Hi everyone, and welcome back to another episode of Airway First, a podcast from the Children's
Airway First Foundation. I'm your host, Rebecca St. James. My guest today is acclaimed dentist,
international speaker, and author, Dr. Susan Maples. Dr. Maples leads a successful insurance
independent total health dental practice in Holt, Michigan. She is the immediate past president of
the American Academy for Oral and Systemic Health. And in 2012, she was named one of the top 25 women
in dentistry and one of the top eight innovators in dentistry. She's also the author of Brave Parent,
Raising Healthy Happy Kids Against All Odds in Today's World. We're also very pleased and honored
to have Susan as one of the Children's Airway First Foundation board members. I'll include
Dr. Maples' full bio for your review in our show notes, and it will also include links to her website,
as well as her books. So now let's jump into my interview with Dr. Susan Maples.
All right, thank you so much for joining us today, Dr. Maples. I really appreciate it.
My pleasure, Rebecca. Nice to be here. Thank you so much. So let's just jump right in. I'd like to
start with something that you cite in your book, Brave Parent, which we will put a link to in our
show notes for anybody to check out. You cite that 75% of our country's health expenditures
for lifestyle diseases are preventable. So that's right. Yeah. Yeah. And you say that our
healthcare system is in pain for prevention, only treatment. So how do we impact that? Well, that's
a crazy number. If we did actually focus on prevention, we wouldn't have a healthcare crisis.
It's true that this is the largest decrease in human health in the history of the human race,
and it's a non-communicable disease that's preventable to begin with. So when we think about our
killers, heart disease, diabetes, sleep apnea, chronic systemic inflammation from all kinds of
aspects, I mean, we cancer, we're most of these are preventable. And when if I gave you, Rebecca,
$100 and said this represents all of healthcare spending in the US, tell me how much of that
$100 you believe is being spent on prevention right now? Take a guess. I would say at best $10.
$1. Wow. $1. So you know, you might be thinking about early detection like mammograms or PSA
tests or colon, things like that. Those are not prevention. Those are early detection because
we know that cancer early, we have better outcomes, but I'm not talking about catching
disease early. I'm talking about preventing the diseases that we're paying dearly for.
It's very... Yeah, that is very different. And when I look at the fact that obstructive
sleep apnea impacts 26% of our adult population, only 4% of them know, we're just catching the
low hanging fruit, and it's advanced disease. And you know, moderate sleep apnea increases your risk
of stroke by five times, you know, and cognitive decline. And I mean, there's so many things,
right? But there's this urban legend told that these two men standing in a river fly fishing,
and they happen to see a child floating downstream and the child's drowning. So they drop everything
to do the same. They pull the child out, get him on the bank, and then they notice two other kids
coming down the river drowning. And then three more. And these guys are literally hauling these
kids out when one of them decides to take his waders off and put his sneakers on and start running
upstream. And he says, where are you going? You can't leave me in this mess. Where are you going?
And he said, I'm going upstream to figure out what's happening there. And the whole effort of
pediatric airway identification and intervention and even prevention is an upstream effort to save
a lot of lives later. And not just a lot of lives, because we're all going to die. That's just a
given. It's a quality of our life here on earth. And of course, the quantity, but really the quality
of our life. Right. And well, I guess kind of the build on that then, I mean, with the statistics,
excuse me, the statistics you just mentioned, as far as adults go, and when we back up to where it
possibly comes from, we're looking at what 30 to 35% of children have some kind of sleep
disordered breathing. Right. And if you Google that number, how many kids have sleep disorder
breathing, you're going to be looking at the outcome of sleep tests, how many of our babies
really go through sleep tests? Hardly any. Right. That accounts for about 3%. And that's what you'll
see in the literature if you look. But when we talk about sleep related breathing disorders at 35%
of children, we're talking about a cluster of symptoms such as any audible breathing or snoring.
All this upper airway resistance syndrome, that's actually measurable. I think that we have a lot
more UARS in children than we ever imagined. We tend to typify this condition. By the way, we
begin with healthy sleep. And then we move it sort of less healthy sleep, some obstruction in UARS
than beginning with sleep apnea and then more advanced sleep apnea. But when we think about UARS,
it's measurable in a sleep study. They don't stop breathing for 10 seconds or more. So there's no,
there aren't the apnic events we see. So they're not measurable with the typical
polysamogram or home sleep test. You literally need to have a technician watching the patient.
And we typify this as the sociographic or the demographic is young fit females.
But we see it in children, kids, I'm convinced that it's all over in the pediatric population,
where they have an effort to breathe and then they breathe. So they don't stop breathing for
that full 10 seconds. And they don't become hypoxic. But what they do become is sleep deprived.
Because they're not getting a full night sleep. If every time you start to slip into deep sleep
and you go into REM sleep, and then you wake up with an effort to breathe and breathe,
you don't get to restore your cells, your cognitive function, your brain health, like
you're sleepy. And sleep deprivation is a big deal. That's really a big deal.
Sure. Sure. And we're seeing it manifest in different ways too. In children,
one of the ones that we've talked about that to me, it's still so surprising, ADHD.
I would think as an adult, we just get tired and we just want to go to bed, but they go
the other way in the opposite direction. And in fact, 37% of ADHD is really misdiagnosed.
It's a sleep disorder. And when I think about that, because the symptoms look so much the same.
And how to treat the ADHD was stimulants. The stimulants, while they may create increased
function in these tired sleep-rected kids, they're also robbing them of some of their
nighttime sleep. Take a stimulant, especially if it's by dose, like one in the afternoon,
year and a half. So what I say is before we land any child with ADHD as a diagnosis,
they need to sleep test for sure. And as parents, is that something we can advocate for? I mean,
obviously, for sure. For sure. For sure. And we as health professionals need to be able to alert
people that, you know, when you think about ADHD, it's diagnosis is just a cluster of symptoms.
So if you look at the cluster of symptoms around sleep-related breathing disorders,
they're very similar. So it's very hard for me to think about, well, you know, a child shows up
in their fidgety in school and they have lack of attention and they have some learning disabilities
and they have some behavior, behavior deficits, and we go, must be ADHD. And we've got a stimulant
and they get better. Doesn't that sound familiar to you in terms of the Adheret breathing disorder?
Right? It does. It does. So yeah, I think we have to be careful. There are a lot of
physicians who understand the cluster of symptoms of ADHD. They don't necessarily understand
the cluster of symptoms around sleep-related breathing disorders. Okay. And that's, yeah.
And I guess kind of segue in because we've talked about this on some other podcasts and
in your book, Brave Parent, you referenced some of the information presented by Dr. Boyd, which,
for those who haven't heard it, I'll link that in our show notes so they can listen to that episode.
But you know what? Let me let's back up for a quick second because when I mentioned 35% of kids
have sleep-related breathing disorders, I said snoring and any obstruction, audible breathing,
upper airway resistance syndrome, and then I sort of stopped. It also includes obstructive sleep
apnea, of course, chronic congestion. And I'm going to talk in a few minutes about allergies being
the number one reason for chronic congestion and the effects of that, the impact of that,
chronic respiratory infections, including chronic tonsillatus, which crowds the airway
and ear infections, and then nasal disuse, which is the congestion caused by the mouth
breathing itself. You guys have talked about this before, right? Right. We have.
Goopy nose and the inflamed anterior turbinates that are caused from the mouth breathing itself.
Well, you know, and maybe this is a better time to segue into allergies, because I know you talk
about that and how, you know, the role that it plays with airway dysfunction. So maybe we could
talk about a little bit of that now. Allergies? Yeah. Yeah. I'd love to. This is an area that
I've not heard other people talk about when I know the electric airway seminars. And I kind of stumbled
upon this in writing the Brave Parent book, because Brave Parent, raising healthy happy kids
against all odds in today's world, has several sections beginning with food, relationships
to food, and then drink, and then microbial diversity in the gut, which is really about
what I'm talking about right now, which is gut microbiome. Then I go on to talk about breathing,
which is building the tongue box as we're talking about. Right. Right. And then disorders. Then
we talk about oral health and social, emotional, cognitive health and exercise health. So the
book is broad. Yes. In the research, in the evidence for looking at the fact that our gut
microbiome has decreased in diversity about half in 50 years. So what does that mean?
Oh, for every cell in our human body, we have 11 bugs living on us or in us.
Okay. 11. 11. In to one virus and one to one bacteria. That's a lot, right? Right. As an adult,
the bacteria in our gut, if you were to take it out and weigh it weighs approximately three and a
half pounds, anywhere from like two and a half to seven pounds of bugs itself. Okay. Okay. And what's
happened is we want as much diversity as we can, because in any ecosystem at all, whether it's rivers,
lakes, forest streams, anywhere, if you start to decrease, deplete a couple or major ones or some
more major ones, others overgrow. In dentistry, we see a lot of candy that overgrowth. If you're
on the shore of the ocean right now in Florida, you see red tide, which is a bloom of bacteria,
from depleting some of the natural bacteria in the water. So when we look at what's happening in
the gut, we had an increase that according to the Center for Disease Control in the US, from 1997
to 2011, we had an increase of allergies by 50%. Isn't that crazy? That's insane. In the history of
the human race, we've never seen this. One in every 20 children has a food allergy.
And emergency departments in our country have a visit for allergy, pediatric allergy, every three
minutes. So it's out of control. And what the American Academy for Allergies, asthma and auto
immune diseases did is they said, we're going to take away all of the allergic foods from kids early
on. And that's until later, until they can handle it. And it's right. The allergies were out of
control. It just kept skyrocketing. So now they reversed it to introduce allergens earlier. But
why do I meant the allergies, the chief allergens are like soy tree nuts, which are like cashews and
walnuts and pecans, pistachios and almonds, but also shellfish and fish, and then peanuts, which are
nuts, tree nuts, they grow underground, but they are in the leg and family. And they, but the reason
I mentioned this is because allergies, chronic allergies, cause a chronic stuffy nose.
So how do you, because our mouth was not made for breathing, right? It was made for talking, right?
It's the backup valve. Let's face it. God gave us a mouse so we could breathe through it. If we
got stuffy in our nose, sure, happens if a child is chronically allergic to their environment,
especially the foods they eat, and their nose is chronically stuffy, would you get a chronic
mouth breather? Chronic mouth breather. Right. That's something we haven't addressed. When we
start looking at what most of the health professionals say about sleep related breathing
disorders is we start with habit control, thumbs and pacifiers. And then we move to guided growth,
which is really myofunctional therapy and growth, appliances, and then orthodontics,
which is moving teeth or orthopedics, which is expanding the, the maxilla. So when we think
about this, I believe that we ought to be doing allergy identification early as part of the airway
protocol. And so there is this thing called the atopic march, A-T-O-P-I-C. You can look it up.
It starts at about a month old with eczema. Sometimes that, and eczema in early, those early
years goes on to be food allergies at about two years old. And then rhinitis, chronic running
nose at about three years old, and then on to asthma. And this tends to be this march of auto
immune progression. And it is impacted very much by the lack of diversity, by a whole bunch of factors.
But we don't want these kids on it. We don't want these kids on this march where they get these food
allergies and chronic stuffy nose. So how do we avoid it? Well, the causes of this in our children
today versus 50 years ago, or God forbid 200 to 300 years ago, which by the way, in the history of the
human race is a blink of an eye ago, right? But the causes are many, probably the primary cause.
We'll save those for the end. Number one of the causes is C-sections. 32% of our kids are born of
C-section. The world of the organization would like us to be at 10% no higher than 15%. There's a
bunch of problems with that. So why are we having so many C-sections? Well, convenience, it's more
profitable, it's more scheduled. And also, we have a lot of obese young people who are having
babies. And that's considered high risk. So there are obviously high risk pregnancies. But we have
also kind of enjoyed the convenience of it. You know, and risk management, liability, if there's
any complication at all, anything at all, we're scheduling a C-section. So why is the C-section
so important? Well, because if you're lucky enough to be born through a vagina, you're
basically coming in through the vaginal canal, mouth open, face down, picking up the mom's
vaginal microbiome. There are four really strong microbiomes, the vagina, the elementary canal,
the mouth, and the skin. So coming down face down, the baby's picking up the mom's natural
bacteria from the vagina, then picking up gut bacteria from the elementary canal,
because they're right there in the middle of the poop chute, right? And then they crawl up the skin
to suck on a breast. So they get the skin microbiome. If they're born of a C-section,
they're born relatively sterile, being out without that. And what babies who are exposed to those
early microbes, you spend about three days, just as a little factory right away, producing, producing,
producing more bugs. It's worth to digest breast milk. While the mom moves from a colostrum in her
breast to breast milk, the baby is moving from a gut that can't digest to a gut that can digest.
So we end up seeing more allergies and autoimmune problems from C-section babies, no question.
Then we have the child's antibiotic history. And we start by dumping antibiotics in their eyes the
minute they're born, right? And then 80% of the antibiotics in our country are sold for livestock,
for meat and milk. So if you're not buying humanely treated animals that are raised without
antibiotics, you're getting all of that antibiotic, right? Right. Then we have over sanitization of
our world that started back with hot dishwashers and hot washers and dryers, but has really progressed
during COVID, I mean, during everything from sanitizing everything, plus indoor play versus
outdoor play, we live with these hermetically sealed homes. We need to be out in the earth.
Kids need to be out playing in everything except animal feces, really. Rivers and streams and forests
and digging dirt and all of that. Also, the biggest ones that I didn't mention first were
ultra processed foods in places where there's no soil, no living bugs, none of that. And
it's a whole bunch of chemical additives that we are unfortunately needing to process.
Emulsifiers and thickeners and flavor enhancers and all of the chemicals that keep foods on the
shelf for six months or a year. And then there's the probably neck and neck with ultra processed
food is just the lack of diversity in our food. 75% of our food comes from only five species of
plants and 12 species of animals. We're super narrow when we get into these little habits of
eating chicken nuggets and mac and cheese and hamper. I mean, it's really, really sad.
So when you think about all of that, we're going to see an increase in allergies.
Allergies are the number one reason for chronic stuff you know. And you're going to have compensatory
compensation by popping the mouth open and breathing through the mouth. And that is going to have a
negative effect. The tongue is low, the facial muscles collapse, the arch. We don't grow a big
enough tongue box. The entire airway isn't developing up and forward to meet the anterior
growth and width of the maxilla mandible. And we end up with a thwarted development of the
growth that we can't get back. So I think this area of pediatric allergy is huge.
I don't know any while talking about it, but I wish everyone was because I think it's a big
deal. I think we need to really look at that. I would agree and correct me if I'm wrong, but
can't these allergies or the allergens themselves impact inflammation, which again,
is going to go back and impact your airway? Totally. Absolutely. Yes. Absolutely. Yes. And
then the other part is, you know, we focus on putting anti-inflammatories up the nose like
xylitol and nasal clearing and things like that. But if you are unaware of a food allergy and you're
getting chronic rhinitis from the food allergy, like no amount of rinsing is going to get at that
root cause, we need to go to the root cause of the congestion. And that's what I think we're missing.
So thank you for asking about that. Absolutely. Sure. And I guess, and then this does kind of
build on it. And it's kind of where I was leaving before because maybe you had referenced some things
that Dr. Boyd had mentioned. And one of the things that you mentioned that we really haven't talked
a lot about, which is surprising, but incorrect swallowing patterns. So as a parent, you know,
what exactly is this? And what should we be looking for? Well, it's interesting, D, I'm not a
myofunctional therapist. All three of my hygienists are trained in myofunctional therapy. We have one
on our team, one who's practicing on our team. So I will tell you that I know something about it.
I'm not an expert in myofunctional therapy or speech language pathology. But I do know that
when we look at tongue function, the tongue has to work a lot harder at sucking from a breast
than a bottle. We need proper latch so that we can give us a child if the mom's willing,
as much breast time as possible. Okay. And that way, the 16 muscles that come together to make the
tongue, by the way, the tongue is the tip part that you use for articulation or pointy, the pointy
part is just fragment of the entire tongue, right? Right. Because it's much longer than I think.
Thicker, it's like huge, you know, it's a big mass of muscles. And those 16 muscles need to do the
work to expand that mingpalital suture and grow the tongue box that it lives in. In dentistry, we
always say muscles always win. So what does that mean? You know, in the scissors paper rock game,
the paper covers the rock and the scissors cut the paper and the rocks, of course, the scissors.
So you go like, scissors, paper, rock. In dentistry, I don't care what you put up against
muscles, muscles win every time, every time. So when you have a muscle group like the tongue,
if it's strong and robust and has the ability to move the way it's supposed to, and we develop that
growth of musculature, you will absolutely develop a tongue box that supports nice straight teeth,
broad nasal base, because remember the roof of the mouth is the floor of the nose. It's a very thin
hole, right? You drilled a hole through your palate and I don't recommend it. But if you do drill,
you'll be there in a heartbeat, a quarter of an inch, right? You'll be right there.
So, but the idea is that we want a broad nasal base, a nice rounded arch form, and a palette
that mimics our flat tongue so that the tongue can take a neutral resting position suctioned up
against that palette without effort. That's how we get to sleep with our tongue out of the way.
I think that's it. With that effort thing, that's the part that I think a lot of us are having
trouble with. Yeah, because during the day, we can all do it. Not all of us. You're doing it right
now. So why do you do it now? And then during REM stage sleep, you don't do it. Well, at night,
during REM sleep, all of our muscles are completely paralyzed, our skeletal muscles.
And that turns out he has advantages. So you don't kill anyone when you have dreams of doing that.
All of our spouses are alive for a reason, right? But the disadvantages are that if you're,
if you can't hold your tongue in its proper, rightful position up on the palette out of the
airway, if that's not the neutral resting place for the tongue, the tongue will fall back and
collapse into the throat. And that causes obstruction. Right. So we have to think about the tongue
as early as possible. Does it, is it able to suction the back of the tongue up against the
palate? And does the child have the movement to be able to put the tongue out over the lower
adenchalous ridge, the bony ridge? Kevin, calling me, isn't that funny? You want him to answer the
Yeah, Dr. Boyd. Dr. Boyd. Anyway, the if you want the tongue to be able to move out over the bony
ridge onto the lower part of the mom's breast, the alveolar or the region of the breast that produces
the milk, right, the glands. And you need the baby to be able to swallow that milk.
You need kind of a front to back movement. But we also want the lateral movement of the tongue
to develop, which means when we start to move, okay, so let me let me go back for a quick second.
If the if the baby's tongue cannot suck from a breast efficiently, it's often because of a an
anterior or posterior tongue tie. Okay, by releasing the tie, we can allow the baby's tongue to
but releasing the tie and then having parents stretch the wounds during the healing process,
we can allow the tongue to take its rightful place in the palate and suck efficiently. So it begins
with a good latch. Okay. All right. Now, from there, I'm a firm believer that we need to start
as we start to move from breast milk to breast milk and real food, whole food, hopefully,
not just pureed jarred baby food or pouches, right? Right. What those pureed baby foods are,
if you think about it, how long ago did we develop blenders in the history of the human race? A quick,
hot second ago, right? We didn't have blenders. When you blend the food and give it to the baby,
they literally are mimicking that front to back motion of sucking. And now we have pouches of
blended. So now they're just sucking from a pouch instead of a breath. Instead of masticating food,
where they're literally using, this is called baby lead weaning, where you're making food soft enough
that they can pinch it and squish it and gum it. But they're literally having to navigate food in
their mouth and use those masticatory muscles, including the lateral motion of their tongue.
So I'm a big believer that we need to get back to basics, which is introducing whole foods one
at a time, just like we do, and including the allergenic foods, but also foods that babies
can mow on, that they're basically learning to navigate in their mouth and that they're able,
when their teeth come in, they're able to really chew real foods and use that tongue laterally
to do the expansion. And foods like starting out with there's a lot of books on baby lead weaning,
but anything sure, avocados and bananas, and you can cook the carrots and give them a carrot to
mow on it. Like, you know, every food that we eat, you will be surprised that babies can do this.
And I know the pediatricians are a little, are cautious because of choking, but it turns out
that research really does support that. I mean, you're not giving kids hot dogs and, you know,
breadsticks with rounded, you know, corners. We're talking about foods that don't,
that babies can break down, but also babies tend to gag when they try to swallow something whole.
It's parents that are going like this that apparently cause the baby to gasp and to do,
to choke. So I know that that's a fear for people, but watching countless babies of my patients and
my nieces and nephews and a variety of people really work on this baby lead weaning it,
it's pretty impressive. It's also easier for parents because they're eating the same foods you are.
It's very much better for what we talked about earlier, which is allergies because we're introducing
whole foods and a variety of foods where kids can develop not only a palate where they actually
prefer a wider range of foods, which is so much better for everything, obesity, diabetes, and,
you know, all of that, but also that we're introducing a larger diversity of food for
gut microbiome health. Okay. More fibrous foods, more foods from the vine. The fiber before we
grind it up with a blender is really, really good for our gut microbiome in the duodenum,
which we call prebiotics. They feed gut bacteria and they mitigate an insulin response. So they
really sugar slowly. I'm not suggesting that, you know, if the only way you as an adult get
your vegetables is through a smoothie that you eliminate your smoothie, but if you eat your food,
you think about the huge calorie glut you get from drinking a whole bunch of foods blended
up where you can just suck it right down. That's a bit of an issue for pediatric obesity too,
is how much they're able to consume without chewing it. All of this part of that whole
digestive process, right? Right. Right. It was designed that way for a reason. Yes. Anyway,
yeah. Sure. Most people might think we're off subject for airway, but I don't think we are.
Nope. I think we're right on on on topic. And you're listening to Airway First with today's
guest, Dr. Susan Maples. You can find out more about the Children's Airway First Foundation
and our mission to fix before six on our website at children'sairwayfirst.org.
The CAF website offers tons of great resources for parents and medical professionals,
including videos, blogs, recommended reading lists, comprehensive medical research,
podcast, and so much more. Parents are encouraged to join the Airway Huddle,
our Facebook support group, which was created for parents of children with airway and sleep-related
issues. You can access the Airway Huddle support group at facebook.com backslashgroups backslash
airwayhuddle. If you're a medical professional or parent interested in being on an upcoming episode,
or if you have an idea or topic you'd like us to cover, shoot us a note via our contacts page
on our website or send us an email directly at info at childrensairwayfirst.org. As a reminder,
this podcast and the opinions expressed here are not a medical diagnosis. If you suspect your child
might have an airway issue, contact your pediatric airway dentist or pediatrician.
And now let's jump back into my interview with today's guest, Dr. Susan Maples.
Dr. Maples, I want to build on that a little bit because we did touch, we're talking about these
kind of habitual complex tasks like chewing and swallowing and you know this proper tongue resting
position, which we've talked a lot about. We've had myofunctional therapists come on and try to show
us what it looks like and things we can work with our kids. But how do we identify this earlier?
Because I know that I've heard that they can see some of these things in utero and obviously
maybe it's- That's a Kevin Boyd question. That's a Kevin Boyd question exactly. But
after they get here, how do we identify this and how do we address these issues?
Dr. Maples, well, I think that we have two problems here. One is the lack of fulfillment
of the promise, not the promise of the hearty recommendation among all health professionals.
Let me just go back and say it a little bit differently. The American Medical Association,
the American Pediatric Association, the American Dental Association, the American Pediatric Dental
Association, they all state that we should be seeing a dental health professional under the age of one.
It's not that it's happening, but most physicians, family practice docs and pediatricians,
are telling the parents their child needs to have a dental home under the age of one.
I actually think it should be under the age of two weeks, but we'll get there eventually. But
under the age- Because that way we could really test for these things, right?
Dr. Maples, okay. Because even the lactation consultants oftentimes don't know really how
to evaluate a tongue and a lip tie. Even if it's not a tongue tie, it's an anterior tie,
not a posterior tie, and they're not dealing with the lip at all because the lip function is
important for sucking too. I find this interesting. I think we've talked about it at least once, but
because it was kind of a revelation to me that even as a mom, having gone through childbirth
twice, that new baby exam that they take your baby and they walk away with them,
they don't look in the mouth. That's not part of the...
No.
It looks...
No one's looking.
Literally in the late 1700s that we divided the body into systems and gave all the subspecialists a
system, the dentist got them up and it's the only area they never addressed in medical school.
No part of the mouth. They literally get right past the lips to the back of the throat and don't
ask me what they're looking for back there because 80% of pediatricians are not picking up pediatric
airway problems. By the way, 76% of adult physicians don't pick it up in adults either.
They don't stop using it for telltale science that we do. That's us to help teach the physicians
how to do it. In general, part of the problem is that we can't get general dentists to see babies
under the age of one. If you were told by your pediatrician that your child's to have a dental
home under the age of one and you said, okay, I'm going to call my dentist and you call on the phone
and the dentist says, I'm sorry, the receptionist says, we don't see them till three years old.
You go, huh, I best get on the internet and find out who's going to see my baby.
And now you end up in a pediatric dental office and you end up there for 16 years while that
dentist missed out on your child all those years. Now the pediatric dentists are full of normal,
healthy kids that should be seen by general dentists instead of the kids they're trained to see,
which are the behavior problems and the, you know, the syndromic kids and the kids that really need
them. It's really hard to get in with a pediatric dentist now. And it's my contention is because
of all these babies. But in any event, if we can get babies seen under the age of one, and by the
way, that was not, that was never supposed to be about airway. That was supposed to be about
carry's prevention, the number one disease on the planet for children. And it's 100% preventable.
But we got to see them under the age of one to prevent transmission of strep mutants
from mom saliva to reduce. But anyway, if we could, going back to that statement, if we
get kids seen under the age of one, and we could incorporate an early airway exam by every dentist,
we would be able to identify us boatload of kids. Wow. Yeah. And that's kind of what we're working
towards. Steve Carson has been really instrumental with the ADA and helping make dentistry the
gatekeepers for pediatric airway. And along with that, trying to develop a very short
qualified or validated screening tool for pediatric airway. I'm not one to love these very
short screening tools. I'd rather have more, more parent signs and symptoms talked about so the
parents can really identify that their house significant, the problem is in their child. But
that's another question altogether. So the first thing, an answer to your question, the first
problem we have is the lack of identification. And you asked how we could do it. We can try to
get every dentist in the United States seeing babies under the age of one and doing a really
good infant oral health exam that includes not only growth and development stuff, but not only
looking at food and dentistry and at Carey's disease. I got sidetracked in my mind because I
think about the fact that by two years old, 20% of kids have tooth decay and process already. So
sad. Anyway, back to that, talking about what to do if there's an emergency, if a child breaks a
tooth or evolves to a tooth, what to do, how to, what about fluoride in your water? All of these
things that need to come up at that infant oral health exam could include a really good airway
exam. But let's say we did that overnight. Okay. What, where do these kids get treated? That's
another issue altogether. Just to ask people for early identification means now we have,
we have a call to action with no action. And that's a problem. That's the part that our
endeavor group, but part of AAPMD is really working on building globally, which is some
access to help to care for these kids. So, and I guess that kind of segues into, and I'd love
your opinion on this because I've asked other guests this, you know, so the parents read your
book and, and you know, they read Dr. Lim's book and they come on our website and they're seeing
these symptoms in their children. Yep. And they go to their pediatrician and they either get,
they're going to grow out of it or no, there's nothing wrong or, or they have ADHD.
Or they have ADHD here, have a pill, right? So, how do we, as parents, and again,
they don't know what they don't know. We understand they weren't taught this in medical school. So,
again, we're not attacking the medical profession. We're just saying as parents,
we're becoming more aware. We have this information now. How do we better educate
our pediatricians or advocate for our child if we see these things and we're hitting these walls?
Well, that's a really good question. I think one of the ways that we can impact the entire movement
is to arm parents with not only symptoms, physical signs, so that they can do an examination
on their child to look for the low hanging fruit and then be able to ask more of their pediatricians
and more of their dentists to say, here's what I know. What do you see so that the dentist or
the pediatrician can say, oh, I didn't know that. Let me do some more learning because it does take,
and I don't, I don't want to be dismissive because the people who listen to this podcast
are the people who are astute. So, I don't want anyone to feel like, oh, she's really down on us,
but there are so many who aren't, and they need our help. They don't need our judgments. They need
our help. They need us to help them see it. But I believe that, you know, mama bears and daddy
bears, people that are protecting their kids can also be that help. They can be part of that change
they want to see by saying, all right, I've got a list of physical symptoms here, and I've got a list
of physical signs. And from what I can see, this is an issue. Tell me what you see it and show those
signs and symptoms to them. So the symptoms are things like ADD and ADHD type behaviors,
snoring, audible breathing, open mouth breathing, headaches, behavior problems in general, learning
deficits, sometimes speech deficits, bedwetting, bruising, and hormonal imbalances. The physical
signs, now I differentiate symptoms from signs. Signs are what parents report in terms of behavior
or what they've, you know, what they're seeing, maybe the behavioral imbalances diagnosed by the
pediatrician, but bruising, bedwetting, a learning deficit, headaches, these are things that parents
notice, right? The physical signs are things that we see as we examine them. And I believe we can
teach parents to see this too. Large tonsils, you could just look at a diagram and look at the
grading of tonsils and be able to go because that's all subjective anyway, right?
Nazal congestion, easy thing for parents to figure out. Forensial opening, it might be a little bit
more difficult, but again, if you look at the melanpati classification, that's just four choices,
right? And I'm going to go, which one does my child look like? Retrognathia, which means the lower
jaw seems to be retreated or back, you know, the lip curl and the lower jaw setback. Maxillary
deficiency, especially the transverse width. So are the upper teeth inside the lower teeth, or are
the outside the lower teeth? You know, we could teach parents that by looking at a diagram. The
tethered tongue, again, how do, because we have a hard time even teaching lactation consultants
and OBs and midwives, you know, baby docs to be able to do this, but you know, what is it that
they look for? What is an anterotide and posterior tie? Those are things that we could easily teach.
Narrow vaulted palate, if the palate doesn't have the shape of the child's flat tongue, why not?
And by the way, we haven't talked about pacifiers and thumbs, but when you put a tongue underneath
a pacifier or a thumb and push up with it, you're literally shaping the palate around the object,
right? Yeah. All right. So back to narrow vaulted palate and tongue thrust,
which is when they're breathing, it's that open, sorry, when they're swallowing, if that
tongue is pushing through an opening in the, in the front of the teeth. And then the dark circles
under the eyes, which is literally the pooling of venous blood from the maxilla being too far back
and pressing on the sphenoid plexus of, of, of vessels. So you get a pooling of unoxygenated
blood that is underneath the eyes, we call it venous pooling. So if parents could notice some of
these signs along with some of the symptoms and go, Oh my gosh, because when you read a book like
Shereen Limbs or read a book like mine, Brave Parent, the parents would be like, you are describing
my child. And then I described the physical science and they're like, Oh my goodness, I've had
people coming to me like, I read your book, my child has an airway problem. I need help. Like,
it's not that hard. Yeah. Hard for parents to get it, you know? No, no, and I can also, we have
in our recommended reading, we have about 14 books, 15 books that, you know, we've put out there
that we say, you know, we've read it, you're going to get something from it. But when it comes to
parents, anytime I get an email from a parent, what do I read? Yours and Dr. Limbs are the first
two that we cannot have a gate with because the way it's explained and detailed out, it's just,
as a parent, you go, Oh, like, I'm not the parent that has these tags. So I'm just going to go in
and go, Okay, see this page and then this page, I mean, I'll tell you what you do.
I tell you what you do. Shareen Limbs is a good friend of mine. And I have a book coach who I
love to write and I love to write for the public, but she and reading my book as she was putting
together the whole manuscript, she was like, my child has a reading disorder. Great. Oh, you know,
and, and so Lauren became, I was gonna say Lauren. Yeah, became an advocate. And then Shareen was
having trouble with her book because her book, Shareen is very analytical and very, very much
into the research. And she wanted a book that was really relatable to parents. And I said,
you need to work with Lauren, she'll help you with this because, and so if that's a real honor that
you would say that, that my book and Shareen's are more easy, easily digested for the public,
I actually think Shareen Moore's book is also phenomenal, right? Absolutely phenomenal. You
know, she's a health therapist and she's really good at speaking to the public as well. So,
yeah, so thank you for the, for that. Oh, absolutely. So let's just, you know, as we're
getting kind of towards the end, I really wanted to shift gears because we talked a lot about
information for parents. And we touched briefly on the fact that, you know, there's this huge gap
just on the medical side. And obviously, you are a huge advocate for sleep education and
airway education. And, you know, obviously, because you're on our board, we're well aware of that and
very appreciative of what you bring to the table. So honor. Why are these causes so important to
you? I mean, you travel the world speaking and you're, you still have your practice and you're,
you know, you're leading these discussions and you're 24 seven. Where does this drive from?
I am. You know my personal story, Rebecca? I don't. I'm sure. It's written in the
preface of the book. So in Marty. But I was born of two parents who smoke two packs of eight each
and born with bad lungs premature lungs and in an oxygen tent for three months, my lips would turn
blue as I go home. Remember? I do. Yes. Okay. That's when I got the allergies and I had allergy
shots twice a week and I had a seven hospitalizations for pneumonia under the age of 12.
So it wasn't until I met an internist at the age of my early teens that I began to,
um, she helped me reframe my life and reshift shift what I was doing and I started focusing on
exercising, um, for lung health and, and diet and sleep. Uh, I was not, I had
asthmatic bronchitis. I was pre-diabetic. I mean, this were all because of my situation,
but I don't need to go on and on about myself only to say that I know what we're capable of
as health professionals because I know that my life is very much impacted by some really good
health professionals that my mom helped choose and my mom, um, I was just lucky enough that my mom
was getting a PhD in Calcium Psychology and took her first major job as a psychologist inside the
College of Osteopathic Medicine at Michigan State University and navigated those systems to find
good doctors for me. But I will say, um, I wouldn't be here without health professionals and I know
that we're capable of more than we're doing and it is a joy for me to turn health professionals
on to what we can do for kids, um, early, early. I teach a whole bunch of things, you know, I teach
oral systemic health for, uh, adults, you know, cardiovascular disease, diabetes, acid reflux,
food, uh, nutrition deficits, uh, food sensitivities, HPV, oral, pharyngeal, cancer,
the acid reflux, the list goes on and on. But pediatric health and more in particular, I mean,
I do everything from obesity and autoimmune problems to airway, but pediatric airway,
super special to me. And it's, it's an area that so many, uh, dentists have gotten involved in,
uh, sleep treatment or diagnosis for adults, but they have no idea that they could prevent all that
and people that if we look at children a little differently, and I also say we can fix under
six, let's get these kids before they end up at North and Honors office, right? You can change the
shape of the inside of their mouth, teach them through myofunctional therapy, how to use their tongue,
release other tissues if they have them. Like we can do this without having the need for,
um, braces. And by the way, braces really, really, uh, for often kids are retracted during braces,
so they move things back and smaller, not right into the airway. Yeah. Yeah. Yeah. So it's a passion
for me. And I think the other passion for me is connecting the dots in my community really,
um, establishing networks of physicians that support this in all aspects of subspecialty.
I did a great big seminar for all aspects of physicians in our, in our community called Breathe
Well, Little One. And we brought a pediatric ENT, a pediatric sleep doctor and myself to speak
to a group of, of health professionals represented by 17 different varieties. There were about a
hundred and fifty people there. It was a big deal. And those are the kind of things that our
communities need. They need us to be together, uh, aborating, building friendships, uh, having each
other on a text thread, being able to create co-referral relationships. You had asked, one of
these questions you had asked, like, it's a lot of people have a hard time, you know, getting their
referrals taken seriously among the medical profession. Yeah. We need to continue to write
letters of advocacy to their docs, even when they aren't referred by their docs, especially when
they're not referred by the docs. Let's say they come to you from their, um, from their midwife or
their doula or their lactation consultant or whatever. We need to write letters to the pediatricians
to say, we saw your patient. Here are the parent reported symptoms. Here are the physical signs.
Here's what we did or are planning to do. And we just wanted to keep you in the loop.
That's how we educate them. We don't need to like knock on the door at the time, but you can't just
do it when you want something from them. You need to know you're playing for keeps here.
And we have a health relationship coordinator in our practice who's, who's part of a big part
of her role is to be the liaison between our patients and the medical, the medical world.
So it's a pretty much phenomenal. And you know, and some of the groups that you mentioned are also,
you know, groups that we support and we work with and I want to make sure
for any of the medical professionals listening, you know, check some of these groups out like the,
like the endeavor group, like sleep education consortium, airway revolution,
airway health solutions, and they just had airway, Palooza in December. I mean, these are,
that was, wow, they were, and they're just phenomenal groups. So, and we'll make sure we
put links to all of those and our showings as well.
And collaboration cures, which is in,
Oh, that's right. AP and D. Yes. Yep. And we'll put a link to that as well. That's right.
I've raised in cures. Yep. Where a, a, p, and d come together, which is massive.
Yeah, it's awesome. And I will say it's this, none of this is a thankless job. I was very proud
of my community. I practice in a small town adjacent to the capital city and the capital
city of Michigan is called Lansing. And in our area, we had these entrepreneur of the year awards
for businesses, young businesses, mostly, but they're really celebrated with all of the business
owners in the, in the area. My practice is 37 and a half years old. And we, we want to
Panera the year award in influence and impact this year. So I will tell you, it's not unnoticed
what we're doing. Continue to reach out, continue to build bridges, continue to help people understand
without diminishing or complaining about anybody. Don't just, just, you know, you just need to
breathe in some confidence and breathe out some fear and allow yourself to call people and
write letters to them and learn to speak their language and help them speak yours, help them
learn the mouth. They're very appreciative. Literally, physicians have no idea what they're
doing with the mouth and using the mouth, the tactile science of sleep related breathing
disorders and children is huge. Just, it is, it's absolutely huge. Well, at the end of every podcast,
and I know we've covered, we covered a lot. So I always like to turn the floor back over to the
guests. Cause again, you know, y'all are the experts. Final words for either parents or medical
professionals that you would like to just leave with our listeners. I just like Margaret Mead's
words. Never doubt that a small group of committed citizens can change the world because indeed it
is the only thing that ever has. So your children's foundation is really a first foundation is really
that group and, and there are many others, but I believe that we can do this. I don't know how
many people listen to this podcast, but I do know that you're listening for a reason and that you are
chosen because of your interest to help spread the word. So if you like something on this,
I repeat it to someone and just continue to be the change you want to see in the world.
In a world that's lacking prevention, we circle around to how we started. In the world that's
paid for prevention, we're doing it out of the goodness of our heart to make a better tomorrow.
And it's important that we continue to talk about it. Absolutely. Thank you. Thank you for,
for, and I was probably one of the most profound and just, thank you. Yeah. Thank you for that.
For all the work you're doing, Rebecca, and we're enabled. And so I know we are. Yeah, Michigan.
Thank you. Yes. Have a great evening. Thank you again for having me on. Thank you. Thanks again
to today's guest, Dr. Susan Maples for sharing her medical insight and each of you for listening
to today's episode. 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 most.
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