Episode 146: TOTs Myths Debunked

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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.

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Let's get started. Hi and welcome to episode 146 of the Untethered Podcast. Today it's me, your host, Kelly Balkan, and we are going to debunk some tots myths. Now, what are tots? Tots are tethered oral tissues. We're talking tongue ties, lip ties, cheek or buckle ties, and we're going to talk about some of the most common myths that I hear on a regular basis because it's just time to debunk them once and for all. Now, before we get started, if you are listening, between January 17th and the 31st of 2022, we have. If you're an OT or an SLP, join us because we have a free training, five days to start screening your first pediatric feeding patient coming up, starting the week of January 31, 2022, all the way through the end of that week. So you're going to want to join us. Go to feedthepeds.com training and you can join us for that free training and get five hours, five free hours on a certificate of completion. So again, that's FeedThePedes.com training. Alright, let's jump in. So let's just start with the biggest one. Right, first myth. Tongue ties are a fad. Hmm. Well, no, no, they're not. Far from it. They've actually been around and documented for thousands of years. Okay. It's written to the bible for those of you who follow. It's, you know, midwives, wet nurses used to use their long fingernail to just go under the tongue and slice or release that restricted tissue at birth so an infant could feed. You know, obviously we use more sanitary approaches these days and more effective and efficient ones because we also know, as we'll talk about later, that sometimes just a quick little snip or clip is not always sufficient. But they used to do that way back when and it was good enough then. So we're going to talk a little bit about that. Right. With the uptick in breastfeeding education and more moms wanting to breastfeed and more moms feeling more supported in breastfeeding. Not all moms, but more than in the past, we've definitely seen more infants needing support because more infants are struggling to breastfeed and bottle feed at times as well. It's not just a breastfeeding issue. Right. It's breast and bottle and solids and so on and so forth. We're going to talk about that today. And this just in turn has brought a lot of awareness to other family members, to other medical professionals. Right. Regarding what's going on and why an infant struggling to feed. But then it's also brought other awareness to family members, sometimes of a tongue tied infant who also realized that they might have tethered oral tissues, whether it's their tongue or their lips or their cheeks or whatnot, that's causing them a snowball of health issues. So, no, tongue ties are not a fad. We have established that one pretty well. And it's just, it's almost comical that that still gets said because we're basically saying, oh, hey, yeah, you know what? That tissue that exists that we can see or expose by doing a certain type of lingual elevation to expose posterior tissue. Hey, yeah, that tissue that we're seeing with our bare eyes. Yeah. That doesn't exist. It's not tight. It doesn't change presentation when we manipulate it versus this frenulum over here. And yeah, your symptoms aren't ill. That's basically what we're saying. We are gaslighting parents, breastfeeding mothers, bottle feeding parents, infants. We are gaslighting them into starting to believe that maybe they made this up and that maybe this is a fad and maybe they're crazy and all of the symptoms don't exist. Okay, no, enough. That's enough. Move on from that, please. Ok, now let's talk about our next myth. You should wait to see if they outgrow it. All right, well, here's another one that we're going to spend a minute on. Or so you can't outgrow a functional issue that is based on structure. What do I mean by that? If there is physically something preventing you until that physical restriction is released, revised, treated in some way, the issues that it's causing are not just going to go away. Can we do alternative things to make it better? Maybe. But all we're doing at that point is Compensating and maybe helping someone compensate a little better. It's still a compensation. They're still not functioning optimally. They're still going to have some sort of struggle. Maybe we fixed this struggle, but did we fix the other one they're having? Maybe we fix this struggle, but maybe it's snowballed into some other issue now because our body's intertwined, okay? So you do not outgrow functional issues that are based on a structural problem. Okay? You just learn to compensate. Right? And as I mentioned, as compensations build on each other, they oftentimes become larger issues with a lot more layers to the onion, if you will. Meaning the longer you wait, the larger the issue becomes, the longer it takes to address. And at times, it may even involve more specialists to help you get back to optimal function from a health standpoint. Okay? So early intervention here is key. Now, if you have a child who's not an infant, if you're an adult, people always say, is it too late? Did we wait too long? Intervening now is better than not at all in most cases. Obviously, you need to have an individualized evaluation to figure out what's going on, what's your recommended individualized treatment plan for you for your child. But the earlier the better. None of this waiting. I love when I hear, oh, well, you know what? That child's in no man's land right now. Meaning, like, oh, we can't do a release on them, a tongue tie release, because they're between the ages of like 1 and 3 and just going to be too challenging. So let's wait a couple of years. They're not saying that we should wait to see if they outgrow it. They're saying, hey, I don't feel comfortable doing this procedure on a child that age. So let's wait. That's also not fair. They can say a provider. I highly respect a provider who can say, you know what? I prefer not to release children this age, but maybe you should go talk to this person who will. Because I do not think we should put a child off because one single provider doesn't feel comfortable. Again, I respect that provider for doing what they do best and for recognizing when something may not be in their comfort level or their level of expectation. Expertise. Totally respect that. Totally okay with that. What I'm not okay with is telling a parent to wait two years, refer them out, send them to somebody else who is highly skilled, who can also do this procedure and who can do it now or when the team's decided the child is Ready not two years from now, because, oh, at that point, for me in particular, it's easier to address this. Then it's not about you as the provider. It is about that patient sitting in front of you. And if you're not the right person, that is okay. But you better be referring them to the right person. Okay. Anyways, that took. That took a turn, as things do usually when I get on. On these heated topics. All right, let's go on to the next myth. So tongue ties stretch. You might be able to release some tension in the surrounding tissues or surrounding areas or muscles even, but it's not truly stretching the tongue tie. Okay. Or the frenulum. Right. The tight frenulum. We may see a relaxation which may make that, let's say, lingual palatal suction or tongue to spot. If you're holding your tongue up, the tongue tip up to the top of your mouth, we may see that that appears to increase that. That they can do it a little better. Well, that could be because they've. Maybe they've had some therapy. Maybe they had some myofascial release. Maybe they had some myofunctional therapy. Maybe they had some oral motor intervention. If there are younger ones, like under the age of, you know, four, and they're not ready for traditional mile. We, you know, maybe they've had. They've seen a cranial sacral therapist or a chiropractor or whoever, osteopath. Right. Like, maybe they've gone to some of these providers and we have seen a change in the tissue and a change in some of their skills. And maybe if they were borderline, and we weren't sure if, like, they needed a procedure or not, maybe they don't appear to need one now. But I want everyone to understand we did not stretch a tongue tie in that situation. We released tension. We allowed for better function as a result of releasing tension. But then we have to ask, was the frenulum the issue from the beginning, or was it surrounding tension because something else was off? Or did it. Was it that frenulum that caused it? And will it hold? Right. Will these. This release of tension hold, or are they going to become tense again within a few days? Because they'll. Lingual frenulum really is tight and is really causing them to compensate and is leading to surrounding tension. There could be so many different scenarios going on here. I'm just trying to give you a basic example of what we might be seeing. But what I'm saying is you might be able to release some tension in the surrounding areas that might lead to an appearance of the tongue tie stretching, but really a lingual frenulum, which is under your tongue. The buckles, there's four of those. Both sides of your tops of your cheeks and both on the bottom teeth. Right. Your top and bottom. We have different labels for those. If you're a parent listening. Right. Our mandible is our jaw, our lower jaw. So we have our mandibular buckles and we have our maxillary, our upper jaw, or our maxilla, maxillary. So there's two maxillary, one on each side up top and two mandibular one on each side on the bottom. Okay. Then we have two labial frenula as well. We have the or frenum or frenulum, whatever you want to call it. The upper one is our maxillary one and our lower one is our mandibular one. Right. Our upper and our lower. And so a lot of people hyper focus on the tongue and the upper lip tie, not realizing that we may also have a lower lip tie. And for buccal or cheek ties. And so, you know, just heads up, that could be going on as well. And if, if those need to be released, if those are causing issues, we need to pay attention to that because it might be more than just the tongue. Right. I've had babies, for example, that come to me and we release the tongue and we release the upper and or lower lip. And then it's like they improve a little, but we're still seeing a lot of tension throughout the cheeks and struggle with feeding. And we've done some oral motor work. They've got the body work going, and then they go back to the release provider and they say, you know what? I was, I didn't want. I didn't want to overdo it, but I'm thinking we may need to release the buccal ties as well. They release them and oh, my gosh, it's like within a couple of days, magically, baby starts feeding, and all the work that we've done just kind of falls into place. Cheek ties are like the ugly duckling, right? Like, nobody wants to look at them, nobody wants to deal with them, nobody wants to treat them. And honestly, a lot of times it's not necessary. But we need to keep in mind that they are there, they do exist. And if issues persist, we may need to look into them. So I just wanted to give a little plug for those, those cheek or buckle ties. All right. So the other thing I want to mention too, is that these ties, right These frenula are really. They're made up of thick webbing of fascia. Okay. And if you want to go read about fascia, like, you can go down a whole rabbit hole, you're going to learn that certain types of fascia, especially the fascia that exists like under the tongue, for example, it doesn't stretch. Okay. You might get like a tiny, tiny, like 1% like, elongation on it, but it really does. It does not stretch. So a problem now, like I said before, is going to lead to a snowball of problems and compensations later. All right, let's move to the next myth. So lip tie stretch. No, no, they don't. I kind of already alluded to that, but I wanted to say this one separately because, again, I think that lips and cheeks, like I said, are like the ugly ducklings. They just don't get enough attention. So again, no, we may see it recede a bit over time with growth. But if it's caus causing issues with feeding, mouth breathing or speech and. Or speech could be any of those, it needs to be addressed. Okay. So I just wanted to, like, put a little plug in there for lip ties in particular. All right, what else? So when someone says, oh, they aren't tied, they can stick their tongue out. Myth false. Most tongue tied people, whether they're infants, older children, adults, can in fact stick their tongue out past their lips. This is not a good indicator as to whether or not somebody is tied, but is. It's inappropriately used by many health care providers to dismiss tongue ties. So I'm not going to name any particular groups, but if you've heard, like, oh, they can stick out their tongue. They're fine. Yeah. No. That person is unfortunately not very educated on tethered oral tissues or its impact on speech, feeding, or breathing. Let's go to the next myth. Posterior ties don't exist. Oh, my goodness. Okay. I could talk about this for 30 minutes, but I won't. I won't bore you. We're going to get down to the nitty gritty. Just because you can't see it doesn't mean it's not there. An anterior tie where we see it, like, tied to the tip of the tongue or tied to, like, a little bit further back behind the tip of the tongue. Okay. Yeah, those are really obvious. Right. But we have to actually put the patient in a certain position and. Or manipulate the tissue under the tongue a certain way to expose. Expose the tissue. There's a certain maneuver you have to do. And providers who don't do this again have not been educated in how to do this. And so babies and children who are often turned away for having like quote unquote, no tongue tie despite having all the symptoms. And this could also be true of other ties. But we're here, we're focused on posterior tongue ties at the moment. They may have a posterior tie and a Thai savvy provider will know how to assess for this and they should be consulted. Okay, so if you have found like you've got, your gut is telling you something going on with you with one of your kids and you have been turned away by providers and something still tells you, you know, what these symptoms like, they tell me something is up, you should be finding a provider who can assess if you're under the age of 4. I always recommend an SLP or an OT trained in feeding tongue, you know, tethered oral tissues and myofunctional therapy because we're going to take a sensory oral, motor approach to feeding. That's going to be very different than what we do in traditional myofunctional therapy, which is more appropriate for like you need to have the cognitive level of a four year old and then up through like adulthood. You know, basically MYO applies. So think about it. If we're asking adults to do the same thing that we're asking 4 year olds to do, can this child do what we're asking? Otherwise if they're not quite there yet, they would be more, they'd be more appropriate for a or they would be more appropriate. But the program that we would recommend that would be more appropriate would be, like I said before, a sensory oral motor for feeding intervention with somebody who's trained in feeding tots and myo. Okay, all right, let's move on for that one because I could go on more tangents for posterior ties all day long. In fact, I've done like 20 minute trainings on it for free before on my account. But let's move on. All right, so a clip or a snip is sufficient for function Myth. Not true. Oftentimes my oral surgeon that I love to refer to in Maryland has to fix or fully release like complete a release on cases that have been clipped or snipped as they either were insufficient. Right. We didn't get enough of a release for long lasting improved function. Right. Sometimes we get like a day or two of improved function and then it seems to disappear. And at other times, sometimes it's a really superficial release and it reattaches. So the other issue we've seen too, is sometimes if they release too wide, it collapses on. It collapses on itself more easily as well, and it does not allow you to release enough tissue for functional improvement. And this is something that's been told to me by both dental and oral. And oral surgeons are by nature dentists, but dental providers in my area. So I'm just repeating what they've shared with me. When you release too wide, we do not get usually enough of an improvement in function, because if you go too wide, you can't really go as deep. And so I don't know how to explain it beyond that, but I will just tell you. You really want to make sure you know who you're going to. And it's really important to trust the providers that have been referred to you by your team because they've oftentimes vetted these providers, and you should ask them, have you vetted these providers? Have you seen releases that they've done? Do they release children? You know, children or adults with my issues or that are around, you know, my age? If you're dealing with, like, an infant versus a toddler versus a young child versus a teenager, you know, ask questions. It's okay to ask questions because you're. You don't want to walk into something blindly and then have to find someone to fix it if it doesn't go as planned. Right. All right, so here's our next myth. You ready, Tom? Ties don't impact sleep or breathing. I always find this one so interesting. Like, oh, that tongue tie won't. That won't. That shouldn't have any impact on their sleep. Oh, that. Why would that have anything to do with their sleep? Well, maybe it's something to do with their breathing which impacts sleeping, because, you know, you have to breathe whether you're asleep or awake. But, hey, who knew? So really, the whole tongue should be resting up in the palate when you're not eating or speaking. Okay. When you're at rest, when you're playing a game, when you're sleeping, when you're basically, when you're doing anything except for eating or speaking, that tongue should be on the roof of your mouth with your lips closed, and you should be breathing through your nose. Right? We always say tongue up, lips close, breathe through your nose. Right? That's. We say different. We say it differently depending on if you're in therapy or not. But sometimes it's three steps, sometimes it's four steps. The bottom line is we want the tongue up, the lips close, and we want you to breathe your nose Sometimes we'll also add in teeth apart because we don't want you clenching. And the teeth are supposed to be slightly apart at rest. Couple millimeters apart at rest. So you can try this. While you're listening to this episode, suction your tongue to the roof of your mouth. Lightly close your mouth, make sure your teeth are apart, lift it together, and breathe through your nose. If that's challenging, you might want to have a orofacial myofunctional evaluation. All right, but let's move on. So let's go back to talking about tongue ties and their impacts on sleep or sleep and breathing, because there is an impact. We need to have that tongue up in the palate. Even the back of the tongue. If only the front of the tongue is resting up in the palate, the back of the tongue can fall back and block the airway, especially when asleep. So, you know, like, the whole back to sleep campaign thing didn't really work for my kids because they would flip themselves onto their bellies. Like even, gosh, I don't think they were even two months old yet when they started flipping themselves on their bellies to sleep. And it didn't matter how many times I put them on their back, they flipped themselves back under their belly. Lily, my now oldest, my six year old, she was a tripod sleeper where she slept with her bottom in the air and her hands kind of up near her head. And she's got a beautifully shaped head, which I'm very grateful for. But I also now realize she was probably throwing herself into the most safe airway position because of her tongue tie and, and her high, narrow palate. And, you know, probably was. Probably was one of those kiddos who, you know, was maybe not breathing as, as well as she could have been, but I didn't know that at the time. Didn't know that. Now I know, and I look back at her pictures and I'm like, wow, it's a little bit scary now that I know this. Holy cow. Why did nobody ask me about this? This is, this is interesting. And then it threw me into the. Have they done research on SIDS and why, you know, if these babies had open mouth postures or tongue ties? Just, just wondering how they slept. Like, what were the. What was their sleep position? Were they able to roll to their belly if they needed to? Just wondering, you know, so many questions. There is some research out there, but that's a conversation for another day. All right. But, you know, for my child, it seems like it was a survival skill to keep her Airway open. Just saying. So a tongue that sits on the floor. Also, I want to point out it often will lead to an open mouth posture and then mouth breathing instead of nasal breathing. Breathing through your mouth instead of your nose. I say often because sometimes we've got children who learn to nasal breathe. They'll have their lips closed, but they'll have their tongue down in their mouth still, or pushing against their teeth or sitting between their teeth with their lips closed. The tongue's not always in the correct position, despite their appearance otherwise being okay. So we need to look into that too, and we can talk about that more on another episode as well. Let's go on to the next myth. I've got two more myths for you today. The next one is that speech isn't impacted by tongue or lip ties. Yes, it is. We aren't saying that every child with a tongue tie. We? Who's we? I. I am not saying that every child with a tongue tie will have speech issues, but anyone who makes the claim that speech isn't packed by tots at all lacks an understanding of basic oral anatomy and physiology. And that's scary, especially for the speech pathologist. And, yes, there is a divide in the industry where some believe that tongue ties aren't real. They don't exist, and they surely don't impact speech. So that's fun. But when you understand how the human body is connected, like our fascia lines, right, We've got this deep frontal line. You can go Google and read about our fascia lines. There's a book called fascia trains. Look it up. It's really very cool to see how we are literally connected. And if you follow me for a while, you've heard me say this. We are literally connected from the tip of our tongues to the tip of our toes. Okay. And from the tip of our tongue to our tip of our toes, we are connected by fascia. It's pretty cool. So because we are connected from the tip of our tongue to the tip of our toes, you better believe that an impact in one system or one area of our body can also influence other parts of our body. And this starts to open our eyes to, like, the myriad of issues that one impact one area can have on other areas of the body when you truly understand human anatomy and physiology and how everything truly is interconnected. But really, the tongue and the lips, they're pretty straightforward, right? I mean, we can see. See it most of the time. If there's a posterior tie, we might need to expose it. But, like, we can See if a child's tongue is sitting forward in their mouth, if they thrust their tongue forward, if their mouth is open at rest and their mouth breathing. Right. We can see if they struggle to close their lips. We can see if the lip is skinny and kind of flipped inward, the top lip sometimes like that. And you see, like they have a very gummy smile. This can be kids or adults. We sometimes see that they're using their teeth on, their upper teeth, on their lower lip to make certain sounds because their lips just can't do it. Well, why? Why? If they physically could, they probably would be. So can we try and teach them and see if they can do it without, like a surgical intervention? Yeah, absolutely. I mean, that should be step one. But if we can't make some pretty quick progress there, we better be looking at other avenues to see why and what may be going on. Right. What is the root cause of this? It's not the child just being lazy. The children don't decide to just be lazy at a young age. They. They basically compensate for survival. That's what they do. They're really good at it. So again, if a child struggles to close their lips due to tight fascia, the body is just going to allow and actually prefer for the lips to rest open because that's the path of least resistance. That's the easiest thing to do. And in turn, they will mouth breathe. They're also going to compensate to produce certain speech sounds like B, P, M, W. Right? That's the letter B, letter P, letter M, letter W, the ones that require our lips. And then we've got some vowels like oo and E that require rounding of the lips and spreading of the lips. Those are also going to be harder to produce. Right. And that's going to lead to speech that's harder to understand, especially as they work to put words together. And then the tongue, the tongue, the tongue's got a longer list of sounds that it directly impacts, like T, D, N, O. Right. T, D, N, L. The tip of our tongue needs to elevate without our jaw helping up right behind the upper central teeth, or we call them the upper central incisors. So the tongue tip needs to go up there. It's not touching the teeth. It's a couple millimeters behind the teeth. It needs to touch our alveolar ridge, as we call it, and go tl and if we can't do that with keeping our jaw in place without it moving with our tongue, we got a problem. If we can't fix that in therapy and we think they're tongue tied. We got a. But, yeah, most people aren't looking at this, unfortunately. If this, if the sound sounds good, then they just check, mark it and say, oh, they're fine. Problem is. And there's more sounds I'll get to in a second. But the problem is they're not fine because they fatigue when talking as adults. As real. Like, I had a realtor once who I evaluated who said by 10am, one phone call and a cup of coffee, and her mouth hurt, her tongue hurt, it hurt under her tongue. She was fatigued, she was exhausted. It takes energy. And when you take energy away from other areas, it leaves you with less energy for the other things you need to do throughout your day. This is a real thing. Okay, like, look it up. We use energy. It's a real thing. It's studied. Okay, but what other tongue tie sounds are there? So the sh, the quiet sound Sh, like in jump, right? That J sound that like in measure. Measure that J in the middle that, like choo choo at the beginning of the choo choo ch. That's the H. That S and Z, which basically are similar sounds. One has a voice and one doesn't. We won't go into that. That's a speechy thing. Where the tongue is for production of these sounds. That last sound was an S and a Z. That matters. Our tongue position matters. Unfortunately, again, not everybody agrees on that, but it matters. And then, of course, my favorite sound of all that has 32, maybe more, if I'm remembering correctly, variations. There's at least 32 variations of the R sound. Because R can come at the beginning of a word. R can come in the middle of the word. R can come at the end of the word. R has certain vowels before it. And when a certain vowel occurs before R or following R, or if it's in the middle, you know, it changes how we produce it. Right? So prevocalic, post vocalic, and all these other fun versions of R. And what I want you to realize is R is like its own. I was going to say vocabulary. It's not a vocabulary. Its own Alphabet. What is the word I'm looking for? R is like its own Alphabet. And so sometimes people are like, oh, they just need speech for R. Oh, really? That could be a much larger issue than every other sound they've ever needed to work on if they had other sounds that they had to address. Because R really is highly impacted by a posterior tie in many cases. And sometimes we can't get it until that tongue has been released. And sometimes kids spend way too long in speech therapy, way longer than they ever should, because nobody has looked under their tongue. So I'm just gonna leave that one right there. Okay. The one thing I want to add on this, that children are often drilled or prompted to use sounds in isolation or single words in therapy. But then when it comes to actually putting them together in sentences and then using them in everyday conversational, or as we call it, like, connected speech, they fall apart. It doesn't what we. It doesn't generalize. We say it doesn't generalize without intervention, meaning it doesn't start happening every day very naturally like it should without ongoing therapy or at all. Even with. Even with the therapy. It's not always happening at all. So why. Enough is enough. Like, therapy is expensive, and we know that it's an investment. So you better be quizzing who you're going to finding out what approach they're taking. Have an understanding if they've looked in your child's mouth. And I'm not just saying like that. They wrote on an evaluation that they did an oral motor examination, and things appear within normal limits. Because if I see another evaluation ever again that ever says that, I'm going to try to figure out where they learn that from, and I'm going to go back to the source and be like, please stop teaching clinicians this. This is just really highly ineffective. Because Hyatt was me. That is what I was taught at my university. And I quickly learned that, no, no, this was very insufficient. And for such a large health issue, we need to be doing better, much better. We are failing our children by not choosing to get trained in these areas. Leave that there. That one's for the professionals. Tongue ties are real. We have plenty of cases where speech has spontaneously improved during myofunctional therapy following a tethered oral tissue release without even addressing the speech directly. We've also seen some cases where disfluencies have resolved, like people who stutter have stopped stuttering following a release. Very interesting. Very fascinating. Not saying that it's a treatment for everybody. Not saying that this is going to be the outcome for everybody. There's no promises here. I'm just telling you what we do and what we have seen with our patients. Not all of our patients. There have been some where we have needed ongoing therapy because there's other things going on, right? Sometimes there's something neurological going on. Sometimes there may be apraxia present. Sometimes there's other issues, other diagnoses. Other things we need to sort out. But for some or really a lot of our pretty straight myofunctional therapy cases who also had speech sound errors, more often than not, we don't even have to address those speech sounds directly. Sometimes we do, but not always. So just something to think about there. All right, let's talk about our last myth here. And this is me going to bat for my dental colleagues. Okay? Dentists and release providers just want a profit or play with their lasers. I mean, this is comical because really, one for one, if that was true, like, that's malpractice. But also, no, they're not like the profile. First of all, the providers that we refer to from my practice, we have vetted, as I've mentioned earlier, and we know that they are not profiting off of this. In fact, by doing this, they're actually making less money than if they did other procedures that they could do in a much shorter time period in their office and bill more for. Okay, I know that for a fact. I'm not going to go into the details, but I want to just like give you an example. For example, like a filling, right? The average filling according to the Internet. I looked this up so it wouldn't be just based on my area of practice. It's 200 to $600. Right. However, the cost can actually range from $100 to $4,000 for a single filling. Depending on the size and location of the cavity, as well as the type of filling material used. It could take as little as 10 minutes, could take as much as an hour. Right. But let's say that it takes an hour and they can fill more because it took longer. They used more materials, it was deeper, it was located in a hard to treat area, whatever. Right. Let's say that's more expensive and for less time than the time that gets spent with a family who is having a release done. Because there's the initial consult, then there's the communication behind the scenes with other providers on the team that really nobody's billing for. Right. We don't bill to hold a conversation or hop on Zoom to discuss a case. That's just something we do out of the goodness of our hearts because it's best practice. And we want to make sure that you or your child receive interventions that are going to work and that you know when you're investing your money, especially if you're paying out of pocket, because sometimes these things are not. They're not covered by insurance. When you, when you want to go to the best High, most highly skilled providers. We want to make sure that you all get results and that you're not. We're not putting this, you know, putting you or your child through a procedure for nothing. Right. So there's the consult, then there's the collaboration between providers that you're not even always privy to. You don't even know what's happening. We may tell you it happens, but you don't always know that. Right. Because we're trying to figure out the best timing for a release procedure and where the child's at and what else needs to happen in this case in order for the child to be ready. And then we like to collaborate and learn about what happened. How did it go? What, you know, where do we think? You know, where are things now after the fact, so we can track progress and understand if everything we're doing together is, you know, working for this patient. Right. So this is not a big. And then there's also the follow up appointment, you know, after the procedure with the release provider. They're spending a heck of a lot more time for a lot less money. And I just want people to realize that this is not a big money maker for most dentists. Okay. At least not the ones I work with when it's done in a newborn infant. I also want to point out that this may prevent other issues down the road. Keyword may. We can't promise anything, okay. But there may be things that are preventative beyond dental caries. If you're doing other types of intervention now, we may be able to treat any current sleep issues. Any, you know, suture lines still haven't formed. So we may be able to shape the palate. We may or we may not. It depends, you know, but there's a lot that goes on that may prevent other things down the road, like sleep issues, which lead to behavior issues, which lead to issues and so school, orthodontic issues. You know, there's a long list of things. Again, it may prevent that. I'm not saying it absolutely will. Okay? This is a gray area, but the investment, in my opinion as a parent, far outweighs the future issues that we often see arise when, when we don't do what we need to do up front. Okay, so that's my little plug for doing, you know, what you feel is best in your gut as the parent or the patient, and then also what you know, obviously your team is recommending as well. But you're an important part of the team, so you, at the end of the day, as the patient or the parent of the patient, you call the shots. You make the final decisions as to what you do or don't do. But I always say follow your gut and make sure your team is. You're keyed in with your team and that you feel good and ready for whatever it is you're embarking on. Because if you don't, then you probably have more questions that need to be answered and it's okay to ask those questions. So wanted to leave you guys with that. We're going to talk about like two more myths at length that really deserve their own episode next week. So the two myths that we're going to go into next week, which I'm going to tell you right now, they are myths. Feeding isn't impacted by tots. That's a myth. So we're going to talk about the impact of tots on feeding and another myth, only infants who are breast or bottle feeding need to be released. There's no evidence to support tots releases in toddlers on up. That's also a myth. I'm going to talk to you about, like I said, the impact of tots on feeding, about how it impacts us beyond breast and bottle feeding into transition to solids and up through adulthood and how and why. I mean, yes, there is limited evidence in some of these spaces with more evidence coming out in support of release procedures and myofunctional therapy and feeding and all that. But we're going to talk about why it's so challenging to do level one studies on infants. Right? It's nearly impossible in what people are asking for. And this is the kind of information that people use to discount this type of intervention, which is absolutely absurd because we know that it works when you are working with the right providers and everybody is working together as a team. And so but the right approach also has to be taken. Not a, you know, not a cookie cutter approach where everybody gets the same thing. Now it really has to be individualized to your child and your family. So I'm going to leave you guys with that again. If you're Nestle Pure and OT who's been listening, we will be hanging out from January 31st through, I think it's the 4th, whatever that Friday is. January 31st, 2022 through February 4th, 2022. Go to feedthepedes.com backslash training and you can join us for that free training. I will chat with you all next week.

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