Dr. Mathew Ramzy, initially a qualified Pharmacist, became a Doctor of Dental Medicine after experiencing changes within the Pharmaceutical industry that didn't line up with his values. Dr. Ramzy shares not only his experiences within Dentistry, but delves into the pathologies and neurologies of dental medicine. An intelligent individual, this episode will interest A LOT of the other practitioners out there!
Dr. Mathew Ramzy, initially a qualified Pharmacist, became a Doctor of Dental Medicine after experiencing changes within the Pharmaceutical industry that didn't line up with his values. Dr. Ramzy shares not only his experiences within Dentistry, but delves into the pathologies and neurologies of dental medicine. An intelligent individual, this episode will interest A LOT of the other practitioners out there!
Welcome to the Balance Experience. I think today we have a very special guest. It is our very first VIP episode of the balance experience. Jac, welcome.
Jac Simmonds :Thank you, Nicko. Welcome.
Nick Papastamatis :Today we have a very special guest. His name is Dr. Mathew Ramzy.
Dr. Mathew Ramzy :Hi guys. Pleasure to be here. Thank you for having me.
Nick Papastamatis :You're very welcome.
Jac Simmonds :Good to have you, Mat. So yeah, this is our first VIP which is pretty cool. So basically this, this episode is going to be focused on specialists. So getting people who was specialists in their that field in, and learning a little bit about that and, you know, obviously, relating it back to some physio stuff and just learning I guess, what they do and how they do it. So good to have you here Mat.
Dr. Mathew Ramzy :Sounds fun. Thanks for having me. Looking forward to the program.
Nick Papastamatis :Yeah, well, um, I like how you said look forward to the program. There isn't one. Yeah, no, there is. There is no there is there is.
Dr. Mathew Ramzy :First time I've been involved in something like this. I don't know what I'm stepping into.
Nick Papastamatis :Yeah, right. Well there is a huge audience here.
Dr. Mathew Ramzy :Awesome.
Nick Papastamatis :Yeah, probably that one that's listening. But I think what we should do is maybe start off with an introduction.
Dr. Mathew Ramzy :Yeah, definitely.
Nick Papastamatis :Um, I know that sometimes interactions can seem a bit cheesy, but I mean, if without going too far into it, I think what might be helpful is to give us like some idea as to like what you do, and like, and, and essentially how you do it.
Dr. Mathew Ramzy :Yeah, sure. Well, yeah, as you've already pointed out, my name is Mathew and I am a I'm actually a dual qualified. So I've I've trained in pharmacy and I currently practice as a dentist, obviously, trained as well. So I got into the pharmacy industry. And I worked for a couple of years and basically figured out through a number of reasons it really wasn't for me, it's not really where I wanted to steer the course of my life, although it's a obviously a very critical, highly valued profession. There's just a few changes, you know, especially at like a government level that I wasn't really interested in and...
Nick Papastamatis :That's interesting. Can we touch on that later.
Dr. Mathew Ramzy :Yeah, for sure.
Nick Papastamatis :Okay.
Dr. Mathew Ramzy :So after working for about two years, and you know, complete all the requirements for registration, everything. I decided to basically pursue a career in dentistry. A few reasons for that, but I think to summarize, some of the biggest things were, that I found it to be a really good combination of, you know, science/medicine, art and engineering as well sort of all three.
Nick Papastamatis :Thats a really cool combo. Yeah.
Dr. Mathew Ramzy :Yeah. And and obviously you get to work with people and it was pretty much anybody with with teeth and even without teeth. And yeah, definitely something you can contribute to society. And I think obviously it's, you know, a whole separate topic of discussion, but it has its its pros. And its cons. It's a it's a testing profession. But now I think it's safe to say that I'm lucky that I really enjoy what I do. Yeah. Is that a good intro?
Nick Papastamatis :That is that's heaps, so awesome.
Jac Simmonds :How long have you been practicing as a dentist for then Mat?
Dr. Mathew Ramzy :So going on about four years now. Yeah. After a lengthy period I'm studying at Sydney Uni.
Jac Simmonds :Yep.
Nick Papastamatis :You finished your masters of dentistry? Yeah.
Dr. Mathew Ramzy :So it was it was a doctor of Dental Medicine. So it's not a master's program yet. Yeah, and both of them were 4 years each with a 2 year in between, so about 10 years went before I could work around.
Jac Simmonds :Bloody hell, you would have been keen to be finished by them.
Dr. Mathew Ramzy :Oh, yeah. I knew every single cafe and library desk at Sydney Uni.
Nick Papastamatis :I can imagine 10 years a long time it was double what I did.
Jac Simmonds :I was five too, and I was ready to get out.
Dr. Mathew Ramzy :It was a lot. It's a bit of a worry when the librarians recognize you in 2008. Hello, Matt. Yeah, yeah. And I don't even want to..
Jac Simmonds :You're still here Mat.
Dr. Mathew Ramzy :Yeah, it's funny because I know never introduced myself. But you know, they'd see me and I 2009 was finishing pharmacy and I swear, the same guy was still sitting at the same desk and you're like, 2015 and he was just looking at me.
Jac Simmonds :So that two years in between, that's when you're working as a pharmacist? Yeah,
Dr. Mathew Ramzy :Yeah. So there's like a compulsory 1800 and something hours that you have to undergo like a supervised practice, and it's a couple of exams and assessments and everything that you have to submit in that time. So that's what I was doing. Yeah, fan, you know, highly obviously goes without saying it's a very essential industry. I mean, we're seeing it now more than ever.
Nick Papastamatis :Of course, yeah the whole essential services.
Dr. Mathew Ramzy :Yeah. And yeah, but there was just just a bit of...the politics behind everything and and what happened with with the change in the system with a PBS and what was subsidising and what wasn't I think it drove a lot of pharmacists away or some I'm not exactly sure, but you know, some of the things that happened, I think what you wanted to touch on later, yeah. But yeah, they weren't the most enticing things to sort of keep you there.
Nick Papastamatis :Is that right?
Jac Simmonds :Was that a sort of industry wide thing?
Dr. Mathew Ramzy :Yeah. Well, look, there was a lot of them. Me personally, I mean, I can't speak for everybody, I think from from some of my colleagues that I've spoken to, they have moved on to other professions, right. I think they're just sort of cheapened the image of medicine or pharmaceutical services, you know, about discounters and you know, cheap this and get your cheapest medicate, yet, here. Yeah, and I won't name names.
Nick Papastamatis :No, I know exactly which, which chain you're talking about.
Dr. Mathew Ramzy :Yeah. And, you know, there's, there's, there's a whole sort of aspect of, a lot of people don't even know, like the extent to what what pharmacists actually do. And I think it's, you know, take a script and give something out, obviously, the concept is yes, you know, you're given a direction from a physician or your GP, and you're given a prescription and obviously, the pharmacist role is to fill that but at the end of the day, they are the expert, you know, dispensors of medication, they have to know, you know, all about medicines and all about what medicines can work with others and what can't and, and even like, benign things like vitamins and milk and what to take when and some of the things that can happen as a consequence can be potentially life threatening. Yes, absolutely. Right.
Nick Papastamatis :Because I think it would also act as a bit like a. So let's say for example, you've got a script. But let's say you went to a doctor because, you know, your usual GP wasn't there. They didn't have your notes and let's say for example that that doctor fills out a script for you and you go and the pharmacist has to say you want any other medications it's almost like a almost like a second a second pair of eyes or like a bit of a..I don't know what do you call like a safeguard would you say like something like that?
Dr. Mathew Ramzy :Like a like a like a safety net. It's like a point sort of the last point which...
Nick Papastamatis :Because they are meant to ask you?
Dr. Mathew Ramzy :Absolutely.
Jac Simmonds :Yeah we know people miss...miss their history all the time or just under a port so yeah, definitely a missing link I guess sometimes. Maybe in pharmacy like where things can go under the rug a little bit.
Dr. Mathew Ramzy :Yeah, well something as simple as say if somebody is you know being prescribed, say a Panadeine Forte which is which is a strong painkiller you know, indicator for more severe type of pain, but the fact that it has paracetamol, which is one of the most common commonly issued over the counter medications for anything from like a fever or a headache or something like that. If say, you know, for example, the pharmacist failed to sort of say, hey, you're taking anything else and somebody was buying panadol the patient might not know that, you know, the maximum dose is about eight tablets of panadol on day or four grams. And if you tip tip them over to take a couple extra, you can overdose and it can be you know, liver failure and so other things.
Nick Papastamatis :So I know like, you know, you watch all the all the all the, you know, the sitcoms like the the hospital sitcoms and stuff and they talk about things like ibuprofen, and stuff like that, and they basically just open the mouth chuck, chuck a handful in whatever sticks is the right dosage. Is that not the case with paracetamol or paracetamol? So for example, if you take a whole packet of panadol, that's an overdose.
Dr. Mathew Ramzy :Absolutely, yes.
Jac Simmonds :And so what would that result in?
Dr. Mathew Ramzy :So the main thing is is really severe liver toxicity because you have certain reserves in your body which are able to deal with what's known as the metabolites of paracetamol. So when you swallow a pill goes through a system your liver breaks it down. And there are certain byproducts which can be toxic, basically. And too much of that, because we don't within our own bodies have the resources effectively to deal with that. You can get a buildup of toxic metabolites. And that can go into cause pretty serious consequences mainly to do with the liver. And, you know, there is a reversal agent for that particular particular scenario. But yet, you know, people think, yeah, obviously panadol quite sort of benign.
Nick Papastamatis :Yeah, that seems like a pretty menial thing.
Jac Simmonds :With I guess, with the populations we see like being a lot of chronic pain as a pharmacist, were you seeing a lot of misuse of pain medication?
Dr. Mathew Ramzy :Oh, yeah, absolutely. Yeah. Yeah. Yeah. Particularly with the opioid containing preparations.
Nick Papastamatis :What do you tip just for listeners, what are your typical opioid medications?
Dr. Mathew Ramzy :You've got a range depending on how they're scheduled so you have the ones that formerly were over the counter ones. So things containing codeine up to a certain dosage are no more than 15 milligrams was legal. Prior to, I think it was February '18.
Nick Papastamatis :Now that's neurofen plus.
Jac Simmonds :Yeah. And now, you have to have a script for anything with codeine.
Dr. Mathew Ramzy :That's right. That's right. So there's no longer they're no longer schedule three. So schedule three were pharmacist only medications, but they didn't require prescription. Right. So I think, as of February 2018, so over two years ago, now that was made illegal.
Nick Papastamatis :That's good, cause everyone's getting addicted.
Dr. Mathew Ramzy :Yeah. Well, that's right. That's right, that there wasn't any, like formal a number or like studies, I think on people actually abusing over the counter. But it was pretty obvious.
Jac Simmonds :What's your, what's your opinion on like, where that fits into managing, I guess chronic pain, or?
Dr. Mathew Ramzy :Well, I think you know, the basic definition obviously opiods was there for a reason. And then they targeted as an analgesic. And they're really there for a number of reasons. But obviously for more the severe end of pain.
Jac Simmonds :Yeah, that's what I sort of. I mean, I'm not a pharmacist, but we get asked a lot in the clinic. I'm sure you do as well, Nicko. And, like, I always frame it as look, I'm not a pharmacist, and I shouldn't be the person you're asking this question for, but it's probably best for a rainy day. Like...
Dr. Mathew Ramzy :Yeah, yeah, well, essentially, yes. You don't want to be your first resort. And there's a lot of issues with with opioid medications. Namely to do with you know, dependence, otherwise known as you know, addiction. And just, you know, effectively people will take it and they can get high off it.
Jac Simmonds :I remember after my knee surgeries coming off the panadeine forte what else endone, thta's some strong stuff.
Nick Papastamatis :Yeah, yeah. So if you've got, hang on, so panadeine forte that, that is a painkiller that is not an opioid.
Dr. Mathew Ramzy :No it is it is.
Nick Papastamatis :It is an opioid.
Dr. Mathew Ramzy :Panadeine forte has an opioid in it, which is why it has codeine.
Jac Simmonds :Paracetamol and codeine yeah and then endone is oxy oxy.
Dr. Mathew Ramzy :Oxycodone.
Jac Simmonds :Oxycodone? Yeah, hillbilly heroin.
Dr. Mathew Ramzy :Yeah, pretty much full on narcotic.
Nick Papastamatis :Is that what that's called?
Jac Simmonds :Hillbilly heroin.
Nick Papastamatis :That's endone?
Dr. Mathew Ramzy :Yeah, endone and oxycodone pretty intense one. Yeah.
Nick Papastamatis :So you took that combo?
Jac Simmonds :I was, I can't remember, I took the only thing I remember about those was...
Nick Papastamatis :A great time of your life was it?
Jac Simmonds :It was. It was a it was a period of about seven days where I don't think I went to the toilet.
Dr. Mathew Ramzy :Oh, yeah. Highly constipating medications.
Jac Simmonds :Yeah, that was probably the side effects. I remember but yeah, I think I was on. Yeah. A bit of that stuff.
Nick Papastamatis :Did you record a podcast at that time?
Jac Simmonds :It would have been interesting. Chronicles of hillbilly heroin.
Dr. Mathew Ramzy :You can get really quite high off it.
Nick Papastamatis :Is that when you got when you coined the nickname a wacko Jaco...it is now.
Dr. Mathew Ramzy :Record that from this day forward.
Nick Papastamatis :So um so Mat, I think, like, as much as I feel like we've dived right in. And that's really cool, because you know that I do that sometimes. Now this is it was on purpose, because what this has done is, is it's really set the scene because we are in a position where there's been a discussion about essential services. And one of the things that that was a huge discussion for for us as chiros and physios was, well, are we essential. And from a from a pharmacy point of view, it's not necessarily like, you know, how many people are going to be lining up at the Medical Center? It's more hell like how important is it to be able to keep managing pain as naturally as possible? Because how quickly can someone get addicted to something like this? And yeah.
Dr. Mathew Ramzy :I think that's a very good question. I don't I don't know. I think there's many, many factors that will tie into sort of answering that with any kind of accuracy, but I think first of all it, you have to look at the personality and the capacity for for somebody to be addicted. And generally speaking, I think that yes, certain people will be more prone to, you know, addictive behaviors than others. I think there's a certain psychology and set of qualities that fall behind this kind of people. But yeah, I mean, there's this, there's definitely certain people who you'd rather opioids end up in the hands of than others, I think.
Nick Papastamatis :Sure. Let's say someone who's in pain here, do you think pain pain would be if if pain is left untreated, does that alone, irrespective of addictive quality, psychological predispositions, if you've got if you're in pain, do you feel like that alone is enough of a driver to create this dependency?
Dr. Mathew Ramzy :Look, I don't I don't think so. Because I mean, depending depending on the pain, I mean, there's just going to be certain modalities that can, that can treat it. So I think that depending on how, obviously how house how acute or severe pain is, a certain things will work, obviously, if a person is in severe pain, then yes, I think it can can drive them, maybe a bit more so, to resort to stronger painkillers, and then you know, a few other things will determine whether or not they have the capacity to be addicted. But, you know, you know, as good as anyone, like when there's a pain, if you don't sort of elicit the source of the pain, then it just becomes like a symptomatic sort of treatment and you're not actually addressing the cause and it's just a symptom. So somebody's gonna ban painkillers forever, if we're not addressing it and you know, from a musculoskeletal perspective, you know that, you guys know that more than more than anyone.
Jac Simmonds :And then I guess the other argument is like, with the essential services that the pain left untreated become sensitized as well.
Nick Papastamatis :Yes, yes.
Dr. Mathew Ramzy :And that's a big problem. Yeah. Yeah. That's that's that can become a big problem in any field, but especially in the head and neck region.
Nick Papastamatis :Because then you've got yeah, well, that's a good that's a good segway actually because the head and neck region is your specialty, isn't it? I mean, your a dentist.
Dr. Mathew Ramzy :Well, it's, yeah, in my profession. Definitely. We deal with a lot of pain in the head and neck region, obviously. Primarily, we're associated with, you know, oral tissues. So teeth, gums, muscles and bones inside the mouth.
Nick Papastamatis :No tongue.
Dr. Mathew Ramzy :Yeah, tongue. Yeah, yeah, tongue. I mean, it's not a painful things. And yeah, there are.
Nick Papastamatis :The tongue is not that pain sensitive?
Dr. Mathew Ramzy :Less. Ah, no.
Nick Papastamatis :It is.
Jac Simmonds :Have you ever bitten your tongue?
Nick Papastamatis :Yeah, I forgot about that. You can try talking about.
Jac Simmonds :What other what other painful stimulus would be for the tongue?
Nick Papastamatis :I don't I don't know.
Dr. Mathew Ramzy :Well maybe that's it. That's after hours podcast.
Nick Papastamatis :Yes, is not the balance experience anymore. Moving on.
Jac Simmonds :So day to day Mat. What's day to day look like for you then what are you what are you sort of seeing?
Dr. Mathew Ramzy :Yeah, well, obviously I'm a dentist. So yeah, we deal with we deal with oral health. And I guess, you know, loosely that makes up to as I said before, the components which make up the mouth so you know, mainly the teeth, the gums and the muscles and the bones inside there. So that's obviously first and foremost and you know, a range of things associated with that, what we deal with, from general stuff, preventative stuff to do with the teeth. And, you know, whether it's things like Invisalign, or cosmetic work, and some dental implants and a range of other things I personally deal with and I'm also one of the a dentist among among a number of other who does facial aesthetic or facial cosmetic work. So, you know, that's loosely speaking things like botulinum toxin and dermal fillers. Okay, Botox, yeah, yeah, that's right. That's right. That's right. Yeah. So those things and we use them, you know, therapeutically and also cosmetically.
Nick Papastamatis :Well. I've had my dose of Botox. Yeah from you.
Dr. Mathew Ramzy :I remember that.
Jac Simmonds :Yeah. Where did you have that done? Temporalis?
Nick Papastamatis :No, no, no.
Dr. Mathew Ramzy :Nah, I think you did you know.
Nick Papastamatis :I had temporalis also had masseter. Yeah.
Jac Simmonds :Well for the listeners, what do those muscles do?
Nick Papastamatis :Well, they make you clench the fuck out of your jaw.
Dr. Mathew Ramzy :And where you doing a bit too much of that?
Nick Papastamatis :Well you know it doesn't help when your Greek.
Dr. Mathew Ramzy :Nick's jaw is a bit intense. Yeah. Souvlaki wraps are pretty big.
Nick Papastamatis :If you go to Marrickville Yeeros they're quite big. If you go to Zeus Street Greek, Yeah, it's pretty small.
Dr. Mathew Ramzy :Yeah.
Nick Papastamatis :I think my dad is my brother's call the guy there Cyclops. Yeah, I think so. So anyway, But the point is, stress is probably my major aggravator module. Yeah. And when I have but it's usually stress on its own isn't enough usually because I've got also a neck issue. If I've, if my neck isn't good and I'm stressed at the same time and I haven't been exercising, that is pretty bad sort of combo for me. I'm usually I usually end up with some serious pain. And when I say serious pain, I'm talking about headaches and migraines. And for me that's quite debilitating. And I need to function. So the Botox injection and we did it asymmetrically. Actually, actually, I think one side was quite, it was quite, I deviate my jaw quite a bit. And I wouldn't mind talking about that malalignment because a lot of people think about, you know, releasing the jaw and what chiros in some physios do in terms of internal releases, sometimes might be a bit out of their lane, especially when most of the issues seem to stem from the maxilla row. I want to talk to you about that.
Jac Simmonds :I mean, in like in Nico's case, for example, Mat, how would you like initially assess for that, because obviously, we see a lot of people with with jaw pain and they might have pain on one side of the jaw, where it's sort of like a starting point for you, like, in Nick's case, it was getting, like on the right side, your pain, like, where would you start with that?
Dr. Mathew Ramzy :Yeah. So it comes down to, I guess, a basic assessment of the jaw. So in your initial extra oral exam, you want to be, you know, palpating, the TMJ from the outside and just assessing things, you know, from their ability to open and close first of all, and then if that's accompanied by any sounds like clicking or popping or if there was has crepitus in the jaw, and then you know, you assess things like their path of opening, you know, do they open and close up and down in a straight line? Do they deviate? Do they correct that deviation? If so, by how much and, you know, off from the midline and that kind of thing. And then you know, we that's that's the joint itself and then you want to assess, you know, the muscles attached to that joint. The main ones that we assess the masseter and the temporalis because they're the ones that are mainly found to be problematic in, you know, bruxism or parafunctional. It wasn't as grinding which is...
Nick Papastamatis :so the temporalis just for people that don't know that's, that's literally located above your ear.
Dr. Mathew Ramzy :That's right. Yeah, it's a big fan shaped muscle, which essentially is on the side of your head. Yep, behind your ear and sort of goes back to the, to the back part of your skull. Yeah, essentially, a huge it's, it's a very wide muscle but it's actually relatively thin compared to even like the masseter, but actually it's very wide. And it just spans a big distance but it's um, it's a pretty important one involved in in grinding mainly just retrudes the jaw, brings it back. Especially when you when you close.
Jac Simmonds :What do you think is the big causes of jaws... jaw pain coming through your clinic?
Dr. Mathew Ramzy :So I think jaw pain, which can be a number of things is a very big topic actually. And it falls under sort of orofacial pain or pain in them, you know, around the oral cavity around the face. And that in itself is actually one of the most complex like regional pain syndromes in the whole body. Mm hmm. And that's really due to just the complexity in the grave like the neural network from all the structures that are innovated by like say, the trigeminal nerve, and even things like the facial nerve and the vagus nerve, pharyngeal, and other on the nerves, but there are, there's a very common sort of site up in the brain near in the inside the cranial fossa where all these pathways sort of converge or they come together, and it's almost like a, I think I had known as a uni Professor that that explained it like a like a train station kind of thing where you're getting just imagine like Central Station being this place where they all meet and you've got all these train tracks coming from from different sides you know whether it's the teeth, the mouth, jaw muscles, even the the eye, the ear, the sinuses, even the heart Even down to the heart - the Vegas nerve.
Nick Papastamatis :Yeah, that's why when I get my jaw release, I can feel my heart.
Dr. Mathew Ramzy :Well, yeah, you might want to get that checked out aswell with a cardiologist but I don't know why.
Nick Papastamatis :Yeah, I reckon. Let's Let's leave that for after the show.
Dr. Mathew Ramzy :Yeah, yeah, well, we'll call emergency.
Nick Papastamatis :I'm not feeling it now. But I'm just when you've got your finger in my mouth. Yeah.
Dr. Mathew Ramzy :It can't happen look, and you know, people, people, people can come in to, you know, feasibly people can present to dental clinic, because I've got paint in their tooth but really they've they're having an issue like a cardiac issue. Wow, yeah. And Holy moly, yeah, that's back to the you know, like the train track, everything sort of coming together. But the the captain, if you will of the station wherever all the trains are coming in can find it hard to differentiate exactly where it's coming from. So you can have referred pain where yeah sorry, where we have pain which has felt at a site other than the site that is injured, essentially. Which can be very problematic, obviously, because you can treat something that's hurting but that's not actually what's injured.
Nick Papastamatis :Is it because they that those neural networks, they converge obviously they've got to converge somehow. Yeah. Or, or is it? Is it because they they're physically connected? Is it because...
Dr. Mathew Ramzy :so it's, I think, in short, it's a very, very sort of complicated mechanism, but it comes down to something, you know, that initially that started was called as a primary or peripheral sensitization. And then it moves on to something called central sensitization. During primary sensitization when you've got sort of chronically activated or pain receptors on nochi, noci receptors, they're just basically receptors that are pretty much everywhere in your body other than your brain. And they will fire or give a signal to the brain whenever threat is perceived. So that can be like a something mechanical or like something's too hard to push against you. It could be thermal, something's too hot. Or it could be like chemical like something's like acidic, and it's about to burn you down, or something. And they basically send and there's a few things that happened. And so you have, you know, a few different things that happened on on the nerve level. And then there's something called like, secondary secondary messenger pathways. You've probably heard of something like cyclooxygenase or sorry. Camp. Yeah, yeah. Things like that, that are that happen beneath the cell, or within the cell, I should say, and there's certain things are things like cytokines and stuff. And messengers, which which every time you have these nochi receptor stimulated, they almost I guess they, they sort of build up. And you can have what's already developed something called peripheral sensitization. And what that does is it sort of constantly nicking and ticking when aggravating this particular pain pathway. And when that happens enough times, through, you know, some relatively just complicated mechanisms, you start to have this thing called central sensitization where now you have what we call second order neurons. So we're all this what I was alluding to before the train tracks meet at this one level in the brain, that one level then relays information further up to a part of the brain called the thalamus where we interpret like pain signals. And over time, essentially it can become very convoluted with chronic activation of these pain fibers so you can have...
Nick Papastamatis :Because the thalamus will also send the thalamus is also kind of like the the freeway of of the ascending tracks where we're going to send it to, you know your frontal lobe, you know, attach meaning to that yeah, it's gonna it's gonna have some sort of historical implications as well and might even will it will that will that also go into the into the hippocampus and create some sort of some sort of memory based fact based historical finding.
Dr. Mathew Ramzy :The particular neurology of it i'm not i'm not 100%.
Nick Papastamatis :I can imagine I can imagine how how convoluted that would get. But yeah, yeah, like as soon as it hits the film is just gonna go further up, isn't it?
Dr. Mathew Ramzy :Yeah, well, it that's that's that effectively is further up. And what will happen is now, when you become sensitized to these chronic activation of the pain fibers, you now can have what they call like the afferent or fibers going to the the collection point, if you will in the brain, you know, one might be coming from the teeth or might be coming from the eyes. And one might be coming say from the ear or something over time where these inputs may be individual so there's only one connection from its respective origin with you know, peripheral and then central sensitization, you can have actually sprouts from the origin of the sites, nerve sprouts, were the one that was coming say, you know from the eye then joins up to the one coming from you know, the sinus or the one coming from the sinus syndrome. So basically, you might be touching your, or the might be a problem in your sinus, but over time, there may be you know, this sprouting, as we've said, through peripheral and central sensitization...and that, that then that basically shoots off an extra little nerve fiber so that it connects to you know, the one going to the brain from another part of your body that's not the eye or wherever it was arranged originated and the significance of that is you start to, you start to feel pain from what your brain perceives is coming from an area other than what's actually the problem and then obviously that can go on to be treated, which can be very very painful.
Nick Papastamatis :Try and uncover that and that's a tricky finding.
Jac Simmonds :I guess like with the pain we treat are you finding you can often link this back to like a behavior or trauma with the person?
Dr. Mathew Ramzy :Yeah, well, that on its own is its own sepearte issue, anything to do with with paint in the oral facial region, they break it down to what's called a biopsychosocial model. Yeah. So I'm sure that a similar kind of concept applies in both fields for you guys. But yeah, obviously there's there's definitely a range of social conditions and psychological conditions which predispose somebody more than somebody else. For this kind of pain.
Jac Simmonds :It's funny even just like with myself, as a physio like me thinking about dentistry, and I'm sure this is the common perception as well, like I think of it almost purely by mechanical sometimes. And I'm sure like it's obviously not. So that's really interesting. Yeah.
Nick Papastamatis :Can you...Can you give us some insight as to, we know that often like, we've got patients that come in for a jaw release, and that's fine. I mean, I'm happy to do a jaw release. Over the years, I've gotten a little bit more, I suppose I've put my ego to the side and realized that I have less success at helping people with mal alignment because of things like it's not coming from the mandible. And so clicking and stuff like that, that's not normal is it clicking?
Dr. Mathew Ramzy :No. So clicking is not normal. Okay, but it's something that essentially is not treated unless it's it causes symptoms, namely pain, or dysfunction. Okay, so if somebody can't open or close because of it, or somebody has pain, and that's accompanied by clicking, then that's when it has to sort of in inverted commas be treated, but somebody comes in and says I've got a clicking jaw, but open my jaw really wide, no problem, I can chew, I can eat, no pain whatsoever that in itself doesn't need to be treated. Sure. And they might have issues with you know, clenching or grinding your teeth and which has obviously we would look at that. But...but clicking in itself, simply is crepitus. Yeah, that's right. And it's really just down to, you know, when the jaw or the mandible can, you know, is connected to the skull, the disc can be, you know, maybe too far ahead of the condyle and then you might have when it moves, where it shouldn't, that's where you can actually get pain.
Jac Simmonds :In your opinion and with like in terms of physio, and chiros role with jaw pain, when do you think for the patients listening when we when do you think we should be the first call? And when do you think you should be the first call?
Dr. Mathew Ramzy :I think it's interesting question.
Jac Simmonds :I have my opinion on that a little bit as well. I think probably there's a lot of things that physios treat which is out of their lane when it comes to jaw pain.
Nick Papastamatis :Do you think that's one of them? Oh, you think I just think generally?
Jac Simmonds :Yeah, I think generally jaw pain is out of our lane. I think we under refer a little bit sometimes.
Dr. Mathew Ramzy :Yeah, I'll probably agree. Because I think sort of touching back to what we were talking about before it's it's it's a very complicated area, and the jaw and just the facial region, obviously, for the things that we were talking about before with all the like, the neural inputs and everything. But primarily, I think it's down to what can you do for that person who's, you know, suffering as a patient for them? And I think that if anything will probably dictate, you know, should they be referred? Or should you help? I'm not saying that it's a bad thing. Somebody comes in and, you know, during an exam, they've said to you, I've got jaw pain that you release, absolutely not, I've had my jaw released by a chiropractor by a physio and it was good. But I think in terms of like a full assessment, obviously because the jaw is the jaw and yeah, it's it's complex.
Nick Papastamatis :It...It's complex when it functions normally.
Dr. Mathew Ramzy :Yes, let alone when it's it's actually one of the most unique if not it is the most unique joint in the entire human body. Because it functions like no other. Yeah, I mean, it's a sliding and a hinge joint as you guys know.
Jac Simmonds :i have a question actually. So you know, Nicko how we see people walking down the street or we watch people in the gym, watch how they walk, watch how they squat you're constantly looking at people's teeth?
Dr. Mathew Ramzy :You know why I think you can help it, but yeah, I know it's hard.
Jac Simmonds :Have I got an underbite or overbite? Got him, thanks for coming Mat.
Dr. Mathew Ramzy :Nah their not bad.
Jac Simmonds :I am actually.
Dr. Mathew Ramzy :You can't you can't help but um...
Jac Simmonds :You know a good dentist?
Dr. Mathew Ramzy :Yeah, just down the road. But now like you can't, you can't really help but look yeah, on sometimes its annoying, but yeah, somebody is talking and of course you end up stairing at their teeth.
Nick Papastamatis :So we've got we obviously have a lot of patients that come in with with jaw issues. And, you know, we find that, like, I know, one one patient springs to mind straight away. And that is, you know, she's got a she's got like a left wrist pain. Now, I'm not going to get into the complexities of why I think the left jaw is causing the left wrist pain, because that's what gives her relief. Treating the wrist makes it worse. Interesting. Yes. But the point on...the question she asked me was, why does this keep coming back? Now, it is the biopsychosocial model at play, but what would be an explanation from your viewpoint on why would a psycho issue be causing jaw clenching?
Dr. Mathew Ramzy :That's another great question. So, look...
Nick Papastamatis :I have a theory on this by the way.
Dr. Mathew Ramzy :First of all psycho...psycho issue could mean obviously many things, but you know things like anxiety...
Nick Papastamatis :Yes. Yes, I'm thinking stress, I'm talking about stress.
Dr. Mathew Ramzy :Anxiety, stress, depression, obviously, they're, you know, complex psychological conditions that people suffer from. And there are definitely associated complications. And one of them definitely say for an anxious person, they might clench or grind their teeth as well. Some people might say they don't do more. You know, why is that related? Look, I think the theories surrounding TMJ or temporomandibular disorder, which jaw pain and clenching and grinding ties into, so as does and that forms a big component of things like oral facial pain and that kind of thing. But yeah, there's obviously a big psychological model, but it's it's highly complex because just because of the variability that you see in people and when they us as clinicians, you look for sort of facts before you decide on how to treat formulating diagnosis. With the TMJ, there are a lot of things that we see in say healthy people with a perfect bite that we, you know, may also see in people with, with with sort of a messed up so to speak by. And the second person might have no symptoms, but the person with a perfect bite has symptoms. Yes. So I think that picking up the facts and then sort of deciding to treat that in itself becomes very complicated because it's not clear cut for everybody. Yes. And sometimes you might have a perfect set of symptoms, and you might issue something like a like a splint or a mouthguard, and that works very well for somebody and you have you know, Person B come in same symptoms issue and doesn't work the same for them. So, when you're talking about, you know, psychological issues, I think that's just down to you know, personal factors and that's why that the psychosocial part of the whole model comes And I think it's a number of things but things like you know, just basic capacity to enjoy stressful times pain, resilience, hope, obviously are a whole topic for another day, but that ties in very closely with with TMJ and jaw pain..
Nick Papastamatis :Is there anything we know about why specifically stress or stressful situations create jaw clenching? Like, what? What is the link between that?
Dr. Mathew Ramzy :That's that's a good question.
Jac Simmonds :Nick's really asking, Is it. Is it grinding your teeth to prepare you for your enemies?
Dr. Mathew Ramzy :Prepare you for your enemies? I haven't heard that one.
Jac Simmonds :Sharpening your teeth.
Dr. Mathew Ramzy :That's interesting. I haven't heard that one before.
Nick Papastamatis :No? That's a Nick-ism.
Dr. Mathew Ramzy :Sharpening your teeth. I guess I they do make them sharp.
Nick Papastamatis :Yeah, prepare you for battle.
Dr. Mathew Ramzy :Um, I haven't heard that one before.
Nick Papastamatis :They came straight out of the Acropolis archives.
Dr. Mathew Ramzy :Really? Yeah.
Nick Papastamatis :There's a library in the Parthenon.
Jac Simmonds :Are you fine? Are you finding me that then are you referring often? like as if we're looking at your pain is stress and anxiety being the main source? Are you referring a lot for that?
Dr. Mathew Ramzy :No, not typically. Are you referring to like to a psychologist. Yeah. Yeah. Not Not Not really. I mean, I think that's obviously circumstances where i think it's it's pretty obvious that there's an overarching psychological issue and you definitely do that. But in terms of what I can do, I think based on if I can pick up some of the exam whether it's you know, during the muscle exam or the jaw function exam, then it's something that I can affect and obviously yeah, well I will try and we do it we have a lot of success treating jaw pain and and jaw or team day. But yeah, sometimes I think that yeah, point where referrals necessary Yeah, yeah.
Nick Papastamatis :Now, now there's look mate so far, amazing stuff. I've got I've got a question and I want to I want to hear I want to hear maybe some interesting stories. Okay. Yeah, and I'm sure and I'm sure like, I'm sure you've seen some some pretty bad shit.
Dr. Mathew Ramzy :Yeah, I'm sure we all have. Yeah, but the answer is yes.
Nick Papastamatis :Is there is there is this something that springs to mind for first off?
Dr. Mathew Ramzy :What? What? What category?
Nick Papastamatis :Think of something horrific.
Dr. Mathew Ramzy :Jeez. Okay, I'm thinking of something horrific. What do I do now?
Nick Papastamatis :This podcast. More like more like, have you had something in? Like someone presented the clinic and you just thought, holy fuck what do we do with this?
Dr. Mathew Ramzy :Oh yeah, well, I think...
Nick Papastamatis :Can you give us an example?
Dr. Mathew Ramzy :Yeah, well, I can actually. I think it was not too long ago. We had a patient come in. It was 46 year old man, I think you haven't seen a dentist. He told me in about 25 years.
Nick Papastamatis :Well, holy shit.
Dr. Mathew Ramzy :And, you know, he opened his mouth and that was true. Yeah, so I believed him straightaway. But no he, he had a lot going on. And what he didn't know was just how serious his condition was. So he..this is this guy in particular, had a few severely or grossly decayed teeth in his maxilla. And basically, they're all abscessed so essentially the section it was where he was actually he was actually a bit February so he had a fever and he was a bit lethargic, he was getting septic. Yes, yes, it was just because he's septic. septic means the infection is going into your blood. You know what I mean? What brought him in was apparently his wife told him I think you should see a dentist.
Nick Papastamatis :Yeah, his wife was making out with that?
Dr. Mathew Ramzy :Oh, geez, I hope not. I feel sorry for her. God bless her but...
Jac Simmonds :You should get her into the clinic and make sure she is ok.
Dr. Mathew Ramzy :Maybe? Yeah, that's right. He came in. And....
Nick Papastamatis :I'm sure she doesn't.
Dr. Mathew Ramzy :Yeah, probably. Yeah, she wanted. She did want evidence, though that his teeth were in fact decayed. And that was quite easy. But, you know, this guy sort of came in and it was it was actually it was actually in a bad way. And he didn't know what, which was the scary part. But he was like, Oh, I just feel tired and got a bit of a fever. And we looked into it, it was all this is one of the cases where a dental infection can get very serious, I think in like Western society, and, you know, in this day and age, we're fortunate enough to have, you know, readily readily available access to dental clinics, especially in Sydney. I'm not talking about, you know, rural or regional areas. But you know, and then obviously, affordability of private services becomes a consideration but there's definitely you know, services there in the case of emergencies but this guy who was an example of where spread of a dental infection which can start as like a little cavity goes and spreads through like the nerve chamber and they can basically pierce through the apex of the tooth is basically just like the end of the route and then spread to wherever that's in close association to. In this case, it was you know, one of his premolar teeth and it was really it basically perforated or the infection got that bad that it had resorbed or eaten away the bone in his maxilla and he's upper jaw through the tooth and was starting to sort of spread out inside the mouth through the gums and getting very very close almost upwards near his eye.
Jac Simmonds :Oh, wow.
Nick Papastamatis :Wow.
Dr. Mathew Ramzy :Yeah. So that can be highly problematic. It can spread. Yeah, yeah can spread into something called like the cavernous sinus and that can be...can obviously the end result can be death.
Nick Papastamatis :Well, what's the cavernous sinus remind me?
Dr. Mathew Ramzy :So the cavernous sinus is a compartment in the brain, essentially where it's a few different nerves, cranial nerves converge. One of them is the one that also supplies muscle activity say to the eye, okay, so he certain people, they can start to have or they can one of the things that can cause actually blindness yeah as well yeah, this is advanced and obviously look he not not specifically him but the fact that he was, you know, displaying symptoms. It was it was obviously that there was systemic and we'd gone from it from a dental to a spread of Advanced Dental infection. Um, yeah, it was it was very worrisome, especially when he opened his mouth and it was literally just puss sort of oozing out. Now well, look, we I mean, we we, we drained the infection and we gave him a little bit of numbing. So he basically had to incise or cut open the abscess and drain, remove the offending teeth in this case, which were about three and place him on some antibiotics and just basically monitoring closely.
Nick Papastamatis :What did you have to do to, how did you numb that?
Dr. Mathew Ramzy :Yeah, so look, that was actually not not the easiest as well, because it's very difficult when you come to do local anesthetic. You don't you can never really you're not you should never inject into an abscess with local...with local. Yeah.
Nick Papastamatis :Why is that?
Dr. Mathew Ramzy :You can actually spread the abscess further from the pressure of the fluid being injected. Oh, yeah.
Nick Papastamatis :So no, it's not that it doesn't work?
Dr. Mathew Ramzy :And that to that to actually there is a problem with it not actually working okay. Because of the infection the acidity can actually affect the onset of the anaesthetic itself. So yeah, whenever whenever there's this acid present because of an infection, say in puss or something that that does compromise the effectiveness of the anaesthetic.
Nick Papastamatis :So if you've got a tooth infection and there is and there is an abscess, you can't have local?
Dr. Mathew Ramzy :You can, you can I mean, there are ways sort of around that you can numb adjacent areas you can numb through the palette or something if it's on on if the abscess on the other side or something like that, but look, obviously, it won't be as effective as you know if your whole area where it has to be numbed up if you can't, but you know you have to do what you have to do it's that or it's potentially life threatening.
Jac Simmonds :I've never been more conscious of my jaw in my life right now. Are you seeing in the practice of seeing much facial trauma?
Dr. Mathew Ramzy :No, no, no, no. So facial trauma I think in private practice, unless you're in a rural area.
Nick Papastamatis :Are you asking like people walking in with with a broken jaw?
Jac Simmonds :More like post facial trauma pain.
Dr. Mathew Ramzy :You can see that you can see that, but look in terms of like blunt trauma, you know, like motor vehicle accidents there's no doubt that they'll be presenting to the emergency department. I'll find it very peculiar. Oh, yeah, buddy. Thanks. I went to dental surgery for that. I mean, whether if something's broken or something hanging out, yeah, his face is cut in half. You might want to go to the emergency department.I'd love to help you.
Nick Papastamatis :Mate a bit of that panadeine forte concoction that have.
Dr. Mathew Ramzy :You're gonna need some probably some advanced life support.
Jac Simmonds :Yeah, I guess. I ask because, I don't want to make this console myself, yeah, but I had a facial trauma. Okay, quite a quite a bad one. And I get neuropathic pain, or at least that was the diagnosis. Yeah. And in the left side of my... in the left side of my mouth.
Dr. Mathew Ramzy :Really?
Jac Simmonds :I guess the question would be, is that something you see often and what is neuropathic pain? In I guess, as a diagnosis?
Dr. Mathew Ramzy :Yeah. Um, so I think the first part is that something you see often not so. The Phantom Pain of the neuropathic pain referring to not necessarily sure. Okay, I wouldn't say you say often. Yeah, I think neuropathic pain is sort of loosely defined is a primary problem with the neurological system, we're aware. You can have things like a phantom tooth pain, or phantom pain, like phantom limb pain. So some people, you know, as you probably know, they get their limbs dissected, or that limbs have to be cut off through tragic accidents or something, and they can actually start having pain in their hand, which is no longer their same sort of thing can happen with a tooth. And in your case, you know, you've had some trauma. So, I mean, that falls under the category definitely of neuropathic pain, and the ones that we deal with specifically as dentist and mainly like trigeminal neuralgia that can have classic presentations or sort of atypical presentations coming right. Yes, yes. Well, that actually is that is a differential diagnosis to to neuropathic pain. We're specifically talking about the facial region by your migraines, headache, referred pain, myofascial pain, neuropathic pain and pain from the oral cavity. They all are one of the differentials that you will have to go through. And intracranial things, you know, like a, like...a tumour.
Nick Papastamatis :A tumor.
Dr. Mathew Ramzy :Yeah. Yeah, for sure. facial pain, but yeah, Neuropathic pain. Yeah. So it's a primary disorder of of the neurological system. Okay. And very difficult to treat.
Jac Simmonds :Yeah, trigeminal nerve pain, where are you where people feeling that that's side of the head. Yeah.
Dr. Mathew Ramzy :So initially starts like a uni lateral on one side. And there are certain highly sensitive zones like triggered to his Trigger Zone, the trigger points. It can, it can happen, you know, directly beneath the eye on top of the maxilla. Okay. It can also happen anywhere else in the distribution of the of the trigeminal nerve.
Nick Papastamatis :There's three branches aren't there of the Trigeminal.
Dr. Mathew Ramzy :Yes.
Nick Papastamatis :Up the eyebrow?
Dr. Mathew Ramzy :Yeah.
Nick Papastamatis :That's the, towards the nose. Yeah. And then down the chin down your jaw.
Dr. Mathew Ramzy :Yeah. Okay. So and yeah, just almost like you can picture Mike Tyson's tattoo. That's almost what the, yeah, that's kind of what the trigeminal nerve looks like. Yeah.
Nick Papastamatis :I wonder if he did that on purpose?
Dr. Mathew Ramzy :Maybe. A couple times. Yeah. Who knows? Yeah, that's true. Actually. Maybe you never know. We should ask him get him on the podcast. Yeah.
Nick Papastamatis :Yeah, I reckon I'll get him to bring his tiger with him.
Jac Simmonds :Yeah, my back broken.
Dr. Mathew Ramzy :My back is broken.
Nick Papastamatis :He's back. He's getting back into.
Jac Simmonds :He wanted to fight Barry Hall and Sonny Bill Williams. I have for a second what's mike tyson doing fighting those two battlers? He's got better things to do than that.
Nick Papastamatis :He probably doesn't.
Dr. Mathew Ramzy :Well, yeah. It's interesting. I think he'll knock him out. Personally...Sony Bill. I'd love to see that.
Jac Simmonds :I think he's already refused it. Yeah, refused Sonny Bill. Yeah, he owns a cannabis company now.
Nick Papastamatis :Who does?
Jac Simmonds :Mike Tyson.
Nick Papastamatis :Does he.
Dr. Mathew Ramzy :A few of the big guys in America do now. It's a big thing apparently.
Nick Papastamatis :Yes. There you go. Well, making some money.
Jac Simmonds :Exactly.
Nick Papastamatis :Where are we guys? So I think we've talked about neuropathic pain. And like a primary disorder of the of the nerves. Yeah. We've talked about how how much the nerves all interdigitate. And you can have a symptom from the heart coming up into your tooth. Yeah, the major...the major takeaway for me is if you've got fucking tooth pain, mate go get it checked. Like, just get it checked.
Jac Simmonds :Yeah, that...hundred percent. And probably one more thing. I want to touch on Mat. Just quickly. An air at something I've always been interested in is how oral health plays into gut health. Yeah, what's your what's your sort of view on that? Because I'm very, very elementary sort of knowledge about it. But where do you sit with that?
Dr. Mathew Ramzy :Yeah. So I think first, to answer that, probably how it ties into overall health and well being to start with, and obviously the gut is its own infinitely complex, I think as we're starting to learn now is the role of like resident gut bacteria and everything very complicated, but oral health in general, is vital part of overall health and well being obviously primarily the teeth and the gums, you know, we don't have to go too far into it to understand that you know, if tooth loss can lead to a range of complications and lasting, you know, physical and even psychological disability. At initial level, and I think without teeth, obviously, aside from that how it looks, chewing and swallowing become very difficult. And almost in some cases, I won't call it impossible but I'm sure you could manage but very, very hard. And you know, that will inevitably affect the choice of nutrition or nutrition for a person and that in itself will have systemic health consequences. And can obviously exacerbate existing health conditions. Further to that, you know, on the sort of well being part I know goes without saying obviously, if a person is reluctant to smile or show their teeth or can cause disturbances to appearance, and we know that it can affect self esteem. It can affect you know, involvement and things like schoolwork at home. And, straightaway this can have a big psychological impact. I mean, if you just think for a second if every time you went to smile you got it and you stopped. Just think of that sort of negative circuit back in your head and ...
Nick Papastamatis :That's the gut brain thing right there.
Dr. Mathew Ramzy :Yeah, well, I mean, this I'm just now specifically talking about like the smart that the psychological aspect of it, but with the gut brain thing, I think the main impact of this hasn't been any, to my knowledge, formal studies directly. I'm tying oral health to gastrointestinal health as much as say, heart health or lung health or pregnancy. You know, preterm birth or preterm babies with low birth weight, or even Alzheimer's...
Nick Papastamatis :Tied to what?
Dr. Mathew Ramzy :Tied to oral health.
Nick Papastamatis :Oral health?
Dr. Mathew Ramzy :Yeah. Diabetes. Yeah.
Nick Papastamatis :Really?
Dr. Mathew Ramzy :Yeah.
Nick Papastamatis :Heart health, what did you say that's basically all health.
Dr. Mathew Ramzy :So cardiovascular, lung conditions, diabetes.
Nick Papastamatis :How?
Dr. Mathew Ramzy :Yeah, yeah. So largely due to like of correlation, and even even preterm babies and low birth weight, largely associated with obviously the mouth is a very dynamic environment. And there's constant constantly fluctuating levels of bacteria is the relationship between good and bad bacteria constantly in the balance, and that's what oral health is so important because essentially, when you look inside the mouth, the reason that it's so pink and around the gums it is and around the cheeks because it's so vascular. There's so much blood supply, and it's the most sort of readily accessible interface almost to your to your bloodstream. You know, that's why things can readily absorb under the tongue, things like that. So I think bacteria, it's no different you can have, you know, bacteria disseminate or spread. And they've been found, you know, let's say in people with atherosclerotic plaque in the heart. Which, you know, when people have like a myocardial infarction or something, a lot of that has been a big correlation between some of the really nasty bacteria and the gums and periodontal disease or gum disease, and that and they've been, you know, found when they dissect arteries, that, hey, we're finding these bacteria which cause really gross deterioration of the gums in people's hearts when they had a heart attack. And then obviously, those bacteria can travel to other places is one of them as well. And they have been implicated in some some research in lung conditions. And also in there being studied in Alzheimer's. So yeah, yeah. In some of the plaques there.
Nick Papastamatis :Take care of your mouth guys. Take care of your mouth.
Dr. Mathew Ramzy :Yeah, yeah. And then these these are things I mean, it's..
Nick Papastamatis :Pre term babies like, like underweight babies. Yeah, guys. Yeah. Is this because of the digestion? No.
Dr. Mathew Ramzy :No, no, as I said, it's mainly due just bacteria, which if they're not mechanically removed, and they become entrapped in hardened plaque or calculus, or tarter people call it, then if they're not there well then there, they have no free rein to be very close to your blood vessels in the gum. And they can travel as they do. In terms of the question on the gut. Well, I mean, I don't know specifically about the connection, but I'm sure that there's there's...
Nick Papastamatis :What about amalgam?
Dr. Mathew Ramzy :What about amalgam?
Nick Papastamatis :I don't know.
Jac Simmonds :What's amalgum?
Dr. Mathew Ramzy :Yeah, amalgam...amalgam's are like a restorative material. So it's a silver based alloy that we have used for many years to restore teeth for like fillings.
Nick Papastamatis :I've got patients that have gone in and taken out all their amalgam.
Dr. Mathew Ramzy :Yeah, yeah. Well, look, there are looking at it. Yeah, there are patients There are also countries like, you know, the Netherlands I believe, or the Netherlands I think or Germany that have actually banned. banned. banned amalgam. So, I mean, there are people that have health concerns about it. Here in Australia. It's not banned, it's still legal.
Nick Papastamatis :And we like metals in our mouth.
Dr. Mathew Ramzy :Hmm. Yeah. Look there the in terms of the whole, you know, conspiracy about, you know, Mercury and poisoning and all that stuff, the studies I mean, this is what's very important, because we can prove something versus you know, what somebody thinks, yeah. That the levels...
Nick Papastamatis :The level the Acropolis archives.
Dr. Mathew Ramzy :Yeah, like sharpening your teeth before battle.
Nick Papastamatis :It's, there's nothing wrong with that theory.
Dr. Mathew Ramzy :The I think I've done a few tests and I basically said that the concentrations that are found in your fluid are no where near enough to cause the problems that happens with toxic levels of mercury. Mercury, make no mistake is obviously can be very toxic heavy metal in the right concentrations and that's that's the key thing you know panadol can kill you in the wrong concentration. Yeah. So and the problem lies with you know somebody coming in have you know, a mouthful of amalgam fillings and they think that Oh, hey, if I remove my amalgam, I'll suddenly get better. And then you, you know, may incorrectly promise them that that will happen, which which won't, and then they get upset when all of a sudden they're not cured of their chronic disease. Yeah, or something like that. So, you know, in short, the scientific says no. My particular problems with amalgam is that you know, sometimes it can, in teeth, and over time, it can actually expand and that makes it a lot more prone to cracking which leads them to need more extensive and heavy intervention as opposed to other materials but it's it has in some cases and has been for many years been a very reliable choice of material.
Nick Papastamatis :I think I've got one last one last very silly question. Okay. The gold tooth. Yeah. Now they're they're...
Dr. Mathew Ramzy :You kept asking me about that I tried to steer you away from it.
Nick Papastamatis :I'm not I'm not interested in getting it for myself. Yeah, right. It's for my wife.
Dr. Mathew Ramzy :Her front tooth you want it to be gold.
Nick Papastamatis :I want her left front to be a gold tooth. I want my right front to be a gold tooth. Yes. Just so we're chequered together.
Dr. Mathew Ramzy :I can put your initials in both of them.
Nick Papastamatis :Matching. Yeah. Yeah. Do you get? Do you get many people asking for a gold tooth anymore?
Dr. Mathew Ramzy :Absolutely not.
Jac Simmonds :Was it in fashion at some stage?
Dr. Mathew Ramzy :It actually was.
Nick Papastamatis :Yeah, it was actually very much a European thing to do.
Dr. Mathew Ramzy :I think a lot shouldn't...look gold, by the way is a fantastic material to be used in the mouth.
Nick Papastamatis :It's an anti inflammatory too, isn't it?
Dr. Mathew Ramzy :Yep. Gold is anti-inflammatory.
Nick Papastamatis :They use to use gold to treat inflammatory arthritis.
Jac Simmonds :What you just swallow it?
Nick Papastamatis :I don't know mate.
Dr. Mathew Ramzy :Yeah, they used to swallow gold, there's a number of you wouldn't believe if you look at the Merck manual 1901. So well, you should you should have a flick through that. That'd be a lot of things you'd be very surprised that you read about what was used to treat what. Some of the things that are now illegal heavily punishable by law we use for common things.
Nick Papastamatis :I'm very interested in now what do you mean?
Dr. Mathew Ramzy :Well, back back around the era when Coca Cola used to formulate their drinks with actual cocaine. Yeah. The same time Is that true? I've heard that. Yeah, that's true. Yeah, apparently it's true and even. So there used to be things like in cough medicine over the counter medicine like cocaine and opioids, opium but um, they used to use I think if you look, I think it's 1899 1901 McMahon, you I think we're back In the pharmacy days, I don't know how we stumbled across it. But yeah, they use cocaine for things like asthma. Well, really? Yeah. Yeah. I mean, I don't know what formulation I don't remember.
Nick Papastamatis :It's a bronchodilator?
Dr. Mathew Ramzy :Yeah, but it's mainly uses topical anesthetic nowadays it's used I think, with ENT surgeons during surgery just to control bleeding.
Jac Simmonds :So just a bunch of asthmatic kids run around cooked at school.
Nick Papastamatis :Yeah. Well, that's the thing like sorry miss I'm just gonna.... Can I use your desk, please?
Dr. Mathew Ramzy :Yeah, little Simon needs his asthma shot. And that's perfectly it's perfectly fine. And I'm not sure how you concentrate.
Nick Papastamatis :Is that the whole thing that Simon says? That's where...Simon says I gotta do this.
Jac Simmonds :Little Johnny's extra productive this afternoon.
Dr. Mathew Ramzy :You'd be really sure if you serious if you pick up that that bull army manual. The Merck manual. I think it's 1901 or eight 1099 one of them. But it's, and this is proper, like British pharmacopoeia. It's not some guy written in his garage. This was the mainstay. You know, if you read through that you just look at some of the things that were prescribed even like things like cannabis and stuff. It's crazy. Yeah.
Nick Papastamatis :Then all of a sudden, the pharmaceutical world probably figured out that that stuff actually works. And then they banned it. And all of a sudden, anyway let's not go into that.
Dr. Mathew Ramzy :You gotta be careful because people listening to this and yeah...
Nick Papastamatis :There might be a target on my head.
Dr. Mathew Ramzy :Exactly. We don't talk about China either. No.
Nick Papastamatis :I don't know. I don't know. What are you talking about?
Dr. Mathew Ramzy :Or injecting detol Donald Trump. Inject disinfectant, and goes yeah that should work.
Jac Simmonds :Detol had to put a Twitter post up just saying please do not please do not inject.
Dr. Mathew Ramzy :Yeah. So be careful what you listen to and do your own research.
Nick Papastamatis :I really want to put forward the idea of grinding your teeth to prepare you for battle. I think that is quite plausible. Okay. And I reckon if you read the Merck manual, you'll probably find it in there.
Jac Simmonds :After they've taken some asthma medication.
Dr. Mathew Ramzy :Yeah, that's. That's right. That's right after they've treated their asthma they prepare for battle, I think it goes hand in hand.
Jac Simmonds :Well, that we've just took that over the hour.
Nick Papastamatis :Oh, wow, I was quick, quick, quick, quick. We talked about a lot, a lot he met. I think, I think what we might do is take the opportunity to firstly, thank you for your time. I suppose you know, a lot of our a lot of the listeners might be in Sydney. If they're not, this probably doesn't apply to you. But for those that do. Can you please tell everyone where they can find you and your services?
Dr. Mathew Ramzy :Yeah, I'd be happy to. So I'm currently working at two locations, one in Bondi Junction just actually a few shops down from you, where we are now in Spring Street, Bondi Junction and I'm also working in Sydney CBD in Pitt Street. I I will My name is Dr. Mathew Ramzy I have just started a social media page actually after going back and forth after a couple years but I find that apparently people find that quite useful so um you can find me currently at Dr. Ramzy on Instagram if you need to get in touch with me or probably if your Google search my name as well.
Nick Papastamatis :There aren't too many of you.
Dr. Mathew Ramzy :No now I checked in I think I'm the only one in Sydney so that's pretty cool but you know what I mean? I'm sure there are more but hopefully I'm the special one....will say but yeah I'd love to love to help you within any any inquiries or concerns
Nick Papastamatis :We'll put through your details as well. When when we release this episode and awesome ...and for people that that is your my personal dentist I am and you've been looking after me for several years, couple years now. And thankfully I haven't had too many problems.
Dr. Mathew Ramzy :Now you've been all right. But I do you remember that time I tried to trick your wife?
Nick Papastamatis :Yes. Yes. Should we finish off with that story of...Mat do you wana?
Dr. Mathew Ramzy :Yes, I'd say Nick's got a, it's got a gap gap in his front teeth, a double diastema. And I think one time, we had a bit of extra time within an appointment, and we just thought I was just about to get married, wasn't it? I think it was pretty close. So we thought, why don't we surprise Kat, his wife? And why don't we just tell her that we've closed your gap? So we did a quick, you know, like a mock up. And we closed the gap, you know, just temporarily. And I remember I was like, Okay, well, I can't wait for the Kat's response, right? There's gonna be drastic. She's known Nick as the guy with the gap in his teeth that he loves him for it. Right here. I'm thinking, I've built up this scenario in my head, and I think I can't wait to see Kat's response. And so we send Kat a photo. And of course, what did she say, Nick? She said, Oh my god, geez, your teeth look really white, really white.
Nick Papastamatis :I was upset. It's called. My gap is not there.
Dr. Mathew Ramzy :I said, Wow, this is like a defining moment.
Nick Papastamatis :Has she not noticed my gap?
Dr. Mathew Ramzy :She didn't notice? Wow.
Nick Papastamatis :I don't know. No, she did.
Dr. Mathew Ramzy :She did after a while, and then what did she say to you?
Nick Papastamatis :She said, she said, and then she said you didn't have to do that for me Nick, it was just a joke number one.
Jac Simmonds :Yeah.
Nick Papastamatis :You know what? When I was growing up when I was in high school, I was really conscious of my gappers. That's why I had the braces. Yeah, I got my brace because I didn't want to smile. When you were talking about that. I didn't want to smile.
Dr. Mathew Ramzy :A tower that said, if you've got a gap between your front teeth, yeah, you're gonna get more money or something. Yeah, I think it's a Greek thing.
Nick Papastamatis :Look, it's it has not eventuated. Look, firstly, I chose the wrong profession. And secondly, and secondly, I've got Jac working for me, which means that's where the money's goin.
Jac Simmonds :I've got more room for shit talking.
Nick Papastamatis :More lies yeah.
Dr. Mathew Ramzy :We're yet to see if the the more money through the gap is true.
Nick Papastamatis :Yeah, I don't I really don't. I think the other one was if your hand gets itchy you're about to get you're about to receive some money. Yeah.
Dr. Mathew Ramzy :Or if you if your nose is scratchy somebody or you're gonna be angry, I don't know. And then if your ears scratchy someone is talking about you. I hear all the stuff. I want to see some evidence.
Nick Papastamatis :Yeah, look, I think we should have enough that probably goes in the Acropolis archives as well. Through the Alexandria library don't don't swim too soon after you eat that's a big bullshit.
Dr. Mathew Ramzy :I can verify for that. I was very close to the ...
Nick Papastamatis :What else? What are you going to drown? That's bullshit, man.
Dr. Mathew Ramzy :Nah nah but you should check your underwear.
Nick Papastamatis :All right, Jac's looking at us goin we have gone way overtime.
Jac Simmonds :Too easy. So thanks for that Mat, that was awesome. We covered heaps then so. Yeah, it's been really good.
Nick Papastamatis :Thanks for coming on board.
Dr. Mathew Ramzy :Absolute pleasure.
Nick Papastamatis :Yeah, I'll see you in the end and Jac I think you better book in mate.
Jac Simmonds :I'll be there every day. I hope he wasn't serious when he said I need a clean. I will leave that for exactly. now. I'll be booking in soon. Now. Thank you Mat that we appreciate it.
Dr. Mathew Ramzy :Thanks, guys.