Key highlights

• Why a TMJ surgeon stopped performing surgery: Urbanek explains what he learned after treating more than 2,000 surgical cases and seeing some patients return with recurring symptoms.
• Starting with the patient: He describes how conversations with patients influenced the development of his device and protocol.
• TMD and inflammation: Urbanek outlines his theory that joint damage and chronic inflammation play a central role in TMD.
• Symptoms beyond the jaw: The conversation covers headaches, neck and shoulder pain, tinnitus, dizziness, and arm and finger symptoms.
• The hygienist's opportunity: Urbanek argues that hygienists are in a strong position to recognize potential TMD symptoms during routine appointments.

Episode description

In this episode of A Tale of Two Hygienists, Jessica Atkinson and Dave Torres talk with Dr. Anthony Urbanek about his decades of experience treating temporomandibular disorders. After performing more than 2,000 TMJ surgeries, Urbanek describes why he stopped performing the procedures and began researching a nonsurgical approach to TMD.

Urbanek discusses the symptoms he associates with TMD, including jaw pain, headaches, neck and shoulder pain, tinnitus, dizziness, and arm or finger tingling. He also explains his view of inflammation and joint loading, describes the device and protocol he developed, and emphasizes the opportunity for dental hygienists to recognize potential TMD symptoms during routine patient care. His explanations and treatment claims reflect his perspective discussed during the episode.

Surgery, inflammation, and a different approach to TMD — 00:35

Dr. Anthony Urbanek: Surgery has some value, but I could not face a patient and look them in the eye and say, “This is a surgery that is best for you. I'm going to do this for you,” knowing that a third of the time they would be back within a year or two with the same symptoms.

This is a device and protocol. This isn't something you just stick in somebody's mouth and hope to see what happens. You've got to know a little bit about the nuance.

You have to know a little bit about anatomy and cell biology. If you're not getting the response you expect, you need to know why. Treating symptoms is nonsense. Just make the inflammation go away by resting the joint according to a protocol, just like the orthopedic surgeons do for tennis elbow.

Tennis elbow and TMD are the same disease, exact same disease, exact same pathophysiology.

Welcome to the episode and an introduction to Dr. Urbanek — 01:35

Dave Torres: And welcome back, listeners, to another episode of A Tale of Two Hygienists podcast. I'm Dave and I am here with Jessica. And Jessica, I have something exciting to tell you. So in this week specifically, it was told to me by not one, but two to three people that I know, with one of them being one of my co-workers. My neighbors, too. Shout out to Pedro Nakamura and shout out to Dr. Williams.

And I have four patients who told me this week that they are listening to our amazing episodes and that they're having a lot of fun. And that makes me really excited, slightly nervous that, you know, you get to hear me on your headphones on the way to the gym.

But I'm excited and I just want to thank all the listeners for our support. And I'm just so excited for today's guest because I am just at the edge of my seat learning a little bit more about what we're going to be talking about, which is TMD and obviously how that affects our TMJ. And so, just without further ado, let's talk about our guest.

Jessica Atkinson: We have an expert on TMD with us today. We are joined by Dr. Tony Urbanek and he is, I'm gonna coin it, you're like the godfather of TMD. That's what I'm gonna say.

And he has a dual degree in oral and maxillofacial surgery and his career has spanned more than five decades. So he knows what he's talking about.

He earned his DDS and MS in anatomy and cell biology from Indiana University and completed his medical degree, internship, and residency at Vanderbilt University. While at Vanderbilt, he also held a research fellowship with the National Institute of Dental and Craniofacial Research, studying facial growth anomalies through laser-induced intrauterine surgical models.

Watch out, rabbits. Dr. Urbanek's coming for you.

After decades of treating some of the most complex maxillofacial conditions and performing TMJ surgery for 36 years, Dr. Urbanek began questioning the traditional approach to temporomandibular disorders. That question led to approximately 15 years of research and ultimately to what he describes as a new paradigm for understanding and treating TMD, addressing the underlying inflammatory disease process rather than simply managing its symptoms.

Today, he is president and CEO of TMJ Services and works with a network of clinicians providing nonsurgical TMD treatment. But dentistry is not all Tony does.

He has founded charitable medical clinics in Haiti and Jamaica. He has owned an aviation fixed-base operation, served for 20 years as an aviation medical examiner, and become president of an organization representing 1,500 private pilot physicians. A private pilot himself for 54 years, he admits — this is one of my favorite parts of his bio — that experience has provided more than a few “hold my beer” moments along the way.

His greatest joy, however, is his family. His wife, Anne; three grown children; seven grandchildren; and one great-grandchild.

So, Dr. Urbanek, we are so excited to have you here. And maybe give a little bit of context about why I said that rabbits should fear you.

Dr. Anthony Urbanek: Well, that was a little of our pre-conference discussion, that my work on the facial growth and development was on the rabbit model. I used the rabbit as a model primarily because, number one, they're easy to work on, but they make a lot of baby rabbits. And I was doing intrauterine fetal surgery. And once you figure out how to do the surgery itself, you had plenty of little rabbit fetuses to work on and to do this particular kind of research.

Creating facial anomalies, facial problems induced by laser intrauterinely. So, yeah, I have to say that first, part of the research — I don't want to focus too much on this — but I had to learn to anesthetize these rabbits. And I have to admit, talking about the problem that the rabbits have is I did away with several rabbits just trying to figure out how to do the anesthesia for these little rabbits and keep them alive before I was able to actually proceed with the research itself.

But anyway, most of the rabbits lived and they were happy that they could participate in such interesting research.

Jessica Atkinson: Bless rabbits. Bless rabbits.

Why Dr. Urbanek stopped performing TMJ surgery — 06:48

Jessica Atkinson: And the word that caught me was the anomalies, that you did anomalies. One of the things I find as an anomaly in dental hygiene or dentistry in general is you have a patient come in and they say that they have TMJ. And I go, well, yeah, I also have TMJ.

And the anomaly is that it's not actually what they're describing to you as TMJ. They're really saying, “I have TMD. There's discomfort, there's a disorder, there's a dysbiosis happening with my TMJ.”

And you have done TMJ surgery for 36 years. So what made you stop and say, “There's got to be a better way to treat this?”

Dr. Anthony Urbanek: Jessica, that occurred very, very easily after 36 years of doing every type of TMJ surgery possible. I did everything from total joints to lysis and lavage. If there are oral surgeons listening, that'll be very meaningful to them. But those are different levels of surgery. Half of them through an arthroscope and half of them open joint surgery.

Open joint meaning you make an incision, go into the joint itself and do whatever kind of surgery you're going to do with that joint.

And then through an arthroscope, just like knee arthroscopic surgery or hip arthroscopic surgery, you use an arthroscope and do your surgery through instruments and watch your surgery on the television screen.

But the point is I did over 2,000 cases. And after evaluating my statistics, I found out that a third of my patients, no matter what kind of surgery I did for them, would be back within a year or two, sometimes six months, with these same symptoms.

Now, looking back through the retrospective scope, I found that two-thirds of them to this very day are doing well, but a third of them would be back. I have a file with some of my patients who come back after 20 years and I go, you know, the operated side's doing well, but now I'm having trouble on this side.

Surgery has some value, but I could not face a patient and look them in the eye and say, “This is a surgery that is best for you and I'm going to do this for you,” knowing that a third of the time they would be back within a year or two with the same symptoms. Couldn't do that.

I thought about that over a long weekend. I walked in my office on a Monday morning to my staff and I said, “Ladies, I decided we're not doing any more TMJ surgery.”

And that was a huge part of my practice. I was basically the TMJ surgeon in Nashville, Tennessee, on the private side other than Vanderbilt. And they were surprised, but I just, I couldn't see facing patients because when I did orthognathic surgery, microneural surgery, cleft palate, cleft lip surgery, I could predict what was going to happen. I would tell them exactly what to expect and it would turn out that way.

And that is the reason that I decided that I wasn't going to do any more surgery. And it was a defeat for a moment. I was defeated. And I remember the morning, it was a Monday morning, and I remember going back to my office and sitting at my desk before the patient started, very defeated.

And then I kind of had an idea. I said, “You know, you've got a lot of experience here in research. You got a lot of background. Why don't you take a look and see if you could figure this out?” And I did.

Listening to patients and developing the device — 10:29

Dr. Anthony Urbanek: I decided that I was going to do the research. And actually, the story that goes with that surprised me because if you're going to do research, where do you start out on a disease, any disease you want? Pick the disease. You start out with the patient, the person who has the disease. And I have plenty of those. I have plenty of TMJ patients, quote, “TMJ patients.”

Jessica Atkinson: Every single one of them.

Dr. Anthony Urbanek: Every single one of them.

So I told my staff, I said, “Don't tell the patients I won't see them. Just tell them come in for a consultation. I want to talk to them.”

And this is what I heard. I did a survey on about 20 patients and they'd come in. I say, “I just want to find out from you, what do you think about this? What can you tell me about the issue? What does it mean to you? What does your husband say about it? Give me the symptoms. What makes it better? What makes it worse?”

And I sit there and listen. Just listen for 15 minutes, 20 minutes, 40 minutes, 45 minutes.

After listening to at least 24 women, I heard something like this, something similar: “If I put my finger, my tongue, a pencil eraser, piece of cloth between my front teeth and gently bite down, it feels better.”

I had never heard that before.

I heard a lot of things from these ladies because it's, by the way, it's primarily females. I mean, you need to know that if anybody who treats TMD, you need to know it's 90% females.

Jessica Atkinson: Why?

Dr. Anthony Urbanek: It's in the literature. My value is that I know how to read literature and I have read it.

Jessica Atkinson: Reading is essential.

Dr. Anthony Urbanek: It's a female problem because estrogen exacerbates inflammation. That's kind of the end of the story here. But at that time, that's why you need to know it's a female problem. Estrogen exacerbates inflammation.

So I had the patients tell me if I put my finger, my tongue, a pencil eraser between my front teeth, it feels better.

So I heard that enough. I went in my lab and I made a little device of my own design that went between the front teeth that I figured that they could talk with, that they could wear 24-7, except when you eat. You can't eat with this thing in your mouth. But you can drink liquids, you can drink coffee.

And I had a lot of experience doing cleft lip and cleft palate work and a lot of experience making devices for clefts and trauma and orthognathic surgery. So I made this device.

I gave it to the first lady in line and I said, “Put this in your mouth and keep it in 24-7 except when you eat and come back in three weeks. I just want to see what happened.”

I didn't tell her she was an experiment, but I didn't feel unneeded. I wasn't going to hurt her with it. And she came back in three weeks.

I walked in the room and she looked up at me and this was a lady who had the typical, typical 20 years of headache, earache, jaw pain, neck pain.

The symptoms, by the way, are frequent and/or recurring headache, earache, jaw pain, neck pain, tinnitus, ringing in the ear, subjective hearing loss, which is that feeling of fullness in your ear, but we would call it subjective hearing loss because they go to the ENT doctors, get the workup and say, “I can't hear out of the ear.”

And the ENT doc says, “No, I'm telling you, there's nothing wrong with your ear.” And the patient says, “No, I know there is.”

That's subjective hearing loss: dizziness, vertigo, which are those three are the nonpainful symptoms, which the ENTs call Meniere's disease and don't have any solution for Meniere's disease.

And then upper back, shoulder pain, arm, hand, finger tingling and numbness, and various kinds of jaw locking. Those are the symptoms of TMD.

And this woman had most of those or at least half of those symptoms. And I walked in three weeks later, walked in the room. I said, “How you doing?”

And she looked at me and she says, “Doc, thanks. My pain's gone.”

It's just like, I took a step back. I literally remember it vividly. I took a step back and I go, “Really?”

And she looked at me like I wasn't expecting that, which I wasn't.

And that's where it started. And so I had a long line of these females and I brought them in one at a time and made a custom device similar to that. And within three weeks to two months, all of them came back significantly improved.

Not everybody came back in three weeks and said all their pain's gone. Didn't happen. But we now know what the numbers are after treating over 5,000 patients with, personally, 5,000 patients with this device and protocol.

It's not just a device, it's not a widget, it's a device and protocol. And I'll explain in a minute what I really discovered, but that started the ball rolling. That is what started the ball rolling.

From an observed effect to an inflammatory model — 15:17

Dr. Anthony Urbanek: So I did another 24 cases just like that. And the patients came in and at one point or another said, “Thanks, my pain's gone. My neck pain's gone. I can chew now,” whatever their response was.

And after about 24 cases, I realized I had no idea what the cause was. I had no idea what I was doing.

Jessica Atkinson: Like it works.

Dr. Anthony Urbanek: True, but it worked, right?

So I went back to the books. I mean, again, I went back to the books. I have this broad background knowledge, MD, DDS, cell biology, anatomy, two years with the NIH. And I went back to the books, and especially anatomy.

And this is what I discovered. It's all in the literature already. It has been in the literature for 70 years. And it is the following. And I'm gonna, because we have limited time here, I wanna just spell it out, and then fact-check it if you'd like. You can do that easily.

The orthopedic surgeons, if they had kept control of this joint, these joints, the temporomandibular joints, this problem would have been solved 70 years ago. That is my belief. That is my statement. Because the orthopedic surgeons knew all about what I'm about ready to tell you.

Jessica Atkinson: And the dental profession didn't listen or hear or want to hear.

Dr. Anthony Urbanek: I'm not sure which.

So the data has been known by the medical profession, orthopedics particularly, for a long time, decades, decades and decades. And here's what they know: inflammation in a joint, see—

Jessica Atkinson: We had selective hearing.

Dr. Anthony Urbanek: So the data has been known by the medical profession, orthopedics particularly, for a long time, decades, decades and decades. And here's what they know: inflammation in a joint.

How Urbanek describes the causes and progression of TMD — 17:03

Dr. Anthony Urbanek: All the dentists are taught in dental school. And maybe, Jessica, this is maybe what you teach your hygienist when you teach them. I don't know.

But the dentists, I can tell you this, every dental school in the country teaches that this joint is different. Unique, complicated, no less. Not true. That is why they never were able to figure it out.

This joint, the temporomandibular joint, works like every other joint in the body. And when you start out with that premise and fact, that is a fact, then it's easy to see what's going on.

All right, so here's what happens. When the temporomandibular joint gets damaged, the joint gets damaged for only three causes. Three categories damage the temporomandibular joint.

The one everybody focuses on and thinks it's the only one is bruxism, clenching and grinding. We could talk about that for almost an entire 30 minutes.

Jessica Atkinson: Day, year.

Dr. Anthony Urbanek: Clenching and grinding, bruxism, acute trauma.

The most common is motor vehicle accidents and especially whiplash injuries because when the neck snaps back, the mandible drops, snaps open and damages the internal tissue within the joint.

And then the third is functional malocclusion. Now, functional malocclusion, that would take, to explain it completely, that would take 20 minutes or 30 minutes.

But the bottom line is functional malocclusion is either where the teeth or the jaws or both are in such bad harmony that they overload the joint.

What all three of those circumstances create is overloading the joint. Bruxism, trauma. In Tennessee, it's for the guys, it's four-by-fours off the back of the pickup truck or bar fights. And then for the ladies, it's motor vehicle accidents and then functional malocclusions, which all of you see on a daily basis one way or another.

And they're very common, literally at least 10% to 15% of patients have significant functional malocclusions.

Those are the three things that damage a joint. When a joint becomes damaged, it creates inflammation.

What is inflammation? Inflammation is the body's response to repair, to heal. That is what inflammation is, wherever in the body it is.

When the inflammation does not heal, for whatever reason, you can talk about, you know, you get additional insults or the damage was so bad it's not going to heal well or you've displaced something.

But once the healing inflammation is there long enough, the cell types turn into what we call chronic inflammation. And chronic inflammation cells have a different biology to them. They have different cell fluids that they create that damage the joint.

So now you're off to the races. You have a damaged joint that has chronic inflammation.

And here is what has been in the literature for 70 years. Chronic inflammation will send autonomic nervous system signals, ANS, sympathetic portion. I know I'm getting a little deep with the big words here.

Jessica Atkinson: We got it. We got it. We know ANS. We know PNS. We got it.

Dr. Anthony Urbanek: Excellent.

So you have chronic inflammation, it sends an autonomic signal, sympathetic portion to the brain stem, doesn't go up into where we think, basically to where we have action and your mechanisms call in the brain stem and says, “I'm inflamed, I'm damaged, I'm inflamed.”

That's in the reticular system where all the nerves begin and they are all congregated in the same place in the very small brainstem.

The brainstem then takes this information and sends a signal back out, autonomic nervous system.

“I'm going to help you out. Don't move the joint. Just don't move it. Tighten up. Just become tight. We're going to help you out.”

And then they send signals to the muscles of mastication first.

And we know where those are.

And if you ignore your anatomy, Jessica, which I know you do because you taught it, right?

You have the muscles of mastication and the origin and insertion of these muscles.

They get tight for sure, but the pain is not coming from the muscles.

It's coming from where the muscles are inserted onto the bone.

Why there? Because the periosteum is where the nociceptors are. The pain receptors are in the periosteum of the bone.

So when you have these big muscles, the masseter, the temporalis, the internal and external pterygoid, the myohyoid, these muscles get tight, they pull on the bone and wherever they're attached to the bone, origin and/or insertion, is where it's going to hurt.

And this pain can move around from side to side, from muscle to muscle.

And sometimes patients will come in, they'll show you exactly where the anatomy is. I mean, the number of times people come in and it hurts right there every morning.

Dr. Anthony Urbanek: Well, Jessica, what is there right there?

Jessica Atkinson: Now you're telling me your insertion.

Dr. Anthony Urbanek: You're, yeah, you're talking to your temporalis muscle.

Jessica Atkinson: Yeah, the insertion point's right there.

Dr. Anthony Urbanek: Right there.

And they're telling you what this disease is all about almost. They don't know.

But anyway, so now, but if that holding, trying to hold the jaw still, which you can't, right? If you continue to brux, you got to eat a couple times a day, whatever you're doing, you're talking, you're on the cell phone.

You're moving your joint. You're not holding it still. It's not going to heal.

If it doesn't heal, these signals continue on into the brainstem.

The brain says, “Hey, I told you, hold the jaw still. Now what I want you to do is hold the whole head tight. Tighten up, man. Don't move.”

That is why neck pain is the second most common symptom of TMD.

Jessica Atkinson: True.

Dr. Anthony Urbanek: If you talk to anybody who treats TMD to any degree, they will tell you headache is #1, neck pain is #2.

And then if that is not enough to tighten up the jaws and then the head through the neck, then it sends out signals to tighten up the entire upper shoulder girdle.

And patients will complain constantly of upper back and shoulder pain and tightness.

The connection he describes between TMD and arm and finger symptoms — 23:19

Dr. Anthony Urbanek: And then the last symptom that I mentioned, which is not well known, but I'm not the only doctor who actually has found this out.

I did it independently because we had one of my patients come in years ago after I started treating it this way and say, “Thanks so much, my headache's gone and my neck pain's gone, but what about this tingling in my arm and my fingers because it went away too?”

I said, “Can you tell me how that is?”

And I went, “I have never heard of that before. I mean, I have no idea.”

About six months later, another woman comes in. It's pretty much the same story.

So I went back to the textbooks. I went back to Gray's Anatomy, actually, trying to figure out why that would be.

And how that happens is your strap muscles, the scalene muscles on the side of the neck, their little strap muscles, when they get the signal to get tight, through the strap muscles go the brachial plexus.

And the brachial plexus supplies the arm, hand, and fingers. And patients will complain when those strap muscles tighten up on the brachial plexus, arm, hand, but especially fingers, and especially these last two digits, the little finger and the one right next to it.

Not all the time, and it does vary, but I can tell you more often than not, patients who have that symptom — and not everybody has that symptom, it's not one of the primary symptoms — but they'll talk about those last little fingers are the ones that are numb.

Anyway, so that is the mechanism of what's going on.

The nonpainful symptoms and the middle ear — 24:51

Dr. Anthony Urbanek: And then there is the nonpainful, that's the painful symptoms.

The nonpainful symptoms, again, I had to go back to the book and I go, you know, I had the broad background.

So I pulled out the Gray's Anatomy and sure enough, when I lecture on this, I actually pull up the diagrams off of Gray's Anatomy.

There is a fissure, literally an opening. A fissure is a lengthy opening, okay?

A fissure called a petrotympanic fissure. It was identified in 1680 by an anatomist by the name of Johann Glasser in Switzerland.

1680. We've known about this fissure.

And this fissure allows inflammatory fluid to go from the glenoid fossa, from the glenoid fossa of the temporomandibular joint into the middle ear.

And when you get inflammatory fluid, I don't think you're gonna get cells going up there, but inflammatory fluid going through the petrotympanic, quote, Glasser fissure — it's also called the Glasser fissure — into the middle ear, it affects the hearing mechanism and the vestibular mechanism to cause what?

Tinnitus, which is the proper, not tinnitus, tinnitus, ringing in the ears, fullness in the ear, subjective hearing loss, and dizziness.

And how I know that — I know that as fact because we have had now after 5,000 cases that I personally treated, this doesn't count the other doctors in the United States who use this technology that I developed, the ringing of fullness and dizziness go away.

I mean, it's like it goes away.

Not all of these symptoms do not go away simultaneously. I'm the first to tell you that.

Painful symptoms come down pretty fast. Tinnitus, subjective hearing loss, and vertigo dizziness. Those are two separate. They're not identical, but they, for the patient's point of view, “I'm dizzy.”

They go away slower.

Sometimes it takes several months for those to calm down and tinnitus is almost the last symptom to go away.

We have found sometimes that can take six months, eight months, even a year sometimes.

And I got a lot of stories about that.

But that is the mechanism, both the painful and the nonpainful mechanism.

The device, protocol, and what he calls the Urbanek device — 27:22

Dr. Anthony Urbanek: And we have now doctors who are licensed because I discovered it.

I'm going, now I've got 50 cases, 100 cases, and I'm going, “Wow, this is amazing. I wonder if I could put a patent on this little device.”

And sure enough, it took two years to do that and a couple more years to get the FDA clearance so I could tell other doctors about it.

And now we have a company that makes these things and teaches other doctors how to use the protocol because, again, I think you heard me say this is a device and protocol.

This isn't something you just stick in somebody's mouth and hope to see what happens.

You got to know a little bit about the nuances. You have to know a little bit about anatomy, cell biology.

If you're not getting the response you expect, you need to know why, because that's, you know, and there are reasons.

I mean, we figured that out years ago.

You know, if you have a patient and you're not getting the right response that you're expecting, there are only a couple reasons that could be happening. And then you handle those and then they get the response.

So I see we're kind of running low on time.

I just want to say that, I had to, so we have this company and we teach other doctors to do it.

And we had to call it, I had to give up. I had to call it the Urbanek device and protocol because when I surveyed my patients and we had a lot of those—

This was 10 years ago.

We did a survey and the patients wanted to call the top two survey number responses “save my life device” and “miracle device.”

Jessica Atkinson: And isn't that synonymous with Urbanek? Isn't it, you know, save your life and miracle? Isn't that what your name means, Dr. Urbanek?

Dr. Anthony Urbanek: No.

It's just around in Middle Tennessee, of course. In Middle Tennessee, pretty much everyone knows about what we do here.

That's for sure.

A practical message for dental hygienists — 29:27

Dr. Anthony Urbanek: So if, and I do need to get this in two minutes. I really, I believe in you. This is the one thing I wanted to get across.

Hygiene, the hygienists in our country are the first people to see these patients and have the best opportunity to diagnose them.

It's easy to diagnose. This is not a complicated disease. Now you know the symptoms. You ask the patient, “Do you have any of these symptoms?”

Forty-five percent of patients will say yes. Forty-five percent of females have temporomandibular joint disorder.

And then you have symptoms and then you do confirm your diagnosis by walking beside or behind the patient, having them open widely, put your fingers in the glenoid fossa firmly, firmly.

Warn the patient, by the way, don't do it without telling them what's going to happen. And have them bite down quickly. Have them close quickly.

If the joints inflame, they will say, “Ouch,” or some of them scream. It hurts. If it hurts, the joint's inflamed.

Now you know what the proper diagnosis of TMD should be. It should be inflammation of the joint.

Doing Botox, and that would be a totally different thing to talk about, is nonsense.

Treating symptoms is nonsense.

Just make the inflammation go away by resting the joint according to a protocol, just like the orthopedic surgeons do for tennis elbow.

Tennis elbow and TMD are the same disease, exact same, exact same disease, exact same pathophysiology.

Elbow, brain, don't move the joint, your forearm hurts. That's what tennis elbow is.

Dave Torres: Perfect.

Well, I mean, that's super practical. I mean, I think anybody listening to this right now can put their fingers instead of their ear canals and just do that quick test and see if that's something that we are all suffering, including ourselves, right?

I mean, you mentioned numbness. How many hygienists have numbness in their hands, right?

It could be not just our posture, seeing our patients clinically, but it could also be the fact that we may have TMD as well.

And it starts with us.

Nothing like explaining to the patient that we also suffer from that as well, like sensitivity, right?

We all suffer from sensitivity from time to time and being able to kind of properly screen these things and help our patients out is what we're here about.

And I love episodes like this because we get to learn so much and we get to have a lot of practical takeaways that we can implement immediately.

Jessica Atkinson: Thank you, Dr. Urbanek.

Dr. Anthony Urbanek: Thank you, Jessica.

Dave Torres: Thank you, Dr. Urbanek.