Episode #336: How the Face is Supposed to Work, with Dr. Michael Gunson

Faces have multiple functions. It needs to breathe, eat, and communicate. But while a face may excel at these tasks, it may not be aesthetically pleasing — and vice versa. And to talk about how to achieve a functional and aesthetic result with treatment, Kirk Behrendt brings in Dr. Michael Gunson from Spear Education to teach you how the face works and how to redefine normal. For the best practices on treating the face for form and function, listen to Episode 336 of The Best Practices Show!

Main Takeaways:

• The face has three key functions: to breathe, eat, and communicate.
• Understand why something looks good in a particular location.
• “Normal” is just the average of what has ever been observed.
• Using standardized normals won't always make a face aesthetic.
• Understanding why something looks good will help you adjust for people who are not “normal.”
• Connect with patients. Help them understand the problem, and they will accept treatment.

Quotes:

• “My partner was at the forefront of figuring out how to move the teeth and jaws in a way that's aesthetic for the face. Because prior to him, for the most part, people were just going by cephalometric normals or, ‘Let's just put the teeth together, and that'll make a good face.’ And that was not true. So, he devised a way of measuring and treating the face aesthetically. But as I did that, I discovered you don't always hit the bullseye going by these standardized “normals.” And what I started to discover is that “normal” is a bad word. None of us should be trying to make anything normal. Normal is just the average of what has ever been observed.” (07:17—08:14)
• “My partner, Dr. Arnett, says, ‘Put the chin here. This is the location where the chin belongs.’ So, I started asking questions like, ‘Well, why? Why does the chin belong there? Why does that look good?’ Because if I understand the why behind it, then I can make adjustments for people who are “not normal” or not underneath the bell curve. So, I started asking all these “why” questions.” (09:59—10:26)
• “There are some functional keys to the face. In other words, the face has a job to do, and that job is to do three main things: the face needs to eat, it needs to communicate, and it needs to breathe. And what I discovered looking at all kinds of data, all kinds of articles, is that the brain is in charge, and the brain will override just about any aspect of the face in order to accomplish those three goals. So, does the brain care that the teeth wear down when somebody chews or talks? No. The brain only cares that we eat and that we communicate. Does the brain care that posture can be deformed in the neck and hurt if growth is incorrect? No, the brain doesn't care if the neck hurts. The brain’s actually responsible for the neck hurting as the patient cocks their head forward, has bad posture, in order to breathe.” (10:32—11:46)
• “In me speaking with my patients and having a connection with my patients, I felt like I was not connecting with them based on, ‘Oh, let me just explain to you that your jaw is in the wrong place, and we need to put it in the right place.’ And the patient’s like, ‘Okay?’ So, the patient has to believe me, at that point. That's far different than sitting with a patient and listening to them, ‘Well, what is the problem?’ ‘Well, my neck hurts. My jaw hurts here. My mom’s always yelling at me to stand up straight. I drool.’ It’s like, ‘Yeah. I'm sorry you're going through that. Do you want to know why you're doing those things?’” (13:03—13:52)
• “I'm connecting with the patient’s story. This is their life story, and I'm connecting with their life story, and they're feeling me connect with that. They're feeling me understand that life story so that now we’re on this same level; we’ve joined stories. So, now, the question comes up, ‘Well, what are we going to do about it?’ Well, they know that I understand them now, and they understand me. And so, when treatment planning comes into the picture, a couple things have already been established. One is trust. And not just trust but, really, empathy. Being able to tell somebody, ‘This is why you're experiencing what you're feeling,’ there's a certain amount of empathy. And everybody wants that. Everybody wants to feel heard, to feel understood.” (14:09—15:08)
• “When you can connect with a patient, it’s one of the best feelings. And then, on the other side, actually coming through and providing the relief [for] the migraine, providing the breathing that they’ve never had, and the better posture, ‘It’s so easy to chew,’ now their lips are together, a lot of satisfaction, a lot of emotion is attached to those kinds of results.” (16:11—16:35)
• “Without slamming anybody in particular, as a general rule, I find physicians are generally abdicating certain parts of their role. For example, I don't think I've ever met a physician that enjoys looking in somebody’s mouth, let alone diagnostically looking in somebody’s mouth. So, even the sleep physicians, many of them are not open to the relationship of the teeth and the bones and how it affects the airway. It’s absolutely ridiculous. Absolutely ridiculous to think that the airway is not affected by the teeth and the bones where the airway itself is defined by the attachments of the orbicularis oris, the buccinator muscles, the buccinators at the raphe connecting to the pharyngeal constrictors. And it’s like, yes, the airway is literally defined by the attachments of muscles to the teeth and the bones.” (17:44—18:53)
• “There's a quote from Gregory Bateson, and it’s one that altered my practice completely. And it says, ‘The pathology is not in the thing, it’s in the relationship between the things.’ So, it’s simple. You look at a cavity. Is that the pathology? No. A carious lesion is not the pathology. And if you're going to be successful in providing somebody health, then you'd better treat the system. Otherwise, there's going to be more cavities. Because you drill and fill, sure, you’ve stopped the pathological process. But that's just a manifestation of dysfunction in an entire system.” (23:16—24:04)
• “Where are the lips supposed to be? Where is the chin supposed to be, and how do the teeth influence that? So, I tell dentists, ‘You can affect lip projection in your patients in ways that you've not considered. And if you do it, patients will turn around and say, ‘What did you do to my lips? I love my lips now.’ And because you have worked within the system and you've worked to help the system accomplish its goals, the real result is a functional result, but also an aesthetic result.” (24:09—24:50)
• “Can a patient have an aesthetic appearance and still have a malocclusion? And the answer is, yes, if the face is able to perform its function. So, a patient who is a Class II high-angle, the tendency is for the anterior vertical to be too long. And so, the patient suffers from an inability to close their lips. We call it lip incompetence, an interlabial gap. So, what happens is, throughout the day, the patient is making efforts to close their mouth. And so, those efforts to close the mouth make for thin lips, make for lines in the lips. It causes the mentalis muscle to bulge and to project, so they get kind of a witch’s chin. And then, it just doesn't look good to have somebody spend the day with their mouth slammed together. So, here, you have a Class II high-angle where the inability to close the mouth is affecting their aesthetic, their function, their airway.” (26:50—28:06)
• “When you look at a magazine like Vogue or Bazaar, or any of these fashion mags, and you look at the models that appear in them, the most common face is the Class II deep bite. And that is because when the face is shorter in the front with the tooth relationship being Class II, that lower jaw rotates up and the lips actually come together and push forward in the face. So, what you end up with is, you end up with a chin that's further forward because of the rotation and you end up with lips that are smashed together. So, strong chin, protruding lips. That's definitely what they want to see on the covers of their magazines. They don't want to see a flat chin as a result of mentalis strain. They don't want to see people with thin lips on the covers, as a result of a Class II high-angle.” (28:25—29:29)
• “It’s all about communication. Just as we spoke of about communication with the patient and establishing my story and the patient’s story, that same interpersonal relationship needs to occur with our colleagues. We need to understand where they’re coming from, so we have to have listening ears. But at the same time, we have to work with people that are willing to listen to our story as well. I think that's the beginning.” (31:53—32:25)
• “This is a Bateson idea as well. We cannot make sense of the world unless there's a difference in it to be appreciated. It’s very simple; light, dark. You can't appreciate dark unless you have some kind of comparison. Our eyes are meant to evaluate difference. Our sense of touch is about difference. So, we have to have difference in order to perceive. So, if the motive of any individual is to simply retract into their world and do what they do, there is no difference, so there is no growth. There is no ability to perceive or observe correctly. Listening is just part of that. It’s just part of the observation process.” (36:20—37:14)

Snippets:

• Dr. Gunson’s background. (02:49—06:13)
• How the face is supposed to work. (06:59—11:59)
• The importance of connecting with patients. (12:41—16:35)
• Dentists are more important than ever for people’s quality of life. (17:23—22:37)
• Learn to ask better questions. (22:56—25:50)
• How dental classifications and aesthetics come together. (26:10—31:19)
• It’s all about communication. (31:52—35:09)
• Listening is difficult but rewarding. (35:47—40:28)
• Dr. Gunson and Dr. Rebecca Bockow’s course, November 11–13. (40:57—43:44)
• Focus on being a better clinician. (44:59—50:03)

Reach Out to Dr. Gunson:

Dr. Gunson’s Instagram: @arnettgunson https://www.instagram.com/arnettgunson/

Dr. Gunson’s Facebook: https://www.facebook.com/ArnettGunson

Register for Dr. Gunson and Dr. Rebecca Bockow’s course (November 11 – 13, 2021): https://www.arnettgunson.com/arnett-gunson-products/healthy-growth-healthy-faces

Dr. Michael Gunson Bio:

Dr. Michael J. Gunson graduated from UCLA Dental School and received his Medical Degree and Specialty Certificate in Oral and Maxillofacial Surgery from UCLA. Upon completion of his training, Dr. Gunson partnered with Dr. G. William Arnett at the Center for Corrective Jaw Surgery in Santa Barbara, California. The surgical practice is limited to facial aesthetics and reconstruction.

Dr. Gunson examines and treats thousands of patients with aesthetic, functional, and sleep conditions. Dr. Gunson’s treatment process enhances his orthognathic and aesthetic surgical techniques, which provides patients with improved health and satisfaction.

Dr. Gunson lectures throughout the world and publishes his research on orthognathic surgery, facial aesthetics, obstructive sleep apnea, and the treatment of TMJ arthritis and condylar resorption. He enjoys sharing this information with colleagues through publications and lectures.