COURSE PREPARATION MATERIALS

Advanced Neuromuscular

Team 1

LVI Global 1401 Hillshire Drive, Ste 200

Las Vegas, NV 89134 www.lviglobal.com

888.584.3237

LVI Global | concierge@lviglobal.com | 702.341.8510 fax

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 | concierge@lviglobal.com | 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 | concierge@lviglobal.com | 702.341.8510 fax

Hamular Notch

LVI Global | concierge@lviglobal.com | 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.

Please note the notch areas are smooth and without distortions.

Caliper

Hamular Notches Hamular Notches Marked

LVI Global | concierge@lviglobal.com | 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 | concierge@lviglobal.com | 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 | concierge@lviglobal.com | 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 | concierge@lviglobal.com | 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 occlusion and their bite

HEALTH HISTORY

Name: ___________________________ DOB: ______________ Age: ________ Sex: ___________ Height: __________ Weight: __________

Medical History Y N Abnormal Bleeding Y N Alcohol Abuse Y N Anemia Y N Angina Pectoris Y N Arthritis Y N Artificial Bones Y N Artificial Heart Valves Y N Asthma Y N Blood Transfusion Y N Cancer Y N Chemotherapy Y N Colitis Y N Congenital Heart Defect Y N Cosmetic Surgery Y N Diabetes Y N Difficulty Breathing Y N Drug Abuse Y N Emphysema Y N Epilepsy Y N Fainting Spells Y N Fever Blisters Y N Frequent Headaches Y N Glaucoma

Y N Hay Fever Y N Heart Attack Y N Heart Surgery Y N Hemophilia Y N Hepatitis A Y N Hepatitis B Y N High Blood Pressure Y N HIV&AIDS Y N Kidney Problems Y N Liver Disease Y N Low Blood Pressure Y N Mitral Valve Prolapse Y N Pace Maker Y N Pneumocystis Y N Psychiatric Problems Y N Radiation Therapy Y N Rheumatic Fever Y N Seizures Y N Shingles Y N Sickles Cell Disease Y N Sinus Problems Y N Stroke Y N Thyroid Problem

Y N Tuberculosis Y N Ulcers Y N Venereal Disease Y N Yellow Jaundice Y N Do you Smoke/use tobacco If you are Female Y N Are you on birth control? Y N Are you pregnant? Y N Are you nursing? If yes # of weeks: Allergies Y N Aspirin Y N Codeine Y N Dental Anesthetics Y N Erythromycin Y N Jewelry Y N Latex Y N Metals Y N Penicillin Y N Seasonal Y N Tetracycline Y N Other _____________________

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 _____ _____ Chance of dozing _____ _____ Sitting and reading _____ _____ Watching TV _____ _____ Sitting/inactive in a public place _____ _____ As a passenger in a car for an hour without a break _____ _____ Lying down to rest in the PM when circumstances permit _____ _____ Sitting, talking to someone quietly after a lunch no alcohol _____ _____ In a car, while stopped for a few minutes in the traffic_____ _____ TOTAL

Scale: 0 = Would never doze

1 = Slight chance of dozing 2 = Moderate chance of dozing 3 = High chance of dozing Score: 0-10 Normal range 10-12 Borderline 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 Gums 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 lips/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 ____ TMJ Pain ____ TMJ Noise ____ Limited Opening ____ Ear Congestion ____ Vertigo / Dizziness ____ Dysphagia (difficulty swallowing) ____ Loose Teeth ____ Clenching / Grinding ____ Facial Pain

____ Tender, Sensitive Teeth ____ Difficulty Chewing ____ Cervical Pain ____ Postural Problems ____ Fingertip Paresthesia ____ Thermal Sensitivity (Hot / Cold) ____ Trigeminal Neuralgia ____ Fibromyalgia ____ Bell’s Palsy ____ 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 Lip 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 ____ Crossbite

Name: ___________________ DOB: ______________ Exam Date: ____________

Existing Restorations

Tooth No. US (International)

Present Condition Diagnosis Recommended

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 US(Inter.)

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)

Lingual

Lingual

Tooth US(Inter.)

32 (48)

31 (47)

30 (46)

29 (45)

28 (44)

27 (43)

26 (42)

25 (41)

24 (31)

23 (32)

22 (33)

21 (34)

20 (35)

19 (36)

18 (37)

17 (38)

Facial