Ep 347:Airway First:The Pediatric Dentist's Essential Role in Treating Tongue Ties and Growth Issues

A lot of times I'll talk about sleep hygiene too. These kids are all going to bed with 50 stuffed animals and blankets in their bed. And I'll bring that up. And I'm like, you know, those are harbingers of dust mites. And they're like, oh, we already tested her for dust. Don't worry, she's not allergic. And I'm like, you don't have to be allergic to have a problem with dust mites. You know, it's, it's stuff that never gets cleaned, stuffed animals, you know, and it's sitting there, you know. So even if you can't get the expansion, let's make sure we're doing everything possible for nasal hygiene.

Hi and welcome to episode episode 347 of the Untethered podcast. Today we have Dr. Anita Gorey joining us. Dr. Anita is a board certified pediatric dentist and owner of Lafayette Pediatric Dentistry. She's been in practice for nearly 16 years and is a Louisiana native. She and her husband Brian have two daughters. In 2016, Dr. Beret decided to pursue extra training and tongue ties and airway as a result of her own daughter's difficulties with eating and sleeping as an infant and toddler. She received her taught training and laser certification in 2017 and became an ambassador of the Breathe Institute in 2020. Dr. Durie is one of Louisiana's preferred providers for diagnosis and treatment of oral ties from infancy through adulthood. So to aid in proper feeding, speech and breathing, Dr. Guri has pursued her passion of helping ensure children's facial growth is harmonious with proper nasal breathing, oral motor control and airway development. She's been an invited speaker locally, regionally and nationally, presenting education on the importance of identifying tongue ties as well as speech, feeding and breathing problems early. Welcome to the Untethered Podcast.

I am your host, Hallie Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to.

Bring you the most up to date.

Information in the orofacial myofunctional therapy, airway, tethodoral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture.

Tongue up, lips closed, teeth apart. Breathe through your nose. Let's get started. Anita, welcome to the podcast Hi.

Thank you for having me.

I'm excited to have you join us today. You're very important in our world because I know you work with. You helped one of our near and dear team members and with her kids. So I would love for you, before we jump in, to just share a little bit about how you got into the airway. Tethered oral tissue, focused space.

Sounds good. I am a pediatric dentist, and so I'm in the oral cavity already, but they don't really educate. At least I graduated in 2008 from residency. Back then, they were not a lot. There was not a lot of talk about airway. And my daughter was born in 2010, and she had trouble latching onto the breast. She even had trouble bottle feeding, constantly having colic gas, spitting up, throwing up could. It got a little better when she transitioned to solid foods, but she could never eat anything that wasn't pureed until well past the age of 2 years old. So I just felt like. And nobody could ever tell me what was wrong, you know, oh, as long as she's gaining weight, this, that, and the other, it was fine. And I was grateful for that, but it had always remained a mystery to me. And then around the age when she was seven years old, my nephew was diagnosed with the tongue tie. And he had been having all of the exact same issues that my daughter had seven years earlier. And so I started immediately researching diving, going down the rabbit hole and all this kind of stuff. And my nephew was living in Virginia at the time and went to a release provider there who actually happened to be my chief resident at children's hospital in D.C. where I did my residency. And I started talking to her about it and went home that day, looked under my daughter's mouth, and boom, there was her tongue tie. So from there came everything else, not just the eating and the latching, but airway, speech, everything. And since then, a big part of my practice has been devoted to that. Not just releasing tongue ties, but referring appropriately for early palatal expansion, making sure we avoid orthodontic extractions at all costs if we possibly can, things like that. And looking for sleep apnea, early signs of sleep, disordered breathing. And I'm even getting adult patients now in my pediatric practice for this. And so it's really been a passion of mine for personal reasons, but also because unfortunately, not a lot of people are on board with this yet. And so here we are.

Here we are. Here we are. I always love to ask about that because I feel like I lived a very. I'm Not a pediatric dentist. I'm a feeding therapist. But you know, I lived a very parallel.

You know.

And so it was really. I always tell everyone I was working with toddlers with feeding. And then I had my child and she threw me into infant feeding. And then I went to Mayo and I came home. She was 24 months old. I flipped her over, I looked under her tongue and I was like, there it is there. Yeah, it was painful for 13 months. And no wonder. She got super picky at 15 months of age. Everything before that and you know, it was just very eye opening. And again, there were just not enough providers that could help me, my own child. And I felt like, okay, well I am the provider and I should be able to help my. Help my own kids.

Ready to do this?

Right? Fast forward. You know, she's now two and a half. I have a baby that one, you know, that child's born with a tongue tie. She went at day five and had her tongue tie released. Very different feeding experience. We dealt with some other things. They. She's now had two rounds of expansion. My older one is now 10 and has had three rounds. And they're actually getting their final expanders out tomorrow. So they're very. So it's just, it's really opened up my eyes to this airway world and world and you know, to the point where I as a pediatric feeding therapist and myofunctional therapist, I was like, I don't even feel like I got that education post grad school, you know, that I had to seek it out. And even in my feeding courses, nobody's talking about this.

Yeah.

And created it. But you know, to that same token, I'm like, it's because my own child was such a good educator and really threw me down this rabbit hole that I also then went like, well, I had braces and expansion as a kid, but clearly I need more. So I had an adult tongue tyre release and I had, you know, Ivo's DNA appliance, which gave me a little bit of teeth, I think expansion, you know, tooth borne expansion. Not necessarily through expansion, but now I'm in a market, so there's that. There you go. It's been like a whole whirlwind, you know, because like you had like this is just not something that's traditionally taught. It's still not being taught in our graduate. So. Yeah. And here we are.

Right.

Preaching to the choir. Right, Right. So from your perspective as a pediatric dentist, right. In this space, do you feel it's important for children to be Seeing pediatric therapists, you know, whether it's an SLP or OT or an ibclc, somebody that can work with them, collaboration with you, especially if you're going to be doing release, for example, 100% I'm for, I.

Prefer them to come to start there. A lot of people hear that I do tongue ties and just immediately refer to me. But I'll actually tell these people actually you should send them to a therapist first. And it's a lot of, you know, back and forth on that because they see therapy and they see me as a quick fix and never the twain shall meet sometimes. So it's been a, a big battle in education on my part, but always I want them to start seeing ibclc, pediatric therapist, ot, speech therapist, whichever angle first because it's so much better for the outcome if they indeed have a tongue tie that needs to be released.

Yeah, I love, that's music to my heart. And I admittedly as a therapist even who got into this space in the very beginning didn't understand the importance of like the pre. Sure, we're sending for a release. And it wasn't until we kind of updated our protocol. We were collaborating with a lot of pediatric dentists. Everyone had different ways of doing things, but the one required that they have a sign off that the child was ready, that they've gone through therapy, they've kind of gotten to a certain point. And then we had these kids come back to us after the release. We were like, oh my gosh, these children are responding so much better than the kids who are just coming for post op therapy and who didn't have the pre op therapy. And that was, that was a whole big eye opening experience for me. So what are your thoughts then on, you know, not just the pre op but then the post op intervention as well?

Oh gosh, I see it all the time. I see higher chances of reattachment or no reattachment. But that tension is still there. We're still battling, the symptoms aren't resolving. And you know, every parent I see, I tell them this is what's optimal for your baby. But I'm going to be honest, access to care is not there in our community. For Medicaid, there's very few providers and there's a wait list and access to care is simply not there because they're single moms and they're going back to work and you know, you still want to remove that obstacle. So it's, it's a lot. There's a, there's a Lot of gray area, but I absolutely are. I'm in the position many times where I see like, oh, I wish we were able to get in with that therapist beforehand. And I. If, you know, we lived in an ideal world, that's how we do this, you know.

Yeah. I was talking to another provider and we were talking about textbook and ideal and then real life. And yes, we might suggest one thing, but also like, we will meet you where you're at and as long as it's going to be beneficial, we believe it'll be beneficial for you and your child. You know, we unfortunately, even people that are.

That do have access to everything, if their pediatrician is not on board with this, which unfortunately many of them are not, they won't even sign off on the therapy orders. But insurance companies require a medical doctor to sign up. They're not. It's not okay for me to sign off. So there's a lot of barriers, fortunately. But yes, absolutely. Pre, pre work is a thousand times better for everybody involved, you know. Yeah.

And that's, that's a world I feel like where I personally don't have a lot of experience in because we have a private pay, private practice and I live, you know, I live. And my practice exists in the Maryland, Virginia area. There's literally a practice on every corner. So like we can get away with that. There are practices, insurance we do not. And so thankfully, we don't have to wait for someone to sign off technically. Right. For insurance reimbursement. And in some cases private insurance will reimburse without that, you know, as long as they have a report from us or the dentist has signed something. But it's so unfortunate that it's still so highly dependent on providers who don't get it in and that really, that's the thing standing between children getting, you know, the ideal saving care. Yeah, yeah.

Like changing care, rather so.

Yeah, yeah. That's fascinating to me. One of the things that I set out on when I created my current online business because I have an online continuing ed company was, you know, I want to get these children off of pediatric feeding wait lists. That is my main mission. And everything that I do, which is why I train SLPs and OTS. We talk about tongue tie tots, myo, you know, airway, all the things as it relates to pediatric feeding and then try to bring people into communicate about all the related therapies and topics and everything. But, you know, even though We've trained now 2,600 SLPs and OTS in the past five years, but there's still wait lists. It's like, I just go back to, can we get these kids? Like, no child should have to wait 100% therapy that they absolutely need. Right. It's not like, oh, this would be a nice to have. No, this is a necessity.

Yeah. So there's a lot of variability with the therapists that are available too. So it's. So. It's so hit or miss sometimes, too. So. Yeah.

Yes, I hear you. And there's a very, very interesting divide even within the SLP community where there's still a number of SLPs who don't believe tongue ties are real.

Correct.

That only believe tongue ties should be addressed in breastfeeding infants.

Correct.

I'm like, where do we get these one. It's just.

And no, no home exercises are given and different, different things like that. So it's just, you know, the parents will do everything. Right. And then still there's a barrier there. So, yeah, it's tough.

And then in the older kids. So I know we briefly were reviewing some talking points before we hit record. And, you know, I know you're a believer in getting an airway evaluation before putting children on ADHD meds, which I am a big proponent for a little bit about that. Right. That's also another barrier.

There's only a few ents that are willing to do it, but. But yes, we are big believers. And I definitely, you know, we look for tongue ties, we look for tonsils, we all the other things on our own, but sometimes there's nothing there that's obvious that we can see, but you can tell this person is suffering. And so there are a couple of ents in area, in the area that we do work with that it's been life changing for some of these kids.

You know, so do you find that these children are going to like psychologists or psychiatrists that are putting them on medications and they haven't had the proper airway? 100%.

Yeah, that's in the majority of cases, actually. Yeah.

Yeah.

Much like they come to me for the quick snip, the quick laser, because they just think it's the quick, let's try this first, you know, kind of thing. So, yeah, it should be the other way around. Right.

But yes, well, and it's kind of, you know, going against the grain. It's. This has been the traditional way that we've done things now for however many decades and someone is saying something different. And, you know, it's. I always like to show parents not that their child is at this Level. But like, the finding. Was it finding Connor Deegan video? That video. And you know, I think when a lot of parents see that, they're like, oh my gosh, like their eyes are just open. And if we can. And like, if we can empower the parents, sometimes we can get them to advocate. And they're like, I will not settle for anything less than, you know. But it's, it's unfortunate because not every parent has the opportunity to get that education or has the capacity to advocate full time for their child the way that they're smiled needs in the current landscape of medicine. So, yes, that's really what it is.

It's the barrier, you know. Yeah.

That you put lots of barriers, unfortunately. And then to that point, you know, it's also encouraging parents to trust their gut because, like, I know as a mom, like, I knew when something was off, but even as a professional, like in this space, I was like, I don't know exactly what's off. I just know something is off, something's not right now. I went and got the education and was able to do that. Right. You know, it's like sensing like, if something is wrong, your baby's not feeding well, they're not sleeping well, there's something, behavior, whatever, you know, I think giving parents permission to seek the help that they want and not just settle if they feel like what's been provided to them as an intervention is what feels right for them. I've had a lot of conversations with parents about just trusting their gut and pushing for more. Right.

I agree, I agree. I definitely tell people to share their story, especially if they came from a provider who was kind of anti, you know, So I think moms advocating for themselves are also advocating for people who are silent, you know, silently suffering. So sharing their story is, is crucial, for sure.

Yeah, yeah, no, that's. And that's a really good, like, perspective on this is like if you can speak up and if you want to be speak up and this gives you the encouragement to speak up, you are also helping those others who are either unable to or unaware or, you know, they just like, this isn't my place or whatever the case may be. Exactly. I haven't really looked at it through that lens before, so I really love that because it's like giving somebody else a voice.

Absolutely, absolutely. So, yeah.

So, okay, let's talk about some more of the airway things. So if someone is newer to airway, are there certain, like, signs or symptoms that you tell parents to look out for? You know, obviously mouth breathing, etc. What is it that you usually educate them on?

The big one that they don't realize they should, other than mouth breathing that they don't realize that they should be looking for is the hyperextension of the neck when they're sleeping. A lot of people, a lot of parents just think it's kind of cute, you know, like, oh, look at, they're all thrown back there in deep sleep and their mouths hanging open and those of us who know are like kind of a red flag. And they're always sleeping like that as well as just the constant tossing, turning restless, sleeping, making a little clock around their bed, which is another thing my daughter did until she had her palatal expansion. I feel like the conversation needs to start early in the medical field about those kind of like signs and symptoms to look out for the sleep, the sleep. But I feel like it starts with sleep and then, you know, it, it goes forward from there because with kids I feel like that's where you notice the signs the most. Certainly people are mouth breathing throughout the day and all that too. But you'll see the breath holding, moving all around. Hyperextension of the neck. A lot of people think I've noticed this. A lot of people think the breath holding where they is just normal sleep pattern or they're just in really deep sleep right now. That's how they know they sleep good. You know, I've heard that. So, you know, a lot of changing up perspective kind of thing, which you have to plant the seed too. It can be very overwhelming. So we just kind of have like a little list. I'm like, oh, you know, kind of look out for these things and it may be nothing but it's just always, we always want to be aware of how often it's happening and, and things like that. So. And then, you know, we're not sleeping with our kids in our room, many of us at certain points, so you're not even aware it's happening, you know, so just observing your child's sleep. Well after bedtime to me it's what I always tell parents is the key. Sometimes just taking a simple video, like they say in the, the Breathe Institute where I trained, don't wait, don't take a video of them right after they've fallen asleep, wait an hour or two, you know, and then, and then go look and it's like a different child almost.

So yeah, yeah, it's, it is fascinating. I had one patient, the mom was a, worked with adults but was a therapist and you know, they would say. She would say, well, I mean, my child sleeps great. Like, she goes to bed and sleeps 12 hours, doesn't get up, doesn't bother us. And let me tell you, that child in preschool was snoring like worse than a middle aged, like, male.

Right?

Like, and the teachers were like, we have concerns.

Yeah.

They pulled me in and I was still in the preschool, at this preschool at that point as a private provider going in. And so like, I didn't really have like an agreement per se, where I could just go screen any child. But they were like, hey, you're dropping this kid off. Can you just stay for a minute and like, listen to this kid? And I listened and I was like, oh my gosh, this child has sleep. They sound like they have sleep apnea, right? I went and I told the director and they ended up calling the family. I was like, look, I will talk to the family for free. They want to hop on the phone. I just, I would like to tell the code to an ent. Really. Anyways, they ended up rushing that child for like emergent surgery, which is not your typical case by any stretch of the imagination. They said that she was so occluded that her tonsils and animals, she just couldn't breathe. Like, these parents were thinking like, well, my child sleeps 12 hours per night now. This kid was turned around at circle. Didn't respond to their name. They're technically asleep, but like very like kind of like, you know, like loopy or kind of like out to lunch. Holy cow. Like when this child had the tonsils removed and adenoids were reduced and they started to sleep. And this was again a more of an emergence case. Within a week, this kid was responding to their name. They were sitting face forward at circle time. I mean, it was a different kid no longer snoring. And the parents were just like, I had no idea. Why would you.

Right?

No one's ever said anything. And I was like, thank goodness for this child having that nap time as a three year old in preschool so we could identify this because how scary. And so it's, it kind of begs that question of, you know, when do you go in and listen to your child? And I love that you brought up, you know, that the Breathe Institute mentions like an hour to two hours after they fall asleep because, you know, that gives them time to get into those deeper sleep patterns where we probably are going to see that maybe they're not actually entering deep sleep and maybe they are turning and their mouth is open and you're going to hear Audible breathing and all like the perfect storm right there. They're probably going to themselves and correct. We do the same thing where we ask families like can you just snap like a two minute video video of them sleeping and send it to us and you know, we're able to see so much in that little snippet. Yeah, it's right. Yeah. And I, my Now oldest, she's 10. But when she was an infant and I didn't know this at the time, she used to sleep with her. Her tush up in the air with her. I know it looks so cute, but. Cute but like tripod sleeping, obviously opening her own airway and so red. Correct audible breathing or anything. But she was definitely popping her airway open. And I was like, if I only knew that. What I know now I know you.

Just think it's something cute. And that's the thing, that education of it. The ones that always prefer sleeping on their side or tummy, is it because they don't like sleeping on their back, they can't breathe when they're on their back. You know, all of that makes so much sense.

And she was a child who, she was very intense as well, but she flipped herself onto her belly at three, three months of age. So that was a kid who was determined to get off of her back and open that airway. Yeah, yeah. It was like, wow. Like when I started to really look at it, I was like, oh my gosh. Because she was not a kid who was. She got sick once in a while, but she was not a kid who had like, she wasn't snoring, she didn't have infections all the time, you know, and so that's the thing.

It's so variable. Everybody like has different things that affect them. Like my child never had a problem with speech, for example.

Yeah.

But she didn't eat solid foods until she was after age 2, table food. So it's so variable.

Yeah.

You know?

Yes. Yeah. And then there was my now youngest who had croup as an infant into her third year, she had croup nine times and was on a steroid nine times. And I finally was like, has got to give. And we moved down here to South Florida and I was just like, okay, I need to find a holistic pediatrician. This thing exists. Let me find a holistic pediatrician. And she was just like, well, what we know is she is constantly being put on steroids which is going to deplete her immune system and she's going to. It's like this, this cycle. Cycle I took it upon myself to take her for expansion at, you know, age she was almost 4. And we went right into rapid paddle expansion because she was kind of an airway crisis kid. And I was like, we don't need a slow start. Like, I want to. I want to dive right in. I know this is fun. We've got multiple phases coming, but let's just. And what do you know, we expanded her and she never caught croup again. It was like she would get a normal cold and it would go away and, you know, looked at her wrong or sneezed next to her, she would have croup by like 12:00am like, it was wild. So anyways, I'm a big proponent for all these me too interventions and, and that's probably a good segue into, like, early ortho and all of that. So I'd love to hear, like, your perspective as a pediatric dentist on intervening early and expanding these. These palates to open the airway.

Absolutely. We, luckily, we are very fortunate to have somebody in the area that does do early expansion. And I'm not talking about six years old, seven years old. I'm talking. I've even done as early as three or four. And it just depends, obviously, on the child's ability to tolerate it. But it is surprising how many people I talk to in the orthodontic field that do not believe in early expansion unless they have a crossbite. They have to have the cross bite. It is interesting, but you'll look at their palette and you can barely fit your pinky finger up there, you know, and that's the thing. I realize it could be something that's over diagnosed and just isn't taught. But in, in several cases, the anatomy simply speaks for itself. So I'm always trying to get people to. To get this done. As long as the child would be able to be compliant. And a lot of things, a lot of times I'll talk about sleep hygiene too. These kids are all going to bed with 50 stuffed animals and blankets in, and I'll bring that up. And I'm like, you know, those are harbingers of dust mites. And they're like, oh, we already tested her for dust. Don't worry, she's not allergic. And I'm like, you don't have to be allergic to have a problem with dust mites.

You know, it's.

It's stuff that never gets cleaned. Stuffed animals, you know, and it's sitting there, you know, so even if you can't get the expansion, let's make sure we're doing everything possible for nasal hygiene, you know, saline sprays, all that kind of stuff, because all clearing the nasal passages as well, you know, so combining that with expansion whenever possible. I've seen just dramatic life changes. The allergic shiners under the eyes disappear. All of the things. Sleep hygiene, mouth breathing. There are times when I've not even had to release the mild tongue tie because the expansion took care of the issues. So a lot of people like to think that I'm automatically cutting or automatically saying, get your tonsils out and all this kind of stuff, but it's really, it's really so much more than that. Even your diet, your inflammatory diet, you know, we live in a. In a hard world where it's hard to eat organic farm to table food all the time. I get that. But my husband stopped snoring the minute he gave up gluten. And I never thought I'd be one of these people that said that ever. I was like, oh my God, these people and their gluten. And I'm not talking about celiac disease. I'm just talking about gluten sensitivity. It is a thing, you know, so we talk a lot about diet, we talk a lot about sleep hygiene. It's. It's all a big part of it. And sometimes when you can't get, let's say your child is really fearful and they just can't cooperate for the expansion. Basic sleep hygiene and dietary changes have helped as well. So it's all kind of part of the big picture. And I feel like that is something parents feel like they can control a little more too. So, yeah, there's a lot of talk about, you know, all, all the things.

I love that I'm trying to get.

More providers to be on board with the early expansion. And some have come around, but it has been more difficult than I thought.

I'll say that It's a very interesting space. I mean, obviously it's. I'm not licensed to make decisions about or provide, you know, to the therapies that, you know, interventions that move bone. I'm only in charge of the muscles. But it's as a mom now who, like I had that traditional expansion and braces and then I went into DNA vivos and now I'm in a marpy with these, you know, lower expanders, which are mostly operating my teeth because we know, especially as an adult, like the mandible, that's. That's all we're doing with the mandible. It's been really interesting. My orthodontist is working with pediatrics and adults. She's doing research, she's done research, she's created her own like protocol and everything. And it's, it's been fascinating to go through it as an adult, but it's also been really interesting because my, my oldest had an ALF appliance when she was age 4. And that's at the point that we entered into she about halfway through the pandemic started. So the only intervention she really had, we didn't end up doing really much bodywork or anything because everything was shut down. And so the really cool thing with that was, even though it was a slower expander, was that her tonsils during cold and flu season up north went from being like really enlarged and almost kissing tonsils and enlarged adenoids to everything calming down. And we have like the before and after CBCT to see, you know, what happened with the expansion where she was even, I don't want to say it was a full year afterwards. I don't remember exactly when we did the follow up cbct, but it was a friend of mine who was using her case in her alf, you know, residency, mini residency that she was doing and it completely opened her airway and I was like, I know we're going to need further expansion. She's only five. But to see how well that helped her in a time where the world was like in this respiratory crisis. Right. Fascinating. And meanwhile, my younger one was going through a croup and she got diagnosed in the pandemic as it started in D.C. we got diagnosed with viral induced asthma because she was constantly sick. And she ended up being on Flovent that summer. And I was like, this is just a kid who's constantly inflamed. Now we built a house where I put in all hardwood floors, no carpet. I put, you know, I was doing all of the nasal, they were doing nasal, you know, all the things. And I just could not keep my kids healthy. It was wild. And so anyways, fast forward, we moved to south Florida. I end up taking them from Boca to North Miami to an airway expansion dentist who put them both in a rapid paddle expanders or hyraxes with like a forward brisk component on them. Okay. And, and they both had, they both had tremendous growth. That's what got me, my youngest one, out of like the inflammatory crisis that she was in with every, all her airway stuff and kind of started her down a healthier path. But my older one, I think she was six when we went into that and it was wild. Because I took her to like the Three Top or if it was in Boca, and one of them supposed to be airway centric and they did a whole airway centric evaluation and then the treatment plan was not airway centric. And I was sitting there like, well, I have a hard time telling an ortho that he does not going to say he doesn't know he's doing. But like, I know I'm not paying you money to do this to my kid. There were other issues too. But anyways, so I took them. Now I'm presenting her case. It's now a year or so later and she's coming out of expansion and I'm presenting her case with like two dental colleagues. And they are like looking at me and they're like, she's not done. She needs more. And I was like, oh my gosh, she's gonna kill me. Right, right. I'm here for it, but she's not going to be happy. Anyway, so they're now with like a, the same orthodontist that I'm with and they're getting their expanders out tomorrow. Right. And they just, they have beautiful spacing between all their baby teeth. And it was really interesting because for both of them, the first time they went into any type of expansion, their delayed, you know, eruption or delayed Lou, you know, losing baby teeth started. It kicked into gear. They started to lose teeth. There was space for the adult teeth to start coming in. Everything was delayed until we started expansion in both of their cases, which was wild to me, but also very much so. Like, oh, this makes sense. Okay. And you know, so anyways, long, long, long story long. They have both, you know, my oldest has now been in three expanders, my youngest in two. And we're finally hopefully at the end of their journeys, at least for now. But they're going into clear aligners to help kind of continue to hold the expansion guide growth and everything. And it's really cool to see how far things have come, even just in the past five years. Yeah, I mean, they, when they get sick, it's easy to get them back to health. You know, they are doing their nasal rinses every day. We've got them on probiotics. They. It's like all the things, but it's, it's a lot of work and a lot of work.

Changing the conversation there too, with people realizing it's not a quick fix. I say that from the beginning. It's a process.

Yes.

It's a quality of life changing process. You know, yeah, that. That's the hard part for sure.

Yeah. Well, even understanding that your child may go into expansion now, but it's not going to be the end all. Be all. They may need more expansion as they grow, because I don't actually see that conversation happening too much. I get a lot of people saying, oh, early expansion, get in there now, and you won't need your traditional expander embraces. You're going like, well, hold on a second. Like, these kids are making promises.

And I do think that's part of the argument some orthodontists have against early expans, is that you're just going to need it again. But like you said, there's a, there's a quality of life change that needs to happen right now, you know, so it, you know, it's kind of. I get where they're coming from, but.

Yeah, and then you can be an adult like me and have it when you're 40 years old. So, I mean, I'd rather have it twice as a kid. Yeah, exactly. As an adult. Right, right. Absolutely. Oh, my gosh. Yeah, yeah, yeah. So. And I know. And it's, it's an investment, you know, it's an investment in time and energy and money and all the. And I do think that people need to realize, like, just like we talked about, like with tongue ties and everything, like, it's, it is an investment, but it's an investment in health. Correct. I've only seen positives come from, you know, the big investment that I have made across the board. So I'm like, use us as guinea pigs. We have updates on the podcast. You can tell my kids. Yeah, exactly.

I tell my kids, my pay, everybody, my kids story, for sure. It was like my younger daughter was not tongue tied. And that's when I was like, oh, breastfeeding shouldn't hurt at all. You know, like, not really. And, you know, so I, that, that also kind of helped me realize when I got into tongue ties, like, oh, okay, I studied both of their anatomies and all this kind of stuff, but she still, my younger daughter still needed palatal expansion and she didn't have a frostbite. Luckily, our airway focused orthodontist was on board and it even changed her smile. She stopped getting ear infections. Like, she was still getting ear infections. Like, she couldn't get her ears to drain properly, you know, well into early elementary school. So all of that factors. And it's not a quick fix for everybody. I realized that. But I just go back to the. It's all about anatomy basics, you know, it's really just that simple. Yeah, yeah, absolutely.

Well, and to that point, as a release provider, can you also enlighten everybody on why when I hear people say, oh, well, this, this dentist said, we'll just do a quick snip. When I hear that, I got my, like my aunt, like my, I'm like, my antennas go up and I'm like, no, you want to see this provider like a quick.

Right.

Can you. And I know we try to educate. Well, you want someone who talks about doing a release and they talk about the pre and post op therapy and da, da, da, da, da, da, da. Any thoughts on that whole quick snip terminology?

In some cases, when it's super anterior, I have had some therapists ask me to do it simply because they can't physically get under the tongue. So there's small number of cases where that makes sense. And then there are a small number of cases where you do see immediate improvement on the latch. It's never full though, or it's enough to get by with the breastfeeding and everybody's happy and we're good. But then a couple years later, a lot of them end up having speech issues, for example. So there are a few cases where that might be indicated. But I always educate people. Well, a quick SNP does not get the entire tie, the posterior tie. So yeah, for sure. Access to care is also another issue, I'll say that. But for the most part, I feel like people who take it upon themselves to get an evaluation with me kind of know the quick SNP is not the way to go, or they went through that already, are still having problems and now they've been told to come here. So. Yeah.

Right, right, right, right. So in your area, do you have like a multidisciplinary team that you generally work with?

Yes, I have a myofunctional therapy, who's also a lactation consultant in house, actually, as well as several lactations, OTs, STs, craniosacral even. We're very lucky in our small little town here to have a good number of people that are special, are into this area and specialize in this area and then collaborate. And like I said, we have the orthodontist that I refer to that does the early palate expansion as well. So we're really, it's really been awesome. And a lot of pediatricians are coming around. We have a good number of them that know this is a thing and, and know what to look out for. And they come to our little study clubs and lunch and learns and things like that. So we are. I am grateful for what we have. It's still a work in progress, but it's been great.

Yeah.

Because it's so important. If you're just the loan provider, you're. You're just running the standstill sometimes with. With what you're doing. Yeah. And I do see it on my. On my patients that unfortunately don't have the access to care, you know, they have somewhat of an improved outcome, you know, and I. I even say that arguably that therapy is more important than what I do, you know, and I've had some people go in for mayo, and we don't even have to do the release. Like, it's all very. I say that all the time. Like, it doesn't mean we have to do the release ever. You know, plenty people don't have to. So it's. It's great to have somebody to. Well, let's try this first, you know, let's stick with this first, you know, in the area.

Yeah. And that was. Thank you. Kind of led into my next, like, thought and question around, you know, what comes first, the chicken or the egg, the therapy or the release or the this or that. And obviously, you know, like, you're, you know, we've kind of shared your stance on that. But I think it's really interesting, too, because I know Zaggy talks about this with, like, the whole space issue. And, you know, sometimes what might appear to be a tongue tie, when you actually go through myofunctional therapy and expansion, will the tongue fits differently in the palate, and maybe you don't need that release. And so we tend to be like, obviously other providers we work with will go forward with it when necessary when we feel like, okay, you know, yes, maybe we'll get more space, but we're pretty sure that this tongue is still going to be restricted. You know, obviously no one has a crystal ball, but in those borderline cases where it's like, I mean, like, let's do. Let's least invasive option. Let's go with expansion. Let's go with myo. That. That whole tongue space conversation, I think, is happening a little more, but still not enough. Right. Right.

No, you're so right about that. So. And then there are times where, for whatever reason, I've had, and I still can't quite figure it out, I've had some patients be able to tolerate the myo and the release just fine, because on older kids, I put the sutures, you know, after and they're able to sit for that awake but they're not able to tolerate the expander.

Interesting.

So you know there's. It's a chicken and the egg thing for sure as far as that goes. But you know, that's what's great about this. You know there's. Yeah. Therapy really helps with the interim as well. You know, we're still getting expansion by getting our tongue up there as much as we can. So.

Yeah, I mean I always wonder about that too because as an adult who went into the vivos DNA and this is not to knock that appliance. I know it works really well for some people. There was no room for my tongue between those between the upper and lower appliance and you know sometimes and you know I don't know how you feel about my O brace but both my kids tried was kind of a fail for both. It was more of a holding pattern kind of tool. Anything else? Yeah. My older one couldn't keep it in. She would gag on it and spit it out within. My younger one kept it in all the time and she was chewing on it and everything the way you're supposed to and it got a hole and then got moldy and I was like well this is, is awful. And then it was. Yeah, one that never used anyways. You know, I'm like why are we filling their mouth with something when they can't breathe? So it's like I wrap the paddle at spanner. It's not going to completely fill their mouth. But also is it putting them into that fight or flight where they're sort of like I can't find possibly. I didn't think about that.

You're.

You're quite right wonder like having that space, having something space. Especially as someone right now who has mars like it's invasive and it's invasive.

And it can trigger your gag reflex.

A lot and you know. Yeah. So working on like trying to get the gag reflex move to the back of the tongue and trying to do things through myotherapy or feeding therapy before the expander goes in. Just like desensitization type of therapy. I think, you know, maybe that's. Maybe that's it. I don't know. But to your point too with the foods, like we have a lot of these kids who are, I believe they have these gag reflexes because of the soft food diet and because of the processed foods and you know, they are not used to chewing, moving things around their mouth. It stays on the side they put it in on or they're used to mashing things with their tongue against their palate. And it's their foods that break down very easily, you know, and they're not really using that adult, like, rotary chew. And they're not actually having that sensory motor experience throughout their entire oral cavity. And so in goes something new. And it's just like, hold the line. No, thank you. So that's. That's. I mean, that's a big conversation right there. But, you know, I also relate with your husband. I have. Apparently, based on blood work, I can't actually digest the gluten protein. I don't know. No one's ever actually diagnosed me with celiac, and I don't know if that's a diagnostic criteria. I should probably look into that. When we were in Italy, I was like, I'm just gonna eat it because I think it's the other chemicals here. And I ate it and I got really sick, but.

Oh, wow.

So that wasn't fun. But I also kind of came back pretty quickly. So anyways, my younger one has been pulled off of gluten, too. She's super glute sensitive. It also, like, upsets her tummy now if she reintroduces it, even in Italy. And. And she's seven. And so I think it's just that for some people, it is so inflammatory, you know, being off of it. Like, I just feel like a different human. I feel. And I've been off it for seven years now, but, like, it just. I feel so much better. It's not even worth, you know, anymore. So it's. It's very interesting, the whole food conversation, too.

It really is. And going back to the basics is not always easy because our food has just been so genetically modified at this point and all that. So we try to do what you can otherwise, you know?

Yeah, so. Yeah, absolutely. So.

All right.

Well, this has been amazing. Are there any other thoughts, topics, anything you want to share or discuss before we start to wrap?

If you could have the magic answer to how and we can get insurance companies to pay for myofunctional therapy. Lay it on me. But.

But, yeah, that.

That, like, barriers are my biggest problem, I think.

Yeah.

More and more people are becoming on board with the understanding of it all. It's. It's the barriers to care.

Yeah. I mean, I will tell you in our private practice, because we are private pay. And yeah, my team, we do provide super bills and our families are able to get out of network benefits apply. We do do that.

The.

Because we're SLPs. And SLP, OT, we are able to bill it under pediatric feeding therapy because we're doing the motor work and airway that all falls under like that. That's how we're able to do it.

What about for adults? Do you have any for adults, too? Okay.

And also. And there's different codes for, like, dysphagia, the oral phase of dysphagia.

Okay. Specifically for sleep apnea, though, like, sleep issues, like, let's say they're.

We are still. We can assign that diagnostic code if it's been given to us by, like, a dentist, ent, ortho, that's run, you know, certain things and you guys can diagnose. But we're able to assign that dysphagia diagnosis because the oral phase work, which is what we work on as SLPs notes and, you know, even RDHs. But they can't build this code, unfortunately. Right. I think that's probably the biggest issue, is we're able to build oral phase dysphagia, which is what we do in Mayo. So for adults, we can build that. It used to be the same codes across adults and peds, and then they came out with new pediatric dysphagia codes a couple years ago for, like, acute and chronic.

Okay.

And so we can bill those codes for pediatrics, whereas we build, like, the typical dysphagia, oral phase dysphagia code for adults for myofunctional therapy. Because what we're working on, even when we're addressing airway specifically, is still the oral muscles and that oral, you know, dysfunction. And so it's the, you know, the patterns, the muscles, the, you know, the exercises that we're doing that overlaps with what we would bill for issue, which at that point, it's really the two bolus prep, which all falls under myo. That is how we do it. Okay.

Yeah. I have to remember that.

Yeah.

That's another barrier, you know, if they're not having a known feeding or known speech issue.

That's good to know.

Yeah. Yeah.

It is all related, right? Absolutely.

And I'm always hoping they'll discover they have a feeding issue that they didn't realize, you know, like, oh, you're not supposed to just eat soft processed foods.

You know, and it's, you know, if they. If they were to go for like a, you know, MBSs or fees or something to swallow study, they're not necessarily going to present with a swallow issue in that sense. But we break, you know, the swallow for us is built under three different levels. And so because we can focus on just the 2N, like initiating the swallow up into the point of the swallow, starting in the mouth, like two bolus prep. Getting the food just like moved around the mouth, getting it onto the tongue, getting it ready to swallow. Exactly what we treat in myo. And so for us, it's, you know, yes, we can build oral fascia, but there is no MYO code. Right. But it is the overlap. Because I will tell you that pretty much every adult who's in MYO is not chewing and prepping their food properly. They identify as having an issue with that or not. They got TMJ issues, chews. There's no way they're biting crunchy foods on both sides. Right. They're probably biting predominantly on one side. They may be chewing predominantly on one side. We see it in their masseters. We. There's an asymmetry on their face. So I can look at a face and be like, I know where you chew.

Right.

So they don't recognize it as an issue. It's kind of like with the sleep stuff, where sometimes adults and I was even this person because I had nasal surgery three years ago, where it's like, you don't know what you're missing out on until you know what you're missing out on. Right. Like the expansion. You have the nasal surgery, you have whatever the procedure is, and you're like, oh, my gosh, I've been walking around for 40 years of my life and I had no idea what I was missing out on. And here we are. Right?

Yeah.

So I do.

Yeah. Well, perfect. Yeah. To remember all that. Yeah.

Well, awesome. This has been amazing. So where can everybody find you?

I'm located in Lafayette, Louisiana. That's where my practice is. Been a Louisiana native for pretty much since I was 2. My website is lafayette@ pediatricdentistry.com and.

They.

Can shoot me a message on there. Anything just to get in touch if they'd like.

Amazing to link that in the show notes so it's easy for them to find you and learn you. So thank you so much for joining me. Thanks for having me.

It's been a pleasure.

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