Really, It’s the Opposite of What We’re Taught

DSP interview with Howard Hindin, DDS

If you’re a dentist, you are taught to focus on smaller and smaller parts of human anatomy. From a big-picture overview of physiology, training is intensified to the oral cavity, then to the tooth, then to parts of the tooth. If you’re going to take the Airway Pledge and become part of the mission to raise awareness and educate the public (and yourself!) about the airway, you turn all that around and think back to the whole person.

DSP presents someone who has been leading the profession in raising curiosity about the entire body for over 50 years – most recently with the Foundation for Airway Health, the American Academy of Physiological Medicine and Dentistry, and soon Collaboration College. Dr. Howard Hindin – Howie to everyone – practices outside of New York City and influences healthcare around the globe.

DSP: Howie, tell us how you got started in this unique kind of dental practice.

HH: I started out wanting to be a history professor, but my family convinced me to consider a real career – and try dental school. I enjoyed my early dental practice, doing surgery, TMD, and cosmetic dentistry. Early in my practice, I spent 4 days at a workshop to learn a practice to help my pain patients achieve a deeper, alpha state of relaxation, so I could become a better TMJ dentist – that was in 1972. I haven’t had a headache ever since, and I learned that we can be taught how to influence general health. Acupuncture training came next – that’s something I’ve used for my entire career. I’ve been part of working to ensure dentists and physicians can add innovative ways of therapy to their practice in an acceptable way without risking their license over it.

I studied nutrition because I wanted to help my patients control and reverse their diseases. I used to love to do periodontal surgery – really believed it helped my patients. After some training in nutrition, as an experiment, I treated the next 20 patients, half with surgery, half with nutritional counseling. While the surgery patients looked great right away, after six months, I couldn’t find the difference between the ones who took care of themselves after surgery and those who changed their nutritional habits. This isn’t a scientific study, of course, but being curious about what could be done helped me realize that what I’d been taught had its limits.

I believe the body wants to, and can, heal itself. If we can learn to recognize the obstacles to a higher level of function, then we can remove them. There are always ways to improve our general health. Early on, I studied with Mariano Rocabado, the famous physical therapist from Chile. He would hold a baby upside down to see if the child turned its head one way or another. He believed that would indicate bad posture habits were forming and he would advise the parents on how to reset them. This story, and so many others, taught me to be constantly curious, to recognize and use the clues the body gives me to advise my patients on how to approach their health issues.

From my earliest days, I set out to make time to learn. I practiced three 12-hour days in clinics, so I could spend time in mentors’ offices – Harold Gelb, Brendan Stack, and others stoked my curiosity with their approaches to health. I’m thankful I never fell into the thinking that only one ‘camp’ was right, as so many did, and learned something from many dentists, physicians, acupuncture practitioners, and others along the way. I guess I was just too curious about everything to limit myself to one topic.

DSP: How would you advise today’s curious dentist to learn more, to follow a path like yours?

HH: First off, I don’t think there is a one path. Look for the crossroads, detours, and scenic side roads. If you do things that are interesting, more choices will present themselves, and you can build your skills by being open and curious about what comes your way. I’ve seen too many dentists align themselves with one guru or group or specialty, becoming comfortable and complacent, and make changing the way they think even more difficult. If you are a curious practitioner, there is always an “AHA!” moment that presents an opportunity to expand if you allow yourself to see it. Proper communication is a key, though. No one wants to feel like an idiot – and too often, a lack of training creates a defensive posture. I think I’m pretty good at getting people to talk with one another; so, when I’ve encountered a dentist or a physician who has less training in airway health, I try to be careful how I talk about it to keep the conversation going. It is less important to impress someone with what I know than to find a way to open a clear path to learning.

One periodontist who was cotreating a patient warned me off expanding the arches. The patient had OSA and persistent periodontal disease, even with pretty good home care. I wanted to replace the oral device they were using with expansion, but the periodontist couldn’t see the connection between inflammation and OSA. The automatic, trained response was orthodontics with periodontitis is dangerous. However, if in fact OSA was a major contributor to the inflammation, nothing was going to solve it unless breathing was improved.

DSP: Out-of-the-norm practices sometimes present risks to dentists. Some are getting in trouble for stepping up to help patients with medical problems.

HH: Yes, when I started using acupuncture, nutrition, and things like posture evaluation, the FDA and state regulatory boards were paying attention to these things. I looked around my busy restorative practice, thought about my two little children, and kept things quiet for a while, not willing to risk all that. But I stayed curious. Some of us formed a group, called the Foundation for Advancement of Innovative Medicine (FAIM) to advocate for patient and doctor rights to practice complementary medicine. We were getting practitioner, patient, and corporate support and doing a lot of good education. One of my proud achievements is we helped get a bill passed in the New York legislature protecting the right of licensed health-care providers to practice complementary medicine (outside the ‘norm’ at that time). The bill provided they couldn’t be prosecuted just because their practice was different. This was the first health-care bill ever passed in New York over the objection of the NY State Medical Society. I became President of FAIM – think I must have missed a meeting and got elected – and that’s what led me to always think about what else we can be doing to help our patients.

There is so much more we can and should be doing for our patients. I can usually get people with different perspectives to sit together and have a conversation, to work together on mutual goals. One big problem we all have is that narrow focus – as I said about dentists getting interested in smaller and smaller parts of the oral cavity. I like to turn the funnel around and expand into other areas. We as dentists need to expand our view and find colleagues in other practice disciplines to collaborate with and cotreat. With these colleagues, once we recognize all we have in common, like airway, we can find ways to provide more complete care for more optimal results. Together we turn our awareness from tiny parts to how the body works as a whole, seeing clues we’ve never seen before.

DSP: You have been an advocate for dentists to work with physical therapists.

HH: Breathing is a whole-body function. All practitioners influence the airway for good or bad, whether they know it not. We’ve been watching our patients stand and walk in the clinic for a long time and noticed that changing jaw position and changing breathing makes a difference. As we’ve learned more about breathing, diaphragm function, and how it interacts with posture, what has become obvious is the way people stand and walk shows the compromises they’ve had to make over many years because they don’t breathe well. As breathing improves, they don’t have to work to compensate as much; those long-established physical compromises are best treated by physical therapy. At the same time, people seeking PT who don’t breathe well may not respond to treatment  – just like the periodontist’s patient I talked about. When I found a few physical therapists through my studies with Rocabado, Ron Hruska, Gregg Johnson, and others, I not only had answers I never had before, but partners in care. There is now a rapidly growing group of physical therapists in the AAPMD

DSP: What’s next?

HH: Every dentist, actually every health-care practitioner, should take the Airway Pledge: go to the Foundation for Airway Health website, AirwayHealth.org, and follow the prompts. When we all choose to ask our patients about how they breathe, we’ll be moving them in the direction of health.  In case anyone needs an incentive, my web managers told me over 1,000 people a month are looking to connect with an airway practitioner through our website. Taking the Airway Pledge, which costs nothing, is the way to get on the list.

A long-held vision of mine is Collaboration College. Today, if health-care providers want to learn about airway, they must go here and there to find information. I want there to be one place they can get everything they need. Clinical, scientific, communications, different specialties, even finance courses will be available to help every provider find answers to their clinic needs. It’s coming soon from the American Academy of Physiological Medicine and Dentistry, aapmd.org.