Episode 299: Breathing, Bites, and Breakthroughs with Dr. Nora Ghodousi-Zaghi DDS

Hi and welcome to episode 299 of the Untethered podcast. Today we have Dr. Nora Zaghi joining us. Dr. Nora provides functional and integrative oral health care and interoceptive orthodontics with a focus on whole body health and well being. She's a diplomat, board certified pediatric dentist, published author, clinical researcher and educator. She's the Director of Pediatric Dentistry at Breathe Babies and Kids and provides care in a collaborative environment. Dr. Nora is a graduate of the Breathe Institute's MyoMasterMinds program and has advanced expertise in the field of myofunctional therapy. Beyond her academic studies and clinical experiences, she has continued her education in the fields of sleep breathing, ankle glassia, early interceptive orthodontics, oral motor and feeding therapy. 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 health care 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.

Foreign.

Doctor Nora, welcome to the podcast.

Thank you so much for having me.

I'm excited to have you on. It's been a long time coming and I'm glad we were able to coordinate our schedules, but I would love for everyone to learn just a little bit more about your background because I know you've always been a very, you know, airway focused provider, but you became more of a functional integrative dentist, you know, in, in the more recent years. So can you tell us a little bit about like, was there a catalyst or something that something happened that kind of shifted you into the more integrative holistic space?

Yeah, absolutely. So just introduce myself. I am a pediatric dentist by training and I have advanced expertise in sleep breathing, early interceptive orthodontics, maxillofacial development and Tongue ties. So I would say when I was in residency, I had a patient that was seemingly very sick, always had very dark under eyes, open mouth, and always very, very fatigued and tired at the same time. Had a lot of tooth decay, and he also had a lot of allergies. And I referred him over to my orthodontics colleagues in my residency program because they had an ortho residency. And they sent me back a prescription that said, take out these four permanent teeth. And being so young in my career and just learning like the basics of dentistry, I said, okay, this is what the specialist told me to do and I'm going to do it. And then I had an amazing director who, our mentor who said, Dr. Nora, put your, take your hands off those forceps. You know, you're responsible for this child's care. You can't just take out teeth without giving them their options. And I'm like, oh, interesting. Like what, what are their options? Because the specialist is telling me to take out the teeth and she's like, this is your patient. You're also specialist. There are other options. And options include making the mouth wider to accommodate the teeth. And that can also help this child sleep and breathing. And I'm like, how could teeth and a mouth affect the child's sleep and breathing? So I really didn't understand, but I was like really wanting to understand. And lo and behold, I gave the patient the option and he accepted. And we moved forward with the treatment under the guide of my, my mentor. And the patient got better, his sleep got better, his breathing got better, and he felt healthier. And it's, to this day, gives me chills. I wonder how that little one is doing. Well, not little one anymore. He's probably in college or more or out and about doing something in the world. And I was like bamboozled by the fact that we could do interesting techniques to help patients with their jaw structure, but also to help them with their sleep and their breathing. And I did a deep dive into myofunctional therapy, functional dentistry, and airway centric appliance treatments. Then later on in my life, I met my husband. Well, not, not too much later, but during my residency, I met my husband, Dr. Suaki, who's an ear, nose and throat doctor and sleep surgeon. We had been friend of the friends in the past and then reconnected at a party. And after we reconnected at a party, I brought up the topic of myofunctional therapy and somehow he said he was involved with it. I didn't really believe him. But then that same week, I ended up at a, I ended up at a party and I'm. No, not a party, I'm sorry. At a conference and they had his picture up and I'm like, oh my goodness. I was just texting this guy this week and he's. And then I texted him and he said, oh, I'm actually invited to that same course. Do you want me to stop by and speak? And we could go to dinner afterwards and then look, the rest is history. Let's put it that way. I love it. We have two kids now, but I started learning more about like not natural, more natural or root cause approaches to dentistry. I would say about five or six years ago when I got a little bit sick, I had an illness and got very sick and sick in ways that it couldn't be explained by traditional medicine. And then when I started learning about my own health because I couldn't go to work because I was so sick, I had to take it upon myself to heal myself. When I did, I realized that some of the approaches in dentistry, like for example, using BPA in our treatments or endocrine disruptors that could be affecting kids, like the types of products we use can be affecting our patients long term. And when I started learning about the alternatives and how I could maybe do a little bit better to help the kiddos be better, I decided to take it upon myself to do so. So the last, I would say five years of my career have been incredible. I feel like I've really been making a huge difference in the patients and my patients and the lives of my community. But also like with my following online, even though it's just small, but you know, we, I do learn a lot of, I do meet a lot of colleagues that are also interested in the same things. So I feel like this new wave is coming of us trying to do root cause oriented treatment to better help our patients, but also with a public health focus, like being the best providers that we can, being able to collaborate with doctors in our communities that can help our patients in a more whole body focused way. So that's my approach and here's where I am now.

I love it. I love it. And we need more providers like you because I feel like there's, you know, when we talk about all of these symptoms that we're seeing and I know I've experienced similar things myself that have thrown me down complete new rabbit holes in my own health healing journey and you know, immune system issues and just all the things it really, between that and then having my own children who were tongue tied. And, you know, I saw some mouth breathing early on. They had tight necks, you know, all the symptoms, struggle to feed, high narrow palates, you know, check, check, ch.

Right.

It really threw me further down a rabbit hole of kind of figuring out, well, where does this all begin? Right. And as a feeding therapist, I know we study, you know, what happens in utero. And I started to go, wait a second, the way that everything's formed in utero. And that basically the swallow that we're going to be born with is established around 12 and a half weeks in utero, based on, you know, what's going on with the tongue and, you know, it's all form and function, but it just started to really open in my eye, my. Open up my eyes. And I kind of went like, okay, hold on, we gotta get. We gotta get to these babies. We gotta start assessing these babies at birth. We've gotta start looking at their oral facial complex, but really looking in the mouth. And I started to really learn that the mouth was our window into our health. And, you know, the rest is history from there. But, yeah, I mean, I would love for you to speak about, you know, I know we have this whole mouth breathing epidemic that's happening right now. Oh, my gosh. I always joke when I'm like teaching that I'm like, go to an airport or a grocery store. I apologize now, because you're never going to look at anybody the same ever again. And I was walking through an airport yesterday, and this woman's mouth was hinged open, and she looked very, like, fit and in shape otherwise. So I was almost like, mind boggled by it. And I was like, if she doesn't have sleep apnea, she has uas. Like, it's just these are the things that go through my brain now. And I'm walking just, you know, you can't walk around without seeing it. But just knowing that it's starting with these younger patients. Are you seeing a lot of mouth breathing and hearing about children snoring and all of these types of symptoms in your practice?

Yeah, absolutely. And it's sad because they've been ignored so long from other providers, like, oh, you're fine. Your child will grow out of it. Everything's going to be okay. You don't have to do anything right now because your kid is like 5 years old. But maybe like when they're 12, you can start working on X, Y and Z, kind of holding things off or keeping people on pause. So it's Interesting that you mention adults because you probably see that. You probably look around and see a lot of adults with these issues. But I see these issues so often in children because that's really what I'm laser focused on, what you said, going to the airport. Then you see that all. Absolutely. You're so true. That's so true. But yeah, mouth breathing is such an epidemic, and I think it's due to epigenetic changes in our jaw structure. Now we're more focused on having. Well, there was the industrialization of food. Processed foods have big become on the rise. Pouches, foods that are very soft. And then eventually our epigenetic changes occur and people are now born with much smaller jaws. I see babies in my practice for concerns about tongue tie. And it's interesting to see that some children, some of these little babies have a lot of these issues with not being able to have deep latches or being able to handle having certain types of bottles because their jaws are so small and the palates are so high and narrow and not always because of ties. So it's interesting to see this because I hadn't seen this in the years before, such a. Such a large volume of this issue in the year before. So epigenetics have definitely changed over time. Um, and I think it's up to us as dentists to. And speech therapists and speeding therapists to really acknowledge the changes in the structures and to refer appropriately and to treat appropriately because there is a lot you can do at a really young age. A lot you can do at a really young age.

Oh, 100%. Yeah. I mean, my, my private practice is primarily pediatric. And then we do see, like adults from IO too. And so we also see exactly what you said with, you know, a lot of mouth breathers. And it's amazing to me too, because, you know, I was very language when I started, like speech and language based when I started in the field. And I went into, like, working with, you know, young pediatrics. Birth to five initially. And I bought that's pretty much where I stayed outside of the myo world, but in the feeding world. And it was just fascinating to me because I had no idea I wasn't trained this way. And so I, you know, then I started to see patterns actually in children who are autistic. And I was like, why do these children all want these softer foods, very bland colors, you know, and then they're struggling to pass bowel. You know, their bowel movements are not regular. They have stomach aches. There's all these digestive issues going on. And, you know, we know that the. The gut is the second brain. So we're like, what's happening here between the entire system? That something is not functioning properly. And I've had all these theories about it, but that really threw me deep into the feeding world. And then when I had my own with a tongue tie and got into the Mayo world, that's where I went like, okay, there's a whole lot more going on here that we really need to dive into, because, like you said, just the epigenetic changes. And anyways, we won't go into the whole, like, autism conversation per se, but it just really made me start to look at patterns, and I started to look at everybody's faces very differently and just so much mouth breathing. These children's mouths that were hinged open, you know, a lot of speech therapists are like, we work in a business where children cough and sneeze in our faces all the time. Whether you're doing speech or feeding, it's like, there's always germs. And these kids mouth, you know, the more severe they are with the speech sound disorders, too, the more their mouth is hinged open, or the more they're drooling or the harder time they have, you know, controlling their tongue and their jaws just hinged open. Their tongue and their jaw work as one unit together for feeding, for speech, at rest. You know, it's really. It's not. It's not a good scenario. And that whole early intervention thing is just so key. But the one thing you said that I really liked was that not all, like, high narrow palates. Right. Are caused by tongue ties. Because I get that all the time. People just kind of assume in my field, you know, if they believe in tongue ties, which is a whole nother conversation, they just assume, oh, there must be a tongue tie. That's why the tongue's on the floor of the mouth, and that's why the palate formed in a high, narrow shape. And I'm going, well, not always. Like, there can be times where we have high, narrow palates that are not, you know, present second to a tongue tie. So I don't know if you want to speak to that a little bit, but you kind of did already. But I think that comes up a lot.

Yeah, absolutely. So, like you, I think it's interesting that you mentioned that some people don't even believe in tongue ties. And it's just there. There's been a huge change in research or there's been a lot of research that shows that there are different classification scales. We have to acknowledge those classification scales and that's how we identify ties. Different ties. Some of them are more towards the front of the tongue, some of them are more towards the mid tongue portion and, and that can help us identify ties. So I urge everybody that's listening to look into like the tongue range of motion ratio scales to look into correlate classification, to look into Cutler classification, because that can help you identify where the frenulum position is. Because it's not always about like looking at the tongue. Can it move side to side, can it move up? And then you're good. There are different ways of looking at like the position of the frenulum that'll help you identify if there's something that needs further evaluation or treatment. And it's not always that you need to have it treated with a laser or scalpel or scissors. Therapy in some cases alongside other treatment options like photobiomodulation can be really, really effective now that we're learning. And that's, I think, where research is shifting and changing. And I think it's really interesting to see how laser technology can help our field. So I'm, I'm really excited about all that. Sorry to diverge, but that's what, that was interesting to me that you mentioned, because it's true. And I think a lot of people, even, you know, even in la, where I think we're really progressive in medicine and we have a lot of great providers in our area. You know, I do sometimes see a lot of doctors that are like, oh, don't worry about it, your kid's fine, he's feeding through the bottle, don't worry about it, you're going to be okay, your kid's going to grow, your kid's going up on the growth chart. So I do still see a lot of that too.

Yeah, yeah. I mean, that was said to me with my own child. Oh, she's on her own growth curve and she was like first percentile across the board. And I was just like, she is on her own growth curve and we are like slowly gaining. But I know that's not an indicator that we want to solely depend on. Like, that's one piece of the puzzle, right? There's many other factors we want to look at. So I love that you speak to both form and function, because I think that there's a lot of people that tend to either just look at function or they just look at structure. And I always tell everyone, like, for it to even be a tie, we need to look at both, we need to be able to assess and diagnose through functional evaluation. Where we're looking at form and structure, right, we're looking at function. There needs to be some sort of functional impact. You know, we've had BAB that have come in that have been released because it appeared that they had a bad tongue type, but they were actually feeding very well and then they were feeding horribly afterwards and they couldn't get back on track. They also weren't prepped properly and we said, you know, I basically told my team and that that wasn't in our practice. We kind of received this case in particular but which was fun and really, you know, then we have, then we get to fix the, fix the issue. So now we are, we're a little bit more conservative where we absolutely refer all the time for consultations to see, you know, what the release provider thinks and if we think we need to proceed with a release. But we're also more cautious to tell parents, like, let's do a little therapy first. Like it's changed over the years, let's do some therapy first because regardless of what happens, whether we need a release or we don't like this therapy is necessary anyways. This is going to help prepare the body for the release of or it's going to help us determine if a release is necessary along with the rest of the team, you know, the functional release provider and everybody else on the team. So yeah, it's really like we've really evolved in our approach over the past five years because I think in the beginning we were like, oh, there's a tie and they're struggling to feed. Just go, go. And then we started to see there was a major difference between the kids getting like the pre op therapy and the ones who were not. So I don't know if you see that as well, but I know you guys are very team based out there.

We do see that. And not, not always can parents do receive all the therapeutic treatments that they need. That's the honest truth. But we see it both ways and absolutely when they have a therapist on their team, it's just a world of a difference. Yeah, yeah. But with, specifically when we're, we're talking about infants, when it comes to ages 3 and up, up, it's less of a time crunch to and up, it's less of a current time crunch and we are able to get therapy indefinitely. But when they're, you know, infants, for example, meet my own kid, I'll tell you, my first child had a Tongue tie. And I put him. Both of them did. But when I put him on the breast immediately, it was so painful. So before my epidural even wore off, I went straight to the office and we treated it. And I had to because I was in so much pain. And I knew that if I were to continue, I would have definitely stopped breastfeeding if I waited. But I will tell you, if I was able to breastfeed and do therapy first, I definitely would have had a much more successful feeding journey thereafter, because my second child, Matisse, who's now a year and a half, he was feeding well, but he still had a tongue tie. So we did two weeks of therapy with my lactation consultants, as well as with two different craniosacral therapists who were amazing. And we did two weeks of therapy and then we treated and, you know, amazing. Just.

Yeah, yeah, I had similar. Similar story, a little bit different, but my first one. So she was 2. When I actually had somebody acknowledge that she had a tongue tie, I actually diagnosed it because I'd come back from my mayo course and was like, I've been to other providers, nobody wanted to help me, but here we are. And so I actually had to go to a couple ents, both of which kind of wrote her off. And then finally an oral surgeon was like, this is one of the most severe tongue ties I've seen. Like, she's. And I, at that point, I was like, yeah, we had 13 months of really painful breastfeeding because I was stubborn and refused to bottle feed her because she couldn't digest the formula. I gave it to her and she screamed bloody murder all night. I was like, I'm never doing that again. And the office was like, oh, she might have. Maybe she's got an allergy or maybe she's just sensitive. Let's give her milk proteins. And I remember my mom and I, we went and picked up the formula and I donated it. I was like, I'm going to breastfeed her. Whether it's through a bottle and pumping or we're going to figure it out. And that was just my own stubborn nature. And I could not get anybody to acknowledge what was going on in her mouth. And I wasn't really trained yet either, but she had her release at 24 months. And then my second one, day five, I texted my oral surgeon. I was like, we're coming in. When can you see us? And so I tried to do a little prep on her as much as I could at that point, but, you know, she didn't have any of the body work at that. And we even put her into PT during her first year because a lot of her issues became more gross motor than feeding. And she was like, dragging one leg behind her. And, you know, again, like, 13 months. I finally found a really great osteopathic doctor who is also pt. And it was a couple, actually, and also a craniosacral therapist. And I took her, like, to both them, like, about 10 days apart. And the kid went from dragging her leg behind her to standing, pulling to stand and walking within, like, a week of seeing them, and then crawled across the couch like, a week later. And I was like, it's all integrating. This is amazing. And my husband's like, who cares if she can crawl? She can walk. I was like, no, no, this is a really important skill. Like, things are crossing midline and integrating. Like, this is important. And so, yeah, I mean, it's. I always say, like, I didn't do anything perfectly. I don't do. I didn't do anything the way that I preach it. I feel like I try to share with parents, you know, there's reality and then there's textbook. Right. And so, you know, do what you can do. But ideally, we always like to see especially, you know, a newborn, if possible. Like, we'll see them for a couple of sessions at minimum and just make sure that their. Their body is prepared and that the parents feel really confident going in or, you know, if the release provider or their team has not already prepped them. So, yeah, so anyways, there's. There's always different scenarios. So I do like that you kind of pointed that out, because it's also not feasible financially, I know, for a lot of families to get all the things. Because a lot of it's not covered, unfortunately.

There's a lot that's covered. And I though luckily all that is covered, so. Yes, yeah.

Yes, it's exactly. It's a combo. It's a combo. And it does depend on, like, where you live and what your insurance is and all that fun stuff. But I want to talk about. All right, so I know we talked about mouth breathing a little bit, but I want to talk about that a bit more because one of the big things that I know, like, I've heard you say and that I've said a lot too, is, like, not to ignore the snore and, you know, to really pay attention to that also, just because maybe they're not. They're not snoring, but they maybe have audible breathing, loud breathing. Like, we shouldn't ignore that either. So I'd love for you to talk a bit about that from your. Your perspective.

Yeah. So the topic of sleep disorder breathing in general is vast, and sleep disorder breathing is kind of like a spectrum. So when we start to notice concerns about sleep disordered breathing, it actually could be very early on in life where we see a child with a tongue, with the tongue down and open mouth posture, a lot of people think, oh, if the mouth is open, they're definitely breathing through the mouth. Not always. Sometimes the child could still be breathing through the nose, but more often than not they'll be breathing through the mouth. And then later on in life, you might start to notice some noisy breathing and that could develop more to pauses and breathing and then later on to snoring and apneas. And it's important not to ignore this when they're in the absence of sickness. So, for example, if a child is sick and they're snoring, or if they're in a car seat and in a really funky position, that's not a good way to acknowledge how they regularly sleep or breathe. But if they're sleeping without being sick in their bed and you're walking in about an hour and a half after they've fallen asleep, because you want to see them when they're in a good sleep cycle and you walked in the room, it's an hour and a half after they've fallen asleep and you're seeing their mouth open, their arch, their back is arched, and their neck is hyperextended. That could be. And they're snoring. That could definitely be a sign that they have something that's impacting their sleeping and breathing. That could be anything from a tongue tie to enlarged tonsils or adenoids. Something going on in the nasal area like a deviated septum or enlarged turbinates, which is what filters and humidifies there and etc. So what it's. What's great about working with an interdisciplinary team is that you can work with all sorts of providers that can acknowledge these different components of sleep disorder breathing. For example, if a child has a tongue tie, you might want to see an airway focused dentist. Or if their tongue is low because the tone of the facial structure is low, you might want to see a functional, functional provider like a myofunctional therapist. If, for example, the tonsils and adenoids are enlarged, you definitely need an ENT on your team. So these are there. There are different components to airway focused treatment. Not one one provider can't do it all. It's usually a few providers that are on the list. But what's really important to note is as children continue to sleep with their mouths open, or breathe with the mouth breathe with the mouth open, what happens is we tend to see something like that we call the cycle of oral dysfunction. And the cycle of oral dysfunction is important because it all starts with, for example, let's say the child having their mouth open and then having tons of tooth decay because they don't have saliva to coat their teeth. And saliva acts as a buffer to neutralize the acid in the mouth to protect the teeth, to prevent tooth decay, to prevent acid breakdown. And if you have your mouth open, you're more than likely going to have a dry mouth that's not going to protect your teeth and cause tooth decay. And then later on in life, we tend to notice a lot of crowding, small jaws and really pulled back lower chins. And that's because as we continue to, to mouth breathe, what happens is that the form follows the function like what you mentioned earlier. And the teeth usually start to grow in around the tongue and where the tongue is located. So if the tongue is consistently low, what happens is that the upper teeth are just going to move wherever they would like to move and likely not in the right place. But when the tongue is up, what happens is that the teeth are going to be formed in that U shaped, that U shaped arch that we would like. So it's not just all about, hey, a child's mouth breathing and it doesn't look good. It's more so what is this doing to the child? Because when they're not breathing through the nose, a lot of other things can happen. And all the viruses and bacteria that are in the air, they just go straight into the airway. They go straight where the tonsils are and then there's inflammation. And the inflammation causes hypertrophy or enlargement of, and that causes a lot of illnesses. So a lot of kids, parents come to me and they're like, gosh, my kid has had this cough or this runny nose or this for so long, I can never catch them on a good day when they're not sick. And I'm like, well, let's figure out why. And it can all start with just a tongue tie or a low tone and later on develop to these other things like we mentioned before.

Yeah. And I, and I feel like this speaks so beautifully to so many of the kids that we see as speech pathologists. You know, whether you're focused just on Speech or you're focused on feeding. A lot of these kids have this presentation and I mentioned it earlier in the episode, but it's like, you know, at one point my really severe speech sound. Kiddos who have a lot going on and sometimes it's just like I can't. We can't seem to correct these sounds. They can't seem to figure out how to put their tongue where it needs to go. Well, they can't breathe. And whether their tongue can or cannot function, we're asking them to do things that biologically right now their body just can't do. It's not going to happen. Or maybe they can do it in isolation, but they start speaking and they need to catch their breath and so everything kind of starts to fall apart. And so I haven't treated speech in a very long time, but that was, I was very deep in the speech world before I got deeper into feeding and myo. And it was just absolutely mind blowing to me that I was never taught this in grad school and that these kids were sitting in front of me and I really had no idea how to help them because drilling sounds and teaching them where to put their tongue was not working. And so it's. Yeah, it all came back to airway. And so I, you know, I love that there are so many providers now that, you know, I've now met and that I've come across that we can collaborate together and really figure out how best to help these children. Because until they can breathe, we can't even address tongue movement and closed mouth posture. And you know, we have to make sure that they can. You know, I always say our two basic functions in life are breathing and eating. If we are struggling to do one or the other, then we kind of have to hit pause and ask why. But first and foremost, breath, breathing, you know, like we need to. The airway needs to be patent. So it's wild.

It is, it is. And it comes to a point where we just had. When you, when you mentioned like research, believing in things. This is. We just got to put the kids first. Like forget. Yeah, yeah, just put the kids first and worry about the, the. I don't want to say the word, but worry about your reputation later because it's not the reputation, but more so what your concern is about the evidence and all that. Because the evidence is showing that we have a lot of research that shows that we have to consider tongue tie and the presentation of disorder breathing and not only tongue tie, but other things as well. So myofunctional therapy, oral facial dysfunction, all of these things play a role in sleep disorder breathing.

Yeah, well, and I know it's true. I've heard also from other colleagues at Guillemano, when he created the whole scale for sleep disorder breathing and or really obstructive sleep apnea, at some point he kind of said, you know, I never intended it for it to be used as like a 0 or a 1 is, like not anything to worry about. Like, no, there is presence and that means we need to address this. And so I've tried to share that on the podcast in the past, that just because you might be mild on a scale doesn't mean that it's, you know, you shouldn't be treated. Which is, I think, how a lot of not so airway centric providers kind of treat that scale. They kind of go, oh, you're mild, you know, you're not really moderate to severe, so you're fine. No, no, we're not fine. You know. And then I think it's really interesting too, because I was diagnosed with UARS a couple years back and I even remember going to my ENT down here and she had heard of it, but she kind of was like, I'm not even sure I fully understand what it is, but she was still willing to like work with me and, you know, take a very airway centric approach to help me because I ended up having my turbinates reduced. My septum was turned like back to the left, which you couldn't really tell when looking at my nose. But you know, because it was very posterior, it was completely blocking the left side. And I honestly, even being in this space, didn't realize how severe it was because my body was compensating. And that was also very mind blowing to me. I also had my nasal spell bodies reduced, which I'd never heard of before. I was like, what are those? And so I'm like, basically I had inflammation coming from the outside in, from the inside out, plus a deviated septum on one side. And then it was like, I was like, let's just go ahead and do the whole thing. Just if you're going in, just do a nose job while we're at it. Because I, in pregnancy, I clearly had sleep disorder breathing, and I developed this big bump in my nose from my kids, so get rid of that. So we did. And she's, she's like a double board certified ENT and facial plastic surgeon. So I was like, you are the person to do this. Let's have fun. And I Will tell you, it's really been amazing because I used to always hear people say, you don't know, like, what you're missing out on until after the treatment, until you're now living a different reality and experiencing something different from what you were so used to. And so going through that myself, I was like, I totally get what they're saying now because I, I couldn't tell you how severely impacted I was before the procedure. My body dropped 10 pounds. All this inflammation just fell off of me like I was sleeping again. It was actually not that I wasn't sleeping, but it's like my sleep was actually restorative, not just, you know, numerical, in numbers of hours anymore. So it was, it was transformational for me. And that's, I think, a big reason too, why I've, I've even preached this more. I'm like, if we can help kids avoid all of this, if we can get in there early and try to avoid some of things that a lot of the adults are dealing with so many years down the road, you know, I feel like we have a big, we're doing a major disservice to children if we're not looking at these things early on. But you know, we all want our kids to succeed and have the easiest life possible. So why are we not, you know, doing all this on the early end of things?

100%. Yeah, absolutely. I, I've had a few patients in the last month that have told me like, I'm here, my kid is one or two or three because my dad passed away from sleep apnea when he was like 47 or 50 or 65. And they have like a deep rooted trauma and their family member passing away because of sleeping up. And like, wow, that hit me hard because. Oh my goodness, I'm so sorry to hear that. That's, that's heartbreaking. Right? And it really brings you back into reality. Like treating early and doing early interceptive treatment can be life changing. Like you said, transformational in the lives of some adults. But imagine these little, little children. Yeah, thanks for bringing that up. That was a beautiful story. Thank you for sharing that.

Yeah, yeah, well. And I know we're almost at the end of our time together today, so is there anything that we haven't talked about? I want you to tell everybody where they can find you or your practices, but anything else you want to share before we wrap up?

If you are a parent that have these concerns and you notice like my child is waking up with like, you, I think everybody should look up the Fair six, which is really, really important if you're a provider or even a parent. I do something interesting in my practice where when they have like a initial consultation with me, I give them something called the fair six. And the fair six is one of the six most. It's the six most statistically significant associations with sleep disorder breathing. Some of the associations include open mouth breathing, something that looks like a tight underneath a tight frenulum which is underneath your tongue, a tongue tie. A lot of parents can't notice it, but they might see some tightness so might give them an indication of like that's interesting. Maybe I should see somebody that's more advanced in this topic so I could get a further assessment. Enlarged tonsils. When you open up your mouth and you look back at your tonsils, you could kind of see if they're large or small. And you could look at those areas right next to the uvula, which is right in that midsection in the back of your throat. And then you could look at the upper jaw and see how the palate appears. Can you another indication is can you sleep with your lips closed for about three minutes or can you just keep your clips closed and breathe through your nose easily for about three minutes? So, and then do you have like a gummy smile when you smile and a lot of teeth grinding? So I want you to kind of as a parent or even a provider look at your patient and see which do I see significance in any, any of these six, six factors? Yes or no. Right. And if you don't know, you can look it up and see like what is teeth grinding teeth look like or what, what do enlarged tonsils look like? And it's so fascinating when I give this to parents and if you're a provider, I highly urge you to do so because it interesting to see a parent have a deep dive and look like I just came here for you to look at my kid's teeth because I could tell she has cavities. But now I'm noticing like you asked me about this and I know it was a medical exam, but I noticed my kid is grinding every single night and it's really severe and her teeth are worn down like that picture on Google or I looked in the back of her throat and those tonsils, they look like big balls in back their throat and it's like, wow, parents can really do deep dives in their children. And they're. I only see children at one point in time, right? You, you'll see the child at one point in time. The Parents are the ones that are seeing their children at night and daytime and noticing their behavior in the morning when they're waking up after bedtime and how they feel more tired or if they have emotional waves very often and what those emotional waves look like. So I always tell families like I'm seeing you right now. So I always tell you what I see in this exact moment. But you're going to be the one that's seeing the child throughout time. So I take everything that you say very much to heart and making my evalu, doing my evaluation and making my recommendations. And it's also important to note that like I can have two kids that look very similar with structure and with, with what you think the treatment options would be needed for a child. But they could be very different in what we recommend because of a child's individual situation. Like some kiddos cannot tolerate like the vitamins and supplements and everything that I recommend. Right. And some kiddos have very, very different diets and oral hygiene and behavior. Right. So I'm going to make different recommendations based on also what you tell me with regards to their behavior. So we have to take into account not only like structure and function like you mentioned, but also environmental things like the child's sense of self and etc. So there's so much to it rather than just like a cut, let's put it that way. There's so much to it. It's multifactorial. The treatment's so multifactorial when it comes to airway focus treatment. And I highly urge everybody to look at the first six because it could really be revolutionary for you as a parent, you as a provider and so much more.

I love that. We will definitely link that in the show notes. I know you also shared a research article that we will link as well that's you know, related to determinants of probable sleep bruxism in a pediatric mixed dentition population. So we'll, we'll link that too because I know like you mentioned, there is research out there and I do think it's important for people to at least be aware of it. And I know sometimes from one article you can scroll to the bottom, find other related articles and start to do your own deep dive. So I think that's really great. But you have a parent parent Airway Academy that I just want you to share really quickly. Where can people, I know they can find you on Instagram Dr. Nora Zaghi, but where else? How do they find information on this Airway Academy?

Yeah, I would say send us a direct message. So we're doing, we did a cohort about, of about three months and it's coming to a close at the end of this month. So the next launch of Parent Airway Academy will be in 2025. And this is a academy for parents that are all over the world because I often get patients that say, hey, I can't come see you. What can I do about this? Well, what we do is we help parents understand airway focused treatment at a very, very basic level, but also build them up to being more advanced in their understanding so that they can help identify things like such as sleep disorder breathing, but also help with nose clearing, help with mouth taping if they decide to decide to do so, if they're eligible, how to acknowledge or understand if their child's eligible for these things like mouth taping when myofunctional therapy would be needed, and so much more.

Amazing. Well, this has been amazing. Thank you so much for joining me. Thank you for your time. And we'll make sure that they they know how to find you on Instagram.

Yes, thank you for having me.

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