Episode 235: Pediatric Airway Orthodontics with Dr. Jamie Liu, BSc. DDS. AEGD

Hi and welcome to episode 235 of the Untethered podcast. Today we have Dr. Jamie Liu joining us. Dr. Jamie Liu is a general dentist practicing for the last 20 years in London, Ontario and Canada. Dr. Liu graduated from the University of Windsor with a degree in Biology. She obtained her Doctor of Dental Surgery degree at the University of Toronto. Dr. Liu furthered her dental education by completing a one year postgraduate residency program at Stony Brook University in New York. In 2017, Dr. Liu traveled to Tufts University in Boston to learn about releasing restricted lip and tongue ties for infants who are struggling to feed well. Since that eye opening course, she started seeking more education about aesthetic and airway dentistry, tethered oral tissues, oral myofunctional therapy and infant feeding. She's a member of ICAP whose vision is to promote best practices for the assessment, diagnosis and integrated treatment of restricted oral tissues. She's certified to perform laser surgery by the American Board of Laser Surgery. She's an Ambassador at the BREATHE Institute in Los Angeles and has attended airway related courses from Spear Education, KM Academy, Gold Learning and and more. Dr. Lou is a partner at the practice Sony Dentistry located in London, Ontario. She loves reading, staying active and spending time with her husband Aaron and their two daughters, Karina and Rosanna. 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 tether, Dural 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. Jamie, thank you for joining me today. I'm excited to have you on the podcast.

Thank you for having me Halle, because I've been listening to you for a few years and I'm super thrilled to be here and speaking to you after listening to you while I was driving for so many years well, pretty cool.

Thank you for being a loyal listener. I love that. I love how, you know, a podcast can bring so many of us together. It's really very cool. Cool. So I know you're a general dentist. I also know you're a release provider. I also know you are more of an airway and holistically minded, you know, provider as well. So I would love for you to share with our listeners, you know, how you went from general dentistry into this, this, you know, specialty space that you exist in now.

Okay, sure. So I've been practicing for about 20 years now, and I'd say about a decade and a half into my practice, you start to see what works and what's not working, what's breaking down. And I think at that point I was starting to see always a lot of people grinding to their teeth, and we're just trying to learn more about it rather than just prescribing the traditional night guard. So I started taking more courses about that, and then the word airway breathing started to come up. So it was just kind of at the the side of when I was taking some of these courses. And then at the around to 2017, one of my hygienists had a new baby, and she was having lots of trouble breastfeeding. And it was recommended that she can look into tethered oral tissues or a tongue tie. And at that time, I think there was very few providers in my area who were actually knowledgeable in providing the service. So she had to wait about two months to even be seen for a consultation. And as a mom who's breastfed two children, you know, two months is a very long time. It can be just even a few days is enough for someone to give up. So she had asked me to consider taking some courses to maybe, you know, be another person who can provide this for families in our community. So at that time, she's super resourceful. I was. I just did a preliminary search. I couldn't find anything. Told her that. And then she went and found a course for me at, in Boston at Tufts University and said, here, go. Can you go here? And I'm a person that's kind of like an obliger. I'd like to meet other people's expectations. So I was like, okay, yeah, I'll do this for you. Because, you know, we've been working together for a long time. And then that's when I met a pediatric dentist, a laser dentist, a lactation consultant. And I learned so much in those few days. And in addition, like, with My own family, that that's just where it kind of started. When. Then we're talking about airway, reading more papers on it, and that's where it, where it all started in 2017.

Yeah. I, I feel like so many specialists in this space and practitioners, whether it's lactation, you know, dental, you know, it's the speech therapist, feeding therapists, OTs, PTs. We've so many of us have fallen into this space because one, like you said, either we've been practicing for a long time and we start to see these patterns and we're like, I want to learn more, I want to figure out how to better help my patients and. Or like we have children who throw us deep down that rabbit hole of all the coursework we never knew we were going to take in this arena.

Yes, yes.

Yeah. So now you mentioned that your own, your daughter, I believe, had airway struggles. Was it airway related? What was it teal tissue?

Yeah, exactly. So as soon as I started learning more and then I started to notice some of those signs in my younger daughter. And sometimes I was just wondering if I'm. Am I learning too much and just like, overthinking things. But there were things about, like our breastfeeding journey, for instance. For my first child, we breastfed. It was amazing. I loved it. Abundant milk supply. It felt great. With my second one, it was a completely. Even though I was a more experienced mom, it was a completely different experience. It was more challenging. I didn't enjoy it as much. My milk supply actually dried up by the time I was nine months postpartum. And I just thought that was normal. I didn't know anything. But there were all these other signs. Like, she cried a lot. Turn only one way. That's when my midwife at the time had recommended, oh, maybe you should go see an osteopath. Because I did bring her to her pediatrician just to make sure everything was okay because she was crying all the time. And the osteo. After two visits with an osteopath, my baby was moving side to side again, and I could actually put her down for more than 20 minutes. So I just realized as a person who was medically trained at a wonderful university, that there was a lot that I didn't know about health and there was a lot of medical or other avenues of treatment that I didn't understand. So then when I started noticing she was having. She was breathing very loudly, audibly, like across the room. We could hear her when she was sleeping, even with the door closed. I Could hear her snoring really loudly. And it started all. Like. I started. Everything just started clicking like there was an issue with her.

Yeah. Yeah. And I. I think it's interesting, too, because, you know, as I took my. Some of my initial courses in this space, and I was sitting there, like, diagnosing myself and then thinking about my first child, I was like, I got to get home and look under her tongue. I got to look under her lip. We had that breastfeeding journey, the first one, my older daughter, that was just. It was challenging, and it was painful, and just like you. Like, there were things that I did not know weren't normal because everyone said, oh, it's your new mom. It hurts. And I'm like, but for how long? And now since I've learned it shouldn't hurt. You might be a little sore in the beginning as you get used to it, but, like, that should go away pretty quickly. And here we are, 13 months of, like, painful breastfeeding because I just was, like, determined. She also, like, screened at the top of her lungs in response to the one formula trial that we did. So I was like, we're done. We're not doing that. I'm gonna pump and feed her, and I'm gonna. But wouldn't take a bottle. Well, and, yeah, I mean, same thing with, like, the tight neck and slept in a tripod position with her little, you know, bottom in the air with her hands under her head, propped and all these little pieces that I didn't know at the time but have since learned. I'm like, she was screaming, like, airway, body tension, all the things. And, yeah, I mean, it's just. It's a shame that we have to go deep dive into this after all the education that we've already had. It's not part of what we learn as just a basic part of a curriculum, really, anywhere these days. And I know they say they're changing some of that in some professions, but I'm like, you cannot change it fast enough.

So, yeah, that had believing in it, too. Right, right.

Exactly. Exactly. And that's the thing, too. There was an osteopath, Dr. Daniel Lopez, who had once said, you know, because people say, oh, I know. I don't believe in tongue ties. And he's like, you don't have to believe in them. They're not a religion. It's like, it's tissue. It's physically there. Believe it or not, it exists. You know, it's. It's so frustrating at the same time, with this divide that still exists today. Because at the end of the day, it just feels like we're preventing patients, whether they're pediatric or adult, from getting the care they need.

Exactly. And I think the one great thing about practicing for so long, and I see a whole range of patients, all different ages, that I do see adults with tongue ties who have issues that. So they don't stretch out, they don't go away.

And another one of those. Yeah, another one of those common sayings like, oh, it'll stretch, you know, And I always like to say, I'm like, well, if it appears to have stretched, it's like that the frenum wasn't actually stretching. Maybe that body work or the other work you did helped to release surrounding tension that appeared to, you know, made it look like it wasn't as restricted. But I'm like, no, that. I love hearing that you. You say that. Because I'm like, maybe you don't believe me, but maybe you'll be believe. You know, Dr. Lou, Jamie knows what she's talking about here. But, yeah, so. So you went. You took this mini residency course. It was pediatric airway orthodontics. And are you using that now in your practice to, like, inform what you do with patients?

Yeah, so I did bring my daughter to five different health professionals in my community to. To help resolve, like, hopefully address it. You know, she had a lot of those symptoms, signs and symptoms that you see, see structurally, with all her baby teeth. There was actually crowding and overlapping of her baby teeth. Very deep bite and like I said, very loud breathing. Even just when you're in the room with her, you could hear her just audibly, like, plugged up all the time. So we did. We did a home sleep study, but they have a computer on your belly when. During the home sleep study. And you said your daughter was sleeping in that tripod position? Well, same thing over here. She could only sleep on her tummy because she couldn't breathe when she was on her back. So that obviously didn't go very well with the computer on your belly. Plus, when you have a child who's not sleeping well, they're often sweaty because they're not rested. Right. So then all the leads that were on her body were coming off through the night, and I was trying to, like, stick them back on so they. I was told she didn't have any sleep issues, but I didn't. Like, I don't even know how accurate that sleep study was because, you know, it just wasn't. It just wasn't ideal, like, in terms of the monitoring. But we knew that she had poor memory as well. She could, couldn't remember things. It was hard for her to learn. So I just coincidentally I was talking to a colleague who was also doing tongue tie releases and sort of like in the same. Going on the same journey as me and had recommended that I look into a course by Dr. Herman Ramirez and. And I had already come across his name at different courses. I know that he's done a lot of research and luckily he's here in Ontario maybe a few hours drive away from me. So like a local source, which was absolutely wonderful. This is when Covet hit. So he was started offering an online course and luckily I. It was a biggest, it was a big investment. I took the course, but it was one of the best things I did for my family. And my biggest achievement, one of my biggest achievements was taking that course. Hughes been a invaluable mentor to me and you know, help guide me on like step by step how to help my daughter. And it was so quick because she was only four or five years old and it was, yeah, like, it was just so amazing. Like, I'm so thankful that I crossed paths with him and he's been just wonderful and in teaching me, I love that.

So do you mind sharing a little bit about like what her, her treatment plan looked like in terms. You said it was kind of a quicker treatment, but I know you also share things like there isn't just like one tool that fixes everything. Right. So it was an approach that I'm guessing you took with her. Like, did she have an appliance? Was there other. Yeah.

Yes. Yeah. Because like that's the challenging thing. Like when you go into this deep dive, there's a lot of different products. Right. And there's different courses and you have limited time and limited finances. One of the wonderful things that Dr. Ramirez really incorporates is using different tools because he says not one appliance cannot can be applicable to all patients. So there's a, you know, he has a book and it's that it's free on his website. And so if anybody is ever interested in reading more and maybe learning more about it. It's called early treatment of Mal occlusion and it of guides you on how to start. So there's something called planets direct tracks where you can put sort of filling material on their baby moers and change how their bite is. So I told you that she had this deep bite. And that's kind of like when you're in this room with really low ceilings. Like, you're like an attic. So there's no room for the tongue. There's no room for, you know, air. And in general. So even just with different angulations and it takes some practice getting used to how to do it. I was able to just open her up. And even with that simple first procedure, I already noticed a shift in how she was sleeping. I just. It was just like being in a big, wide room with tall ceilings. Yeah.

Now this. So both of my daughters have had various, you know, interventions, and my. They actually both have planus tracks currently on their molars. So I completely know what you're talking about.

Yeah.

Which I saw when you said that. I was like, yay, I love this. But, you know, my youngest, when we lived up in Maryland, had an ALF appliance. And at the time she was 4. And we ended up not really doing bodywork because that was during the pandemic. She got it during that time. That said, it completely decreased all of her inflammation. Her tonsils and adenoids shrunk down. We have the before and after cbct, but we noticed the tonsils decreased in like, October of. What was that, 2019. Like, we're right in the middle of cold and flu season, and it's cold weather up there, and, you know, now we live down south in Florida. But I was. I was just floored. I was like, oh, my gosh, this has got to be the appliance. We've changed nothing about her diet. We haven't even started mayo or anything, because we were waiting till she had a little bit more tongue space. And I'm like, but she was getting some expansion. And I was like, huh, there's something to this. And now there's. There's research that's actually come out to Support this since 2019, which is very cool. But I was. I was then presenting with a colleague, and he said, she's not done. She needs a little bit more forward growth and she could probably use a teeny bit more lateral growth. I was like, okay, fine. But moving to Boca Raton, Florida, could not find. I found someone who did a great, like, airway focused evaluation. But, you know, she was six. And they. He was like, she's fine. You know, we don't need to start anything right now. And I was like, no, I think we. We should. I don't know why we would wait. She's a very compliant child. She's had an appliance before. Like, I figured it'd be harder to find somebody for my then four year Old, my second child. So anyways, we did find an amazing dentist about an hour south of us. And so we've been going to her. And so she ended up putting my oldest into a rapid palatable expander that a hyrax, but she has a forward growth component on it. And with that also did the planus tracks. And so we've gone back there. They are both out of their. Their appliances at this point. So my youngest, we ended up putting her into that same expander because she had croup nine times the year before. And she was like that airway kid at 4 years old who she was like, you know, typically we probably wouldn't be as aggressive this fast in a child her age because she's going to move fast anyways. But she said when we have airway kids like this, then that rapid expansion could be really helpful for their airway. And so I was like, done. You tell me, like, whatever you think we need to do. And we put plaintiff tracks on her because she sounds very similar to your daughter. She's that deep bite kid who grinds her teeth when sleeping. And I'm just like, oh, goodness. Like, I know these are baby teeth, but now that I've learned from all my colleagues, like, this is not okay. So we, we just went back. Let's see. So they're. They're both out of their appliances now, and they did go into like a. A temporary, like, permanent appliance just for like a handful of months just to kind of hold the shape while everything kind of settled. And those have now come out and they're wearing a myo brace at night and they've got their planus tracks in. So that is our current plan. But I mean, and that's why I love how you said, like, there's not one tool for everyone. But also, you know, as a mom, I think, and like you said, limited time, limited resources, whether it's time, money, whatever it takes a lot. Takes a lot. Especially when you have to drive to a provider who's not nearby. I'm like, I get that firsthand now. I mean, an hour is only an hour, hour and a half either way, but that's a whole day sometimes in traffic and the appointment and my kids are in school, you know, and I'm like, I get it. I get that it's a commitment, but at the end of the day, I'm so happy that we did it because they're so much better off for it. And, you know, I think it, like you said, your daughter, you are noticing These other symptoms, like it impacts their ability to pay attention, to take in information, to pull information out of their brain and share that information and. Yeah. So have you noticed any, any other changes with your daughter?

Yeah, we did. It was like I said, immediate. We also used mile brace for her as a first appliance and within three weeks some of those that crowding, like she started getting spacing immediately. Like when they're little, it just, things just happen so fast. And even her kindergarten teacher at that time had remarked like her reading levels jumped up. Like because we go by Alphabet here and she was at level C and we, we read a lot in our family and, and she also couldn't like explain things to us. It was just, or couldn't remember like really basic stuff. But in that short time, like all of a sudden she just jumped, I think to like level J and reading and, and then was able to recall things better. Like, like she never had behavioral issues because I know some sleep deprived children will be acting out. I never had that. But it was those other things that were like worrisome, like how come she can't remember that she just brushed her teeth, like those kind of things, you know. So yeah, it was just, it made a huge impact in, in our family. So I think now you start to recognize those structural signs because structurally if there's some restriction, not enough space, often function is impacted as well. Right. And it's, you know, the more I learn, they're saying it's usually function that's determining the structure. So now you kind of start to see that in patients coming in and you just kind of bring it up a little bit and see where the family is at, see if you can meet them there and you just kind of, you know, give them a little bit of information. Trying not to overwhelm people. That's, that's the biggest thing I have to learn right now is how to not overwhelm people with information.

Yeah, yeah. No, and it's, it's so true. I always try to like impart that too. Like in my own team where I'm like, okay, let's not make three referrals today. Like, let's try and focus on one. And if they ask questions, you can say this other. I might make another referral to X, Y, Z down the pike. But for right now, like focus here. I'm like, because as a mom, for me to receive that much information and more than like one action item at an appointment, I am going to walk out and I'm in the space and I'm going to be like, oh my gosh, I can't. It's just like so much to do, you know, and so I think that keeping the patient out of overwhelm, especially like when you're delivering new information to them, is so key. So I love that that's a focus for you. And, you know, it's. Some of these patients are like, well, why? You know, mine looks the same. Why isn't my, you know, why don't I struggle with that? And I'm like, you compensate better. Or like, you, you know, and I try to tell parents too, like, the buckets of energy. Like, I'm like you. Everybody wakes up with 10 buckets of energy and someone who has a tongue tie. You know, a child with a tongue tie who didn't sleep well now wakes up with nine buckets of energy. And then it takes them, you know, more energy to brush their teeth because of that, you know, that lip tie. And they're having to work around it. Now we're down to eight buckets of energy. And then they take more energy to get ready and to eat breakfast. And by the time they get to school, they're down to five buckets of energy, but their friends still have nine, you know, and it's like, I think when we just kind of like take a lot of the, I would say legalese, but that's not it. The medical terminology out of it. All right. You know, and just give them a really, I think, easy to understand analogy. Like you had, you had used one earlier in our chat. You know, I think that that just kind of helps parents, like, take a deep breath and go like, oh, okay, so how do we help them? And it's like when they're like on, you know, bought in, then it's like, okay, great. Well, now that you're asking, let me, let me share some information with you.

Exactly. Yeah. Because I do have people bringing their children in just for me to look at their tongue tie. But then I'm like, oh, but there's a deep bite and not enough space for the teeth. And, and then you're just like, oh, where do, where do I start?

Right.

Yeah, but I'm. Now my daughter is in an ALF appliance as well. And, and, and that's working out well. So. And I'm hopeful, hopeful that with the development we've had, like, if we need braces, it'll be very minimal because now she has some. She's almost 8 and has a lot of permanent teeth coming in. And so far there's no overlapping, no crowding of the teeth. So, yeah, it's been pretty cool to see that.

Yeah, it is. It's so cool to also see all the different, like, treatment plans that you can, you know, take to at the end of the day, achieve airway space and more space between the teeth and, you know, space to get the tongue up to the top of the mouth. And there's a lot of people say, well, what's the best appliance? And I'm like, one, that's out of scope for me to tell you that. But two, you need to go see somebody who can do an evaluation and give you the options. And hopefully they offer more than one appliance, because that, you know, and that's where I got really spoiled. Up north in Maryland, I was working with this. This, like, you know, practice where they had a whole variety of different appliances. They treated pediatrics and adults very airway focused. And so, you know, even if a patient was like, I don't want that one, even though you're recommending that as a top appliance, what else might. Even if it doesn't achieve all the same results, what gets close to that? Like, they had options, which was nice because I think it also was very patient. Cent. Um, but anywho, yeah, we. The myo brace, though, is interesting for me because we did try to start with that with both of my girls before we went into the expanders. And, you know, they both. They put it in and they would read with it in their mouth for 20 minutes or, you know, they would do something while they were awake, but I couldn't get them to sleep with it. It would just pop out of their mouth. And with my youngest, who was the very airway, you know, deep bite, very airway impacted, kiddo, she was like, let's just. Let's table the myo brace for now, and let's just go right into that expander, Aware of the myobrace as she lets you until the expander comes in. And, you know, it's really cool, though, to see now that there's nice space between all of her baby teeth. You know, she's five and a half, so she hasn't lost any teeth yet. And, you know, she smiles, and every time she smiles, I'm like, look at all that space. Like, it's so exciting. Nobody else probably has this reaction to their child when they smile, but I'm very excited about all this space between your teeth, so it'll be cool to see what happens. And, yeah, I mean, for My, like my husband, I was like, the big selling point, the goal is to not need braces. And I was like, I mean, if we do, fine, whatever. But my, my 8 year old's very motivated to wear her my brace because she does not want braces. So I'm like, okay, then keep wearing that myo brace so it can guide your continued growth while you're sleeping, please. They're doing it going.

Yeah, no, I'm trying another. Yeah, we do some traditional expanders, the Alf, myobraze, the tracks. There is another myofunctional appliance that we like using called the Bioactivator and that's from Italy and much more. I think they have a lot of different sizes. You have to do more analysis to see which one is applicable for your child. So that's been when you sometimes, when you see other things are not working and more resilient to when people grind their teeth because sometimes I find that children can grind through some of those appliances. So so far that's been working really well too in our practice.

I'll have to check that out later. I've never heard of that one. That one's new for me. Yeah, yeah, well, and I know also, you know, we were, before we hit record and we were chatting. You were talking too about, just earlier on in your practice, noticing that patients sometimes like grind through a nighttime appliance or a nighttime. I guess it's not an appliance, but the trays that they'll wear that are supposed to either be supportive of, you know, supporting their TMJ placement. I don't know, we get that a lot. And even this week I saw a post. It must have been on Instagram or something. But I saw something where there are different discussions. Oh, I know what it was. Somebody sent me like a meme that was shared and it was some well meaning. I don't know if she's a psychologist or what, but she had a whole like bunch of different memes in a post and one of them was it was just trying to talk about like, you know, relaxing and decreasing anxiety and stuff like that. And so this meme was something along the lines of like, unclench your jaw, drop your jaw as far down as you can go. Really release your tongue from your palate, let it fall to the floor. And so someone sends this to me and she's like, I'm so curious to know your reaction to this. And so I click through and I just, I go immediately down. And two of the first three comments were like, well, actually. And meanwhile, there's 10 different memes, right, all about different things, and this is only one related to this. And two people are like, well, actually, you should keep your tongue resting on your palate. That is the natural resting position. Your lips should be closed. You should be, like, breathing through your nose. And that actually should help reduce anxiety. And I was like, people, I don't know who you are, but I love seeing this. And then I started to see some, like, myofunctional therapists that I know. I'm like, clearly this is made. It's. It's circulated around. But it was just, it was interesting to see that. And from. I was just like, oh, no, no, no, please don't tell people to do that.

Yeah, I've, I've heard that. I've been instructed to do that during the meditation process in the yoga classes.

Yeah, yeah, yeah. Well. And then there were other people in the comments who were saying, like, you know, oh, I've chewed through night guards and I've, you know, and then they just want me to spend another five to 700 for my next one. And I know I'm just gonna chew through it again. And I'm like, people starting to get it. Is it starting to click? Like, are you a patient? I don't think you're a provider. I'm like, this is a great conversation that's happening because it's, It's. I think things are evolving and people are starting to go, well, why are we doing this again if it didn't work the first time? Like, yes, yes, please ask. And if you don't get the answer that you feel like, sits right with you, like, get another opinion, you know?

Yeah, and, and just be okay that it's okay to question your provider and to ask questions instead of doubting them within yourself. Like, it's. Yeah, just give yourself permission and the confidence to do that.

Yeah, I love that. Now, do you have, like, a good team where you're located in Ontario? Do you, like. Of different providers in the space?

Yeah. Well, not in my space. It's been a challenge because when I was first in this, like I said, there was only one provider in the area who was doing releases. So I did have to take a lot of extra courses just even to learn more about breastfeeding and then learn more about body work. Not that I'm practicing any of it, but just, just so I understood because I saw the limitations, you know, when you first start doing something. I was like, yeah, I'm gonna fix everybody's Tongue tie. And then I would see, hey, this didn't work. Even though I know I did a good job and this. So it just makes you understand why didn't that work? Because I would see people for two or three follow ups after and that's where that went. But then now it's finally, you know, we're getting some lactation consults at IBCLCs who are becoming tot savvy. I have some great SLPs who are also in, you know, have learned along with me. And we, we share cases, we talk about what's working, what's not working. And now there are more release providers in the area, more body workers where we're communicating. I had one child who's his maxilla were trying to move it forward and there was all this asymmetry, the left side, eyes higher, you know, there's this cant in his maxilla. And even though I was using an appliance that was symmetrical, the right side was moving, but I couldn't get the left side to go like fix the crossbite on the left side. And then so, you know, with that more learning, they're like, oh, there's tension C1 and C2 that might be limiting the maxilla. So then you have to reach out to the osteopath to talk to them about that. And then, and then within two adjustments, like, okay, the crossbite's actually moving now. And so it's just, it's, it's happening. But it took a long time to get here. So I think there's been a lot of sweat and some tears when things are not working, especially at the beginning. A lot of time put into the program to get it to where it is. But yeah, finally, I wish we were all in the same building, but it's just we're not.

I know. It's one of those things where I feel like it takes time to build your team and to develop those people who get it and who see things through a similar lens. And I think what's really cool too is when you have these shared cases and you can all kind of quote unquote come to the table together and review a case. It's really neat to see the perspective from all the different professionals that have eyes on the case because I think like you said, like, you're taking all these different courses and you're not planning to do lactation necessarily or some of these other things yourself, but you're like, you need the knowledge, you need to understand when things are not functional and they're not functioning the way they should, so you know when to refer or you know, how to best help the patient. And I think that really also speaks to like creating the timeline for the treatment plan for that patient. And you know, you, you said like in the beginning, you're like, okay, I know this was a good release. Why, why is this not working? Like, why are they not improving after? And you know, again, I think the best practitioners question themselves in a sense that it's like, okay, here are my patients. Here's what I've learned over time. Like, I know none of us now are doing the same thing we were doing like 15 years ago. I know that all of our practice will continue to evolve based on the patients presented to us and, you know, more research that comes out and just experience of working with these patients and getting them results. And so I always can appreciate and respect like a provider who can say, you know what? I don't have a 100% success rate because I was still part of my learning process. And it drives me up a wall when people go, we have a 100% release success rate. I'm like, how do you know? And probably not.

Yeah, yeah, yeah. That's the tough part. And I think experience too, coming with it, that, that is, can humble you because sometimes I'll have success for like a long period of time and then you're feeling like, wonderful and then something happens and you're like, shoot, that knocked me off. And, and that makes you understand, hey, you don't know anything. Everything you need to keep learning. One of the main things, even when I work with the infants and the, the family, just understanding, even the stress levels of the parents play a factor in the success. I can do a great release. I can recommend what I recommend, but I do find that that stress really can impact the success of things as well. So yeah, that emotional factor and that I think comes with experience too.

Yeah, no, I've had several really great conversations with individuals, whether it was, I think I had maybe pts on that do the craniofascial cycle therapy and, you know, release and everything. And some others that do craniosacral therapy and other, you know, Cairo and other types of body work. And I think that's come up a lot is the nervous system and, you know, the how the babies especially, I mean, all children really, but babies especially, and especially when breastfeeding and when there's that, you know, feeding connection and the feeding, you know, dyad, they feed off of the parents energy and it doesn't have to just be the feeding parent. Either it can be, you know, or any caregiver they spend a lot of time with that they totally feed off of that energy. And you can see, like, when mom relaxes, baby relaxes. And it's so critical even like in feeding therapy to have that discussion. And it's a tricky one because you never want to make a parent feel like, badly about it. They don't know that they're, you know, that. And then they're going to be more anxious that their anxiety or whatever may be happening is potentially impacting their baby. Right. So it's definitely one of those delicate conversations. But I do find that the families that will jump into some form of body work and both mom and baby, or at least mom, you know, if not baby yet starts, we tend to see like a big like. Like just like kind of calming and over everybody. And the baby definitely benefits from that as well. So it's, it's very.

That's actually a good suggestion. I. I haven't ever really recommend mom go for body work that much, but actually that's. That's actually a really good suggestion.

Yeah. Well, and one thing that kind of opened my eyes to it too, because, you know, if you had asked me five years ago about osteopathy and all this body work, I would have been like, I don't know. I mean, I don't know. Like, I don't really have much to comment on it because I haven't seen it firsthand. But going through an adult appliance myself and having a maxilla that is locked up on one side and not being able to turn the appliance key on my removal appliance. Until I saw the physical therapist who was PRI trained. He was doing what he called manual counter strain technique. Like, he would work on me. And that same appointment, I could then go from not turning the appliance during the, like before the appointment to turning the appliance like after or during the appointment. And it was incredible for me to see that firsthand and experience. I was like, okay, everybody needs this if you're. Especially if you're going through expansion. And then on the flip side, with my second, I took her to cranial sacral therapist and to an osteopath as well. And they worked on her, like while she was sitting on me. So she was like facing me breastfeeding, and they were working on her. And it's almost like. I don't know. I don't know how to explain it, but, like, I could almost feel like through her, the changes of what was happening in her body. And she was like a very sweaty baby and was not walking yet and did never crawled. She dropped. You know, she had a tendency to drag one leg behind the other. And within a week of this appointment, she was walking and like within. Or maybe she just started to walk right around the appointment time she got. She started to crawl though, like a week and a half after the appointment. I'm forgetting the timeline. Exactly. But it was a very short period of time. She's crawling across the couch and like with knees and hands down. And I'm like, I'm like pointing this out to my husband and he's like, but she already walks, like, what does it matter? I'm like, oh, it matters because everything's integrating. I was like, and this is not even a hard surface with support. This is like a soft couch that she's doing this on. I was like, this is a big deal. And I was like, whatever. You don't have to understand. I'm very happy with my decision to take her to the osteopath and pay out of pocket for that work. It was just like. But, you know, it's like these little things that clicked for us in my own family that really made me kind of go, okay, now I feel really good about making these recommendations for my families because I've seen how it really, truly does make a huge difference. And then like you said, experience wise too, then you sometimes see when you don't have that support surrounding feeding, therapy or a release versus a child who does, it's. It's very different. In most cases, they definitely make progress much faster. The families are, like you said, when, you know, speaking to your point, everyone's more relaxed when you go in prepared and you know what to do following a procedure. And you don't just go right into a procedure without knowing what's going to happen and how you, you know, need to work with your child following. So anywho, I know I could talk about this all day, but yeah, I think it's, it's such a critical component of this conversation and experience.

You're lucky you found really good providers to support you that way.

It was tough, but the. Thankfully, the PT was actually in my dentist's office. So that's how I came to know about him because they found him and he was in there two days a week. There was also another PT who was also pri trained who was in there one day a week. And so they basically included it in the, the package quote, unquote for an appliance in their practice because they wanted everyone to have at least some adjustments. So they were like, if you want more frequent and it's outside of your appliance appointments, then by all means, like you can go to them directly and privately, which I did. But you at least got it when you were going for adjustments with your appliance, which was incredible. Yeah. And then just the osteopath I found just through a lot of networking and a lot of time and you know, colleagues who were like, they're phenomenal. And unfortunately they're moving away from the Maryland D.C. area now. We're like, oh no, we have to start all over because I still have a practice up there even though I'm in Florida. And we still, I'm like, we still need to refer patients. So it's a constant changing process.

I feel like, yeah, yeah, it's hard to like know how to integrate things and build things when you don't have a lot of like a model to, to go off of. But yeah, that's amazing that you found that practice.

It was incredible and it was absolutely incredible. But that's also, I think, why I've become a believer of, you know, seeking out these individuals who think differently and think like, you know, like we do in a sense, just in terms of alternative ways of helping people heal and feel better. And then I tell like, like all the, you know, clinicians in my courses or therapists on my team, I'm like, you know, I know it costs money but go try it out for yourself. Like go have a session and see what happens for you. Or even if you have a child, your child. Because I don't know, for me there is no better way to know the impact or whether someone's going to be great to refer to unless you have that first hand experience, you know, and it's easier to do when it's a body worker or something than you know, a dentist who may be giving you an appliance. You're not going to go get an appliance for five different people. But, but yeah, it's one of those things where I'm like, if you have the opportunity, like, it can't hurt to see like who you connect with and click with and you know, and it's nice to have when you can, multiple people in that space too because not every patient clicks with every provider even if they're highly skilled. So it's, it's been a very like humbling experience and a very, you know, rewarding journey at the Same time. But yeah, it's the time and energy into building a practice is not something that anyone really, you know, can teach you. It's kind of like you just kind of have to get out there and do it.

Yeah, exactly. Yeah. So what's wonderful is that, that some of our staff is, you know, learning a lot because I talk about it all the time. And one of my longtime hygienists is now trained to be an ipclc and she runs my baby program with, along with side with me. So it's just, it's been nice to see other people grow too.

That's awesome. And it's, that's amazing. I mean, they always say like, nobody loves your business like you do. But I always say like on, in response to that, I'm always like, but when you get the people on your team who dive in with you and almost treat it like their own because they love the patients and they want to give the best for the patients, you know, I'm like, then you've got a good team. Then you've got, you've got the, the right people who really, you know, are in it for the right reasons. And that's, that's the best. So that's exciting. So you offer. So tell us more about like what you offer. You have like a breastfeeding clinic or classes or what does that look like?

No. Well, so we basically are just. When we have a child, a baby who's having trouble feeding, we just try to at least educate a little bit on the phone because we don't want to. We don't do same day releases. That's. I used to do that at the beginning, but I just again found that I didn't get success. And it was very stressful because often parents came in not knowing anything, even though we emailed them a lot of information along with videos of starting to, what to do, they come in, they haven't watched the videos. So it was just very stressful. And then, and then lots of tears, indecisiveness, what to do, what not to do. And timing, right timing of release is something I've heard, I've heard on your podcast as well. It has to be the right time for the family, has to be right time for the baby or the child or adult that I'm treating. And often we're rushing into it. So now we, we screen first and we just really try to push people to go see a lactation consultant first or something. You know, just kind of those preliminary questions. Does your baby show sign of tension. You know, please go see a body worker. Some people are still resistant until they meet me. And then I, you know, we do an assessment first and then we watch baby feed again. We're not, not, not a lactation consultant, but we can kind of see, you know, some signs and of things. And if we feel like they need more, okay, the next step is going to see lactation consultant. You know, if there's an issue continuing, then come back. Or even like, if there's a lot of neck tension, you need to do this first. And then if there's still remaining issues, then you come back. So we really try not to do the same day. And so some people want a quick fix so they will go somewhere else. But I just found that my success rates did go up because I waited. It's only if for emergency cases. And now it's even only from providers I know who are experienced with tethered oral tissues and know that this is an emergency. That's when I would do it the same day. But I just find that I don't get success that way. So that's, that's how we do it. We've. We assess first and then give them edu. We educate, educate, educate. And then sometimes people just want an appointment, so we'll time it accordingly to give them time to work on these things. And then sometimes they cancel because things have improved or they, even with the exercises and things we give them, a lot of times they even see improvement in feeds already, even before we even consider releases. So it's just, that's just how we've worked our program now.

Well, I love it. I mean, it's definitely evolved and it sounds like you're doing right by your patients. And, you know, I. Not that we don't want to try and help everybody, but, you know, the, when you get those calls where it's like. Because we get calls too, where it's like, we were released today. We need to see, we were told to see you. And I'm like, well, we travel to our patients. We're not even a clinic based. Like, we're not like, in one place. So I'm like, I can't get somebody to your house today. Like, that's not happening. So we, you know, and I know our release providers know that too. Like, they, they know how we operate. And that's really how most people operate in, you know, the D.C. metro area. But you still get those calls sometimes where they're like, we were released now. We need to see you. And I'm Thinking like, how did this happen? Like, how is this still happening? Because someone told that, told you you needed to see us, but you're call the day that your child was released, after the release, you didn't, you know, so, so there are some providers in our area who have like a system where we basically have to either verbally or physically, like, sign off on the, you know, child or adult is ready for release. They've worked with us. We know they're prepared going in, they know what to do after. We know that they're going to educate them even further in the dentist office. And they already have done that with the consult. And we've all, you know, we've all communicated together on the patient case. You know, there's been, there's been a road to release, if you will, where it's like, like you said, it's not just that same day. And, and at the end of the day, you know, I'm not a release provider, but I'm like, I prefer to work with children who have been prepped and then, you know, these families who know what they're going into and what's going to happen afterwards. Because again, I do think it, like you said, it, it improves results. We actually see faster results. We see calmer families. You know, if something, you know, because we tell parents, sometimes feeding gets worse. Even when you are prepared, it gets a lot worse before it gets better. And if we know that going in or we can have that conversation again because they don't remember that, like after the release. And we say, this is okay. This is very common. This happens. That's why we're here. That's why we're all working together. We have to now, you know, teach baby to use this new newly released tongue that they didn't have full access to before. And that's why things are not going so well. But like, let's, you know, a week and a half from now, let's remember this conversation because this is what we're working for is coming and that's why it's a work in progress. And I just, I think again, as more families are educated and actually fully like, understand that or are willing to hear, even when they are educated, you know, the better it off. Better off the child is. And really everybody.

Yeah, yeah, yeah. Sometimes it takes like three times right before it gets really absorbed. You have to hear information multiple times. Yeah. And even for children and adults, if they're not prepared during the procedure, there's definitely. It takes longer and there's more bleeding and there's more. It just, it's just harder to do. But whereas someone who's prepared, it's much, much more smoother. Everything about it and amazingly enough, like almost no bleeding when, when you're doing a release, when someone's tone their tongue and strengthen their tongue. And so it's pretty cool.

That is cool. That's really interesting. I would love to like, see, you know, and not that I need the research necessarily, because I know that a lot of us have the experience and we share it, but I'm like, I would just love to hear that from more providers. Like, what do you notice when your families are more, you know, prepared? Whether it's the lactation consultant, the feeding therapist, if it's slpot, pt, whatever, you know, it's the release provider themselves. Because I think having like more conversations around that, like, I feel like a lot of us are saying that, but I'm not sure that we dove into like the specifics of like, like you said, like, you can see that the tongue is stronger, it's got better, it's more tone. You know, we notice that it's easier and there's less bleeding. I think that would be very motivating to families to know, like, oh, your child's not going to bleed as much. You know, they're likely gonna have a much easier time post op and during the procedure because they're prepared and you know, things like that. Anyways, I think that would be, you know, I think that's more of a conversation that, you know, should be had.

Yes, I agree. Yeah, yeah.

So blob. Right, I know, exactly. So, so your practice has evolved. So basically, I know it's, it's changing slowly. You've shared from general dentistry to including more of this, you know, tethered oral tissue treatment, if you will, for infants and then some older children and adults. You've mentioned that there's the early orthodontic intervention too, and the younger children. Is there anything else that we didn't cover that you're doing that you want to share?

No, I think that's pretty good. Yeah, it's, it's an exciting thing to be part of. A little bit scary to see the, you know, what your trained in school is like, you're just kind of changing it. But it, it's, it's, it's exciting, like I said. And, and then to speak to other individuals like yourself who are along the same path. That's wonderful too because as we also talked about in the beginning, you know, not, not every, there are other health professionals who aren't on board and really, at this point, probably don't understand and. And that can be really lonely and challenging sometimes in a community, in a smaller community. I'm located right between Detroit, Michigan and Toronto, Ontario. So it's a little smaller city. And it's hard to change the mindset of a community controversy when I'm typically have grown up not just being quiet and not speaking up in class and now having to kind of project a voice and even being on here, it's really way out of my comfort zone. So that's a little bit exciting and scary.

I love it. I love it. And there's somebody who says, do it scared. I don't know who the quote is from, but it's. I don't know if it's like Brittany Brown or who it is, but sounds like it'd be, yeah, but it's, you know, it's one of those things too, where it's like, you see the larger need, and it's almost like, you know, this mission is bigger than all of us combined. And so for me, I know that that's been such a big part of, like, pushing forward and becoming so vocal and being that big voice. I've never liked public speaking. Not a fan, but I'm like. And people, like, just assume that I love the spotlight and I love public speak. I'm like, no, I'm sitting in my office on Zoom, recording and then putting out a podcast or I'm recording a class, or I'm going live on Zoom and teaching. I'm like, I would much prefer that than, like, getting in front of a room and talking like, I'll do it, but I don't love it. It's not my forte. And people are like, what? And I'm like, yeah, I'm like your extroverted introvert. Like, I just. I don't know how to tell, how to explain it. But, you know, again, at the end of the day, I think it's that that larger mission and the greater cause that kind of like, pushes me forward, too. So I'm glad that you agreed to join me today and that you are that voice for your community, because I think those smaller communities, they so badly need it. So glad they have you.

Thank you. Thank you for inviting me. It was pleasure.

Absolutely. So where can they find you?

So I'm located, like I said, in London, Ontario, between Detroit and Toronto. And we're at Sony Dentistry. S O N I so you can go to sonydentistry.com I'm also on Instagram and that's how I connected with you, Dr. Jamie Liu. And yeah, perfect.

Well, we will make sure we have all of that in the notes underneath the podcast episode so they know how to find you. And yeah, thank you so much for joining me today.

My pleasure. It's been wonderful.

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