Unlocking the Secrets of Children's Airway Health

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. Hi everyone, welcome to today's show of the Holistic Dentistry Podcast. Today we're going to focus on children's airway health because airway is such a huge part of overall health. If you're not breathing well, then your child most likely is not thriving. They can't function, they develop ADD, and it's super, super important that we diagnose properly any kind of breathing issue. So with me today to talk about what we can do about children's Airway Health is Brianna Reiser. And Brianna has been working in dentistry for over 14 years. And about 5 years ago, Brianna actually lost your mom after a long battle with sleep apnea. And that's how basically her eyes were open into understanding airway health. So Brianna, welcome to the show.

Thank you for having me. I'm so excited to be here.

I'm excited to have you to talk to you a little bit about your passion about what airway plays in overall health. And I'm sorry about your mom. As most people probably know that have had to deal with sleep apnea is that you can die in your sleep from sleep apnea. It's a high percentage. I think it's about 47, 48% likelihood that people can die in their sleep if they have undiagnosed and untreated sleep apnea. But this, the sleep apnea also translates to kids. A lot of people don't know that kids can also have sleep apnea. So tell me a little bit, Briana, about what we can do here or what has been your experience with children's airway health.

Yeah. So just to kind of go back a little bit to my mom. So after she passed away, I had no idea about airway health or airway dentistry. And I started working for a company and my job was to listen to lectures. And so I was listening to incredible lectures from airway dentists across the states, and they were showing case studies of what they were doing for adults. And this is the first time my eyes were open. These patients that they were showing, I'm like, that's my mom. That sounds just like my mom. That looks like her mouth. And then I was seeing the results. And with fixing adults, it's, it's hard. It's complex. It's not very easy. But what I do know is a lot of this starts from the very beginning. So there's this window between 3 and 7 is just this golden window where we can get in there and we can make some incredible changes that are gonna last a lifetime for their overall dental and health. And so, yeah, so seeing in these kiddos, and I can speak personally for my own children cuz they've both gone through treatment and it's one thing. So with my job, I would look at case studies, I would review presentations, I would see the before and afters, and I believed it and I thought, oh, this is so incredible, everyone should know about this. But then when I experienced it firsthand with my own children, that's when I became a firm believer. And so now I can't stop talking about it because it's just so amazing what we can do for these kids. And it's pretty gentle when they're young. It's very gentle, very guided.

Kids, Brianna, how old are your kids now?

So now they're 9 and 7, But when we started this journey, they were 6 and 4.

So tell me about the start of the journey for them.

Yeah.

As a mom, you know, a lot of moms are probably listening and wondering, oh my God, should I be just looking the way they're sleeping or how they're functioning?

Yeah, so I had two very different journeys for both boys. For my older son, um, I didn't see too many symptoms. I wasn't overly concerned. I just wanted to give him the best start at life, so we got him into treatment. But for my younger son, he had all the symptoms. The biggest one being his behavior and his overall tiredness during the day. So he was a 4-year-old little boy, right? You know, as a mom, I was like, okay, well, what's typical 4-year-old little boy behavior and what goes beyond that? And he definitely went beyond that. So constantly getting calls from school. At the time he was in pre-K and in pre-K they still nap. And he actually had a special corner because his teacher would let him nap from nap time to pickup because if she woke him up from nap, she couldn't teach the rest of the day 'cause he was so upset and so tired. And so that was just his special little accommodation. He would go to sleep at nap time and she would let him sleep till we picked him up. And then for bedtime, I would go in there to wake him up in the morning. He would be twisted in the sheets. He would be sweating. He woke up tired. He woke up like he was wrestling a bear all night, and then throughout the day he just continued that behavior. Meltdowns were more common. Just him regulating his emotions was a lot harder. And so for him, we got him into treatment. It took us about 6 weeks of exercise.

I'm gonna kind of backtrack. Yeah, so you go to, okay, oh my God, he's having all these symptoms. Who did you contact first? Was that a physician or did you know to go to dentists right away?

Yeah, so by the time I had children, around this time I was already working with these incredible airway dentists, so I did go to them, but I also, I did consult our pediatrician and the conversations going to our pediatrician and going to the teacher, because we kind of started there, and I was going down this path of we should look into starting maybe putting him on some type of medication. That was the answer. Is it so?

Yeah, yeah, because then they were just so indoctrinated into going to the bottle, pill first, because if a pill can fix his problems, what was it, like an ADD type of medication that they were offering?

Correct, or just like behavioral therapy, um, also that was something they recommended, maybe seeing somebody to help him with his behavior, and to be honest, even knowing what I know, I was so tired, as a mom, you're just you just want that relief. Everybody wants that relief. That I can see why parents are like, yes, just try anything. And, but I'm so grateful. I'm so thankful that I knew what I knew now because our experience was so different than what it could have been for the typical mom going through that.

Yeah, yeah, yeah. I understand. So, uh, tell me a little bit about what the dentist did for you once you expressed that, uh, you know, our son was having these issues.

Yeah, so I sent in some photos and I answered the sleep questionnaire and right away they can tell he was underdeveloped and that he had, for lack of a better term, a lazy tongue. So his tongue was free. There was no restriction, but it just didn't know where to go, right? So it didn't know how to live in the roof of the mouth and keep it out of his airway at night. And Dr. Ben, he explained to me what is happening is that when he's going to sleep at night, Instead of his tongue staying suctioned to the roof of his mouth out of his airway, it's falling back. And so he's not breathing, getting enough oxygen, and our bodies are so smart and it always wants to protect itself. So it's keeping him in this state of arousal saying, "Roll over, move, get in a better position 'cause we need to breathe better." And so that's that tossing and turning, that's kicking and moving, and it's keeping his body in this fight or flight all night. So he's not dipping into that deep restorative sleep that he truly needed. And hearing it explained like that just made so much sense. And then even just knowing that and then watching him, cuz you know, we go on vacations and we sleep in the same bed and this poor bud is just all over the place. He's waking up at the foot of the bed, on the floor. He's not sleeping peacefully for sure.

What did Dr. Bren prescribe for him?

So there's 3 main components that he wanted us to look into, and keep in mind he's 4, and so the first one being good nasal hygiene. So keeping his nose clean, keeping him breathing through his nose. Nasal hygiene as important as oral hygiene. So we brush our teeth at night and we clean out our nose at night. So that was the first step. The other—

clean his nose, for example, I mean, at 4 years old, obviously you can blow his nose, but maybe not as good as an adult.

Yep. So we used XClear, which is just a little rinse. We did that every night. Even my biggest tip is do it even when you don't think they need it. Just get in the habit.

We actually have a whole episode in the Holistic Dentistry Podcast with the founder of, uh, XClear, and we went over the importance of it. It's a spray that I use, and as an adult, every night, especially living in Los Angeles, just to help to clear out my airway.

Yeah. And here in Texas, we have really bad allergies too, so we would spray, blow spray, keep his nose really clear. I found that he really enjoyed nasal strips too.

Okay.

And I started buying the pediatric size ones, but I quickly learned just the adult ones are fine and they work just as good. And so I would put those on him at night. So we got his nose clear. We did myofunctional therapy. So we trained that tongue where to go. He was, uh, he had a tongue revision as an infant, but we never did any myofunctional therapy. So His tongue, his tongue was free to move. It had no attachment. It just didn't know where to go. So we trained his tongue and then we also did a guidance appliance along with that. And so he would wear it all night and during the day. And between all of that, we got his muscles functioning properly. We got him being an obligate nasal breather. And when those two came together, we got a good sleeper. And then that is what changed everything else.

And you mentioned it took about 6 weeks with all these 3 things combined for him. To actually feel different?

Yeah. So for us, again, I have an older son who just took to all of it a lot easier. And, you know, it was no big deal for him, but for, for Rowan, he was 4, it was a big adjustment. I was doing the whole mean mom headlock, cleaning out his nose.

Oh my goodness.

All of that good stuff. And then to wear the guide, you know, I always say the kiddos that need them the most are gonna struggle the most. So for my older son, he popped that in, went to bed with it, no problem, but he had good muscle function, he had good swallow patterns, and he was a decent nasal breather, so of course he did just fine. With Rowan, it was so hard to get adjusted because he was so used to breathing through his mouth, and he— his tongue had no clue what to do, so it wanted just to push it right out right away, and so it took about 6 weeks of Slow and steady. We did 5 minutes day 1, 10 minutes day 2. By a week, we were watching a movie wearing his guide, and then by 6 weeks, he was wearing it at night, all night long, and that's when I really started to see all of the changes happen.

I see. So this, this appliance he was wearing, what is this appliance called?

So, um, he's actually been in 2 separate appliances now because, um, We, for his particular case, we switched him, but he started out in the Vivosky, and then now he's in a Myobrace. So he started in the Vivosky, um, and then we switched him over to a Myobrace just because his bite was kind of shifting a little bit. And so now he's in the Myobrace, but they're both very similar. Very— are you familiar? Do you use those in your practice?

I'm a periodontist, so I do a lot of integrative oral health. I work with adults, so I don't get a chance to do that kind of treatment. What I use for actually for sleep apnea is a procedure called NightLase, which basically, you know, opens up the airway without the discomfort and the downtime so people can breathe better. But myofunctional therapy is such a huge part also of just overall health. You know, I love that. That's good for adults and children. We've had a couple of myofunctional therapists that I've had the privilege to interview on the Holistic Dentistry Show that talked about, you know, different modalities that can help children and adults with their their breathing issues.

Yeah, these little guides, they're really incredible what they can do. The 3 main ones that I've heard of are Vivos Guides, Myobrace, and Healthy Start. At Toothpillow, the 2 guides that our doctors typically prescribe are the Vivos Guides or the Myobrace, but they are all— they meet all same goals and outcomes. And they are— the one tricky thing is, is it's a compliance-based device, so they do really amazing things, if they're worn. So that, with the kiddos, that can be the hard part is we have to wear them. And so with my older son, he's never given me any pushback. He wears it so great. And now with my second, my younger son, he does just as good. But the, the start was a little bit trickier to get them, to get them going.

So do you feel like I was an actual client?

Yeah, yeah, you— I can kind of share with you how it works.

Yeah, where are you located?

So we are actually a virtual clinic. And so the way it works is we have a mom who submits a child and they submit 6—

What does that mean, submits a child? They have to send you photos or?

Yep, so they'll go online, they'll take 6 photos, they'll answer a sleep questionnaire, and that goes to Dr. Ben Moraglia, one of our founders. And he's the first doctor that will review the child and he'll either approve them for virtual care or he'll deny them for virtual care. If they're denied, typically it's because they need fixed expanders, and if they're denied, we will help locate them to a great provider. So we'll find the closest one that we trust and we'll get them in the office. If they're approved, then they'll go to the state provider and we have 80 doctors in our network, and that doctor will review the child, prescribe a device, and oversee their care for 2 years.

Okay. That's nice that you have 80 doctors. That way you can service, you know, more people. This is such a big problem. What about people that don't, like, live, you know, in the middle of nowhere and they don't really have access? Do you deal with people like that?

So if they're approved for virtual care, that's no problem. So I'll use Dr. Hillary Fritsch. She's phenomenal. She's our Montana doctor. She has a brick-and-mortar practice. She sees patients in her office and she treats virtually all of Montana. Now where it gets tricky is if they're not approved for us, which sometimes kiddos are just a little too underdeveloped for a guide. They really need fixed expanders, and so then we have to navigate them in office, and we do our best to try to find the closest one and also just work hard on training up and educating more providers so there's just more of them. And there— that was really why Tooth Pillow was created for 3, for 3 reasons. We needed to solve for a Accessibility, affordability, and education. Those were the 3 hurdles that we were facing. And so with this platform, accessibility was super easy because now, like Dr. Fritzsch, she can service all of Montana. There's so many moms that would have had to drive 5 hours to see her can now be treated remotely. Um, affordability, as you know, being a dentist, the overhead is so expensive. So when we take out the brick and mortar, we can make the price more affordable. And then education, our platform is really an educational platform. We're kind of like the middleman. So we're gonna educate the families and then we're gonna help navigate them to the right providers. And we were just at AAPD conference for pediatric dentists and our booth had a line around the block because dentists are saying, I have moms coming in asking about this company. What is it? Like, I need to be able to tell them what you guys are. And so we're really going straight to the mom and the families and the dads, educating them on Airway Health. So they demand it from their current providers, and then it encourages them to go get the training and start implementing this in their practice as well.

Yeah, I think that's amazing. We do have actually dentists and hygienists that listen to this show, uh, and we can certainly put a, like, a sign-in link. What does that training look like if they wanted to join being an affiliate?

Yeah, there's a couple levels of how you can partner with ToothPillow, and it just depends on the dentist and their level of Participation. So we have a good amount of dentists who believe in airway dentistry and myofunctional therapy guides. They just don't necessarily wanna do that in their practice because they're busy doing other things. And so they just screen their patients and refer them to Tooth Pillow. And that's a great way to be in our network. The next level is our hybrid offices. So these are doctors who screen the patients, but then they treat them virtually. Through our services. And then we have Prime offices, and these are dentists who have airway offices that treat kids and adults, and they want to implement the Toothpillow way in their practice because Toothpillow's done a really great job of making it fun for the kids. So, you know, fun equals better compliance, and we have our incredible app that provides such a resource for our dentists. So There's different levels. And then we also have doctors who just hear about airway dentistry and say, you know what, I wanna do this. Let me go get trained and do this on my own in my practice. And that's exciting as well because the need is so great. There's not enough. So if we just spark enough of a patient base that they decide to go and train and do this on their own, we're excited about that as well.

Yeah, I love it. Very good. We're gonna put some information down in the show notes. Briana, thank you so much for giving us this information. Any dentist or hygienist listening, I highly encourage you to learn more about AOA Health. I think it's definitely making a change in our patients' lives. And also for patients listening and for moms out there who, you know, you see your child has behavioral issues, check out some of the resources at Toothpillow. You know, even if becoming a patient is not necessarily in, you know, your neighborhood, you can also take advantage of some of the resources there.

Yeah, that'd be great.

Yeah. Okay, everyone, thank you for joining us on today's show on Airway Health. See you next time. 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 @DrSandaMoldovanova. This is Dr. Dr. Sanda Moldovanova, and remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.