Hi everyone, and welcome to another episode of The
Children's Airway First Foundation. I'm your host, Rebecca St. James.
My guest today is Dr. Tracey Tran, a board-certified pediatric dentist who specializes in infant and pediatric oral
ties, as well as pediatric sleep issues. She is a Michigan native who first landed in Southern
California to attend dental school at UC's Ostrow School of Dentistry. After graduation,
Dr. Tran went on to complete a one-year general practice residency where she received additional
training in all aspects of dentistry with an emphasis on oral surgery. She performed surgical
procedures in maxofacial trauma under the attending oral maxofacial ENT and plastic surgeons.
During the following two years, Dr. Tran continued her specialty training in pediatric dentistry
while completing her master's in biomedical science. Since being in private practice,
Dr. Tran has focused her continuing education on pediatric tethered oral tissue and its
relationship with oral dysfunctions in order to diagnose oral-facial myofunctional disorders.
This includes difficulties with infant nursing, toddler feeding and swallowing, speech, articulation,
and pediatric sleep-disordered breathing. She has successfully treated these patients through
a collaborative team approach and continues to expand her knowledge and experience in this niche.
She's also proud to contribute to the advancement of academics by volunteering her time teaching
at USC as a clinical assistant professor in the Division of Dental Public Health and Pediatric
Dentistry. You can find out more about Dr. Tran at drtracetrann.com. And now let's jump into
today's interview with Dr. Tracey Tran. Great. All right. Thank you so much for joining us today,
Dr. Tran. I appreciate you being here. Thank you for having me. I'm really excited to be here.
Yeah, absolutely. So let's just jump right in. I know we were talking a little bit beforehand,
but I'd love to just share with our audience a little bit about your journey and how you got into
Airway. Yeah. So I started off just being curious. There were two major things I would see in the
dental office just as a regular pediatric dentist doing exams and two major complaints. One was
my kid grinds their teeth a lot. And the other was, you know, I'm brushing and flossing and feeding them
the right things. And yet there's still been cavities. So both of those things I never had good
solid answers for. And then one day I met a good friend of mine, Mary Ellie Mitchell, she's a
occupational therapist and does my own functional therapy as well. And she was like, Hey, you're
pediatric dentist. You do tongue ties. And I'm like, No, I don't. Why do you have a fast? And then
when we started to get into it, I realized like, Oh, okay. She was like, it can cause ADHD. It can,
you know, lead to all these problems, feeding issues, speech issues, and like, Okay, they can grind
their teeth. And I'm like, Whoa, okay. Keep grinding. Then I caught my attention. Then I started going
down the rabbit hole like anyone in the space does. She led me to the Academy of Oral Facial
Myopropyntal Therapy. And I went to their Fremulam Inspection Workshop. And one of the speakers
that they had there was Saruj Sakhi. And I'm very evidence based. I don't like to do things without
good solid evidence or just good science behind it. And he presented some pretty good compelling
arguments about tongue tie and functional problems. And it looked like that he had been doing some studies
around it. So kind of like following him around after that. And he created the Breathe Institute after
that. And he started taking courses and learning more and more about it. But when you have patients who
have a problem that you cannot solve or your answer to them is, Oh, they'll grow out of it. You're just, you
just know that's not, that's the answer you give when you don't have an answer. You know. So when I finally
found the answer, I'm like, these patients need help. So it all had to do with what does teeth grinding
mean? And it means, Oh, you're grinding your teeth, there's some sort of stress. And we knew that that's
something we learned in dental school. It's a stress response. Okay, well, why are they stressed out?
Well, it could be that they're not breathing well in their sleep. And well, why are they not breathing
well in their sleep? Oh, well, could be that their airways getting obstructed. And then I started
to learn, okay, where are some areas where your airway can get obstructed? Could be the nose, nasal cavity,
adenoids, soft palate, face of the tongue. Oh, the face of the tongue. And that makes sense. That's my space. I work in
the mouth. So then you start to understand, okay, tongue tie can relate to this because when the tongue is
tied, the tongue is down low, can have a low resting tongue posture, might have poor tone because you're not using
it correctly. And that can fall back into the airway during sleep. That's where the obstruction can occur.
And when you're not sleeping well, when you're not getting enough oxygen, and that's that your body gets
stressed out, then the stress response happens, the teeth grinding. And that's that made a lot of sense to me,
it made absolute sense. So, you know, that was the first thing that got me going down this rabbit hole. I'm wanting to
help solve this problem for a lot of families. And a lot of it also, it spotted a lot of other questions, like, you
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
side of it, like, sure, it makes sense. But, you know, can we actually help the families with this? So, I've been doing
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
more information evidence coming out on it. And the studies are there. And I've always been on this mission to help
all of my colleagues to understand this and educate parents on this, so that indirectly the medical community
community will eventually accept it. And that's what I want. I want there to be more acceptance around this so that we can
help more families because there's nothing more disheartening as a provider when a family comes in and they're like, you know, it
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
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
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
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
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
really well, so that they can also bring that information back to their pediatricians and dentists. And I want them to know
that this isn't just some hippie-dippy voodoo.
Right, there is science. There is factual evidence. Yeah.
Exactly. Yeah. And so it's really important to me that when I communicate and educate these things that it's done accurately and
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
is. So diagnosing properly is key. And getting a good diagnosis can be tough to get to.
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
tongue tie or sleep issues?
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?
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.
If your child is tongue tied, think about what the tongue does. It helps with sucking and swallowing, especially for an infant earlier on.
Right. It helps with feeding. Because the tongue has to move food around in the mouth for chewing.
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.
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.
Yeah. Because you can breathe when it's down low, but it's not where it's supposed to be.
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.
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.
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.
Just like you can speak with the tongue tie and your tongue's not working correctly, but you might not be speaking correctly.
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.
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.
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.
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.
And usually what will happen is if they can't do it correctly, we're going to compensate.
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.
And your arm can only lift maybe 20% of the way off your body.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
So if they're not functioning well to start, right, already impacted the growth significantly because a lot of it has already happened.
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.
Because part of fixing the tongue tie isn't just we snip, let you go all good.
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.
You're gonna say you still have to train.
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.
And that can also impact the healing. That's another factor that's really important is making sure you heal well.
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.
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.
It didn't heal well. They needed therapy. So therapy is really crucial and important to the successful outcome of doing a release.
But therapy before and after.
Yes. Yeah. Because before it's giving your tongue awareness. After it's teaching you what to do with its new range of motion.
Okay.
So when I do a release, all I'm giving the tongue is range of motion. They don't know what to do.
So they have to train for it. And when I would do the releases and they weren't successful.
I think that's where I was talking about. There was a point I was trying to get to.
I wish I could listen to myself talk and what I was saying.
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.
And they weren't successful.
Yeah. So this is just to say, like, no, there was another point I was trying to get.
And I should never have this happening before.
Mom, I think after having a baby, the sort of stuff happens.
It does.
It totally does.
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.
But you, with all the experience that I've had in doing all of this and when you do a tongue tie release.
The success of it.
Gosh, I can't like this is really eating at me right now because I can't.
It was saying.
We can back up a little bit and see if it'll trigger.
We just kind of start talking about that you have to have it.
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.
So those are the main things that the tongue does.
And the original question was about how we treat.
How you can tell there's a problem.
Right.
So the compensations.
Oh, okay. I know what I was getting that now.
So.
The thing is, they have to do the therapy before.
They have to do the therapy after.
And then.
Before that, though, if there's no space.
In their mouth to even do the therapy to begin with.
Then it's a moot point to even do the therapy and do the tongue tie release.
So by three years old when they come to me when they're an older child, have to create space too.
So now there's more involved in treating the problem. It's not like what we do for an infant and infant.
Yes, they might need a little bit of training, but the therapies may be like a couple weeks.
Oh, wow.
Maybe four weeks math.
But when it's a child, it's usually several weeks or months before we get to doing the release.
And then several weeks or months of therapy after the release as well.
But if while they're doing the therapy, they have to suction their tongue up.
They have to move their tongue side to side. We want to get them full range of motion.
The thing of the tongue is the car and your mouth is the garage.
Okay.
The garage is too small. And if it's too small, the car can't move within it.
It's separate. And where does it go? You can you shut the garage door?
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.
And that's going to need your airway.
So we usually, before we do therapy and release the tongue tie, create space first.
You have to expand the jaw, make it bigger.
And it's because of how the tongue tie affected the growth in the first place.
And so this is a really important concept that I want parents to understand when they come into my office.
And just I want most people to understand in general, because even pediatricians don't know and understand this.
This is this is science that we know about. There's no arguing this at all.
Okay.
As the upper jaw grows, our bones are in separate pieces.
And I have like a little skull here.
Perfect.
These different pieces. Okay.
All these areas.
Between each bone, each of the separate bones is called the suture.
And the suture, we have one right down the center of the palette right down the middle and it splits our palette in half.
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.
That's how the upper jaw grows.
Okay.
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.
Also attached to the nasal bone and makes up part of these other structures, part of the cheekbones.
So when this grows, the rest of the face gets to grow with it.
But if it doesn't, then everything else stays small too.
I'm zoom.
So if the tongue doesn't rest up and the jaw doesn't widen, you might get a narrow face.
And that's what we also see in mouth breathing. So it's not just tongue tie.
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.
Let's let's get to the problem. It's time.
It might not be.
There's other reasons why people mouth breathe.
It's not just low tongue posture.
It can be from allergies, you know, nasal cavities too small, turbinate inflammation, lots of problems, adenoids inflamed.
So then you can't breathe through your nose.
So that might induce mouth breathing.
And then that also, if in order to breathe through your mouth, your tongue has to stay down low.
You can't put your tongue up and breathe through your mouth.
It's impossible.
Right.
So that low tongue posture, then again, if it's happening in a child, that will affect their cranial facial growth.
And then so by the time they're three years old, 70 to 80% grow.
And they've been mouth breathing.
Well, we've already had a major impact on the growth and development there.
So we have to jumpstart that development, make that space before we release the tongue tie.
But in that regard, when you understand that you understand why mouth breathing should not be done early on in life.
Because of how it impacts the jaw growth.
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.
And I typically do it around that age five, six.
I've done it as early as three when it's needed.
Okay.
But it's more complicated as we get older because everything's a little more established.
It can still be done.
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.
Oh, wow.
Yeah.
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.
In the middle.
Show you what that looks like.
And it looks like this.
Okay.
It sits on the teeth. You've got a jack screw in the middle here.
The parent turns this once a day. It expands by point two millimeters. So you're only winding by point two millimeters.
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.
But as that suture starts to fuse, you can't get that pressure there anymore.
It starts to push more on the teeth.
And the roots of the teeth of the baby teeth are starting to dissolve because new teeth are coming through.
Right.
So you're trying to anchor on the teeth and you're pushing on it. Now the teeth start to push out.
So you do get a change in the dental arch. It looks wider.
Now what's happening is the teeth are tipping out. You're not actually widening here in the center of the palate.
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And now let's jump back into today's podcast.
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.
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.
Yeah.
You know, it happens earlier for girls.
So what do you do once it's fused, you know, for somebody that has an older child?
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.
And that directs force directly around the suture itself, and then you widen at the suture.
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.
Sure you can, but you're going to get mostly dental alveolar expansion. You might not get that orthopedic expansion.
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.
Right.
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.
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.
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,
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%.
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%.
Wow.
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,
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.
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.
And I sent a specific orthodontist airway focus orthodontist who understand that.
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.
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.
It's actually not that bad. It sounds, I was gonna say it sounds horrible.
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.
You have to custom make the expander itself and it has arms on it that help direct force and pressure in the right places.
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.
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.
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.
It means you're actually standing where you're supposed to expand.
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.
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.
It looks flat and smooth. What if you have a bump down the middle?
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.
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.
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.
But I don't actually do Marfi in my office.
But if your child has a bump up there, you could, there's still somebody to do it.
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.
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.
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.
And it occurred to me, that's what my children look like, but mine doesn't feel like that. I feel this bump.
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.
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.
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.
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.
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.
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.
Because when their tongue tied, and they're so tight there, it's pulling on their diaphragm as well.
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.
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.
Right.
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.
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.
With that tension as well. So then we essentially didn't do anything.
Yeah.
I want to, and I'm caveatting this for anybody that's heard this.
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.
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.
I think my thoughts are probably more philosophical, but I really believe that.
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.
I wanted to learn because I was seeing that parents were having a hard time getting help from their pediatrician.
Then we would do the procedure and they would get improvement. So it was like, this is really frustrating.
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.
But then I would also see groups that were doing tongue tie releases at everyone.
And they weren't doing therapy. They weren't recommending all this. They were just doing the procedure and it was like a mill.
And the article specifically talks about a lactation consultant. And we have that problem here in Orange County.
There's a lactation consultant nearby that works with a dentist in another group and they are just everybody who walks in the office.
And mind you, the lactation consultant is not allowed to diagnose the problem. Yet they're doing it sometimes.
Not all of them. I work with plenty of lactation consultants who know, I think this is a problem for your baby.
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.
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.
So and that way you can make a decision.
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.
But just like in any industry, there's bad apples in every industry. Right. That's the same here.
I think that
it does hurt families, but did it with me for a second? Yeah.
So the problem with the article is that it does.
It does hurt some families from getting the help that they need.
Because since then I have had some parents come to me saying, you know, I almost didn't come because of that article.
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.
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.
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.
I go through part of like a power play presentation. I show.
That's key, right? The education piece is key so that everybody understands that we're all working towards the same goal.
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.
And that they're not pressured into it. And that we're not using fear to, you know, get people to do procedures.
Right, right. That happens in every industry. You know, if you don't do this, this is going to happen.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Right. And let's just watch it by the way is not good advice.
Waiting and watching needs to be an educated decision. Okay, if we're waiting and watching, what are we watching for?
At what point do we decide to do intervention?
Right.
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.
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.
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.
Okay, maybe this is not the right time. Do this instead. Let me give you some other support in the meantime.
Yeah, I like that.
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.
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.
Right.
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.
So the fear mongering happens in every industry. Don't do it.
And you can't make a decision that way, right? That's not a, yeah.
It's not a good way to make a decision based off fear.
No, it's not, right?
So to make the decision to do nothing based on fear, not a good decision either.
Right.
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.
Yeah, it is. It is.
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.
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.
So where did you develop this philosophy because, and with all due respect, they don't teach this in medical school.
They used to a hundred years ago, but they don't now. So where did this philosophy come from?
You know, I think that one of the things in medicine that's a problem in healthcare in general is, is having an ego.
I think a lot of people have egos that are doctors and myself included. Sometimes I have to check myself.
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.
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.
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,
myofunctional therapists, ENTs, orthodontists, and sleep surgeons, sleep doctors, trying to learn from all of them.
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?
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.
I don't.
Right.
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.
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
claiming to know all the answers to your problem. Probably not the best person to go to.
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.
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.
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.
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
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
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.
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.
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.
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.
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.
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.
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.
Okay. Now this kid is super crowded. All right, maybe we just take out teeth to make the teeth bit.
Right. And now we have a whole different problem. Yeah.
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.
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.
Right. Because again, they weren't taught. Yeah, they don't know what they don't know about the airway.
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.
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.
Yeah, by cuspids on me. I got all four premolars taken out.
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.
And I remember it was right after they closed up my spaces where they had extracted the teeth.
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.
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.
Right. And it's funny because what is it that doctor about it? No.
Yeah, I want to visit the doctor. I guess it's all the time just because something's common.
Doesn't mean it's normal.
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.
And that's what I want. I want that kind of provider working on me.
I want the one about it because sometimes we are not perfect. Doctors are perfect. You can't expect them to not make mistakes.
But you're human.
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.
Right.
For science.
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.
And have a game plan for it.
It doesn't work. Then we'll we'll pivot and we'll go this way.
That's that's not thoughtfulness. That's the kind of doctor that you should work with.
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.
So what what is a final thought that you would like to leave our listeners with.
Good.
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.
Sometimes it might be a lot to have to go to different consults and get second opinions.
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.
Before committing, because when it comes to airway and tongue tie issues, the treatment is never a magic one.
It's not the bullet magic bullet to do a tongue tie release or expand.
It's usually a full comprehensive treatment plan that involves surgery, therapy and other supportive care body work.
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.
Right.
You also don't want to create other problems. So take, take the time. Take the time.
Really good, good advice. Thank you so much for being on Dr. Tran and sharing so much great information.
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.
Absolutely. Absolutely.
Thanks again to today's guests, Dr. Tracy Tran for sharing her medical insight and each of you for listening to today's episode.
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