Hi,
Hi everyone, and welcome back to Airway First, the podcast from the Children's Airway First
Foundation.
I'm your host, Rebecca St. James.
My guest today is Courtney Robertson, a dedicated registered dental hygienist with over 11 years
of experience.
In recent years, she's honed her expertise in oral-facial myofunctional therapy, a passion
she pursued in her hometown of Ottawa, Ontario, where she has proudly established one of the
pioneering independent myofunctional therapy practices in the city.
Her journey into myofunctional therapy is deeply personal, as both she and her children
have faced their own challenges with airway and myofunctional issues.
It's this personal connection that fuels her commitment to helping others overcome similar
obstacles.
From her base in Ottawa, Courtney's had the privilege of virtually assisting patients
across Canada, the United States, the UK, and Australia.
Additionally, she does maintain an in-person clinic for her local patients in Ottawa.
She collaborates closely with airway-focused dentists and orthodontists, working with both
children and adults.
Her particular passion lies in fostering children's airway health and guiding optimal
jaw development to ensure a brighter, healthier future.
You can find out more about Courtney at archwaymyo.com.
And now let's jump into my interview with today's guest, Courtney Robertson.
I thank you so much for joining us today, Courtney.
Thank you for having me.
I love what you're doing with the Children's Airway First Foundation.
I think it's so great that you're bringing so much awareness to airway health and myofunctional
issues in kids.
A lot of parents don't know where to go, so it's a nice resource to direct them to.
Thank you so much.
I appreciate that.
Yeah, that's our goal is just to get the information out there and try to support parents
any way we can.
So thank you for that.
So let's go ahead and start our conversation with just a little bit more about you and
your journey.
So for anyone that hasn't already read your blogs, I know you do explain it on your blog.
Let's just go ahead and talk about what it was that drew you into the profession of myofunctional
therapy.
Yes.
Okay.
So I am a registered dental hygienist.
I've been now a dental hygienist for over 11 years, and I'm based in Ontario, Canada,
and I'm not sure what the dental hygiene training is like everywhere, but I know for myself
I did not learn about airway issues, sleep, very much about tongue ties or myofunctional
therapy in my hygiene training.
So I feel like I went through a lot of my...
We hear that a lot.
Yes, yeah.
I'm hoping that that's starting to change, and I'm hearing that that's starting to change,
which is really great.
But I was seven, eight years into my career of dental hygiene in a pretty busy and modern
practice without really knowing much about this.
So I first learned about myofunctional therapy when I was on maternity leave with my second
child.
So my daughter, she's now four.
So back in 2019, I was listening to podcasts on my walks, and I came across a dental hygiene
podcast episode, and the speaker was Sarah Hornsby.
She's a well-known myofunctional therapist in this field, and it was a four-part series,
I remember, because I listened to it so many times, and it just totally opened up my world
to myofunctional therapy.
And initially, I was thinking about my own kids, my baby at the time and my toddler at
the time, my toddler especially, was showing a lot of he still wasn't sleeping through
the 90s, and we had a really difficult breastfeeding journey and all of that.
So looking at helping them and then realizing, oh my gosh, myself as an adult, I am still
suffering from all of these issues and discovered I had a tongue tie that I never knew about,
which seemed kind of embarrassing as a dental hygienist that I felt like I did a lot of
continuing education.
So it really started with a personal journey.
I took in all the free content that I could.
I ended up enrolling in Sarah Hornsby's myo-metre program and treating myself and family first,
but then I, you know, it's been such a positive thing for myself and my family that I founded
my independent myofunctional therapy practice in 2021.
I think I'm one of the first independent myo practices in Ottawa where I live.
But I have treated patients from across Canada, the United States, the UK, and Australia so
far just because I do have, you know, a virtual practice as well that helps me reach more
people.
Which I really love.
That was one of the things that drew me to you when I first ran into you on Instagram
and then started digging around a little bit more.
I haven't seen another solely virtual practice out there.
And one of the things I do love is you can reach so many more people this way.
So what is it like doing it virtually, you know, as a parent, you know, what should I
expect?
I bring my child to you.
What is that like as a virtual relationship versus, you know, if I were to take my child
to you in person?
Well, so things have evolved over time.
So in the last two years, I mean, when I started, there was, it was COVID times first of all.
So I'm trying to do my job with all of the PPE and everything was not really realistic.
Also not so long ago, it doesn't sound very long ago, but two years ago, there was a lot
less awareness in my area.
So I was getting less local referral.
There was less awareness in our area.
So it was more natural for me to start online and have more reach and use social media to
grow my practice.
So I did get really comfortable with the online stuff.
Usually what I'll do when I work with someone solely online is I'll send them intake forms,
a request for photo uploads.
So I send them a template that I use to get certain views that I need.
And then we'll do a video parent consult first to kind of go over the intake.
I help to connect the dots for them on some of the symptoms that they're seeing.
And we review the photos together and I share some things that I see through my unique lens
of, you know, signs of red flags in those photos.
And if we feel like it's the right fit, we'll do a video functional assessment where we
keep it light and fun for the child.
I really only need to be able to see from the collarbones up when I'm doing an oral
facial myofunctional assessment.
Now mind you, things like I said, have evolved over time and the awareness has grown quite
a bit.
I have lots of amazing referral partners and I've built a really good network in my area.
So I do now have an in-person space, which if you can do it, if you can get a myofunctional
therapist locally for children, especially I'd say even under 10 years old, in person
can be, you know, really great.
There's more than you can do.
It's because I think that I'm able to be a little bit more interactive with the child
and, you know, we can keep them moving.
We can do more games and things like that.
There are some limitations to online, but I have adapted my online practice as well for
those that just aren't closed.
And I love that you do that because one of the things, pardon me, that we hear a lot
from our parents help me find support, you know, and it's heartbreaking for someone like
me, when I get these emails, there is no myofunctional therapy available in my area.
There isn't an airway centric dentist in my area.
So the fact that you have been able to adapt your practice to actually help a child virtually
is amazing.
Yes, yeah, it's been a work in progress, but we have some fun.
We try to keep it really interactive.
I have some different things that I share on my screen with them to make it a bit of a
game.
We use some fun timers.
I call them fun timers for them to kind of will compete against each other to see who's
going to win watching these little races, but then also doing our therapy exercises at the
same time.
So I've learned even just doing these things on my own children that, you know, we need
to keep it fun and we need to have it play based for the smaller kids, which is which
is big, right?
Do you have to keep their their engagement through through the whole whole session?
Yeah.
On your website, and I will put a link to this in our show notes.
You have a blog where you talk about the shrinking jaw line and that's something we've talked
about on our show several times.
You know, we talked about it with Dr. Boyd.
We've talked about it with Dr. McIntosh.
It's becoming a little more mainstream in the conversation that people are becoming aware
that yes, over the last hundred years, everything is shrinking and let's not pull out teeth.
Let's take a step back and kind of reset.
But as a parent, when you hear that for the first time, that's a little overwhelming.
That's kind of scary.
So how do you approach it with parents for the first time when they hear this and maybe
they've already had a child that's had some teeth pulled or they've had retractive braces?
How do you approach it so that it doesn't completely, for lack of a graceful way to
say this, flip out the parent?
Oh my gosh, you know, I've damaged my child because we've all gone through this.
So how do you approach that?
Well, it's, you know, as a parent myself, I know how overwhelming that it can feel.
So I approach it carefully because I know that there's a lot of like mom or parent guilt
that comes along with that.
When, you know, there were things that you just didn't know.
And while it's so interesting, all of the anthropology and the history of, you know,
our changes, there's just so much information that we can share with parents.
So a lot of times I will share resources with them.
So I won't overload them with too much information all at once.
I think that that's something that I've learned over time is that I can't just give so much
information right off the bat because it's hard for them to take it all in and we all
need some time to reflect on it.
So I'll give them reading material.
I'll direct them to these different podcast episodes with the experts like Kevin Boyd
who are speaking about all of these things.
But I think most importantly, just breaking it down into bite-sized pieces.
Okay, where are we now?
And what can we do?
What are some easy steps that we can do right off the bat?
And I'll create kind of a roadmap for them and have them know that I'm there with them
throughout the whole thing.
As a myofunctional therapist, I think a lot of us refer to ourselves kind of as a traffic
director where we help the parents advocate for their children and we help them to know,
you know, we're not just doing the therapy.
We're also connecting them with other professionals that can help with these different pieces
of the puzzle.
So I think that's been an important part of my practice is meeting the parents where
they're at and helping them to move forward in some way.
Yeah, absolutely.
So many things I could respond to you there.
I mean, first off, I say this, I swear, every episode we should change the name to you don't
know what you don't know because that's the first thing that I always have to tell parents
when they contact us.
It's okay.
You didn't know.
You know, I went through that whole mom guilt myself.
I didn't know.
I look at my two daughters and think, oh, I kind of missed the mark there, but you course
correct.
And so many physicians and dentists that we've had on the show, same thing.
They weren't taught.
So we're all kind of in the same boat.
You know, let's turn the ship.
Let's course correct.
So and we have talked about this a little bit more.
How does for those that haven't heard this before, how does myofunctional therapy help
a child and their development and their jaw growth?
Yeah.
So I know you've had some other myofunctional therapists on the show too.
But I guess, you know, hearing them from different ways of explanation are always helpful.
Absolutely.
So one of the things that I often tell parents is that our ultimate focus with myofunctional
therapy is to achieve correct oral rest posture.
And what that means is we want children and adults, all of us to have our tongue in the
right place.
So we want the tip middle back of the tongue to rest sealed to the roof of the mouth with
the mouth closed, lips sealed, and breathing through the nose.
Now in achieving those goals, in having proper rest posture, there's a lot of connections
to that.
So when the tongue is resting in the right place, it helps to open the upper airway for
a clearer space to breathe through.
So and that translates also into nighttime.
So that's where myofunctional therapy can help us to breathe better and in turn sleep
better.
And we know how important that optimal breathing and sleep is, especially for a developing
child.
But the tongue also resting in the roof of the mouth and exerting pressure on the roof
of the mouth during those really important developmental stages helps to guide the way
that the upper jaw grows.
So our tongue exerting pressure on the roof of the mouth provides that internal support
for children.
Primaric before I would say before the age of eight is the most key time for that.
And the bones are still soft and easy to manipulate.
So when the tongue is in the right place, it will guide the palate to grow wide, flat,
and forward and fit all of the teeth.
You're listening to Airway First, the podcast from the Children's Airway First Foundation.
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Parents are also encouraged to join the Airway Huddle, our Facebook support group which was
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As a reminder, this podcast and the opinions expressed here are not a medical diagnosis.
If you suspect your child might have an airway issue, contact your pediatric airway dentist
or pediatrician.
And now let's jump back into today's podcast.
But another thing that we don't often think about as dental professionals is that a wide
enough jaw, a wide enough palate is also going to fit the tongue.
And then when the mouth is closed at rest, it's also stimulating the lower jaw to grow
forward away from the upper airway and set them up for a clear airway space and airway
structures into adulthood.
So when we are prioritizing these things early on, we are setting our children up to have
better breathing and better sleep and overall health into adulthood.
So there are a lot of connections there, but it really comes down to, you know, our breathing,
our sleep, and our craniofacial development.
Right.
And you mentioned this, if you sleep well and breathe well, then they're going to have
better motor functions, better brain activity as well, because otherwise it can impact all
of that and their behavior, right?
Yes, exactly.
And we see this often, you know, we'll see children that are not breathing well during
sleep and their body is just in this chronic state of fight or flight, even when they're
sleeping when they should be in a pure sympathetic state where they're resting, digesting and
their body is repairing itself.
So if they aren't getting into that restorative sleep, we're going to see the effects during
the daytime.
We can't expect a sleep deprived child to perform at their highest level if they're not
breathing well and not sleeping well.
Absolutely.
And you also mentioned the tongue, having enough space for it.
And for those who haven't read the six foot tiger, we'll put the link to that in here,
but maybe we could talk about that a little bit, because is it accurate to say that sometimes
we hear about, oh, that child has a big tongue?
Well, perhaps it's not that they have a large tongue, it's that their mouth has not been
formed correctly.
Yes, exactly.
I would say a vast majority of the time that it's actually that the jaws are too small
to house the tongue, not that the tongue is too big for the mouth.
So as I discussed that the tongue, when it's in the right place, it's exerting pressure
on the palate and guiding healthy jaw development and creating that space as they get older.
The opposite is going to have a negative effect on the jaw development.
So if the tongue is not resting in the correct place, maybe because of a tongue tie, restricting
the tongue's mobility, or maybe because of low muscle tone or chronic mouth breathing,
when the tongue is resting low, there's no internal support telling the roof of the mouth
how to grow.
So a lot of times these kids, and most of the time they'll experience a downward growth
where the ridges that support the teeth grow downward, and it'll give the appearance of
a high-involved palate.
We'll see crooked teeth, no space for the teeth, but also when we see no space for the
teeth, we know there's no space for the tongue.
And that's going to put them into more of this vicious cycle where now they don't have
enough tongue space, and it's even more likely that the tongue is going to obstruct the airway
during sleep.
And as a parent, because we've talked about some of the symptoms before, and I'll put
them in our show notes, but how could we check or what are some of the things we could look
for to identify a possible tongue tie in our children?
I mean, I know if your child doesn't lisp, for example, but they're going about their
everyday lives and everything seems okay, and then you come to find out 10, 20 years
later they have a tongue tie.
So is there anything as a parent we can do to look to try to spot it for ourselves and
maybe think, oh, you might, so I need to take you in?
Yeah, there's a lot of connections with our tongue.
I'll first say that our tongue needs full range of motion.
It may seem kind of silly why we would focus so much on tongue mobility and our tongue's
role.
But I would argue that our tongue's function is, it's involved in every vital aspect of
our survival and day-to-day life as a human being.
Our tongue is composed of 16 muscles and the way that it functions impacts the way that
we do and swallow and sleep, the way that we breathe, the way that we sleep, and in
the way that our jaws develop.
So there's a lot of ways that, you know, there's a lot of little clues that can tell us when
the tongue doesn't have its full range of motion because it's not going to be able to
do all of those jobs without compensating.
So you know, if we start kind of early on in infancy or we think back to our child's
infancy, there may have been some breastfeeding challenges, but not always.
Sometimes kids get really good at compensating or sometimes maybe breastfeeding was not something
that was a fit for our family.
So there was bottle feeding and we weren't identifying the issues with the suck and swallow.
But I know for my own child, I breastfed.
It was something that, you know, I was determined to do, but it was never comfortable.
There was pain with nursing.
There was a lot of reflux, you know, frequent waking in the night that now I would attribute
to it.
And then, you know, sometimes we'll see, you know, in a little bit older, if we look into
like our toddlers, did they have issues transitioning to solid foods?
Did they have a really strong gag reflex?
That could tell us that maybe their tongue wasn't very efficient at, you know, lateralizing
the food and swallowing and it was presenting as, you know, difficulty transitioning or gagging.
I've also seen children that will compensate for their tongue tie by oral habits like sucking
their thumb.
So we know that if the tongue isn't able to rest in the roof of the mouth, it's not stimulating
the vagus nerve.
There's some nerve endings in the roof of the mouth that help to regulate our nervous
system.
So some kids are really clever and they'll use their thumb.
They'll suck their thumb.
Sucking the thumb could also be helping them to open their airway when the tongue tie is
holding their tongue partially in their airway.
Now as they get older, so I kind of, I guess I kind of started with infancy.
Sometimes we will see challenges with speech sounds, especially like the R's and the L's
and the S's and the Z's.
And again, it depends on how a child compensates with their tongue tie.
So sometimes that's not something that's immediately something that we'll think about.
And then when we look at sleep, so there's certain signs that our tongue isn't resting
in the right place.
And again, that could come down to a tongue tie.
If we see a mouth breathing or hear snoring, that could tell us that something is narrowing
the airway.
That could potentially be a tongue tie.
Teeth grinding, your teeth grinding a lot at night that we now know is a protective
mechanism of our body to help us open the airway during sleep.
And I do find that a lot of the children that are grinding their teeth will end up having
this underlying tongue tie that was causing their tongue to obstruct the airway.
So there's a lot of different things that we can look at that could give us some clues.
And as an adult, if we were missed as a child and somehow we've gone through everyday life
and everything is fine, but all of a sudden you start hearing these symptoms and you think
I have that, I have that, I have that.
Is it too late to have a tongue tie released as an adult?
No, it's not too late as an adult to have a tongue tie release.
I had a tongue tie release done in my twenties and it was life changing for me.
So if you are an adult and you're realizing, oh my gosh, I'm a clincher, I'm a grinder,
I've got all these sleep problems, it's worth consulting with a myofunctional therapist
or an airway focused dentist to have a look and assess because it's never too late to
get your tongue tie released and notice benefits from it.
And I want to read this because I don't want to get this wrong.
I saw this on your website, which I'll put the link for.
You have a post and in there you say dysfunction of the muscles can be the root cause of many
issues such as poor facial growth.
So if you would just kind of elaborate to help us understand a little bit more about
this, what dysfunction of the muscles are you talking about specifically?
Yeah, so we talked about what's functional and what's normal when we're talking about
like the oral facial muscles.
So like I said, tongue up, lips closed, breathing through the nose.
We also want to be swarming correctly with the tongue exerting upward pressure on the
palate.
Now what's dysfunctional is anything outside of that.
So mouth breathing, for example, is dysfunctional.
And when we're chronically mouth breathing, we're underusing the muscles of the face and
the mouth.
So we'll have some low muscle tone in the tongue and the muscles in the upper airway
and the face.
So low muscle tone is dysfunctional.
We may have a dysfunctional swallow pattern because of that low tone or restriction of
the tongue, which presents as a tongue thrust or a reverse swallow pattern.
Having the tongue resting low in the mouth and not against the roof of the mouth, that's
also dysfunctional.
Now if the muscles of our face and our mouth are not working properly, that can result in
poor facial growth.
Because as I said, if the tongue isn't acting as that scaffolding in the roof of the mouth,
we will experience, we won't experience our jaws growing to their full lunatic potential.
And then the underdevelopment of the jaws can lead to all kinds of things like poor sleep,
poor breathing.
You're more likely to experience sinus issues because your nasal volume may be decreased.
So there's a lot of things that can come back to poor facial growth and even before the
poor facial growth, in the poor muscle function.
Okay.
All right.
And another thing, you actually have one of my favorite quotes on your website by Maya
Angelou.
When you know better, you do better, which I think is a huge mantra for all of us now
as we're starting to really understand what's going on and how we can impact it and how
we can save the children of this generation so that they don't end up like us.
How do you implement this in your own airway journey now and your own practice?
So it's also one of my favorite quotes.
And I say this to parents all the time, but I tell myself this too, because when I found
out about all of this, I had a newborn and a toddler.
And my toddler definitely went through more challenges because of that because I didn't
know what I didn't know.
So I just kind of use this to encourage parents and adults who are going through this journey
that it doesn't matter what you did in the past or what maybe negative habits that you
may have had in the past or things that didn't support your child's journey.
We need to start where we're at and not be hard on ourselves and just move forward and
then continue to share this information with other people so that they can start the journey
earlier too.
So for myself as an adult, it is a little bit more of a challenging journey than it
is for kids.
Because in kids, we can work with their growth patterns.
It's easier for us to get structural changes in children and they just adapt so much more
quickly.
For myself as an adult, I mean, I've done the myofunctional therapy.
I do all the nasal hygiene.
I've had my tongue tie released.
But I know that my jaws are still too narrow.
And that's kind of eventually going to be the next thing.
But I try not to be too hard on myself for what I didn't know before and just trying
to manage my hygiene control now.
And I think that's a great way to approach it 100%.
So typically at the end of every episode, I like to turn the floor back over to our
guests because you guys are the experts.
What is a final thought that you would like to leave with our parents or any medical professionals
in our audience?
I think for parents, the best advice that I can give is that you don't have to go out
it alone when you learn all of this information, try to align yourself or partner up with a
myofunctional therapist or an airway focused dentist that have dedicated all of this time
to learning.
Because even for us, it takes a long time to get comfortable with this information and
change our mindset around airway health and myofunctional therapy and all of that.
So there are a lot of people out there like myself that have devoted so much time to learning
and building networks that you don't have to be by yourself in it.
If you find somebody to work with and consult with, there is a lot of help out there.
You just need to find the right people.
And then for the dental, medical professionals that may be listening or just getting started
into all of this, I think it's such an important thing to learn about.
Once you discover this whole other world of airway stuff, you feel like a beginner again
and it takes time to put all of the pieces together.
So again, finding mentorship was a huge thing for me.
And just always going back to community because that's what's going to help you to connect
the dots and see the life changing results in your patients that just are going to be
so much more fulfilling than constantly putting, you know, band-aids on symptoms.
Agreed.
Thank you so much for being on today, Courtney, and sharing all of this amazing information.
I appreciate it.
Thank you so much for having me.
It's been great chatting.
Thank you.
Thanks again to today's guest, Courtney Robertson, for sharing her medical insight and to each
of you for listening to today's episode.
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Take care, stay safe, and happy breathing everyone.