Episode 215: Airway-Focused Dentistry and Myofunctional Therapy with Dr. Annie Babb, DDS

Hi and welcome to episode 215 of the Untethered podcast. Today we have Dr. Annie Babb joining us. Dr. Annie has practiced general dentistry since graduating from Indiana University School of Dentistry in 2011. She's always been interested in the whole body connection and found her passion in airway dentistry. In 2021 she joined the Braces for All Ages team, became an ambassador for the Breathe Institute, and decided to limit her practice to performing functional frenuloplasties and frenectomies. She's determined to help children and adults develop to their fullest potential by encouraging proper breathing, tongue position and facial movement muscle function. She believes in a collaborative approach to care and works closely with other providers in her community to help her patients get the best results for their smiles in their current and future health as well. Outside of the office, Dr. Annie enjoys spending time outdoors, especially on Lake Michigan. Their husband and their two children, Gracie and Leo. She also enjoys traveling with family and friends. 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, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway, tethered oral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Annie, welcome to the podcast.

Thanks. I'm really excited to be here and talk to you.

So I want to just dive right on in because I always love to ask this question whenever I have someone on the podcast who has maybe shape shifted in a way when it comes to how you practice and really find out, like your story about how you got started in the more airway focused dentistry arena, if you will.

Yeah, so my dad was a dentist, so I've been, you know, around dentistry my whole life and after I graduated I came home and started practicing with him and you know, he was kind of getting close to retirement age. And the plan was always for me to take over the practice. And I just kind of thought, this isn't. This isn't what I want, you know, this isn't what I want to do long term. My husband works in Chicago, so it's, you know, busy. I have two young kids, and I take care of them. And I just thought, there's no way I can do all of this. So I kind of, you know, had a hard conversation with him, and he was really supportive. And then we ended up selling the practice right when Covid hit, Like, it was all starting right then. So it's a very, very crazy time for us. And I ended up working for the dentist who bought his practice for about a year. And I was only working one day a week, which was intentional. I truthfully kind of thought I didn't even want to be a dentist anymore. I was just really disillusioned by all of it. But in that time, I got into kind of a lot of the airway things because of myself and my daughter. I was having some breathing issues. I'd seen an ent. They didn't really have much to say. So I went to the orthodontist, who I always had a really good relationship with, and, like, hey, you have that. You know, I. Cat, can you see my airway?

There's.

I don't even know why. Like, why. That's what I asked. And just, like, it's. It's really small. And I reached out to one of my really good friends from dental school who had just also gotten into all the airway kind of arena, and she recommended I go see Dr. Lipskis, who's in Illinois. And I just went down this rabbit hole. You know, I started as one does. You start researching, and you're like, why is this happening to me? Why do I snore all the time? I'm, you know, a young, healthy female. Like, I'm not the. I'm not the type. Like, this shouldn't be happening. And so I just kind of jumped in. My husband, actually is the one who encouraged me to take a course on it, you know, and I started in with tongue ties, because that. I don't. Something about that just. I've always loved surgery, and I kind of just dove in, and I'm like, this is it. This is. This is what I want to do. And so I went back to Dr. Brenda, and she's like, teach me. You know, Teach me what you've learned. And I'm like, well, this is. I think I want to do tongue releases. And she's like, great, come do them at my office. And so it just really snowballed, and we both look back and think, how in the world, like, what. I think we just knew it was the right thing, and so we just jumped in a crazy kind of way. So I just kept taking courses. You know, I had the time. I was lucky enough to have the time to be able to do that. And it was during COVID so a lot was virtual, which made it much easier for me to taken a lot and very quickly.

So, yeah. Yeah. Both the blessing and a curse. I think we all kind of fell down certain educational rabbit holes during that time.

Sure. Yes. Yes.

Oh, my gosh. So. So now you. So you're going through this yourself, right? You're on your own journey. And I think that's, you know, it's cool to be able to learn these things about yourself, but also to then relate to patients in a way that, you know, you can speak as both the patient and the practitioner, because I think it brings a certain level of understanding of, you know, about what your patients or their children are going through. That's always been, like, a really big point for me, just to be able to sit back and, like, have that, you know, understanding of, like, what my patients are experiencing or what the parents of my patients are experiencing. And I always. I always say it's kind of like my, like, secret superpower in a sense. Right. Because, you know, just it helps you, I think, navigate things a little bit better and what's realistic from one patient to the next.

Yeah, absolutely. I agree with that completely. And I've learned a lot just through my own experience on how to kind of guide them. So I had my tongue released, actually, last July with Dr. Zagi. I went and shadowed him for a day and then had my tongue released. So just things that I learned about, okay, this is how it felt in my body. You know, how can I recommend you stretch better? How can we get better results from then the surgeries that I perform? And so that's been really helpful because you kind of just. You're like, this. This feels better. You know, I get more mobility or, you know what, I have tension here. I wonder if someone else does. And it's definitely been a blessing to have that to talk to patients about it. It makes you more relatable, and I think just makes it all kind of hit home for them. And I'm a more understanding practitioner, I think, because of it, because I've gone through the majority of what they're going through.

Yeah, yeah, for sure. And so then do you. Do you work in a practice where that's really a big focus, or are you sort of that component of your practice? Because I know it just. It looks different in different practices, if you will.

Yes. So actually, it was a very traditional orthodontic practice. And Dr. Brenda is a very holistically minded person just in her personal life. So I think that's why I felt like I could go to her with all this. I felt like she would. She'd get it. And so we've really transformed the practice over the last couple of years into being more airway focused. I brought in, obviously, the tongue release procedures, but then I also started our myofunctional therapy program, and that's been. It's just really been a whirlwind. So now all of our patients, all of our orthodontic patients have myofunctional therapy as part of their treatment, and we have really kind of streamlined the whole process. It's been a lot to figure out how to integrate it, how to explain it, how to get all the parts running smoothly, how to find the space, honestly, for all these additional practitioners. And so in our office, we're really, really fortunate to be able to address tongue space with orthodontics and forward growth and all of that with ortho and then tongue tone with myofunctional therapy, and then tongue tie if they need it. You know, not everyone needs it. And that's something I try to explain to patients all the time. If you are in ortho or your child's in ortho, we pretty much know your tongue's low. You developed narrow because of that. But why is the tongue low? It doesn't always mean there's a restriction. Sometimes it's, as you know, it's low tone or just habit, or they have a nasal obstruction or large tonsils or adenoids. There's so many different components to it, and we have to get to the bottom of that. As I tell them, if you have nasal obstruction or tonsils, large tonsils, no matter how much myofunctional therapy you do, no matter how much palatal space we get you, you're not. You're not there. You know, you're not going to be able to breathe through your nose, which is the goal. So that's been. It's really evolved a lot, and it's been really. It's been really fun and really rewarding. Obviously not without stress, but it's. It's Been great. Yeah.

Hopefully minimizes now that it's, you know, rolled out and kind of there already. Right?

Yes, it is, it is. Now I feel like we're in a really good groove now and have a really nice flow. And now that we've been at it for two years, you know, we have patients who've really done the whole program the way that we intended and to see those results is. It just seems like every week there's more and more amazing results that were, you know, it just can't help but make you proud of, of all of it. So it's been, it's been great. I'm. I love what I do now. I really do. I can't imagine not practicing, you know, and to think a few years ago I, I didn't even necessarily want to practice and now I'm so passionate.

So I love that. I mean, it is, it is such rewarding work especially to see, you know, children thrive, to see, you know, for those who work with adults, to even see adults get their lives back. And now, like, as you've experienced, I'm sure certain, you know, I don't want to assume anything, but I know for me, like, I experienced certain health benefits and a lot of changes physically and mentally, you know, just being able to sleep better and have more mental clarity and digest foods better and just the whole gamut. I feel like there's been so many far reaching, like, benefits of like my entire journey and my journey's not done. But, you know, it's really cool, I think when you do get to see the whole program kind of come to fruition, if you will. Like you said, you now have some patients who are on the, you know, the other side of having gone through the entire holistic approach to basically growing their airway and palates and getting that tongue up where it belongs, correct or rest, posture, all the fun stuff through myo. So it's really cool, I think, to see it kind of come full circle and to see the results, really. And to see like, okay, yeah, this does work. It's a journey, but it works for sure.

And it's taken, you know, to shift it from traditional ortho to airway. It's a totally different ballgame, honestly. And the way we explain it to patients is we're addressing why, why you are here. You. We love to deliver beautiful smiles. I'm not so much on that side, you know, I do, I'm a general dentist, so I don't practice the ortho side of things, but that's still that's what we want. But we want a healthy smile, and we want a lasting smile, and we really want to help patients realize why they're in our chair to begin with and. And help with more than just that. So it's been a lot of collaborating with, you know, providers outside of dentistry, which that has also been really neat and not something I really ever did prior to this. You know, we have craniosacral therapists, pediatric PTs, chiropractors working on the ENTs and the pediatricians, but trying to get all those people in and on board. And, you know, as everybody says, once you see it, you can't unsee it. So I think our patients are kind of speaking for that methodology. You know, I think other providers are seeing those results in their patients, and you can't help but wonder, you know, okay, I think there's something to this, you know, so that's been. That's been really, really neat, too, to connect with all these different people. And I feel like I'm constantly learning. Every single day there's something new I learned from someone. And so it's humbling and also comforting that, you know, I don't have to have all the answers for these people. We all have a different part in this, and we all have different strengths and areas of expertise and combining that is really profound for people.

Yeah, well. And you said something that I know some of our listeners who may be like, SLPs or OTS or RDHs, who struggle to find some of their practitioners like to help make up their team. You said you're working on the ENTs, the pediatricians, and, you know, not that I'm happy that you're struggling by any sense, but happy that others are hearing that. It's not just the myotherapist. It's not just the speech, you know, and ots and pts and feeding therapists. It's not just us who are looking for these more holistically minded practitioners to kind of, in a sense, join our team. Right. Someone that we can trust to refer our patients to, who sees our patients through a similar lens that we do, or who at least appreciates the work that we're doing and will assess for, you know, upper airway issues beyond just looking in the throat, going like, they're fine or, okay, let's do a scan. And they see that the adenoids are 80% enlarged, and they say, you're fine. Go home, come back in three months. You're fine. There's nothing to do. So it's a challenge everywhere. And I think for anyone in this space, it's evolving slowly. But, yeah, that's one of our biggest challenges, too. Pediatricians and ents.

Yeah, absolutely. I think that's probably been the hardest. And to be honest, I get it because I've seen some of the tongue releases that are done. You know, obviously, that's the lens. I look at it through the most. And I've seen them when they're done and they're done without myofunctional therapy, and they're done without enough tongue space. And, you know, there's. There's obviously different approaches to a tongue release, but you see some of them and you think, okay, this is. This is what they're seeing. This is. This is the patient that goes back to them and says, oh, I had my tongue release and it's scarred down because function was never addressed, or it's scarred down because there's not enough space. And, you know, of course they think, what. What are they doing? This isn't helping anything because it doesn't. It doesn't help if you don't do it right. And I think that that's the majority of what they've seen. You know, they've seen partial releases or, like I said, releases without the full picture. And I always tell people, my job is one part of this giant puzzle. I'm not the one that's going to be a savior here. You have to do all these other things. And really, myofunctional therapy is a huge, huge component of that success. I tell them that's the treatment. I do a tongue release to enable you to do that treatment properly. But a tongue release without that is.

So what is the protocol like if someone comes to your office? Right. What? You know, it sounds like you're very pro. Myo. Eval. Myofunctional therapy. Let's prep for that tongue tie release, which is exactly what I preach, you know, every single day. So what. What does that protocol look like? And what if, you know, throw this wrench in there? What if someone is like, well, I. I don't want to do that. You know, all that therapy beforehand. I just want the tongue tie release. I'm so curious to hear, like, how you approach that.

Yeah, so they come in all of our patients, except for the infants. I do see a small number of infants. The infants have to come pretty much from one specific lactation group that I work with. They're all IBCLCs. They do all the things. The babies typically also have some kind of body work along with it, too. And then potentially feeding therapy, depending. So that's a different ballgame. But all of our orthodontic patients have to come through an ortho consult first. And we have an amazing treatment coordinator who just makes all of this information so relatable and just explains it so beautifully to our patients that they are so prepared. So the patients come in, we take some ortho pictures, they get an icat done so that we can see their airway. We look at, you know, the upper airway, as well as the nose and adenoids and the tonsils. You know, we kind of get a lay of the land, so to speak, and then come up with an orthodontic plan. I would say the majority of our patients now are in some kind of expander and often some kind of protraction to bring that upper jaw forward, because that's a big component of all of it, too. It's not just that palatal width, it's the forward growth. So they start with that. Many of them end up in my chair for upper lip release at some point during the protraction, if. If needed. And then from there, I evaluate all the frenums, and I will say, okay, you know, the tongue looks like we're probably going to need to do a release. And sometimes I can tell them, yes, absolutely, it's going to have to be done. There's no amount of. You're not going to be able to do myo appropriately, but other ones are kind of in between, as you know. And so those. I say, let's see how you do, you know, let's see how you do with that better space and through myofunctional therapy. And then we'll evaluate. A lot of them have sleeping issues, behavior issues, all those kinds of things. So all of that's addressed. And they fill out at that console also, they fill out a list of symptoms. And our treatment coordinator came up with this great idea to have the parents check it and the kids highlight it. So the kids are then. And some parents are very surprised, like, they don't realize that their kids have, you know, all these different things. And that's a pretty thorough list. So that just kind of gets the parents prepped. So they start the expansion. They may come to me for a lip release. When they're about two months out from getting those expanders and the protraction is done, then they'll be sent to myofunctional therapy. So we now have. We actually have another myotherapist starting next week, which I'm really excited about. But I started doing the MYO and now we have four hygienists who do it. So they get assigned to one of those therapists and they will see them for an assessment which is a pretty long, you know, hour long appointment. And then they have four sessions with them. If we think they need a release, they come back to me and then I do the release and then I see them for the post op and I will guide them on those, you know, week after exercises because I'm trained in it. And then they go back to their myotherapist. So we have about 12 sessions in Myo. So typically four before and eight or so after would be the standard. And they're going through ortho all at the same time. But I try to time the release with the expander being out, then having some understanding of nasal breathing and also the strength to hold their tongue up there. You know, they have to be able to do palatal suction and do it well for me to safely do their procedure. And that's really explained to them. You know, that's, that's what we want. We, if I do a release and you don't know where to hold your tongue or you don't have the strength, there's no point, you know, it's just going to continue to sit low in your mouth and, and we've done no favors. So that's our protocol.

I like that you highlighted certain things like, you know, obviously they need for pre op and post op and that, you know, they need to have the ability to hold their tongue up. They need to know where the tongue goes. They have to have some education on breathing. You know, just because like you said, if you throw somebody into a release and they're not prepared, that tongue is just going to continue to live on the floor of the mouth where it's always existed. And you know, I think that one of the things that we saw early on was that, you know, when a parent would go for a release and call us after the fact and like was not the patient prior to versus like patients who came through our practice and we prepped them and they went for the release, we saw a huge difference in just simply in. Well, one, we didn't know baseline. We didn't know baseline without an evaluation for children who came to us after release. But two, we didn't. We or not we didn't. We noticed that the children who worked with us pre op had an idea of what they needed to do and afterwards it was like, oh, okay, now it's all clicking, like, right away. And that. That needs to happen in order for success to happen because of how quickly our body heals, sutures or not. You know, it's. We see this tongue kind of going, like, where do I go and what.

Do I do and.

And it's fatiguing, right? I mean, these children have not had that experience. Or adults, you know, as well, infants, toddlers, adults, older children, younger children. You know, your tongue has never lived there. And it's like going to the gym and working out a new muscle. You are going to fatigue, and you have to build up stamina over time. And so you're really needing to set yourself up for that before the release, so that once the release happens, you can then focus not necessarily on understanding what you're supposed to do, but rather, like the precision, like the range of motion, you know, the reps. Right. Just trying to get some. The exercises in as if you were building a muscle at the gym and trying to teach the tongue. Hey, we live up here. This is tiring. We're gonna work towards this, but, like, a little at a time. Here we go. Okay. Like, now you're existing where you're meant to exist, you know, which we know then naturally holds any growth from that palatal expansion. I love that you talked about bringing, you know, jaws forward, because if the tongue is too far back, because the lower jaw is not in the right position, we're also going to have trouble getting the tongue into the palate where it needs to be. We have kids where the jaws are misaligned, and we see them really, really. You know, we don't always know if it's the tongue tie or if it's the misalignment until the, you know, until that the jaws are brought together in the right place. Because we see these kids, like, the tip of their tongue will kind of slowly slip back, you know, and almost sometimes turns backwards, too, but sometimes just pull straight back, and sometimes it. The tip turns backwards. And they had to do this fun little. Fun little curly thing with their tongue up on the palate. And we're sitting here in the beginning, I was sitting here. Like, I don't, like, why is this happening? Like, why does this happen for some kids? Why can some kids who are cognitively intact, like, they're smart, they are doing everything else we're asking them, but when they go to suction their tongue to their palate, it just seems to be slipping backwards. And we weren't convinced they had a tie. And then, you know, eventually it kind of clicked when I spoke to some. Some orthodontists and some dentists. I was like, oh, well, yeah, I mean, I guess that would make sense anatomically, if your jaw is not in the wrong. Is in the wrong position or it's not in the right position. Right. Your tongue can't possibly hold the correct position when suctioning to palate. And I think that was a big light bulb moment for me because I was like, ah, okay. And we can't be sure it's a tie or not until the jaws are in the right place. And so that really kind of flipped my perspective on going, you know, into expansion, if needed, also bringing the jaws forward before even addressing that tongue tie, unless there was something so severe going on that we were like, okay, step one, let's address the tongue. And then we may have to revisit the tongue again after expansion. But, yeah, so I love to hear these conversations and kind of protocols, if you will, because I think it's still not widely. Not. Not accepted, but it's still not widely approached in this way. A lot of people just go for the tongue and they don't really worry about the dots. Right?

For sure. I think something I see a lot is a tongue thrust, and that is kind of can be a hallmark of a tongue tie. But there's a. You are much more the expert on this part. But there's so much that goes into a tongue thrust. And you think about if those. If the jaws aren't as far forward as they should be, of course they're going to thrust their tongue forward because it's either forward through their teeth or it's back and closing off the airway. So, of course, you know, and. And again, no matter how much myofunctional therapy you do to try to train it, the body's going to protect itself, you know, so that's. I just think we're so fortunate to be. Or I am so fortunate to be in an orthodontic practice where I can talk to the orthodontist and say, hey, you know, what do you think about this? And I think we really now understand what the other needs. And so that's been. That's been nice, too. And that was the journey, too, to figure out, okay, before they were expanding to make room for the teeth. That was what they did, you know, so patients had expansion, but they weren't expanding for better nasal passage or, you know, more tongue space. They looked at it from, can I fit the teeth in here? And now they're Expanding to make room for the tongue. And like I said, both wide enough but also forward enough, which is a really big missing link, I think, a lot of times. So, yeah, that's.

Yeah.

And. Yeah. And myofunctional therapy before release, too. You asked earlier how I handle that. If they won't do it, that's not an option. I won't, I won't see him. So I love that. Yeah, I'm very particular and I can tell. I think our patients are amazing and have really adapted because it's a lot of work. It's a lot of work from the patients, it's a lot of work from the parents. And I get it. I've got two young kids, I work, I'm busy. It's one more thing, you know, one more thing to add in. But the difference in the patients who are super dedicated to myo, when I go in and do their releases, it sounds weird, but it's beautiful. You know, I can see exactly what.

I need to see.

The tongue instantly goes where it's supposed to go. It's just, it's a great surgery and it's easier for them and it's easier for me and it's safer. So that's a non negotiable for me. I just won't do it. And I will tell them, you know, if you can't be dedicated to this, you're better off not having a release, frankly. I'm not doing you any favors. That's my. If I, if I think I can get you better than where you are, then you're a good surgical candidate. But that takes a lot of work on your part to make that happen. And, and if you can't do that, whether it's choice or, you know, some of them are just not cognitively there or emotionally, or the family is going through a lot and it's just not the right time. And I will tell that to parents. Do I think this needs to be done? I do. But if we, if we add this to your plate right now, you're not going to get a success. And so, you know, I don't feel that this is the right time to do it. So I'm very upfront with patients and I think they appreciate it most of the time at least.

Yeah, yeah, yeah. I mean, we've had those scenarios too, right, where families will say, oh, well, we're traveling or oh, this is happening, or oh, but this, we've been waiting to get in with this, you know, provider for so long, and we're like, okay. But we have other providers that we actually work really closely with that understand our protocol and that we really think we're going to be doing, you know, a disservice to the child. And for us, sometimes that can be pediatric feeding, too. And so these. Yeah, babies, you know, sometimes the parents will take the child and they'll have the release anyways against our, you know, we'll say, child's not ready if that's, you know, an issue. And you can't get back into this provider when the child's ready. Like, there are other providers in our area that we highly recommend and work with, you know, regularly. But sometimes, you know, we've seen parents do that and just. They just go and they. They do the release on their own. And, you know, it puts us in a hard spot because one, if we're already working with them, it's like, we don't want to move into a point of client abandonment, especially now that the child's struggling more. But it's that we do have those upfront conversations as well, because every single time, especially with infants and toddlers who are struggling to feed, every single time this happens, that child struggles more afterwards. I've never seen a case where they were already in therapy and we said, they're not ready. The parent then went and did it anyways, and the child did not actually have a harder time afterwards and cut out, you know, and it. It becomes stressful for the parent. The child is having a hard time. They're cutting out more foods or refusing to drink or. And it's not a good situation for anybody just because we can get into a provider that we've been waiting months to see. You know, so it's. It's one of those sticky situations. But up front, you know, we do try to tell families, like, like you said, like, we've got our certain. Certain things that are in scope and certain things that are not in scope that we have to really toe that line gently. Like, we've had families go, oh, well, we're getting a tongue crib put in next week. And we're like, no, no, you're not. Okay. But like, off the record conversation from one mom to another, please don't do that. Okay, back on the record, would you like me to call your provider and have a conversation about why, what we can do maybe as an alternative to putting that in your child's mouth? And we have had a number of kids not go into them. And now, you know, on the flip side, that orthodontist now refers to us instead of usually using that appliance, because at the end of the day, we've had kids get around those. They have a tongue thrust like you're talking about. That tongue is going to get around that tongue crib and it's going to continue to upset the beautiful work that the orthodontist did. So. Yeah, and to, to your point too, when it comes to tongue thrusts, yeah, it's exactly as you said. The tongue is going to go where it needs to go so it doesn't block the airway. But then also from a feeding and swallowing standpoint, the tongue, we need that negative pressure to swallow. And if our tongue is not suctioned to the roof of our mouth right, then it has to go somewhere. And we got these little holes between our teeth, even if they're closely spaced to get enough, they're spaced together and there's not adequate spacing. And a young child, there's still gaps. And there's a way that, you know, the only way that we're going to then accomplish a swallow is to push our tongue either up against our teeth, through our teeth, or through our lips, and, you know, enter that tongue forward swallow or tongue thrust. And so it impacts things more than, you know, people hear tongue thrust and I think they assume it just is a speech thing. And they're like, well, yeah, my, my child's tongue comes forward, but their speech is fine. Like, yeah, my own child actually had a quote unquote tongue thrust anatomically, you know, from like the physiological standpoint, but her speech sounded totally fine. You know, but knowing what I knew, I was like, we still have to address this because that's not where your tongue belongs. And it's more than just speech. So, yeah, it's. I think it's a really good conversation to have with families. And I love that, you know, you kind of, you have your expectations set, you've got your boundaries, you kind of have like, this is what I'm willing to do, this is what I'm not willing to do. But at the end of the day, it's really putting the patient's best interests, you know, forward over anything else. And, and yeah, I do think that, you know, to your earlier point as well, there are release providers who will just release any tongue, ready or not, which I do think is. It makes it extra challenging to then continue to those teams in our area, because sometimes that's all they know.

Right. For sure. And I think that that is probably historically what these providers have seen. And there's just so Many components missing to that. I have a lot of patients who are in speech through the school system, and that's kind of tough because they don't have a ton of time with the speech therapists. And so I actually just had a school system reach out and ask me to come speak to all of them, which was really exciting. And that was so great to be able to talk to them, because through their lens, you know, they didn't really know how to even assess for a tongue tie, which is probably most providers, no matter what area you're in, no matter what field. And I think people assume that some fields know how to look, and they just don't. And so we spent a lot of time talking to them about, okay, here's some quick screening things that you can do during these appointments. And they're talking about patients who've been in speech for a long time and not making progress or they plateau or whatever. So we had some really, really good conversations there, and that was a great opportunity. And I think that parents tend to think that maybe an ENT knows best, knows to assess. And if the ENT says it doesn't need be done, or the speech and language pathologist says it doesn't need to be done, or the dentist, then it's fine. Or the pediatrician, definitely the pediatricians. And so one of my goals is to try to get to those providers and educate them on how to properly assess, because so many are just looking at the front of the tongue. That's how they. They're like, oh, well, it can move. Or you ask a patient to lift their tongue, and they can lift it, but they're lifting the floor of the mouth, Their whole neck is engaged, their eyebrows are up. You know, everything's activated. And the provider's like, yep, their tongue looks great, you know, But a line I tell parents all the time is, you wouldn't say you had good arm mobility if you had to move your entire body to lift your arm. It's the same thing with the tongue. You know, we are great compensators, some better than others. And you really have to get to those compensations to determine whether it's. It's habit or tone or a physical restriction. So that was a really good conversation with. With the SLPs, you know, because they were just, oh, my gosh, I've never. You know, I. I never thought about it like this, or it's not what we were taught in school, because, frankly, none of us were taught this in school, which I hope changes. You know, we didn't have. We didn't have training in this as a dentist. We didn't have training as an slp. You would think of all things as an SLP that would be addressed, you know.

Yeah, and it's. Yeah.

I mean, and for me in school, I think we had, I don't know, one lecture where they talked about a Z plasti or something on a tongue. And it was this really big surgical thing. And that's not what a tongue release is, to be honest. I mean, it's actually really very gentle and very conservative. And so I think, as parents think that we have all the answers because of our schooling. And I think you have to go through more to really learn about it, truly learn and truly understand why it matters and the function. You have to understand the function to understand why you're doing it and for patient selection. If you don't understand how the tongue is functioning or what its function does, then then don't do a release. Because I think a lot don't even understand how much the tongue impacts that facial growth and development. You know, that's not. They don't think that that's part of it. It's huge. You know, if the tongue is up in the roof of the mouth, you are going to naturally get a wide upper jaw, a forward upper jaw, and your lower jaw is going to come forward, and that's going to be a beautiful airway. If it's low, that's not going to happen. So you have to understand function first and foremost, I think, to know when to intervene and how to intervene.

Yeah, it's one of those funny, not funny conversations with, like, the whole slp, you know, community. Because I feel like there's still this 50, 50 split of, like, SLPs who are being introduced to this information. They're waking up and they're going like, wow, that makes so much sense. Why didn't we learn this in grad school? And then you have the other 50% of SLPs who either haven't learned about it yet or who have learned, but who are adamant that, like, this is a fad, this is not a thing. And I'm like, airway's not a thing. And like, there's actually research now, right, that's starting to show. Show everything that we've been talking about, whether it be, you know, expansion leads to decreases in inflammation in certain tissues, like adenoids and tonsils, opening the airway, bringing the jaw forward. All these different things that we're starting to see, you know, talked about a bit more in the Literature, some things that have been in the literature. But you have to know where to look for that information outside of your own, you know, daily journals that you might read. And it's just, it's almost mind boggling to me that this debate happens. Because when you have kids, like you had mentioned earlier, where these kids get stuck in speech for years, why wouldn't we want to look through a different lens and see if there's something else that we can offer these patients to maybe help them graduate from speech? Right. I mean, one of my favorite cases is a kid who was going to high school and came to me because their goal was just that he. So he wanted to say ours, he wanted to say his Rs. By the time he went to, to school like the next fall for high school. And when I assessed this child, he had speech that qualified at the level of a two year old on a standardized test. His sounds were so impacted, he was so hard to understand. His intelligibility was so low. But his goal was R, because he'd been in speech therapy for like 12, 13 years of his life. You know, and at this point, mom was just like, we've heard that like, like, you're helping children who've been in speech for a long time. Can you help us? And I was like, let's do an eval. So I do, I do a mile eval. And I'm like, oh my gosh. Like, I mean, you can just see right away how restricted the tongue is. It had extra tissue underneath it. It was a very unique case. But still, he had been to seven speech pathologists before me over his, over the course of his lifetime. And I just sat there and was like so upset for this parent that they had spent so much of his life, this child's life in speech therapy, when this could have right. Been addressed much earlier on. And we prepped him, he had a release, he went and we then took a mile approach which did impact and improve his speech drastically right afterwards when he had the range of motion to make the sounds that he'd been taught to make for so many years. And then we did have him work with somebody just to do like a lot of extra drill on those R's because R can be a really challenging sound in general. And retraining the tongue and that was his goal and to keep him motivated. I, you know, it's like that line of like, let's keep the child and parent motivated and also do what we know we need, we need to be done as well. And it was just a really cool case because he just the confidence, the ability to speak, to be able to go to high school and not get made fun of, to be able. You know, it's like at the end of the day, I always say, like, when I'm teaching, I was like, we have to remember we're working with humans. And, you know, yes, adults can be mean, but kids can be nasty. And we have got to give these kids the best opportunity to succeed, whether that be socially, you know, emotionally, psychologically, educationally, you know, just their health in general. Right. And we also know that these kids, as you mentioned before, a lot of them have behavioral issues. There could be some adhd, like, symptoms or true ADHD at play. You know, that sleep disorder, breathing and everything, what it does to the brain, the inability to rest and restore and even have the ability to take on the next day. How are you performing in school? Do you have the capability to perform in school? Are you acting out? You know, and instead of labeling these children, really looking at them, because also speech pathologists work on executive function, on language. These children that are on caseloads working on all of these other things in our profession, I just. I just sit back and I go, has anybody done a sleep study? I mean, you refer them for an ADHD eval.

Like, ADHD eval.

Like, did anybody look at their sleep? Has anybody looked in their mouth? You're a speech therapist and you're telling them what to do with their tongue, but have you looked under the tongue? Have you looked in the mouth? Have you looked at the palate? Because usually the answer is no. And again, many of them don't know to do that. So I'm not, you know, I'm not discounting that. But there are also a lot who do know now and are still continuing to push this agenda of speech therapy is enough. We don't need to do releases. You know, it just boggles my mind, really.

Yeah, I think that's across all fields, you know, and I. I can't understand it. You know, I think so many of these kids are. They're recommended to take ADHD medicine. They're recommended to have their tonsils and adenoids out. They're recommended to have ear tubes. And. And people are okay with sedating these kids for these invasive surgeries. I mean, and I'm not. I'm not necessarily against tonsil removal. You know, if you have touching tonsils 100% like you, you know, you're not going to shrink those with better breathing. I mean, there are definitely instances where it has to be done. But I think that our society has gotten so used to those interventions that no one questions it and no one's addressing why that needs to be done in the first place. And then a procedure that can be done, you know, in a dental chair takes me about 30 minutes now, you know, and local anesthetic, I mean, drops. Drops of local anesthetic, and they're so opposed to that. And I think, why not try this before we do all these other invasive things? But I think it's just what we're used to, you know, oh, well, I had to have my tonsils and adenoids out or my friend, you know, it's. It's mainstream and this is not mainstream yet. And so it's questioned and, you know, I guess rightfully so, because like we talked about, some are done not. Well, not addressing the function. And that's really, I think the key, like I said before, that's the key to success is making sure you're addressing function. If you're just doing it as like a quick snip or whatever, people say you're missing the boat. So, you know, a lot of the practitioners, that's all they've seen. They've seen the quick snp, they've seen the results of that, and those results aren't great. So of course they're hesitant. But there is so much research now. You know, there's. There's a lot of research out there. You just, like you said, you have to know where to look for it, you have to know how to read it, you have to know how to understand it. And things in medicine take time to. To research and to prove that research. I think the results in patients, though, speak for themselves. You know, you were talking about a patient being bullied. We had a very similar experience in our office. And it was same thing. It was a speech thing, it was a lisp and had a tongue tie. Saw the patient definitely needed more, more palatal space. And this was kind of right in that transition, right where we were transitioning from traditional ortho to more airway focus. And so I said, yes, you know, you need a release, but. But really we need more space first to do this. Well, and so that was disappointing, but they did it. Very dedicated patient did it, did all the things and did the tongue release. Lost a bunch of weight, runs 5Ks now is just a completely different kid. So confident, so grateful, got the braces off and just, I mean, like a light, you know, he just looks like a different person. And that's kind of something that's been happening more and more frequently. We see these patients, honestly, even just at their post op appointment, they're standing taller, which that's a fascia thing, you know. But they're also just exuding confidence. They talk louder, which also, I mean, it's all related. You know, they can talk louder, but they are just truly different patients. I had another one recently who had a lot of issues with anger, really of kind, quick to anger and just not great emotional regulation, I would say. And that was kind of the big thing that the parents and the patient were hoping to see resolution in, you know, and I'm very careful to not over promise, you know, I say I think this is probably part of it, but let's see. You know, I would hope that you'll get some changes because you'll be able to stay in deeper sleep, hopefully, because you're doing mayo and you're doing expansion. You're doing all this. Just came in for the post op. And I mean, the mom was like, this is. She's a different kid. You know, she's sleeping, she's still. When I go in in the morning, she's not all moving all around the bed. Much more slow to react, you know, better emotional regulation. And the moms are always so neat to talk to because they'll say like, my baby has been tight from the beginning. And I remember that with my own daughter, you know, just like tense and moving all the time. And she was my first and I had no idea my mom was worried about it. She's like, she's never relaxed. I'm like, yeah, I don't know. She's just high strung.

I don't know.

You know, I didn't know then what I know now. And I look back and she was very tongue tied and no clue. Difficulty nursing, you know, all the hallmarks. And it was a very difficult journey. And then you get that release and the body can just relax and you can actually get into that relaxed state. I think people don't realize how much in sympathetic overdrive in that fight or flight these kids and these adults are. And that's a horrible state to be in. You know, you're constantly waiting for what you need to fight. And it's usually because, you know, you're not breathing well or you haven't got good sleep to even let your body relax. That's pretty profound to see those kind of results. And you were saying like GI function, you know, constipation is a thing that I see resolve often and and that's rest and digest. That's better. You know, chewing. A better start to the GI process, better peristaltic wave. I think it's all these unexpected things that it's all related. And it's so neat to see the kids, like, these things that they've struggled with for ever, you know, resolve over time. It's not always that quick, but, I mean, it's just so rewarding to see.

Yeah, yeah. No, it is.

It is.

It's incredible. It always gives me, like, the most excitement about this space because I feel like, you know, yes, we're helping so many people, but there's so many more people out there who just don't even know this is a thing. They don't know that all their symptoms are tied to what's going on, whether it be, like, the parent, they're an adult, just in general, or their child. And, yeah, I think that when you start to realize that that holistic impact. Right. You mentioned the fascia. You know, it's all. We're all connected. It's all interconnected. And, you know, with my own child, when she was 24 months old and we had her release, her tongue tie released, the next day, her constipation went away and basically never came back. And, you know, there was maybe, like, occasional situations that she ate, like, Mac and cheese or something where that just seemed to do it for her. But normally she would be that constipated kiddo that we're trying to find remedies for all the time. And, yeah, tongue tie released and gone. I mean, and so you see things like that, you hear things like that, and, you know, people go, well, is that supported by, you know, the literature? And I'm like, look, maybe at some point more of this will be, you know, written, and there'll be some random controlled trials, but at the same time, like, who are you at the end of the day? Who are we withholding a necessary procedure from? Especially with a pediatric patient? Like, if we think the child needs it and the parent needs it, like, you can't. Anyways, there's certain things that can't be done in a way that people want them done, at least you know, in this space, especially with infants and young children. But I do think that it's really cool for cases that have been documented, and I'm hoping for more of those because, yeah, I know we're seeing a ton of benefits and child first, like, put the kid first. You know, if it was. I always tell people, like, if it was your child, what, what would you want to see? Like, what would you want the outcome to be? Why would you withhold that from another parent's kid when we are seeing this in dozens and hundreds of other, you know, pediatric patients? And that really more speaks to those who are kind of on the, you know, anti tongue tie camp or whatever you want to call it. But yeah, no, we've, we've, we've gone a good distance. I think we still have a very far distance to go. But I love always having conversations with like practitioners like yourself because I think that, you know, you were able, like you said, you went into a practice where like this wasn't really what was being done, but the, you know, the owner was very holistically minded and was very open to a conversation and seeing, you know, what possibly could happen for the patients. And now the patients have a team of providers between, you know, the dentists and orthos and the hygienists doing myo and everything in there that are, you guys are truly making a difference. And it's really cool to, to see that model. And we can all hope that that model then kind of clones itself.

I do, I do hope, I hope that more realize, you know, you can, you can do it. It's not easy. I mean, it's been tough, it's been tough on our whole office, our whole team to go from what they were doing to how we do it now. But those results, like those are real. That's, that's life changing things, you know, and it's not just one of us, that we're all part of that, every part of our team is contributing to that. And that is just.

We all love it.

I think we're all very proud of it. And it's not always been easy and it's not always easy in terms of how other people in the community talk about it or view it. It's a process, it's a long process and it's different than what most people are used to. And so there's a lot of pushback. Although I think, like I was saying, when you have these results and the SLPs are seeing the results, that's kind of how I ended up going in to speak to them. Because we had a mutual patient and they, they were open minded and they're like, well, tell us why, you know, why. I think the more and more patients that go out there and say like, hey, I had this done or this is how my ortho was approached and, and I've had all these positive changes, I Think the practitioners who are willing to listen, you can't ever be the same practitioner after that. You start to look at, okay, maybe there is something, maybe there is something to that. And I just hope that continues to happen. I hope more and more this becomes the mainstream. Because of course, it's my opinion that this is how it should be done and practitioners should all work together. We, the body is all connected and it shouldn't be so separate, you know, which is how traditional medicine in the US is. So I hope, you know, with more collaboration and more podcasts and more talks and all that kind of thing, we get, we get the word out there and parents know there's some answers, you.

Know, yeah, there's other options, there's other choices, there's other paths that you can take. Absolutely. And I love that you had that opportunity to go in and speak to those speech pathologist. I like, every time you say it, I'm just like, yes, more of this, please. But I think it also helps for them to hear it from someone who's not a speech pathologist. Right. It's nice to hear from your own, but it's also, I think, very helpful to hear from somebody who gets the work that you do on a certain level, but also sees things through a different lens. And you obviously have the patience. So that's, you know, like you said, it's like one of the best ways to get buy in is having that mutual patient and that patient having results and then the other provider code and like, hey, what would you do? Like, this is cool. How'd this happen? Because that's, you know, obviously you can't, you can't argue facts, you can't argue what's sitting in front of you and what, you know, changes you've seen in a child. So that's very, very cool. And you had mentioned before too, that you have, you know, obviously you've got the dental myo and ortho kind of in house and that you have like an IVCLC practice that you often will, you know, accept referrals from. Are there other providers that you regularly work with in your area that you know, you've worked hard to kind of build that team with?

Yes, and that was kind of a big part of my journey and something that I have worked really hard at and, and our whole office has worked really hard at. I actually started off, I kind of left this out earlier, but how I really, like, really snowballed into this was I had met an SLP at a networking event and I was just Kind of dipping my toe in. And I'm like, hey, do you have. Do you do myofunctional therapy? She's like, what? You know, why would I do that? Like, oh, you know, as an slp, I just didn't know if. Because that's someone who can do it. And if a patient needs a tongue release, this would be done. And she's like, what? Why would you do, you know, a tongue release? And so we kind of had this, like, slightly combative conversation. It was fine, but I just felt like, you know what? I want to go back and just. Just. I want to smooth things over. And so I went back and I just said, hey, I'm sorry. I'm not here to tell you how to do your job. I'm sure you're fantastic. This is just an area I've gotten into recently, and, you know, I think there's something to it. And she's like, well, send me the research. I want to learn. And so I had it forced me then to find more research and email it to her. And so I work with her a lot, and then she's great. She has, like, a whole pediatric group of professionals that we meet, you know, quarterly. We try to meet quarterly. And so in that group, there's ots, there's slps, there's, I believe, chiropractic. Yes, there's a chiropractor that comes pretty frequently. Pediatric PT craniosacral therapist is a big one for me. I love if people will do that before and after a tongue release. But, you know, I also try to meet the parents where they are, because overwhelming to recommend all these different providers. So I kind of approach it as, like, this is what we can do in our office. And, you know, it may get to a point where we need to rope in some other providers. And like I said, a lot of them are already in speech, so that's helpful. A lot of them have already seen an ENT or an allergist or, you know, their pediatrician, obviously, but almost any provider that you can think of. I feel like we tried to collaborate with, you know, anybody that could be.

A part of it.

We try, and I think we've gotten pretty far with a lot of them. So I'm hoping, kind of my project for this year is. Is to really get. Especially. I've. I've been talking with one particular ENT and really hoping I can get that to kind of become something, because we need them. We need them. I'm not taking out tonsils. I'm not Taking out adenoids. I'm not straightening a septum. You know, I don't want to do that and I don't want to take that from anybody. We need, we need that. But I also need them to know that they may need me too. And they may need our orthodontist and our myofunctional therapists and all these different providers, you know.

Yeah, yeah, well, and you kind of alluded to it a little bit earlier, kind of, sort of. But like when you can also go and have these, these tissues right, reduced, remove, right tonsils, adenoids. But a lot of these kids still have persistent upper airway issues. They still are not breathing correctly. And that's ultimately over time, sometimes we see regrowth, especially if they've only been reduced and not fully removed, although they say they can grow back if they've been fully removed too. You know, if you have that, that harsh, you know, mouth breathing, that whole cycle going on and you're constantly, you know, that area that's now been removed, if you will, that's trying to heal, is not going to heal properly if you're continuing to mouth breathe. And I think It's a catch 22 because obviously if a child has like obstructive sleep apnea or like, you know, like you said, kissing tonsils, we may need to go in and address that. And that just is what it is. But we should also then be working hand in hand with someone who can teach the breathing re education with at least with what they have right now, you know, the anatomy that's in place right now with then the goal to move towards whatever the additional treatment plan may be for that patient. But yeah, that was also a big conversation that was very eye opening to me. All these kids going for tonsillectomies, adenoidectomy is tonsilladenoidectomies, and still having persistent sleep disordered breathing and breathing issues post op. And you know, in the beginning it was like, oh, maybe it's because they're like still really inflamed from the surgery. Like, let's give them some time. And then time passes and they still have the same issue. And that I think also to me was just at the end of the day I was like, wow, we're putting these kids through these procedures and they're okay, maybe they're a little better off for it. But like, it didn't help the underlying issue and all the symptoms are still present. So we really didn't do much for them. And that I think also for me, that Was sort of where my brain was like, wow, okay, let me put my, like, let's, let's go, let me put my 4 year old, 4 year old into a growth appliance. Let's see what else can be done. And so I did not actually have the surgical procedure done with her. Not. It wasn't even an option. It was an offer to us to. Despite the fact that she had like three plus tonsils, very unhealthy looking and large adenoids, when we did her cbct, her sinuses were filled, her nasal cavity was filled and everything was inflamed. She couldn't breathe. And the ENT was like, she looks good, she's fine. I mean, that was that her tonsils are very unimpressive. I was like, okay, I'm impressed by them, but that's fine. And I was very grateful that for her having the appliance did allow for those, you know, for that, for her to start nasal breathing, for the inflammation to decrease. And her tonsils did go down, they did shrink. And that was one of my early cases where I kind of went like, huh, okay, there's something to this. And it just again, so eye opening. And I'm so grateful that I had that experience as a mom with my own child to be able to track that and see it happen without the expectation of something like that happening. Because that again, just said, oh, okay, maybe there are other pathways to addressing this because we have a lot of families who don't want surgical procedures. Okay, great. What are our other options? You know, and I think again, just having the opportunity to experience that, learn as a provider, what else is out there? Who else is out there? What the research is now showing, because now the research is supporting all of this. It's just been a very cool journey. And it sounds like you've been on a similar, you know, learning journey. And I just, I love everything that you've put in place.

Yeah, thanks. It's, it has been. And I think what's really cool about this area of, of dentistry, or it's, it's not just dentistry. I mean, it's more than that. But what's, what's cool about this group of people is so many of them have a personal story, whether it's with themselves. Often it's their children. And there's, you know, many women in it. There's obviously a lot of men too often they've seen their wife struggle to breastfeed or, you know, they've, they've seen it in their kids and they want to Find the answers. And I think it's just such a passionate group of people who does it truly because they love it. It's so much more than a job to anybody that's in this kind of area. And that's just really nice to be around people who are that passionate about what they do and so passionate about helping especially kids develop and be the best they can, you know, let's do our part in it and, and do better for everybody, you know, And I, I think that that has been just neat to be part of a group like that. And it's very rewarding. And like I said earlier, I. Learning something from somebody, you know, it's constant and, and I love that. I love to learn.

So it's great. Same. Same Me too. And that's the best part, I think of, you know, the best, the best providers, I should say, are the ones who are constantly learning and who are open to new information and who don't just kind of sit still, status quo with what they know, what they've always done, but they kind of go, okay, how can we continue to evolve? Like what are we seeing today? What new information is coming out? You know, what are my patients telling me? What are my patients goals? How do we try and approach that and help them achieve their goals? I may see a certain pathway like does that align with their goals, you know, and really keeping them motivated. Right. It's, it's all of the above. And I think that, you know, when you have a holistic approach, it allows you to step into that space of even just being vulnerable and saying, hey, I'm still a learner and I'm a lifelong learner and I don't know everything. And you know, this is, things have changed over time. This is not how I've always done things and things could change five to ten years from now, you know, but being open to that and I think, think truly telling patients like you all, it seems like you all do. Like this is what we know now, this is what we're seeing deliver the best results holistically. This is what's going to help give your child the best lease on life, you know, or adult, you know, I think that's just, it's incredible and it's, it should be commended. I think it's, it's very, it's hard work. And you said in the video it was very stressful to set up, but now you're starting to like reap the benefits. You're starting to see the rewards of going through this journey both for Your the practice and then for your patients. So I love it. I love everything about this and you know, share with us before, before we wrap up. Where can they find you?

So I work at Braces for all ages. We have an office in Portage, Indiana and an office in Hebron as well. I am just out of the Portage office because I use a light scalp, a laser. It has to be in one place. I don't want to transport that. But I work with Dr. Brenda and then Dr. Murphy, who you've talked to before too. And. And that's where we're at.

Perfect. Well, we'll make sure that the website and everything is linked so that everybody knows where to find you guys and just thank you so much for joining me today.

Yeah, you're welcome. Our website is not. It's pretty reflective of the old practice. We've been trying to kind of get that into a better place. So if they go to the website, it's not going to really reflect how we do things now. Just a heads up. But that's one of our big projects that we're trying to get improved too to really relay how we do it now and why.

We can put that disclaimer there and say this is the old website not reflective. And we'll make sure that. But we'll leave that in the episode as well so that you guys all hear it firsthand from Annie so that you guys know that it's old website but at least you can have the contact information and know how to get in touch with them and. Yeah. Is there anything else that you want to share with us before we wrap up today?

No, just thank you so much for having me. This was great to just, it's like I said, it's always great to talk to like minded people and you know, it's just people who get it and to just try to reach more and more patients and you know, let parents know that there could be more going on and that there are providers who are looking at those things and, and if you have a gut instinct that something is going on, look, look into it more. You know, there are people there who, who believe that and who, who will look, you know, if something's getting brushed off, keep going because you as a mom know your child the best.

So you're the, you are the best advocate. Right. For your 100. For your own self.

100.

I love that. Yeah. Well, thank you so much, Annie. This has been amazing.

Yeah, it was so fun.

Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@halliebalkin.com or pop over to Holly Balkan on Instagram to get all the latest updates.