Santa’s not the only one on a journey tonight!

Dear Colleague,

At Christmas time, I find myself reflecting—not just on family and gratitude—but on the long arc of our professional journeys and the lessons that only time can teach.

I’d like to share one of mine.

In 1978, I was a young practitioner and volunteer faculty member in the Department of Oral Surgery at Columbia University’s dental school. What I had learned about TMJ at Tufts—despite graduating magna cum laude—could fit on the back of a business card, with room to spare. I learned little more during my general practice residency, though I vividly remember unlocking a young woman who had sat, mouth open, through a three-hour restorative procedure. She was escorted to the ER—by a poor dentist who was being screamed at and threatened by an irate parent.

I knew enough to know I didn’t know enough.

That year, I attended a lecture at the Greater New York Dental Meeting by Dr. Harold Gelb. I left angry and confused. Some of his claims felt implausible—almost offensive to my academic sensibilities. When I asked my oral surgery colleagues what they thought, the consensus was clear: quackery. I accepted that verdict—and held onto it for over a decade.

At the time, TMJ philosophy lived in silos. Columbia was firmly in the “Chicken Soup” or palliative camp. Others favored medication, occlusion, or appliances. No wonder so many dentists simply ignored the issue altogether—and patients were left confused and underserved.

Yet clinically, something didn’t sit right.

I kept seeing patients—especially those who had orthodontics as teens—with crowded teeth, dysfunctional bites, muscle soreness, and clicking joints I had been taught were “normal.” They didn’t feel normal. They weren’t functioning normally.

So I went back to school, enrolling in a three-year continuing education program in orthodontics and craniofacial orthopedics. I began to understand the relationships between teeth, jaws, and joints. I treated symptoms. I made appliances. I referred to physical therapists and neurologists.

But the deeper question still lingered:

Why?

That answer didn’t arrive until decades later, when I began reading about the relationship between jaw position and sleep—specifically obstructive sleep apnea. For the first time, I truly grasped that jaw position affected breathing. And breathing, of course, affects everything.

That realization changed my professional life.

I enrolled in a Dental Sleep mini-residency at Tufts and reconnected with my friend Dr. Noshir Mehta, who had also moved beyond traditional specialty boundaries into TMJ care. I met Dr. Jamison Spencer, who began his career treating TMJ and later incorporated sleep therapies. The pieces were finally coming together.

Then, in one of life’s great ironies, I found myself relocating my Manhattan practice into the former office of Dr. Harold Gelb—now run by his son. As I began seeing the patients who sought him out, and as we spoke about what he had observed over decades, the final connection clicked.

It wasn’t about teeth.
It wasn’t even about joints.
It was about breathing.

The body will do anything to fulfill its prime directive: breathe. It will recruit muscles, reposition jaws, strain joints—whatever it takes. Once I understood that, nearly everything I did as a dentist took on new meaning.

Dr. Harold Gelb had unknowingly hit on something.  His orthotic device, in some instances opened up the airway.  And by doing so, it impacted other bodily functions, including sexual function.  His observation was correct.  He just didn’t know why.

For years—myself included—we aligned teeth for esthetics and function without fully appreciating why dysfunction existed in the first place. We didn’t yet understand the role the mouth plays in breathing.

Now we do.

And that’s not an indictment—it’s an invitation.

Which brings me to a Christmas reflection beyond TMJ.

What if we thought about our practices the same way?

So many dentists spend their careers treating symptoms:

We apply palliative fixes—new software, another consultant, a marketing campaign, new staff, a bonus plan—without ever asking the deeper question:

What is the prime directive of a healthy private practice?

Just as breathing is non-negotiable for the human body, every thriving practice has a foundational imperative—one that drives decisions, behaviors, culture, patient experience, and long-term sustainability. When that directive is unclear or compromised, the practice adapts in dysfunctional ways… no matter how talented the dentist.

At Christmas—a season of humility, renewal, and honest reflection—I’m reminded that growth in our profession doesn’t come from certainty, but from curiosity. From the courage to revisit what we thought we knew. From asking better questions—of our patients, and of ourselves.

My hope for you this holiday season is rest, gratitude, and renewed curiosity—for your patients, your practice, and your own professional journey.

Warmest wishes for a meaningful Christmas and a healthy, fulfilling New Year,

Michael