Episode 125: It All Begins In Utero with Tara Erson, DMD, IBCLC

Hi and welcome to episode 125 of the Untethered podcast. Today we have Dr. Tara Urson joining us. Dr. Tara Ursin never imagined that less than 10 years out of dental school teeth would no longer be her focus, but tongues, jaws and airways have become her passion. She was introduced to tongue tie while attending Leche League meetings with her first child. As time went on, she began to see how negatively ties impacted breastfeeding and so much more. Over the last five years, Dr. Tara has completed over 500 hours of continuing education in the areas of ties function, airway and interceptive ortho. In 2018 she started Smart Mouth, a team based practice dedicated to all things related to the tongue. In 2021 she completed the process to become an International Board certified lactation consultant. Dr. Tara shares her time between the office and home with her husband Cliff and three sons, Kale, Rye and Sage. 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 healthcare provide. Welcome to the Untethered Podcast. I am your host Hallie Balkan. I'm a certified orofacial myologist, feeding specialist 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, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. So let's get started. Tara, thank you so much for hopping on the podcast with me. I'm really excited to chat today.

Thank you so much for having me. I'm excited.

So let's jump in because I know everybody just heard that you're a general dentist and that's really where you got started in general dentistry. And then you sort of fell into the oral or oral dysfunction space. What was your story? How did you end up here?

When I graduated dental school I really only had an interest in treating kids, but I was pregnant and gave birth to my own child. Right after graduating dental school I took about a year off with my baby. I spent a lot of time in the breastfeeding community, going to Leleche League meetings. When I was ready, I basically started working maybe one day a week with kids, just doing regular dentistry stuff. Meanwhile in the background I'm breastfeeding my own child, getting pregnant with my second child, breastfeeding him and so throughout that time, I'd been hearing from the lactation community about tongue ties. And I was like, look, I just graduated dental school. I'm trying to be a mom, you know, stop. I don't know. Like, this is. This is too much for me. So it just got to a point eventually, though, where it's like, okay, what are you talking about? Like, let's figure this out. Because I had not. I mean, I couldn't even tell you if I heard that word in dental school. Yeah, I always say the tongue is the thing that we were taught to, like, push out of the way so that you could fix the teeth, you know, an oral cancer exam. So I. I went and started looking into it a bit, and I shadowed and I started taking classes. And the more I learned about it, the more I realized that it was something that I should probably pay attention to, especially since I was so passionate about breastfeeding. And, you know, when I finally was comfortable, I did a couple procedures and had some of those, like, miracle experiences where baby couldn't breastfeed, now baby can breastfeed. And it just, it was very organic, very slow, but I just couldn't ignore it. And I started getting busier and busier with tongue tie stuff. And meanwhile, I was still only working one day a week because mostly I was a stay at home mom. And. And I realized that I could try something new and try to see what that would be like to focus on this unique area that no one else was really talking about. And so that's kind of where it started. In 2018, I started doing one day a week, just oral function, oral dysfunction, tongue ties. And now I have a whole practice dedicated to it, which is kind of exciting.

That's amazing. That is amazing. I love that I got like, I get like, chills knowing, like, the journey, you know, and it's interesting too, because I think so many of us, especially the women that I speak to on this podcast, have had these experiences where we're just, you know, going along with our, our professions, and all of a sudden we have a baby and baby is struggling to breastfeed, and here we are trying to get support and somebody mentions tongue tie or doesn't mention tongue tie. You know, with my first one, I took her to the IBCLC at the dentist. And if you've listened to the podcast, you know how that goes. It was sort of like, you're holding her wrong. And, yeah, that was a very painful, unenjoyable, definitely impacted, like, our bond early on kind of situation where I breastfed her for 13 months. And it was not a happy experience for either one of us versus my second child, where I had gone and taken my MYO course. I had started on my certification. I finished my certification right before I popped out. Baby number. And then all of a sudden, I'm like, yep, in the hospital. Like, let's see who it was. Almost like a game. Like, are they going to look in her mouth when I tell them that she's not feeding well? Like, when I give them the same information I gave them with my first. And I know they've got gag orders and they couldn't diagnose in the hospital anyways, but it was so fascinating how quickly they went from not looking in her mouth, not diagnosing, to agreeing with me and then offering their hospital surgeon to perform the procedure. And I was like, wait, what? What just happened? Hold up. So it's. It's such an interesting con. And I always love to hear everybody's kind of evolution into this space because none of us are coming out of grad school with the information on hand going like, this is what I'm going to do with my life. We're all stumbling upon it either through our own personal experiences or through, you know, other people we've connected with in the space, or through just patience, kind of trying to find a different way, a better way, a more holistic approach to solving some of the health issues that we're noticing, especially when it comes to oral function and oral dysfunction. So I love that, you know, you had another. You had that type of evolution of, you know, I became a mom, and I kind of just fell into this, and here we are, and I have a whole practice that, you know, survives around this, what we're doing and what we're doing to help everybody. And I love that. Now, I know we talked about some things that we're going to cover today, and I'll turn it back over to you, but I would love to just chat about, from your perspective, why it's important or what we should understand when it comes to dysfunction in utero and the impact on the oral structures from your viewpoint.

Sure. So my third baby is the one who really made me think more about this because he was going to be my perfect baby. He was going to be born into my practice, where I have a lactation consultant, a myofunctional therapist, a massage therapist. You know, I collaborate with the SLP every day. I had the whole team. I had everything, everything I could possibly need. You know, and he came out and he Had a tongue tie and I was like, I know someone who can, who can treat that. Three days postpartum. I waddled into my practice and, and treated his tongue tie. On a side note, I thought it would be a great idea to treat my four year old the same day because I was like, let's just all suffer together. Then preparing for over a year with the slp, I forgot about postpartum hormones like that. That hadn't factored into my decision. So I don't recommend doing two of your children the same day, you know, postpartum. But anyway, so I treat my 3 day old and I've got the whole team and nothing got better.

And.

He was snoring and he was stuffy all the time and breastfeeding still hurt. That only lasted maybe another week or two. That did resolve with better tongue function, but still clicking, still spitting up more than I would want him to. And I just was flabbergasted. I mean, this is literally what I do for a living. And I couldn't help my own baby. And therapy, bodywork, lactation for six months, trying to, you know, do whatever I could to avoid having to do the procedure again. And I finally just, I knew, I knew it in my heart that it needed to be redone and I did it again. And the rest of the symptoms resolved in terms of tongue function. But he still snores, he still is an open mouth breather, he still, I mean, he has cavities, my 20 month old has cavities. And I like, literally everything went wrong with the baby who was supposed to be my perfect baby. And so I've spent a lot of time thinking about what did I do wrong, what could I have done differently and why, why can't we just fix babies? And it really comes down to understanding that at three months in utero, when that tongue tie is supposed to, you know, apoptose dissolve and baby has to start learning how to use their tongue properly, that's where it starts. And we all tend to think about baby comes out and that's when it starts. And if you really think about how much the tongue impacts facial development, airway development and just the ability of the tongue to function properly, how that impacts breathing and living those six months in utero where things didn't just develop optimally, there's not a lot, there's, we can't fix everything about that, right? And so that really helped me kind of articulate my feelings about why I couldn't help my baby. But it also really opened my eyes to How I talk to parents and how I talk to colleagues about this idea that. Yes, I mean, I already was a huge believer that just cutting a tongue tie isn't the solution. Right, that's part of the solution. But even more than that, there are many things that we might not be able to quote, cure or fix at this stage. And so, you know, I'm trying to myo munchie with my baby. Well, he doesn't want to use the myo munchie. So how can I. Toddlerhood.

Right.

How can I force that on him? And you know, in the last couple years I've learned more about again because of my own children addressing what comes next. Fixing the tongue tied didn't solve everything. So what do we do next? I've learned a lot about early intervention expansion and especially the ALF from Dr. Derek Nordstrom. And so when my baby gets his second baby molars, gonna slap an appliance in there and continue the journey of trying to optimize his health. But it is, that's what it is. It's a journey, you know, after I treat a tongue tie and they come back for the four week check and they say, well, he still mouth breathes sometimes. Yeah, well, I mean he had a lot of dysfunction leading up to that. And it's the long journey when you see the mouth open, close the mouth and if in five minutes it opens again and you notice it, close it again and tomorrow night you have to do the same thing and it's not going to be a quick fix. So I think that kind of mind blowing understanding of how much can happen even before baby comes into the world and how much that affects what we're trying to treat.

Yeah, well, and I, and you made a really great point that you know, three months in utero, right around that 12 week mark in utero, that's when we develop the swallow, that's when baby starts swallowing and we, you know, I teach that in my course and I've highlighted that for, you know, SLPs and OTs because this is just not something that we're taught, we are not taught what typical oral function should look like in utero. And if you don't know what typical is, how do you know what atypical is? How do you know where things are starting to fall apart? And you know, we've had some presentations from like an oral surgeon who does a lot of infant tongue ties and we talked a lot about this and it was like so many of the attendees that you just see like the light bulbs Going off in everybody's heads when they started to realize, oh, like you said, this is not just there at birth. It's not like this is like okay, day zero and baby's just born and here we go. No, these patterns have been in place for the past six months, months and like they are hard pressed patterns that we have to start working on. And so you know, while a lot of times, and I don't know if you're of the same mindset, while a lot of times, like if a baby's in the first couple weeks of life, a lot of our providers around me will, they'll release a tongue if a baby's like a newborn. But once they get past that like four week mark or so, like we typically say, okay, halt, like we need to do some pre op before we go in to release that tongue. And that's just based on some of the results that we've seen. Now all of those babies we require post op from regardless. But it's just that pre op that sometimes changes depending on the presentation of the infant. And so it's just very interesting though because like I was always taught, you're born with the swallow like you're with your swallow that you're going to have for life and unless obviously intervention happens. But it's, it's even more than that. Your swallow is developed 12 weeks in utero, that's the swallow you're going to have for life. And so it's just, and then to fully understand how fascia, how bone, how everything develops around that during the rest of that baby's in utero gestational period, there's a lot of development that happens between weeks 12 and 40. So it's no small feat to be developing a swallow that early on and then to have all of this other dysfunction occur as a result of the failure of apoptosis as you mentioned. So you know, I think this is such an important conversation and something that I often tell people like go find a textbook and read about this, go understand this concept better. Because we were not taught it. This was not taught to us in our grad school programs. Tongue tie wasn't even mentioned in my grad program. Like this was all post grad learning for me. But it's such an important topic.

Yeah, absolutely.

So now let's go into like talking a little bit about breastfeeding. I mean I was a breastfeeding mama. I know you've had that journey as well. There's this topic of normal versus common that you had meant you had Brought up when, you know, when we were preparing for this. And normal versus common. I know everybody says, oh, that's super common, right? Doesn't mean it's normal. So I'm going to turn it over to you. But is this something that you hear a lot in your practice?

Well, I think it's something that I try to say a lot in my practice, that common does not equal normal. Because. And as much as I love Facebook and get a lot of, you know, benefits from Facebook, especially as a parent, it's hard to see sometimes when you go in the mommy groups and they're throwing around the word normal like crazy. And every problem, every problem that you can imagine, it's normal. And somebody else's baby went through that too, and their baby is fine now, and so, you know, it'll be fine. And I talk a lot about quality of life. Just because your baby's gaining weight doesn't mean that it's normal. And it has to be that way. And so, I mean, there's a billion things that we could list of, you know, even just the lip blister that they call the nursing blister or the nursing spot or that's. That's very common, extremely common, but it's a sign of overusing the lips, you know, and even. Even if it was as simple as that, it's something to show you that not everything is working the way it should. And, you know, the other thing I talk about with patients is I'm going to discuss things in a way that means optimal. I mean, that that's my goal, right? Optimal. There's a huge spectrum between terrible and optimal. And a lot of times it comes down to parents, how they feel about it. Is this the right time for them? Is this the journey that they want to go on? Of course, people ask the question all the time, like, well, do I have to treat this tongue tie? I don't know. I can only tell you what I see and what's optimal and what my treatment plan would be to get to optimal. There's a million different paths you can take. But again, just if more parents were aware of, and even, you know, even medical professionals, like, let's. Let's put that on them. Knowing the difference between normal and common would really help a lot of people with quality of life.

Oh, 100%. 100%. I think that it's so common that, you know, and people ask, like, well, what ent in our area is really great with X, Y and Z? And I'm like, I haven't Found one yet. And I, I hesitate. I mean, obviously, if a child has a major sleep issue, if we think we need a sleep study, if we think there is a major airway blockage, like it's, you know, a severe issue, I'm going to send you to the ENT regardless. And I'm, you know, that's typically when they, they find something, they see something, they treat something, when it's more subtle, like upper airway restrictive right syndrome or maybe mild sleep apnea or things that they write off. I'm usually referring to my pediatric dentist in the area or my oral surgeon to do an evaluation as part of their oral. They do an oral evaluation in addition to maybe looking at the airway, and then we're doing our evaluations as well. And people have said to me, it was interesting because I've actually gotten into a back and forth, even with people in my industry. Well, well, the standard is that you should be referring to an ENT first as a first line to defense, like, why would we change that standard? And I'm like, that's good and great in a textbook, but when you are constantly referring patients to providers who are not, you just, you can't really trust that what they're going to say makes any sense. And then the family comes back to you and they're frustrated because you just wasted their time, you wasted their money, you wasted. You know, we knew what the outcome was going to be. We knew they were just going to get sent back to us with the same story as 75 other patients that received back from these providers. It's frustrating, you know, and so then it comes down to like, well, who do we even trust in this space? And I think that that's a conversation that, you know, we want to trust everybody. We want to give everybody the benefit of the doubt. We want to believe that everybody's specialty covers the areas that they should cover. But not everybody is of the same training, has the same background, has had the same experience or even is as aware of some of the things that we might be aware of. And so it's, you know, I don't like to throw these providers under the bus because in some ways it's not their fault. But at the same time, I'm not going to refer somebody there when I know that this is that provider's mentality or mo, you know, so it's a very interesting conversation. And then we get into that conversation of, well, who do we even trust in this space? Like, who does. Who knows about tongue ties to the extent that they can objectively diagnose it. Objectively, you know, it's like objectively diagnose a tie and. Or tell us like, you know, hey, it should be released or it shouldn't be released. That's. That's a big conversation that could involve several providers and a care plan that we may not know that answer on day one. Or maybe we do. It's such a case by case, individualized approach, at least in my experience. I don't know about.

Yeah, for sure. And when, you know, it's much easier to teach, you know, these facts, right. This is what a tongue tie looks like. And this is how I treat a tongue tie. And, you know, these are some symptoms that babies, children and adults have when they have a tongue tie. But when new providers are wanting to enter this world. When I teach, I talk a lot about the team, right? But how to find the team and how that is literally, that was the roadblock. Each time that I grew, right. I didn't want to start the whole practice until I had the members of the team in place. And it took years of talking to people and Googling, you know, random stuff and then emailing everyone who came up and then finding out that 99% of them have no idea what I'm talking about. And, you know, and that's every profession, every single one. There is no word for what we do. And so you have to build that team brick by brick. And that's challenging. And even now, it's. I mean, I have some really great oral motor colleagues in my area. Do I want one in my practice? More than anything in the whole world. But that person doesn't exist in my world right now, you know, and so with some of my other teammates, it was like, oh, you're interested in this? Like, let's get there. Let's take the classes. Let's learn this together. And so there's so many different ways you can do it, right? You can luck into the perfect person or you can kind of build it, build it yourself. But I think that's the part that for medical professionals coming from these traditional schools, we are so used to the status quo. If your child has crooked teeth, you say, go see an orthodontist. If you need a root canal, you say, go see the person you need to see. It's not that big of a deal who it is, because we know what they learned in school, and, and that's what you need. But when you're talking about oral function and tongue ties and airway, none of that is being taught in school, which you know. And so you just have to dig and dig and dig until you find the right people in your team.

Yeah, no, and it's, it's so important to spend the time and the energy building that if that's what you desire, because like you said, it takes a long time. It's not like this was just born overnight. I got very lucky that there are a number of release providers in my area who I trust who do decent releases and then there's other ones who do really fabulous top of the line releases, in my opinion. And like there's like three that I typically refer to in the D.C. metro area. And I keep saying my area, even though I recently. My brain is still in the dmv, so my practice is still there too. So I'm still like fully the brain is there. But you know, it's interesting because we really struggled to find an ENT in this space and we've even had some sales that they're in this space and then they're not. And I'll email like some big name colleagues in this space that are like out in Virginia. I'll be like, okay, who'd you find? And they email me back and they go, I was hoping you were emailing me with somebody, that's why you were emailing me today. I'm like, no, no, not yet. Circle back next month. You know, and it's just one of those situations where you have to talk to people, you have to try. But one of the most powerful things that's really cool is when you can find that person like you mentioned, who is willing to grow with you, who's willing to learn with you, because we don't even know everything there is to know in this space. Like I'm still Lear and never will. I mean, you'll never know 100%. Exactly. And you know, and I got to go to a number of events with my, with one of my dentists who was growing in this space. They were already in the space. They were already doing, you know, growth appliances who my children were expanded by or my child was expanded by and my husband and myself. And you know, they use ALF and DNA and they have a whole selection of different appliances based on the patient's needs and the age of the patients in their family practice. But anyways, you know, we were able to go to TOTS training, we were able to go to the Bronson families, you know, annual event, you know, CEU retreat thing that they did in McLean, Virginia. We were able to go and Sit next to each other at some of these learning opportunities where we can then have these really amazing follow up conversations. And coming from different perspectives, right? She was coming from the dental side, the natural dental side. And I'm coming from like the holistic SLP feeding my side. And we're kind of bringing our brains together. And it's just so powerful when you can find individuals that really are willing to sit down and learn with you because it just opens the door to different conversations. And we also had built a study club pre, pre pandemic where we met in person every month and reviewed cases together. And around that table we would have the pediatric slp, ped, slp and also I do adult MYO as well. And then we'd. So you got feeding and MYO covered and then you've got the dentists who are the natural dentists who do growth appliances. You've got the oral surgeon, you've got the osteopath, we got a vision therapist, we had the RDH present. It was really interesting just to bring all these different perspectives to one kitchen table and all the way that we all looked at the same case with this, you know, with different sets of eyes. And the conversation that came out of that was just phenomenal. Our osteopath is a couple and the husband actually is also a physical therapist. And so to see his PT background in addition to the osteopathy and then, you know, it was just the most enriching conversations and the best learning opportunities that I'd ever had. And that's where I turned around and said, you know what? I got to create something like this. And you know, virtually, because I feel like this is a big struggle. This is what a lot of people want, but they struggle to gain access to and this needs to be more readily available, which is why I created that as part of my Mayo Group MYO membership. But yeah, it's just, it's a very interesting conversation. And it comes up a lot like, how do you find these people? How do you know who to trust? And you talk to people, you ask them questions. I mean really it's like anything else, but it's tongue ties, I think. You know, it's a heated, heated debate type of conversation depending on which circle you're in.

And sometimes it's just trial and error, right? Oh yeah, you, you think you might be on the same page with someone and you start working with them and then you find out that you're not and happen to talk about it and you're still not on the same page. And then you just, you know, maybe reorganize your resource list a little bit because that's just not, it's not right for you and it might be right for someone else.

Yeah, yeah. And now. So you mentioned that you are looking into the ALF for your little one once the two year molars are in. So have you started with anybody else that young or will this be like the first little patient at that age?

I had, I, I've done 12 year old, almost 3 year old and then several 3 and 4 year olds. It's, you know, getting the, you know, you got to sit still for this. You know, I invested in a scanner because I can do that better than I can do an impression on a little one that age. But yeah, I mean, and what, what good are our kids if they're not our little experimental, you know.

Exactly.

I mean, I, as soon as I learned alf, I came home and put it on my two older kids and have had gone forward and back as I've learned, but forward more than back. And they're way better off than they would have been if I hadn't done anything. You know, that's another concept that I try to get parents to understand. A lot is, you know, I can't, I can't promise that I can cure your child of, of anything. Especially a lot of parents want to, want to prevent future issues. Right. And I can tell you why a lot of those issues come up and a lot of them have to do with oral function. But it doesn't mean that just by fixing a tongue tie or even doing therapy now is going to solve those problems in the future. I mean, my kids have been in all kinds of myo, speech feeding, occupational therapy. Again, some of it is just me kind of. What is that like, what does that look like? So that I can have a better understanding when I talk to people about it. But I'll see them improve in an area and then they'll go through a growth spurt and completely revert back to the way they were doing it before. And so it doesn't mean that I didn't, it doesn't mean that we can't solve the problem. It just means that again, it's a journey, you have to keep working on it. And so when I hear that an orthodontist doesn't want to see a child till they're 12, they say, isn't there absolutely anything that we can try to improve their state of health? Now when I hear, I hear it way more than I would like someone telling a three year old that they'll have to have jaw surgery when they're an adult, you know, and it's like in 15 years, I mean, that's it. We're just gonna shrug our shoulders and say, well, in 15 years you're gonna have to have jaw surgery. I mean, there is a lot of stuff we can try, and in some cases it's not going to solve all your issues, but they're gonna be so much better off.

Yeah, well, and I think that's a really great point too. I mean, it's interesting because this happened with my own daughter. So with Lily at, what was she, 24 months, I came back for my myo course. I jumped right into having her tongue tie released. And we didn't do right. That was. She was my little guinea pig. I learned a lot from her. And then she was a toddler who wouldn't let me in her mouth afterwards either. So I wish we would have sutured her, which my oral surgeon now does on all of our toddlers. So, you know, that was a learning experience. And she got a little bit of reattachment, but it's really. She's pretty pliable and she can do a full suction. And she's now been expanded. And what's been interesting is at age 4, we put her into. Right before her 4th birthday, we put her into the ALF and she had upper and lower, and she has had beautif growth, you know, forward, laterally. It's just. Her growth is phenomenal. And so I was really excited. But then what I also noticed about halfway through was that she was starting to choke on water when she would drink from a straw. And I was like, what is going on? I'm like, is the posterior portion of her tongue, like, more restricted than I realized is, is her tongue just failing? Because, like, she's got oral dysfunction and she can't manage the liquid once it gets past a certain part. Like, is she just not suctioning her tongue to the top of her mouth the way she should be? I mean, what's going on here? And you know, and it really opened my eyes to that same conversation because I went, huh, all right, this is not an end all, be all. You can do all the therapies, you can do all the right, quote unquote, right things for your child. You know, you have the pre op, you have the post op, you get the body work, you have all the right providers, you do all, you know, you're a super compliant family and your child that it seems to be okay. Then all of a sudden, something changes in their oral structures and things seem to fall apart a little bit. And so that really made me realize, wow, well, as children grow, we might have to, like, check in with them. Like, we might need to go back and look at what's going on with their airway, what's going on with their oral rest, posture. Like, how do they present now? Are they maintaining those skills they learned earlier, or do we need to maybe brush them up a little bit, you know, or is something else necessary at this point? And one of the individuals who actually opened me up to that thought even further was Lenny Kundal. When he was on the podcast, we were talking about how he likes to start with them really young, and then he follows them. And he said, if it was up to me, I'd keep them in an ALF appliance until they were like, I don't know. I don't know if he's at, like, 16. I could be making stuff. But don't quote him or me on that. I don't know. I just. It was sort of like this concept of, like, if we could just keep them in a light wire appliance, or if we could just keep going back and, like, helping them along their journey, that would be beneficial. And it was sort of this idea of, like, we continue to grow, our bodies continue to change, and if there was dysfunction present in utero and early on, like you were saying, things can very easily kind of collapse back to where it was, or maybe not all the way back to where it was, but it's not going to always be like a smooth, easy ride. Right? We need to be checking in. And so, you know, I know with traditional myofunctional therapy, we typically say, okay, let's check back in three months after dismissal, six months after, and then 12 months after. But I really think we should probably doing some, like, you know, oral function checks at certain points. Like, this should be part of what happens when you go to the pediatrician's office. Like, this should be part of your well check at your annual visit. And if they're not going to do it, then that. That falls on. Maybe it falls on the RDH and the dentist, and, you know, maybe that falls on. I don't know who, but this is really important. And when you start to have these conversations with parents, Nico, you know, when they're not sleeping well because they're not breathing well because their tongue's not in the right place, and they have these ADHD like, symptoms and they're chatty in school and they can't pay attention and they're exhausted halfway through the morning and they don't respond to their name. And, you know, it doesn't mean they have all these other diagnoses. Who's looking at their sleep? Is anybody looking at their sleep? Like, is anybody looking at their airway? If, you know, that should always be the first line defense. And I feel like for every single child we receive, it's usually the last. And that's where I really want to see the conversation change more. And I want people to start looking more at like sleep, airway breathing, history of upper respiratory infections, you know, all of these things that point us to, oh, hey, maybe this child doesn't breathe optimally. Maybe that's where we should be starting. And how can we change that? Because I think you're never going to fail a child if you do early expansion. You're only going to be helping them, even if you have to go back and expand more later. I think it's a very dangerous conversation for people out there who are saying if you release the tongue now, you're not gonna, and you do myo now and you do early expansion now, you're never gonna have to have braces later. We don't know that. We don't know that. Yeah. So anywho, that's my whole little, you know, rant on that topic. But my own child taught me a lot.

Oh, yes, absolutely. And I, I always wonder, there are so many accepted medical procedures. You know, if, if you're told your kidneys, braces, you don't, you don't really bat an eye, that's very socially acceptable. You know, if you end up kind of from the pediatrician to the ENT because they noticed your kid has large tonsils and the ENT says, let's get them out, you don't really question that. I mean, most people don't, but they're never looking at the root cause. Right. And you're not treating the root cause. So you're really, you're going to give them a little bit of a benefit, but you're not really going to solve the problem. And I tell people that's why the studies, in my opinion, say that tonsillectomies and adenoidectomies don't have long term benefit.

Yeah.

Because, well, they were that way for a reason and we didn't solve the root cause as well. Now, you know, I changed a lot as I learned through this. I mean, even with tongue ties, I Definitely had more of this, you know, naturalistic point of view that our bodies are, they work together and why are we taking things out that we need to for different things. And then I learned that if you don't breathe well, you don't grow well and you don't live well. And I thought, well, I'm willing to sacrifice tonsils and adenoids for that if that's where it's come to. Right. When my kids, when I, you know, with my older kids, when I started learning this and I opened the bedroom door and realized that they were mouth breathing and snoring and their tonsils were touching, I said, holy crap, get them out. My kids need to breathe tonight. And now let's figure out how we got here, why we got here, and what are we going to do to maintain and improve. Yeah, but it always. And I understand that if you don't kind of understand that background of how you got to that point, you're less likely to understand why those treatments are so important. But it's still frustrating to hear. You know, I get tagged all the time locally, like, oh, this person wants braces. Or, you know, I have an alternative. I have just another way to talk about it. And they want to know if I take their insurance and I don't. And, and if, if that's all you're looking for is, you know, someone who will put braces on your kid with your insurance, then it's not a right fit for my practice. But it also makes me a little sad that it's not more common knowledge.

Yeah, yeah. Well, and, you know, and I'm in a practice where we're private pay and we don't take insurance either for the work that we do as SLPs and OTs. And really, honestly, it's, it's, it's partially because I wouldn't be able to have a private practice. Like we would not be operating. There's no way they don't reimburse well enough for me to actually pay my therapist. So it just is, it's a no. Right. And that's actually become the majority of private practices in the D.C. metro area. Do not take insurance anymore. In my space, just in the SLP OT general space, there are some that take it. Thank goodness. Because some families really do want those benefits and do use them and need them. But for, you know, we do try to help our families. And what I've also found. This is a totally off topic conversation, but I've actually found some of these insurance companies will reimburse our Patients higher for out of network benefits than they would reimburse us if the patient was in network. And I'm like, this is bogus. So we help our patients, you know, figure out how to get pre authorization if necessary and submit the super bills we give them and all that fun stuff. Because our goal really is if we can help you to some extent, we really want to, but our goal also is to take some of these teenagers who have gone through braces on their parents insurance or out of pocket and had orthodontic relapse. You know, well, why are we relapsing for the second, third, fourth time? And we get adults who. I've had adults come to me and say, look, I don't want to go through the whole gamut. I know what you do. I understand what's optimal. I just want to stop this from getting progressively worse. I mean, we've had some really interesting, you know, patients and conversations, and we're here to work with you and we're never going to push our agenda on you. We'll show you, we'll share with you our best, you know, our most optimal treatment goal for your health, in our opinion. And then if you feel like you want something different, then we have that conversation and we meet you where you're at. But it's a very interesting conversation when you start to educate either parents or adult patients or even teens who are involved in sports, and you start to tell them all about the tongue and their jaw and their facial development and growth and how airway plays into all of this. And nobody's ever told them. I mean, most of these providers don't know about it. So how do you expect families and patients to know about it? When they start to hear about the interaction between these orofacial structures and the airway, they start to go like, oh, okay, well, that makes a lot of sense. Why has nobody told me this before? Great question. Why has nobody told you that before? We need you to function optimally. You can't survive in life optimally if you're not functioning optimally. So it's just very interesting how many patients know. We say we take you from surviving to thriving because so many patients come in hanging by a thread, regardless of the issue they come to us with, they're just kind of at their wit's end. And, you know, our goal is always to take you not just to functioning, you know, not to, you know, but really to truly functioning optimally. So, you know, and it sounds like you're, you're very much the Same if your parents, if your patients are on that. That track, you know, and they allow you to kind of implement your treatment plan. The goal is optimal function. And it's just a very interesting conversation.

Absolutely.

Yeah. So is there anything else just about tongue ties or optimal functioning or the interaction between all these things that you want to share that we didn't discuss today?

I actually, last night went on my treadmill for the first time, I would not like to say, because we went on a vacation recently, and we walked a lot, and I realized I slept so much better, you know, and we don't make time for. I don't make time for exercising in my life. I've got three kids and a business to run and a family and a house. But the first thing I said to myself when I, you know, got on was, I can't go faster than I can breathe through my nose. And I learned that I was lucky enough to see Patrick McCown speak in 2017 way at the beginning, and I didn't even know who he was at the time. And he said, that's the limiting factor, that should be the limiting factor for how you exercise, is you should be able to breathe through your nose. And at the time, my husband had started running, and I texted him immediately, and I said, you have to breathe through your nose while you run. It's really, really important. And he's like, what? That's the craziest thing I've ever heard. Like, I can't breathe. I have. I have to breathe through my mouth. And I always consider it a win if I can convince my husband of something because he's. He's my super. Like, prove it to me, you know, show me. So, you know, I let it go. Obviously, this is something I just learned. Who am I to, like, insist? And about six weeks later, he came to me and said, I could not get past this speed. I just couldn't. And so I want to say he even was taping because he was having such a hard time forcing himself to breathe through his nose that he was taping while he would run. And he said he had to, like, greatly cut down how fast he was going at first, and. But by six weeks later, he was way surpassed, you know, his endurance and his speed and just because he was breathing through his nose. And again, I just think it's such an important. You know, I'm a dentist. What do I know? I mean, about breathing or who am I to be talking about that? But there are so many factors to whole health, and all the little pieces that. And that's why a team is so important. Right. Because if it was just me seeing patients doing dentistry stuff, then it wouldn't occur. It would never have occurred to me that something like breathing through your nose. And I'm sure to us now that sounds so silly, like, who could possibly not know that you could always breathe through your nose?

Yeah, we were never taught that either. As SLPs. It wasn't until I took my myo course when I was already, I don't know, 10 years out of school. School and maybe a little bit less. And I. Back in 2017, I took the course, and they were like, tongue up at the roof of your mouth. You know, teeth lightly apart, lips closed, breathe through your nose. And I was like, say what? I was like, wait, am I doing that? Am I not doing that? I don't know. Let me. I'm like. I feel like now I'm doing it because I'm aware, but was I doing that before? And so. And this is the same conversation we have with, like, families, too, where we start to educate parents and we say, hey, does your child do, you know, does your child sleep with their mouth open or closed? Is their mouth open or closed while they're playing during the day? Like, not when they're talking, not when they're eating, you know, but just when they're playing or sitting in front of the TV or on an iPad or, you know, throwing a ball outside, doing some kind of, like, a passive activity, like, what's their mouth look like? And most parents have no clue, rightly so. I had no clue about my kids either, until it was brought to my attention. And so that's when we start. That's a really awesome place to open the conversation because it's. It's so relevant to these families. And I go, hey, well, will you go home and, like, pay attention? Like, you can do daytime first, and then we'll do nighttime later, or you're gung ho, like, check it all and report back. Just tell me, like, you know, tell me tomorrow. Tell me in three days. Tell me next time we talk, like, or when we see you for your next appointment. Because we get to see our patients. Like, if we do an eval this week, we usually start with them next week. So we're not. We're seeing them pretty close together. And most of the time, they come back and they go, oh, nope, that mouth is just. Just, you know, hinged open. Their. Their tongue is back, but the mouth is open, or their tongue is forward and the mouth is open, or oh, this is why they drool. And I was like, I already kind of knew that. But I wanted you to realize that, you know, they can't maintain their saliva if their tongue is forward in their mouth. And, you know, maybe sometimes they're generating extra saliva or maybe they just don't. They don't have anything telling them to swallow that saliva back because the mouth is hinged open. And then other times we have kids with like total dry mouth who are stuck in back water all day because her mouth is open. It's. It presents so differently in so many patients. And, you know, when we start to look at it all holistically, though, it's, you know, we have a lot of mouth breathing, kiddos, and we know that the mask in the pandemic has definitely not helped with that. It's basically forced, you know, mask mouth on a lot of kids and adults. And so, yeah, it's function is everything. You know, I know that you, you said that here. And it's, it's one of those things where if we have dysfunction, we have to get to the root of, why not just slap a band aid on it? So I love everything that you stand for. And, yeah, you know, anything else that we didn't cover that you want to share? Nope. Okay. This has been awesome. This has been great. Thank you so much for joining me today. Tara.

Thank you very much. I appreciate it.

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