Fix Before Six: The Feeding Habits That Shape a Child’s Airway

Welcome back once again. I am super excited about our guest today, Dr. Susan Maples. She's a, probably one of the best, well-known functional dentists in our, in the country. And we're going to talk about a lot of great topics today. We actually have already talked for a while and I'm super excited about today's topic. So after I'll give a brief introduction, we're going to dive right into today's episode. My guest today is on a mission to take a bite out of Americans' declining health, starting in a place most of us never think to look. The mouth. Dr. Susan Maples leads a total health dental practice in Holton, Michigan, and brings more than 35 years of experience, master's in business, and a reputation as one of dentistry's true disruptors. She was named one of the top 25 women in dentistry and one of the top 8 innovators in the field. She's a past president of the American Academy of Oral and Systemic Health and the author of Blabbermouth and Brave Parent, and the creator of tools like selfscreen.net, and the Total Health Academy that are teaching both parents and clinicians how the mouth can reveal what's happening in the rest of the body. Dr. Maples, welcome to our podcast today.

Thank you so much, Aaron. I'm delighted to be here.

Yeah. So, um, I want to first just have you briefly introduce yourself to my audience. You know, what got you into this kind of dentistry? Because I mean, it's a totally different way of looking at things, what your personal story is before we kind of dive into, um, the topic, some of the topics I want to discuss.

Well, my story goes way back to when I was a child. I was born of 2 parents who smoked 2 packs a day each, when a time when the physicians recommended that my mom increase her smoking to relieve her anxiety since she already had a babe in arms and that we were only a year apart. So she doubled her smoking. I was born premature with bad lungs and had all kinds of, I had, you know, 52 allergies, hospitalized 7 times for pneumonia under the age of 12. I had lots of— I was pre-diabetic, all of these, all of the things. And I had a physician in my adolescence who came to my rescue. I was told that I needed to see an internist and they didn't have pediatric internal then. So I was in the hands of a bright young internist who took me on as a resident and she spent a lot of time with me and helped me turn my life around through exercise and diet and Really get off all my medications, get rid of my, all of my allergies. I mean, to imagine that that was possible after the life that I lived was incredible. So that, you know, I would never be in medicine or dentistry without that. And it's always been my goal to try to give back in a way that left people feeling like I made a difference for them. And so I've always been inspired to do it. And I became a dentist at 25. I'm in private practice. I was able to design, you know, the practice the way I wanted to and started practicing total health and never looked back. So I work in, I started a wellness and prevention study club. We have about 32 wellness docs in my area and me that share a lot of patients and a lot of ideas and we meet monthly and So we have a truly a collaborative interdisciplinary team. It's been really a labor of love. And then my ability to teach in front of audiences, physicians and dentists, has been a joy because not only can I just touch individual patients, but I can touch other clinicians to touch more patients like you're doing through this podcast. So my doctor was as passionate as you are, and I'm grateful to be in your presence.

That's awesome. So I want to just dive into it because I was actually just talking with you before we started. We started going on the rapid trails and I was getting really excited. So let's talk about the pediatric airway and sleep apnea. I think this is, this is one, and even the adult world, you know, sleep apnea is something that's commonly overlooked. You know, in my adult world, 10% of adults, maybe 20% have undiagnosed sleep apnea, but kids don't get this, right? This is not a thing in kids we have to worry about, or Is it? And if kids have it, why should we care?

Yeah, it's way more than 10%. We don't really know the extent of it, but it is way more than 10%. We're looking at, uh, it's probably about 38%, I would guess. It's, we're looking at a generation of people my age who were bottle-fed babies, grown up on pureed foods and pacifiers and had underdeveloped jaws. And when I got to dental school, the crowding of the teeth was something that the that in the '80s they attributed to the orthodontists in my University of Michigan, best dental school in the country at the time, just said it was from interdisciplinary or inter— I guess they thought that America was a melting pot and that because we were creating humans Outside of our little bubble, we mixed teeth with large jawbones and, or small jawbones and large teeth. And that until they said, until we got around to back around to marrying our own kind, this crowding situation would go on. So I had the guts to ask, well, what happened to all the large jaws and small teeth? Why aren't we seeing gaps? Why does everybody have crowding? They're like, well, we haven't quite figured that out. Well, it turns out it was a functional problem. And the formula, which was touted as better than breast milk when I was a little child, became the norm. And everybody, unless you were poor, everybody was bottle-fed. And it takes about, in like maybe a 1-year-old, it's about 60 times harder to extract breast milk through a breast than a bottle. So what's happening there is that we're working harder to suck. And when we do that, our tongues become more developed and we grow a bigger tongue box. So let me just back up and say, for all of you who have sleep disordered breathing, upper airway resistance syndrome, or obstructive sleep apnea, or restless sleep, or restless leg syndrome, or any of that, this creates a huge metabolic problem. You know, we can, they say we can live with Without oxygen for 3 minutes, without water for— without oxygen for 3 minutes, without water for 3 days, and without food for 3 weeks. So oxygen is our number one nutrient. And when you are not getting good oxygen, you have brain damage, right? The neurons are very sensitive to hypoxia. And the neurons in the brain are really a small part of the brain. Probably 20%. The rest are like all the glial cells and microglial cells that help the brain recover during deep sleep. So here's how sleep apnea works. During REM sleep, all of your muscles are paralyzed so you don't act out your dreams during your very busiest, you know, brain state of the entire 24 hours. You have these wild dreams and you can't act them out. Well, the tongue is 16 muscles and it literally Falls to its neutral resting position when the muscles are inert. So everyone right now who's listening is able to keep their tongue outta the back of their throat. And that may be something you've learned to do, but if your tongue is not resting right now as you speak with the tip of your tongue on the roof of your mouth and the entire rest of the tongue all the way back residing on the roof of your mouth. So many people feel like, I can feel it in the front, but the back is definitely not there. That's 'cause the tongue never learned to be up there. And therefore, during your early facial development, your tongue didn't do the work to lateralize. So I wrote a book called Brave Parent: Raising Healthy, Happy Kids Against All Odds in Today's World. And it really looks at, in the breathe section, which is subtitled Growing the Tongue Box: The Shape of Things to Come, it really looks at How do we get this collapse of the midface? And so I describe it like the pushing wars. As we grow, the buccinator, the muscles around the lips, and the facial muscles in this cheek area are pushing inward. And the tongue is on the inside pushing out. And if the tongue is either tethered to the bottom of your mouth because you're tongue-tied, or it's just low and lazy because the muscles fail to develop because you're slurping down milk super easily through a bottle and aperture that's too big for you. Then the tongue doesn't get to do its part and the facial muscles collapse that upper arch. So what happens if the palate is narrow and then vaulted like a cathedral ceiling? Well, I want you to keep in mind that that tongue, that roof of your mouth is so, so thin. The bone on the roof of your mouth is literally the bone on the floor of your nose. If I were to drill through it, and I don't recommend you do that, but you'd be on the other side of that pretty quickly. So what's happening as you get these squished, narrowed upper arches that impinge upward like a cathedral ceiling, you're stealing space from the nasal cavity. And the nose has all the magic. Not the nose that's the pointy thing you look at, but the nose in the back of that. All that nasal space is full of little caverns called turbinates. They're covered with mucosa and they release nitric oxide that sterilizes the air. And then there's moisture that humidifies the air and it warms the air, all preparing the outside ambient air And little filaments that filter the air. So all of these things prepare the air to enter the lungs, and it's a perfect setup for success. But without it, if you're mouth breathing, which many people do, if you're mouth breathing by habit or mouth breathing because you can't close your lips in your natural resting position, you're taking all the ambient air in through the mouth. And you miss the magic of the nose. And now we have all kinds of other problems. We activate lymph tissue. So we get overgrowth of the tonsils and adenoids. And that further crowds the back of the throat called the pharynx, the oropharynx, which is right behind the mouth and the nasopharynx. And then the whole pharyngeal space underneath at the hypopharynx. So all of this area gets small and crowded. And when you fall asleep at night, if you go into REM sleep and the tongue slumps back, now all of a sudden air can't be exchanged at all. So you become apneic. Literally the word means without breath, apneic. So what happens then is whenever your brain gets around to sending a poison signal saying, wake up, wake up, or you're going to die of carbon monoxide poisoning or carbon dioxide poisoning, Then we wake up to offload CO2 and we draw in a breath of oxygen. The problem is that that period of hypoxia causes a high risk for all kinds of things we don't want, including as adults, dementia and stroke risk. And so when we see this, the other part about that is that it's not just the hypoxia, but it's the lack of deep sleep. Because I mentioned all those other magic cells in the brain that replenish the brain and help you think better and feel more clearheaded and all of that, make better decisions and stay alert behind the wheel and, you know, and have good mood control. If you don't ever get past REM sleep to the deeper levels of sleep, then we don't get to repair the brain. So we wake up feeling You don't know that you haven't slept. You feel like you've been in bed and you've been sleeping, but we wake up feeling like we haven't slept. And so that literally causes increase in hunger, hunger for quick carbohydrates that are converted to sugar. So we get increase in fat deposition and metabolic syndrome, insulin resistance, all of that, right? It feeds into everything. It feeds into depression, feeds into deteriorating relationships. I mean, I myself wouldn't want my behavior judged on my least best sleep day, right? So we start to say, what could we predict and pre— how could we predict and preempt this during early facial development? And so now I'm finally getting around to answering a part of your question, which is why children? Well, we get to see it very early. The problems we have with musculature in the mouth that start to create what I call deformity in the midface and the palate and the nasal structure don't get any better. The crowding that we see in teeth is just a little symptom, just a little cosmetic symptom. And during the '80s, when this was really starting to become apparent to us, We came in with something called Tweed Orthodontics that caused us to retract stuck-at molars back to make room and to pull teeth out to make room. So pulling everything back toward the pharynx, which further crowds the tongue box. We didn't know it was a problem. We thought it was a convenient orthodontic approach to a crowding situation. If you're just looking at teeth, great. Take out some teeth and unravel the crowding. We have a perfect solution. Unfortunately, all of these kids aged up, and now we consider this a major problem. When I say it's we predict it's 38% of adults have obstructive sleep apnea, that's probably low, Aaron. When you say 10%, that's the diagnosed potential. That's not all the people that died from heart attack that never had a sleep test, right?

So.

When we see little kids, audible breathing, nasal breathing, open mouth breathing, or I'm sorry, mouth breathing and snoring. And we also see that these are the same kids that have bedwetting because the antidiuretic hormone that you should be releasing when you're fully asleep is filling, it keeps the bladder from filling. So any of you adults that say, I only wake up to pee at night, but I wake up 4 times. That's a major clue right there. So the bedwetting for children, the ADHD symptoms, about 40% of ADHD is really sleep deprivation in disguise. It just wasn't diagnosed well. All of the syndrome from ADHD and sleep deprivation look exactly alike. And how do we treat ADHD? With stimulants. Same thing that works with sleep deprivation. The problem is when you give stimulants, drugs that stimulate awakeness in children, and some of them have a half-life, but caffeine even has a major long 6 to 8 hour half-life. So many of these kids that are taking Ritalin and Adderall and caffeine are losing more sleep at night, right? Because now we're blocking that natural adenosine, that sleep hormone. So We're making the problem even worse for them. So there are all kinds of reasons why we might want to get involved with children by taking a look from the very beginning at the suck, swallow, breathe part of it. If they cannot latch on a breast and have a successful breastfeeding, what do moms do? Well, they change direction. They pick up a bottle because you can't have your child not gain weight. So if they can't latch or the mother's in such pain or they get mastitis or bruising or cracked nipples, all of that, then all of a sudden they abort the mission and start breast bottle feeding. So if we could fix the latch in the beginning of a child's life to the point where they can literally bring the tongue up to the whole top of the roof of the mouth and create a really good Breathe, suck, swallow pattern, then we can change the entire shape of their midface. But what if we miss the mark? Well, we have, you know how physicians have these milestones, their benchmarks of growth for children? Well, we have those too. We have measurements inside the arch, the intermolar distance. We have the distance from the edge of the front teeth to the tip of the nose. We look at some of the midface development measures and say, are they Are they growing appropriately? And if not, is it time to intervene? Is it time to create a better bony structure while these bones are super mushable? They're super juicy, right? If we could create a better bone structure, then the teeth won't need an orthodontist at all. The teeth, the teeth will just come in where they're supposed to. And so most orthodontists will only see a child After, well after the 6-year molars erupt. So they're doing expansion like at 7 or 8. But what do we do for these kids that have sleeplessness and they're moody and defiant and their learning ability is limited and they're ADHD diagnosed and they're a hot mess? Those children oftentimes are 3, 4, 5 years old. And by the time they're in middle school, they have a reputation. I've never seen a child that doesn't grow into the reputation created by the adults around them. So when the parent comes in and says, I have 4 kids and this one is my holy terror, believe me, it is a real problem. So how do we help these kids inside of 6 or 8 months change everything, including their future, to try to build a bigger tongue box and work with them on breathing with their lips closed and their tongue up on the roof of their mouth. Now that often you mentioned myofunctional therapy. Myofunctional therapy is like a physical therapist for the tongue, right? Or for the mouth. And what we notice is that kids come out of the womb very undeveloped. They can't hold a pencil. They can't stand up. They can't even focus, but they have this amazing ability to recruit All the neuromusculature to breathe, suck, and swallow at the same time, right? It's absolutely imperative that they're able to do that or they fail to thrive. Now, in our culture, we could give them a feeding tube. We can do a lot of different things, but in other cultures, we couldn't do that. If they couldn't breathe, suck, swallow at the same time, they died. Infant mortality was a lot higher. So what we do with children now is try again to see how We could work with them to develop musculature that would prevent them from having sleep apnea in the future. So while I can restructure the architecture of the mouth through bony expansion techniques and uprighting lower teeth and building more bone around the mandible, we can do all of that, but they still need work to figure out how to use the new tongue box we're creating. So if I'm creating a bigger home for the tongue, but the tongue still can't get there, I have to look at tethered tissues that maybe were missed, like the tongue tie. And also the child has to learn how to create new muscle memory around these 16 muscles that are going to coordinate every time they rest and every time they swallow. So they work with someone called a myofunctional therapist or orofacial myologist. Same, same thing. So that was a lot on one question. Are you sorry you asked me?

Well, no, I've actually written down like 10 other questions. So I don't think we can go through all these questions, but I think just to iterate the aspect of sleep apnea, it's largely overlooked because we think obese males with big necks and we don't think, we don't think ADHD kids. We don't think allergy kids. We don't think Um, just kids with disruption or learning problems. We don't think about kids with like prediabetes. We just don't realize that sleep apnea can be related with so many different things. And we think it's just adults, just people with big necks who snore and have big tongues. And it's actually, I have mild sleep apnea and I've got a skinny little neck and it's like, you know, it's, I wouldn't have known that until I got tested.

Turn sideways. Let me look at your profile.

Yeah.

So you can see that if you put your finger on your nose and your chin and make a straight line, your lips, if you just relax your lips, your lips don't even touch that. Like you're a little deficient here.

Yeah.

You have this profile. Your lower jaw and your upper jaw should be out further. And this is again, part of our culture from eating pureed foods. And, you know, we didn't have blenders 200 years ago. We didn't have sleep apnea, right? We didn't have bottles, you know, rubber nipples and plastic pacifiers and things that shake the mouth without our, you know, people, little kids' mouths are shaped exactly like the piece of plastic they choose in the store. And if you think about it, the tongue is pushing up on that little bobble, creating a nice little wraparound, a nice little mold of that. And then the, even the pacifier, the little guard that's around the pacifier, every time you suck in puts a little more pressure backward on those upper and lower jaw development. But one thing I was going to tell you is you mentioned the fat old man with the thick neck, right? It's interesting that the number one demographic for something called upper airway resistance syndrome, UARS, is thin fit females. And males like you, you're not female, but you're thin and fit. And so typically those don't show up on the sleep apnea test. So let me tell you why. With upper airway resistance syndrome, instead of— so when you take a sleep test, whether it's a home sleep test or a test that you do in clinic, right? You get something called an apneic-hypopneic index. The apnea, they measure how many times in an hour On average, do you stop breathing for 10 seconds or more? And how low does the oxygen go during that time? Those are the big scary things, right? But with upper airway resistance syndrome, healthy, younger, especially people, when they stop breathing, they may not stop breathing for 10 seconds. They may stop breathing for 6 or 7 seconds, right? Before they have a respiratory effort. And that's what they're— what's called a RERA, the respiratory effort to breathe. And when they do that, oftentimes they take a breath. So it never gets registered as an apneic event. It doesn't get scored in the positive column. Because when you get diagnosed with sleep apnea, it's not like, do you have it or don't you? It's how many of these episodes did you have per hour? All right. So if you don't show up with any, you assume you don't have it. But if you're waking up, let's say 30 times an hour, but you've only gone, you've only had like a 6-second gap and then had a rerun effort to breathe. You also never get past REM sleep down to deep sleep. So these thin fit females that have never been diagnosed with sleep apnea or people like Aaron Hartman, right? You end up with syndromes and oftentimes we see— All of the, like, fibromyalgia, chronic fatigue, chronic pain, all of the things that come with autoimmune disorders that are really related to your body's inability to repair during deep sleep that just keep cascading or adding on. And I think that upper airway resistance syndrome, which is pretty common in children these days, is much more significant than we think. Unfortunately, it's harder to measure. They have, you have to have a sleep technician actually count RERs. And so you have to be in lab with a technician or swallow one of these intrapleural monitors. It's like a little pressure gauge that you swallow, like a little balloon, which is, it's an inter— it's a pharyngeal balloon that measures intrathoracic pressure during these episodes. So it's not easy. I'm hoping it will get, become easier. And I'm helping more people become able to avert that.

What's interesting with mine, because, um, I never dreamt in my— I always told myself in college and medical school, you know, a superior mind doesn't need to dream, which is a very egocentric way to think.

I'm sorry to hear it.

Yeah, I know. It's like now I realize I was suffocating my brain for 40 years or whatever. But when I did my home test, you know, my HI, Apnea-Hypopnea Index, was like 4 to 6, which is not bad.

Nope.

And I desaturated to 90%. And I was like, I'm desaturating 90%. That doesn't quite make sense. And I have a little bit of a high, you know, narrow dental arch, high arch palate. So, I went on and got a dental device because I also grind my teeth, have a little bit of TMJ.

Oh, yeah. Oh, it goes right with it.

And I spit the dream for the very first time. And I was like, oh my gosh.

Oh, Aaron.

Yes. And so, So now I dream every night because I wear my oral dental appliance. But the point is, like, how many people like that who have an increased risk for dementia and prediabetes and all kinds of things are not being— are being missed because we're not using— we're using like the old obese numbers. We're not using a functional perspective.

You've had that your whole life, Aaron, that upper airway resistance syndrome. It is the precursor on the scale of sleep apnea. If you were to go back and do a sleep test in lab now without your appliance in, you, and ask them to look at RERAs, I'm guessing you'd have a lot more than 4 to 6 an hour.

Yeah, this is a home test based on monitoring.

Yeah, it's only going to, it's only going to look at apneic events. But anyway, I know we're not supposed to be talking about our personal health, but I, it's, it's fascinating, right?

But so let's, let's. into this a little bit because I don't think people— well, let me just— I'm just going to put something out there. I'm going to ask you a question. So, you know, in adults, you know, sleep apnea, metabolic syndrome, diabetes, you think heart disease, obesity, the PCOS, which is now polycystic— polyendocrine metabolic ovarian syndrome.

Yeah.

It's like all these infertility, dementia, heart attacks. But in kids, it's behavioral issues. It's ADHD. It's learning.

It's obesity. Yeah.

It's a whole bunch of things. It's not necessarily bad kids. And so all of a sudden, you know, are we screening all of these kids? Are we getting more and more and more of them? Are we screening them for sleep apnea? And the answer is no.

And honestly, screening for sleep apnea, like getting it in lab for a study, isn't as helpful as just fixing the problem because they may not register. They may just have upper airway resistance syndrome and they grow into it like you have.

But the thing is, how many— okay, so let's Let's take a little over. Let's jump off the road here for a second. So how many of these kids, like orthodontic issues, pay for orthodontic stuff? Let's talk about the actual addressing it before it's a problem in childhood. So you have narrow airway, sucking a bottle. What's the earliest? What should a parent be looking for in their 1-day, 1-month, 1-year-old if they have an issue? And what's the earliest you can actually start addressing this? And I'm thinking about your parents preventing orthodontics, preventing crooked teeth, preventing a lot of things. When do you start with that? Or when should you start?

Day old. Day old. I've got midwives who refer to me on the very day the child's born. It's really weird to work on a baby the day they're born. But I will tell you that right away, especially moms who Have nursed three other babies, and they know there's a problem. But if there's a failure to latch, and you've got a good IBCLC lactation consultant, a good pediatrician, or a good midwife who can literally look in the mouth, retract the tongue, and see that they can not only lift the front of their tongue, you know, to a point, but the back of their tongue. Can lift as well. If it's tethered and the baby can't get the tongue over the top of the bony ridge where the teeth go, right, to get on the bottom of the areola of the breast, if the tongue can't do that and sustain it, if they can do it, but they take 3 or 4 sucks and they pull back and then munch down on the mom with the bone, it's a problem, right? So we should be better at evaluating the suck because That it's— I'm okay with children receiving breast milk through a bottle, but it is the function of the breast that grows the arches. And so if we could help that, and I'm not here to shame anybody who is not able to breastfeed or chooses not to, I think you can get a slow-flow nipple and you can keep it slow. Don't change the aperture and have a child work harder. And we can start to switch not to sippy cups, but cup sipping or cup Sipping so we can lateralize the movement of the tongue. There's other things you can do. But I do think that you asked how early can we see this? You can see it in little babies and we can predict and preempt that. And then if we miss it, we get this little gap where you can't do a whole lot with a 2-year-old. I'm not appliance-ing 2-year-olds and they're not attentive for, usually for, For myofunctional therapy. We have little trainers that they can use to munch on, to strengthen their tongue, to do some early myo, and to do a little tiny bit of expansion. We can get rid of pacifiers. We can do some of that. But for the most part, that 2-year-old is hard. By 3, many times, even with kids who have disruptive behavior, tantrums, I mean, it's really hard to tell whether a 2-year-old's just a typical 2-year-old tantrum kid or— A kid that really is falling behind in terms of enjoyment in life and learning ability. But by 3 and 4, we can start to fix these. And my motto is fix before 6, or at least get going on that process before 6. So there are— most dentists are not doing this. Most pediatric dentists are not doing this. Most orthodontists are not doing this. So if I'm creating a deficit right now and it makes you feel like, okay, now I've got this child and I need Susan's number because I got to figure out if I can find a dentist in my area who will do this. I think it's very hard. I've been on an international consortium to try to help build this awareness and help dentists jump into the fold all over the world. Most of the dentists who are doing pediatric airway development, including pediatric orthodontics, are dentists who work forced into it because they recognized that their own children needed help. And so they go to classes and figure it out and start to treat other kids. So the IBCLC, the Internationally Board Certified Lactation Consultant, is the one who generally would help with the difficulty to latch. And if you're born, if a baby's born in like an urban area where there's an IBCLC on staff Monday through Friday, 8 to 5, maybe they would see someone in the hospital, maybe not. Sometimes they don't go to a lactation consultant unless they're having problems. But they also are not necessarily looking for tethered tissues. They're looking for different techniques. They're looking for ways. So not every IBCLC is in the know on tethered tissues. We also look at the labial frenum from a standpoint of like the little thing that connects your upper lip to your upper to your, their gum tissue. If that is really low and the, and the lips are blistered because they're, they're too, the lips, the upper lip is too tight and can't flange out on the top of the breast, the top of the areola, areola, then you often see some pretty significant upper lip blisters and bruising on the, you know, soreness on the top of the mom's breast. We also release those. These are simple soft tissue releases. I always say to parents, like, you know, pediatricians have been like combative almost, like, oh, it's the dentist's way to make money. I'm thinking, are you listening to your patients? Because we had 2, we have 11 pediatricians in one group in my town. And when 2 of them ended up coming within a year for their own child, then all of a sudden the game changed, right? But a lot of times they were naysayers and I am not saying everybody doing lip and tongue ties are well-trained. I can't speak to that. I can just tell you that it's pretty powerful when you experience within 3 weeks kids getting off feeding tubes or all of a sudden jumping out of their danger, you know, danger with being able to feed and to get off bottles and back on the breast. And it's pretty impressive. But I don't think that pediatricians are often, they don't, and I will just say no shame to you, Aaron, or your profession, but the medical students rotate through every single specialty except dentistry. You know, when we disconnected the body in the 1800s, we gave the heart to the cardiologist and the kidneys to the nephrologist and the skin to the dermatologist and on and on it goes, right? We gave the entire mouth to the dentist and it all took place in another school. So while you're going through medical school, you get zero training on the mouth. Zero. Like literally physicians look from the tip of the lips to the back of the throat and don't ask me what they're looking for back there because the back of the throat is a great way to predict whether someone has sleep apnea. The Mallampati score, the drape of the soft palate, We're looking at, uh, you know, whether or not you can even see the posterior pharynx. You can predict, and if you have someone lying back in the chair like we do and you look in the mouth, you're looking at it in their sleeping position rather than you guys who look at them sitting up on a, on a bench. So the mouth is a fabulous predictor of all this. Um, my dream in the next couple years is to try to make it in to speak to more medical groups. Physicians don't want to hire dentists. Hygienists don't want to hire dentists. People hire from within their profession. But I really want to be more in the— help physicians see what, just by a simple look in the mouth, what is possible for them. It's not just how oral disease impacts the body, but what they can tell, what early smoke signals they see. I mean, diabetes shows up first in the mouth. We have all kinds of problems, fungal infections and nutrient deficiencies. And how do we determine whether the bleeding of the gums is from plaque around the teeth or whether it's from gluten sensitivity? Like, how do you know this? Right? So a lot of it is like, I really would love to speak to more medical groups. If you can help me with that, that would be great. But it's true that we could do a lot better in our collaboration.

Well, it's interesting because A4M just started a, um, I think last year, maybe a small, it's like a mini course on functional dentistry for doctors. And with—

I'm on the faculty.

Well, that's actually how I got your name because you're one of the people that are lecturing. And so I was like, let me, let me send you a message through social media. And that's kind of how we got connected. But it was interesting just going through that. And it's like a lot of that I'd figured out, some of the things I've figured out over, you know, the last 15 years of doing functional medicine, but it was really like, it took me 15 years to figure out a lot of these things that I literally was able to learn. And, you know, whatever it was like, you know, a couple weeks going through the coursework. But just even like doing DNA testing on biofilms in the mouth and finding bacteria that was associated with cardiovascular disease or IBS or inflammatory bowel disease. Yeah.

Crazy, right?

Yeah. Or autoimmune problems. And it's like, okay, we need to do oral biofilm, oral work to actually work on your cardiovascular, gut, autoimmune, inflammatory stuff. So, You know, that's kind of— I recommend people do that who are physicians or providers because it just, it's not going to make you a functional dentist. I'm not a dentist, but it actually, if you're a non-dental medical practitioner, it gives you the idea that, holy moly, I need to put my team together. I need to get my stuff together because I can't address it. I need the right people on my team.

That's right. That's right. And you got high inflammatory panel, interleukin-6, interleukin-1, tumor necrosis factor alpha, you know, CRP levels that are high. And you can't find anything, definitely refer to a dentist who is astute in looking for periodontal and endodontic issues. A lot of patients will say, oh, I get my teeth cleaned every 6 months. And, you know, let me tell you what, I, our preventive cardiologist refers to us for a dental exam all the time. And it's amazing to me how many people are seeing a dentist regularly and someone's overlooking the fact that there's 4 and 5 millimeter bleeding pockets in the back. And they're like, oh, you gotta floss a little better. Never looking at the biofilm, never spitting in a cup and taking a look at what's growing there, what anaerobes are growing in those sockets that are being absorbed into the body and circulating through the bloodstream and creating a major cardiovascular risk.

Or you've had 4 root canals that are 30 years old and no one's bothered to do a cone CT to see if there's resorption or, you know, it's just super basic stuff or, oh yeah, I've had That root canal failed and they did an apexectomy and they put a cap on it and now it's fine, but I got some, I get some sinus problems. I'm like, is it sinus problems or is it the chronic infection in your tooth that's, you know? And so, it's just having your eyes open to like, wow, I need this person on my team if I'm going to give people whole body health.

Yeah.

But I want to get back to the dental thing because I think a lot of, I think I'm really passionate about personally about If you can get kids early and change their diet, change their environment, change their food, you can literally like change their entire life. And I think—

Absolutely.

Oh, sleep apnea, dental crowding thing is important. I think in general, because sleep apnea is ridiculously common. So, from 3 to 6 is when they can actually start. So, birth, they get with a lactation consultant or someone that can actually— a functional dentist that can help them with this. So about 3 to 6, is that when some of these expansion devices can start being used? What's the age at which the kids can actually, if they have a high arch palate, if they have crowding, that you can start using some kind of devices?

As soon as they'll tolerate us with a wand scanning the mouth and getting an appliance in there. And honestly, a lot of these kids, when we start working with them on desensitizing their mouth to having stuff in it, are good. You mentioned food. A lot of these same kids have gagging problems. They, they have texture problems. They only want pureed foods and pouches and sucking down applesauce and, you know, smoothies and things like that. And so these are the same kids that like don't wanna tolerate anything touching their tongue and they'll gag or something. So we can desensitize them pretty quickly and get, get 'em in and get an appliance in their mouth and start. And then once we can do that, we are just, we're grooving. We are just on, we're on giddyup mode. And, and when, when we're working with them over the course of a year or so to try to change all of this. I will tell you, we work a lot with the families on, you know, getting rid of processed foods and introducing whole foods. And I have developed some food rules. They're really called food pillars now. It's a nicer word, I understand. But they were developed by eating pathologists and myself and Esther Rose Park, a PhD at Michigan State University, a number of years ago. And they're really on building better relationships with food, not using food as a reward or punishment, and not forcing or restricting food. And they also go into like getting all the sugar beverages out of your house, you know, getting rid of all commercial breakfast cereals and trying to get kids to eat whole foods. And there's one on there that is really about neuroplasticity. And we all know this, if you start to Make a healthier choice and you do it for a while, it becomes tolerable and then it becomes preferential. That's neuroplasticity. So with kids, we talk about this, we talk about this idea that they have a polite bite, that they taste everything on their plate. They don't have to eat it. They don't even have to swallow it if they're a severe gagger, they could taste it over the sink, but that they start to register the taste. And then they start to build synaptical responses around that. I mean, there's a reason why Australians like Vegemite in the morning and we like peanut butter, right? It's because we've developed a taste for it over time and time of taste and taste and taste. And I will tell you, it takes about 7 to 8 tastes of a food on average for them to like it. That's the average because savory foods are a little, take a little longer. And, you know, it doesn't take kids long, long to get used to a Reese's peanut butter cup, right?

Yeah.

So that whole idea is that we have The ability in our practice to shape the entire fabric of these children's lives. And in the Brave Parent book, I start out chapter 1 with eat, and chapter 2 is drink, and chapter 3 is digest, which is building microbial diversity in the gut to get rid of allergies, autoimmune diseases, eczema, all of that, right? It's like, how do we help these young parents who Find themselves pregnant, often with bad habits themselves that they're promulgating onto their children. How do we help them rethink what they're doing in their homes? And you can change everything because what we know about diabetics is this insulin resistance has been there for decades for many of these people, right? Cardiovascular disease in process for decades. So how do we turn this around? Getting some daily movement, getting kids outdoor play, exposure to more microbes on the outdoors, you know, less about indoors, not over-sanitizing their homes, which changed a ton during COVID You know, how many people have a bunch of stuff that kills 99% of all germs and they don't mind spraying it around every time they use the bathroom? It's like, what? And on their hands and on their skin. This is crazy.

Yeah.

It's— So.

Those chemicals are horrible. You know, it's, um, now help me understand.

Okay.

So we got the 3 to 6, start working with someone.

Yeah.

What's the latest, you know, cause when do they, what's the latest that there's different, different devices to help with spreading the palate, um, making the dental arch wider, creating space. What's the oldest or latest that that can be helpful for a person?

So the cranial sutures are the sutures in the brain that grow when the brain grows, right? The baby's born with about a head that's about 33% adult size. And by 2 years old, it's 80%. So the head's growing, and as it does, the little plates of the skull are growing in there. They have these little zigzagged lines, for those of you who've never seen a skeleton. And these zigzagged lines, once the head is shaped, they fill in, the bone ossifies, right? So it's no longer flexible. Well, the palate does the same thing. It's got a zigzagged line of bone. It's a jigsaw puzzle in the middle of the palate that literally spreads apart.

Easily.

And then it takes about 6 to 8 months for that bone to ossify. And what we're trying to do with kids is move that apart before it's impossible. Now, what we find is that women, especially thin women, you can sometimes do that right on up into early adulthood with low, slow pressure on the palate, not tipping the teeth, This way, but literally spreading the bone. With boys, earlier and heavier bones, so then sometimes they need to go in and have the palate zipped apart and spread out surgically, which is possible. But what we're— what we do sometimes is we put an appliance in that has little tiny implants that drill into the palate. They're really small implants. I mentioned that that palate is thin, so they're really tiny little implants. That go into there. And so when we're cranking it, instead of moving the palate, uh, with just anchoring it onto the teeth and the, and the gums, we're basically, uh, taking this appliance and anchoring it into the bone and turning it. And then it kind of does these little microfractures and pulls it apart and then starts to spread. So it's not a clear-cut answer what you're saying. There isn't like a particular age that it's just a cutoff. Right. But we, I can tell you it's a lot less traumatic. Kids are super flexible. They're really resilient and their bones just change really fast because that suture is really mushy. So we can kind of crank on them.

And these procedures, are they, who does this? Is this a functional dentist? Is it a functional orthodontist? Like who's doing like those actual procedures where you're drilling in and zipping the palate and spreading it up?

So again, I think the airway orthodontists are few and far between. There's a handful of, you know, maybe a dozen orthodontists in the country who I know and run in my circles who are masterful at it. But we also have a whole group of pediatricians that are masterful, and then a whole group of general dentists who are masterful. But these are people, again, I could, I can count them Almost by name, and maybe I know 45 in the country. So this is not like they're in every town. Not like if you just called a person that called themselves a functional dentist, would they even treat kids, right? Or, and most pediatric dentists are not involved in this. The caries rate in our country, the cavity rate from caries disease is rampant. It's the number one disease on the planet, and it's not going anywhere because our sugar consumption is whacked out of control. And so we, they can't keep up with trying to put the fires out, just drilling holes in teeth. By the way, drilling a hole in the teeth is not treating a cavity problem, right? It's treating the ramifications of disease. It's not the root cause. The root cause is, again, the diet, the frequency and the amount of the carbohydrate consumption. So yeah, most pediatric dentists and aren't into airway at all. And there are some who have left pediatric dentistry proper to do just pediatric airway. And again, you can find them if you look under pediatric airway specialists. But not everybody does this, even though my orthodontist in my town might talk a good talk, and they don't necessarily expand to where I'd like them. And then I have to ask them to re-expand, right?

That's been great information. Dr. Maples, I want to respect your time because we've been talking almost an hour at this stage. I feel like we could just keep on going. I had like, you know, my 1, 2, 3, 4, 5, 6 pages of questions and I got through like one of them. So I feel like we could be here for a bit.

So if people want to— We can talk about adults sometime too, periodonties and all the— yeah. And acid reflux and diabetes and things like that.

Great. If people want to learn more about you, what you're doing, get some education from you, because you are, I mean, a wealth of education. How can people learn more about you and what What are you doing right now? What are you doing next that you'd like to share with the audience?

Well, that's a good question. I kind of take, I like to take the summer off from speaking. I do things like this, but it's about to ramp back up because school's in session. So I'll be speaking all over the country very soon here. So I'll be all over the place. But I have a website called drsusanmaplespeaker.com, also Total Health Academy for those of you who are interested in, it's really more designed for dental practices, but it For those of you who are interested in learning step by step how to do all of this stuff and how to get exposure to total health and dentistry, and then I also have a couple books you might be interested. Blabbermouth is 77 secrets only your mouth can tell you to live a healthier, happier, sexier life. That book is all about adults, and the Brave Parent book is—I don't want to say all about kids because literally when you read it. You will be parenting yourself all the way through it too. So there's a whole lot there for adults and kids. Um, they're both evidence-based. There's literature in the back of each section, references in the back of each section. But, um, those are some ways. And then my cell number is 517-819-6330. I know I'm generous with it. I find most people don't abuse it, but if you want to hear more, you've got a burning question, you want to give me some feedback on this podcast. My email address is susan@drsusanmaples.com. So S-U-S-A-N-M-A-P-L-E-S dot com. susan@drsusanmaples.com. And my dental practice is Total Health Dentistry in Holt, Michigan. So those are some ways to get through to me.

Great. Well, thank you for that information. And maybe we'll be lucky enough to have you again on our podcast a future date to talk about some other topics as well.

It would be my pleasure. I owe you because I'm sorry about the last blip in the week's schedule. So thank you for hanging in there with me and honoring me in this hour.

And thanks for coming out. I really appreciate it. And hopefully this was helpful to everybody, and I'll talk to everybody soon.