EP 349: Myofunctional Therapy Explained — Root Causes, Airway Health & Collaborative Care

But some of them have never even heard of myofunctional therapy. So then why would they know and who and what we do as myofunctional therapists? Well, there's so, so, so much, you know, what we can do to be able to even support what they do, right? So we're kind of like the cheerleaders for them. We take all of these advanced courses and now we teach advanced courses.

Welcome to the Untethered Podcast. I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, PODC 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 tether, dural 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.

Hi and welcome to episode 349 of the Untethered Podcast. We have Angela Richfine joining us today. Angela has spent nearly three decades in the dental field, starting as an orthodontic assistant in 1996, earning her dental hygiene certificate in 2000, and completing a Bachelor's in Applied Sciences in Business from Campbell University. Having personally experienced myofunctional disorders such as thumb sucking, open bite and low tongue resting posture, she developed a deep passion for helping others overcome similar challenges. After discovering orofacial myofunction disorders in the early 2000s, Angela pursued extensive advanced training and hold certifications as a certified orofacial myologist, qualified orofacial Myologist, and in the Buteyko breathing method, Guasha and craniosacral facial therapy arenas. In 2020, she founded Central Virginia OMT LLC where she provides both virtual and in office myofunctional therapy. Angela regularly teaches and mentors dental hygiene students and dental office staff, equipping them to identify and address myofunctional disorders. She collaborates with medical and healthcare professionals local internationally to ensure each client receives comprehensive holistic care and recent she is a mentor inside of the MYO membership. Angela, welcome to the podcast.

Hi. Thanks so much for having me. I'm so happy to be here.

I'm excited to have you here too. I feel like we have recently Just linked up in a number of ways, especially now that you're in the MAYA membership as a mentor. So, you know, I'm excited to record together.

Oh, my gosh, what an exciting journey that all of this has just turned into. And being a part of the membership is just. I love it. I just cannot tell you and thank you enough for creating this space that just brings so many professionals together, which as a dental hygienist and graduating back in 2000, but I was in the dental field prior to that, starting at the young age of 19. And coming into this, I always knew that. Or working at the dental office, I was always seeing so many patients who had a list and who had other speech things. And that's all that I knew at that time was just things. I had no idea of the rest of everything that came together. And I just have to tell you that I kind of wish that I went down the speech and language pathology route, but I also found a love and passion for the dental route. And just being here now in the membership and seeing. Seeing what you have built and the people that. And the professionals that you have gathered into this, people who trust you and trust all of your mentors. I'm just so honored that I was even asked to be a part of this. So thank you. Thank you for having me here.

Yeah, well, and thank you for accepting. I mean, it's been so important. I know we'll probably dive into this today, but just the collaboration and bringing together the knowledge base from the speaker, speech, language side, the dental, you know, hygiene side. And I'm all. I was always so interested in, like, what our dental colleagues had to share because you all have a wealth of information that we don't learn, and I know, like, vice versa, that kind of goes both ways. But then when we come together and we talk about patient cases, it just. It leaves no stone unturned, you know, and so I think it's a really beautiful relationship when we all can collaborate and work together. And so, like I said, I know we'll dive into collaborations. I feel like collaboration is like my life. And I'm sure, like, you know, you do a lot of that too, but. Yeah, so let's dive in a little bit to, you know, you kind of shared a little bit about your story, but I always like everyone to share, like, what's your why? Like, why? Or like, what was it that got you into the myofunctional therapy space? Specifically?

Yes. What a great question. My why? And it's funny because I. I did a Presentation with@pani. Dr. Steve Lamberg has his Pani event annually up north northeast. And I explained what my why was there and I think I spoke for about 10 minutes and I still feel. I don't feel like I was able to really express everything that I wanted to. But for the podcast sake, I'm gonna wrap it up like wicked fast. I don't know, maybe tenants, I don't know. But what it comes down to is my own myofunctional disorders. In addition to me noticing things with my own children, I have three boys. My oldest is 21. And when he was born, they had to use the suction tube to pull him out of the vaginal delivery. But with the suction, he had a cone head. Right. I had absolutely no idea that with the shape of his cranium. Nobody recommended to see a body professional. So, you know, we had latching problems. I mean, I was crying every time that he would latch. Crying tears, the pain and the agony. I did not look forward to breastfeeding, but my mother was right there by my side and she is a nurse and she worked in obgyn, delivered babies. She was just like, Angela, you've got this. He's going to grow out of it. He's going to grow out of it. Hang in there, it's going to get better. We have to toughen you up. And it never toughened up. And I was discouraged from breastfeeding. I made it to about four months with him, but it was not exclusive breastfeeding, sadly. And he was just in and out of the doctor's offices. Ear tubes, mouth breathing. I have so many pictures of him as a baby. We have sad, tired eyes. We have elongated face. And it's him who is my why. He's my why. And it wasn't until probably he's now 21. So it was probably around age one and a half to two that my. I was married into the military and so we would move around. I always came back to Virginia. I live in Virginia and I always came back to Virginia because that's where my dental hygiene license was is and in California because we were stationed out there. And I took my boards out there. I digress. I come back for my CEUs, my annual conference, state conference. And it was a quick webinar or a quick topic. Kimberly Bengart. And she spoke and she was there for about 15, 20 minutes and she spoke about breastfeeding a little bit and things to what happens with the. With the symptoms that can occur between the mother, baby dyad and my ears just turned on, like really turned on. I was tuned in. I felt like out of the room of 100 to 200 people, I don't even know how many were there. I felt like I was the only one there and she was speaking directly to me and everything that she said rang true. And that is when I started. I came home and I started reading and reading. We just didn't have, we had access to the Internet. It's not like it was the stone age back then, but the accessibility to textbooks was almost non existent where, where I was trying to go and learn and read. And that's all I wanted to do was learn more and more and more. How can I help my child? Gut reaction for a mom. Any moms listening right now? Listen to your gut, your intuition. It's so important. If you feel like something is not right. I feel as though your myofunctional therapist. Google it in your area. Reach out to me, reach out to Halle. Reach out to the professionals who are here to help you. We don't learn about myofunctional disorders in school. We don't period yet. And I don't know, I might be dead by the time we do. I hope not. But I feel as though your myofunctional therapist is not just a myofunctional therapist. We don't just talk about muscles. Myo is muscles. And we want to help you because we're passionate about what we do. We are moms also and we, what we want is to be able to guide you into the right direction with the continuing education that myofunctional therapists take. It's not required, so to speak. I mean, we do have our continuing education units that we have to take for our licensure. But for myofunctional therapy, the continuing education is so important not just for the whole head and neck area, but for the entire body. Because if you think about the mouth, it is the gateway to the body. We eat, we breathe. Not just, we don't want to breathe through our mouth. We just for a back note here, side note, we breathe through our nose, okay? We were born to breathe through our nose and we were born to eat and speak through our mouth. So. And here I am taking a big gasp as I'm speaking. Do as I say, not as I do. Not in the moment. Of course you're going to breathe through your mouth. But what I'm getting to is when you have a concern as a mom and you want to listen to your intuition, find A myofunctional therapist. Because our continuing education is for the whole body, we take courses that cover what happens with the deep line of fascia, which starts in your tongue and goes all the way down to your toes. So if there's some sort of tension or something that's off, it's going to show up mostly in maybe your posture, how you walk, how your head is tilted, maybe how one shoulder might be higher. Think about this deep line of fascia as this spiderweb throughout your entire body. And say a fly just lands on that spider web, which could be your shoulder, or it could be in your midsection, or it could be on your knee. The spider's gonna go on over there and wrap that little fly up in a cocoon and bring it back to the center of the web. That's great. But what if it starts to rain and storm and the spiderweb gets ruined? That's that a dysfunction that's going to cause dysfunction to that spider not being able to catch a fly on that spot. So that whole entire spider web is just going to be one big dysfunction. So if there's something going on inside of your body or maybe in your child's body, your myofunctional therapist is educated in that. We look at the big picture, the whole body, and then we know who to refer you out to. So your pediatrician is going to be your pediatrician. Your orthodontist is going to be your orthodontist. Your ear, nose, and throat doctor is going to be your ear, nose, and throat doctor. I'm not saying that we are the specialist for each and every one of those, but we can see the signs and we can listen to your symptoms and being able to know who to refer you to to be able to help you get to that next point. Myofunctional therapy, the muscle exercises can only get you so far. We need a full team. So the myofunctional therapist I feel. I feel is that we sit in the center of this big circle, and in that circle, we have the link to all of these medical doctors, but not just the medical doctors. We have physical therapists. We have occupational therapists. We have your speech and language pathologist. We have your massage therapist. We have your cranial sacral therapist. We have. Helly. I think I'm kind of getting ahead of myself on.

Oh, you're good.

You're good.

I mean, we're talking about a lot of really great things, and I think you've kind of alluded to, like, how much There is under the umbrella of myofunctional therapy and like what we all learn and the continuing ed side of things, which is great. And now I love that we've kind of moved into like the collaborative team, right? Like who's on the team and, and it's so true because like you're talking about how you know that myofunctional therapist can be that center role if you will, almost like the case manager. Like I feel like our patients come, right? We assess them and then we're sitting here going, okay, well there's a laundry list of people I would like you to see. Where are we going to start? Let's go see this person and this person first. And once we do that, then we'll talk about this next thing later because these are most pertinent right now, right? So I love that because I think, you know, a lot of people are like, well, who do I refer to for collaboration? And very interestingly because I was teaching this three day screening but for peed feeding and after the screening packet we talk about like where are we referring? And it's really onward for a full eval. And so a lot, you know, but then people are going, well and I'm using my daughter's case and so people are like, well what about you know, EMT or what about an airway dentist? I'm like, well you know, she had a tongue tie release and you know, she's already in expansion, so already on the team and we can't refer from a screening. We need to do a full email. So it was sort of like trick question because unless you have a dire like this child is going to die in their sleep kind of concern, we're probably going to go straight to the ENT without recommending like a full on eval and that that holds true whether it's pediatric feeding, myofunctional therapy. And so it was very interesting because everybody is very quick to diagn off of just like a screening tool. And I'm like, no, we need that full on comprehensive evaluation. And like let's just use myofunctional therapy as an example since that's our topic here. Once we do that, like you're saying it's like then we've looked at posture, we've looked at upper airway from what we can see without scope or scan. You know, we've looked at the muscles, we've looked at function, like how everything's functioning together like form and function, right? And so then we have a better idea of like okay, who should be on this person's team? Because it's not always the same person. And anyways, I can see you nodding your head but you know, it's, I think it's a very interesting conversation. And everyone's like, oh well, automatically emt. And I'm like, well why, why are you recommending that? Like what is the. And why would you refer there before you'd refer here? Because you said there's two or three people you'd like to refer to. And so it, you know, I like to stop and make people think and really fully understand and have an explanation for why they're doing something. But that more and more people in our space I feel like are looking to the specialist who's going to be part of that team. Like, how do we collaborate to best help this patient?

Yeah, excellent. That's so excellent. That's so wonderful said. And part of our team is it's not just that one person let you like just like what you said. And there may be two different orthodontists or four different orthodontists in town or maybe several different dentists. And we're seeing more and more of the dentists getting these CBCT scans in their office. But not everybody, those are very, very expensive machines. And what I'm not seeing is the ents having these machines in their office. The CBCT scan machine itself is a multipurpose machine. And not only can we see the cephalometric side of things, we can see that panorex, we can capture the bitewings, we can look at the bony structure, this whole skeletal system, we can look at where we can take a lot of measurements from these. And there are, there are more orthodontists that I'm starting to see now have these machines in their office. But I'm seeing more dentists do it because it's more multi purpose purpose. They, they use it for more than just the one thing. Now when, when I bring that up because let's talk about the referrals. So there may be four orthodontists in town or within the driving distance that maybe a patient will, will drive because I do refer to, you know, an hour away or maybe even sometimes an hour and a half away. And that's because I know that this office in particular has the CBCT scan, has the knowledge, the dentist has the knowledge and has taken all of these courses and classes and continues to educate herself to provide a wealth of knowledge to the patient. So when the patient is coming in an ALF device may not be the correct device for that patient. Maybe a Marpeus or a removable palatal expander bioblock or, you know, some other device. And maybe this one might even need a reverse pole, a protractive headgear unit. Now, there are a couple of different ones. And I say unit just because I'm, you know, rambling on and on, probably because I'm mouth breathing right now. But. But when they have these devices, having a, a professional who has the knowledge of multiple appliances is typically where I may send a patient because of, I might, I'm not, I'm not going to diagnose. I don't diagnose number one. I assess. And if I have, since I have a lot of experience in the dental field, I can see the growth pattern. There are, you know, high narrow palates, these mandibles, those posterior dent, the posterior dentition, albeit deciduous or permanent teeth. If they are tipping or lingually inclined, leaning inwards towards the, the tongue, then we know that those teeth need to be uprighted. But why? And you had asked me, what's my why? And I gave you the answer of my child. But I like to ask these parents, what's your why? Why are you here to see me? Okay, I was referred. Okay, great. But why? And then when we try to discuss the why with the parents, the aha face comes on. And we, as the provider, during our assessment, we have to have our toolbox opened for all of the options. And that's why we educate ourselves so, so much and take class after course after course. And, you know, you are teaching these courses. I have been teaching courses, but I also take that time to educate myself as well because it's so important with all of this new research that's coming out that more and more information is coming in from other countries, from. Brazil is the only country right now that is assessing for tethered oral tissues at birth. And when I am saying they are the only country, there will be physicians who may, I don't know, say, come to me afterwards after this. If they listen to this and saying, are you kidding? We look for it in the ER now in the United States, from my understanding, in professional conversations with ENTs, with lactation consultants, with the entire OBGYN staff, those who are in the room when a baby is born and that tongue is sticking out of the mouth, if the tongue protrudes fully from and passing the lips, oh, they don't have a tongue tie. That is the most inaccurate statement that could ever cross a human being's Lips, because they're not the ones taking that time to understand what a tethered oral tissue is. And yes, they have taken courses in there, but even after speaking to dentists and other medical doctors, that in the curriculum, the healthcare curriculum, we have a grading scale for those who are listening, who might not be a professional or might even be a professional. We have the grading scale, we have the Mallampati, we have the Freeman, we have the Brodskis, we have the Coriolis, and I'm so sorry for stumbling on that one. And we have all of these other grading scales for airway and for tethered tissues. Now that for those who are not taking the time to take these courses that are educating and having this awareness and knowledge, that's where I think that the myofunctional therapist comes in. Because we have a very, very open mind and we are really taking that time to be able to help all of these parents. Because again, I'm going to drop back to that. You know, we are moms, and I'm not saying that other physicians are all dads. You know, we're moms. Moms are the ones who grow the babies in the belly. They have a different type of connection to the child. And I'm not an expert in that field, but I am a mother and I have been pregnant more than my. My. More than the births that I have had. And it is incredible, the connection that you can feel. Some moms don't have it. That's okay, that's okay. But just having awareness. And I'm going to go back to the gut feeling that intuition, if something's going on, you know, reach out to us. Because most of the time we're going to do a phone consultation first before we, before we go ahead and we see you for the moms out there. But oh, my gosh, Hallie, here I am again. I'm just kind of going off in.

This is all so good. I love it. I mean, I was, like, taking notes so I could, like, go back and speak to some of the things you mentioned. And I mean, to speak to your point about, like, mom's into, like, mother's intuition 100%. And I can't tell you how many parents I speak to, to that are like, you helped me, like, you know, really trust my gut instincts. Like, I knew something was off, but I've been gaslit by so many medical professionals and I tried to get help, and everyone's just basically told me I have Munchausen syndrome. I'm just crazy. I'M just making it up. And then I met. Then I meet you, and you literally confirm every single thing I ever thought to be true about my child. And so, you know, I tell parents this. I'm like, you might not be the medical professional, maybe you don't have the education in the space, but you know your child best. And if you see certain signs, certain symptoms, something in your gut tells you that something is off and you don't know what it is, I'm like, just reach out to somebody who seems to be speaking your language, even if it's on social media, and ask them if they know anybody like them in your area, because that's the best way to get connected to someone who might actually be uniquely qualified to help you and actually hear you. And it's been really cool because some parents have also told me, they're like, you know, I created this podcast for professionals initially, and I've had parents come through and say, like, oh, this was such a helpful episode. I use this information to advocate for my child. And I was like, wow, that's awesome. Like, the unintentional benefit of the podcast, right? Like, giving parents the verbiage, giving them the permission to go and get their kid the help or even know that they need to get help or that their intuition is, you know, driving them in the right direction. And so I think that's really cool. But you said something else about, like, the CBCT thing. And it was. That was interesting, too, because I had a parent who messaged me on Instagram, and it's someone I've talked to over the years, like, back and forth, and they're in the professional space. And they said, well, you know, is it. Is it weird if, like, an orthodontist office doesn't have a CBCT or they're not doing a CBCT first? And I said, well, actually, most orthos that I know don't have cbcts in their office. It doesn't mean they're not airway centric. But usually they'll write you a script to go get one somewhere else if they don't have the proper scanning equipment in office. And so I'm like, I wanted to circle back on that because when I lived in the D.C. metro area, and I was like, I know I need a septal plasti. And I didn't know what else I needed at the time. I was too afraid to let somebody touch my face. I was like, these ents aren't airway centric enough for me. Which sounds so funny because they do airway. You know what I mean? It just sounds weird, but it wasn't airway in the way that I needed. And as you, it makes sense to you. It's like a myotherapist, right? So when I moved down here, I through a mutual friend had this conversation about somebody that basically did her. You know, her husband had gone and had his septoplasty and terminus reduced and everything. And so I call over there and they're like, no, no, no, you don't want this ent. You want this one in our office. And I was like, okay. So I schedule a consult. I go, I don't know what to expect. They don't tell me anything ahead of time. They send me down the hallway to a cbc, a CBCT scan that I guess maybe they share it amongst a couple practices. I don't know if they're all in the same network or what. I didn't even ask, but I was like, okay, that's cool. And then they brought me right back into the consult room. They pulled up my results on the screen. The doctor comes in like 10 minutes later. She's already reviewed everything. She's reviewed the paperwork I filled out. And I was like, take my money. I don't even know what you're going to recommend, but I'm so impressed. And she proceeded to spend 30 minutes with me. Now, I did pay out of pocket for this consult, right? It was not completely cut. But she spent this time with me and I felt so good about what she was saying and the options she gave me. And she said she introduced me to nasal swell bodies. Had never heard about nasal swell bodies as a myofunctional therapist. But I knew my turbinates were enlarged. I knew my septo, my septum was deviated. I didn't realize how deviated it was to the left side. It was completely blocking my left airway, which is wild nasal passage. I didn't realize that. Wild. And then at the very end, I also had learned she was a double board certified ENT and facial plastic surgeon. So I was like, I trust you to touch my. So while you're in there, could you just get rid of this bump that like kind of my, my nose got a little crooked in pregnancy. Can you fix this for me? And she was like, oh, okay, now we're talking. Like, you know, she was never going to push that on me or even offer it up because I was never something else. And I was like, that made me appreciate her so much. She didn't try to sell Me, her other services. She didn't say anything until I asked about it. And because that's cosmetic versus medical, you know. And so it did change the procedure from a. Instead of it being a closed procedure, which she could have done the nasal septum, the small bodies, and the turbine reduction as a closed procedure, it became an open procedure because I wanted the rhinoplasty. And I was like, well, am I going to be under general anesthesia with either one? Because I have a hard time processing that. So we're doing this. We're doing this one time. And she was like, yes. I was like, then we're just going full out. Like, open me up. But I share that story because it's so rare to find a CBCT in office. We even had a provider down here that I took the kids to where she had went in her office. It was broken. It was very expensive to fix, so they weren't using it. And she was referring out to somebody else. But it was $800 to have the.

CBCT to take it.

Yeah. And they came to like my driveway. So that was kind of cool, but also like, it's in a car and like a truck, you know, and my three year old, four year old is standing there holding the thing like this, and I'm like, the car motor is on. I'm like, is this even going to be accurate? I mean, it was fine, but. And it still goes to the beam readers and all that fun stuff. That said, on the flip side, I've also been to an ortho in office who has a cbct, did a beautiful airway eval, and then the treatment plan was not airway centric at all. And it's a big name in Boca. And so just because they have a CBCT in office also does not uniquely qualify them to do airway centric intervention. So it's like, you know, I feel like people are like, well, what do we do? Like, well, you really got to know what you're looking for. You know, it's not just all about the equipment or, you know, what they say to you. But anyways, there was one other thing you brought up too. Oh, the parent education piece. And so I think we kind of touched on that already. But I think that I love. Because you really highlighted, like, how you do the parent education and like, when somebody comes to you. And that made me think of something because people in the membership even will say, well, how do you get kids to graduate, like to the point of graduation? Like, how do you get your patients through the whole like, through therapy, Like. Like, they don't fall off. Well, are they bought in? Do they know why they're there? Like, you mentioned that you're, like, you ask them, why are you here? Like, what is it that you want? And so I don't think I've ever said, why are you here? But I said, what is your goal? And, like, what do you hope to get out of this? And I think it touches on the same thing, is, like, why are you here? Right? It's. It's like the same question kind of in two different ways. And so it's checking in with that person to be like, do you get why you were referred to me? Do you know what we're going to be working on? Do you understand, like, the goals of what we're trying to accomplish? Like, are you on board? Because if you're not, this is a waste of time for everybody. Right? And so I love that you brought that up, because it's people. It's so funny. I did this, like, training. I think it was like, December 2022, and it was like, airway first, and it was just for our members in the membership. And I talked about that. I was like, one of the reasons why I think our patients are so compliant is because we listen to them and we make them a part of the team and we ask them what their goal is. And even though we might have a different goal for them, we can educate all we want, but at the end of the day, they're kind of driving that ship in terms of, like, how far they want to go through therapy and what it is they want out of it. And if you don't know that going in, then you're working blindly towards a unshared goal that nobody else is on board with but you. So that could be why no one's really completing the program or, you know, making it all the way through their therapeutic program, whatever that program looks like. So, yeah, I wanted to highlight that because I was like, that's brilliant. Just asking them, like, well, what is your why? Why are you here? Like, how can I help you? What is it you're desiring from this, you know, time with me? It's a beautiful question. And I think not enough of us stop to ask because we're not used to being asked that in medical settings.

That's right. That's right. And I find that every time that I go in for a checkup or any type of medical appointment, it is just boom, boom, boom, boom, boom. And I'm snapping my fingers over here. Because it is a constant, consistent turnover and it's quick and they're very efficient and how it works. I think that with the finding out what their why is, what their goals are and things going back there, going back to something that I want to bring up. And for those professionals and myofunctional therapists who are, and those who are not myofunctional therapists, but any other discipline listening today, that on my assessment form for my therapy sessions, every single time that they come in, and typically I see my clients about every two weeks. And when we are at the beginning of our session, what I like to ask them is, what are your improvements from the last time that I saw you two weeks ago? You know, is there any more bedwetting? Are we clenching our teeth still? Are we able to fall asleep more easily? Are we able to. Are you noticing that you're chewing on the other side of the mouth too, in addition to one side? Because, you know, with your palatal expander, it may feel off. And so the whole dental mindset is, where are your teeth touching? And because if you are touching on one side more than the other side, typically you will chew on the side that makes contact first. So that's leaving the other side not being used. Well, our title is myofunctional Therapist. Myo means muscle functional. Of course, you pull them together. And we're working on the function of the muscles. Well, if you're only chewing on one side of the face, guess what's not being used on the other side of the face? Is it being used? Yes, of course it's being used. Not as much. We want to find symmetry, right? So being able to find and be able to have symmetry is a very big thing, because then we're just going to walk all crooked, right? No, but we may not be able to have that good posture, that straight posture. And so because I love to go on tangents, and I think everybody here listening is just like, yep, that's Angela. She's a tangent. But I do, I love it.

Me too.

But circling back to what in my. In my therapy sessions, every single time, every two weeks, I ask them, let's review our goals. Our goals are, you know, in a myofunctional therapy, we want to breathe through our nose. We want to keep our lips sealed. We want to keep our tongue up in the palate, especially if we are young, because the palate takes shape and form of the tongue shape. So, you know, form follows function. Function follows form. It's a big circle. What came first the chicken or the egg. And I always love to reiterate the goals. What is the why? Okay. That's going to keep us focused. What percentage of the day is your tongue up? What percentage of the day are your lips sealed? Let's allow them to take accountability for their why. I don't want to waste their time and I don't want to waste their money, because that's another spot on my schedule where another client who does want to do their exercises, who does want to see improvement, they know their goals, and they are working towards them. Are we preparing for a tongue tie release? Right. Are we preparing for. Just preparation for getting a marpi placed? You know, for those people who are gagging in the dental field. Oh, my goodness. I really in dental hygiene for almost 29, 29 and a half years now. I don't know, I kind of lost count. And when we take X rays, bitewing X rays, so many people have a gag reflex. And it wasn't until I learned about myofunctional therapy that they're protecting their airway. They are protecting that airway. Are we told dental hygienists? We are told, okay, here's the trick that you can do. You know, put salt on the tongue, breathe in, out through your nose, wiggle your toes. And there are little things that keep their mind preoccupied. While we're getting that, quick, let's get this shot taken so that we can find out if there are any carious lesions anywhere in the teeth. And for those who don't know what that is, it's a cavity. So, you know, cavities, we can't see them in between the teeth. But what we can do is we can get those X rays taken. But if there's a gagging reflex going on, or, you know, what if we try to put an X ray, a bitewing sensor in the mouth, but on the floor of the mouth, there's all of this bony protrusion coming in from the canine and the premolar area. We have mandibular tori growing back down in there. Whoa, timeout. What's the why? How did those get there? Why? So we're just the investigators. And what can we do to help the next person not have those bony overgrowth? What can we do to help the next person? But what if somebody comes in, you know, they're 50 years old and they already have them, and they're almost kissing. Well, you know, what's the why? That tethered tissue is what I have seen in my clinical experience. And, you know, we have this poor mandible that could be just so tight. We have 16 muscles that help the tongue move more, more because everything is connected, right? So we have the hyoid bone, which is that free floating bone in the neck, in the upper portion of the neck, below the tongue. And all the tongue muscles are connected to that hyoid bone, helping it to stay balanced and accurate. Accurately placed in the mouth and in the head and in the neck. And it is. Or helping, helping every. Not in the head and in the neck, but that hyoid bone is a horseshoe shaped bone where a lot of the muscles connect to it. And we do want that goal to keep it balanced. So the goals are going back to the goal. You know, I want to stand taller. I don't want to lean to the side anymore. I don't want to slouch. I have forward head resting posture. Okay, we're gonna, we're gonna get through this. We're going to get through this. But you know what? I'm gonna remind you what your goal is every single time that you come in here. And we're gonna work towards attaining that goal. We're gonna work together. So we're gonna go through exercises today. We have, we are your personal trainer and we are gonna get you to that point. You know, we're gonna. I giggle because I just hired a trainer and we're gonna get you into that bikini again. You know, we are going to get you to that point. Our goal is to help you attain your goals. And maybe you don't really know what your goals are because you were just referred by your dentist. Hey, you need to go see a myofunctional therapist because blah, blah, blah. So being able to communicate with your patient and allowing them to have that aha moment. As therapists, I personally like to rewind and I like to use this as maybe even life lessons. And not just with a patient in front of you, but rewind. What's the why? Well, when did that happen? And why did that happen? Okay, well then let's rewind to that reason. Okay, well then let's rewind to that reason. And so we go all the way back into utero. But I have taken courses and classes in babies, infants, toddlers, but that is not my expertise field. So I'm not going to get into the utero part of this. Although me and my tangents. I could, but I'm not. Stop me.

Quick. Hurry.

Toss me that rope. Get me out of this. But, but setting goals, acknowledging them, taking accountability and finding that Responsibility and allowing them to take that response. Responsibility, pride. Pride of ownership, ownership of your own body. And let's work together, because that's what we're here for. We're therapists. Right? We want to help.

Yeah, well, and I love that highlight of, like, the root cause kind of asking the why? Why? Why? Because I. I've been in business courses, I worked with business mentors who have the same exercise where it's like, well, why? Okay, let's go deeper. Why? Well, why did you say that? Okay, well, what. And really, what they're doing is the same thing you were doing, right? You're getting to the root, root cause of that behavior that we're observing now, or that symptom or that sign or whatever it might be. And I think it's really cool when we can have that vision and really guide patients or their families, you know, for kids, their caregivers to understand, like, the root cause behind it. Because we always say we're root cause providers. Like, treating the symptoms is basically often a band aid on the issue. And we know that's what traditional medicine often does. But we are not here to practice like traditional medicine. We are here to get to the root cause, to fix whatever it is that's going, like, help you kind of, you know, get past that, get over that so that you can thrive. Like, we want to help you thrive. We don't want to see you back here in three years. Like, you might need a little touch up here and there if something happens. But, you know, like, our goal is to give you full, functioning health. And so if we can achieve that through root cause approaches, it's a whole different ballgame. And it's really amazing, too. It's cool because I typically work with pediatrics, but when I talk to adults, and I was actually just talking to an adult who was trying to sell me something last week, but is on their own airway journey. And. And I did buy what they were selling, and I'll record back once I try it. But what he was saying was he was just talking about, like, his own airway journey and how he's. He said the same thing that all of the adult patients eventually say, which was, I didn't know what I was missing out on until I knew what I was missing out on. And I was like, hi, I'm the practitioner. And I didn't know what I was missing out on until after my nasal surgery. And I knew what I was missing out on for my whole life, that I now had the sevated septum it's wild. It's really wild. If you could be as educated as you can be. But it's that lived experience, right? And you talked about like living through that breastfeeding journey and all the struggles you've had with your son. That was my now 10 year old. Like, we had that same journey. I was gaslit. I was told, oh, your baby feeds fine. We went home. It's like driving. I would say it's like driving your car to the shop. The sound stops. You get home, the sound continues, or you drive off the lot and the sound continues. It was the same thing. She fed well during the appointment. We got home, it all fell apart. But I was told, she's fine, she's fine. And I was like, at that point, I was working with older toddlers in feeding. I wasn't working with infants. So I didn't have. Even though it's a speech pathologist and a feeding therapist, and I didn't have the knowledge of the infant feeding at that point, like 10 years ago. And so, oh, she threw me deep into it. Like, right away I was like, okay, I need to learn. And so, you know, nine years later, now I can say I have that background. But still to that point, I didn't even know as the provider. And so, you know, again, going on my own journey. And she's the one who threw me into myo because I went first and did infant feeding and was like, okay, now I can do all pediatric feeding. And then I from there went into Mayo when she was about 24 months old and I was pregnant with my second. I remember calling and like moving my course up because I was like, well, I'm pregnant, so let's get this thing going. We moved it up like six months. And it was just so eye opening. I remember coming home, flipping Lily over. Like I was sitting with her in her little chair in her bedroom. I flipped her over, I looked under her lip and her tongue. I was like, oh, there it is. And that explains, explains everything. Okay, because like you said, painful breastfeeding, like the latch, like, I would have to turn my face away so she didn't see me like grimace because it was so painful. I did make it through 13 months of breastfeeding, but we were like pumping and bottle feeding the breast milk and she didn't respond well to formula. So I was like trashing that because I was like, I just. She's screaming. I don't know why. Maybe there's no protein issue. You know, that's a lot of the story. For another day. But I was like, so, so determined to breastfeed her. And if I wasn't breastfeeding, bottle feeding milk, the breast milk, and I'm like, man, those 13 months are burned into my brain. Burned into my brain. The second one came out, had a tongue and lip tie. We took her for the release, Boom, done day five. And her breastfeeding changed overnight. Like it was the same journey for.

The first five days.

And then all of a sudden, it was such a different journey after that. And it's like you live and you learn, and then you don't want anyone else to go through that.

Amen.

And here we are with both my kids and expanders and myofunctional therapy and, and, and, and, and. Right. And so we all practice what we preach. I'm in my own Marpi journey, as many of you know. And so if you're listening, this might be one of the initial episodes actually that comes out after I got my Marpi. I don't know that because I recorded a whole bunch that will carry us through the end of, like, October. So this might go out either end of October, beginning of November. And. And this is the first one. So everyone let me know how I sound because it's probably a little bit different, but I do feel like when I don't have my lower aligner in, I take that out. My speech is a lot clearer when I have the lower aligner in. It's wild how hard it is for me to speak, even obviously still with the Murphy like up in my palette. So here we are. But that's a conversation for another day.

That's great. Yeah. The Invisalign really does. With that full covering on the front, the side. The tops of the teeth everywhere is covering the entire.

Yeah. And entire is doing her own. So it's actually a thicker aligner than Invisalign because I've had Invisalign in the past. I did that after DNA Vivos, and that's thinner. And my kids have Invisalign for their upper and low. Well, they have it lower right now. They're about to get their upper appliances out in, like, in October. And then they'll go into his line on the top too. But yeah, it's this, like, it's really wild. You put it in. I can't put it in very easily without warming it up. So I have to actually put it into like, warm water for like 30 seconds. And it kind of like unmolds. Kind of like think about, like, you know, the Mouth guards. And then you put it on your teeth, and it has this, like, memory. It's like a memory shape. So then it goes back to that initial positioning, but it kind of like, locks into the teeth and everything. And it's further down on the gums, too. It's not just, like, to the base of the teeth. So it's very, very the base of the tooth that you can visualize. So it's very interesting to see. You know, I don't know. We'll see. We'll see what happens. But I'll keep everyone posted. I'll have to, like, do a little thing where I show everybody the. The aligner. But, yeah, I soon get my. The metal removed in, like, two weeks from touching my teeth. And then I'll go into another clear aligner on the top as well, and they'll have two aligners, and then we'll really get to see how fun my speech is.

Are you measuring your diastema and taking photos along your journey?

So I have not been measuring it, admittedly, but I've been taking, like, daily photo. I take photos every time I turn the appliance because now I'm down to, like, every other day. So I have been taking them. It moved so quickly. It was interesting because they had said to me, oh, you're. You're probably going to split around, like, 20 days or so is usually like, when we see it, because what, what Dr. Koval does, and she talked about this on the podcast we recorded, she does a piezo corticotomy. So. And she does it all the way to the back. She said, not everybody goes all the way back. She goes all the way back. And she goes all the way up until about the front 8 millimeters. And the front 8 millimeters split on its own just because of the nervous there. She doesn't want to come close to it. So she was like, you might wake up at like, three in the morning and feel this little ping, you know, the front splitting. And I was kind of like, I'm not an anxious person. And I was like, oh, my God, this is so anxiety and this is so weird. I was. I remember the night that it happened, and it was like 10 days early because it should have been. If it was 20 days, that would have been close to like, a week ago. And I've been split for a couple weeks easily now. And so. And I'm about four weeks into turning the key, but five weeks into getting the appliance, because she doesn't have you turn it the first weeks and she does a PA Support economy. So I remember. And it was funny. Like, I remember seeing a teeny little space between my teeth, and I got so, so excited. I was like, it's working. Things are moving. And now it's just this big old gap. But I was laying in Lily's bed, my older one, like, putting her to sleep, and I was just on my phone, and all of a sudden, like, an hour. It was an hour after I turned it. All of a sudden, I start to feel, like, tingling in the alveolar ridge. And then, like, some pressure and some pressure. And I remember I started breathing, like. And Lily's like, what are you doing? What are you doing? I was like, I don't know. Something's happening. And then literally within, like, a minute, it was done. And it did. It wasn't, like, super painful or anything, just kind of. It was, like, a lot of pressure. It kind of happened. Boom.

Ping.

Done. And I was like, oh, was that it? That was really uneventful. And I was like, that couldn't have been my palate splitting. Like, that was not it. And then it never happened again. And my teeth were, like, split apart. So I was like, I guess that was it. Okay. Yeah. So, you know, and I share that with people because I was so scared. But I do think there's a difference between her approach, which she is, like. She's patented, like, her approach and everything she's doing, she's also doing research around it, which is really cool. And, like, I know there's other people out there who do the piezo court economy. It's not done the exact same way. So I'm not. I'm not her. So I don't know the differences. Right. I just know from talking to other people, theirs was not the same as mine. Exactly. And then I also know some people don't have anything split, and it all splits on its own. And she told me. She was like, I. She was like. She said my palate was very thick. The bone was very thick, which is unusual for females. And it was thick throughout the entire palette, where she said, I think sometimes it's, like, thinner on one part and thicker on the other. Either mine was, like, opposite, or it was thick throughout. And she was just like, this is great. This is really. I was like, yay, me. I don't know what's great, but I'm just going to pat myself on the back. I was like, but does that mean it's more painful when it splits? It was fine. So I say. I mean, this. This journey in this process has definitely been like, it's not for the faint of heart. Like, I don't want to downplay it. But on the same token, I went. I get nervous when I go into new things where I don't know what to expect. And I think even hearing other people's journeys and watching people do this, it still was not enough for me to really understand what I was signing up for. But I'm very grateful that I took the plunge and decided to do this because I immediately noticed benefits, which has been the most exciting part of it for me. So I'm, you know, very happy that I've done it.

I think that's so wonderful. Oh, my gosh, how very exciting. I think I want to. Exactly what you were just talking about is just. You don't know what you're. What you were in for. Right. And I want to circle back to what myofunctional therapists are in. This is that we want. The reason we take so many of these continuing education courses, not just in our discipline. So as you know, Speech and language pathologist. Do you only take your courses through speech and language pathologists? I'm a dental hygienist. I don't. I don't take my courses only through dental hygienists. Why? Because every single discipline has a reason to help in a different way. So being able to understand what everybody does when we are seeing our patients and we are referring them, knowing that we just talked to them about maybe the vivos DNA appliance. Excuse me, DNA appliance. Or the MARPI or the ALF device or a Invisalign. Anything at all, we need to be able to explain to them or at least give them an idea. Yes, there's Dr. Google. But to have a professional know what's going on and being able to explain it to them, they feel comfort, they feel comfortable. So that we can reduce their anxiety. So that we can reduce your anxiety. You know, we want to make sure that. I don't know if you've ever seen this. That movie, I believe Jennifer Aniston. And maybe. Oh, dear, I see his face and I'm so bad with names that the line in the movie is, I want you to want to do the dishes. Okay. I can't remember the. So whoever is right here listening to this and yelling out the name of the movie, thank you very much. Or maybe the actor. But I. I would love to have every single healthcare provider want to want to know what it is that we, as myofunctional Therapists do, but some of them have never even heard of myofunctional therapy. So then why would they know and who and what we do as myofunctional therapists? Well, there's so, so, so much, you know, what we can do to be able to even support what they do. Right. So we're kind of like the cheerleaders for them. We take all of these advanced courses, and now we teach advanced courses because we have taken all these other courses. We've incorporated them into our clinical setting, into our therapy. And we've been doing this for years now that we can look at somebody sitting in Central park on a park bench and people are walking by, and we can pinpoint people. Oh, you know what that one has? You know, mouth breathing, low, tongue resting, posture. You know, we can just rattle off a lot of things. And once you see, you cannot unsee. And what you don't know, you don't know. Right. So we also, as providers, what the other provider doesn't know, we can't be upset because they didn't learn it in their curriculum. Right. Just like we didn't. And when it comes to, you know, the different disciplines of. Of course, that's why we want to know what they do. We want them to want to know what we do. But again, it may not happen in that reciprocation, which is okay because people will still come to us because there are all of these, and you touched on this just a little bit ago, is social media. And there are so many Facebook pages and Instagram pages now that have just this plethora of information where moms can go search and ask questions. And so many of these social media pages. I'm going to use Facebook, for example. We have. I live in a town called Fredericksburg, Virginia, and there are, I don't know, three major hospitals near us. And I could walk into that hospital and I could have, hi, I'm a myofunctional therapist written across my forehead. And they're going to look at me as if it's a foreign language. I'm sorry, what? And could you repeat that? And I'm okay with that. But there are the moms or dads who will go into the doctor's offices and say, ask a question. You know, I'm wondering, because of this whole, the signs and symptoms, the symptomatology, that if these parents are going in and asking these providers, and the providers say, no, he'll grow out of it. Suzy Q. Will grow out of it. It's going to be okay, well, what happens is these children are learning to adapt to their compensations. And these compensations can be mouth breathing, it can be snoring. Oh, my gosh, it's so cute to see a sleeping baby snore because they're making noise, you know, because they haven't started talking yet or because they haven't started walking yet.

Oh, cute.

Just like grandpa.

No, no, no, no.

It's really not cute. And we want to help those babies and we want to see what's the why. We want to see what the why is so that we can help. So they do turn to the social media groups and I will tell you that there are so many of us professionals who are aware of the airway now, who are in these social media pages and groups, and we are there to help these parents and we are there to help guide them too. But we can only offer so much information and guidance because we have not done a full assessment on these individuals. And a full assessment does not include a picture that's being posted on social media. We just cannot look, we can see that there is maybe a tethered tissue, a lingual tethered tissue that is connected to the very tip of the tongue that tells us automatically that that's, you know, a grade four tethered oral tissue. And we want to be able to guide them into the right direction because I need to know why. What are your symptoms? What? I already see the sign or I already see that, but what are you feeling? What are you experiencing? What are you going through? What is your why for even asking this question and posting this picture. What do you want out of this? And those are the questions again that we want to ask our parents. Why are you coming to me? And you know what? I'm going to find out the why for those symptoms that you're telling me, for those signs that I see and that you see. And that's my job. That's what I'm here for, that's what I want to do. Because nobody was there for me as a mom and for my children. None of them. In fact. In fact, I was told, let's remove premolar teeth.

Oh, no.

And let's do this. And now I will tell you that I started off in orthodontics as a 19 year old. I worked as an orthodontic assistant for six years before becoming a dental hygienist. And I'm aware of what extractions of healthy teeth will do to the mouth. The tongue does not change shape. Okay, what does change shape is the skeletal bone. If you remove premolars, what's going to happen to your entire face? It will become retracted. You will retract that maxilla and then the mandible as well. And then what happens when you retract the bony structure? And that tongue has nowhere to go. Nowhere to go, because guess what? That tongue doesn't change its shape. So where's that tongue supposed to go? Forward, backward, out to the sides, up, down, everywhere? Yes, it has nowhere to go. It no longer has a home. So we want to encourage these parents to ask their physicians questions. Ask questions, because when your physician has an answer, they've done their homework. And if they don't have the answer, and I tell my patients this all the time, and I use patient client interchangeably the term that I tell my patients, my clients, I'm going to go to my professional forums where I think I know somebody has the answer and I'm going to write down that question and I'm going to write down the patient's phone number because I will forget because I have about you know, maybe eight other patients that day. And I'm going to write it down because it takes seconds to write it down to find the answer, to put in that extra minute of work for these people. Because again, nobody did it for me. I don't want people to have to go through what I went through because it's not fun. It's a, it's a horrible journey. And my children, yes, are at two very, very well known great universities right now. But I have a third child right now who I actually got to catch later in life past his Gerry at his geriatrics age with the bony growth. And what is that age? Oh boy, it's anywhere between 7 to 9. Some will bump it up to 11. So we want to catch early. We want to catch these myofunctional disorders early. And the first thing for what we can do is we can look for those signs. Is their mouth breathing? Are these children snoring? Are they being told by their teachers to the parents, your child was disruptive in class today? So many reasons that we have been slapping medication onto and into our bodies is lack of sleep. We're not allowing our bodies to heal and rest and recover at night because there's just so much busy, so much busy. But there's also not enough education in our healthcare curriculum to help these parents. And I have to tell you, I see a lot of children of medical providers, once they start getting the aha moment and they start reading about this because all of these now airway providers are speaking at orthodontic conferences. Yeah, there's still a lot of naysayers and that's not true. And a lot of research that is still being taught is old. It's just old. And a lot of the newer research is just not being read and comprehended and understood and actually being practiced in the medical community. And we want that to happen more and more. And for those new doctors, they are being bombarded when they come out with these parents who are saying, hey, what about this and what about tethered tissues and what about mouth breathing? What about enuresis and what about, you know, apraxia, dysphagia, everything that they're reading about in these parent forums that, or you know, these groups that, you know, we want to help these parents because they're the ones begging for the answers. And we were once there.

Yeah, 100%. I echo everything that you're saying and it's, you know, I do feel like we are slowly getting more providers on board. Slowly.

Right.

And I do think it helps that more people are speaking at general conferences and that, you know, I feel like for a long time it was just like everyone speaking within this circle of our world and I was like, we got a break out. We gotta go speak at other places where we may not be so well received, but maybe there'll be two people in that audience that start going, huh, I should look into this further. I'm like, that's how you start, like a trickle down effect. Right. And so I do feel like we are slowly making waves, but it's, we still get all the time. What you were saying with, you know, oh, they'll grow out of it. No, they won't. No, they won't. Show me how that's worked for this child that's now an adult with obstructive stress, sleep apnea. Show me how this, you know, it's like I can show you many cases where they don't, like you said, sitting in Central park, or I would say go to the airport. You'll be really angry at me that you took my MYO class because you're never, like you said, you can't unsee what you now know. And like the airport because everyone's like tired and rushing and just like they are at their absolute worst most of the time. Like people are just fatigued. So the mouth breathing is strong there. Like if there, if there is mouth breathing present, you're going to see it at the airport. But it's wild it's really, really wild. And so anyways, this has been an amazing conversation. Thank you Angela so so much. Tell everybody where they can find you if they want to work with you or reach out to you.

Thank you. Thank you so much. I am located again in Fredericksburg, Virginia. I am able to see clients virtually and in person. I am my website is My business name is Central Virginia OMT and OMT is Orofacial Myofunctional Therapy Central Virginia Orofacial Myofunctional Therapy and my website will give you the link to being in touch with me. It has my phone Number on there 540-369-6044 and email is connect@centralvirginiaomt.com awesome.

Well, thank you so much.

Thank you, thank you, thank you. I've really enjoyed this quick Disclaimer.

All information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified health care provider. Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@halliebulcan.com or pop over to Hollybalken on Instagram to get all the latest updates.