 1:03
  have
• 1:03
  bruxism.
• 1:04
  New
• 1:05
  onset
• 1:05
  bruxism.
• 1:06
  Okay?
• 1:07
  The
• 1:08
  scary
• 1:08
  part
• 1:09
  is
• 1:09
  that
• 1:09
  only
• 1:09
  20%
• 1:10
  of
• 1:11
  these
• 1:11
  patients
• 1:11
  are
• 1:11
  even
• 1:12
  aware
• 1:12
  of
• 1:12
  it.
• 1:12
  Now,
• 1:13
  for
• 1:13
  those
• 1:13
  of
• 1:13
  you
• 1:13
  who
• 1:13
  are
• 1:14
  unfamiliar
• 1:15
  about
• 1:15
  bruxism,
• 1:16
  it
• 1:17
  is
• 1:17
  the
• 1:17
  involuntary
• 1:18
  clenching
• 1:19
  or
• 1:19
  grinding
• 1:19
  of
• 1:19
  your
• 1:20
  teeth,
• 1:20
  mostly
• 1:21
  during
• 1:21
  sleep.
• 1:22
  Well,
• 1:22
  that's
• 1:22
  a
• 1:22
  really
• 1:23
  big
• 1:23
  problem.
• 1:23
  If
• 1:23
  80%
• 1:24
  of
• 1:24
  your
• 1:24
  patients
• 1:25
  are
• 1:25
  not
• 1:26
  even
• 1:26
  aware
• 1:26
  that
• 1:26
  this
• 1:27
  is
• 1:27
  happening,
• 1:28
  80%
• 1:28
  of
• 1:29
  them
• 1:29
  are
• 1:29
  not
• 1:29
  aware
• 1:29
  that
• 1:30
  this
• 1:30
  is
• 1:30
  happening.
• 1:30
  And
• 1:31
  one
• 1:31
  out
• 1:31
  of
• 1:31
  every
• 1:31
  seven
• 1:32
  that
• 1:32
  you
• 1:32
  start
• 1:33
  an
• 1:33
  antidepressant
• 1:33
  on,
• 1:34
  this
• 1:34
  will
• 1:34
  happen
• 1:34
  to
• 1:35
  them.
• 1:35
  How
• 1:35
  do
• 1:35
  we
• 1:35
  know
• 1:36
  that?
• 1:36
  Because
• 1:36
  in
• 1:36
  fancy
• 1:37
  schmancy
• 1:37
  studies,
• 1:38
  the
• 1:38
  evidence
• 1:39
  shows,
• 1:40
  with
• 1:40
  like,
• 1:40
  sophisticated
• 1:41
  bite
• 1:41
  tests,
• 1:42
  that
• 1:43
  patients
• 1:44
  are
• 1:44
  actually
• 1:45
  clenching
• 1:46
  their
• 1:46
  jaws
• 1:47
  and
• 1:47
  their
• 1:47
  teeth
• 1:49
  and
• 1:49
  they
• 1:49
  don't
• 1:49
  even
• 1:49
  realize
• 1:50
  it.
• 1:50
  But
• 1:50
  it
• 1:50
  is
• 1:50
  detectable.
• 1:51
  That
• 1:52
  grinding
• 1:52
  is
• 1:53
  detectable
• 1:54
  on
• 1:54
  an
• 1:55
  official
• 1:55
  bite
• 1:56
  test.
• 1:57
  And
• 1:57
  this
• 1:57
  is
• 1:57
  important.
• 1:58
  It's
• 1:58
  not
• 1:58
  just
• 1:59
  this
• 1:59
  abstract
• 2:00
  thing,
• 2:01
  okay?
• 2:01
  You
• 2:01
  clench
• 2:02
  your
• 2:02
  teeth.
• 2:02
  Now
• 2:02
  what?
• 2:03
  This
• 2:03
  has
• 2:03
  real
• 2:04
  implications
• 2:05
  for
• 2:05
  your
• 2:06
  patients
• 2:06
  and
• 2:06
  their
• 2:06
  dental
• 2:07
  health.
• 2:08
  Okay?
• 2:08
  Number
• 2:08
  one,
• 2:09
  this
• 2:09
  erodes
• 2:10
  the
• 2:10
  enamel
• 2:10
  of
• 2:11
  their
• 2:11
  teeth.
• 2:12
  Okay?
• 2:13
  Your
• 2:14
  teeth
• 2:14
  are
• 2:14
  wearing
• 2:14
  down
• 2:15
  a
• 2:15
  lot
• 2:15
  faster.
• 2:16
  Years
• 2:16
  of
• 2:16
  damage
• 2:17
  can
• 2:17
  take
• 2:17
  place
• 2:18
  in
• 2:18
  just
• 2:18
  months.
• 2:19
  The
• 2:19
  bite
• 2:19
  force
• 2:20
  of
• 2:21
  teeth
• 2:22
  clenching
• 2:22
  and
• 2:23
  chattering
• 2:24
  is
• 2:25
  significantly,
• 2:26
  we're
• 2:26
  talking
• 2:26
  hundreds
• 2:27
  of
• 2:27
  pounds
• 2:27
  of
• 2:27
  force
• 2:28
  during
• 2:28
  sleep.
• 2:29
  And
• 2:29
  that
• 2:29
  far
• 2:29
  exceeds
• 2:30
  your
• 2:30
  normal
• 2:31
  chewing
• 2:31
  of
• 2:31
  like,
• 2:31
  a
• 2:31
  potato
• 2:32
  or
• 2:33
  when
• 2:33
  you're
• 2:33
  chewing
• 2:34
  like
• 2:35
  a
• 2:35
  gummy
• 2:36
  bear
• 2:36
  or
• 2:37
  a
• 2:37
  cheeseburger
• 2:38
  or
• 2:41
  asparagus
• 2:42
  or,
• 2:43
  you
• 2:44
  know,
• 2:44
  you're,
• 2:44
  you're
• 2:44
  chewing
• 2:45
  on
• 2:45
  a
• 2:45
  funyun
• 2:46
  or
• 2:46
  beef
• 2:46
  jerky
• 2:46
  or
• 2:47
  a
• 2:47
  zebra
• 2:48
  cake
• 2:48
  or.
• 2:49
  Right,
• 2:50
  like,
• 2:51
  this
• 2:51
  is
• 2:51
  different.
• 2:51
  This
• 2:52
  is
• 2:52
  hundreds
• 2:52
  of
• 2:52
  pounds
• 2:53
  of
• 2:53
  force
• 2:53
  and
• 2:54
  it
• 2:54
  is
• 2:54
  fracturing
• 2:55
  your
• 2:56
  teeth.
• 2:56
  It
• 2:56
  can
• 2:56
  crack
• 2:57
  the
• 2:57
  enamel,
• 2:57
  it
• 2:58
  can
• 2:58
  flatten
• 2:58
  your
• 2:58
  cusps,
• 3:00
  it
• 3:00
  can
• 3:00
  loosen
• 3:00
  your
• 3:01
  dental
• 3:01
  restorations,
• 3:01
  your
• 3:02
  crowns,
• 3:02
  your
• 3:02
  fillings,
• 3:03
  your
• 3:03
  veneers,
• 3:03
  and
• 3:03
  it
• 3:03
  just
• 3:04
  makes
• 3:04
  your
• 3:04
  teeth
• 3:04
  hypersensitive.
• 3:06
  From
• 3:06
  that
• 3:06
  enamel
• 3:06
  loss.
• 3:07
  Well,
• 3:07
  that's
• 3:07
  a
• 3:08
  big
• 3:08
  problem.
• 3:08
  It
• 3:08
  can
• 3:08
  even
• 3:09
  cause
• 3:09
  next
• 3:10
  day
• 3:10
  headaches.
• 3:10
  So
• 3:10
  it's
• 3:10
  really
• 3:11
  important
• 3:11
  you,
• 3:11
  you
• 3:11
  ask
• 3:12
  your
• 3:12
  patients,
• 3:12
  like,
• 3:12
  are
• 3:12
  you
• 3:13
  experiencing
• 3:13
  any
• 3:13
  newfound
• 3:14
  headaches
• 3:14
  in
• 3:15
  the
• 3:15
  morning?
• 3:16
  Of
• 3:16
  course,
• 3:16
  there
• 3:17
  are
• 3:17
  some
• 3:17
  medications
• 3:17
  out
• 3:18
  there
• 3:18
  that
• 3:18
  can
• 3:18
  cause
• 3:19
  that
• 3:19
  on
• 3:19
  their
• 3:20
  own.
• 3:20
  But
• 3:20
  with
• 3:20
  SSRIs
• 3:21
  in
• 3:21
  particular,
• 3:22
  those
• 3:22
  morning
• 3:23
  headaches
• 3:23
  are
• 3:23
  mighty
• 3:24
  suspicious
• 3:25
  of
• 3:25
  a
• 3:25
  bruxism
• 3:26
  problem.
• 3:27
  And
• 3:27
  again,
• 3:27
  they're
• 3:28
  not
• 3:28
  going
• 3:28
  to
• 3:28
  volunteer
• 3:28
  this
• 3:29
  information.
• 3:29
  They're
• 3:29
  not
• 3:29
  going
• 3:29
  to
• 3:29
  even
• 3:30
  really
• 3:30
  know
• 3:30
  they
• 3:30
  have
• 3:30
  it.
• 3:31
  Only
• 3:31
  20%
• 3:32
  are
• 3:32
  going
• 3:32
  to
• 3:32
  know
• 3:33
  they
• 3:33
  have
• 3:33
  it.
• 3:33
  You
• 3:33
  see
• 3:33
  this
• 3:34
  in
• 3:34
  some
• 3:34
  of
• 3:34
  your
• 3:34
  high
• 3:35
  risk
• 3:35
  medications.
• 3:36
  Zoloft,
• 3:37
  Lexapro,
• 3:38
  Effexor,
• 3:38
  Paxil,
• 3:39
  Cymbalta.
• 3:40
  Right.
• 3:41
  Of
• 3:41
  course,
• 3:42
  antipsychotics
• 3:43
  are
• 3:43
  known
• 3:43
  for
• 3:43
  movement
• 3:44
  disorders
• 3:45
  more,
• 3:45
  more
• 3:45
  broadly.
• 3:46
  Okay.
• 3:47
  Geodon
• 3:48
  has
• 3:48
  the
• 3:48
  highest
• 3:48
  risk,
• 3:49
  according
• 3:49
  to
• 3:49
  some
• 3:50
  evidence,
• 3:50
  in
• 3:51
  inducing
• 3:51
  bruxism.
• 3:52
  You
• 3:52
  see
• 3:52
  it
• 3:52
  with
• 3:52
  Abilify,
• 3:53
  Lanzapine,
• 3:54
  Risperidol.
• 3:54
  You
• 3:55
  see
• 3:55
  it
• 3:55
  all.
• 3:55
  But
• 3:56
  this
• 3:56
  is
• 3:56
  pretty
• 3:56
  significant
• 3:57
  because
• 3:57
  it's
• 3:57
  coming
• 3:57
  from
• 3:58
  serotonin,
• 3:58
  it's
• 3:58
  coming
• 3:59
  from
• 3:59
  SSRIs
• 3:59
  and
• 4:00
  SNRIs.
• 4:00
  Well,
• 4:00
  why
• 4:00
  is
• 4:01
  that?
• 4:02
  Well,
• 4:02
  you
• 4:02
  all
• 4:02
  know
• 4:02
  this
• 4:02
  already.
• 4:03
  Maybe
• 4:03
  it's
• 4:03
  worth
• 4:04
  a
• 4:04
  refresher.
• 4:05
  But
• 4:05
  SSRIs
• 4:06
  flood
• 4:06
  the
• 4:06
  brain
• 4:06
  with
• 4:07
  serotonin.
• 4:08
  And
• 4:08
  of
• 4:08
  course,
• 4:09
  too
• 4:09
  much
• 4:10
  serotonin
• 4:10
  will
• 4:10
  suppress
• 4:11
  dopamine,
• 4:12
  specifically
• 4:13
  in
• 4:13
  circuits
• 4:13
  like
• 4:14
  the
• 4:14
  substantia
• 4:15
  nigra,
• 4:15
  which
• 4:15
  you've
• 4:16
  probably
• 4:16
  read
• 4:16
  all
• 4:16
  about
• 4:17
  as
• 4:17
  a
• 4:17
  student.
• 4:17
  And
• 4:17
  when
• 4:18
  serotonin
• 4:19
  suppresses
• 4:20
  dopamine
• 4:20
  in
• 4:20
  those
• 4:21
  circuits,
• 4:21
  now,
• 4:22
  we
• 4:22
  don't
• 4:23
  have
• 4:23
  control
• 4:24
  over
• 4:24
  our
• 4:24
  movements,
• 4:25
  our
• 4:25
  involuntary
• 4:26
  movements.
• 4:27
  Right.
• 4:27
  So
• 4:27
  it's
• 4:27
  kind
• 4:28
  of
• 4:28
  a
• 4:28
  weird,
• 4:29
  paradoxical
• 4:29
  thing.
• 4:30
  But
• 4:30
  remember,
• 4:30
  when
• 4:30
  you
• 4:31
  suppress
• 4:31
  dopamine,
• 4:32
  you're
• 4:32
  kind
• 4:32
  of,
• 4:32
  you're
• 4:33
  making
• 4:33
  smooth
• 4:33
  motor
• 4:34
  control
• 4:34
  more
• 4:34
  difficult.
• 4:35
  So
• 4:35
  involuntary
• 4:36
  movements
• 4:36
  are
• 4:36
  harder
• 4:37
  to
• 4:37
  suppress,
• 4:38
  they're
• 4:38
  harder
• 4:39
  to
• 4:39
  manage.
• 4:39
  So
• 4:39
  you're
• 4:40
  going
• 4:40
  to
• 4:40
  get
• 4:40
  these
• 4:40
  bizarre
• 4:41
  involuntary
• 4:41
  movements.
• 4:42
  This
• 4:42
  is
• 4:42
  why
• 4:42
  you
• 4:42
  actually
• 4:42
  can
• 4:43
  get,
• 4:43
  you
• 4:44
  know,
• 4:44
  extra
• 4:44
  pyramidal
• 4:45
  symptoms
• 4:45
  with
• 4:45
  SSRIs,
• 4:46
  because
• 4:46
  they
• 4:46
  also
• 4:47
  suppress
• 4:48
  dopamine.
• 4:48
  Maybe
• 4:49
  not
• 4:49
  to
• 4:49
  the
• 4:49
  extent
• 4:49
  that
• 4:49
  antipsychotics
• 4:50
  do.
• 4:50
  Right.
• 4:51
  You
• 4:51
  see
• 4:51
  the
• 4:51
  dystonias
• 4:52
  a
• 4:52
  very,
• 4:53
  you
• 4:53
  know,
• 4:53
  a
• 4:54
  lot
• 4:54
  more
• 4:54
  frequently,
• 4:54
  probably
• 4:55
  with
• 4:56
  your
• 4:56
  antipsychotics.
• 4:56
  I
• 4:57
  know
• 4:57
  I
• 4:57
  do.
• 4:57
  When
• 4:57
  I
• 4:57
  prescribe
• 4:58
  antipsychotics,
• 4:58
  I
• 4:59
  definitely
• 4:59
  hear
• 4:59
  about
• 4:59
  aesthesia
• 5:00
  way
• 5:00
  more
• 5:01
  than
• 5:01
  in
• 5:02
  SSRIs
• 5:03
  and
• 5:03
  Dystonias
• 5:03
  Way
• 5:04
  more.
• 5:04
  But
• 5:05
  bruxism
• 5:05
  is
• 5:06
  essentially
• 5:06
  like
• 5:06
  an
• 5:06
  aesthesia
• 5:07
  of
• 5:07
  the
• 5:07
  jaw.
• 5:08
  It's
• 5:08
  a
• 5:08
  focal
• 5:08
  movement
• 5:09
  disorder.
• 5:09
  Okay.
• 5:10
  And
• 5:11
  so
• 5:12
  we
• 5:12
  still
• 5:12
  are
• 5:12
  dealing
• 5:13
  with
• 5:13
  that
• 5:13
  dopamine
• 5:14
  suppression
• 5:15
  in.
• 5:15
  With
• 5:15
  respect
• 5:15
  to
• 5:16
  antipsychotics,
• 5:16
  it's
• 5:17
  more
• 5:17
  of
• 5:17
  a
• 5:17
  dopamine
• 5:17
  Blockade,
• 5:18
  and
• 5:19
  your
• 5:19
  jaw
• 5:19
  will
• 5:19
  grind,
• 5:20
  right?
• 5:20
  Your
• 5:21
  teeth
• 5:21
  will
• 5:21
  clench.
• 5:22
  This
• 5:22
  is
• 5:23
  a
• 5:23
  very
• 5:23
  big
• 5:24
  problem.
• 5:24
  And
• 5:25
  your
• 5:25
  patient,
• 5:26
  you
• 5:26
  know,
• 5:26
  will.
• 5:26
  Will
• 5:26
  sustain
• 5:27
  some
• 5:27
  damage.
• 5:28
  Their
• 5:28
  dentist
• 5:29
  might
• 5:29
  be
• 5:29
  the
• 5:29
  first
• 5:29
  one
• 5:30
  to
• 5:30
  recognize
• 5:30
  it
• 5:30
  if
• 5:30
  they
• 5:30
  don't
• 5:31
  volunteer
• 5:31
  the
• 5:31
  information
• 5:31
  and
• 5:32
  we
• 5:32
  don't
• 5:32
  assess
• 5:32
  it.
• 5:33
  You
• 5:33
  know,
• 5:33
  a
• 5:34
  lot
• 5:34
  of
• 5:34
  our
• 5:34
  patients
• 5:34
  have
• 5:34
  tmg,
• 5:35
  TMJ
• 5:36
  pain.
• 5:36
  We
• 5:36
  hear
• 5:36
  that
• 5:36
  all
• 5:37
  the
• 5:37
  time.
• 5:37
  A
• 5:37
  lot
• 5:37
  of
• 5:38
  that's
• 5:38
  really
• 5:38
  just
• 5:38
  from
• 5:38
  stress,
• 5:39
  too.
• 5:39
  I
• 5:39
  mean,
• 5:39
  they
• 5:39
  can
• 5:40
  come
• 5:40
  into
• 5:40
  an
• 5:41
  appointment
• 5:41
  with
• 5:41
  you
• 5:41
  with
• 5:42
  decades
• 5:43
  kind
• 5:43
  of
• 5:43
  a
• 5:43
  mind
• 5:43
  body
• 5:44
  connection
• 5:44
  with
• 5:44
  their.
• 5:45
  With
• 5:45
  their
• 5:46
  stress.
• 5:46
  And
• 5:47
  I've
• 5:47
  had
• 5:47
  tons
• 5:47
  of
• 5:47
  patients
• 5:47
  who
• 5:48
  have
• 5:48
  never
• 5:48
  been
• 5:48
  on
• 5:48
  SSRIs
• 5:49
  that
• 5:49
  report
• 5:50
  TMJ
• 5:50
  pain.
• 5:50
  So
• 5:51
  it
• 5:51
  can
• 5:51
  be
• 5:51
  hard
• 5:51
  to
• 5:52
  really
• 5:52
  distinguish
• 5:53
  the
• 5:53
  two.
• 5:53
  But
• 5:53
  please
• 5:54
  know
• 5:54
  that
• 5:54
  whenever
• 5:54
  you
• 5:55
  prescribe
• 5:55
  an
• 5:55
  antidepressant,
• 5:57
  one
• 5:57
  in
• 5:57
  seven
• 5:57
  of
• 5:57
  your
• 5:58
  patients
• 5:58
  will
• 5:59
  develop
• 5:59
  bruxism.
• 6:00
  80%
• 6:00
  of
• 6:00
  them
• 6:01
  won't
• 6:01
  even
• 6:01
  know
• 6:01
  they
• 6:01
  have
• 6:01
  it,
• 6:02
  and
• 6:02
  yet
• 6:03
  90%
• 6:05
  will
• 6:05
  show
• 6:05
  some
• 6:05
  increase
• 6:06
  in
• 6:06
  grinding.
• 6:07
  And
• 6:07
  that
• 6:07
  can
• 6:07
  really
• 6:08
  damage
• 6:08
  your
• 6:09
  patient's
• 6:09
  teeth
• 6:10
  again.
• 6:10
  Fractures,
• 6:11
  cracked
• 6:11
  enamel,
• 6:12
  loosening
• 6:12
  of
• 6:13
  dental
• 6:13
  restorations
• 6:14
  like
• 6:14
  crowns
• 6:14
  and
• 6:14
  fillings.
• 6:15
  Tmj,
• 6:16
  morning
• 6:16
  headaches.
• 6:16
  Ask
• 6:17
  about
• 6:17
  morning
• 6:17
  headaches.
• 6:18
  For
• 6:18
  sure,
• 6:18
  you
• 6:18
  can
• 6:18
  explain
• 6:19
  that
• 6:19
  the
• 6:19
  serotonergic
• 6:20
  medications
• 6:20
  inhibit
• 6:21
  dopamine,
• 6:21
  and
• 6:22
  that
• 6:22
  can
• 6:22
  cause
• 6:22
  some
• 6:22
  kind
• 6:23
  of
• 6:23
  movement
• 6:23
  disorders
• 6:24
  or
• 6:24
  movement
• 6:25
  problems
• 6:25
  that
• 6:26
  are
• 6:26
  very
• 6:27
  obnoxious,
• 6:28
  sometimes
• 6:28
  painful,
• 6:29
  and
• 6:29
  certainly
• 6:30
  damaging
• 6:30
  to
• 6:30
  their
• 6:31
  dental
• 6:31
  health.
• 6:32
  You
• 6:32
  know,
• 6:32
  just
• 6:32
  ask
• 6:33
  them
• 6:33
  straight
• 6:33
  up,
• 6:33
  any
• 6:34
  jaw
• 6:34
  pain
• 6:34
  or
• 6:34
  tightness
• 6:35
  when
• 6:35
  you
• 6:35
  wake
• 6:35
  up?
• 6:35
  You
• 6:36
  know,
• 6:36
  has
• 6:36
  anyone
• 6:36
  ever
• 6:36
  told
• 6:37
  you
• 6:37
  that
• 6:37
  you're
• 6:37
  grinding
• 6:37
  or
• 6:38
  clenching
• 6:38
  your
• 6:38
  teeth
• 6:38
  at
• 6:38
  night?
• 6:38
  Do
• 6:39
  you
• 6:39
  have
• 6:39
  any
• 6:39
  new
• 6:39
  headaches,
• 6:40
  especially
• 6:40
  first
• 6:41
  thing
• 6:41
  in
• 6:41
  the
• 6:41
  morning?
• 6:42
  Does
• 6:42
  your
• 6:42
  jaw
• 6:42
  feel
• 6:43
  kind
• 6:43
  of
• 6:43
  bigger
• 6:44
  or
• 6:44
  tighter?
• 6:45
  Okay.
• 6:45
  Any
• 6:45
  tooth
• 6:46
  sensitivity
• 6:46
  or
• 6:46
  pain
• 6:47
  that
• 6:47
  your
• 6:47
  dentist
• 6:47
  isn't
• 6:48
  quite
• 6:48
  sure
• 6:49
  about?
• 6:49
  Even,
• 6:50
  you
• 6:50
  know,
• 6:50
  ask
• 6:50
  if
• 6:50
  they're
• 6:51
  clenching
• 6:51
  during
• 6:51
  the
• 6:51
  day
• 6:52
  right
• 6:53
  now.
• 6:53
  How
• 6:53
  do
• 6:53
  we
• 6:53
  fix
• 6:53
  this?
• 6:54
  What
• 6:54
  do
• 6:54
  we
• 6:54
  do
• 6:54
  if
• 6:54
  our
• 6:54
  patient
• 6:55
  is
• 6:55
  complaining
• 6:56
  about
• 6:56
  this?
• 6:56
  Well,
• 6:56
  one
• 6:57
  thing
• 6:57
  you
• 6:57
  could
• 6:57
  do,
• 6:57
  of
• 6:58
  course,
• 6:58
  is
• 6:59
  switch
• 6:59
  them
• 6:59
  to
• 6:59
  a
• 6:59
  different
• 7:00
  antidepressant.
• 7:00
  If
• 7:00
  they're
• 7:01
  perfectly
• 7:01
  suitable
• 7:01
  to
• 7:01
  be
• 7:02
  on
• 7:02
  Wellbutrin,
• 7:02
  go
• 7:03
  ahead
• 7:03
  and
• 7:03
  do
• 7:03
  that,
• 7:03
  right?
• 7:04
  If
• 7:04
  your
• 7:04
  patient
• 7:04
  especially
• 7:05
  has,
• 7:05
  like,
• 7:05
  anhedonia,
• 7:06
  low
• 7:06
  energy,
• 7:07
  they
• 7:07
  can't
• 7:07
  concentrate
• 7:08
  very
• 7:08
  well.
• 7:08
  Maybe
• 7:09
  weight
• 7:09
  gain
• 7:09
  is
• 7:09
  a
• 7:09
  big
• 7:10
  deal
• 7:10
  breaker.
• 7:10
  Well,
• 7:10
  Wellbutrin
• 7:11
  is
• 7:11
  your
• 7:11
  buddy,
• 7:12
  right?
• 7:12
  As
• 7:13
  long
• 7:13
  as
• 7:13
  they
• 7:13
  don't
• 7:13
  have
• 7:13
  any
• 7:14
  past
• 7:14
  history
• 7:14
  of,
• 7:15
  like,
• 7:15
  seizures
• 7:16
  or
• 7:16
  where
• 7:16
  they're
• 7:16
  withdrawing
• 7:17
  from
• 7:17
  alcohol
• 7:17
  or
• 7:17
  any
• 7:18
  kind
• 7:18
  of
• 7:18
  eating
• 7:18
  disorders,
• 7:18
  then
• 7:19
  Wellbutrin
• 7:19
  could
• 7:19
  be
• 7:20
  your
• 7:20
  buddy.
• 7:20
  And
• 7:20
  you
• 7:21
  can
• 7:21
  solve
• 7:21
  this
• 7:21
  problem
• 7:21
  because
• 7:22
  this
• 7:22
  is
• 7:22
  a
• 7:22
  serotonergic
• 7:23
  problem
• 7:23
  that's
• 7:23
  suppressing
• 7:24
  dopamine.
• 7:25
  As
• 7:25
  you
• 7:25
  know,
• 7:25
  Wellbutrin
• 7:26
  is
• 7:26
  more
• 7:26
  dopaminergic
• 7:27
  so
• 7:27
  switch
• 7:28
  to
• 7:28
  Wellbutrin
• 7:28
  if
• 7:29
  this
• 7:30
  profile
• 7:30
  fits
• 7:31
  the
• 7:31
  patient
• 7:31
  right,
• 7:32
  if
• 7:32
  their
• 7:32
  form
• 7:32
  of
• 7:33
  depression
• 7:33
  is
• 7:34
  conducive
• 7:34
  to.
• 7:35
  To
• 7:35
  that.
• 7:35
  Now,
• 7:35
  if
• 7:36
  you
• 7:36
  have
• 7:36
  a
• 7:36
  patient
• 7:36
  who's
• 7:36
  predominantly
• 7:37
  anxious
• 7:38
  and
• 7:38
  you're
• 7:38
  prescribing
• 7:39
  SSRIs,
• 7:40
  Wellbutrin
• 7:41
  could
• 7:41
  make
• 7:41
  them
• 7:41
  more
• 7:41
  anxious.
• 7:42
  I've
• 7:42
  seen
• 7:42
  it
• 7:42
  kind
• 7:43
  of
• 7:43
  go
• 7:43
  both
• 7:43
  ways.
• 7:43
  But
• 7:43
  a
• 7:44
  lot
• 7:44
  of
• 7:44
  times,
• 7:44
  Wellbutrin
• 7:45
  can
• 7:45
  make
• 7:45
  them
• 7:45
  more
• 7:45
  anxious.
• 7:46
  Well,
• 7:46
  that
• 7:46
  wouldn't
• 7:46
  be
• 7:47
  a
• 7:47
  very
• 7:47
  smart
• 7:47
  move
• 7:47
  then.
• 7:48
  But
• 7:48
  you
• 7:48
  have
• 7:48
  a
• 7:48
  really
• 7:49
  good
• 7:50
  treatment
• 7:50
  for
• 7:50
  bruxism
• 7:51
  that
• 7:51
  not
• 7:51
  only
• 7:51
  can
• 7:52
  treat
• 7:52
  bruxism,
• 7:53
  but
• 7:53
  also
• 7:53
  reduce
• 7:54
  their
• 7:54
  anxiety.
• 7:54
  And
• 7:54
  that
• 7:55
  would
• 7:55
  definitely
• 7:55
  be
• 7:55
  buspirone.
• 7:56
  Buspirone,
• 7:57
  as
• 7:57
  a
• 7:57
  lot
• 7:57
  of
• 7:58
  you
• 7:58
  all
• 7:58
  know,
• 7:58
  is
• 7:58
  a
• 7:58
  5ht
• 7:59
  one,
• 7:59
  a
• 7:59
  partial
• 8:00
  agonist.
• 8:01
  Fancy
• 8:01
  schmancy
• 8:02
  way
• 8:02
  of
• 8:03
  saying
• 8:03
  that
• 8:03
  it
• 8:03
  kind
• 8:04
  of
• 8:04
  decreases
• 8:04
  serotonin
• 8:05
  output
• 8:06
  by
• 8:06
  activating
• 8:06
  those
• 8:06
  presynaptic
• 8:07
  5ht1a
• 8:08
  autoreceptors.
• 8:09
  It's
• 8:10
  kind
• 8:10
  of
• 8:10
  like
• 8:10
  a
• 8:10
  thermostat.
• 8:11
  Kind
• 8:11
  of
• 8:11
  tells
• 8:12
  the
• 8:12
  serotonin
• 8:12
  to
• 8:12
  fire
• 8:13
  less,
• 8:13
  thereby
• 8:14
  suppressing
• 8:14
  dopamine
• 8:15
  less.
• 8:15
  It
• 8:15
  also
• 8:16
  increases
• 8:16
  dopaminergic
• 8:17
  activity.
• 8:18
  It
• 8:18
  has
• 8:18
  a
• 8:19
  little
• 8:19
  bit
• 8:19
  of
• 8:19
  a
• 8:19
  D2
• 8:19
  affinity,
• 8:20
  and
• 8:20
  that
• 8:21
  can
• 8:21
  partially
• 8:21
  restore
• 8:22
  that
• 8:22
  dopamine
• 8:23
  that
• 8:23
  is
• 8:23
  suppressed.
• 8:24
  Okay,
• 8:25
  so
• 8:25
  5
• 8:26
  to
• 8:26
  10
• 8:26
  milligrams
• 8:27
  at
• 8:27
  bedtime.
• 8:27
  The
• 8:27
  evidence
• 8:28
  shows
• 8:28
  that
• 8:28
  that
• 8:28
  can
• 8:29
  be
• 8:29
  helpful
• 8:29
  with
• 8:29
  buspirone.
• 8:30
  Single
• 8:31
  nightly
• 8:31
  dose.
• 8:31
  And
• 8:32
  it
• 8:32
  can
• 8:32
  often
• 8:32
  bring
• 8:32
  relief
• 8:33
  within
• 8:33
  days.
• 8:34
  And
• 8:34
  not
• 8:34
  only
• 8:35
  does
• 8:35
  it
• 8:35
  not
• 8:35
  interfere
• 8:35
  with
• 8:35
  antidepressants,
• 8:36
  it
• 8:37
  can
• 8:37
  actually
• 8:37
  augment.
• 8:37
  You
• 8:38
  know,
• 8:38
  the
• 8:38
  STARD
• 8:38
  trial
• 8:39
  showed
• 8:39
  that
• 8:39
  buspirone
• 8:40
  can
• 8:40
  actually
• 8:40
  make
• 8:40
  it
• 8:40
  even
• 8:40
  better.
• 8:41
  Right.
• 8:41
  So
• 8:41
  now
• 8:41
  you
• 8:41
  have
• 8:41
  this,
• 8:41
  like,
• 8:42
  anxiolytic.
• 8:43
  It
• 8:43
  does
• 8:43
  take
• 8:43
  time
• 8:43
  to
• 8:43
  kick,
• 8:44
  but
• 8:44
  you're
• 8:44
  fixing
• 8:45
  the
• 8:45
  beer
• 8:45
  bruxism
• 8:46
  within
• 8:46
  days.
• 8:47
  And
• 8:47
  you've
• 8:47
  added
• 8:47
  this
• 8:47
  other
• 8:48
  agent
• 8:48
  now
• 8:49
  that
• 8:49
  may
• 8:49
  also
• 8:49
  serve
• 8:50
  as
• 8:50
  an
• 8:50
  adjunct
• 8:50
  to
• 8:51
  the
• 8:51
  antidepressant
• 8:52
  in
• 8:52
  that
• 8:52
  it'll
• 8:53
  make
• 8:53
  the
• 8:53
  patient
• 8:53
  less
• 8:53
  anxious
• 8:54
  over
• 8:54
  time.
• 8:54
  Kind
• 8:54
  of
• 8:55
  lowers
• 8:55
  the
• 8:55
  volume
• 8:55
  on
• 8:56
  their
• 8:56
  anxiety
• 8:57
  counter
• 8:57
  sexual
• 8:58
  side
• 8:58
  effects,
• 8:58
  too,
• 8:58
  which
• 8:59
  can
• 8:59
  be
• 8:59
  very
• 8:59
  helpful.
• 8:59
  So
• 8:59
  you
• 9:00
  get
• 9:00
  kind
• 9:00
  of
• 9:00
  a
• 9:00
  two
• 9:00
  or
• 9:00
  three
• 9:01
  for
• 9:01
  one
• 9:01
  here.
• 9:01
  Buspirone
• 9:02
  can
• 9:03
  be
• 9:03
  thought
• 9:03
  of
• 9:03
  as
• 9:03
  an
• 9:03
  adjunct
• 9:04
  that
• 9:04
  not
• 9:04
  only
• 9:05
  can
• 9:06
  fine
• 9:06
  tune
• 9:06
  the
• 9:06
  patient's
• 9:07
  anxiety
• 9:07
  and
• 9:07
  make
• 9:08
  that
• 9:08
  easier
• 9:08
  on
• 9:08
  them,
• 9:09
  but
• 9:09
  it
• 9:09
  can
• 9:09
  also
• 9:09
  fine
• 9:10
  tune
• 9:10
  the
• 9:11
  rather
• 9:11
  blunt
• 9:11
  serotonergic
• 9:12
  effect
• 9:13
  of
• 9:14
  our
• 9:14
  meds.
• 9:15
  Right?
• 9:15
  Our
• 9:15
  meds
• 9:15
  kind
• 9:15
  of
• 9:15
  bluntly,
• 9:17
  broadly
• 9:18
  affect
• 9:18
  serotonin
• 9:19
  in
• 9:19
  good
• 9:19
  ways
• 9:19
  and
• 9:19
  in
• 9:20
  bad
• 9:20
  ways.
• 9:20
  They
• 9:20
  affect
• 9:20
  motor
• 9:21
  side
• 9:21
  effects.
• 9:21
  They.
• 9:21
  They
• 9:22
  can
• 9:22
  lead
• 9:22
  to
• 9:23
  sexual
• 9:23
  side
• 9:23
  effects.
• 9:24
  Right.
• 9:24
  They
• 9:24
  can
• 9:25
  even
• 9:25
  lead
• 9:25
  to
• 9:25
  too
• 9:25
  much
• 9:25
  anxiety
• 9:26
  because
• 9:26
  there's.
• 9:27
  Or
• 9:27
  nausea.
• 9:28
  Right.
• 9:28
  Because,
• 9:28
  again,
• 9:28
  it's
• 9:29
  not
• 9:29
  just
• 9:29
  increasing,
• 9:30
  you
• 9:30
  know,
• 9:30
  the
• 9:31
  reuptake
• 9:31
  of
• 9:31
  or
• 9:32
  blocking
• 9:32
  the
• 9:32
  reuptake
• 9:33
  of
• 9:33
  serotonin.
• 9:34
  We're,
• 9:35
  we're
• 9:35
  doing
• 9:35
  this
• 9:35
  in
• 9:35
  various
• 9:36
  parts
• 9:36
  of
• 9:36
  the
• 9:36
  body,
• 9:37
  in
• 9:37
  the
• 9:37
  gut,
• 9:37
  in
• 9:37
  the
• 9:37
  brain.
• 9:38
  And
• 9:38
  serotonin
• 9:39
  doesn't
• 9:39
  just
• 9:39
  exist
• 9:40
  in
• 9:40
  isolation.
• 9:40
  So
• 9:41
  to
• 9:41
  fine
• 9:41
  tune
• 9:42
  that,
• 9:42
  sometimes
• 9:42
  you
• 9:43
  can
• 9:43
  add
• 9:43
  something
• 9:43
  like
• 9:43
  buspirone,
• 9:44
  which
• 9:45
  mitigates
• 9:46
  the
• 9:46
  unpleasant
• 9:47
  side
• 9:47
  effects.
• 9:47
  You
• 9:48
  can
• 9:48
  even
• 9:48
  switch
• 9:49
  to
• 9:49
  mirtazapine.
• 9:50
  Right.
• 9:50
  It's
• 9:50
  a
• 9:50
  5H2
• 9:51
  5HT2C
• 9:52
  antagonist.
• 9:52
  We've
• 9:53
  talked
• 9:53
  about
• 9:53
  this
• 9:53
  before,
• 9:54
  right?
• 9:55
  So
• 9:55
  it
• 9:55
  actually
• 9:55
  blocks
• 9:56
  the
• 9:56
  receptor
• 9:56
  that
• 9:57
  causes
• 9:57
  the
• 9:57
  problem
• 9:57
  here.
• 9:58
  The
• 9:58
  problem,
• 9:59
  of
• 9:59
  course,
• 9:59
  here
• 10:00
  is
• 10:00
  that
• 10:00
  we
• 10:01
  are,
• 10:01
  when
• 10:01
  we,
• 10:02
  when
• 10:02
  we
• 10:02
  start
• 10:02
  an
• 10:03
  SSRI,
• 10:03
  we
• 10:04
  are
• 10:04
  often
• 10:04
  hitting
• 10:04
  that
• 10:05
  5ht2c
• 10:06
  receptor.
• 10:07
  Okay,
• 10:07
  which,
• 10:08
  which
• 10:08
  is
• 10:08
  suppressing
• 10:09
  the
• 10:09
  dopamine.
• 10:09
  Well,
• 10:10
  no,
• 10:10
  mirtazapine
• 10:11
  actually
• 10:11
  blocks.
• 10:11
  That
• 10:12
  adds
• 10:12
  a
• 10:13
  little
• 10:13
  bit.
• 10:13
  It,
• 10:14
  it
• 10:14
  leads
• 10:14
  to
• 10:15
  less
• 10:15
  of
• 10:15
  a
• 10:15
  suppression
• 10:15
  of
• 10:16
  dopamine,
• 10:16
  which
• 10:16
  is
• 10:16
  good.
• 10:16
  That
• 10:17
  also
• 10:17
  causes
• 10:17
  weight
• 10:17
  gain
• 10:18
  though,
• 10:18
  right?
• 10:18
  The.
• 10:19
  When
• 10:19
  you
• 10:19
  antagonize
• 10:20
  the
• 10:20
  5ht2c
• 10:21
  receptor,
• 10:21
  I
• 10:22
  think
• 10:22
  cravings
• 10:23
  or
• 10:23
  weight
• 10:23
  gain.
• 10:23
  Right.
• 10:24
  And
• 10:24
  so
• 10:26
  there
• 10:26
  are
• 10:26
  always
• 10:26
  trade
• 10:26
  offs
• 10:27
  in
• 10:27
  psychopharmacology,
• 10:28
  right?
• 10:28
  There's
• 10:29
  always
• 10:29
  trade
• 10:29
  offs.
• 10:29
  Some
• 10:29
  patients,
• 10:30
  none
• 10:30
  of
• 10:30
  these
• 10:31
  answers
• 10:31
  are
• 10:31
  going
• 10:32
  to
• 10:32
  be
• 10:32
  good
• 10:32
  for
• 10:32
  them.
• 10:32
  Maybe
• 10:32
  they
• 10:33
  don't
• 10:33
  want
• 10:33
  another
• 10:33
  medication
• 10:34
  and
• 10:34
  they
• 10:34
  want
• 10:35
  to
• 10:35
  get
• 10:35
  like
• 10:35
  a
• 10:35
  referral
• 10:36
  to
• 10:36
  dental
• 10:36
  for
• 10:36
  a
• 10:37
  night
• 10:37
  guard.
• 10:37
  You
• 10:38
  know,
• 10:38
  it'll
• 10:38
  protect
• 10:38
  their
• 10:38
  teeth.
• 10:39
  It
• 10:39
  won't
• 10:39
  really
• 10:39
  stop
• 10:40
  the
• 10:40
  grinding
• 10:40
  itself.
• 10:41
  Maybe
• 10:41
  they're
• 10:41
  gonna
• 10:41
  want
• 10:42
  Botox
• 10:42
  or
• 10:43
  what
• 10:43
  have
• 10:43
  you.
• 10:43
  So
• 10:44
  whatever
• 10:44
  it
• 10:44
  is,
• 10:45
  you
• 10:45
  have
• 10:45
  kind
• 10:45
  of
• 10:45
  at
• 10:46
  least
• 10:46
  a
• 10:46
  broader
• 10:47
  conversation
• 10:47
  and
• 10:47
  something
• 10:48
  to
• 10:48
  look
• 10:48
  at
• 10:49
  to
• 10:49
  make
• 10:49
  your
• 10:49
  patient
• 10:50
  a
• 10:50
  little
• 10:50
  healthier,
• 10:50
  to
• 10:51
  keep
• 10:51
  them
• 10:51
  on
• 10:51
  guard.
• 10:52
  Remember,
• 10:52
  bruxism
• 10:53
  is
• 10:53
  the
• 10:53
  number
• 10:53
  one
• 10:53
  movement
• 10:54
  disorder
• 10:54
  linked
• 10:54
  to
• 10:55
  antidepressants.
• 10:56
  Higher
• 10:56
  rates
• 10:56
  than
• 10:57
  akasthesia,
• 10:57
  dystonia,
• 10:58
  parkinsonism,
• 10:59
  or
• 10:59
  tardive
• 10:59
  dyskinesia,
• 11:00
  which
• 11:01
  again,
• 11:01
  are
• 11:01
  more
• 11:01
  associated
• 11:02
  with
• 11:02
  antipsychotics,
• 11:03
  but
• 11:04
  nonetheless,
• 11:05
  it
• 11:05
  is
• 11:05
  certainly
• 11:06
  problematic.
• 11:07
  And
• 11:08
  so,
• 11:08
  yeah,
• 11:08
  I
• 11:08
  hope
• 11:09
  you
• 11:09
  guys
• 11:09
  really
• 11:10
  enjoyed
• 11:10
  this.
• 11:10
  Pearl
• 11:11
  drop.
• 11:11
  High
• 11:11
  yield,
• 11:12
  quick,
• 11:12
  fast,
• 11:13
  straight
• 11:13
  and
• 11:13
  dirty.
• 11:15
  Remember,
• 11:16
  if
• 11:16
  you
• 11:16
  want
• 11:17
  to
• 11:17
  understand
• 11:18
  your
• 11:18
  field
• 11:18
  in
• 11:19
  more
• 11:19
  depth,
• 11:19
  you
• 11:19
  want
• 11:19
  to
• 11:19
  understand
• 11:20
  the
• 11:20
  how
• 11:20
  and
• 11:20
  the
• 11:20
  why
• 11:21
  behind
• 11:21
  your
• 11:22
  clinical
• 11:22
  decision
• 11:22
  making.
• 11:23
  The
• 11:23
  best
• 11:23
  thing
• 11:23
  you
• 11:24
  can
• 11:24
  do
• 11:24
  is
• 11:25
  go
• 11:25
  over
• 11:25
  to
• 11:25
  our
• 11:25
  show
• 11:26
  notes
• 11:26
  and
• 11:26
  become
• 11:26
  a
• 11:27
  Patreon
• 11:27
  member.
• 11:29
  The
• 11:29
  knowing
• 11:29
  the
• 11:30
  how
• 11:30
  and
• 11:30
  why
• 11:31
  really
• 11:31
  separates
• 11:32
  you
• 11:33
  from
• 11:33
  a,
• 11:33
  from
• 11:34
  a
• 11:34
  good
• 11:34
  to
• 11:34
  a
• 11:34
  great
• 11:35
  clinician.
• 11:35
  And
• 11:35
  patients
• 11:36
  smell
• 11:37
  that
• 11:37
  a
• 11:37
  mile
• 11:37
  away,
• 11:38
  right?
• 11:38
  They
• 11:38
  trust
• 11:39
  you
• 11:39
  more.
• 11:39
  Your
• 11:40
  rapport
• 11:40
  deepens,
• 11:41
  your
• 11:42
  outcomes
• 11:42
  get
• 11:42
  better,
• 11:42
  your
• 11:43
  clinic
• 11:43
  runs
• 11:43
  smoother.
• 11:44
  And
• 11:44
  so
• 11:44
  we
• 11:45
  have
• 11:45
  a
• 11:45
  vast
• 11:45
  library
• 11:46
  of
• 11:46
  clinical
• 11:47
  resources.
• 11:47
  If
• 11:47
  you
• 11:47
  just
• 11:48
  go
• 11:48
  to
• 11:48
  our
• 11:48
  Patreon
• 11:49
  page
• 11:50
  via
• 11:50
  the
• 11:50
  show
• 11:50
  notes,
• 11:51
  click
• 11:51
  it,
• 11:51
  join
• 11:52
  it
• 11:52
  today.
• 11:53
  Bye
• 11:53
  bye.