Episode 137: The Evidence Based Research Behind Tethered Oral Tissues with Richard Baxter, DMD, MS

Hi and welcome to episode 137 of the Untethered Podcast. Today we are welcoming back our very first speaker on the podcast, our very first guest, Dr. Richard Baxter. Dr. Baxter is a board certified pediatric dentist and diplomat of the American Board of Laser Surgery. He's a nationally recognized speaker on tongue ties, instructor of the comprehensive online course Tongue Tied Academy, and lead author of the best selling book Tongue Tied How a Tiny String under the Tongue Impacts Nursing, Speech, Feeding and More. He's passionate about educating parents and healthcare practitioners about the effects that tongue tie can have throughout the lifespan. He lives in Birmingham, Alabama with his wife Tara and their three girls, Hannah, Noel and Molly. He's the founder and owner of Alabama Tongue Tie center where he uses a CO2 laser to release oral restrictions that are causing nursing, speech, dental, sleep and feeding issues. He had a tongue tie himself and all three of his girls were treated for tongue and lip tie at birth. So for him, this field is a personal one. 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 provider. 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. Let's get started. All right. Well, Richard, I am so excited to welcome you back to the podcast.

Thank you for having me. I know I was like the first guest. Right you are. How long has it been? A year and a half? Two years?

Yes, it's been just over two years. We launched in July 2019 and you are episode number two, the first guest.

Yeah, right now I'm sad to be back. Thanks for having me.

It's exciting. So I'm excited too, because I know we're going to talk a bit about some of the research that you've done over the past couple of years. I know that you had your Speech Feeding and Sleep Perspective cohort study that was published in clinical pediatrics in September 2020 and that was exciting for all of us in this space. So let's jump right on in and talk about that was. What can you tell us about what you did there and your findings.

Yeah, so I was just looking at kind of the research that's available. A lot of it's smaller studies like Messner Lalockia, 2000, 2002, like 10 patients, 11 patients. A lot of it just focused on one aspect. So like articulation. But like, as you know, speech is so much more than just articulation. But anyway, it's. We had a prospective cohort study, meaning whether we were going to uh, see good results or not. Hey, you're in the study no matter what happens. And so we took all those people and can you hear the. Is there a leaf blower in the background? Can you hear that now?

I don't hear that.

We're okay. It's right next to just cut this part out.

But anyway, we'll edit that out.

Um, I went like, great. The leaf blower just started outside my window.

Um, it's my kind of luck. It's all good.

So, yeah, we basically have this research idea where we look at holistically like speech feeding, sleep and then all the other weird stuff like constipation like you talked about on the podcast before, which is mind blowing. These kids like have less constipation afterward. Anyway, so we looked at all these things and we had 37. We should around 50 people enroll. And then about 37 of them actually did the follow up for the one week and the one month checkup, which is really difficult to do clinical research unless you're at like a big academic center. So it's really as close as you can get to randomized control trial in an office where people are coming to you referred from you. And so yeah, the results we had, we had statistically significant results for improved speech feeding, sleep at one week and one month. Certain things like slow eating, picky eating, we saw improvements with snoring, gasp. Let me find it here. Mumbling or speaking softly. Speech delay. This is the first article to report an improvement with speech delay. And what was interesting was for example, eight of the moms out of the 16 that said they had 16 said they had speech delay. Eight of them improved, but overall 13 actually saw improvement. So that means that five saw improvement and the parents didn't realize like, oh, like my kids talking more now after the procedure. So sometimes they don't realize things like, you know, poor sleep quality or issues until they see it improved after the release. But yeah, trouble with sounds, difficulty speaking fast, getting words out, trouble for other people understand frustrated communication. All those were highly significant with eating, slow eating, grazing on Food throughout the day, picky eating, choking or gagging on foods and spitting out foods all saw improvement as well. All Those highly significant, like.001 for the P value. And then sleep as well, saw some improvements. We get the table here. Sleeping, weird positions, kicking, moving at night, sleeping more deeply, wetting the bed was almost significant. So less wet in the bed, waking up, less tired, less teeth grinding, sleep with the mouth open, less snoring. So we also had some less gasping for air too, but it wasn't significant because only a few people indicated it. But 11 out of the 37 saw less gasping for air. Constipation was also significant. So less hyperactivity, less reflux, like lots of things. So this is really the first study to look at it holistically and look at, just basically took our assessment form that we, we were talking before the podcast about how it's hard because like you don't grade those. Like, okay, this is one point, this is two points for this. It's really kind of a nebulous concept. So we try to put some handles on it to say like, okay, these people saw improvement with these, these things. It really can work if it's done properly. You have proper release, proper team approach. All that kind of stuff that you guys preach on the podcast. Yeah, I just, this is one of my favorite podcasts. So excited to be back. Thank you.

Well, I mean that's, it's incredible. And it's one of those things where until you start working in this space and until you work with enough cases where you can start to see patterns, a lot of, I think feeding therapists don't really truly recognize that a lot of the results that we see following a frenectomy or frenuloplasty is directly connected to the fact that the tongue is now mobile. The tongue can, with proper pre and post op therapeutic intervention, it can now do what it needs to do. And I mean it's. People always say to me, well, I don't understand the connection between constipation patient. And I was like, look, I don't understand it either. But my theory is that if our tongue is able to lateralize to the molars and move, you know, move the food over so we can properly prep a bolus and we can then swallow without extra air. We're swallowing less air so we have less, you know, digestive upset. We are prepping the food better so our body can digest the food better. And you know, I saw this in my own 24 month old where I, the next day her constipation disappeared and never came back.

Yeah, that's like, parents just tell us unsolicited. They're like, my kid has less constipation. Like, I didn't even ask the parents before or tell them that's a possibility. And they come back saying that. I was like, well, I should add it to the list then, of symptoms. And then we're seeing these kids with bowel impactions and all these issues. And they've been to the GI specialist. They don't know what's going on. They're on all kinds of medicines and stuff. And then we have the release and it is improved. Three reasons I've. I've my hypotheses, like yours. I tell the parents if they can start. If the food starts the journey right, it should end the journey right. So if they can chew it up better, obviously, you know, the body can digest it. Chewing is the first step in digestion. Also the strength of the swallow. I feel like they do have a stronger swallow afterward. And from what I understand, correct me if I'm wrong, but the swallow, that wave of the swallow actually becomes the peristaltic wave that travels most, if not all, the GI tract. And the third reason is just parasympathetic. So when you release that, it puts them more into parasympathetic rest and digest versus fight or flight. That probably, along with what you were talking about, some of the reasons behind it. But that's the interesting thing, like, the less neck tension that has to do with the fascia. There's so many connections here that we see on literally a daily basis with babies to kids to adults. So.

Yeah, well, and that's that whole. That deep, you know, frontal line of that fascia. Fascia trains. I love that image that circulates social media where we can see how our fat from the tip of our tongue is literally connected all the way down to the tip of our toes. And so it's no wonder if you understand anatomy and physiology and the connection, you know, how the tongue connects to the hyoid, and the hyoid's supposed to elevate and come forward. And if things are tense and not functioning properly, it just. It ups. There's upset throughout the entire digestive tract from your mouth down to your stomach. So it's. It does make sense.

And, like, how does that have anything to. I was like, I know crazy. Or like, people saying, like, I'm doing yoga and, like, I'm backward now, like, I'm upside down. Like, what is going on, like, I'm so much more flexible. I feel like I could barely touch my toes. Like, me personally, I could touch my toes, but not like that. Well, I can get my hands almost flat on the floor now after my. And I didn't think about it because I was like, you know, stretching windows, like, whoa. Like, I am way more flexible. Like, nothing else has changed. So, anyway, it is cool.

No, it's. It's interesting, too. Lily had her release at 24 months, and then she went into expansion with the ALF at right before her fourth birthday. And we have this picture that the dentist took of her extending, you know, her neck upward and her range of motion. We had no body work because Covid, our area was highly shut down during her alpha appliance. And her extension of her neck almost doubled in range of motion compared to the start of the appliance and at the end of the appliance. Now, I don't think we would have gotten that if her tongue hadn't been previously released. But it was also just so incredible to see what happens when you start to put, you know, hard tissue in place and what it allows the soft tissue. You know, how they support each other. It's just.

Oh, yeah, it's phenomenal function, vice versa. I love having, like, moms that are SLPs or OTs or PTs, and since they're so observant with their own kids. We had one just last week, and mom's like, he's like, crossing midline better. And, like, I don't even know all that stuff, but, like, that's a good thing. From what I understand. Like, all these things. They've been working on an OT and like, now he's doing those better. Or kids that should be crawling and they start crawling like, that week. Like, oh, it's just a quince. And it's like, I mean, like, you should have been for a while. Like, you know, it's like you put the turkey in the oven and it comes out brown. It's like, it was probably the heat right then. It's not the whole picture, but, like, you know, that little, you know, or they should be walking. They're like 18 months and they start walking, like, the next day. I mean, it's not every patient, so we never guarantee it. I always tell them if I guarantee it, it won't work.

Exactly.

We'll hope and pray for the best, but I'm not going to, like, you know, I don't want to ruin it for you. So.

Yeah, yeah. Now we see. And we see that all the time. And it's. It's incredible. It's so incredible. And you want to tell parents, like, we're not going to promise you all these outcomes, but we should be looking at what's going on beforehand and doing whatever therapy is necessary leading up to a release and then again reviewing that information afterwards, because getting to some standardized form of assessing these children would be ideal. But like we said already, I think, and like we talked about before recording, there's no standardized pediatric feeding assessment. There's commonly used assessments. I made one inside feed the peas, which we had from the myo airway tetheral tissue pediatric feeding specialist, S.L.P. we all, you know, put our heads together and it's very comprehensive, but it's also very hard to quantify some of what we observe in our feeding evals. So that makes it tricky.

Well, we'll keep working on the research, though. If you think of something, let me know. If listeners have any research ideas, let me know. I'm happy to work on that with whatever assessments we can.

Amazing, Amazing. So now let's talk about the tongue restriction questionnaire. Right, so this was published in March 2021. So tell me about that.

So basically. Hold on one second. Hold on one second.

You're fine.

Okay, sorry.

All good. All good.

He was like, right outside the window this time. It's the yard guy. Thankfully I speak Spanish. I could tell them that's perfect.

No, it's amazing. In our old house and actually they came this morning in our old house, though I would always schedule podcasts on the day when I knew they weren't coming and then they wouldn't come on their dedicated day. And they'd come the day. I was recording a podcast and I.

Was like, I know, I'm sorry, we're.

Just going to have to sit here for 10 minutes away at the beginning of the thought.

I'll go back to the TRQ here.

Yes. Yeah. So here I'll re ask you the question. So I know the tongue restriction questionnaire, which was published in March 2021, so not too long ago. It's new and it's really to screen children. So can you tell us a little bit about that so our listeners can understand what that is and how they can find it?

Yeah. And you can download all these on our website. It's tongue tieal.com. if you look at the blog, tonguetail.com blog, you can find them all. They're in there somewhere. But anyway, basically we had about 300 kids and this was not kids coming to us for tongue tie. This is just kids coming for, you know, normal dental reasons. And I thought, you know, we need to have some kind of a screening tool, kind of like a greatest hits of our about 50 or 55 item questionnaire. So we got it down to like maybe 15 or 20 items that parents can just sit there and do that are the most like slow eating, like frustration with communication, that kind of stuff. And so basically that's designed to be used. You could use it in a speech practice, you could use it in OT pt, you could use it as a well child check if you're a pediatrician or as a dentist, like we were doing. So just for a hygiene check. Basically when the parents come in for their cleaning, we'd give them the form, have them fill it out, and then we would check the patient. We have the hygienist check first. They had some MYO training, as I mentioned earlier, but they would check for the tongue range of motion ratio basically of grade one through four. How high can they elevate their tongue? Because that's the real key. Protrusion. It doesn't tell you that much. Tells you a little bit if it's really bad. But we do a ton of kids that can stick their tongue out but still have tons of issues because the symptoms and function are always more important than the appearance. So anyway, we had them lifted up and then I came and checked independently and we had high intra rate of reliability. And then. But what we saw was, that was interesting was a lot of these kids again, snoring, all these things that are common, like 20% of the kids snore, 30% of the kids snored. But if they had issues as a baby, it was higher correlated to having issues as a child. So again, early treatment is better. We did see that often these symptoms like spitting out foods, slow eating, let's see what else. Milk leaking out of the mouth as babies had a higher risk of having issues currently. But really the key takeaway was like 26% of the kids, I think it was, I was trying to find it here, had symptoms and an appearance bad enough where after talking to the parents they thought, yeah, it's probably best to get this checked out. Like we want to look into this like for a deeper evaluation. Basically we said like refer to the tongue tie center because they're in the dental office. And so I mean if it's a quarter of the kids and it's likely higher than that because in our office we've already picked out a lot of the kids that have pretty obvious tongue ties, and we've already fixed them. So this is excluding those kids. But, yeah, it's extremely common as the main takeaway. And you can use this tool to screen. We have two different versions of it, one that includes the baby issues and one that doesn't include that. And it always looks at, you know, quality of life. So if they have all these symptoms but it's not causing issue with quality of life, well, then it's not worth doing for the parents. So, hey, mom, just wait. If it comes an issue later, then let us know. And obviously it takes some parent education too, right? Because some parents, like, oh, snoring, it's so cute. He snores like he's still bedwetting, like when he's like 8 or 9. Like, that's not, you know, it's common, but it's not normal. So having those discussions with parents is always helpful, just basically to create a dialogue between parents and the professionals, whoever that may be. So we can identify these kids early because as we talk about in the podcast all the time, like, early treatment is key. You know, brain development. By the time they're just 3 to 80% size of adult brain, by the time they're aged 5, they're 90% size of adult brain. And so, yeah, the earlier we can get these kids, the better. And so the more tools that are easy to use and don't take up a lot of time because we're all busy, right, the better it will be. So, yeah, that's a little bit about the trq.

I love it. I love it. I love anything that we can use that's been studied that we know is making an impact. And I think, think that it's really phenomenal that, you know, the hygienists who are already in the mouth are able to use a really quick tool to help them identify. You know, I'm sure it's like, imprinted into our brains in your office, but I tried to, you know, his three.

Eyes, like, it's like that obvious to them. They're like, this is really obvious, interestingly enough, to the ones that can't hold water in their mouth, right? It's like when they're rinsing them out or cleaning them out and they're laid back and the water's in their mouth. The ones that are choking or gagging because they can't get the posterior part of their tongue up to form a seal. And Mallory, my hygiene is like, yeah, they all have. They all have tongue ties. I'm like, that's honestly like a decent test. Like, have them sip some water and hold it in their mouth and lay back. Like you're at the dentist. The kids that are gagging, choking on water like that, like, there's likely a restriction present. Yeah.

And we work on that in myofunctional therapy. We work on being able to lay them back. Yeah, well, we don't always lay them back, but even just being able to create a, you know, a tongue bowl that shape and then making the posterior contact, you know, with the tongue to the velum, and also holding water in the bowl of your tongue suctioned up against your palate, and different swallows with your mouth open. Because if you have a tongue thrust, you're not going to be able to do that. If you have a tongue tie, you're going to do it maybe with a lot of compensation or not at all. And then, you know, really, it's about, can we. You know, I just. What I just did. Not that they can see, unless you're not on YouTube, but, you know, can you suction your tongue and swallow saliva or a little bit of water with your mouth open? Because that's going to give you a good indication as to whether or not the posterior portion of the tongue can come up and help, you know, create that lingual palace feel and then swallow properly. So that's so fascinating.

I don't know if you've known this. Like, you should have told me. Like, this is really helpful for those kids you're doing fillings on or cleanings and they can't sealants and they can't keep water in their mouth. I'm like, yes, a lot of them have a tongue restriction. I like the term tongue restriction better. Cause, like, so many people think they know what a tongue tie is. Like, they think it has to be a hundred percent of the way to the tip. Speaking of that, I. I like the grading scales, but, like, when we're talking to other professionals, some people use Korilla, some use Cutler, some use other things. It's like, I'll use just percentages, like, oh, it's like 75% of the way to the tip or something. Um, but yeah, there's a couple small things.

Yeah, I always just tell people, like, I stick with, like, anterior posterior, because I'm like, if it's, you know, behind a certain area or if it's not visible, unless you expose tissue, then it's, you know, everybody gets very. You're right. It's hard to know as a class.

Four or Class three. I'm like, well, I need to know what scale. Yeah, it's complicated. They're opposite of each other. But yeah, yeah.

And I teach that in Feed the Peas. In my TOTS module I teach, you know, hey, here are the scales, here's what's available and out there. However, let's just describe what we're seeing and the functional impact. Because you know, everyone gets so hung up on using skills and in my industry and I'm like, it's. That's not as important as just finding.

Yeah, it really is functions is the symptoms. I mean, yeah, if we have so many kids, I probably say three quarters of the kids that come see us. And Dr. Gihari study from 2016 is the 78% I think so it's probably around this have a less obvious posterior tie that are coming to see us. Those very often are the ones that have terrible nursing pain. Not always. Sometimes anterior, you know, to the tip can have that terrible pain. But it's really unfortunate because most of the ones that are real painful are less obvious. So then the parents are told, oh, it's all in your head, mom. Like by the pediatrician. Not to rag on pediatricians. That's maybe that's just an R area, but I have a feeling it's not, it's universal.

It's everywhere.

Like, oh, it's normal. Here's some basically band aids, like, oh, they're colicky. Here's some gripe water. They're gassy. Here's some gas drops. They're refluxy and spitting up. Well, here's some Nexium or Zantac. Oh, sorry, Zantac causes cancer. Nevermind. Well, do Pepcid instead. My, my daughter's got Zantech. So it's just like all these things, they're not brittle broken bones.

Right. I mean it's like PPIs and infancy create broken bones in toddlerhood and you know there's all kinds of. Yeah.

In pediatrics like the gi. If you look at the GI official like gastric guidelines it says do not use acid suppress acid suppression medications in infants unless it's like a last resort. But most like honestly it's given out like candy. So many of our patients come on it and you know, they didn't even realize that can cause bone fractures and these other issues. So. And gut microbiome and everything else. Um, so yeah, it's, it's really interesting. So yeah. Band aid, Band aid, bandaid. Like what's the root cause here? And we always tell parents like it's not just an infancy. It's a problem that can last. Not always, but it can last throughout lifetime. And, yeah, we're taking care of early. It's better. So, yeah.

And I mean, it often snowballs and then we see. So my practice also treats adults and what we are seeing, which is consistent with the research, and I was just looking this up this morning. It's about 98% of adults with temporomandibular joint disorder have a myofunctional disorder.

Yeah.

And myofunctional therapy is very effective in helping them. Oftentimes they need more than just myo. But it is very effective because you're the dentist. I don't have to tell you, pulling.

Your arm out all day, you're gonna get really tired. You're gonna get lots of muscle fatigue in your shoulder. That's basically what's happening. The jaws is not supported by the tongue, like, tripoding on it. So it's just all the forces going, the tmj and they get TMJD dysfunction. And if you can get that tongue resting on the palate, you know, the muscles in harmony, then you're gonna be a much better position. So there's so many people that are just putting splints and, like, all these things, and they don't see much, if any improvement.

Sometimes it makes it worse. I had problem.

I had orthogonal surgery, braces three times, like, the whole thing, expanders. But no one ever picked up my tongue tie. You know, growing up, I had mine really strong.

I didn't have jaw surgery and everything else. I had orthodontic relapse. I just did tears in the DNA and then Invisalign. Yeah.

So it's crazy.

Yeah, it is. So anyway, yeah, let's talk about the latest research project. So you've got some more stuff going on, something related to diastemas and sleep.

Yeah. So we're trying to get that one published. We're encountering a lot of bias. So Dr. Zaghi and I worked through it. He ran the stats for me. I had Ashley, who's actually in dental school now, in Louisville. So she got in dental school, which is great. She's having a baby soon. But anyway, she went through and measured all the patients that we had for, like, 2015 to 2018, I think, that had teeth. We did a lip tie on. And so we tried to get as many pictures as possible, said, please send us a picture, a current picture, or if they came back for a hygiene check or something. If they were close, we Got a picture? We measured the gap digitally. So if your X ray software, you can measure teeth and stuff like that, so you calibrate it based on the average width of a central incisor, you can measure the gap anyway, so we looked at that. The gap decreased in 94.5% of patients. Wow. Those permanent teeth, that was with diode laser. About half of them with diode laser, half with CO2 laser. But if the procedure is done properly, meaning you remove all that tissue down, you know, between the teeth and the diastoma, the gap, it closes up almost always. And so we've been trying to get that published probably about a year now. This is why people don't do research, right. Like if I had said, I guarantee, if I had said it causes scar tissue and it's going to, you know, cause all these problems, it would have gotten published immediately. Again, the first journal because it's like anti tongue tie and there's this just bias or that's. That's goes along with the narrative, right? That's the current thinking. Oh well, if you do, it's going to cause scar tissue. Well, if you look where that's based. Out of all the references I could find point Back to Bashara 1972, who is an influential orthodontist, who basically said. And never once in the article does it mention scar tissue. The quote is, it seems preferable to close the space orthodontically. Well, he's an orthodontist. And then release the diastema so it can heal in that position. But it also says it seems preferable to remove the tissue or sorry to prevent the cause of diastema if it's predictable and possible. Our study shows it is predictable and possible to remove the cause of diaspora in the first place. Because we have some patients that come in, we'll release the liptide and they come back to us a year or two later and they don't need braces at all. That was. That would have been. Their only issue was to be a big gap in their teeth like Michael Strahan. So anyway, it's a huge service you can provide. We're trying to get that data published. I'll keep plugging along. They want a control group. But again, it's so hard. We tried to have the patients like serve as their own control. So we asked the parents, they could send us a picture from like a year or two before just to show it didn't have any change. But then they couldn't because all their. We tried and they said all of the pictures of my child, you can't see their upper teeth at all. Like, because their lip is held down so tightly. It was impacting the aesthetic. So, uh, with less. With the lip tab release, we see improvements with, like, I'm sure you probably this too, like getting food off a spoon. Bilabial speech sounds. So bpmnws, improved nasal breathing. A lot of the adults are reporting that. I think because the fascia release, it feels like that. I think caudal maneuver or whatever it's called, when you put your fingers on the side and kind of open your narratives. Um, so it basically feels like that, like your nose is open, you can breathe easier. Which is interesting, which I would have never really guessed, but something to check your patients for after lip tab release. If they have less, like, nasal resistance when they're breathing easier to get food off a spoon. More aesthetics. They show more teeth when they're smiling. And some adults will say it's like, almost like they got Botox or get like, looks looks nicer. They're happy with it anyway. Reverse cupid's bow or something like that. I don't know. I don't do cosmetic dentistry, just pediatric dentistry. But we do some white crowns and pediatric. But that's it. But yeah, releasing the lift can have a huge impact. So we're kind of getting that published hopefully soon.

That's awesome. That's so exciting. I feel like the more research we can get out there in support of the work we're doing to show what we know to be true, what we see as the other 2/3 of the EBTP triangle. That's not yet. This is not in the scientific evidence, I guess, yet.

It was like a retrospective cohort study. So, I mean, it's good. Did you see Dr. Gahari's new study? I'm guessing the posterior tongue tile?

Yes, I did.

So good.

It's following that.

I was excited when he got that out there because, I mean, it was briefly. I'll just touch. It was on bottle feeding. So people like, oh, they can't nurse. Just give them a bottle. Like, no, not to breastfeeding shame people. But ideally, if you can get. I used to think it's just the breast milk is what's important. It's the actual act of nursing. Helps to expand the palate. I'm probably preaching the choir here. But anyway, so he took a special bottle called an infant N F A N T bottle has a computerized nipple and it's frank nicus and stuff, but it can measure like the burst duration and like the how, how well they're nursing and if they can adapt to changes, all these different parameters. And so he took that objective data with bottle feeding babies and it was not anterior tongue ties, only posterior tongue ties. And he got it published in like the ENT journal. Right. Like the Academy of like Otolaryngology Journal or whatever it's called. And anyway I was, I was excited to see that. So Congratulations Bobby. So that's, that's huge because it has objective data. Plus the moms had subjective improvements of less nipple pain more. They had more confidence on the maternal self efficacy scores above 50 which means they're more likely to continue breastfeeding. So yeah, that was a huge. But that's, that's really good to have that evidence that. Yeah. Oh yeah. Posterior tongue ties don't exist or they don't cause problems. Give them a bottle. Like it just shut all those down. It was published in the ENT journal.

So yes, I love that, I love that we need more of that. But it's amazing to see this, you know, it's so, it's, I don't think randomized.

It was randomized. Like that's so impressive in a private practice. Basically.

Yes. I mean it was. I was following him from the beginning with like. I think I was one of the people who added like early funding to the project.

I gave him some funding for the project as well because the bottles are.

Getting this out there. Oh, they are. Well. And NFANT has actually sent me some of their bottle top like nipples to trial and I've put them on bottles to see and they actually work very similarly to like the Dr. Brown's nipples on the narrow neck. And so yeah, so I, I loved that because I'm like, well these are very similar and that's kind of the gold standard from a pediatric feeding standpoint.

So I guess Autumn says the ones that are like more like breasts are like worse for feeding. Like babies don't latch onto this massive like the como tomos or the other big ones. Yeah, like the Dr. Brown's narrow, not the wide ones. That's probably 95% of our patients end up on those.

Yeah. And that's great. And that's, that's the closest currently that you're going to get to breastfeeding. So. Yeah. So now you also have. Actually before we go there, I have a question for you. So are there any plans to or do you know of anything in the active wound care space in terms of like lifting and I don't know what your protocol is for posture, but yeah.

I think everyone's is evolving as you go. And so like one of the keys that we preach with like Tongue Tied Academy and other stuff, our courses, it's like really, you have to get everyone back for follow up, at least find out how they're doing in a week. If nothing else is, some of our patients are from four or six hours away. We have one family drove 24 hours from Wisconsin to see us because no one would treat their two year old. But on the way back she was already talking better, eating better, you know, at McDonald's, whatever, and not snoring in the car seat anymore. So I mean it can have an impact even right away like that. So they were, they were happy and said it was worth every mile they drove. But. But you try to get everyone back just because that's the only way you're going to learn. So in our area, often it's done with a clipper snip. At other places they don't get them back. It's an incomplete release. There's no wound care. Maybe that's just Alabama. Some people say we're back, we're down here. I don't know, I'm just.

It happens all over, everywhere.

It's all over. It's a worldwide issue, honestly. And so. But the key is that you can't improve if you don't see people back. And so we changed the settings on the laser from like super pulse to non super pulse to see if that would help. It seemed to help a little bit with less reattachment. One of the big keys with less reattachment was having the parents do it before they leave. So we'll have mom or dad put on the gloves before they leave and practice the stretches with one of our assistants showing them how to do it. They show them and then show because otherwise they get home and like we make it look easy. We just pop in there, boop, boop, boop, done. But they're like, I cannot get this. And often they're not controlling the head so they have their hands up high, kind of come, come down like a football, almost in control the head and we just call them stretches. There's exercises in my mind that's more of the myofunctional exercises like for older kids obviously. But when it comes to infants we just say stretches. People can say lifts or like massages or whatever you want to say. Active wound management. Basically you're trying to trick it to heal open essentially. Like if you Got your ear pierced, didn't wear the earring. It's going to close up. So that's normal. That's what it's supposed to do. We're trying to trick it to heal open. And so we have them push straight down in the floor of the mouth, right behind the gum ridge, or if they have teeth, if they're older, straight down, then just right on the diamond, but gently but firmly and not rubbing on it because if you rub on it, that could cause more inflammation or it obviously hurts more. So, you know, respectfully pushing on it. We say for babies four times a day currently, I think at the Breathe Institute with Chelsea and them, they're saying three now for babies. Don't tell anyone this, it's a podcast. But so with Molly, my daughter, I did twice a day almost as an experiment to see what happened. It's best to experiment on your own kids, but I was working and my wife made me do the stretches. I have no clue why. Anyway, but you're the dentist, that's why she made me do it. But anyway, so I did it once in the morning, once I got home, and on weekends I'd throw an extra one in there. But it healed nicely. I mean, she's two and a half years old now. Like, speaks like a four year old, like eating well, like sleeping well, all that stuff. And it didn't, it did not reattach twice a day. But if you do two super high quality ones a day, it can work. For most people, I think probably four is a sweet spot. If they get three, it's okay. But when we were telling people six a day, like they felt like a failure. Like, it's really hard to do that. They've done studies on like taking pills, which is much smaller ask than having them, you know, basically torture their baby or, you know, I mean, that's what it feels like to them sometimes. It's, it stinks. It's not the worst in the world, but it's not fun because they're so sweet and like, you love them so much. No. And no one wants to hurt their kid. I don't want to hurt their kid either, but I also want for long term, I want it to work for them instead of just working for a week or two. And then they're like, oh, Dr. Baxter, I didn't work. So all that to say, yes, push on four times a day for babies, three times a day or so for like older kids. And then for that toddler age, we're sick twice a day. If they're uncooperative or like, if they have autism or sensory issues, you know, once in the morning, once in the evening, minimum once a day, like in the morning, so because it's been still all night. And then during the day they can move it. So I'm not sure if that's similar to what you're seeing, but like, that often no man's land is between six months to two or three years old. People are like, oh, don't treat those at all. But that's the key time. That's what we have to treat them. They have some crazy changes even the first week. So, like, you know, not, not to knock therapy, obviously. I know that's what you guys do, but like that first week, these kids, sometimes they just get their tongue up automatically or they'll start sleeping better or chewing better. And if they're sleeping better, then they have less sensory stuff and they can process the, you know, speech better. And when you combine that with therapy, it's really magical. But like, they, these young kids, it's, it's super cool. It's one of my favorite ages to treat. And you know what, if we have to revise it later when they're five or six and more cooperative, we'll do that. But I don't want to miss out on giving them like 90% better tongue mobility just because we can't get a hundred percent better. You know what I mean?

Yeah, yeah, well, and it improves sleep, which improves cognition, which improves school, which.

Improves, I mean, friendships, IQ points or something you mentioned the other day.

Yeah, yeah, it's. The research varies, but it's somewhere between, depending on where you read it, like 10 to 16 points. A lower on IQ for. Well, these are specifically for children with obstructive sleep apnea. But I mean, most of these kids probably have tongue ties and inflammation, and they're just. The quality of their sleep is not there. Plus now they're choking during their sleep. It's, it's, it's sad, but it's. I've seen some of these kids, and these are the kids that are. They just seem kind of like spacey and out to lunch in the classroom at three years of age. Like, they don't respond to their name. And now we're wondering, are they hearing there? Is it a caught. You know, they're going, oh, gosh. There's probably some, like, cognitive issues going on and language delays and.

Yeah, no, this child is like that, like mouth breathing and like, kind of spacey and like, oh, like.

But what's really cool is that intervening even at 3 with these children. I've seen a complete one, like complete turnaround.

Awesome.

I mean, it's just, it's phenomenal. And so we absolutely need to be working with no man's land. And I've also seen infants too. Or sometimes you release that tongue and all of a sudden it's just like whoop up on the palate. And I'm like, whoa.

So cool. It wants to go up. It's like a magnet, you know, it's being held down. I. I had my tongue down for 30 years and didn't know any better.

Me too.

My lips were always chapped, like in the summertime even. Like, why are my lips always chapped? Like Napoleon Dynamite carrying on, you know, chapstick everywhere. And yeah, it was. I wasn't like, you know, that much like Napoleon Diamond. But anyway, it was like, Tina, come get some ham, you know. Anyway, the. It's so key with like getting these kids the tongue up the lips, seal breathing through nose 100% of the time. All the normal myofunctional goals. A good swallow. But yeah, just aren't taught that. It's not taught in school, it's not taught in residency, dental school, medical school, speech programs. I mean. Yeah. So one of these days.

Crazy. It seems criminal, right? I mean, it's just.

I know, it's unbelievable.

But yeah, so I was, I was asking about that because there's just discussions that there's no research, you know, clinical evidence to suggest that active wound care is beneficial and in fact it's more harmful because it's creating trauma and blah, blah, blah, blah.

It can cause a temporary aversion, you know, for like a few weeks while you're doing it. But normally with. And stopping like a week. Yeah, but stopping a week or two later, like they're back to normal. And we tell people like, you know, play in the mouth at other times, like get them used to, you know, you know, just play with them somehow. Be respectful, obviously. But I mean, with the one or two year olds, if they cannot get. The parents cannot get in there. We'll give them like a malt mouth prop, a tooth chair we call it. To get in there. You can get them on ebay for like $4. So we just give them out to parents, tell them to keep them. But yeah, it's, it's funny, we told them to keep them 1:1 last week and the mom thought we were talking about the baby board we use. It's like a hundred and something. Dollar Board. She took the board with her, and I was like, oh, gosh, we got to send her a UPS label to get that back. No one saw her walk out there. She took the whole board and was confused, Thought we could take the little tooth chair. Anyway. That's just funny.

That's funny.

So we have here with them, not the baby board, and it's like, just walk out with a dental chair, you know? Right, right.

Just take the whole thing with you.

What you're gonna do with that. But okay, if you really want it. But the two feet make a huge difference because if they can't get in there and they can't stretch it, obviously. So that. That just happened from a parent. One dad's like, well, if I had that thing, I could do it. Here, dad, you take this. Take it, and, you know, I want you to get in there.

Do you think there'll be any future research looking into, like, active wound care protocols and healing idea?

Yeah, maybe.

I'd love to see that. That could be kind of cool.

Two times a day versus three. If it's like, I don't want to, like, mess some kids up for. And really, it's hard to tell because we tell everyone the same thing, and most of the time it still comes back. We have to do, like, a deeper stretch at a week, Meaning I'll do a stretch and it will separate a little bit. Sometimes it pops open. If that happens, I tell them they got an A. They did a good job. If it just separates a little bit and has, like, a little bit of bleeding for a couple minutes, I'll kill them. A plus. So everyone gets an A. Because it's. It's hard. It's not easy after the job is just, you know, psychological in nature, like, encouraging the parents and, as, you know, like, helping them see that common does not mean normal. That kind of stuff. Yeah. So anyway, it'd be cool if we.

Could figure out a way to look into that and standardize it to some extent, which I think is also tricky because variables like, kids heal differently. Right. So there's so many factors.

Pressure, like five Newton squares. Like, I don't know what that means.

Right. I know, I know. Obviously we know.

It's like. I don't know.

Obviously, we know it helps and it works.

It's.

Yeah.

Firm but gentle. Because, yeah, when people say, I didn't do any stretches, they come back and it's like, back together a good bit. And, yeah, if it's a week or two, we can pop back open even up to, like, Four or five, six weeks sometimes if they're younger. You can stretch it out a little bit. It'll still stretch out. You don't have to relaser it right away. Um, so we always try that before just jumping and relaying it because I think it pops open. I'm thinking probably two more weeks of stretches. But if it we have to relays it's probably at least three, maybe three and a half more weeks of stretches and then we get them back weekly if we have to revise it. But it's honestly it's less than 1%. And after we started showing people like how to physically do it and then getting being pretty particular, beating as many people as possible back at one week for follow up and more often as needed obviously. But that's helped like way down on the reattachment rates.

That's amazing. And now what about sedation? Because I don't think you use sedation in your office. No, we don't.

It's kind of long story. So if I have a kid that needs like 15 teeth fixed in there too, right. A dental rehab and they're asleep and they have a tongue tie. Did one I think last week or whatever, I'll do all their sleep. I'll even suture them up because they got in that situation because the parent, they weren't brushing as well and so. And they're asleep at perfect cooperation takes another few minutes. I'll suture them up. So that's the only time I do when they're asleep. But if, if they're awake in the office, obviously again they come from a distance, most of them. Then what we're having to do is we just. It's 10 seconds. It's about as traumatic as like if they fell down, skinned their knee or if they got a flu shot or something. Parents will hold their hands, they'll come back with them. We have cocomelon or whatever up on the tv. Daniel Tiger or frozen or something on the TV to watch that. Pretty much by the time they realize it's hurting, we're done. We use a strong topical jelly, not really injectable lidocaine. I try not to say the S word. We don't say shot in the office. I don't want to scare them anyway, but yeah, so if they're like five or so, then we'll do the injectable lidocaine. If I think that, okay, if they feel a pinch, are they going to still sit still or. I've missed my window of opportunity there because like, oh, they're hop up and then they're crying and it's anyway, so we try to do whatever's going to traumatize them the least and like with the stretches, they stink. But I tell parents like trust me mom, if there was a better way, that's what we would do. Like we were all about building a better mousetrap, trying to innovate and improve whatever we can. So yeah, it's 10 seconds for a tongue, it's about 15 seconds for the lip a little bit. Obviously for an adult we take much longer than that. We're getting there. Possibly a little bit of the genioglassis muscle. Check Dr. Zaghi's course, a big fan of his stuff. But we try to get like in kids we don't take the genealoglossus muscle, it's just the mucosa and the fascia. But it's about 10 seconds. Honestly with the CO2 laser but the diode laser, it's about a minute. Not, not all lasers are the same diode NDAG, that kind of. Those are hot tips. Erbium and CO2 are cut optically, meaning it just hovers above it. So erbium doesn't have as good of coagulation as the CO2. So that's why the typically the CO2 wavelength like light scalpel or solea is what's preferred. People doing releases a lot.

Yeah. And then what about cold seal versus, you know, in the whole frenectomy versus frenuloplasty.

Yeah, yeah. So there's frenotomy, frenectomy, frenuloplasty. Frenotomy is like incising it or cut. So Dr. Giheri for example in the article he said frenotomy from the medical background they call it a frenatomy. He probably just using that for just terminology reasons but he. It's physically, it's a frenectomy. He's. Anytime you're ablating tissue with the laser he uses the lightscalpel CO2, it's disappearing. So you're removing tissue. It's technically a probably a frenectomy. That's like what we use when you're removing tissue is ectomy. It's like a. Anyway and then a frenuloplasty means rearranging the tissues. So typically what we do is a horizontal to vertical frenuloplasty means you're cutting horizontally, you're suturing it vertically. There's also a Z plasti where you're making like Triangular pieces and rotating them. I've never done that. But that's, that's the one slide they showed in dental school. Right. I think junior year oral surgery, like, here's how we fix a cleft palate. Like, don't try this at home, kids. I'm like, point taken. Not fixing any cleft palates. And then like the next slide is like, this is a Z plasti for, you know, tongue tie. Like, don't try this at home, kids. And it's like, that looks terrible. I'd never do that. And then like fast forward, you know, five, six years. And then, yeah, doing tons of them. Not the Z plastic, but the tongue tap procedures because it's, it's not as complicated as they make it out to semen in dental school. And there are a lot of vessels obviously in the floor of the mouth. So I'm not saying just go there and do it with no training, but now there's so many good training opportunities for people that there's not really excuse anymore, like, oh, I, I don't know how to do it or something.

So anyway, yeah, and then going back to like the whole cold steel versus laser. I know that you use the CO2. No, no, that's okay. No, I asked you two questions. So I think it's helpful for our listeners because, you know, I've worked with a variety of providers who use different lasers, use, you know, cold steel, who do frenectomies versus friendulplasties. And then there's the sniffing clip, which always goes to. If I want to. A frenectomy.

Yeah, if I hear sniffing clip, that's like a four letter word to me. It was probably not done properly because I got, it's easy. It's, it's from the mindset of like, you know, sinus surgeries and like all these complicated ENT procedures. Like, what's the big deal? It's like the tongue. Just cut it, like not a big deal. But really, I mean, like Dr. Gahari was doing with scissors for a long time. And it's about five cuts, like small little cuts to get like the whole thing. It's not just one cut. Most scissors, as soon as you make a cut, it starts bleeding and then you can't see your landmarks as well. So I can see why they don't want to go deep on that because you could cut like a lingual nerve or artery or vein or something or the muscle and cause more damage. So. And honestly, if you have a sharp object like a scalpel, super Sharp or scissors in there and the baby's moving or the child's moving. That to me is more dangerous than the laser. The laser, it's soft. I mean, you can touch it on kids. I'll, you know, pretend to ride on their hand with it. I just show them. I get, you know, it's soft, it doesn't hurt when you touch it. Um, but you just take your foot off the pedal or on the pedal, depending when you want it. So you don't push your foot down until you have a clean shot. And then if they move it all, you just lift your foot up and it stops immediately. So in my mind, it is safer if you're following all the laser safety protocols. Of course, the laser in use sign, eyeglasses for everyone, all that kind of stuff. Suction, you get the plume. But yeah, it's. If it's done properly, then it has lots of good benefits. If it's done halfway, you're probably not going to see the benefits. And I think that's what gives some people a bad taste in their mouth. That's a pediatrician or whoever. Like, oh, yeah, tongue tie doesn't work. Or they see the ones that are to the tip and they have perfect articulation, but they don't realize all the sleep and behavioral and all the feeding issues.

Eating.

Yeah, like, they can say their Rs and Ls and they. You would never guess based on their articulation. We've had some of those too, but they come in with the other stuff. And so you'll see one kid like that, like, oh, yeah, we have kids with tongue ties all the time. They're fine. Yeah, they're fine. But like, we want them to thrive and like we're going for.

And what are your markers? Right. What are your markers for? Fine. What are you thinking about?

Basically, they're alive still. I mean, as long as they're breathing. And again, in the pediatrician's defense, like, they have like so many things to go through, like car seat safety and like substance abuse for older kids. And like, there's so many things. Wearing a helmet when they're riding a bike. Like, there's so many things in addition to that they have to hit, like in their notes or else they can get in trouble. Then they don't have time to sit there and put all the pieces together of the tongue tie stuff and like, look through that lens because it really does take like a paradigm shift to just see it. Well, this kid does have speech and sleep and eating stuff and like, they had trouble nursing as a baby. I wonder if something's going on that could connect all those. They don't have time to put that together often, and they're not trained.

I mean, I'd love to see. And, yeah, that's. That's what we see, too. I'd love to see. You know, with my prior pediatrician, before we moved, actually, the first one and the last one, too, they would send us in the app, like, certain questionnaires before every appointment. There's a ton the first year. It's like, every time you go for a well check, and then, you know, annually, there's those same questions. And they're asking. They're asking about the mchat to screen for autism. They're asking about, you know, maternal health in the first year to make sure mom's not having trouble with PPA and ppd. And I feel like it's evolved so much, and I'm like, can we just throw one more screen in there to ask about sleep or. And tongue tie? You know, can we, like, get this in?

That's what we're doing.

Find out more.

The trq, the tongue restriction question. They are. Yeah. And, like, y' all are talking the other day. Like, they screen hearing and vision. Like, honestly, like, with the way they circumcise most of the boys in America. There's a documentary on a few years ago called American Circumcision. I watched. It was interesting, but, like, often it's really just preference. Like, hey, mom, do you want to have them circumcised or not? Like, they're not really doing it for the medical benefit, which even that research is kind of shaky for, like, less penile cancer and less risk of UTIs, I think, in boys, which is pretty rare to begin with, but what they look at is just preference. And that's like, 15 minutes. What we're doing is 15 seconds. We're doing it for current actual issues. That's for potential future issues, but for whatever reason, that's accepted, like, by pediatricians and society and, like, oh, yeah, whatever. Like, no one even gives it a second thought. Versus, like, as a society, we would be much better off if we just cut everyone's tongue instead of cutting everyone's penis. And I think it would be, like, just from asleep, breastfeeding, all that standpoint, It'll never happen. But.

Yeah, but, you know, in the Jewish religion, because I'm. Yeah, I'm Jewish, you know, all of the boys get it. All the boys have it. They don't do it in the hospital, they do it. I think it's about like eight days after, like a week after. And the mohel comes and he gives them, like, a little, you know, sterile cotton with. Dipped in some, like, wine and, you know, kosher wine. Puts it in the baby's mouth and does the snip. Like there's no nothing else. And it's a very quick thing. Some blessed. And the mother's, like, cringing in the corner, you know, and it's like.

I know it's not, but, like, the tongue tie, it's so quick. It's way quicker because often.

Yeah, exactly.

Minutes or so, and then the revision rate is fairly high. So when I'm at the hospital fixing kids teeth that like, two years old again with like 15 cavities, we'll just put them asleep for no reason. But there's a urologist there and he, like, I look at his schedule and it's like, circumcision revision. Circumcision revision. Circumcision revision. Like, it has to be redone pretty often. Um, so no one ever talks about that. I can't remember what it's like 10% of the time, maybe. Um, I'm not sure. Don't quote me on that. But it's. It's fairly high. Like, higher than you think.

Interesting. Interesting.

Anyway, I think the. Yeah, the tongue tie. Screening for tongue tie. At least screening for myofunctional issues. Mouth breathing. Like, people used to get a grade. I heard one. One parent or grandparent told us, like, oh, yeah, they got a grade if, like, their lips were together. Like, you know, it was on, like, their behavior score or like, anyway, like, in elementary school, the parents. Yeah, the teachers would assess for that kind of stuff, but it's not done anymore. And breath. That talks about breath the other day on the podcast. But, like, it talks about how people go around the guy, I came out of his name, checking the Indians and stuff, and they would close their lips of the babies and they wouldn't smile because they were afraid some oxygen would get in through their mouth, not through the nose. And all the Chinese proverbs and everything. Breathing through nose gives you life and breathing through mouth gives you death, basically. So. So, yeah, it's. It's really interesting.

Yeah, yeah. So you have your tongue tied Academy, which I know you've got two versions. I took the version for therapist. So tell us a little bit about that.

Yeah, so basically, just out of people asking, hey, we need more training on this. Like, what could we do here? So they're coming to our office for like a live course basically. But we needed something to get everyone on the same page essentially. So for a year I was working on this script. It was actually, it's actually longer than the book, believe it or not. And when Covid hit it was a perfect time. I had the film crew, they were going to come anyway. I think I can may. So we just moved that up to March. Had them because we had the office shut down, had nothing else to do and we basically did that with my Covid project. So my wife's like you're working more now than like, like everyone else has shut down in like home with their family. I'm like I'm still home. Like we anyway. But I have TMJ issues as I mentioned. So I was really worried I wouldn't be able to do it because it's eight or nine hour days of filming and just talking, talking, talking. Ended up. It's at 25 hours of video. It's split into modules and lessons. Like each Lesson is like 5 minutes, 10 minutes, 20 minutes depending on what it is. So it's not like it's on demand so you can watch it during your lunch break. You don't have to like it's like a zoom thing like we're doing now where you have to be present which there's a place that you guys do the feed the peds that way I think.

Yeah, yep. Yeah. We do a combination of like pre recorded and then we get together to like review case studies live for an hour each week during the 12 week course. But yeah, it's all prerecorded in My new mile course will be the same like it'll be on demand with the opportunity to join like office hours. But yeah, I mean I think that's the way of the world now.

They're both, they're both good and I can see better.

Self paced is so good.

I'm not there with people to hold their hand through it but we tried to make it like an answer like all the FAQs that people would think in their mind. And so it's literally takes you from the A to Z of treating tongue ties. Even as a provider, I wish I had that course when I got started. Would have been a lot easier. Would have missed out on a lot of mistakes. But basically people can learn from my mistakes and things that were difficult to learn. But yeah and then with the light version for therapists is 13 hours if you're a dentist or dental hygienist they are ADA approved CE hours So a lot of courses are not. Because it takes a little bit extra to get that, the ADA approval. And then, yeah, it's, it's a lot of fun. So we did that over Covid. We've had a ton of people take it and really good feedback from it. It's just tongue tiedacademy.com but one cool thing, we give away all the proceeds from the course, all the proceeds from the live course from that. We have four dentists a month come in shadow on a Friday, and we have some lecture time and discussion time and they basically watch the whole thing. They're holding the baby's head, they're holding the child's head, they're suctioning as much as they can do without a dental license in the state, basically to learn how to do this on their patients. And a lot of people feel more confident. But all that money and then all the money from the book goes in one account. We give it all away to charity, basically to.

Yeah, that's so cool.

People that don't have clean water, like, yeah, they walk for three hours a day to get like, you know, fill up their jugs of water. They can't go to school or human trafficking in Nepal. Um, there's a health clinic that we're supporting in Nepal that if you have like a broken leg or a heart attack, you have to hike two hours uphill or three hours downhill. And you or me, it would take us four hours because they're used to the elevation, all that stuff. But it's like you can't hike if you're having a heart attack. So helping support a health clinic there in Nepal. So just this stuff like that, which. Give it back. And we're not doing this for the money. Like, we're doing it honestly to help spread the word and help educate whoever wants to listen. So.

Yeah, I love that. That's amazing. It's amazing. Well, thank you. This is so great. Is there anything we didn't cover? I feel like we've talked about so much today.

Yeah, hopefully we packed it in for the listeners there because I have a listener of the podcast. I'm happy to be back on anytime. You'll have me. So.

Yeah, of course.

With your course. Just talk to ourselves for hours and hours.

Exactly right. That's the new the MYO method, one that I'm in the works of creating now. Hopefully I didn't lose anything with my compute shut down before we started recording. It'll all be like self paced, prerecorded as well. And they Take themselves through it. But it's, you know, I think that's. I've had a lot of feedback from clinicians that have said that it's. It's such a great way to learn because being able to chunk it down and learn that you absorb more and then, you know, for mine, being able to go back and they have lifetime access, so to go back and rewatch things as it's relevant to current patients, I'm like, that's so important to me.

Yeah, they can watch the case that. We have 65 case studies. We have a Google Drive with all the articles, all the forms we use. Like, basically, here, get started. Like, here's what to have your front desk person say when someone calls like that granular. Because otherwise it's so difficult to get started. It's a large barrier to entry kind of thing. And we want to make it accessible, but we also want people to do it the right way. We don't want people just doing it for the money. We don't want people just doing it, you know, for, you know, just add a service. Like if you want to make more money, do braces, like, do ortho, you know, the right way. Like airway focus. But, like, this is not. Like, dentistry is more lucrative than tongue ties, right? Like, people are not doing this to make their laser payments. They're. They're doing it because they want to help the patients. Because, I mean, you do a filling and it's like. Oh, yeah, it's about. Like it was, you know, like a lot of times they're not having pain, really, but with a filling, but with this, like, oh, my gosh, these kids are. You're seeing the changes before your eyes. And you see them especially because you're following up with them for months or sometimes years. And they're eating better, talking better, you know, sleeping better. Just their whole behavior can change. The colicky babies. No, babies should be screaming and colicky like that. Like there's a sign something's wrong. You know, that's terrible. Terrible nursing pain for moms. So, yeah, there's so many things that are just intangible rewards you get out of treating the tongue tie. That makes it worth it.

So, anyway, absolutely. Well, thank you and I'll do one last plug. So if anybody has any interesting research ideas in this space, definitely reach out to Richard and his team or let me know and I'll forward it along. Because, you know, I think as long. As long as we continue to evolve as a community, we're just going to continue to do right by our patients. So thank you Richard.

Yeah. If you have any ideas, infoung tiel.com and then you can download a copy of Tongue Tied. If you haven't yet, it's on our page@tue tieal.com professionals. You can also download all the forms we use and the articles we talked about are included in there like the TRQ and everything. It's all for free.

So yeah, amazing. Thank you.

Thank you. Good to see you. Hallie. Thanks so much.

Thanks for listening to this podcast. If you want to hear more of these Myo Tots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts or pledge a small amount on patreon.com if you found value. Others you know in this space will too. So be sure to share this episode on your social media platforms and join us over on Facebook on my Facebook page @hallebulckenbiz, on Instagram Alibulcan. And you can head over to theuntetheredpodcast.com to grab a copy of the Show Notes where you can also subscribe to be kept up to date on the latest podcast episodes.