Episode 35: Rishita Jaju, DMD, MALD, CLC

Hi and welcome to episode 35 of the Untethered podcast. Today we have Dr. Rashida Jaju joining us. Dr. Rashida is a board certified pediatric dentist and is the founding dentist of Smile Wonders in Reston, Virginia. She completed her dental education at Harvard School of Dental Medicine in Boston, Massachusetts and continued to receive specialty training in pediatric dentistry at Children's National Medical center in Washington, D.C. which where she was appointed as the Chief Resident. She's the only pediatric dentist in the Mid Atlantic region who has achieved Advanced Laser Proficiency certification from the Academy of Laser Dentistry and breastfeeding specialist certification. Dr. Rashida gives back to her profession and patient community. She's selected on the Council of Clinical affairs for American Academy of Pediatric Dentistry and Examination Committee of the American Board of Pediatric Dentistry. Each year, Smile Wonders participates in Give Kids a Smile initiative by American Dental association to provide free care for children of North Virginia. Dr. Rashida loves going home to her husband son, two Maltese puppies, Kaju and Kolfi, and she enjoys traveling all over the world with her family and has visited every continent except Antarctica. 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. Hi, I'm your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your.

Questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space.

I challenge you to keep an open mind and join my mission to get.

This information out to the masses.

Let's get started. Well, Dr. Rashida, I'm so excited to have you on the podcast today. Thank you for joining us.

It's my pleasure. I'm so glad that I was able to finally coordinate this thing. I know we've been working for a little while about this coordination.

Yes, absolutely. So you know, one of the things that I was introduced to was a shared patient working with you way back when. And one of the things I really loved about your approach was the form that you use and your collaboration model with other providers. Can you, can we just dive right in and start talking about that and how you do things in your office?

Sure. So this is perfect. So one of the things that I will tell you. So I have been doing the laser dentistry For a while. And I feel like a lot of the patients that now over time. So initially when I first started, it was more that I had colleagues reaching out to me, hey, you're doing laser dentistry. I have this baby or I have this patient that could use your help. Can you please take care of them? And it was almost very nice because they already were prepared. They already knew what was kind of the impediment, right. And they knew what was the extent of care that they needed. And slowly, over time, and then once I opened my own office, Smile wonders. It's in Reston. You're in the fifth year at this location. I found that in the past 4ish years, there has been a lot more. And it's a happy thing. Like, it's, there's a lot of like a sort of tight turning. I know everybody always in our field talks about there is not much awareness. There is a little bit more awareness. There are more providers, especially with like efforts like yours, you know, there is more awareness, there is more conversation, there are more considerations. And I find that there are patients seeking out, hey, I am having a hard time. Is this tongue tied? Sometimes I find that I have moms that have sort of found me on Facebook or found me on Google or more often than not, my neighbor came here. They had a great experience. So I think, can you just take a look? So I am becoming their first encounter for oral assessment evaluation. And then they're expecting, hey, this person had a tongue tie revised. Their child is doing so much better. But they're seeing them when the child is doing so much better. They're not aware of all the things that might be going on. And I needed to come up with a system to be able to educate these parents to say, hey, yes, there is a problem. And you know, sometimes you have to remember that the child came with the tie. There are, you know, some behavioral things or there are some re. Patterning, relearning, some habits, compensations, things that the child has kind of come up with a system of survival. And now we're going to have to train them that this is a better way. So then I need them to be that I am being the person that's referring them out to say, hey, you need. Also depending on age, if there are babies, a lactation consultant, they're a little bit older. A feeding therapist, a little bit older. Speech pathologist, a little bit older. Myofunctional therapist. And all of these can be, you know, I say older, but myofunctional therapist can come at any age. Feeding therapists might be needed at any age. Usually lactation consultants. Not really beyond six months, but it could be there. Like if depending on what type of problem they're coming in with, what started happening is I would refer them and then they would find a provider, other provider that somebody else had mentioned, either their pediatrician or their, you know, another neighbor or something. And they go to a provider that I'm not aware of, that provider may not necessarily know what all I'm looking for. So I had to come up with like this little form to say, and I think you might have seen it. Is this child ready for frenectomy? And I've actually had providers call me. What do you mean is this child ready? That tells me what experience they have into the field. That gives me a little bit more insight on my form. On one side I have like the whole, you know, please help this parent with blah, blah, blah. And on the other side I have, the provider can fill it out. Is this child ready for phrenicomy? Are they seeing you again? Have you seen compliance with things that are, you know, because a child that is not able to cooperate, pre cooperative sometimes. Right. Like they need help. So cooperation is subjective and you need to, for the parent and the provider to have a good system. And I just kind of felt like if I just said parents then started, I. There was a phase where I felt like the parents were thinking this is an obstacle to go see someone else and then come back to you.

Yeah.

So they would say yeah, we went there, but they didn't really say anything. So then I'm, I'm kind of stuck in the middle because I want to reinforce that, you know, get the right help.

Right, right.

Think that this is just a, it's.

Not a one off procedure and a magical fix to everything. Yeah.

And the thing is, I feel like this has been very, very great way of opening doors and opening communication. So there are, I would say at least four or five different types of providers that I have to collaborate with. Right. So I'd already mentioned lactation consultants, speech pathologists, you know, feeding therapists, myologists, you know, orofacial myologist, because sometimes they have a speech pathologist, but they don't have a myology background.

Right.

So they're not, they are evaluating whether this child can produce certain sounds, but they're not able to help them correct the substitutions or correct the way they are producing the sound. You know. And then on, on the dental side sometimes I have to do like a good collaboration with A sleep dentist or sleep, you know, sleep evaluation or an ent. That's going to help me. Because sometimes there are some tonsils issues and adenoids and things like that in the picture as well. An orthodontist can be, because there is. I mean, you know, the child is older, they have such a narrow palate, they have so much crowding. Their tongue does not have a space to be really even performing. And mom's thinking, this is a tongue tie issue. And I'm like, even if I make this tongue freer, where is it gonna go? You know, an orthodontist and then the biggest piece. And I know we always worry about, hey, the pediatricians didn't pick it up, or, hey, the pediatricians didn't do this. I tend to get a lot of referrals from pediatricians because I would. I mean, I think at least the ones that I'm working so closely with in the Virginia area, they know that I'm not going to go ahead and do it if there is any medical component or medical piece. And many times I find that pediatricians didn't really have this sort of picked up because there were other bigger issues that they were focusing on. And, you know, peds as a field, I feel is more of, like, prevention or curing or addressing disease. So if there is anything that, God forbid there's a fever, for whatever reason, they're gonna be on it. Right? But if there is other things going on, they have that in so much higher priority. That quality of feeds or quality of things is really not as much of a priority for them. So if I have a child that should have been kind of. I'm surprised why the pediatrician didn't have this discussion with you. Then I always go, did you mention this to the pediatrician? Oh, no, no. Our visits were so quick, we didn't even get a chance. But they should have brought that up. And I'm like, you know, so then on the form, you'll see, I will always mention, is there a contraindication for me to do this, which lets the pediatrician communicate to me what they're. Maybe sometimes pediatricians say, you know what? I didn't even think about it, or I didn't even have to talk about this with mom. Or sometimes there is a real contraindication where they were concerned about a heart murmur or they were concerned about something where an exertion or tachycardia and things like that can be a little bit of a concern for any kind of procedure, and parents may not be aware of why they didn't talk about it. So anyway, my long, roundabout answer for your, like, the collaboration.

No, I think that's amazing.

There's.

There's a lot of question about collaboration and I think there's a lot of different models that are used. And I don't think one is always better than another. I think whatever gets the job done and gets the team talking and gets the best patient care to the patients is the one that works right for you.

Perfect. Yeah.

And I loved yours when that first patient that we had shared together, I remember that particular case where the parent was really anxious to get the tongue tie release done and kept coming. And that motivated them to be like, well, can we see? They were like, can we see you more than once a week? I'm like, you don't need to see me more than once a week.

You just need to do the homework.

And it took a while before it did take some time. Time before the child was ready for that frenectomy. I would not sign the paper. And the mom, I think, was getting a little frustrated. But it's a great system because now, you know, you know, yes, we're all in agreement. This child needs it, this child is ready. And we're really doing a major disservice if we just throw a child under, you know, a laser or any procedure.

Without getting them right. So that is, that is the biggest piece that I think what you mentioned right now is the reason I came up with the form is because they go to the provider if I've asked them to, but they're so anxious, so they would just tell me, yeah, we went. Yeah, I know you went, but what about it? You know, And I feel like the form and my colleagues always say it's very empowering to them, using even as an incentive to say, I can't sign off on this unless we have gotten the child and it almost, you know, and all this actually, really, if you, if you. I have two different forms. I have one for babies and I have one for older kiddos. Older kiddos, okay, so on the baby one, I have the specialists that I usually collaborate with that are lactation consultants because sometimes it is a, you know, mom milk supply factor as well. So if mom's goal is exclusively breastfeeding, but mom's milk supply hasn't come in and she does not have a lactation consultant to help her figure out how to get the milk supply up because the baby is not your efficient stimulator. Right. So you need a system to be able to say when do I pump? Do I pump and feed? Do I pump instead of feeding? Do I do skin to skin and, you know, just get this a good relationship going and then we can get the feeding piece in? Or am I getting this child more, you know, preference for bottle? You know, those are those questions that specialists to help you address. If that is your goal, your goal is exclusively breastfeeding. Let's make sure that the specialist in breastfeeding is helping you get to that goal. So the child form, I mean, the baby form has some of that stuff. You know, also, if there is a bodywork component, if there is torticollis and they have not diagnosed torticollis, but in the car seat I see that their head is turned and kind of in a rotational fashion, they're sitting there. And then I ask a mom, hey, do you notice that this is kind of normal? Do you notice this in their career bassinet? Or do you notice this in the car seat all the time? And then inevitably there are so many people that have like their iPhones, right? So they'll like go through and yeah, look, she's looking on that other side. And so then I say, hey, you need to get that. Because it's not a diagnosis of torticollis, but there's a head preference. Tummy time is a hard thing for them, all of those things. And they don't put it together that this will affect post op care. So I have the, you know, the bodyworker component of feeding, therapist component. If they're at that many times I get moms that are, you know, breastfeeding was okay. I was home, I was able to feed every hour, two hours. It was not a problem. It was a bonding experience, which is great. But then I'm super stressed now because my maternity leave is coming to an end and I need the baby to be able to take bottles and. And my husband can't feed them, maybe does not like bottles at all, or cannot handle bottles at all, or coughs on a bottle or takes in so much air, spits up a lot reflux. And now they are coming in with that new finding, right?

Because they're going back to work. So they're on a timeline, right? So they're like, timeline, fix everything fast.

And so to be able to make that a little bit more of like an empowerment for me and empowerment for whoever is helping, I mean, of course you want to keep the timeline in mind, but don't miss the big picture of we need to have the child ready, you need to have the mom ready. You need to plan well, holidays were the perfect example. I want to take care of this because that evening I have a flight, right?

Yeah, we got a lot of that.

No, I don't want, you know, or.

Well, let's do it in the beginning of December because I don't want them to be out for Christmas. And I'm going, guys, there's a four to six week recovery period after this tongue tie release. I don't know what you're talking about, but your child's starting to be in recovery mode.

At least a week. Because the first week is going to be your almost like a reset, right? A resetting. The frequency of exercises is higher. Your, you know, child's gonna be in a little bit more of like a different temperament. Just think about you and me when we get a procedure done. Yeah. The first week is you're trying to understand your mouth, how your energy is.

Going to heal that area. And so you're just kind of zonked out too.

And so sometimes parents don't understand that it is, you know, babies have to readjust to the new system. I think the younger ones, my little, little ones, they love, you know, they do it really quick like that. You see difference really quickly. But they are, you know, also mom, still the infant factor versus maternal factor. I call. So the infant factors are so much easier when the babies are young. Young because they are able to pick up things faster. But then the maternal piece is a little bit higher because, you know, postpartum. Yeah, Just from first hand experience. Postpartum, you know, it's crazy. You know, you are trying to adjust to the whole lack of sleep. Your body has gone through so much change. And it is so in my mind, I always say you have to be ready. Baby has to be ready. And if we are finding that there is something else going on, you have to be ready to get the right help. So I love it when they're. I found you on Facebook. I think there is a tongue tie. Can we do the clip today? Right. But I don't know what else comes with it. And that is where I started finding, you know, what if I do this form, they know that I need to do this, this and this piece before.

Yeah. And I love it. I think that's so helpful and brilliant.

I love it.

And you mentioned a lot of parents call and ask for a clip. So let's talk about that. Let's talk about doing a thorough release versus a clip because I know I refer to you and I know you do thorough Releases.

But we know there's a lot of.

People who just do clips. Clips, I understand.

So, you know, a clip is the term that came, was brought up because historically we were looking at tongue ties as a tip of the tongue being tied down. And you can see a visible string or a membrane. Right. So if you are just somebody that is looking for just an anatomical landmark and you want to remove that membrane that's holding the tip of the tongue down, that's where you are doing a clip. And most likely, usually with a clip, you're using either a scalpel or sutures or I mean, scalpel or scissors or something like that. So that's where the clip comes in. And then when we talk about a thorough release, it is, you know, the analogy of like a string that is there versus a sheet that or a membrane that's like wider and goes further deeper. So the anterior one third of the tongue, which is closer to the lip, the middle one third of the tongue, that's closer. When I explained to parents, closer to where like the molars, the baby molars are, and then the posterior one third includes the middle, but towards the throat, like towards the, you know, where the swallow needs to happen if that tongue cannot do the entire wave. And I ask all my parents to swallow when I'm talking with them. If you swallow, you will see that the front part of the tongue has to elevate. The middle portion of the tongue has to elevate, reach the roof of the mouth, which is the palate, kind of squeeze, create that negative pressure, create that little wave. And then the posterior component, which is kind of close to the soft palate, has to contract on itself or contract with the soft palate to get that bolus of saliva or bolus of milk or whatever food to go in like a little rhythmic fashion near front, middle, back, front, middle, back. When we do the clip, we are allowing the front part of the tongue to at least do its like projectile, send the bolus back. When we don't have a thorough release, we are not allowing the tongue to do the nice wave. So if you just take care of the anterior portion of the tongue, then it is easier for a child, of course, but it is still that they have to rely on the jaw and the tongue to compress rather than that soft tissue or the tongue muscle to do its compression or squeezing or swallowing. So those are the kiddos that come in where the parents or moms are complaining. Well, initially she was just not even able to open really wide the anterior part to the clipping helped, but then after a few days, it still didn't work because, you know, they're getting bruises or they're getting compressions on their breast or they're squeezing the bottle nipple and they're relying on chomping, parents say biting, chomping, crushing, all kinds of, you know, just imagine something really sharp. So the thorough release part comes in where you're not just looking at the interior component, where the membrane is. You're actually trying to see if there is that attachment that's going on the sides of the muscle that attaches to the floor of the mouth. There could be a deeper part. Now, if you're using scissors, you have to be that much more skilled at not only stabilizing the child, but also trying to make sure that you are not interfering with the muscle fibers and you're just going for that connective tissue component. So inevitably what ends up happening is when you're clipping because you want to stay away from muscle fibers, you end up being a little more gingerly, a little further, I mean, little less deep. Right. With a laser especially, I find that with the water laser because it is based on water and light energy. If a baby is moving, they're just getting splashed with a little bit of water, like a drop or so. So it's that much safer. In my hands, I can see it releases few microns at a time, and so I can actually see where the fibers are. Also, if the settings are set up in a, you know, nice way, you can tell that it is so much lower than what a muscle fiber is going to be released at all. It's almost like you have, you have to know how to set up the settings for the type of tissue and things like that as well. And there's a whole component of tissue biotype, what type of, how much laser energy to use for what type of tissue. And so for if I'm trying to release connective tissue vs I'm trying to release muscle fiber vs if I'm trying to remove a fibroma on a child, or I'm trying to remove, or I'm working on a cavity, there is different levels that you can have the laser setting on and, you know, the skill level comes into play. So the thorough release is where you have been able to visualize and you have been able to do a digital assessment or you have been able to do a motor function assessment to say, I can have this tongue muscle do what it needs to do completely rather than just the tip of the tongue being released.

And I love how you explain that because, you know, I think you make it really simple for parents to, one try to do this themselves and see, and I'm sure you probably get some parents who go, well, I can't do that. And then you're like, well, hold on, let me look in your mouth too.

I know I go out of my way to not, like, diagnose parents.

Right? Right now I always have parents go.

Do I have a tongue tie?

And I'm like, this is not an eval for you at the moment.

So one of the other things along those lines, I always get parents who are like, I think I have a tongue tie and I have been fine all this time. And I go, great. So you know your definition of fine. Okay. And if you think that you have been able to compensate so well, there are inevitably things that you can come up with that you have to do as workarounds. And many times I will have moms go, I cannot swallow pills. Or I've always had to make some kind of an accommodation, you know, so if I eat certain textured foods, I have to cut them really small. Or, oh, I have history of getting a lot of orthodontics done. Or, you know, things that I try not to say, hey, these are all wrong. But these are all the things that you've had to work around. You want your baby to do the same thing, especially if you're aware of the problem with you. You were not aware of the problem. But now let's discuss is that definition of fine. Right? Right. And then sometimes the spouse will say, hey, but I hear you snore a lot. Or I hear you sometimes have to manage your saliva or sometimes you have to swallow before you say the next word. And all of those things, the fluency, the velocity, the freak that, you know, all the fine quality things of speech or eating right, they're not. They are not.

That's fine for you now as an adult because you've compensated your whole life and you don't really want to go down a road of orthodontic work and.

It'S tongue tied at least.

Okay, great. That's.

You're an adult.

You get to make that choice. However, do you, like you're saying, do you want to put your child through this, knowing all these things are related and tie back to your tie?

Do you want to.

But if we know that there is.

A potential, you know, correlation. And then I always say, you know, I have been doing this for all this time. I have worked with so many colleagues. I have learned so much about other fields. So I can say, hey, yeah, this has a piece where it can be connected. However, as a dental student, I have no idea about these things. As a dental student or even as a resident, I don't think we had as much. And one of the examples I give is my first sort of introduction or first recognition how important hard palate, soft palate junction is and how important a good seal is. Came at an operation smile trip. So I went for a mission and it was in Vietnam. It was a dental mission. I was a second year resident and it was. This is the funniest thing. There were so many kids. So this is a cleft lip and pellet mission. And I go as I went as their dentist on team. And most of the times I had two big groups of patients, patients who had teeth that are going to be in the way of the pellet fix, like the palate repair. And I have to extract those teeth or take care of them. I was not really there to take care of like fillings and things like that because just we just have too many patients. And the goal was to like this was a medical mission. It was on the. And then the other, the group of patients that I got was their palate was too wide or the, the defect was too wide to be able to just do it as a part of the mission. So they needed say like a NAM appliance or something to bring this segments together. Or they were before they do the repair or they were much older. So now one of the things was this child that I was seeing. I say child, but they were 19. They were there because they had a nice big gap every time they would eat, things would go into their nose. And now their parents were wanting to get them married and she was not able to get married. And the parents were there to see if we can figure out something right away because, you know, get her married. So she became my patient because it was too wide of a. Too wide of a thing and too complex of an issue. So we would make an obturator or like a little denture plate that covers it. I made the best in my mind a denture plate that was nice and wide, nice and long, nice and thick. So that it was going to be this really, really durable piece that I, once I leave from my mission, I don't want it to break at all. Well, the beginning of the mission we made that plate and everything. And then at the end when I was doing follow up, they said, oh, she can't use it. Oh, why can't she Use it? Oh, she uses it. But when she's eating, she takes it out. So the whole point was to help her during eating. Right. Like, so it doesn't go in her nose. So I'm trying to figure out what happened and why. And there's like this language barrier and things like that. Right. Turns out it was too thick, too long, too wide. So the speech pathology people on the team, they were like, well, it's going beyond the hard and soft palate junction. So she's gagging on the plate. When she's trying to swallow, it's too thick. So the tongue is not really able to have enough room to really, you know, make that enough to follow the food in her mouth or, you know, manipulate the food in her mouth. And it was too wide. So her, you know, I was trying to see if I can make it wide enough to go right around that little defect. Eye opening experience. Right. Because it was the best way for me to understand the mechanics of a swallow.

Yeah.

Not everybody has that kind of experience. Right. So we rely as a field. So I'm sure my colleagues, when I talk about this, they're like, yeah. And so when I first. Sorry, it's my dogs. Okay. So anyway, I think that different people come to this road, this journey in different ways. I told you, my son, I have a son that is 11 months old. Last year, I was beside myself when I. Within 24 hours, he lost more than 11% of his weight. And you know, I am one of these mommies that I feel like I know, I know the right people to help me. I, you know, I'm sort of my informed parent. Right. I tell you, I felt so, so vulnerable. Right. You are in that space. There are providers that are trying to tell you, you are, you have to feed your child. He's not gaining weight. I want to breastfeed. The lactation consultants were not available at the hospital that day. They had a very busy weekend, apparently, or busy time. And they were not able to come. Of course they give him formula, they do the wait. And then, so the third day, actually, I get a lactation consultant to come and they give me a pump and we get 18ml from one and 15ml from the other side. And then they're like, well, I guess your supply is not the concern. Maybe it was the difference in like the scale from the or to the nursery because he seems to be doing fine. I mean, he had wet diapers, he was doing okay. But to me, I just felt like, oh, my gosh, what Am I missing? And I feel like if the right people are not there at the right time, just like when I was treating that child, if the speech pathologists were not there at the right time for my own baby, if the lactation consultants are not there at the right time, you don't know what you don't know. I know we kind of focused a little bit more on collaboration in this one and maybe we can talk about the different types of lasers and things like that that you asked me another time. But I cannot tell you how much I appreciate different fields over time and over working with experience with the kiddo and not really just treating a site, I'm treating a child, I'm treating them for long term outcomes rather than just a procedure. So I know we went a little bit roundabout.

Well, you know, my first one was born with a tongue tie and everyone told me, no, she's fine. And as a speech pathologist who wasn't really trained in that four and a half years ago, I was a feeding therapist, but I wasn't working with infants. I was working with the kids as they transitioned to solids. And I wasn't looking for tongue ties. I'm the first one to tell you I was not looking for tongue tie. Not even in those 12 month olds or those nine month olds who would not transition. I was getting on the tail end after they were kind of done with lactation. And so I wasn't working with lactation back then. But then the second that I popped out that second baby, I was like, oh, yep, there it is again. I can feel it. I don't need to see it, I can feel it. And I was beside myself because, you know, I was like, I'm not looking for 24 hours. I was like, I'm not looking because I know the answer. And I'm just gonna be in bliss for 24 hours and pretend like my child, my second child, does not also have a tongue tie. You know, not that it's the end all be all or the end of the world, because if you get it early, like she's doing phenomenal and we've done a lot of body work with her and you know, she has zero weight issues or anything. My first one, yeah, my first one was never even to this day. It may not be over the fifth percentile, but she was usually about the first percentile. And like, you know, but the doctor would say, oh, but she's on her own growth chart. But she was that baby who was 45 minutes to feed and you know, every single time, very painful. 13 months of painful breastfeeding. And every time I took her to the lactation consultant, it was like taking your car to the dealership, where I'm like, no, this happens.

And you go.

And they put the baby on the breast and they're like, she looks great and she has a great feed and she transfers milk. And I'm like, in 15 minutes. And I'm like, you understand? This never happens outside of the office. And it can't just be a positioning thing.

I was so frustrated. Let me tell you, one of the things that I also realized is when you are taking your baby to the lactation consultant, that means that you have had that much time where the baby hasn't fed, right? You have gotten yourself ready, you've gotten the baby ready. They're sleeping, they got the car ride. They get there, they're motivated, they're hungry, they're in a different space. But when you are home and you know, you are feeding, it's. It's different location, different positioning and things like that, right? So I always ask parents who tell me, but they. We went to the lactation consultant, they said it was fine. And I said, okay, so how long was it prior? Like, how long was the interval between your feed, last feed and your feed? At the lactation consultant, I also asked, did the baby do the things that they were supposed to? Like what you normally do? Did how many modifications did you do to be in that space?

Well, and also my question too is, did they do an oral motor assessment on the baby? Exactly. Yeah.

Beautiful. So I always say, did they look or did they feel right? You can, nine out of the 10 times, you can feel the dysfunction. You know, you may not be able to see it, but you can feel that there is a problem. Now, the other piece is you have to figure out what I'm feeling. Is this a surgical issue or a therapeutic issue? And that takes some experience. And we can go into how to differentiate those things as a conversation as well. But when somebody says, can you. Can the baby stick their tongue out? Or is there weight loss? If those are the two things for litmus test, that means they are only looking for what has completely failed, Right? The parents have not been able to compensate. The parents have not been able to up the frequency of feeds. They have not been able to hold the bottle in a certain way. They have not been able to supplement with formula. They've not been able to get the right help because weight loss should be the last thing that happens. I mean, you have not been able to pick up on helping this child in so many different ways for weight loss to happen, Right? And then it is almost like looking for. If our system was to give help to students only if they're failing in class, that's what it means.

That actually is, I think, how the school approaches it sometimes. So I feel like we're in a failing society. That's a whole different discussion.

But this was.

The issue with Lily, too, is she lost weight before we left the hospital, and they had said, you need to come to the pediatrician's office tomorrow. And here I am like, new mom leaving the hospital. And I'm like, I can barely walk. You want me to bring my child tomorrow to the pediatrician's office? And then we go in and they're like, okay, you need to come back tomorrow again. And then they're like, okay, now you need to come back two days from now. And I was like, can I just buy a, you know, a scale and weigh my child at home? Like, nobody's. You know, I know they were trying to help, and I know they need to monitor the weight, but it was, you know, I know. No, no fault of the pediatrician, but I was like, this is horrible for a new mom to have to go through this and have to leave the house to bring the baby in every single day.

And you're not giving me any tools.

Or useful information to help me other than, here, pop some formula in your baby's mouth and see if this works. Which didn't work for my child because she was up screaming in the middle of the night. And then I was crying and bawling my eyes up to my mom because I'm like, I think she's allergic to milk. Like, I think she's allergic to dairy because she's. I mean, it was like blood curdling, screams, like somebody was hurting her. And I was like, I am not feeding her formula again. And I called them and told them, and they said, oh, well, Similac has three milk proteins. Why don't you try this one? The gentle. The gentle. Whatever it was Gentalese or Gerber, I don't know, something that only has one milk protein. And I'm going, I just told you, I think my baby has a dairy allergy, but you want me to give her more dairy?

I don't understand.

And I was like, I will come into the office, but I am done. I'm done feeding her formula. We need another solution. And I think just me being that really stubborn human being that I am, I was like, no, I'm not feeding my child formula. Give me another solution. Right.

You know, when they tell you, come Tomorrow, come in 24 hours, we'll weigh you again, do this. I am so surprised that they don't say, get a lactation consultant that can help you do a weighted feed. Do you have enough supply? Do you. You know what I mean? Like, help yourself. So what if you did not have enough supply altogether and that's why the baby was having a hard time? You're gonna need to do formula, but you have to know why. Right? Like, it is not wrong. It is just. Is that the right answer? Is the question? Yeah.

And I had a pump. And I was like, I will pump and bottle feed my baby my own milk, and I will control what I eat. And I will. You know, I was so anal. And thankfully, I also went down the rabbit hole of doing the research and figuring things out myself, but I know that's not possible for everybody. And I'm also. I was a feeding therapist, so I wasn't working with infants, but I at least had the background and the knowledge of understanding normal development mechanics and development. Exactly. And if you have that information, it's a little bit easier, you know? Although I say you become a parent and everything, you know, just goes out the window. So there's that issue, too.

That is true. The funniest part was, you know, the littlest thing. So if you've met my husband, you will see he is the most, like, non dental, non medical. You know, before we had the baby, there was a very good demarcation between. And we're both LEOs, and it is more like the territory. Right. Like, anything medical, dental, you should know and you take care of, and anything that is like house, mortgage, finance, blah, blah, you know?

Yeah. That's like, taking care of it.

And you should see how almost like a role reversal that kind of happened during the postpartum days where I. The littlest thing, I was kind of like, am I seeing this or is this real? Right? Like, am I.

Am I overthinking this? Because I know too much.

Yeah. And I almost. And honestly, in the hospital, I was like, I don't want my name. Like, don't recognize me.

Right.

I don't know anything. Just tell me everything. You know what I mean? Like, just tell me what.

Let me be Mom.

Let me be Mom.

Right?

And I think I took, like, a couple of weeks and, you know, I had a lactation consultant come to me, and, you know, we. We were at that place and she was talking to Me and she. I've worked with her so often, and I love her. She was amazing. And then she goes, rashida, you know, these are the babies we refer to you, right? I was like the classic mom that I treat, Right.

I have my blinders on right now. Hold on.

And it was just the funniest thing. She had to say it, like, a few times. My office team, my lactation, my team, that helps me. So, Dr. Rashida, when are we going to see you? What's going on? And it was the hardest, hardest decision to say, you know. Yeah. And to me, to this day, I feel like I sort of consider myself an informed mommy. And if it was that difficult for me, think about all the moms that are not in the field or not so informed. And if we can do anything to make it so that it is not that big a concern, like, I don't want to make it like, it should not be a concern. It should be a concern. It's a procedure. Your child is having a hard time. But if all of us are on the same page with helping different specialties, all the people, they say, you know, if I was just being a pediatric dentist, and I was just like, age one visit, there are up to 33 times that a baby sees a health care provider before age one visit. Wow. Okay. And when I teach the pediatrics residents or when I'm teaching, you know, doing continuing education for pediatricians and things like that on oral health development and stuff, I had to find out, like, how am I going to make it so that they make oral health a part of their exam? And I was going through the list of things that they have to check off, check off, check off, check off as, like, review of systems and things like that. And they have 15 minutes to do this. And I'm telling them, you should do an oral health assessment.

And they're looking at you like you have five heads.

I was like, so, you know, when.

They'Re starting to talk about, like, whole.

Fluoride and Carrie's risk assessment or Carrie's risk factors, and now we're talking about feeding and, you know, whether it is a tongue tie versus a, you know, torticollis or a bodywork issue or quality, and if mom is having a hard time, but baby is gaining weight, okay. The pediatricians are going, what's the problem here? Yeah. So I feel like understanding other. Other fields made me a lot more tolerant about.

Okay.

And I made me ask the right question. So when somebody comes in complaining that somebody hadn't helped them, then I Go, did this happen in this manner or did you bring this up? Or do they know that you were having to do this or.

Yes, I think that's a really great point because I think that parents expect that they're going to be asked a variety of questions. And while there are a lot of questions that you're asked, and I don't know about you, but whenever I've gone to the pediatrician, we fill out questionnaires before we go into the pediatrician and they are reviewing that at various stages of development. But feeding is usually a very small component of that. So I think you make a very valid point that parents just kind of assume, well, they didn't ask me that. Nobody ever has asked me. Nobody ever looked under the tongue. Okay, well, did you mention that you were having an issue? Because if you didn't, why would that, you know. So I think that's a very, very valid point.

One of the jokes I have with parents is they are looking over the tongue, right? They're looking for tonsils, they're not looking under the tongue, so they never noticed it. But if they're looking on top of the tongue, it's a valid point. I mean, sometimes when I'm talking to my pediatrician colleagues, I go, can you look under please? But at the same time, I think keeping the collegiality or the camaraderie of it is to kind of let parents understand every field or every person is looking through their own specialty sort of filters. So when I speak with parents, I'm giving them that little bit of a reassurance. That doesn't mean that the provider is completely not able to help you in other parts parts of your child's development and life. But this may not be their specialty or this may not be on their radar. When I talk with my colleagues, I go, I think it's incumbent upon us to find out if our patient is having a hard time with something. Isn't it our sort of responsibility ethically to help them? If you cannot be the answer, help them, refer them. And then if they choose not to, or if they're saying it is not that big a deal, it is at least the parents choice. It is our responsibility because sometimes we are not the answer. Or I'm not sure if I can help you, but I am sure. Bring, why don't you bring this up? And sometimes I say, why don't you bring this up with your pediatrician? Or why don't you seek out a help from. You know, there are some benign things sometimes that Parents mention. And I feel like it may be benign to me because I am so used to seeing so much more severe things. Right. But this is affecting their life for them to be able to. So I sometimes have to keep that in my mind as well. I am not your answer, but I will. I don't want to be the person. One more provider that dismissed your concern.

These are so much more compassionate.

Can you also. Are you. Now that you've gone through this as a mom, you understand. I mean, I think that's also why a lot of my patients and families relate so well to me, is because I had a child where it was missed and very painful breastfeeding. And I had just, you know, when I look back at it, and even they actually almost delivered her early because they said her waist was so tiny that all of the nutrients from my umbilical cord was going to her brain. And they were concerned about her gut. And then they. So they were monitoring her very closely. And, you know, at the end of the pregnancy, they said, okay.

She.

She seems to be okay. So, I mean, it started in utero. And tongue ties are developmental.

They're there from the moment, you know.

We kind of joke, from the moment conception happens, that tongue tie is in place. So, you know, it's. It's interesting because I have that experience that I can relate to a lot of glimmers with. And I can also relate to now having a second child where on day five, the tongue tie was released. And while we still did some body work to be more, you know, because she did have a side preference and nobody officially diagnosed her with torticollis. But call it what you want to call it. Two very different experiences with children who had tongue ties. And I had one as an adult, and I had mine released after I had Mia because I was like, I'm not going to go through this procedure while I'm pregnant. Let me deliver the baby first and then we'll. We'll do it. But, you know, so now I've had the experience as an adult. So to. And I'm actually going through, you know, dental expansion and, you know, all this fun stuff. So I think I can relate to my families on many, many levels. And that's why I get along with them so well.

Yeah. And it's, you know, what they're going through, logistical and sort of financial awareness and so educational piece has to be there, like managing their schedule, big child schedule, work schedule, schedule. But getting all the right help. It's hard, right? It is.

It's hard I mean, especially living in where we live in the DMV area, everybody's already over scheduled. There's a lot of dual working families. You know, there's, it's, it's in traffic right here is horrible.

So when you add all those extra.

Factors, then nobody wants that time of.

What time of day it is makes a big difference in the whole experience as well.

And then if it snows like it did yesterday, it doesn't matter what time it is because you can't get home.

No matter what you're done. One of the things that I also wanted to bring up and you know, I feel like I would forget it if we didn't, is, you know, each field there is a little bit of a tide turning that needs to happen before something becomes a part of standard of care. Yes. Right. So, you know, dentists have always had dental examination as a part of their standard of care. I think in the last 10 years, oral health versus dental health has definitely become a little bit more of a, you know, is it incumbent upon us to make sure that the oral health is good? So, you know, you could have had your child 5, 10 years, 5 years ago or so, and the same provider may not be as aware or as much looking into something versus now that same provider might be a little bit more open to it. Yeah. Experience, of course, has a lot to do with it. You want to go to more experienced providers. They have been doing it for a while, this, that and the other. But I also feel like you might run into more providers these days that are more at least open to it. Yes, right. Like there are more. Even within our careers in the last few years that we've talked about, there have been, you know, more providers that have now become like, I never looked for it, like you said.

Right.

I never looked for it, but now I know to look for it. And then when you've gone through it yourself, it makes you that much more sympathetic of the parents and you're that much more able to relate and able to be humbled almost by it to say, hey, I can't believe that this is something that I could have helped, but I didn't, you know, and I went through that experience 12 years ago. Some people are going through that experience now. Right. So one of the things that I think that has come around is aapd, the American Academy of Pediatric Dentistry, used to really focus on the caries burden, meaning the cavity burden of the society. Right. Like, how can we help these kids that have dental decay and they're having difficult time I think our AAPD has now also, over the past few years, sorry, I'm a little congested, but has also evolved to really open themselves to more modalities, more sort of conservative care rather than deferred. I call it not ignored but deferred care. Because I think sometimes it is not. Right now is the answer for many of the. Many of these things because I don't have the right tools for you right now, you know, So I think one of the reasons. So I am a part of the Council of Clinical affairs of the Academy of Pediatric Dentistry. And I have seen as a group, we have sort of evolved as well because we are more open to the different modalities of care. There is a whole. So a reference manual which is considered the go to for many of the pediatric health, pediatric health, or guidelines for pediatric care is now has a piece where it talks about the different types of lasers, different types of applications of lasers, different types of, you know, trainings and things like that that you should be considering without just, hey, I got this laser. I can do this. I'm more aware of it. I'm just trying to do it, get some experience, get some training and then do it. And then there, just recently, there is also a new document that's actually separated out from just oral surgery. So pediatric oral surgery and other parts, which included all the pathologies and things like that, frenulum assessment, treatment, things like that. It is not the most detailed or does not talk about all the assessments and things like that because we are still in that phase where we are still trying to come up with a standard. Right? I know there are many providers. And I was helping Dr. Ryan, Phil, Dr. James Ryan is in our area, and I was helping him with some of the surveys that he was doing. There were a few providers that he had kind of recruited to be able to help him do the Delphi study. And then there are some other providers all over the country that all of us are trying to come up with the same system that, hey, you are finding this. How much of it is. You've come up with this system because you found your parents are able to do this better versus how much of it is truly is this child, like anatomically is the standard versus the, you know, compliance behavior, this and that. There is a document that actually at least addresses the frenulum and impairment and so many parts of contribution, so many phases in life where it contributes. Feeding as a baby, breastfeeding as they grow older, maybe bottle feeding as they grow older, managing purees or textured Foods, table foods, you know, as they grow even a little bit more, you can even kind of try to figure out whether that has that the sleep association or sleep pattern, sleep component to it. And that sleep kind of is all over as they grow. Right. Every phase, we have to kind of evaluate that. And then the speech aspect comes into play. I think that by the time the speech aspect comes into play, it's a whole different patient compared to the babies. Right. But now pediatrics, pediatric dentistry is exploring that, or at least acknowledging that this is something that we need to be aware of. We need to be able to bring up with our patients and not necessarily just focus on, are there cavities? Are you flossing, Are you brushing? Yeah.

And I think that's great. I mean, everyone and everything has to start somewhere. And so I'm super excited to hear about the document, even if it's not the most detailed, thorough. You know, that's okay. Because the more that we get this in front of other pediatric dentists, I keep joking that our pediatric dentists are going to be like our pediatricians 10 years down the road. Because everything starts in the mouth.

Yes, everything starts in the mouth. People don't really understand that. You don't just look at, oh, dentist. And then everything else, because I think the pediatric dentist is going to be. Just recently, I had a whole discussion with parents about sleep. And at what age do you let the child sleep in their own crib? And you sleep, and the parents are like, you know, my husband and I have not slept together because we're in the baby's room and this and that. And I'm like, really? A little bit outside my school. But the way this is really a problem for me is whoever sleeps with the baby at night is giving them a bottle every time baby wakes up. So, no, can we figure this out? And it was the funniest thing because my team was like, should we talk about, like, having, like, 10, 15 minutes added to some of those appointments? Because now you're having a sleep discussion. Like, how long can our, like, exam or consults go?

Right.

So anyway, was there any other, Like.

I think we covered a lot. We can always schedule another recording sometime and chat some more. But no, I think we touched on a lot today. This was amazing. Thank you so, so much, Dr. Rashida. I loved all the topics that we talked about.

You're welcome. I'm glad. I know that you know, and we were joking about this in the beginning. I think this topic is definitely so huge.

Yes.

Pediatric dentistry and oral health is definitely a vast topic. So we can take a piece of it and then focus on more detail in each of those components. I am glad that we talked a little bit more about collaboration. I can go into a little bit more about, like, if you were coming to our office, what are the steps? I am having one of my assistants help me sort of, you know, come up with like a little bit of a roadmap of if you're trying to get help. These are the things that you should be looking for as a little document. And it'll be on our website and then I'm trying to share your website.

We'll share that in the show Notes.

Too, so they can access your website.

And maybe if we can add the AAPD document there too.

I think I shared the link to that document with you. And then there. There are little videos that we have tried to make. They're not the most professionally made because they are what I made on, like Windows Media Player. And I'll definitely try to get some professional help to, you know, make them.

More videos better than no video.

So I love it. There are some videos that on our YouTube page, that way parents can be like, what is the procedure look like? What is posterior tongue tie? Or what is the expectation for home care? Or what are some of the myology exercises that children might be wanting to do outside of what your oral myologist might be telling you? Or focus in on some of the more specific ones. So we can definitely have a call. I mean, another meeting or zoom meeting.

I would love that.

Sure. Well, thank you.

Thank you. It's been amazing.

Have a wonderful day. You too. Thank you, Holly. Bye.

Bye. Thanks for listening to this podcast.

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