1 00:00:00,000 --> 00:00:29,800 Hi everyone, and welcome to another episode of The 2 00:00:29,800 --> 00:00:36,800 Children's Airway First Foundation. I'm your host, Rebecca St. James. 3 00:00:36,800 --> 00:00:44,800 My guest today is Dr. Tracey Tran, a board-certified pediatric dentist who specializes in infant and pediatric oral 4 00:00:44,800 --> 00:00:51,800 ties, as well as pediatric sleep issues. She is a Michigan native who first landed in Southern 5 00:00:51,800 --> 00:00:59,800 California to attend dental school at UC's Ostrow School of Dentistry. After graduation, 6 00:00:59,800 --> 00:01:05,800 Dr. Tran went on to complete a one-year general practice residency where she received additional 7 00:01:05,800 --> 00:01:12,800 training in all aspects of dentistry with an emphasis on oral surgery. She performed surgical 8 00:01:12,800 --> 00:01:20,800 procedures in maxofacial trauma under the attending oral maxofacial ENT and plastic surgeons. 9 00:01:20,800 --> 00:01:26,800 During the following two years, Dr. Tran continued her specialty training in pediatric dentistry 10 00:01:26,800 --> 00:01:31,800 while completing her master's in biomedical science. Since being in private practice, 11 00:01:31,800 --> 00:01:37,800 Dr. Tran has focused her continuing education on pediatric tethered oral tissue and its 12 00:01:37,800 --> 00:01:44,800 relationship with oral dysfunctions in order to diagnose oral-facial myofunctional disorders. 13 00:01:44,800 --> 00:01:50,800 This includes difficulties with infant nursing, toddler feeding and swallowing, speech, articulation, 14 00:01:50,800 --> 00:01:56,800 and pediatric sleep-disordered breathing. She has successfully treated these patients through 15 00:01:56,800 --> 00:02:02,800 a collaborative team approach and continues to expand her knowledge and experience in this niche. 16 00:02:02,800 --> 00:02:08,800 She's also proud to contribute to the advancement of academics by volunteering her time teaching 17 00:02:08,800 --> 00:02:16,800 at USC as a clinical assistant professor in the Division of Dental Public Health and Pediatric 18 00:02:16,800 --> 00:02:24,800 Dentistry. You can find out more about Dr. Tran at drtracetrann.com. And now let's jump into 19 00:02:24,800 --> 00:02:34,800 today's interview with Dr. Tracey Tran. Great. All right. Thank you so much for joining us today, 20 00:02:34,800 --> 00:02:40,800 Dr. Tran. I appreciate you being here. Thank you for having me. I'm really excited to be here. 21 00:02:40,800 --> 00:02:48,800 Yeah, absolutely. So let's just jump right in. I know we were talking a little bit beforehand, 22 00:02:48,800 --> 00:02:57,800 but I'd love to just share with our audience a little bit about your journey and how you got into 23 00:02:57,800 --> 00:03:07,800 Airway. Yeah. So I started off just being curious. There were two major things I would see in the 24 00:03:07,800 --> 00:03:13,800 dental office just as a regular pediatric dentist doing exams and two major complaints. One was 25 00:03:13,800 --> 00:03:23,800 my kid grinds their teeth a lot. And the other was, you know, I'm brushing and flossing and feeding them 26 00:03:23,800 --> 00:03:29,800 the right things. And yet there's still been cavities. So both of those things I never had good 27 00:03:29,800 --> 00:03:36,800 solid answers for. And then one day I met a good friend of mine, Mary Ellie Mitchell, she's a 28 00:03:36,800 --> 00:03:44,800 occupational therapist and does my own functional therapy as well. And she was like, Hey, you're 29 00:03:44,800 --> 00:03:54,800 pediatric dentist. You do tongue ties. And I'm like, No, I don't. Why do you have a fast? And then 30 00:03:54,800 --> 00:04:02,800 when we started to get into it, I realized like, Oh, okay. She was like, it can cause ADHD. It can, 31 00:04:02,800 --> 00:04:07,800 you know, lead to all these problems, feeding issues, speech issues, and like, Okay, they can grind 32 00:04:07,800 --> 00:04:15,800 their teeth. And I'm like, Whoa, okay. Keep grinding. Then I caught my attention. Then I started going 33 00:04:15,800 --> 00:04:22,800 down the rabbit hole like anyone in the space does. She led me to the Academy of Oral Facial 34 00:04:22,800 --> 00:04:32,800 Myopropyntal Therapy. And I went to their Fremulam Inspection Workshop. And one of the speakers 35 00:04:32,800 --> 00:04:38,800 that they had there was Saruj Sakhi. And I'm very evidence based. I don't like to do things without 36 00:04:38,800 --> 00:04:45,800 good solid evidence or just good science behind it. And he presented some pretty good compelling 37 00:04:45,800 --> 00:04:49,800 arguments about tongue tie and functional problems. And it looked like that he had been doing some studies 38 00:04:49,800 --> 00:04:56,800 around it. So kind of like following him around after that. And he created the Breathe Institute after 39 00:04:56,800 --> 00:05:04,800 that. And he started taking courses and learning more and more about it. But when you have patients who 40 00:05:04,800 --> 00:05:12,800 have a problem that you cannot solve or your answer to them is, Oh, they'll grow out of it. You're just, you 41 00:05:12,800 --> 00:05:19,800 just know that's not, that's the answer you give when you don't have an answer. You know. So when I finally 42 00:05:19,800 --> 00:05:25,800 found the answer, I'm like, these patients need help. So it all had to do with what does teeth grinding 43 00:05:25,800 --> 00:05:30,800 mean? And it means, Oh, you're grinding your teeth, there's some sort of stress. And we knew that that's 44 00:05:30,800 --> 00:05:36,800 something we learned in dental school. It's a stress response. Okay, well, why are they stressed out? 45 00:05:36,800 --> 00:05:42,800 Well, it could be that they're not breathing well in their sleep. And well, why are they not breathing 46 00:05:42,800 --> 00:05:49,800 well in their sleep? Oh, well, could be that their airways getting obstructed. And then I started 47 00:05:49,800 --> 00:05:55,800 to learn, okay, where are some areas where your airway can get obstructed? Could be the nose, nasal cavity, 48 00:05:55,800 --> 00:06:04,800 adenoids, soft palate, face of the tongue. Oh, the face of the tongue. And that makes sense. That's my space. I work in 49 00:06:04,800 --> 00:06:12,800 the mouth. So then you start to understand, okay, tongue tie can relate to this because when the tongue is 50 00:06:12,800 --> 00:06:19,800 tied, the tongue is down low, can have a low resting tongue posture, might have poor tone because you're not using 51 00:06:19,800 --> 00:06:25,800 it correctly. And that can fall back into the airway during sleep. That's where the obstruction can occur. 52 00:06:25,800 --> 00:06:31,800 And when you're not sleeping well, when you're not getting enough oxygen, and that's that your body gets 53 00:06:31,800 --> 00:06:40,800 stressed out, then the stress response happens, the teeth grinding. And that's that made a lot of sense to me, 54 00:06:40,800 --> 00:06:51,800 it made absolute sense. So, you know, that was the first thing that got me going down this rabbit hole. I'm wanting to 55 00:06:51,800 --> 00:06:59,800 help solve this problem for a lot of families. And a lot of it also, it spotted a lot of other questions, like, you 56 00:06:59,800 --> 00:07:04,800 know, well, how do you treat it? And how do you treat it? Well, and how do you get good results? Because that's the other 57 00:07:04,800 --> 00:07:11,800 side of it, like, sure, it makes sense. But, you know, can we actually help the families with this? So, I've been doing 58 00:07:11,800 --> 00:07:18,800 this ever since then, I want to say like, it's been about eight years since I got into this. And there's been more and 59 00:07:18,800 --> 00:07:28,800 more information evidence coming out on it. And the studies are there. And I've always been on this mission to help 60 00:07:28,800 --> 00:07:36,800 all of my colleagues to understand this and educate parents on this, so that indirectly the medical community 61 00:07:36,800 --> 00:07:43,800 community will eventually accept it. And that's what I want. I want there to be more acceptance around this so that we can 62 00:07:43,800 --> 00:07:52,800 help more families because there's nothing more disheartening as a provider when a family comes in and they're like, you know, it 63 00:07:52,800 --> 00:07:58,800 makes me feel good because they'll go to all these people who will say, sorry, we can't help you or they kind of gas like the 64 00:07:58,800 --> 00:08:06,800 parents make them feel crazy. And then they come to me and I answer all their questions. And I give them a solution. And then 65 00:08:06,800 --> 00:08:16,800 they're like, why did it take so long for us to get here? Why didn't my pediatrician just refer me? Or why didn't my dentist 66 00:08:16,800 --> 00:08:24,800 just refer me out? And the answer to that is simple. Well, they just don't know. They don't know. We're not taught with 67 00:08:24,800 --> 00:08:32,800 informal medical and dental education. So it's not necessarily their fault. So that's where I'm like, okay, I need to educate my patients 68 00:08:32,800 --> 00:08:42,800 really well, so that they can also bring that information back to their pediatricians and dentists. And I want them to know 69 00:08:42,800 --> 00:08:47,800 that this isn't just some hippie-dippy voodoo. 70 00:08:47,800 --> 00:08:51,800 Right, there is science. There is factual evidence. Yeah. 71 00:08:51,800 --> 00:08:59,800 Exactly. Yeah. And so it's really important to me that when I communicate and educate these things that it's done accurately and 72 00:08:59,800 --> 00:09:11,800 succinctly, that there's clear understanding around what the likelihood of improvement will be, and that there's also clear understanding about what the diagnosis 73 00:09:11,800 --> 00:09:19,800 is. So diagnosing properly is key. And getting a good diagnosis can be tough to get to. 74 00:09:19,800 --> 00:09:32,800 So how do you go about that? Oh, yeah, that's the whole exam that I do in my office. But I get what do we want to get? Diagnosis around 75 00:09:32,800 --> 00:09:34,800 tongue tie or sleep issues? 76 00:09:34,800 --> 00:09:41,800 Let's start with the tongue tie. So if you suspect your child has a tongue tie and they were to come to you, what does that process look like? 77 00:09:41,800 --> 00:09:53,800 So I usually will do a functional exam because when there's a tongue tie problem, there's a functional problem. So I always relate it back to this to the parents. 78 00:09:53,800 --> 00:10:03,800 If your child is tongue tied, think about what the tongue does. It helps with sucking and swallowing, especially for an infant earlier on. 79 00:10:03,800 --> 00:10:10,800 Right. It helps with feeding. Because the tongue has to move food around in the mouth for chewing. 80 00:10:10,800 --> 00:10:19,800 Sure. It helps with speaking. You have to use your tongue to talk. You didn't have a tongue you can talk. And then there's the breathing sleep component. 81 00:10:19,800 --> 00:10:31,800 So the tongue has to be in the right place for you to breathe properly. Not that it has to, but it's ideal that it's in, you know. 82 00:10:31,800 --> 00:10:35,800 Yeah. Because you can breathe when it's down low, but it's not where it's supposed to be. 83 00:10:35,800 --> 00:10:45,800 It's not the best breathing. Right. Exactly. So when I tell parents these functional problems can be present, sometimes the parents are like, well, my kids fine. 84 00:10:45,800 --> 00:10:53,800 They don't have any problems with that. I always have to explain to them. It's not about whether or not they can do it. 85 00:10:53,800 --> 00:10:58,800 It's just like we said about the breathing. Sure, you can breathe with your tongue down, but it's not ideal. It's not optimal. 86 00:10:58,800 --> 00:11:05,800 Just like you can speak with the tongue tie and your tongue's not working correctly, but you might not be speaking correctly. 87 00:11:05,800 --> 00:11:12,800 Right. And you can stick your tongue out with the tongue tie, but maybe you're not sticking it out as far as it's supposed to go. 88 00:11:12,800 --> 00:11:27,800 Exactly. So I bring it back to the basics that when you have a functional issue or a tongue tie issue, this, everything in your mouth, it's a fine motor skill. 89 00:11:27,800 --> 00:11:35,800 It's not gross motor. Like if your child has a problem with walking, that's a gross motor skill. You're going to see it and you're going to want to address it right away. 90 00:11:35,800 --> 00:11:45,800 You're not going to just let that slide. When it comes to the mouth, this is a fine motor skill and you might not see when there's a problem. 91 00:11:45,800 --> 00:11:51,800 And usually what will happen is if they can't do it correctly, we're going to compensate. 92 00:11:51,800 --> 00:12:05,800 And those compensations will turn into other issues. So the example I like to give, I'm always giving the same example is, okay, if your arm is tied to your side and you need to grab something off the shelf. 93 00:12:05,800 --> 00:12:11,800 And your arm can only lift maybe 20% of the way off your body. 94 00:12:11,800 --> 00:12:20,800 There's other things you can do to reach what you need to get off the shelf. You can either bend over, get on your tippy toes, reach up. 95 00:12:20,800 --> 00:12:30,800 Maybe you get it off the shelf. You can go get a ladder, bring it over, climb up the ladder, grab it off the shelf. Okay, you achieved your goal. You've got what you did on the shelf. 96 00:12:30,800 --> 00:12:39,800 But the first way you did it hurts your body. Your body's compensating in some way to get it. The second way is really inefficient. 97 00:12:39,800 --> 00:12:47,800 You have to go get a ladder, climb up the ladder, takes more time. So I'm going to relate this back to infants. So we see this in infants that are tongue tied. 98 00:12:47,800 --> 00:12:56,800 They're still feeding. They're okay, they can take a bottle. They're still getting breast milk from the breast. But maybe they're taking a long time. 99 00:12:56,800 --> 00:13:04,800 And so that's, that's why I help a lot of parents, they get a lot of parents that come they're like, well I'm not having any pain, why would I do this procedure when there's a tongue tie. 100 00:13:04,800 --> 00:13:19,800 It has to do with how you how your baby's compensating. So if they can't do it efficiently, if they can't use their tongue efficiently, then they'll take a long time or they'll tire out. 101 00:13:19,800 --> 00:13:29,800 Keep doing the same way I'm tired and wear out fall asleep. Now we got to wake them back up, feed them some more. 102 00:13:29,800 --> 00:13:36,800 And then they're sucking a lot of air and things to correct which now we have an upset stomach and all these other issues to do. 103 00:13:36,800 --> 00:13:57,800 And then we have to reflux all of that. Yeah. But the basics to it that I want all of the parents to know and understand like the take home to it is like, it's up to you, you can, you can leave it alone. But when you compensate, it's going to affect something else, something else is going to give. 104 00:13:57,800 --> 00:14:10,800 That something is going to be your jaw development, the craniofacial growth and development. And that's where when we get the older kids, and when I say older, I'm talking about three years old. 105 00:14:10,800 --> 00:14:24,800 Right. Right. That's when you're about your problem. Yeah. And the head and neck grow at a different rate than the rest of the body. By the time they're three, for instance, their cranium, their head is 90% their adult size. 106 00:14:24,800 --> 00:14:34,800 That's how much growth is already happened to three years old. Then the base is no different the job row, 70 to 80% by the time you're three years old. 107 00:14:34,800 --> 00:14:43,800 So if they're not functioning well to start, right, already impacted the growth significantly because a lot of it has already happened. 108 00:14:43,800 --> 00:14:54,800 Then by the time they're three, if they want to fix the tongue tie problem, it's not just, okay, let's pick the tongue tie, let it go. You have to make space for the tongue. 109 00:14:54,800 --> 00:15:02,800 Because part of fixing the tongue tie isn't just we snip, let you go all good. 110 00:15:02,800 --> 00:15:13,800 And my favorite way to explain it is all I'm doing when I do a tongue tie release is I'm giving your tongue range of motion. I'm allowing it to move freely. I'm not teaching it what to do. 111 00:15:13,800 --> 00:15:15,800 You're gonna say you still have to train. 112 00:15:15,800 --> 00:15:28,800 You need a therapist to teach your tongue what to do. So when I, at three years old, though, they have to use some myofunctional therapy before I do the release because they have to know what to do with their tongue. 113 00:15:28,800 --> 00:15:33,800 And that can also impact the healing. That's another factor that's really important is making sure you heal well. 114 00:15:33,800 --> 00:15:41,800 And that's what I've learned over time in these last eight years. You can't just do a tongue. I did it. I did it in the beginning. I would release tongue ties because that's what you kind of do in the beginning. 115 00:15:41,800 --> 00:15:48,800 You're like, oh, this will help my patient when you release it. But actually, no, it didn't help the patient. Why didn't it help? Oh, it's because it didn't heal well. 116 00:15:48,800 --> 00:15:57,800 It didn't heal well. They needed therapy. So therapy is really crucial and important to the successful outcome of doing a release. 117 00:15:57,800 --> 00:15:59,800 But therapy before and after. 118 00:15:59,800 --> 00:16:07,800 Yes. Yeah. Because before it's giving your tongue awareness. After it's teaching you what to do with its new range of motion. 119 00:16:07,800 --> 00:16:08,800 Okay. 120 00:16:08,800 --> 00:16:15,800 So when I do a release, all I'm giving the tongue is range of motion. They don't know what to do. 121 00:16:15,800 --> 00:16:25,800 So they have to train for it. And when I would do the releases and they weren't successful. 122 00:16:25,800 --> 00:16:33,800 I think that's where I was talking about. There was a point I was trying to get to. 123 00:16:33,800 --> 00:16:38,800 I wish I could listen to myself talk and what I was saying. 124 00:16:38,800 --> 00:16:47,800 You, well, you were, you were at the very end you were talking about in the beginning, you didn't know about the mild functional therapy and you just released them. 125 00:16:47,800 --> 00:16:50,800 And they weren't successful. 126 00:16:50,800 --> 00:16:58,800 Yeah. So this is just to say, like, no, there was another point I was trying to get. 127 00:16:58,800 --> 00:17:06,800 And I should never have this happening before. 128 00:17:06,800 --> 00:17:09,800 Mom, I think after having a baby, the sort of stuff happens. 129 00:17:09,800 --> 00:17:10,800 It does. 130 00:17:10,800 --> 00:17:11,800 It totally does. 131 00:17:11,800 --> 00:17:21,800 I cannot like, I can't draw from my memory as well as I used to used to just like get back on it really fast and be really sharp. 132 00:17:21,800 --> 00:17:33,800 But you, with all the experience that I've had in doing all of this and when you do a tongue tie release. 133 00:17:33,800 --> 00:17:35,800 The success of it. 134 00:17:35,800 --> 00:17:40,800 Gosh, I can't like this is really eating at me right now because I can't. 135 00:17:40,800 --> 00:17:48,800 It was saying. 136 00:17:48,800 --> 00:17:50,800 We can back up a little bit and see if it'll trigger. 137 00:17:50,800 --> 00:17:54,800 We just kind of start talking about that you have to have it. 138 00:17:54,800 --> 00:18:08,800 Why is it important to have my a functional therapy, both before and after I was talking about before that was about like what the time does and how it helps with. 139 00:18:08,800 --> 00:18:11,800 So those are the main things that the tongue does. 140 00:18:11,800 --> 00:18:14,800 And the original question was about how we treat. 141 00:18:14,800 --> 00:18:17,800 How you can tell there's a problem. 142 00:18:17,800 --> 00:18:18,800 Right. 143 00:18:18,800 --> 00:18:20,800 So the compensations. 144 00:18:20,800 --> 00:18:22,800 Oh, okay. I know what I was getting that now. 145 00:18:22,800 --> 00:18:24,800 So. 146 00:18:24,800 --> 00:18:26,800 So. 147 00:18:26,800 --> 00:18:30,800 The thing is, they have to do the therapy before. 148 00:18:30,800 --> 00:18:32,800 They have to do the therapy after. 149 00:18:32,800 --> 00:18:34,800 And then. 150 00:18:34,800 --> 00:18:38,800 Before that, though, if there's no space. 151 00:18:38,800 --> 00:18:42,800 In their mouth to even do the therapy to begin with. 152 00:18:42,800 --> 00:18:46,800 Then it's a moot point to even do the therapy and do the tongue tie release. 153 00:18:46,800 --> 00:18:52,800 So by three years old when they come to me when they're an older child, have to create space too. 154 00:18:52,800 --> 00:18:59,800 So now there's more involved in treating the problem. It's not like what we do for an infant and infant. 155 00:18:59,800 --> 00:19:04,800 Yes, they might need a little bit of training, but the therapies may be like a couple weeks. 156 00:19:04,800 --> 00:19:07,800 Oh, wow. 157 00:19:07,800 --> 00:19:09,800 Maybe four weeks math. 158 00:19:09,800 --> 00:19:15,800 But when it's a child, it's usually several weeks or months before we get to doing the release. 159 00:19:15,800 --> 00:19:21,800 And then several weeks or months of therapy after the release as well. 160 00:19:21,800 --> 00:19:26,800 But if while they're doing the therapy, they have to suction their tongue up. 161 00:19:26,800 --> 00:19:31,800 They have to move their tongue side to side. We want to get them full range of motion. 162 00:19:31,800 --> 00:19:36,800 The thing of the tongue is the car and your mouth is the garage. 163 00:19:36,800 --> 00:19:37,800 Okay. 164 00:19:37,800 --> 00:19:42,800 The garage is too small. And if it's too small, the car can't move within it. 165 00:19:42,800 --> 00:19:47,800 It's separate. And where does it go? You can you shut the garage door? 166 00:19:47,800 --> 00:19:55,800 If the car sticking out? No. So if you want to shut the garage door and you want to breathe with your mouth close, the tongue's got to go back. 167 00:19:55,800 --> 00:19:58,800 And that's going to need your airway. 168 00:19:58,800 --> 00:20:04,800 So we usually, before we do therapy and release the tongue tie, create space first. 169 00:20:04,800 --> 00:20:08,800 You have to expand the jaw, make it bigger. 170 00:20:08,800 --> 00:20:13,800 And it's because of how the tongue tie affected the growth in the first place. 171 00:20:13,800 --> 00:20:18,800 And so this is a really important concept that I want parents to understand when they come into my office. 172 00:20:18,800 --> 00:20:23,800 And just I want most people to understand in general, because even pediatricians don't know and understand this. 173 00:20:23,800 --> 00:20:27,800 This is this is science that we know about. There's no arguing this at all. 174 00:20:27,800 --> 00:20:28,800 Okay. 175 00:20:28,800 --> 00:20:32,800 As the upper jaw grows, our bones are in separate pieces. 176 00:20:32,800 --> 00:20:35,800 And I have like a little skull here. 177 00:20:35,800 --> 00:20:36,800 Perfect. 178 00:20:36,800 --> 00:20:38,800 These different pieces. Okay. 179 00:20:38,800 --> 00:20:41,800 All these areas. 180 00:20:41,800 --> 00:20:45,800 Between each bone, each of the separate bones is called the suture. 181 00:20:45,800 --> 00:20:53,800 And the suture, we have one right down the center of the palette right down the middle and it splits our palette in half. 182 00:20:53,800 --> 00:21:07,800 Now, when the tongue rests up in the palette, it will put pressure on the palette and that sutural opening will widen and then new bone will grow in between. 183 00:21:07,800 --> 00:21:10,800 That's how the upper jaw grows. 184 00:21:10,800 --> 00:21:11,800 Okay. 185 00:21:11,800 --> 00:21:20,800 So the lower jaw growth follows. And then this is the growth center of the face. So you can see the upper jaw is also attached to the eyes. 186 00:21:20,800 --> 00:21:25,800 Also attached to the nasal bone and makes up part of these other structures, part of the cheekbones. 187 00:21:25,800 --> 00:21:31,800 So when this grows, the rest of the face gets to grow with it. 188 00:21:31,800 --> 00:21:34,800 But if it doesn't, then everything else stays small too. 189 00:21:34,800 --> 00:21:35,800 I'm zoom. 190 00:21:35,800 --> 00:21:41,800 So if the tongue doesn't rest up and the jaw doesn't widen, you might get a narrow face. 191 00:21:41,800 --> 00:21:45,800 And that's what we also see in mouth breathing. So it's not just tongue tie. 192 00:21:45,800 --> 00:21:55,800 There's other reasons and this is also important for a lot of practitioners and parents to understand is that sometimes when we talk about tongue tie, we're like, oh, that's the problem. 193 00:21:55,800 --> 00:21:57,800 Let's let's get to the problem. It's time. 194 00:21:57,800 --> 00:21:58,800 It might not be. 195 00:21:58,800 --> 00:22:00,800 There's other reasons why people mouth breathe. 196 00:22:00,800 --> 00:22:02,800 It's not just low tongue posture. 197 00:22:02,800 --> 00:22:13,800 It can be from allergies, you know, nasal cavities too small, turbinate inflammation, lots of problems, adenoids inflamed. 198 00:22:13,800 --> 00:22:15,800 So then you can't breathe through your nose. 199 00:22:15,800 --> 00:22:18,800 So that might induce mouth breathing. 200 00:22:18,800 --> 00:22:23,800 And then that also, if in order to breathe through your mouth, your tongue has to stay down low. 201 00:22:23,800 --> 00:22:25,800 You can't put your tongue up and breathe through your mouth. 202 00:22:25,800 --> 00:22:26,800 It's impossible. 203 00:22:26,800 --> 00:22:27,800 Right. 204 00:22:27,800 --> 00:22:33,800 So that low tongue posture, then again, if it's happening in a child, that will affect their cranial facial growth. 205 00:22:33,800 --> 00:22:37,800 And then so by the time they're three years old, 70 to 80% grow. 206 00:22:37,800 --> 00:22:38,800 And they've been mouth breathing. 207 00:22:38,800 --> 00:22:42,800 Well, we've already had a major impact on the growth and development there. 208 00:22:42,800 --> 00:22:47,800 So we have to jumpstart that development, make that space before we release the tongue tie. 209 00:22:47,800 --> 00:22:55,800 But in that regard, when you understand that you understand why mouth breathing should not be done early on in life. 210 00:22:55,800 --> 00:22:58,800 Because of how it impacts the jaw growth. 211 00:22:58,800 --> 00:23:08,800 And what is involved later on to help that is to expand, which is actually really easy to do in a four and five year old. 212 00:23:08,800 --> 00:23:10,800 And I typically do it around that age five, six. 213 00:23:10,800 --> 00:23:13,800 I've done it as early as three when it's needed. 214 00:23:13,800 --> 00:23:14,800 Okay. 215 00:23:14,800 --> 00:23:18,800 But it's more complicated as we get older because everything's a little more established. 216 00:23:18,800 --> 00:23:19,800 It can still be done. 217 00:23:19,800 --> 00:23:30,800 So that suture I was talking about, that's fused, the process of fusion starts around seven years old, but it's used by 12 years old. 218 00:23:30,800 --> 00:23:31,800 Oh, wow. 219 00:23:31,800 --> 00:23:32,800 Yeah. 220 00:23:32,800 --> 00:23:48,800 And so this is really important to understand too, because once you reach eight years old and you're trying to expand, there's some mechanics around it that you have to have to understand around it is that we put the expander attached to the teeth and there's a little jack screw. 221 00:23:48,800 --> 00:23:50,800 In the middle. 222 00:23:50,800 --> 00:23:54,800 Show you what that looks like. 223 00:23:54,800 --> 00:23:56,800 And it looks like this. 224 00:23:56,800 --> 00:23:57,800 Okay. 225 00:23:57,800 --> 00:24:01,800 It sits on the teeth. You've got a jack screw in the middle here. 226 00:24:01,800 --> 00:24:08,800 The parent turns this once a day. It expands by point two millimeters. So you're only winding by point two millimeters. 227 00:24:08,800 --> 00:24:21,800 But what I want you to understand about the mechanics behind this is when the suture is really wide open and you're pushing on the teeth and the teeth have really long roots, it serves as a good anchor and you can get that pressure open in the center. 228 00:24:21,800 --> 00:24:26,800 But as that suture starts to fuse, you can't get that pressure there anymore. 229 00:24:26,800 --> 00:24:28,800 It starts to push more on the teeth. 230 00:24:28,800 --> 00:24:33,800 And the roots of the teeth of the baby teeth are starting to dissolve because new teeth are coming through. 231 00:24:33,800 --> 00:24:34,800 Right. 232 00:24:34,800 --> 00:24:39,800 So you're trying to anchor on the teeth and you're pushing on it. Now the teeth start to push out. 233 00:24:39,800 --> 00:24:44,800 So you do get a change in the dental arch. It looks wider. 234 00:24:44,800 --> 00:25:05,800 Now what's happening is the teeth are tipping out. You're not actually widening here in the center of the palate. 235 00:25:14,800 --> 00:25:29,800 You're listening to Airway First, the podcast from the Children's Airway First Foundation. 236 00:25:29,800 --> 00:25:38,800 You can find out more about CAF and our mission to fix before six on our website at childrensairwayfirst.org. 237 00:25:38,800 --> 00:25:44,800 The CAF website offers tons of great resources for both parents and medical professionals. 238 00:25:44,800 --> 00:26:00,800 In our parents portal and clinicians corner, you can find educational and informational content, including videos, blogs, our recommended reading list, comprehensive medical research, podcasts, events, parent support, and educational opportunities. 239 00:26:00,800 --> 00:26:09,800 Parents are also encouraged to join the Airway Huddle, our Facebook support group, which was created for parents of children with Airway and sleep-related issues. 240 00:26:09,800 --> 00:26:18,800 You can access the Airway Huddle support group at facebook.com backslashgroups backslashairwayhuddle. 241 00:26:18,800 --> 00:26:29,800 Are you interested in being a guest on the show? Then shoot us a note via the contacts page on our website or send us an email directly at infoatchildrensairwayfirst.org. 242 00:26:29,800 --> 00:26:35,800 As a reminder, this podcast and the opinions expressed here are not a medical diagnosis. 243 00:26:35,800 --> 00:26:42,800 If you suspect your child might have an airway issue, contact your pediatric airway dentist or pediatrician. 244 00:26:42,800 --> 00:27:10,800 And now let's jump back into today's podcast. 245 00:27:10,800 --> 00:27:30,800 Okay, know that the research shows it in the orthodontic research. The older the child gets, the more dental alveolar expansion you get, meaning the teeth move, and less orthopedic expansion you get, meaning you're not getting much of that expanded. 246 00:27:30,800 --> 00:27:38,800 So by the time you're 12 years old, or for girls, it's actually when you get your first period. That's when it's fused. So it's nine years old. 247 00:27:38,800 --> 00:27:40,800 Yeah. 248 00:27:40,800 --> 00:27:42,800 You know, it happens earlier for girls. 249 00:27:42,800 --> 00:27:46,800 So what do you do once it's fused, you know, for somebody that has an older child? 250 00:27:46,800 --> 00:28:04,800 We have to do something called MSC, maxillary skeletal expansion. So we actually will screw the jack through directly into the palate with these mini screws. 251 00:28:04,800 --> 00:28:11,800 And that directs force directly around the suture itself, and then you widen at the suture. 252 00:28:11,800 --> 00:28:20,800 Now I want you to understand why this is important, because a lot of orthodontist traditional orthodontists will say like, well, we can expand at nine years old. 253 00:28:20,800 --> 00:28:28,800 Sure you can, but you're going to get mostly dental alveolar expansion. You might not get that orthopedic expansion. 254 00:28:28,800 --> 00:28:42,800 And I thought the orthopedic expansion, because the roof of the mouth, we're not just talking about the upper jaw here, the roof of the mouth is the floor of the nose. 255 00:28:42,800 --> 00:28:43,800 Right. 256 00:28:43,800 --> 00:28:51,800 This is the growth center of the face. And as this is widening, the floor of the nose is widening. So look at the nose, it's like a triangle and the floor is the base of that triangle. 257 00:28:51,800 --> 00:29:00,800 So that doesn't widen out. Triangle doesn't get bigger. It stays small and narrow. And now you've got less space to breathe through your nose. 258 00:29:00,800 --> 00:29:10,800 So then now you've got a nasal breathing issue that what we're finding now, what new research is showing is that when we expand in adult, 259 00:29:10,800 --> 00:29:26,800 it was a study that came out of Boston. And this doctor, he showed that when you expand just one millimeter of the palate in an adult, you increase the nasal volume by 2.4%. 260 00:29:26,800 --> 00:29:36,800 So if you expand, you're like doubling it more than doubling. If you expand seven millimeters, you're going to, you know, increase the nasal volume by at least 15%. 261 00:29:36,800 --> 00:29:38,800 Wow. 262 00:29:38,800 --> 00:29:53,800 You can breathe that much better through your nose. And it's important to know this because when we want to get a child or a teenager or adult in here that comes to my office with an airway issue with difficulty breathing through their nose and has a narrow palate, 263 00:29:53,800 --> 00:30:06,800 I want them to know, yes, we need to expand you, but there's a certain way we have to do it to do it properly to get true orthopedic palatal and nasal, what we call nasal maxillary expansion. 264 00:30:06,800 --> 00:30:15,800 So the palate is part of the maxilla floor, the nose is part of the nose. So that's the nasal maxillary complex that we're addressing. 265 00:30:15,800 --> 00:30:21,800 And I sent a specific orthodontist airway focus orthodontist who understand that. 266 00:30:21,800 --> 00:30:32,800 And they know how to do this and they have experience with it. Now, saying an adult wants to do this sutures fused and for men, the bone is really dense. 267 00:30:32,800 --> 00:30:43,800 So you can't just screw it in there and open it up. We actually have to do what's called a court economy and type open the suture in the center of the palate. 268 00:30:43,800 --> 00:30:47,800 It's actually not that bad. It sounds, I was gonna say it sounds horrible. 269 00:30:47,800 --> 00:31:03,800 But it's actually like Dr. Richard Ting, he's in Rancho Santa Margarita here in California. I refer to him a lot. He does this. It's called a Marfi mini implant assisted rapid palatal expander. And so there's a certain way like other mechanics to it. 270 00:31:03,800 --> 00:31:11,800 You have to custom make the expander itself and it has arms on it that help direct force and pressure in the right places. 271 00:31:11,800 --> 00:31:23,800 And then I screwed into the palette. We put open the suture before we screw it in. But there's really like advanced imaging that we do like state of the art imaging with Combin CT. 272 00:31:23,800 --> 00:31:34,800 We get 3D rendering of the entire skull to map that out to plan it. Then the lab makes a custom piece that fits perfectly into your palate. 273 00:31:34,800 --> 00:31:44,800 The screws have to go in a very specific place that you have good in fridge. And then when you start expanding what happens is the adults will get a gap between their teeth, which is a good sign. 274 00:31:44,800 --> 00:31:48,800 It means you're actually standing where you're supposed to expand. 275 00:31:48,800 --> 00:32:00,800 But you can talk to the adults who do this and they'll tell you it helped. They could breathe better through their nose. That's one of the things that improve for them when they do a Marfi thing. 276 00:32:00,800 --> 00:32:11,800 That's amazing. It makes sense too, right? Everything's pushing up. So curious because when you open the skull and you were showing suture, it looks flat up there. 277 00:32:11,800 --> 00:32:17,800 It looks flat and smooth. What if you have a bump down the middle? 278 00:32:17,800 --> 00:32:25,800 Oh, that's called a tori. So that's something where somebody experienced who does this all the time will know how to manage that. 279 00:32:25,800 --> 00:32:34,800 That's hollow bone. It's not really strong bone. So it's something that they have to consider when they plan this, whether or not they can do that for you. 280 00:32:34,800 --> 00:32:44,800 But that you'll have to talk to somebody who actually does that frequently. And I know just from groups that I'm in and all the orthodontists that I talked to and I've taken the courses and I'll learn about it. 281 00:32:44,800 --> 00:32:49,800 But I don't actually do Marfi in my office. 282 00:32:49,800 --> 00:32:57,800 But if your child has a bump up there, you could, there's still somebody to do it. 283 00:32:57,800 --> 00:33:10,800 But honestly, in a child, they rarely have that torus called a tori. They rarely have that there. That's more something, a complication that has to be dealt with for an adult. 284 00:33:10,800 --> 00:33:19,800 That comes from functional problems. If you're like clenching, you don't have space that's more likely to develop. I have one up in my palate actually. 285 00:33:19,800 --> 00:33:27,800 I have one too. That's part of why I was thinking about that. And then I was, you know, when you opted that out, but I was thinking about, you know, when my children were younger, what that looked like. 286 00:33:27,800 --> 00:33:39,800 And it occurred to me, that's what my children look like, but mine doesn't feel like that. I feel this bump. 287 00:33:39,800 --> 00:33:49,800 And I feel like it's like, you know, you're, you know, you're going to have to, you know, you're going to have to get used to your body. 288 00:33:49,800 --> 00:33:59,800 The more other problems will arise from it. And you'll, you know, like I always say, some things got to get your way of compensating is going to affect your body in some way. 289 00:33:59,800 --> 00:34:07,800 And it's going to show up. And that's one of the ways it will show up, just like with tongue time and compensating. You know, it shows up in how the jaw developed. 290 00:34:07,800 --> 00:34:19,800 And it's going all the way down. And so now you understand, you know, when Dr. Leal was on and he talked about, you can see a child's gate and you can understand there's something there. 291 00:34:19,800 --> 00:34:30,800 Deep, broad-lined fascia is what it is. Yeah. What you're talking about. That tongue fascial tissue, yeah, connects all the way down to the toes. It connects to the diaphragm. 292 00:34:30,800 --> 00:34:38,800 And I see an infant, so I see a lot of infants in my office. And one of the things that we do to help those infants is recommend body work. 293 00:34:38,800 --> 00:34:45,800 Because when their tongue tied, and they're so tight there, it's pulling on their diaphragm as well. 294 00:34:45,800 --> 00:34:58,800 So when I refer to body workers, I don't just refer to anyone. I refer to the people who understand this concept that the deep front-line fascia connects from the tongue down to the diaphragm to the psoas down to the toes. 295 00:34:58,800 --> 00:35:05,800 So you really do have to do a full body release and help the body open up because it's been so tight all this time. 296 00:35:05,800 --> 00:35:06,800 Right. 297 00:35:06,800 --> 00:35:17,800 So when I do a tongue tie release, they do somebody work before, but it's really important to target it after. And as soon, like immediately after the procedure, because that's when the baby is the most loose. 298 00:35:17,800 --> 00:35:27,800 We want things to stay loose so that it heals loose. Otherwise, if their body's still tight, and they maintain that tension, then the tongue will actually heal. 299 00:35:27,800 --> 00:35:34,800 With that tension as well. So then we essentially didn't do anything. 300 00:35:34,800 --> 00:35:35,800 Yeah. 301 00:35:35,800 --> 00:35:41,800 I want to, and I'm caveatting this for anybody that's heard this. 302 00:35:41,800 --> 00:35:56,800 I'm not bringing this up just for the sake of bringing it up, but other parents, our listening parents, saw the article in the New York Times about, what was it, the booming business of tongue tie releases. 303 00:35:56,800 --> 00:36:13,800 And you had a really great response on Instagram. And so, you know, just for the parents who haven't seen it yet, and I'll link to it in our show notes, but would you mind sharing a little bit about your thoughts on the article and where you stand on this. 304 00:36:13,800 --> 00:36:22,800 I think my thoughts are probably more philosophical, but I really believe that. 305 00:36:22,800 --> 00:36:32,800 Patients are people who are involved in tongue tie. I see both sides to it. I see people, especially when I first got into this. And I wanted to learn about it. 306 00:36:32,800 --> 00:36:40,800 I wanted to learn because I was seeing that parents were having a hard time getting help from their pediatrician. 307 00:36:40,800 --> 00:36:45,800 Then we would do the procedure and they would get improvement. So it was like, this is really frustrating. 308 00:36:45,800 --> 00:36:52,800 All the pediatricians needed to do was refer them to the right people and they could have had this problem solved instead of suffering for as long as they did. 309 00:36:52,800 --> 00:36:58,800 But then I would also see groups that were doing tongue tie releases at everyone. 310 00:36:58,800 --> 00:37:05,800 And they weren't doing therapy. They weren't recommending all this. They were just doing the procedure and it was like a mill. 311 00:37:05,800 --> 00:37:12,800 And the article specifically talks about a lactation consultant. And we have that problem here in Orange County. 312 00:37:12,800 --> 00:37:21,800 There's a lactation consultant nearby that works with a dentist in another group and they are just everybody who walks in the office. 313 00:37:21,800 --> 00:37:30,800 And mind you, the lactation consultant is not allowed to diagnose the problem. Yet they're doing it sometimes. 314 00:37:30,800 --> 00:37:36,800 Not all of them. I work with plenty of lactation consultants who know, I think this is a problem for your baby. 315 00:37:36,800 --> 00:37:44,800 This is probably why the breastfeeding experience isn't going well. You should go see a provider who can diagnosis and then they'll provide lower to me or other providers around here. 316 00:37:44,800 --> 00:37:53,800 It's not just me. And I think that's important. You don't want them referring to only one person. They should recommend a few for you to go to multiple. Yeah. Yeah. 317 00:37:53,800 --> 00:37:56,800 So and that way you can make a decision. 318 00:37:56,800 --> 00:38:06,800 So I'm not against the fact that they wrote about this. I think that's information that's really important for parents to hear that that does exist. 319 00:38:06,800 --> 00:38:14,800 But just like in any industry, there's bad apples in every industry. Right. That's the same here. 320 00:38:14,800 --> 00:38:28,800 I think that 321 00:38:28,800 --> 00:38:34,800 it does hurt families, but did it with me for a second? Yeah. 322 00:38:34,800 --> 00:38:38,800 So the problem with the article is that it does. 323 00:38:38,800 --> 00:38:42,800 It does hurt some families from getting the help that they need. 324 00:38:42,800 --> 00:38:50,800 Because since then I have had some parents come to me saying, you know, I almost didn't come because of that article. 325 00:38:50,800 --> 00:38:59,800 My friend sent it to me. And then I'm like, that would have been awful, huh? And they're like, yeah, I would have been struggling even longer. 326 00:38:59,800 --> 00:39:07,800 And when I do the procedure for the baby and the mom gets to experience right away, I have the breastfeeding in my office right away to try it out. 327 00:39:07,800 --> 00:39:16,800 And the mom, they feel it right away. They know the difference, especially because I spend a lot of time educating all this functional stuff. 328 00:39:16,800 --> 00:39:19,800 I go through part of like a power play presentation. I show. 329 00:39:19,800 --> 00:39:26,800 That's key, right? The education piece is key so that everybody understands that we're all working towards the same goal. 330 00:39:26,800 --> 00:39:36,800 Exactly. Like, I want every family to know when they come to my office and I'm training a new assistant and I was telling her this morning, I'm like, it's really important to me that the parents make a sound decision. 331 00:39:36,800 --> 00:39:46,800 And that they're not pressured into it. And that we're not using fear to, you know, get people to do procedures. 332 00:39:46,800 --> 00:39:51,800 Right, right. That happens in every industry. You know, if you don't do this, this is going to happen. 333 00:39:51,800 --> 00:39:59,800 So instead, what I do is I educate. Hey, these, this is how development happens. And these are the things that could happen. I don't know if this is going to happen to your child. 334 00:39:59,800 --> 00:40:07,800 They might need these things anyway. But what I can tell you is if we do the procedure, these are the few things that it can help. And we're realistic about it. 335 00:40:07,800 --> 00:40:18,800 It's not a magic bullet. It's not going to solve all your problems. Sometimes reflux can be caused by tongue tie. Sometimes your baby also has a cow's milk protein allergy at the same time. 336 00:40:18,800 --> 00:40:26,800 And that's what's causing reflux, not the tongue tie. And so when you're a provider who does this, you need to understand the differentials. 337 00:40:26,800 --> 00:40:37,800 And so that's also like a part of my mission is I want to educate providers who do tongue tie releases to understand, like, don't be so myopic and just focus on, they have all these symptoms that mean tongue tie. 338 00:40:37,800 --> 00:40:49,800 That means we do a tongue tie release. No, you've got to know that other things can cause the same symptoms and you be, you have to be able to differentiate what those things are. 339 00:40:49,800 --> 00:41:00,800 And if you do the procedure and it doesn't help the parent, you have to be able to give them good advice of where to go because that's why the parents are mad at the pediatricians in the first place. 340 00:41:00,800 --> 00:41:08,800 Well, they told me that it wasn't a problem. It's just a small problem. And they kind of just let them hanging like don't do the procedure. 341 00:41:08,800 --> 00:41:14,800 You know, that's not good advice. Good advice is I'm I don't know. I'm not sure. But this is where you can go to find out. 342 00:41:14,800 --> 00:41:20,800 Right. And let's just watch it by the way is not good advice. 343 00:41:20,800 --> 00:41:27,800 Waiting and watching needs to be an educated decision. Okay, if we're waiting and watching, what are we watching for? 344 00:41:27,800 --> 00:41:31,800 At what point do we decide to do intervention? 345 00:41:31,800 --> 00:41:32,800 Right. 346 00:41:32,800 --> 00:41:40,800 And that's what I spend time talking about with my patients when they come into my office. Okay, if you decide not to do the tongue tie release, that's fine. 347 00:41:40,800 --> 00:41:48,800 These are the things I want you to look out for. And this is an alternative for you if you don't want to do the procedure. You're too scared of it. 348 00:41:48,800 --> 00:42:00,800 Sometimes moms are dealing with postpartum depression and anxiety. Yeah, the postdoc care is too much for them. They can't do it. You don't have help at home. You don't have anyone to help you to allow this procedure to be a success. 349 00:42:00,800 --> 00:42:07,800 Okay, maybe this is not the right time. Do this instead. Let me give you some other support in the meantime. 350 00:42:07,800 --> 00:42:09,800 Yeah, I like that. 351 00:42:09,800 --> 00:42:23,800 That's what we should all be doing in healthcare anyway. But, you know, that article bringing those things to fight, I hope that it's good for parents to know that to look out for those things. 352 00:42:23,800 --> 00:42:33,800 I think parents should take that article with a grain of salt. It doesn't mean don't do the procedure. It means do your research before you find a provider. 353 00:42:33,800 --> 00:42:35,800 Right. 354 00:42:35,800 --> 00:42:48,800 And then you can talk to them. Does their front office talk you through things? Are they using fear to get you to do it? They're like, you don't do this. All this is going to happen. No, I don't like that. That is not my approach at all. 355 00:42:48,800 --> 00:42:52,800 So the fear mongering happens in every industry. Don't do it. 356 00:42:52,800 --> 00:42:56,800 And you can't make a decision that way, right? That's not a, yeah. 357 00:42:56,800 --> 00:42:59,800 It's not a good way to make a decision based off fear. 358 00:42:59,800 --> 00:43:01,800 No, it's not, right? 359 00:43:01,800 --> 00:43:06,800 So to make the decision to do nothing based on fear, not a good decision either. 360 00:43:06,800 --> 00:43:07,800 Right. 361 00:43:07,800 --> 00:43:22,800 So the article is definitely extremely biased. I know that they interviewed a lot of other experts who had really great outcomes but didn't include any of that information. So, you know, that's just how journalism is. 362 00:43:22,800 --> 00:43:25,800 Yeah, it is. It is. 363 00:43:25,800 --> 00:43:34,800 One of the things that you've mentioned a couple of times and it's something we advocate. I think that's why I kind of picked up on it and latched on to it. 364 00:43:34,800 --> 00:43:42,800 You talk a lot about collaboration, especially with, you know, just all medical providers like the whole realm. Let's all just start working together. 365 00:43:42,800 --> 00:43:51,800 So where did you develop this philosophy because, and with all due respect, they don't teach this in medical school. 366 00:43:51,800 --> 00:43:58,800 They used to a hundred years ago, but they don't now. So where did this philosophy come from? 367 00:43:58,800 --> 00:44:09,800 You know, I think that one of the things in medicine that's a problem in healthcare in general is, is having an ego. 368 00:44:09,800 --> 00:44:16,800 I think a lot of people have egos that are doctors and myself included. Sometimes I have to check myself. 369 00:44:16,800 --> 00:44:27,800 And the important thing is, is that when you practice collaboratively, you have to have enough humility and humbleness to say, I don't know all the answers. 370 00:44:27,800 --> 00:44:37,800 And I need to talk to these people to help me understand where I might be missing the mark, where I might not understand how to help my patient. 371 00:44:37,800 --> 00:44:49,800 And so I tried to take that approach to start and that's how I started collaborating with other providers. So I'd go talk to our practice and other therapists, speech and English pathologists, 372 00:44:49,800 --> 00:44:59,800 myofunctional therapists, ENTs, orthodontists, and sleep surgeons, sleep doctors, trying to learn from all of them. 373 00:44:59,800 --> 00:45:08,800 Okay, if a patient has this problem, obviously this is something I can't do that or it's with outside my scope of practice. What should I look out for? 374 00:45:08,800 --> 00:45:17,800 And where can you help this patient? And when you start to learn what other people can do, it's not like you're going to do it. I don't want to do body work. 375 00:45:17,800 --> 00:45:18,800 I don't. 376 00:45:18,800 --> 00:45:19,800 Right. 377 00:45:19,800 --> 00:45:28,800 Like, I'm only doing early orthodontics. There's a certain age that I'll do expansion to like Marbez. I don't do them. I'll send it to the orthodontist who does. 378 00:45:28,800 --> 00:45:44,800 That I adopted just from purely wanting to help patients and do what's right for them. And it goes back to the same thing that I said regarding the article, like, when you're looking for somebody, they, somebody's 379 00:45:44,800 --> 00:45:49,800 claiming to know all the answers to your problem. Probably not the best person to go to. 380 00:45:49,800 --> 00:46:00,800 But we all have to know we don't know everything and schools, education and the way that the healthcare system is set up these days, it's highly specialized. 381 00:46:00,800 --> 00:46:14,800 So you either get a provider who's the jack of all trades, master of none, or you get master providers that might not know enough about other things to like have a good bigger picture. 382 00:46:14,800 --> 00:46:30,800 And that's where it's so important. And, and you've got to be able to recognize. And the other thing I wanted to learn was I wanted to know who the best people to send my patients to work. 383 00:46:30,800 --> 00:46:48,800 Because some people will claim to be really good or to do this or to take the courses even and, you know, have the information but experience is another part of that. You got to have experience to, and you have to have enough humility to know like when I started off, I was charging 384 00:46:48,800 --> 00:47:05,800 for nothing to do tongue tie releases next to nothing. I was not making money doing this. It was more just to learn and help the parents and say, and I would tell them, hey, like, it's kind of new thing. There's not a lot of research on it, but I want to help you out and I think that this can help your baby and 385 00:47:05,800 --> 00:47:19,800 they would trust me and we would do it and I would learn from it if it didn't go well or if it did go well, you learn and you got to like have that mindset. I think having that is really important. And so I try to align myself with those sorts of providers who can. 386 00:47:19,800 --> 00:47:27,800 And I think you hit it the nail ahead too when you said it's learning. And that's something I've heard from quite a few of our guests. 387 00:47:27,800 --> 00:47:39,800 You can't stop learning. Great. You went to med school, you went to dental school, which, wow, incredibly hard and you made it through. But you have to keep going science changes. 388 00:47:39,800 --> 00:47:59,800 And change it quickly. And yeah, we can't always wait for evidence to come up to help our patients. That we know 17 years for the evidence once it's proven and written for it to catch up and be put into standard of care. 389 00:47:59,800 --> 00:48:10,800 17 years that child is an adult now and the damage is done. It's way too late. So we know enough to know that early intervention can be beneficial. We see it. 390 00:48:10,800 --> 00:48:23,800 I post cases on my Instagram all the time, kids that I've treated and how it's helped them with expansion and you can see the difference. I just posted one yesterday of a four and a half year old we start at four and half. 391 00:48:23,800 --> 00:48:34,800 Same thing. They couldn't find orthodontist that would treat them. They're like, no, no, no later on later on. But we know what happens later on. You're right. You're limited with what you can do. 392 00:48:34,800 --> 00:48:41,800 Okay. Now this kid is super crowded. All right, maybe we just take out teeth to make the teeth bit. 393 00:48:41,800 --> 00:48:44,800 Right. And now we have a whole different problem. Yeah. 394 00:48:44,800 --> 00:48:50,800 And then we have a set of different problems. Now we're creating a different problem, but we're not thinking about that when we're practicing traditionally. 395 00:48:50,800 --> 00:49:01,800 Right. I'm thinking about their life, but we're getting the teeth straight and it looks good. And they're not complaining. Well, they're not complaining about the complaints you look for. 396 00:49:01,800 --> 00:49:08,800 Right. Because again, they weren't taught. Yeah, they don't know what they don't know about the airway. 397 00:49:08,800 --> 00:49:21,800 Sleep is rough. TMJ problems. And I actually remember and this is also what got me to this place too. I remember when I was in orthodontics back when I was a teenager. 398 00:49:21,800 --> 00:49:33,800 And I had a lot of crowding. A lot of orthodontists even now looking at me, they're like, you have a great smile. I'm like, yeah, they took out for permanent bilateral. 399 00:49:33,800 --> 00:49:39,800 Yeah, by cuspids on me. I got all four premolars taken out. 400 00:49:39,800 --> 00:49:50,800 And during that treatment, I really remember my jaw started popping. And I said to the orthodontist, Hey, my jaws popping all of a sudden. 401 00:49:50,800 --> 00:49:56,800 And I remember it was right after they closed up my spaces where they had extracted the teeth. 402 00:49:56,800 --> 00:50:07,800 She's like, Oh, that happens to teenagers is common. And I'm like, but no, but it's corresponding to a certain event in the orthodontic treatment. 403 00:50:07,800 --> 00:50:18,800 She's great orthodontist. Nothing, nothing on her. She's wonderful orthodontist. I still look at the thing back and I'm like, she just doesn't know, you know, they might not know that this can be a problem. 404 00:50:18,800 --> 00:50:22,800 Right. And it's funny because what is it that doctor about it? No. 405 00:50:22,800 --> 00:50:27,800 Yeah, I want to visit the doctor. I guess it's all the time just because something's common. 406 00:50:27,800 --> 00:50:28,800 Doesn't mean it's normal. 407 00:50:28,800 --> 00:50:42,800 I mean, it's normal. Exactly. So my great you encounter it all the time, but did you ever stop to think like maybe this is not normal. Maybe it does correspond to something. Maybe we did cause this problem in this patient by doing this and. 408 00:50:42,800 --> 00:50:45,800 And that's what I want. I want that kind of provider working on me. 409 00:50:45,800 --> 00:50:53,800 I want the one about it because sometimes we are not perfect. Doctors are perfect. You can't expect them to not make mistakes. 410 00:50:53,800 --> 00:50:54,800 But you're human. 411 00:50:54,800 --> 00:51:04,800 They're being mindful and they're looking out for your best interests and they're smart enough to think things through, not just like doing it just for fun or just to try out. 412 00:51:04,800 --> 00:51:05,800 Right. 413 00:51:05,800 --> 00:51:06,800 For science. 414 00:51:06,800 --> 00:51:16,800 But you know, you just you want somebody who's going to think through thoroughly and can explain to you their reasoning. Then okay, let's get out and let's see. 415 00:51:16,800 --> 00:51:20,800 And have a game plan for it. 416 00:51:20,800 --> 00:51:23,800 It doesn't work. Then we'll we'll pivot and we'll go this way. 417 00:51:23,800 --> 00:51:28,800 That's that's not thoughtfulness. That's the kind of doctor that you should work with. 418 00:51:28,800 --> 00:51:40,800 You want. Yeah. Oh, 100% 100% at the end of every episode. I always want to hand it back to the guests because you are the experts after all for the final thought. 419 00:51:40,800 --> 00:51:46,800 So what what is a final thought that you would like to leave our listeners with. 420 00:51:46,800 --> 00:51:50,800 Good. 421 00:51:50,800 --> 00:52:01,800 I mean, I guess what I just said is a really great final thought. Be mindful of who you're working with and take the time to find the right person. 422 00:52:01,800 --> 00:52:08,800 Sometimes it might be a lot to have to go to different consults and get second opinions. 423 00:52:08,800 --> 00:52:19,800 But before you start treatment with anyone, take your time to get to know what their plan would be and how they how they function, how they operate. 424 00:52:19,800 --> 00:52:28,800 Before committing, because when it comes to airway and tongue tie issues, the treatment is never a magic one. 425 00:52:28,800 --> 00:52:32,800 It's not the bullet magic bullet to do a tongue tie release or expand. 426 00:52:32,800 --> 00:52:43,800 It's usually a full comprehensive treatment plan that involves surgery, therapy and other supportive care body work. 427 00:52:43,800 --> 00:52:59,800 So before you jump into it and just do your work, do your research and don't don't feel rushed into it. I understand that when your children have symptoms, you want to do something right away. 428 00:52:59,800 --> 00:53:01,800 Right. 429 00:53:01,800 --> 00:53:07,800 You also don't want to create other problems. So take, take the time. Take the time. 430 00:53:07,800 --> 00:53:14,800 Really good, good advice. Thank you so much for being on Dr. Tran and sharing so much great information. 431 00:53:14,800 --> 00:53:21,800 Thank you for having me. I get to do what I love most and that's to educate. So I appreciate the platform to do that. 432 00:53:21,800 --> 00:53:25,800 Absolutely. Absolutely. 433 00:53:25,800 --> 00:53:34,800 Thanks again to today's guests, Dr. Tracy Tran for sharing her medical insight and each of you for listening to today's episode. 434 00:53:34,800 --> 00:53:43,800 If you're new to our podcast, please don't forget to subscribe. And if you enjoyed today's episode, leave us a review or comment telling us about what you enjoyed the most. 435 00:53:43,800 --> 00:53:52,800 You can stay connected with the Children's Airway First Foundation by following us on Instagram, Facebook, X, LinkedIn and YouTube. 436 00:53:52,800 --> 00:54:03,800 Parents can also join us via our Facebook support group, the airway huddle app, facebook.com backslash group backslash airway huddle. 437 00:54:03,800 --> 00:54:14,800 You can find tons of great content for parents and medical professionals on our parents portal and clinicians corner on our website at childrensairwayfirst.org. 438 00:54:14,800 --> 00:54:27,800 If you'd like to be a guest or have an idea for an upcoming episode, shoot us a note via the contacts page on our website or send us an email directly at infoatchildrensairwayfirst.org. 439 00:54:27,800 --> 00:54:36,800 And finally, thanks to all the parents and medical professionals out there that are working to help make the lives of kids around the globe just a little bit better. 440 00:54:36,800 --> 00:54:51,800 Take care, stay safe and happy breathing everyone.