COURSE PREPARATION MATERIALS

Advanced Neuromuscular Team 1

LVI Global 1401 Hillshire Drive, Ste 200 Las Vegas, NV 89134 www.lviglobal.com 888.584.3237

Please note travel expenses are not included in your tuition. Visit the LVI Global website for the most up to date travel information.

LVI Global | [email protected] | 702.341.8510 fax

Each attendee must bring the following:

 Laptop with PowerPoint – remember to bring the power cord

 Cameras (dSLR & point-n-shoot) – don’t forget batteries and charger

 Memory card for cameras and Card reader

 USB drive

 Completed Health History

 Dental Charting of existing & needed

 Perio Charting

 Upper and Lower models of your own mouth – not mounted

 PVS Impressions with HIP of your own mouth (see attached photos)

 Full mouth X-ray series (print out and digital copy needed)

LVI Global | [email protected] | 702.341.8510 fax

Hamular Notch

LVI Global | [email protected] | 702.341.8510 fax

Please note accurate gingival margins on all upper and lower central incisors. We need this degree of accuracy for correctly measuring the Shimbashi measurements.

Caliper

Please note the notch areas are smooth and without distortions.

Hamular Notches Hamular Notches Marked

LVI Global | [email protected] | 702.341.8510 fax

LVI Red Rock Casino, Resort and Spa

Suncoast Hotel and Casino McCarran Airport JW Marriott Las Vegas Resort Spa

Click on the links below to view and print maps and directions to the specified locations.

McCarran Airport to LVI McCarran Airport to JW Marriott Resort and Spa

McCarran Airport to Suncoast Hotel and Casino McCarran Airport to Red Rock Casino, Resort and Spa

JW Marriott Resort and Spa to LVI Suncoast Hotel and Casino to LVI Red Rock Casino, Resort and Spa to LVI

LVI Global | [email protected] | 702.341.8510 fax

What is the weather like in Las Vegas?

In the winter months temperatures range from 15-60. In spring the weather is nice with highs between 70-80. Summer months are hot, highs up to 110, with nice warm summer nights. In the fall it cools down with temperatures back around 70-80 degrees.

What should I wear when I come to LVI?

Business casual. We tend to keep the building cold so you might want to bring a light sweater.

Is food served at LVI?

A continental breakfast is served at 7:00 each morning and lunch is provided each afternoon. Snacks are also available throughout the day.

How far is the Las Vegas Strip from LVI?

Approximately 12 miles. It could take up to 30 minutes with traffic.

Do you provide transportation to LVI?

LVI provides transportation only from the J.W. Marriott and The Red Rock Hotels. Check with the Bell Stand for pick up times on course days.

Where do I check-in when I first arrive at LVI?

For every course you attend at LVI, you must check-in on the first day in the Hillwood Building (the main building). However breakfast will be served in the Bistro located in the Hillshire Building (the new building).

LVI Global | [email protected] | 702.341.8510 fax

Registration fees are non-refundable and must be exercised within two years. LVI Global, LLC (“LVI”) reserves the right to cancel courses 45 days prior to the scheduled date of a course or activity. Should LVI cancel a course or activity, LVI will apply the full value of any deposits and fees related to said course or activity to future LVI course or activities. Should LVI cancel a course or activity, you may also have the option of having the deposits returned to you. Fees remain non-refundable but, may be reapplied to another course or activity. LVI will not be responsible for any other fees, costs or consequential damages associated with canceling this LVI course or activity with the exception of non-refundable transportation or accommodation fees booked through LVI Travel. For courses requiring a live-patient, the treating Doctor must bring a patient of record. During courses conducted at LVI, I understand that photographs or video may be taken of me for educational and marketing purposes. I hold harmless LVI for any liability resulting from this production. I waive any right to inspect the finished production as well as advertising materials in conjunction with these photographs. I understand that I may receive marketing materials as a result of my attendance. In addition, by my signature on this form, I authorize LVI or its partners to contact me via mail, facsimile or email.

Change/Cancellation/Postponement Policy:

- A change, cancellation or postponement of course date is not complete without your required signature and date.

The following do not apply if moving from TBD status to date selection

- If change, cancellation, or postponement is received 60-90 days prior to registered course, 25% of the course fee will be forfeited. - If change, cancellation, or postponement is received within 60 days, 50% of the course fee will be forfeited. - If change, cancellation, or postponement is received less than 30 days prior to your registered class, 100% of the course fee will be forfeited.

LVI Global | [email protected] | 702.341.8510 fax

How many CE hours can I expect to receive from this course?

After completing this program, you will receive a CE form of the appropriate AGD approved continuing education credit hours. These credits represent the lecture and participation portion of the course.

When will I receive my CE credits?

Your CE form will be presented along with your attendance medallion and/or letter. Please keep a copy of this form in your office records.

Does LVI submit my CE credits for me?

We will submit your CE credits to the AGD if you provide us with your AGD number. It is your responsibility to keep the CE form indicating your credits on file in your office and, if necessary submit your CE hours to the appropriate organization(s) (i.e.: your state/territory, etc.).

What happens if I lose my CE letter?

Once you receive your CE form, hold on to your originals and send copies when submitting your organizations. If your original letters are misplaced, LVI must charge a $30.00, per course, processing fee for necessary research. Replacement CE letters can take up to 3 weeks to receive.

Educational Objectives:

The educational objectives for this course are for the participants to be able to:

Discuss why physiologic balance is so important in treatment planning

Screen for airway issues

Gather data efficiently for a comprehensive diagnosis

Prepare a presentation of the data to help the patient to assess their own situation

Help the patient to appreciate the importance of and their bite

LVI Global | [email protected] | 702.341.8510 fax

HEALTH HISTORY

Name: ______DOB: ______Age: ______Sex: ______Height: ______Weight: ______

Medical History Y N Abnormal Bleeding Y N Hay Fever Y N Tuberculosis Y N Alcohol Abuse Y N Heart Attack Y N Ulcers Y N Anemia Y N Heart Surgery Y N Venereal Disease Y N Angina Pectoris Y N Hemophilia Y N Yellow Jaundice Y N Arthritis Y N Hepatitis A Y N Do you Smoke/use tobacco Y N Artificial Bones Y N Hepatitis B If you are Female Y N Artificial Heart Valves Y N High Blood Pressure Y N Are you on birth control? Y N Asthma Y N HIV&AIDS Y N Are you pregnant? Y N Blood Transfusion Y N Kidney Problems Y N Are you nursing? Y N Cancer Y N Liver Disease If yes # of weeks: Y N Chemotherapy Y N Low Blood Pressure Allergies Y N Colitis Y N Mitral Valve Prolapse Y N Aspirin Y N Congenital Heart Defect Y N Pace Maker Y N Codeine Y N Cosmetic Surgery Y N Pneumocystis Y N Dental Anesthetics Y N Diabetes Y N Psychiatric Problems Y N Erythromycin Y N Difficulty Breathing Y N Radiation Therapy Y N Jewelry Y N Drug Abuse Y N Rheumatic Fever Y N Latex Y N Emphysema Y N Seizures Y N Metals Y N Epilepsy Y N Y N Penicillin Y N Fainting Spells Y N Sickles Cell Disease Y N Seasonal Y N Fever Blisters Y N Sinus Problems Y N Tetracycline Y N Frequent Headaches Y N Stroke Y N Other Y N Glaucoma Y N Thyroid Problem ______Are you currently taking any medications (including aspirin)? If yes, please list: ______

Eppworth Sleepiness Scale How likely are you to doze off or fall asleep in contrast to feeling just tired? This refers to your usual way of life. Use the following scale to choose the most appropriate number for each situation. Have your partner give you a score as well. Partner You Situation Scale: ______Chance of dozing 0 = Would never doze ______Sitting and reading 1 = Slight chance of dozing ______Watching TV 2 = Moderate chance of dozing ______Sitting/inactive in a public place 3 = High chance of dozing ______As a passenger in a car for an hour without a break ______Lying down to rest in the PM when circumstances permit Score: ______Sitting, talking to someone quietly after a lunch no alcohol 0-10 Normal range ______In a car, while stopped for a few minutes in the traffic 10-12 Borderline ______TOTAL 12-24 Abnormal

HEALTH HISTORY

Dental History Y N Teeth sensitive to (circle): Hot or Cold? Sweets? Biting or Chewing? Y N Notice any mouth odors or bad tastes? Y N Cold sores, blisters, or oral lesions? Y N bleed or hurt? Y N Loose teeth or change in your bite? Y N Food caught in between your teeth? If yes, where? Y N Clench/grind your teeth while awake or asleep? Y N Bite your /cheeks regularly? Y N Mouth breathe while awake or asleep? Y N Have tired jaws, especially in the morning? Y N Have you ever had (circle): Orthodontic treatment? Oral Surgery? Periodontal treatment? Y N Have you ever had: Your teeth ground or the bite adjusted? Y N Worn a bite plate/mouth guard? Y N A serious injury to the mouth or head? If so, Please describe. ______Y N Have you experienced: Clicking or popping of the jaw? Y N Do you have pain (joint, ear, side of face)? Y N Difficulty in opening or closing the mouth? Y N Difficulty in chewing on either side of the mouth? Y N Headaches, neck aches, or shoulder aches? Y N Sore muscles (neck, shoulders)? Y N Would you like to keep all your teeth all of your life? Y N Do you like your smile? Y N Do you like how your back teeth look? Y N Do you require antibiotics prior to dental treatment? Y N Do you feel nervous about having dental treatment? If so, what is your biggest concern? ______Y N Have you ever had an upsetting dental experience? If so, Please describe. ______Y N Is there anything else about having dental treatment you would like us to know? ______

Symptom Self Report (Check all that apply) ____ Headaches ____ Tender, Sensitive Teeth ____ TMJ Pain ____ Difficulty Chewing ____ TMJ Noise ____ Cervical Pain ____ Limited Opening ____ Postural Problems ____ Ear Congestion ____ Fingertip Paresthesia ____ Vertigo / Dizziness ____ Thermal Sensitivity (Hot / Cold) ____ Dysphagia (difficulty swallowing) ____ Trigeminal Neuralgia ____ Loose Teeth ____ Fibromyalgia ____ Clenching / Grinding ____ Bell’s Palsy ____ Facial Pain ____ Nervousness / Insomnia Please describe your main concern:______CLINICAL EXAMINATION FORM

Name: ______DOB: ______Exam Date: ______

Anterior Golden Vertical Central tooth # ______Central Width ______mm Central Length ______mm LVI Golden vertical ______mm U/L Existing vertical ______mm from # ____ to ____

Muscle Palpation (0-3 Scale) Temporalis Anterior ____ R L ____ Temporalis Posterior ____ R L ____ Masseter ____ R L ____ Digastric ____ R L ____ Cervical Group ____ R L ____ Occipital Region ____ R L ____ Sternocleidomastoid ____ R L ____ Scalenus Group ____ R L ____ Trapezius Superior ____ R L ____ Trapezius Inferior ____ R L ____ Lateral Pterygoid ____ R L ____ Medial Pterygoid ____ R L ____

TMJ Evaluation (0-3 Scale) Clicking / Popping ____ R L ____ Crepitation ____ R L ____ Tender on Palpation ____ R L ____ Tender on Opening ____ R L ____ Tender on Closing ____ R L ____

Signs Evaluation EXTRA-ORAL ____ Facial Asymmetry ____ Short Lower Third of Face ____ Chelitis ____ Abnormal Posture ____ Deep Mentalis Crease ____ Dished-out or Flat Labial Profile ____ Facial Edema ____ Mandibular Torticollis ____ Cervical Torticollis ____ Speech Abnormalities ____ Elongated Lower third of face ____ Forward Head Posture ____ Shoulders Unlevel ____ Eyes Unlevel INTRA-ORAL ____ Crowded Lower Anteriors ____ Lower Anterior Wear ____ Flared Upper Anteriors ____ Anterior Open Bite ____ Chipped Anteriors ____ Lingual Tipped Mx Ant ____ Lateral Tongue Thrust ____ Biscuspid Dropoff ____ Lingual Tipped Md Ant ____ Anterior Tongue Thrust ____ Narrow: Mx or Md ____ Lingual Tipped Md Post ____ Scalloped Tongue ____ Torus: Mx or Md ____ High Palatal Vault ____ Tooth Mobility ____ Wear Facets ____ Abfraction Lesions ____ Locked Upper Buccals ____ Fractured Cusps ____ Missing Posterior Teeth ____ Open Interprox Contacts ____ Gingival Hypertrophy ____ Name: ______DOB: ______Exam Date: ______

Existing Restorations Recommended Tooth No. Present Condition Diagnosis US (International) Treatment 1 (18) 2 (17) 3 (16) 4 (15) 5 (14) 6 (13) 7 (12) 8 (11) 9 (21) 10 (22) 11 (23) 12 (24) 13 (25) 14 (26) 15 (27) 16 (28) 17 (38) 18 (37) 19 (36) 20 (35) 21 (34) 22 (33) 23 (32) 24 (31) 25 (41) 26 (42) 27 (43) 28 (44) 29 (45) 30 (46) 31 (47) 32 (48)

Perio Charting Facial Tooth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 US(Inter.) (18) (17) (16) (15) (14) (13) (12) (11) (21) (22) (23) (24) (25) (26) (27) (28) Lingual Lingual Tooth 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 US(Inter.) (48) (47) (46) (45) (44) (43) (42) (41) (31) (32) (33) (34) (35) (36) (37) (38) Facial