Airway, facial pain and Tooth Movement with Dr Bill Hang

Hi everybody, I'm Dr. Sanda Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body as we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most in a natural way. Hello everyone. Welcome to another episode on the Holistic Dentistry Show. I'm your host, Dr. Sanda Moldovanova, and I have a very special guest today who's been really a pioneer in the world of airway and orthodontics. So listen in if you're interested in learning, for those of you dentists and hygienists, how you can improve your patient's airway health, not just their Smile. And for those patients that are listening and you really want to do, you know, orthodontics the right way, definitely listen in because you'll find out how that is really being done and what have we learned from our past treatments. So Dr. Bill Heng, welcome to the show.

Thank you. Nice, nice to be with you, Sanda Moldovanova.

Dr. Heng, I want to tell you a little bit about him. He was at the top of his class at University of Illinois College of Dentistry and you, received your MSD in orthodontics from the University of Minnesota, where you briefly taught orthodontics there. You were traditionally trained and extracted teeth for crowding and often retracted teeth, meaning bringing them back. Teeth were considered more or less a separate part of the rest of the body and simply needed to be straightened for aesthetics. So Dr. Hing, how, how and when Did you have a realization that maybe that's just not the way we should be doing things?

I had been in practice for 5 or 6 years when I began to look at the faces that I was developing after the teeth were straight. And to be honest with you, they didn't look as good as before I started treatment. And there were some general dentists in the profession who were very strong in their opposition to orthodontists, particularly taking out teeth and retracting. And I initially dismissed what they were saying, but once I saw it in my own patients, I began to know that they were right. In addition to that, they were claiming that orthodontists were producing temporomandibular joint problems. Again, I dismissed that, but then reality hit me and I saw that what I was doing was number one, not making faces attractive. They were less attractive. And I also saw jaw joint problems. So I embarked in 1981 on a very, but as a continuing education journey that still, even though I'm semi-retired, I'm still learning. I, I never stopped going. So I, I've been in more than 50 states and over 30 foreign countries in my travels trying to find out better ways. And I was practicing in a small town in Vermont where I started experimenting, doing new things that I learned from other people. And my practice grew because people's faces were, the kids' faces were better. And I had people coming from all over the place to see me because I had stopped taking out teeth. But it wasn't until really 1990 when I learned how to really optimize facial balance. So I met an orthodontist from London, England, and he was developing the Face Forward, and he had a philosophy of, number one, why does anyone have a malocclusion? I'd been taught it was largely genetic, but in reality it has nothing to do with that. And we've really, if you really dig deep, we've known that for since many years, since at least the 1800s. And so he talked about how the entire face falls back, the upper and lower jaws both fall back. And as that happens, patient doesn't look as good at all. And if you take out teeth, that frequently will make the face even fall back even more. And I have plenty of things, including articles from the refereed literature that support me in making that statement. So I learned not to take out teeth. I learned to develop the face forward. And it was interesting because I set up a new practice in California in 1997. And it was in the year 2000, I was one evening, I was looking at pre and post treatment lateral head X-rays. Of kids that I treated in the mixed dentition, 7, 8, 9-year-old kids. And I saw literally dramatic changes in the airway behind the soft palate and behind the tongue. This literally blew me away. I went to an American Association of Orthodontists meeting in May of 2001 in Toronto, and I looked at all the American Board of Orthodontics cases that were on display there. These were classically, quote, great cases that people became board certified by treating these cases. And what I, I measured the pre and post treatment bilateral head x-rays, and what I saw was very, very compelling. It was very sad because I saw the airways were getting smaller with most treatments, not all, but most. And as my practice changed, everything changed and everything became totally focused on airway.

So, I mean, you, it's amazing to me that, you know, you started looking at the airway, something that commonly orthodontists look at, or not really?

You're gonna blow your mind when I tell you, I couldn't look on a lateral head x-ray and know where the adenoids were. In my training and my traditional orthodontic training, we really did not discuss airway. And I couldn't have, I couldn't have identified where the adenoids were on a lateral head x-ray. It was just a non-issue. And here I am learning about this. And, you know, when I finally started listening to my patients, that's when I really learned. I had a, in The early '90s, I had a woman come to me with a severe TMJ problem. And she'd— this was when I still practiced in Vermont and she'd been seeing a bunch of orthodontists, all of whom were gonna take out teeth. But prior to the advent of the internet, she'd even heard about me that I didn't take out teeth. So she came to visit me driving past a whole bunch of orthodontists and I didn't take out any teeth. And I had her an appliance that developed the face forward and the thing broke. And she was, she was happy when she had the appliance in, but when it broke, She was distraught and almost in tears. And she said, Dr. Hang, she says, I didn't tell you this, but when I came to see you, I was suicidal. This was a 35-year-old woman. I felt great when the appliance was in place, but when it broke, I felt like I did when I came to see you. I felt like I was going to drown or choke to death. Those words hit me, and it was those words that made me go and look at the lateral head X-ray to look at the airway. And I didn't even know what a normal size of the airway ought to be. I called up my oral surgeon friend who did my jaw surgery cases, and he told me it was 10 or 11 millimeters in this one area. And I said, well, oh my gosh, this woman has 3 or 4 millimeters. All of that completely changed my focus so that from that point on in my practice, every patient I'd look at, the very first thing my eye would go to on a lateral head x-ray was to look at the size of the airway. Now, for those who are skeptical about that, I, I will never tell you that the exact size of the airway is diagnostic of having or not having, for instance, obstructive sleep apnea. But having said that, if you could choose your airway, you would be best advised to choose the biggest one you could ever get.

Definitely.

I would. We can do that by what we do and what we don't do. In reality, we really are affecting the size of the airway, and that's a big deal. So I, I say that dentistry really is at, at the key. We are the We are the key of health, healthcare. We're the gatekeeper to health. Without good breathing, nothing good happens.

I agree with you, especially with sleeping. There's so many people that are, you know, have sleep apnea undiagnosed. Nowadays I do CT scans pretty much for everybody coming into my practice. And I look at the airway and I see the narrowing of the airway for a lot of people.

Yeah, it's there. And when people look for it, they're amazed that these people have been in in your dental practice all along, and only now you realize it. And then you say, oh my gosh, I wish I'd known this years ago. And that's of course the way I was when I really found out all this information.

So you mentioned you, you never extracted teeth, even with, you know, when somebody comes in that has really severe crowding, are you expanding the palate?

It's interesting. You know, when I, I can, I can be speaking, I have done this. I've spoken to groups of orthodontists and things were going really well. And they're listening to me and asking questions. And as soon as I say that I quit extracting teeth, the air gets sucked out of the room. I might as well leave. I'm now a leper. I'm an untouchable because we've all been taught that if you move the teeth forward, you're going to push them off the bone support and you will not maybe lose teeth. Now, yeah, I was trained that way and I was just at a meeting. I will not tell you where, 2 months ago, where basically that very thing was, was, was talked about. If you move teeth forward, you're going to cause tooth loss. Therefore, we're recommending that you do these things to avoid that. Well, in September of 1989, I had a 27-year-old woman consult with me. She was desperate. I'd actually seen her in 1985. She came to me and had a pain pattern. She'd had two upper lateral incisor teeth removed as part of orthodontics. Believe it or not, her face was caved in like she'd been hit by a baseball bat. And she had a headache pattern. And I, in 1985, I looked at her and said, you know, I would never have taken out these teeth and you probably need to have the spaces open, but I don't even know that it could be done. So I can't help you. Nice talking to you. I'm sorry. She came back in September of 1989 and I had done a lot more continuing education and I was, I was, had appliances where I was opening spaces for crowded teeth, for instance, upper cuspids that were really crowded. I was taught to take out the first bises. I had stopped doing that. Any amount of crowding that I had, head I could get rid of and, and still get all the teeth in and still have plenty of bone support, by the way. And that's the big thing. Orthodontists are told if you move the teeth even a little bit forward, you're gonna push them off the bone.

Not true. Huh?

Not true. So I told this woman, I'm gonna tell you this story cuz it'll blow your mind. I told this woman everything bad that might happen. I, I might cause gum recession. You may need to see a periodontist. I might cause tooth loss. I might cause an anterior open bite that could only be fixed surgically. And what did she say to me? I don't care. I don't care. I don't care. So I did this and I opened the spaces and I moved the upper and lower front teeth forward easily 4 to 5 millimeters. She'd had some wear and had a missing tooth in the lower. So I opened the spaces in that region. I advanced the upper and lower anterior teeth 4 to 5 millimeters. Gums did not recede. Now I'll make a real quick end to this story. I saw this woman back in Vermont where I still own a home. I saw her. On New Year's Eve of this past year. So I went in to have a pair of shoes reheeled in a shoe repair shop in Vermont. I couldn't find one in North Carolina, believe that or not. And in walks this woman. Now, I had seen her one other time in all that, in all those years, and she was fine and I knew it. And her daughter was treated by the orthodontist who bought my practice in Vermont. But here we are 36 years later, she has had no headaches. She's now 63 years of age and there's no gum recession. She's got a big broad smile. She's happy. She's got what she wanted. Here I am 36 years later, still waiting for all the teeth to fall out that I thought were gonna happen. My bet is that if she lives to be 100, she's still gonna have her teeth. And yet people thinking in this profession, many of them in, in very strong ways, are telling people that they, if they, if they don't, if they move teeth forward, they're gonna cause tooth loss. They will cause tooth loss. And the fact of the matter is I've been reopening spaces for people and have hundreds of cases I've done. Documented for lecture purposes. And that's not what we seem to have. I'm very careful if I think there's a problem before I'm gonna do this. I say, I refer to a periodontist and say, hey, is, is a, is, is there good bone support here? Are we dealing with an ongoing problem? I'm not stupid about it. And there have been some things happen in the profession where people have lost teeth, and I'm completely aware of that. And a CBS documentary, which happened soon to be, let's, 3 year, uh, 3 years now in February or March of, uh, 3 years ago. Showing where teeth were lost, but I happen to know situation about those, some of those cases, and it was ridiculous that anyone was treating them in the first place cuz they had ongoing periodontal problems. But if you have a healthy periodontium, you can easily do this. And, you know, we ended up after doing all this kind of thing, I came up with the, uh, syndrome, which I call Extraction Retraction Regret Syndrome, ERRS. It's an acronym that I came up with while I'm running. I'm, I'm an addict addicted runner. I've run, been running for years. I've run the Boston Marathon 11 times. My, my own, my mind, it really doesn't even work unless I'm running. I'm running.

That's your time for good ideas. I love it.

I came up with this acronym, which is ERRS, as a mistake, Extraction Retraction Regret Syndrome. And I identify it as a quote, constellation of aesthetic, functional, and emotional signs and symptoms brought on by orthodontic retraction, all of which is preventable. Now, I wanna qualify that and say that not everyone who's had teeth taken out and/or has been retracted is going to have a problem. But I can tell you this, I have been contacted from people from every continent except Antarctica with emails like this saying, Dr. Hang, I am an ERS poster child. And then they relate a very long saga of how they hate their face, how they've had pain patterns, how they can't sleep, how they're suicidal, et cetera. And in my practice in Agoura Hills, I had people from more than 30 states and several foreign countries coming largely for me to reverse that thing, that very issue for them. So it is a real syndrome, although recently there's been some things in the literature trying to say that it's a fallacy of extraction regret syndrome. I won't get into that, but from my perspective, I'm happy to see that article come out because it now helps people understand the whole problem. From me, from my perspective, that is a good thing that, that at least the public can see this now.

Yeah, I, I, I would love to dig a little deeper into how does the airway get smaller? So when somebody has premolars removed, these front teeth moved back, is the tongue going farther into the throat? Is that what happened or does it affect the soft palate? How, how does our airway shrink?

There's even more than that. Uh, uh, one of the things that I have in my lectures, I, I take an article outta the refereed literature where a patient was missing upper lateral incisors. And at age 8, he was expanded. And the pretreatment, so from age 8 to 12, the entire face moved forward dramatically with just lateral expansion, which was great. So you see basically completely normal growth and the mandible came forward. The entire face came forward, literally 4 or 5 millimeters. Then when he got to the age where the upper laterals were coming in, they, and they were like 4.5 millimeters of space. Any orthodontist could have gone and opened up a space to 6, 6.5 millimeters and put an implant in. But oh no, orthodontists have a knee-jerk reaction to that. And they don't want to do that. I mean, I was part of that whole game back in the '80s. I didn't want to, we didn't have implants back in the '80s and I closed those spaces up. And so in that very article, I show the very next X-ray after they've closed the spaces up. You can see what happened. They retracted the upper incisors, probably no more than 1 to 2 millimeters. And there was absolutely no further growth of the lower face forward. None whatsoever. Not my patient. This is out of the refereed literature. I also saw this happen with other bicuspid extraction cases. I had one boy in particular who had had 4 bicuspids taken out prior to him seeing me. And instead of saying, can't— he transferred into my practice. And instead of saying, I want to reopen these spaces for you, I just took the path of least resistance. This was many years ago before I discovered that people actually had to breathe to stay alive. Back when it was just about what does the face look like? And I, I, I just aligned the teeth and closed the spaces, realizing that if I had said to the mother that I need to reopen these spaces, she would've said, why did the orthodontist take the teeth out in the first place? And I always said, well, you know, I'm of the belief that it's, that it's gonna affect a lot of things in a negative way. And not the least of which is a facial growth. And it would've been a lawsuit. And I just decided I don't wanna get involved. So I just closed the spaces. And after I finished the case, I looked and saw The distance between the chin and the neck was dramatically decreased. The cheeks started to flatten, the nose started to appear larger. The kid hadn't even gone through puberty, but the distance between the chin and the neck on the soft tissue analysis was dramatically reduced. What I've seen happen is that the entire growth of lower face can be affected by this. And so the real reality is if the both jaws are back, and so you've got the soft palate hooked to the back of the upper jaw, and here's the back of the, the pharynx, the farther back that soft soft palate comes, the worse the airway is. Down below you've got the tongue. The tongue is attached to the chin. The farther back the chin is, the farther back the airway is. It gets really crazy. I get, and I learn from people from all over the world. You're not even gonna believe this cuz everybody on planet Earth, every dentist with a pulse is doing Invisalign and they also do reproximation. It's really done all the time. Why? Why do they go disc the teeth? As a periodontist, you gotta hate this because it's bringing the roots of the teeth closer together and there's gonna be less bone support. But it's done routinely. I had a woman from Singapore contact me a decade ago. She had had reproximation of her lower anterior teeth done, and she did Invisalign to align the teeth. And she tells me in her email to me, I couldn't breathe afterwards. This affected my breathing. How much can you reproximate and how much can you retract by just a tiny bit of reproximation? I don't know. But in her case, it was enough to make it so that she couldn't breathe. Who am I to say to her, oh, lady, you're nuts. That had nothing to do with that. Who knows her body better than I do? She knows it better than I do. And, and this is how I came to all these ideas. And, you know, and in retreating patients, and I had patients that I reopened extraction spaces for and have a sleep report to prove that just reopening spaces merely in the maxilla alone got rid of sleep apnea for a patient. And even the fact that she gained 10 pounds from the, her first sleep test to the one where she had no apnea. Gaining 10 pounds is not good for sleep.

Absolutely.

And anyone will tell you that. So, I mean, learning from my patients was really what I did, and that's how I got where I am. And it, it's, it's, it's really something we need to be looking at in all of our patients.

Yes. I love that you brought up the fact with the, you know, clear aligners, because there's so many dentists doing clear aligners that don't understand airway. And I didn't know that just by retracting a millimeter or two, you can really affect the entire head and neck airway.

It's crazy. One of the things that you may, the audience may find very interesting, and they, and most orthodontists, I would say 99% of the orthodontists, if not 99.9%, do not know that over 100 years ago, orthodontists were treating in the primary dentition before the first permanent tooth comes in. And do you know why they were doing this?

Why?

To prevent mental retardation. I'm not making this up. There's articles in the literature and I cite them in my lectures that they're basically saying that the orthodontic treatment should be completed prior to the eruption of the first permanent tooth. And they're talking about breathing issues in all these patients and mental retardation.

How long ago was this? Yes, in the literature.

Pardon?

How long ago? How many years ago?

Very early 1900s, 1909, 1913. And even going back, you're gonna find this crazy. There's articles out of the 1800s that you just are crazy. Charles Dickens, the author, talked about how juvenile delinquency was a problem of mouth breathing and chronic mouth breathers. And even crime was higher with people who are mouth breathers. And it's all about breathing well. Most of us, I have a nice long face here, courtesy of the fact that my lips were apart every night of my life. My pillow would be wet every morning, and I didn't— I didn't mean anything to me until I began to learn about breathing. And I began to tape my lips every night and have been for 15. I have a long face because I did hang my mouth open. It was more of a mouth breather. My wife, on the other hand, is very attractive, and her face is forward more like yours is. And you didn't grow up with your mouth hanging open, I can tell you that. And nor did my wife. Your face and her face grew forward more, and as the face grows forward, the soft palate grows forward, the tongue grows forward, and your airway is more open. Now, there are many other factors that, that get involved here, like muscle tonicity. And, and as you get older, and I'm a whole lot older than you are, I began to know that there are aches and, and pains that happen, but I also know that you, you lose muscle tonicity. So something may be okay for an adolescent becomes not okay in their mid-thirties and forties. And by the time someone's in their 50s, their blood pressure's going through the roof because they have sleep apnea. It's unrecognized. And when you go back and look, if you were to look at their pretreatment, post-treatment orthodontic records, if they were available, you might see changes in their face that happened as a consequence from this.

I mean, I'm so glad you brought up mouth taping because, and mouth breathers, because I get a lot of questions actually on social media about this topic. Should, and even patients coming to, well, I'm a mouth breather, and of And of course we have oral microbiome changes from the mouth breathing besides the fact of airway.

So it's crazy. It's all related. It's all related. If we could do one thing to improve health in the United States, it would be to make everybody a nasal breather, an obligate nasal breather as soon in their life as is possible, which is why I have been in my ECHO course where I teach people how to treat young kids. I wanna see the orthodontics completed prior to the eruption of the first permanent tooth. I teach treating in the primary dentition. Just as my predecessors in this profession did more than 100 years ago.

Yes, amazing that we're coming back to that, to that wisdom.

Yeah.

I see the same thing, you know, just with the regular periodontal health and good lifestyle, good eating habits, oral hygiene, just the basics are so important. I want to go back to people, you know, that retraction, you mentioned that people get pain. How is that pain triggered?

This is the most interesting thing. And what I'm gonna say is gonna be very controversial because you have, and I don't wanna qualify it this way, you have a specialty in dentistry now called TMJ. And what the people who are in charge have defined that basically as a biopsychosocial problem. I don't happen to believe in that at all. The best way I began to learn was when I sat, as I learned in the 1980s from some of the people I took courses from, one guy said, we, we dentists think we know everything. We need to take off our white coats. We need to sit down, we need to shut up, and we need to listen to our patients. They'll tell us what's wrong. We have to be bright enough to know what they're saying. So I learned from my patients about this very issue. And specifically in April of 1985, I learned from an orthodontist in a rural community in North Carolina. I was living in Vermont at the time. I spent the money to fly to North Carolina where I now live, interestingly. And I learned from this guy, he said, you know, the lower jaw gets trapped. Held back and the front teeth hit prematurely, which shoves the condyles back. And the condyles don't like to be back because there's no place for them to go. There's nerves and arteries behind that in that, in that space. And the biggest problem here is premature contact of the front teeth. Now, there are people out there who have been given prizes about saying that the TMJ problems have nothing to do with the teeth. My wife has not had a migraine headache in 15 years. She used to get 2 or 3 a year. Could guarantee I'd wake up in the morning, I'd tell she was gonna get one. Why hasn't she had one in 15 years? Because I moved her 6 upper front teeth forward so they do not contact at all. Not at all. They're just out of occlusion. And I've done this for zillions of people. I had one woman, blow, it's gonna blow your mind. She had had upper bicuspids taken out as part of a, a stupid treatment for Class II. Brought back like this, and she was trapped. She was in her mid-50s and she was taking 25 Advil per day. And no, I am not making that up. 25 per day. And she was still in pain. I never promise anybody a result ever. I'm an Eagle Scout. I hold my hand up like this. I say, I promise to do my best. But when I see somebody like that and I palpate these muscles here, here, and the joints, and they're all sore, I know that if I move this front teeth forward, I can get the pain pattern gone and I'll be ready for my hug when woman walks into my office. So I did that for this 55-year-old woman, give or take a year, and her pain pattern went away immediately as soon as I gave her a very slight overjet. This is in diametric opposition to what is being purported in the profession by those who are in charge of that specialty. And I can cite articles out of the refereed literature, but I'd rather help my patients and I can help them by listening to them and learning from them. Them, which is what I've done. And again, I never promise a result.

I love it. You know, I recently had a patient, female patient, 50. She mentioned to me, it's like, I feel like I'm banging these front teeth. And I look at her and I actually did a bite check and she, I could pull the thin articulating paper through the teeth. Like, I feel like I'm banging them. So even that kind of light occlusion, and she does get headaches.

What you want to look for is palpate here in the joints and have them open and masseters and anterior temporalis muscles. And if they if they're painful to opening, most of the time that's gonna be an issue. I also take x-rays with the cone beam and look at the condylar position, that kind of thing. There's another very important issue on this too that is largely, largely overlooked. And I have to credit my dear friends, the myofunctional therapists I work with in Southern California who beat me over the head hard for many years before they really got it through my thick skull. About tongue tie. I have seen—

Joy Mohler, by any chance?

How did you know?

I love her. She's awesome.

Joy Mohler, my dear friend, and I used to have her teaching in my mini residency all the time, but Joy and I are, we're like family. I must admit I was a slow learner, but I've worked with her on a number of cases and I can tell you about one patient in particular. It was a 63-year-old registered nurse who'd had pain from the time she was 6 years old growing up grew up on a farm in Iowa. She said, I can remember banging my head on the wall as a 6-year-old trying to get rid of my migraine headaches. I'll make this really short. I recognized that she had a tongue tie and I sent her to see Joy and Joy sent her to see Richard Galen in Beverly Hills. You probably know him well. He did a release and this is this woman's words to me after this happened. She said, I was driving my car from his office to Joy's office. I was, I was driving my car with my right hand and holding my jaw with my left. I thought my jaw was going to fall off.

Wow.

And she said 3 months later, she said how this had changed her life. She says, this is, this whole problem with these headaches has ruined my life, had ruined my marriage. And she says, I don't have, I don't clench anymore. I don't have any more headaches. And what would my life have been like? Had I had this done earlier. So the combination, when you, the other thing that, the other thing I wanna really help people understand is one of the most common things in, in orthodontics is a, what we call a class 1 occlusion with crowded lower incisors. And I was taught I had to remove 4 teeth for that. And I didn't treat my own wife for 11 years because I was, I knew I had to take out teeth and I wasn't about to. But when you have crowded lower teeth, I have a graphic to show this. And you take out 4 teeth, you line up the teeth, the lower teeth are lined up, and you have maybe 2 or 3 millimeters of space left between the lower cuspids and the second bicuspids. They're now lined up. But if you have perfectly aligned upper teeth in a Class I occlusion with crowding, you still have to take out upper bicuspids. So here you are at maxilla, you've taken out upper bicuspids. And you've taken out lower bicuspids. You're in the midst of the treatment. There's a 3mm space left on the lower and a 7 to 8mm space on the upper because you haven't, you haven't retracted at all. So now here you are like this and you start to close the spaces in both arches. The 3mm closes on the lower pretty quickly and the front teeth are still in contact. And yet there's a 4mm space still left on the upper or something like that. Well, are your parents going to pay for you to have orthodontics and leave you with a 4mm or a 3mm gap looking like a jack-o'-lantern at Halloween? No, that's not gonna happen. So the orthodontist continues to close, but the front teeth are in contact. So what happens is the mandible is pushed back. And that's exactly why in a Class I occlusion, you'll often have this patient say, you know, when I, my braces came off, I mean, I couldn't really keep my teeth together. I didn't wanna have my teeth together. I had to, had to hold my jaw forward. We call that mandibular entrapment, and I have a graphic graphic that shows that whole thing. So your practice is loaded with these people, particularly as a periodontist, because they're clenching and grinding and trying to eliminate this interference. But the weak link is A, the enamel, and B, the periodontium.

Yeah, absolutely. And, you know, unfortunately I'm like, okay, clenching and grinding, let's give you a night guard.

Exactly. It's just a bandaid to their It's a bandaid and, you know, we give out too many bandaids and, you know, after a while they don't work.

Yes. I would love to talk to you a little bit about this treatment. Okay. So somebody has had this treatment years later, they're having pain, they can't sleep. Now we're re— moving teeth forward. How do you do that? Do you do that with traditional braces or you use an expander?

It can be done with braces, but the most efficient way is using some removable appliances, which I actually heard about back in the '90s that general dentists doing orthodontics were using. Now, as you well know, orthodontists as a group, and I was one of them in my early years of practice, we look down very hard on general dentists who do orthodontics. We think we are the anointed ones and we should be the only ones straightening teeth. Most of the people who take my courses are actually general dentists or pediatric dentists, because these are the people who've seen, like you have, You've seen the problems and you've tried to get somebody that's an orthodontist to listen to you, and frankly, most won't. So you feel compelled to do the right thing for your patients. And that's what happens with many people. And then they come and learn from me to do this. And that, that's how I teach them is using this removable appliance that I literally, I couldn't have told you, I'd never heard about it when I was in orthodontic training. I used zero removable appliances except an upper Hawley appliance. But now we reopen the spaces and we can open the spaces in a 4-bicuspid case in probably 5 months, getting the, the root crowns of the teeth apart. The hard part is putting them braces on to get the roots apart, and that's very challenging. But again, I wanna make it really clear in diagnosing these cases that it's not just a simple, oh yes, let's reopen the spaces. It doesn't work that way. You have to diagnose the case properly and know you have to see Where is the airway small? If, for instance, the airway is small behind the soft palate and there's a very tiny area here, you can open 4 bicuspid spaces and not affect that very much at all. You may need to do orthognathic surgery to advance both jaws. The earlier you have the orthodontics done that's retractive in nature, the more farther back the jaws are likely to be, and the more likely that surgery has to be part of the, that answer. That's why I have my mentorship called the ERS mentorship. Where I teach people how to diagnose these issues. The last thing you want to do is open 4 spaces and get a sleep test done and see it's no better. And that can easily happen. So before you start the case, it's like, you know, it's like I would never buy a lottery ticket in my life. I grew up in a non-gambling family. But if I knew for sure, 100%, that I was going to win, I just might be tempted and just see, you know, a billion dollars come into my bank account. And that's how sure I want to be about my treatment and making the end goal of helping this person live a longer life. And I, and I gotta, I gotta really add one thing here to you, to this, because it'll really help people, the audience understand just how important this is from a health perspective. Forget about looking at your face. It, it looks good or not good. That's, that's one thing. Of course, we all wanna look better, but about a decade ago, I had a 47 or 48-year-old Filipino gentleman drive more than 2 hours from way east of Los Angeles to see me. And he thought that I was going to grow his lower face forward. And I said, sorry, I can't do that. Long story. I took his blood pressure. It was 163 over 128. It was stratospheric. He'd been on, on meds from his cardiologist for 4 years. And when I took his blood pressure and I saw this, I looked him square in the eye and, and I, I learned that you have to be very, very blunt with men. Men. Men, as my good friend Michael Gelb in New York says, men are in denial and women speak in code. I love that quote from him. And in denial. So I looked at this gentleman, I looked him square in the eye and I was about 6 inches away from his face when I said, you need a sleep test or you're gonna die. I just said it to him with 163 over 128. I said, I'm not a doctor, but if I were you, I would get a sleep test done immediately. And his cardiologist had not even said that. So he went 2 days later, he had his sleep test son, and he had severe sleep apnea and he desaturated to 65% oxygen, at which point the sleep clinic guy woke him up and sent him home. Now, can you imagine why the sleep person at that clinic might've done that? They don't want him to have a heart attack or stroke cuz he is an accident looking for a place to happen. Now, this is the, the, the crux of the matter. I came up with a treatment plan which no one else had come up with for surgery for this gentleman. I won't go into the technical aspect of it was hadn't been done before my, that I knew of at all. We sent him to have this. I set him up perfectly for his surgery and he had the surgery done out of state. 10 days post-surgery, he emails me back. He hasn't flown back to Los Angeles yet. He says, Dr. Hang, you can't believe it, but my blood pressure started dropping immediately after my surgery. It's down to 120, 120-something over 70-something and has remained down every ever since.

Wow.

He's back to Los Angeles and he comes in my office. I've taken his blood, his blood pressure's fine. And the point is his cardiologist didn't even want to know what happened. I'm not joking.

My God. Yeah. Wow. What a big connection there between blood pressure and position of teeth and airway.

I have other similar, similar stories of other medical parameters that changed dramatically as soon as someone began to sleep and breathe normally.

Mm, amazing. For those who are interested, I know we have dentists listening to this thinking, you know, where can they take your courses and where can they find out about the membership?

Our courses, we're gonna start our new ECHO, E-C-H-O, ECHO, Early Childhood Health Center in Orthodontics is gonna start next month in Dallas, Texas. Go to ortho, to www.orthotohealth.com and you can learn about ECHO. And that's, that's where most people should start in their process to learn.

Learn. Is that like a 2, 3-day course or?

It's a year-long mentorship program, which usually goes in, most people then go on to continue what we call ECHO ongoing to continue to learn because this is complex stuff. You can't teach it in a lecture. I have, that course has 3 days in April. We have monthly webinars, hour and a half for case presentations. We meet again in the fall for another 3-day session. There's a lot to learn here. This is not cookbook. You don't just go home and plug it in. Like, you know, you buy this, this new laser and this is how you use it. No, you have to learn. And there's a ton of learning to do. And so just like this morning, I got up and I answered people who posted on my internet forum. I've answered their cases, their questions about their cases. It's a true mentorship. I'm holding people's hands over the internet and helping them learn what I I've learned over my, you know, my 40, more than 40 years of continuing education. The other mentorship is really about treating these more complex cases, what I politely refer to as train wrecks, people who have spent hundreds of thousands of dollars and 20, 30 years sadly looking for solutions, and yet they've, they still come up empty-handed. And this is where the, the whole aspect of the triad of aesthetic, functional, and emotional signs and symptoms of ERS, the syndrome, come into play. After you've you spent 30 years looking for a solution, you're pretty emotionally worn out. And you need to understand that as a practitioner, you need to understand that these are complex cases and so many things need to be looked at.

Dr. Sanda Moldovanova Moldovanova, I love what you said earlier about diagnosis. I think that's one of, even in, you know, in periodontics, we have to diagnose properly because without that you can't treat properly.

No, no. If you don't have a diagnosis and don't have a firm treatment plan with a realistic, concrete, concrete endpoint that you're trying to get to. It's, and you don't want to, for instance, so many people say, oh, you need to have jaw surgery to fix your sleep apnea. Oh my God. I mean, I've done hundreds and hundreds of cases, hundreds, but that's, that's such a, that's such a short-sighted thing. The surgery is only as good as the preparation for it. It's like a 100-story skyscraper. You build a 100-story skyscraper and when the wind blows and blows it down, that's not when you decide to put the foundation in the ground. You put the foundation in the ground first, many stories below ground, and then you build the skyscraper up. And that's what, that's what the orthodontic preparation is, is the foundation for that skyscraper. And if you don't have a good foundation, there's zero chance that that skyscraper is gonna work. Zero. And that's why I see, I've had many patients who've had orthognathic surgery and they're no better off, no better off. Oh, and then the surgeon tells them, well, it doesn't always work. Yes, you're right. It doesn't always, you're right. It does not always work. And even under the best of circumstances, circumstances, it may not, but if you properly plan it, the chances go— and, and prepare right and do it right, the chances of success are much higher.

Yeah. I know we also have consumers listening to the show thinking, oh my God, I have some of these symptoms. Where can I find somebody with your philosophy that they can go see?

Let me— you can email me through that website or go to billhang@ortho2health.com. Com. I will respond to you. Yes, I'm semi-retired, but you know what? The semi is the important part. If I were fully retired, they'd have to put me in an insane asylum. So I'm happy to respond to people and email me and I'll let you know if I know somebody.

Yeah.

I'll even take a look at, at your records for no fee whatsoever and get back to you.

Uh, I, you, thank you so much for being so generous about sharing your email. And we're gonna put all this information also in the show notes because, um, you know, extraction, retraction, regret syndrome, there's probably hundreds of thousands of patients out there.

There are millions. There are millions. There's a group in China where the problem is even worse there because their cranial base is shorter and they also have very short noses and their lips are more full. Therefore, 75%, I understand, of the patients in China are getting teeth taken out. And that's for many of the Asian countries. So there's, there are groups that are, there are hundreds of thousands of them in several foreign countries. And I find this out by people who contact me over the internet.

Well, Dr. Heng, you are a wealth of information. This has been such a great show. And I thank you so much for your time and your generosity.

Thank you, Sanda Moldovanova. I'm so happy that you're open-minded and you're do— you're, you've recognized all this. That's once you, once you see it, you can't unsee it and, and your life will never be the same. but you're also gonna see your practice just, you know, it's gonna grow like crazy when people, when you listen to them and they, and you heard them say, oh my gosh, I, I have an idea of why this is an issue for you. And then hopefully you have someone you can either do it yourself or find someone else you can refer to to help. Okay.

Yes. Yes, absolutely. Thank you everyone for joining us on today's episode on the Holistic Dentistry Show. Until next time, keep smiling.

Thank you, Sanda. Bye now.

Thank you so much. Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram @DrSandaMoldovan. This is Dr. Sanda Moldovan, and remember, your mouth is the gateway to your health. Health, so take care of it in the most natural and best way possible.