Episode 157: From Restorative Dentist to Airway Centric Orthodontist with Dr. Layne Martin

Hi and welcome to episode 157 of the Untethered podcast. Today we have Dr. Lane Martin joining us. Lane Martin graduated Stony Brook School of dental medicine in 1998 where he received a scholarship from the US Navy. After a distinguished career there, Dr. Martin entered private practice, growing into a premier aesthetic practice in Manhattan. While in practice he completed the Advanced quiz continuum from 2013 to 2014. After becoming aware of how significant the dental profession has influence in airway and sleep, he completed the Tufts Mini Airway Residency and became a Diplomat of the ABDSM in 2020 and thrived in practice working with oral appliance therapy. Lane realized oral appliance therapy alone is not the answer, so he decided to complete an orthodontic specialty program at CTR Consortium for translational orthodontic research. Dr. Lane Martin is now an honor professor and expert in Airway first treatment Planning at CTR and CEO of the Gelb Institute and lead trainer in the TAO Method as his continued contributions. He is a co creator of the revolutionary new night guard for airway and wellness, the custom NG2. He has committed the rest of his career to treating sleep disorder breathing problems in children and adults. 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 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. Lane, welcome to the podcast. I'm excited to have you here today.

Thanks for having me.

Yeah, so we're going to jump right on in and I want you to first start with sharing your story because you have a phenomenal story of how you got into the airway space and I'll just turn it over to you and you tell us all about it.

So thanks for having me. You know, it's great to have you as part of our team. Michael and I were just that meeting, we were talking about the Untethered podcast which which we're on today and just raising awareness about myofunctional therapy and what we're doing. And you brought up my story, and it's definitely an interesting one. And I talk to dentists all the time. And, you know, I kind of walk them through of. I received a scholarship from the Navy for dental school. I had a great career in the military. I loved being in. I got out of the Navy, I moved to Manhattan. I'm pretty sure I had $2,020 in my bank account. And I started a practice from scratch. I put my name up on the door, crossed my fingers, and shortly after, I'm treating celebrities and socialites at this prestigious cross practice on fifth Avenue. And I became probably one of the most sought after dentists. And at the time, I thought I was hot shit. You know, I really thought I was that guy. And then I met my buddy Victor Avis, who's a dentist that I taught with. And every time we would bring up a complex case or a case with severe wear or a collapsed vertical, Victor would always say, I bet you they have an airway problem. Next case. I bet you they have an airway problem. Next case. Airway problem. I love him, but he got on my nerves so much that I was like, what the hell are you talking about, an airway problem? Probably about after the 50th time, I'm like, explain this to me. And next thing, he starts explaining it to me. And then next thing I know, I'm doing an airway residency with Barry Rayfield, who's this incredible airway orthodontist. And it's crystal clear that the things that I've seen in my dental practice every day for the last 15 years was a sign of an airway problem, and I missed it. And I was so sick of missing these things. I was spinning my wheels. And I'll never forget, Hallie, that I remember walking home from work, I stopped on 59th street and Madison Avenue, and I just broke down in tears because I was spinning my wheels. I would do restorative dentistry, and it would break the next day. After that, I walked into my dental practice, I pulled my office manager Cherise aside, and I said, I'm selling the practice. I am going all in on this airway thing. And just like that, I was 45 years old, back in school, doing an orthodontic and craniofacial orthopedic residency. So things were great. I was kind of moving in the right direction. And then in 2019, my friend Ellie called that Ron passed away. So Ron was not only a patient, he was a friend of mine, and he died of heart failure. He was 55. And I saw. Chokes me up talking about it. I saw it when I treated him. I knew he had sleep apnea. He had all the signs and symptoms of someone with an obstructed airway. He snored, he had hypertension, he had acid reflux, and he had broken teeth. I told him to see his physician and get a sleep test, and he didn't. And he died that day. I committed to becoming a diplomat at the American Board of Dental Sleep Medicine. Because if it happened in my office, it's happening in every dental office in the country, right? So I always say, you know, ron passed in 2019. I passed my sleep boards in 2020.

Amazing.

But then six months ago, I'm down in Florida. I'm running on the beach. I get back to my hotel, I get a phone call. My buddy Pete called me and said, Dave died. Now, Dave was 42, young kids, patient, friend, same story as Ron. He snored. Hypertension, acid reflux, broken teeth. And that's when I knew it wasn't enough to just be like, all right, let's tell every dentist about this. We really need to create a paradigm shift in medicine, dentistry, to start fixing these problems and not just the symptoms. So today, I don't just train dentists and physicians. You know, we've invented this awesome appliance with my partner, Michael Gelb, and how to really fix these things. But the problem is, you know, when you know better, you do better. Yeah, right. Like, I didn't know better at the time. And that's why I went into ortho, because ortho is a way to fix the problem. Right? In medicine and dentistry, we fix symptoms, right? That's all we do. But this is where dentistry could really collaborate with medicine and help fix a problem and really help them kind of facilitate fixing that problem. So that's kind of my story. Everyone. When we lecture, when I lecture with you, with Michael, with Jen, everyone doesn't have to be a diplomat at the American Board of Dental Sleep Medicine. And everyone doesn't have to be an orthodontist to see these things. Every time I lecture, I bring up the FedEx logo, right? We see it every day. Yet between the E and the X is a white arrow. I can never unsee the white arrow. And I never want a dentist or hygienist or myofunctional therapist to ever unsee broken teeth. Anterior wear, cross bites, scalloped tongue. They're all signs of an airway problem.

Yeah, no, absolutely. And I always the first time I heard your story, I was like, that's, it's really compelling. It's really to hear what you've gone through. And I know so many of us change our path because of a personal experience. Yes, there's always the professional side to it. But as a mom of children, Lily was born with a tongue tie and a lip tie and nobody said anything. I learned later that her tripod sleeping was related to her opening her airway, her jaw position, her tongue position. If I had known then what I know now, I mean, I don't think I would have slept at all at night because it's hard to find people who get it and who understand. And thankfully we did start treating her when she was 24 months old. And at six and a half, we're still on her, you know, her airway journey. She's much improved, but we're not quite done yet. You know, my second one, I knew at that point and was able to have the ties released and get in there and work with the oral musculature from literally day one. She was released by day five and completely different journey. You know, I think she does still need some expansion. But we still, we have not gone through as many of the other issues that Lily's had. And I share this because, you know, all of these adults, I believe, started as children with these issues and we see it now. We're seeing it in three year olds with dangerously enlarged adenoids and tonsils, who cannot breathe, who already have sleep apnea. And everyone thinks it's cute that their child snores or that that three year old at daycare snores during nap time. And just as much as you all want to take it beyond just the dentist, I really feel like empowering parents and teachers and other individuals as well who are seeing children. It's so important that we recognize these signs and symptoms because they lead to very significant health issues. And you know, and a lot of these kids are also not attending, not following directions, sitting backwards at circle time, not responding to their name, you know, different issues because they're not sleeping well. And so it's very fascinating, scary, fascinating to see how it's even evolved into our younger generations. And I know that without the proper intervention, it's snowballing. And I think it's snowballing a lot faster. And you're acknowledging that we've got 30 year olds, 40 year olds who are dying because of sleep apnea and severe health issues that are occurring as a result of it. So I think that's a really powerful story that you shared there with your friend and patient.

Yeah. So, I mean, but you know, here's really the problem, right? Like it's. I could tell you how to fix it, but the real problem, I mean, I've gone through it, right. I'm 49 years old. I'm in Ortho for the second time, right. Because I wasn't breastfed as a kid. Yeah. I grew up on Gerber baby food. I had this high vaulted palate. I had bad orthodontics. Right. So I always say, you know, roof of the mouth is the floor of the nose. So for me, that's kind of what I'm doing. Right. I want to help fix the problem. I'm going through it myself, right. I had add. I was not great in school. I had cognitive issues, behavior issues as an adult, sinus problems, allergies. And I'm in palatal expansion now, you know, at 49. And it's all from the industrialized diets, the lack of breastfeeding, the soft food, because look at it. Michael and I always lecture. If you look at the skulls of our caveman from 500 years ago, 1,000 years ago, you know, they're horizontal growers. They have room for all 32 teeth now. It's. Everyone needs their wisdom teeth out. And to your point, crowded teeth, crowded airway. Right. And an unhealthy kid is going to become an unhealthy adult. Michael and I are perfect examples of that.

Yeah, well, and I'm mirroring your experience too. You know, I just went through a couple years of expansion myself. I don't. I actually don't think I'm done. I think I probably need more. I just did a home sleep study this weekend because I'm headed in to deal with my. My deviated septum. I. When I went to the ENT down here, I actually found out I have enlarged turbinates, which I knew about, but I also have enlarged nasal swell bodies. So not only is my nose, it's. It's pretty straight in the front, it deviates towards the back, but I've got swelling from the outside in and from the inside out. It's really causing an issue. I'm going to proceed with the procedure and see if that helps a bit because I've noticed that even though my tongue now fits up in my palate, even if I could get a little bit more expansion up there, it would be great. I notice that when I'm sleeping, I either wake up with my mouth open or I'm biting my tongue and I'm noticing more tongue scalloping now than I had pre expansion just because of where my tongue is being pushed, especially while sleeping. But it's starting to happen during the day too. And I've had just a ton of nasal congestion that, you know, can't. That doesn't seem to want to clear. So I'm also in my own little journey at the moment of figuring out like what best. What best next steps to take for my airway.

I know we're probably jumping ahead, but in terms of your case, it's a little different than if we were treating Lilly. Right? Because with Lilly, you, you know, in orthodontics we always look at right sagittal, which is the front to back, the transverse, which is the sides and the vertical. So with Lilly, she had alf. They did an amazing job, right? They got a ton of expansion. What happens when you get transverse? The maxilla is really the driving force. And then all of a sudden it's going to free up your mandible. So a lot of times the posterior teeth will upright and that's great because then you get some more room for your tongue. So from a transverse standpoint, it's great. Right. In terms of expansion. On the upper, there's a suture there. They'll get that kind of sutural expansion. On the lower, it's a little different. Right? There is a suture there, but it's closed up by six months a year. On the lower, it's really more dental alveolar. The problem is in Lily's case, it's a sagittal problem, right. Because her mandible still back and it really needs to come forward. In your case, in terms of having the expansion on the upper, you know, you're going to upright a little bit slower. We're older, our biology is a little bit different. So that's really going to happen. Once you kind of get the expansion and your maxilla is expanding this way, then it kind of allows your lower teeth to operate. It's just for you it's going to take a little bit longer than it would for Lily.

Yeah, well. And I did go into the DNA vivos appliance for a couple years and I did get some good growth top and bottom. Bottom definitely moved slower. I did a lot of osteopathic PT type work at that point. That really helped because I was getting locked up and nothing would move until I had that work done. But what I noticed is I still have a cross bite. My maxilla still is Actually, in my pt, noticed this. My maxilla is in a little bit on one side. And so I think I need something beyond, you know, that phase one ortho that I went through. And this is the second time I had braces and RPE as a kid. Right. So this is now. And I went into Invisalign after the DNA, and I think it actually retracted me a bit because I had more growth that is no longer there. So kicking myself.

And did you. Did they do IPR at all when you had Invisalign into proximal reduction, where they file the teeth?

No, they didn't do that.

Okay, good.

No, no. So they were very airway centric. And I know that when I was talking to you and Michael and you were like, okay, but maybe don't do the last couple sets of trays. And I was like, I just finished them.

Yeah, well, that's what happens, you know, that's what happens when they. They kind of do retractions that kind of round out the arches at the end. And that's why. Yeah. You know, Michael and I were on the phone the other day with Itero and Invisalign, and they're great. Right. You know, it's. Obviously, there's so many dentists that are doing clear aligners. Right. From. From a biomechanic standpoint, I think it's good. And someone asked this question on him and, like, when do you know to use which appliance, you know, where. With our company and you're involved in that. You know, we're somewhat agnostic on ortho. Right. Because the dentist is either doing clear aligners, they're doing functional appliances, they're doing a comb. I'm a little bit biased to what we do in terms of biomechanics. Sometimes it's a little bit challenging with clear aligners. Invisaligners. Clear aligners, though, are a good push system. So it's very good at operating molars. You can get good expansion. You just have to be leery of doing a lot of interproximal reduction, because when you start doing ipr, you're retracting, you're closing off the airway. So when you, you know, Michael and I were trying to tell their salespeople, if your dentist receives treatment plans with a ton of IPR change, The treatment plan. I did has to be expansion.

I did have some IPR with a prior dentist growing up, like when I was probably a teen, maybe Even into my 20s, I also had permanent lingual bars placed upper and Lower. And I was told, oh, they'll fall out by the time you're 20. And at, like, 30, I was like, hey, so these things cause a lot of plaque buildup. Can we take this out? And as soon as they came out, my teeth started shifting. And when I said, yeah, go ahead.

No, I was going to say, I just was on. I was lecturing to a group this morning, and I was talking about retention. And that's a problem in dentistry that I never understood, right? Because I had retainers and people, I had crowding, and what is there always, oh, you didn't wear your retainers. Meanwhile, it has nothing to do with retainers. It has to do with your tongue. And I'm preaching to the choir, because that's your world, right? And it's. And the tongue is one of the strongest muscles in the body, and it has nothing to do with putting a wire, putting retainers in. It's about tongue posture, right? Because think about it. I was in the Navy. I did orthognathic surgery on patients. It is a barbaric procedure. I am seeing orthognathic surgical cases relapse because no one addresses soft tissue.

Yeah, yeah. And that's the scary part, right? We have these individuals going through orthognathic surgery and thinking it's going to fix all their problems and then having bigger issues afterwards. A lot of my colleagues are actually having that conversation now because they're saying, oh, you're not a candidate for an appliance. You need jaw surgery. They go for surgery, they come out of surgery, and things start relapsing while they're still healing. And it's just. It's. It's a little scary, but that's definitely out of my scope. So. But let's go back to the conversation about, like, the myo and ortho together, because I think that that's, you know, like you said, you're preaching to the choir here. What I've now learned, and I've experienced it firsthand and I've seen it with patients, is obviously the tongue is going to move teeth before anything else. It's. So it's one of the most interesting cases, or I've had a couple of these kids now where DC Ortho sent them to us because they had put in a tongue crib and, like, a smooth one, not like, not a pokey one, you know, so at least it wasn't tearing their tongue apart. But we see that. We go, oh, no, take that thing out. Like, we can. We can work on this, we don't need that in there. This kid was getting around the tongue crib and still pushing their teeth out. Right. So they were still messing up all the orthodontic work that had been done, despite the fact there was a tongue crib in there. Because that tongue is going to do what it's going to do. Right. And so we need to retrain it so that, you know, I don't know what about my teeth, like, why they held with that upper and lower lingual bar. I don't know what the deal was and why it was, you know, as soon as it came out that my tongue then started pushing things out of alignment. Maybe it was strong enough, the bar that they had in there that it held. But I've always had the issue, and I wanted to make sure that I clarified that because it's not like the tongue magically started pushing the teeth out of alignment and wasn't trying to do that beforehand. I never knew. I never had speech issues, never had feeding issues that I knew about. Did I have an orofacial myofunctional disorder?

Yes.

Did I have a tongue forward posture?

Yes.

Was my tongue pushing against my teeth when swallowing? Yes. Not when speaking, but definitely when swallowing and at rest. Right. And so we know the swallow is actually less of a concern if your tongue is pushing against. Not. We still address it, it's still a problem. But if we're going to really see a lot of teeth shifting, we usually see it in the cases where the tongue is frequently resting against the teeth or pushing against the teeth or between the teeth. That's where we're seeing a lot more of the shifting happening. So it's, you know, one of those topics where I always say we need to have that marriage between MYO and ortho. And. And honestly, what it looks for, it varies based on the case as to when people always say, well, do I do get the appliance first and then start myo? Do we do MYO first and then get the appliance? It depends. It depends on the case. Sometimes we start with. We always like to start with the MYO eval for a baseline. And then sometimes the kids will go into ortho and we'll start partway through ortho and then we'll, you know, make sure they graduate from the MYO program before the ortho is removed. But that also means that we need to have an open palate, and that's not always the case. So sometimes we're working around certain appliances in terms of when we do myo and when we graduate, you know, the kiddos or adults too, from myo. So I'd be loved to hear, like, your opinion on that and if you've seen, you know, if you see preferable timelines and just in terms of like the order of myO and appliance work. Any thoughts on that?

I mean, I have a lot of thoughts. So first off, first off, in terms of tongue cribs, no one should ever use it, right? Because think about it, it's defeating the purpose of what you're trying to do. You're, you're basically telling someone to have their tongue. Right? And to me, that's why without a tongue crib, we're seeing people with anterior open bite. Right. Everyone thinks about it as, oh, they're a tongue thruster. Well, one of two things is going to happen. Either their tongue's going to fall back and close off their airway, or their tongue's going to come forward and keep themselves alive. And that's why to me, people end up with an anterior open bite. And this dentist this morning said, well, if you see someone with an anterior open bite, you probably wouldn't think they have an airway problem. I said, it's actually the opposite. If I see someone with an anterior open bite, I know they have an airway problem because they're getting their tongue forward to open up their airway. That's the first thing. The next question she asked me, and I'll get to the myo part, is thumb sucking.

Oh, yes.

And I said to me, a kid, and I'll ask you this question because she asked me this question, at what age should a child stop sucking their thumb and using a pacifier?

So pacifiers, I mean, if we can avoid either or at all.

Yeah, absolutely.

Present at all. If they're, if they need a pacifier or they need a thumb. That tells me there's an airway issue. Usually.

Absolutely.

You know, I won't say 100% of the time because I'm sure there's cases where maybe that's not always the case, but who knows as far as if we're going to use one, we always say pacifier out by six months before it becomes a true habit, because we know that habits really start to strongly develop at that point. And as far as the thumb goes, the thumb is more challenging. It's hard to take a thumb away. And you can't cognitively use a lot of the thumb sucking elimination programs until a child's about four years of age. Or so. So we don't like to leave it in until that point. But if it's. If the goal is to use one of those programs, then we're a little stuck until four. Now. There's other things out there these days that we will recommend that will hopefully replace the thumb. So we recommend things like chewy tubes. A parent can put, like jewelry, right? There's like little shapes and fun designs that look like necklaces. They can hang it on a little necklace. The kid can, you know, if they feel the urge to suck their thumb, we tell them to chew on that instead, because chewing is also going to open up the airway and it feels good. So that's ultimately my opinion, is the thumb advancement device. It's bringing the lower jaw forward. It's opening up, goes into the palate where the tongue is not. It feels good, it releases endorphins, and so it becomes habitual.

So to me, I had this discussion with someone about thumb sucking because they were like, well, it releases endorphins and it's soothing. And I said, I get that, but I'm telling you, I said, go put your thumb in right now. I said, look what it does. It brings your mandible forward. And that's where I think a lot of kids are having airway issues. And we always talk about tonsils and adenoids, but it's also an anatomical problem in terms of myofunctional therapy and ortho. I think everyone that goes to ortho should have therapy, especially kids that are obviously tongue tied and going to need lingual frenectomy or frenectomies in general. And you know the analogy I always use, and you've heard me say this is kids, you have to like, you know, obviously infants frenectomy the day or day after they're born. But besides that, everyone needs therapy. And I always use the analogy, if you tied my sneakers together, right, And I walked around like that for a year, and all of a sudden you clip my shoelaces, I'd fall right on my face. It's the same thing with frenectomies, because right now in dentistry, it's the hottest thing. Everyone has a laser and everyone's doing frenectomies without therapy. And it's a problem, especially on adults. Like, if you did a frenectomy on me, I'd be like, all right, I don't know where the hell my tongue is going to go. But the other part, which is super, super important, and you brought it up about Staging. I'm a perfect example. I have a high vaulted, V shaped arch. I'm partially tongue tied, and I need a frenectomy. The problem is I can't get the tongue to the roof of my mouth. So the first step in a lot of these kids and adults is you have to expand them, you have to make room so they can get their tongue to the roof of their mouth. Then you do the therapy, and then you do the frenectomy. And that's really the order where we're seeing the best results, especially working with someone like you. And we always say, right, your tongue's the natural scaffolding for your arch. But that's why we see so many of these kids and adults with sinus issues, frequent colds, you know, nasal drainage issues. Nasal patency is because when your palate's like this, it's taking up real estate in your nose. Right? You know, Michael always uses the analogy. If you have a 500 square foot apartment in the village, right, and you take all the furniture out, you still have a 500 square foot apartment. You got to move the walls.

Yeah, yeah. No, it's so true. And it's. It's interesting because I think I learned a lot just from Lily, right? So I was like, oh, my gosh. I came back from a myo course and I was like, I got to get her tongue tie release, not knowing that I needed to do more than a couple, like, stretches on her. And she was 24 months. So, yes. Okay. This new mom, who's also new to Mayo. You think I'm going to get a two year old, do all the lingual exercises? I mean, that was. I was like texting my friends, like, okay, what do you do with 2 year olds? And some of them gave me some really great ideas to get the tongue moving. But we didn't suture her. She did. She went to an oral surgeon who's, you know, very well known and highly respected. He also did mine and Nia's lingual releases. And I look back now, and her frenulum is pliable. But when you look at it, people go, oh, she looks tongue tied. And I'm like, well, she looks tongue tied. But one, she still needs more. I think I'm not doing anything with her tongue until we adjust the mandible because I think her tongue is sitting too far back, which I think is also contributing to her lisp that we can't correct. Her speech sounds fine most of the time, but I noticed when she's talking that tongue Comes forward and it's pushing against the teeth. And I know it's happening when she's swallowing and I know she sleeps with her mouth closed, but I know I'm like, I'm not convinced the tongue is in the right place. So, you know, she's an interesting lesson that I've been, you know, I've been able to follow case study, if you will. And, you know, when I look back at it, I should have done more prep with her before her tongue tie release. I probably should have waited on the tongue tie release until we did some experiments. Expansion. She didn't go into expansion until she was four. And she did move very quickly. Quickly with the alf mostly, you know, we got some on the lower, but the top looks great, so her tongue fits up there. Now she has got great, you know, functional skills otherwise. So we've really, you know, and she went through mayo. But what I learned was, you know, we ended up having to redo mayo with her after her appliance because even though we had done it beforehand, because I think there's this issue with the mandible not being in the right position. And I actually think we've hit a wall in myo because we need to address, you know, the Orthic, the ortho piece, which is our current live journey at the moment, where we're trying to find an ortho who can help her in South Florida. So, you know, it's been a very interesting learning experience just with her timeline, her, you know, her trajectory and everything that she's on. But, you know, you go to a traditional ortho like I went to, who says, ah, you know, I see what you're saying. I agree. We should, you know, you know, expand the mandible. Her maxil looks fine. Let's wait a year. And I'm going, but why? And he, you know, and then he questions, well, why did they do orthodontia on her, her primary teeth? And I was like, because her, her palate was high and narrow and she was, she had an, you know, an impacted airway. And so why not do it earlier and give her room for her teeth to grow in? Because, look, the bottom teeth, right, have not been expanded enough. And now we've got a little shark tooth growing behind one of her lower central incisors and the front tooth is becoming wiggly. And so thankfully, both the dentist and the ortho that we've seen recently said, let's not pull any teeth. Let's wait this out. I think it's going to work itself out. And I was like, that's great because I wasn't going to let you pull tooth anyways. So thank goodness for that. But yeah, it's, it's a journey and I like to bring that up because I think a lot of people think even though you have the knowledge in the space and you know, a lot of providers, it's still hard, depending on where you live, to find the providers who truly are airway centric, who get it and who will work with you, you know, appropriately for your own children.

I mean, you know, Michael and I just lectured and people brought up that question, like, what's the ideal time to get someone into Orsa? And I'm telling them 4 and 5, right? In my ortho program, we were doing bondable expanders on 4 and 5 year olds on their primary molars, right? Because if you see kids, and I see this all the time, a woman I'm teaching with, her daughter's primary teeth are like this. They got to be like that. You need to have spaces. Those kids are crowded. And I always say to the parent, right, Because a lot of parents are in denial. And I'm like, really simple, take a video of your daughter or your son sleeping and then you see it when they're right. Because think about it, kids should be three things. It should be quiet, dry and calm. Quiet. They shouldn't be mouth breathers. No storm, right? Dry, no drool, no wetting the bed. And calm. No hyperactivity. So to me, that's always the threshold of looking at these kids. And so many of these kids have problems. Now the other thing and people brought it up is, well, are you, you know, what are you doing with kids and why are they having airway problems? And do you think tonsils and adenoids is resolving a lot of the problem? Well, in 51% of kids, if you get their tonsils and adenoids out, they're still going to grind, they're still going to snore. Because it's multifactorial nasal patency, soft tissue anatomy. It's all three.

Yeah, well, and I love the analogy that you used when we presented together with the airway and you were talking about having a garden hose versus, what.

Was it, A coffee straw.

Coffee straw. Right, right. And it isn't always even just about the size of the airway, it's the stability of the airway. So that's, you know, another thing, we get that a lot because of these feeding cases. You know, birth to three, birth to five. We have there seems to be this uptick in kids with laryngomalacia diagnoses where they've got floppy airways. And it's just. It's really been interesting to work with these kiddos this young and to go. And the ents are kind of like, ah, they're fine. It'll resolve when they're 24 months old if it hasn't resolved by 18 months. And I'm like, how is that a response? Like, how is that it's okay. Let them suffer for two years of their life. That's fine. Like, we'll deal with it later. No, are we waiting?

But I love Michael. Michael always talks about, you know, orthodontics, not treating teeth, but treating the brain. And he's right, right? Like, think about it. I made a statement and I said, probably half the kids that are on ADD and ADHD medication, you know, Adderall, Ritalin, probably don't have that problem. They're just not getting oxygen to their brain. And that's the other problem. Like, our society, we've normalized snoring and sleep apnea and ADD and their treatments. Like, it's normal to sleep with a face mask or give someone a mouthpiece or give every kid Adderall and Ritalin. That's really the problem. And that's why I find that we're lecturing so much to people, because every time we go out to a big group, to me, it's always about, I love the Finding Conor Diegan video, right? Because someone in that audience is going to have a kid or a nephew or a niece or a granddaughter or a grandchild that has that problem and it's missed. And the other thing is you tell the stories about your patients and things that happen. And for me, it hit home. It wasn't just that I had a problem, but I had patients that I knew had the problem. Right? Because that was the thing. I never knew about it. Once I knew about it. Now it's like, you know, I always talk about, like, ignorance and stupidity. Yeah, right. Ignorance is. You don't know what you don't know. Stupidity is knowing and not doing anything about it. And I think that's where I got stuck, because now I was in my dental practice, I knew about airway, and I was like, all right, those people have a problem. I just didn't know how to fix it. And that's kind of why I went on this journey of seeing orthodontics as being a really great way to help our physician counterparts treat this problem, especially in kids and Adults.

Yeah, well, and that goes back to what you were saying at the very beginning. You know, it's treating the root cause, looking for the root cause. What is the underlying cause behind all of the issues and symptoms that we're seeing? And so few medical professionals work from that place. We're constantly. Not we, but a lot of medical professionals are putting band aids on a problem. So instead of going, hey, let's figure out what's causing all this and work towards fixing that. It's constantly like, oh, you have trouble with reflux. Here's medication. Oh, you can't sleep well at night. Take some melatonin. Oh, you, you know, it's like, well, why, why are we struggling to sleep? Why is this child, why are we even talking about ADHD medication for a 5 or a 6 year old without. Has anybody done a sleep study? Have we even done a sleep screening? And that's where I think we talked a lot about. And I educate on this in my myomethod course. I try to explain I share the whole ADHD component because that's me. I am that both that child and adult. I went all the way through high school with good grades and it wasn't until I was 19 in college that I started flunking tests. And I would go back and look and I'm like, why did I get a C on this test when I know 13 of the 15 answers and I haven't looked at this material in two weeks? It doesn't make any sense. So I got tested and they said to me, well, your IQ is high, but you know, you present with somebody with adhd. So I'm not going to give you the ADHD diagnosis, but here's, here's a Ritalin prescription. And I was like, what? Okay. And I'm like, here, I'm a 19 year old. I'm like, great, this is fantastic. This will help me study. And hated myself on that stuff. I actually recently, because my sleep had been so crappy and I was having trouble focusing, asked my doctor down here to like. I was like, can we try Ritalin again so I can see if it helps me very interestingly, like one again. You know, it kind of makes me like a stimulant, right? So I'm like, I can't drink coffee on it. Hate myself on it. I've since stopped taking it already. It took her about a month and a half and then was like, nope. It created a chronic cough. I had this underlying chronic cough that started that was like a. And here we are in Covid times, sort of still, and you want to go out in public and cough every 10 seconds, people are like, stay. But I was like, I can't even record a podcast because I'm hitting mute every 10 seconds trying to talk to somebody, and I'm like, what's going on? That's causing this reaction, like a tic almost. And so I was smart enough to go, yeah, this is not a good solution. And I know I'm dealing with my airway. I know I'm going to do a home sleep study and the nasal surgery that I've been putting off for so long, but I don't think a lot of people have the knowledge or the idea of other solutions. And so it's very easy to just say, yeah, you know what? This medication seems like a great idea. And instead, we're just. We're causing more issues. Right? It's that big snowball effect of traditional medicine. So fun times.

Can we take 30 seconds? Yeah. All right. I'll be right back. Yep. So that's the other thing. Michael and I right now love treating kids. And that was never my practice. Right. I was in this cosmetic prost practice in New York, but now in my ortho program, working with you as our myofunctional therapist. And your program, it's amazing. We're getting so much great feedback. We're reaching kind of dentists that treat kids. We're talking about early intervention, because that's the point, right? You bring Lily to the dentist. We're seeing it every day. And dentists always ask me, well, when should our child start ortho? And I brought it up about the bondable expander. We have to start intervening early. You have to. You can't wait. And, you know, Michael and I and you, we always talk about healthy ortho of, you know, no more bicuspid extractions, not a ton of ipr. You know, get in. Get into these kids when they're young, right? When they. When they're growing, get them treated.

Yeah, yeah. No. And it's. It's so important. And that's, you know, that's where people go, well, how do we help kids? Because even the speech pathologist, the occupational therapist, the, you know, RDH is, you know, traditional myo doesn't start until four years of age for, you know, a cognitively intact child. And even some kids aren't really traditionally ready until closer to five and sometimes a little later. And so, you know, it's become my goal to say, let's not wait. We can actually adapt what we do in oral motor feeding therapy because we're working more passively on the child versus having them do everything actively. And so it becomes this like marriage of active and passive intervention where we're looking at the orofacial muscles, we're looking at how everything is working together, where what's falling apart, what milestones are we hitting and not hitting? Because ultimately myo comes down to correct oral rest, posture, and how do you chew and initiate that swallow? And, and so, you know, it's. We're already doing this work, so why don't we look at it through a different lens and make sure that there isn't something that's causing an obstruction. How can we expect a child to drink from the breast or bottle if they have an upper airway, you know, obstruction? How can we, you know, if they can't breathe? We know babies, they suck, swallow, breathe. They, that's, that's a pattern. They're supposed to be able to breathe while they're swallowing, while they're sucking. It's something that, you know, only an infant, a young infant who's on a breast or bottle can do. And then that separates at a certain point where we can't breathe and swallow at the same time. There's a brief, you know, stop while we swallow our food. And so we have to start to look at, well, what's going on? Where is the breakdown occurring? Where can we intervene? And so that's why I get really preachy about, you know, intervening, intervening asap. And so it was really disheartening for me to go to this, like, you know, ortho who says, oh, well, Lily's only six and a half. Let's wait a year to address her mandible. And I'm like, oh, no, okay, on to the next one. Because as a parent, I know it takes time, it takes money, it takes effort, energy. And parents are going from one place to the next and being turned away. And it happens not just from ortho or dentists dental world, but it's happening a lot in the ent world. And that's where we're often saying, hey, go to the entire. Let's make sure there isn't a visual obstruction. Let's make sure that the tonsils or the adenoids, once their child there's a scan or a scope done, make sure that we're not working against these enlarged tissues. Like you said, though, addressing those enlarged tissues is not the end all, be all. It's not like we're going to have them Taken, reduce them or remove them, and then all of a sudden we're magically fixed. No, but in some cases where we've had kids with obstructive sleep apnea, the safest thing to do has been to have the surgery to either remove the adenoids or tonsils. In Lily's case, really interestingly, when we put that alf in, within three months, her tonsils shrunk down from like a three plus to a two. And I actually got a lot of hate in a myo group online for sharing her case. I was told to take it down because, you know, that couldn't possibly happen. You know, there's no possible way that tissue changed in response to a clients changing the, you know, the structure, the hard tissue, soft tissue versus hard tissue. And I'm thinking like this is a myo group with a bunch of, you know, professionals from all different walks of life. Really, like this is the one place.

Where I thought that, that, yeah, that group needs to read the Enloe and Morse article. It's called the functional matrix theory. It's why your skull is formed, right? It's formed by your brain. Soft tissue form and function form hard tissue. So that's something they really need to understand. And it's the same reason that airway kind of dictates growth and breathing. And it's interesting you brought up some such important points. And a lot of dentists don't know this. They don't understand it or they don't want to. And when Michael and I lecture together, it's always, he always says it's like you're dumbing it down. And he's right. Because for Michael, he's a specialist. He's been doing this, he's got it right. I'm the one that made the mistakes. And I always say you have to meet the dentist and the pediatric dentist where they're at, right. You know, Michael will talk about oxidative stress and arousal threshold and inflammation, but it's really more like how do you get through to dentists? And I had this discussion this morning of to me, the low hanging fruit are night guards. Every dentist makes a night guard. And we were taught in dental school, people clench and grind because of stress. It's stress from suffocating. Yeah, that's why they clench and grind. They're going into sympathetic overdrive. And it's something that to me, I tell every dentist this, forget about talking about sleep apnea. It's airway, right? We're going to treat sleep, we're going to help them but it's really helping their airway and helping them feel better. So that's what our appliance that we created, all of us, is really a better version of a nightguard. It's the same premise of a mandibular advancement device, an oral appliance. And I'll give you an example. My friend's son, Quinn, was a kid that had add, was falling asleep on the bus, right. And he had problems. And when I. When I spoke to my friend about it, I'm like, do me a favor. Take pictures of him. I want to see his teeth. So he's like, better yet, I'm going to have him ride his bike over. He rides his bike over. I look at him. He's got a 7 millimeter. Over. So I sent him my Craig, he needs ortho. He needs braces. He's like, what are you talking about? He just got out of them four months ago.

Oh, gosh.

However, the orthodontist did us a favor because when I looked at him, I took pictures. I sent them to my other friend who's an orthodontist. And what do you think is the first thing my friend said to do? Take out upper bicuspids.

That was going to.

Right. So instead of bringing his mandible here, they were going to take him and do this.

Yeah.

Which is awful. But that's still happening. Yeah. So I spoke to my friend. I said, do me a favor. Give me eight weeks, and I'll send my friends here. I'll send this son. So what did we do? We made him a mandibular advancement device. Same premise as what I said to you about, like, a binary or a marrow or a twin block. We basically. His mandible flew forward, Right. So now his mandible came forward, and now it's just a matter of, do you do orthodontics and protrude and procline that segment? Do you do restorative dentistry and build up the posterior teeth? But that's really what you have to do. You have to treat them Sagittarily. And one of my mentors, Bill Hang, he has his own appliance. It's called a bio block. He does a ton of sagittal. So that's really what we're doing with our appliance, is just kind of helping people feel better. Right. We talk about workplace sleep. That's what the appliance is. It's taking the place of a night guard. So you could wear it during the day if you're clenching, if you're Studying if you're playing sports. And then at night, it basically prevents your mandible from falling back. So all these appliances. And every time I talk to sleep and airway Dentistry, they're always like, well, how much should you protrude the patient? Right. Like in protrusive. And I'm like, it doesn't matter. It just matters. As long as you prevent their jaw from falling back. That's the premise of all of these appliances.

No, I love that. And so the one that you and Michael have created, that's the NG2, right?

It is.

Okay. So if they were interested in, like, getting a consult, who do they contact for that?

They just go right to our website, Gelb Institute. They could reach out to you. Your app, obviously part of our team. And it's just we've kind of created the invisalign of airway. Right? We're certifying every dentist. We're training them, and we have the appliance. And a lot of dentists were asking us, associated the Hinman dental meeting. Well, how do I get the appliance? For us, it's very simple. We want to really have the quality control of knowing that everyone that gets our appliance is getting a home sleep test. Right. Because our physicians are on board. They're super supportive of what we're doing with oral appliance therapy, with orthodontics, and we're really helping them. And even the people that are on CPAP could still use our appliance. It could actually take the pressure of the CPAP down. So it's really a way for us to control it. We look at every case, we make sure the bite's okay. And we're actually 3D printing our appliance. So we're doing tons of research on it. And, you know, our patients love it. The doctors that we've trained love it. It's super comfortable. It works. Well, right now, I'm still working with our engineering team about the elastic on the side, so we're about 85% there, but we're making them, and the patients are really getting great results with them.

That's awesome. That's awesome. And I think that's the one that Jess is in. And I know that appliance that she's in. She said she had immediate relief, and she slept the best she had ever slept. She's like, I don't remember sleeping this well and feeling this great afterwards. And I was like, wow. I mean, it was. It was fast. So I. You know, I'm like, this is pretty cool. And I know other people who are on CPAPs who could potentially really benefit from the appliance too. So I will be, I will be mentioning it to them because I didn't even realize that would be an option to use that with a cpap. But that makes sense.

And you know, it was interesting. Jen Kirkham, who's trained with you, who's worked part of our team, her and I were on the phone with one of our physicians and we were talking about a disposable home sleep test because we might switch from one to another, which is a little simpler. And you know, I was looking at the report and I'm like, well does it show this? And, and he brought up a really valid point and he's a little abrupt and he's like, seriously, who gives a crap? He's like, there's a billion people walking around undiagnosed. He's like, I'm not going to have an argument about a home sleep test. He's just like, I want these people to get treated. Right. And that's kind of our whole message, Michael and I is like, there's not a lot of dentists that do sleep appliances. There's a lot of obstacles, there's a lot of bottlenecks dealing with medical insurance. We've made it really simple, right? Just get the people treated. You don't have to charge 5, $6,000 for our appliance, just get them in people's mouths, start them that way. And you know, someone asked us the other day, well, what about ortho? To me it's always a threshold. If it's a child that has an airway problem, right into ortho. If it's an adult, I'm putting them in our NG2 appliance because I want to prove the concept. I want them feeling better, I want them sleeping better. Once I could prove that once I could do a follow up sleep test, that's when I put them into ortho because I don't want to jumpstart them, put them in ortho and all of a sudden I'm not be able to resolve their symptoms. Yeah, so that's kind of what we're doing.

Yeah. No, most, most adults are not as tolerant I think to a lengthy process. But we know it takes a much longer time with an adult. So I tell people, look, I was, it was three years between two years in the DNA vivos and a year in the invisalign afterwards. And I didn't have to do the Invisalign, it was more for, you know, cosmetic reasons than anything else, but I think it actually, like we said, retracted me a little bit. So here we are, you know, and.

Companies like that, you know, people ask me all the time about, you know, there's vivos, there's facial beauty, there's. There's a lot of people now getting into that space. And I love them. I really love them all. I mean, obviously I'm biased to what I do through the school and I teach there now, but as long as you're doing it, and as long as you're doing expansive type orthodontics, I'm good with it. Now, things like vivos, it's probably a great entry point for someone that's starting out, you know, that's not comfortable doing a lot of ortho. And it's the same thing for clear aligner therapy. Right. I never did ortho before I went into ortho, so I didn't know anything about it. And, you know, tons of dentists do Invisalign or other clear aligner systems. It's just a matter of modifying the treatment plan. But to me, the threshold's always crossbite. I find that if someone's in crossbite, they're going to need some type of functional appliance. And once their crossbites relieve, then you could put them in some type of clear aligner therapy.

Yeah, yeah. So my, my crossbite didn't really resolve, so there's that. But I'll have to. I'll send you my case next. We'll treatment plan on me. I'll come up to fly up and see you. Because I don't. I mean, I. I don't know what the answer is at this point. Like, my max list still turned in on one direction, and we did get it to unlock a bit and start to make some movement, but then it seemed to kind of go back and so something is pulling it back. And I think I, you know, I'm back in crossbite and I can see it when I speak, too. I can see my mandible shifting differently now that it drives me crazy when I'm watching myself talk.

So are your. Are your lower molars kind of dumped in a little bit or. No, it looks like it. Yeah, it does. So I call that. It's called an X bite or bimaxillary convergence. So you'll see the teeth kind of tipping in like this, and that's where something just molar uprighting will, you know, not only help with tongue space, but it'll also help the vertical, you know, the upper up and down of kind of creating a little bit more room there.

Yeah. Because you'll see, it's. It's awful. I'm in here.

It is. But I'm looking at.

I know you're looking at your back.

Because to me, everything kind of comes in like an X where it really needs to be, you know? And Michael always laughs. He's like, we always talk about Kerbal Wilson, and I do. And even, like, in my program, I would always bring it up because of my training, but I knew people need more tongue space.

Yep.

And it's about molar uprighting, and that's where something with clear aligner therapy makes a big difference, because they're really more of a push system rather than a pulling system.

We'll have to revisit. I'll have to revisit that since I had the year of clear aligners and somehow still ended up like. Like I am today. So, anyways. All right. Well, this has been amazing. I know we covered a lot today. Is there anything we didn't talk about? I know we. I feel like we went over them.

All, you know, I'm just happy that you're part of our team. I think it's. It's such a great thing to offer our dentists, our hygienists that are signing up, the dental assistants, you know, and you brought it up when you spoke with us in Miami. It's really team driven. Right. It's not just the dentist. It's the whole team. It's getting people involved. I mean, you know, that's what I always say. Like, I almost wanted to redesignate the profession of hygienists. Right. I think it should be called oral physician assistant.

Yeah, right.

It needs to be more than tongue scrapers. I needed to be more than a tooth driller. That's all I was for 15 years. And I think we have. We're speech speakers, but we have such an amazing opportunity and that you're part of this, you know, kind of revolution with us of looking at dentistry different. You know, I said it all the time. I focus for 15 years on people's teeth. Your teeth should touch for 20 minutes a day. You have to breathe for 14, 40 minutes. Your airway needs to trump the teeth. And I'm a perfect example. I had palatal expansion. Right. I felt amazing, but I was having problems. Right. I snored. I was tired. You know, I was getting up to pee in the middle of the night, often. Within three months of my expander, my crossbite started to resolve. I started using this thing way more and I felt great. But the real thing is someone asked me the other day, they're like, bite down. I got to tell you, I don't even know where the hell my bite is supposed to go. However, I feel amazing and I don't have one issue chewing any food. So as much as our industry is so focused on teeth, we got to get past that. It has to be airway first and then the teeth. And I'm not telling dentists not to do dentistry, right, because the people that come in with anterior wear, they need the dentistry. It's just make it more predictable and last longer than the dentistry I did because I love the quote by Eleanor Rose about Learn from the mistakes of others. You can't live long enough to make them all yourself. I made tons of them.

We all have.

Trust me, I made tons of them. So one. You know, it's such an honor to be here with you. You're such a pioneer and like it's an honor to have you as kind of part of our team. And you know, I look forward to years to come of working together.

Thanks Lane. This has been awesome and I'm honored to be a part of the team.

Awesome.

Thanks for listening to this podcast. If you want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts or pledge a small amount on patreon.com the untethered podcast 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 at Halle Balkan Biz on Instagram at Halle Balkan. 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.