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Hi everyone, and welcome back to another episode of Airway First, a podcast from the Children's

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Airway First Foundation. I'm your host, Rebecca St. James. My guest today is acclaimed dentist,

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international speaker, and author, Dr. Susan Maples. Dr. Maples leads a successful insurance

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independent total health dental practice in Holt, Michigan. She is the immediate past president of

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the American Academy for Oral and Systemic Health. And in 2012, she was named one of the top 25 women

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in dentistry and one of the top eight innovators in dentistry. She's also the author of Brave Parent,

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Raising Healthy Happy Kids Against All Odds in Today's World. We're also very pleased and honored

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to have Susan as one of the Children's Airway First Foundation board members. I'll include

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Dr. Maples' full bio for your review in our show notes, and it will also include links to her website,

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as well as her books. So now let's jump into my interview with Dr. Susan Maples.

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All right, thank you so much for joining us today, Dr. Maples. I really appreciate it.

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My pleasure, Rebecca. Nice to be here. Thank you so much. So let's just jump right in. I'd like to

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start with something that you cite in your book, Brave Parent, which we will put a link to in our

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show notes for anybody to check out. You cite that 75% of our country's health expenditures

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for lifestyle diseases are preventable. So that's right. Yeah. Yeah. And you say that our

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healthcare system is in pain for prevention, only treatment. So how do we impact that? Well, that's

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a crazy number. If we did actually focus on prevention, we wouldn't have a healthcare crisis.

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It's true that this is the largest decrease in human health in the history of the human race,

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and it's a non-communicable disease that's preventable to begin with. So when we think about our

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killers, heart disease, diabetes, sleep apnea, chronic systemic inflammation from all kinds of

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aspects, I mean, we cancer, we're most of these are preventable. And when if I gave you, Rebecca,

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$100 and said this represents all of healthcare spending in the US, tell me how much of that

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$100 you believe is being spent on prevention right now? Take a guess. I would say at best $10.

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$1. Wow. $1. So you know, you might be thinking about early detection like mammograms or PSA

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tests or colon, things like that. Those are not prevention. Those are early detection because

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we know that cancer early, we have better outcomes, but I'm not talking about catching

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disease early. I'm talking about preventing the diseases that we're paying dearly for.

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It's very... Yeah, that is very different. And when I look at the fact that obstructive

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sleep apnea impacts 26% of our adult population, only 4% of them know, we're just catching the

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low hanging fruit, and it's advanced disease. And you know, moderate sleep apnea increases your risk

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of stroke by five times, you know, and cognitive decline. And I mean, there's so many things,

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right? But there's this urban legend told that these two men standing in a river fly fishing,

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and they happen to see a child floating downstream and the child's drowning. So they drop everything

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to do the same. They pull the child out, get him on the bank, and then they notice two other kids

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coming down the river drowning. And then three more. And these guys are literally hauling these

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kids out when one of them decides to take his waders off and put his sneakers on and start running

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upstream. And he says, where are you going? You can't leave me in this mess. Where are you going?

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And he said, I'm going upstream to figure out what's happening there. And the whole effort of

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pediatric airway identification and intervention and even prevention is an upstream effort to save

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a lot of lives later. And not just a lot of lives, because we're all going to die. That's just a

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given. It's a quality of our life here on earth. And of course, the quantity, but really the quality

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of our life. Right. And well, I guess kind of the build on that then, I mean, with the statistics,

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excuse me, the statistics you just mentioned, as far as adults go, and when we back up to where it

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possibly comes from, we're looking at what 30 to 35% of children have some kind of sleep

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disordered breathing. Right. And if you Google that number, how many kids have sleep disorder

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breathing, you're going to be looking at the outcome of sleep tests, how many of our babies

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really go through sleep tests? Hardly any. Right. That accounts for about 3%. And that's what you'll

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see in the literature if you look. But when we talk about sleep related breathing disorders at 35%

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of children, we're talking about a cluster of symptoms such as any audible breathing or snoring.

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All this upper airway resistance syndrome, that's actually measurable. I think that we have a lot

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more UARS in children than we ever imagined. We tend to typify this condition. By the way, we

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begin with healthy sleep. And then we move it sort of less healthy sleep, some obstruction in UARS

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than beginning with sleep apnea and then more advanced sleep apnea. But when we think about UARS,

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it's measurable in a sleep study. They don't stop breathing for 10 seconds or more. So there's no,

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there aren't the apnic events we see. So they're not measurable with the typical

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polysamogram or home sleep test. You literally need to have a technician watching the patient.

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And we typify this as the sociographic or the demographic is young fit females.

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But we see it in children, kids, I'm convinced that it's all over in the pediatric population,

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where they have an effort to breathe and then they breathe. So they don't stop breathing for

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that full 10 seconds. And they don't become hypoxic. But what they do become is sleep deprived.

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Because they're not getting a full night sleep. If every time you start to slip into deep sleep

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and you go into REM sleep, and then you wake up with an effort to breathe and breathe,

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you don't get to restore your cells, your cognitive function, your brain health, like

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you're sleepy. And sleep deprivation is a big deal. That's really a big deal.

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Sure. Sure. And we're seeing it manifest in different ways too. In children,

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one of the ones that we've talked about that to me, it's still so surprising, ADHD.

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I would think as an adult, we just get tired and we just want to go to bed, but they go

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the other way in the opposite direction. And in fact, 37% of ADHD is really misdiagnosed.

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It's a sleep disorder. And when I think about that, because the symptoms look so much the same.

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And how to treat the ADHD was stimulants. The stimulants, while they may create increased

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function in these tired sleep-rected kids, they're also robbing them of some of their

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nighttime sleep. Take a stimulant, especially if it's by dose, like one in the afternoon,

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year and a half. So what I say is before we land any child with ADHD as a diagnosis,

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they need to sleep test for sure. And as parents, is that something we can advocate for? I mean,

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obviously, for sure. For sure. For sure. And we as health professionals need to be able to alert

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people that, you know, when you think about ADHD, it's diagnosis is just a cluster of symptoms.

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So if you look at the cluster of symptoms around sleep-related breathing disorders,

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they're very similar. So it's very hard for me to think about, well, you know, a child shows up

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in their fidgety in school and they have lack of attention and they have some learning disabilities

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and they have some behavior, behavior deficits, and we go, must be ADHD. And we've got a stimulant

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and they get better. Doesn't that sound familiar to you in terms of the Adheret breathing disorder?

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Right? It does. It does. So yeah, I think we have to be careful. There are a lot of

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physicians who understand the cluster of symptoms of ADHD. They don't necessarily understand

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the cluster of symptoms around sleep-related breathing disorders. Okay. And that's, yeah.

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And I guess kind of segue in because we've talked about this on some other podcasts and

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in your book, Brave Parent, you referenced some of the information presented by Dr. Boyd, which,

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for those who haven't heard it, I'll link that in our show notes so they can listen to that episode.

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But you know what? Let me let's back up for a quick second because when I mentioned 35% of kids

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have sleep-related breathing disorders, I said snoring and any obstruction, audible breathing,

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upper airway resistance syndrome, and then I sort of stopped. It also includes obstructive sleep

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apnea, of course, chronic congestion. And I'm going to talk in a few minutes about allergies being

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the number one reason for chronic congestion and the effects of that, the impact of that,

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chronic respiratory infections, including chronic tonsillatus, which crowds the airway

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and ear infections, and then nasal disuse, which is the congestion caused by the mouth

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breathing itself. You guys have talked about this before, right? Right. We have.

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Goopy nose and the inflamed anterior turbinates that are caused from the mouth breathing itself.

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Well, you know, and maybe this is a better time to segue into allergies, because I know you talk

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about that and how, you know, the role that it plays with airway dysfunction. So maybe we could

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talk about a little bit of that now. Allergies? Yeah. Yeah. I'd love to. This is an area that

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I've not heard other people talk about when I know the electric airway seminars. And I kind of stumbled

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upon this in writing the Brave Parent book, because Brave Parent, raising healthy happy kids

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against all odds in today's world, has several sections beginning with food, relationships

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to food, and then drink, and then microbial diversity in the gut, which is really about

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what I'm talking about right now, which is gut microbiome. Then I go on to talk about breathing,

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which is building the tongue box as we're talking about. Right. Right. And then disorders. Then

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we talk about oral health and social, emotional, cognitive health and exercise health. So the

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book is broad. Yes. In the research, in the evidence for looking at the fact that our gut

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microbiome has decreased in diversity about half in 50 years. So what does that mean?

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Oh, for every cell in our human body, we have 11 bugs living on us or in us.

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Okay. 11. 11. In to one virus and one to one bacteria. That's a lot, right? Right. As an adult,

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the bacteria in our gut, if you were to take it out and weigh it weighs approximately three and a

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half pounds, anywhere from like two and a half to seven pounds of bugs itself. Okay. Okay. And what's

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happened is we want as much diversity as we can, because in any ecosystem at all, whether it's rivers,

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lakes, forest streams, anywhere, if you start to decrease, deplete a couple or major ones or some

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more major ones, others overgrow. In dentistry, we see a lot of candy that overgrowth. If you're

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on the shore of the ocean right now in Florida, you see red tide, which is a bloom of bacteria,

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from depleting some of the natural bacteria in the water. So when we look at what's happening in

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the gut, we had an increase that according to the Center for Disease Control in the US, from 1997

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to 2011, we had an increase of allergies by 50%. Isn't that crazy? That's insane. In the history of

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the human race, we've never seen this. One in every 20 children has a food allergy.

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And emergency departments in our country have a visit for allergy, pediatric allergy, every three

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minutes. So it's out of control. And what the American Academy for Allergies, asthma and auto

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immune diseases did is they said, we're going to take away all of the allergic foods from kids early

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on. And that's until later, until they can handle it. And it's right. The allergies were out of

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control. It just kept skyrocketing. So now they reversed it to introduce allergens earlier. But

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why do I meant the allergies, the chief allergens are like soy tree nuts, which are like cashews and

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walnuts and pecans, pistachios and almonds, but also shellfish and fish, and then peanuts, which are

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nuts, tree nuts, they grow underground, but they are in the leg and family. And they, but the reason

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I mentioned this is because allergies, chronic allergies, cause a chronic stuffy nose.

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So how do you, because our mouth was not made for breathing, right? It was made for talking, right?

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It's the backup valve. Let's face it. God gave us a mouse so we could breathe through it. If we

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got stuffy in our nose, sure, happens if a child is chronically allergic to their environment,

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especially the foods they eat, and their nose is chronically stuffy, would you get a chronic

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mouth breather? Chronic mouth breather. Right. That's something we haven't addressed. When we

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start looking at what most of the health professionals say about sleep related breathing

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disorders is we start with habit control, thumbs and pacifiers. And then we move to guided growth,

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which is really myofunctional therapy and growth, appliances, and then orthodontics,

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which is moving teeth or orthopedics, which is expanding the, the maxilla. So when we think

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about this, I believe that we ought to be doing allergy identification early as part of the airway

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protocol. And so there is this thing called the atopic march, A-T-O-P-I-C. You can look it up.

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It starts at about a month old with eczema. Sometimes that, and eczema in early, those early

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years goes on to be food allergies at about two years old. And then rhinitis, chronic running

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nose at about three years old, and then on to asthma. And this tends to be this march of auto

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immune progression. And it is impacted very much by the lack of diversity, by a whole bunch of factors.

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But we don't want these kids on it. We don't want these kids on this march where they get these food

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allergies and chronic stuffy nose. So how do we avoid it? Well, the causes of this in our children

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today versus 50 years ago, or God forbid 200 to 300 years ago, which by the way, in the history of the

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human race is a blink of an eye ago, right? But the causes are many, probably the primary cause.

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We'll save those for the end. Number one of the causes is C-sections. 32% of our kids are born of

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C-section. The world of the organization would like us to be at 10% no higher than 15%. There's a

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bunch of problems with that. So why are we having so many C-sections? Well, convenience, it's more

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profitable, it's more scheduled. And also, we have a lot of obese young people who are having

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babies. And that's considered high risk. So there are obviously high risk pregnancies. But we have

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also kind of enjoyed the convenience of it. You know, and risk management, liability, if there's

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any complication at all, anything at all, we're scheduling a C-section. So why is the C-section

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so important? Well, because if you're lucky enough to be born through a vagina, you're

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basically coming in through the vaginal canal, mouth open, face down, picking up the mom's

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vaginal microbiome. There are four really strong microbiomes, the vagina, the elementary canal,

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the mouth, and the skin. So coming down face down, the baby's picking up the mom's natural

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bacteria from the vagina, then picking up gut bacteria from the elementary canal,

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because they're right there in the middle of the poop chute, right? And then they crawl up the skin

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to suck on a breast. So they get the skin microbiome. If they're born of a C-section,

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they're born relatively sterile, being out without that. And what babies who are exposed to those

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early microbes, you spend about three days, just as a little factory right away, producing, producing,

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producing more bugs. It's worth to digest breast milk. While the mom moves from a colostrum in her

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breast to breast milk, the baby is moving from a gut that can't digest to a gut that can digest.

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So we end up seeing more allergies and autoimmune problems from C-section babies, no question.

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Then we have the child's antibiotic history. And we start by dumping antibiotics in their eyes the

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minute they're born, right? And then 80% of the antibiotics in our country are sold for livestock,

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for meat and milk. So if you're not buying humanely treated animals that are raised without

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antibiotics, you're getting all of that antibiotic, right? Right. Then we have over sanitization of

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our world that started back with hot dishwashers and hot washers and dryers, but has really progressed

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during COVID, I mean, during everything from sanitizing everything, plus indoor play versus

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outdoor play, we live with these hermetically sealed homes. We need to be out in the earth.

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Kids need to be out playing in everything except animal feces, really. Rivers and streams and forests

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and digging dirt and all of that. Also, the biggest ones that I didn't mention first were

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ultra processed foods in places where there's no soil, no living bugs, none of that. And

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it's a whole bunch of chemical additives that we are unfortunately needing to process.

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Emulsifiers and thickeners and flavor enhancers and all of the chemicals that keep foods on the

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shelf for six months or a year. And then there's the probably neck and neck with ultra processed

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food is just the lack of diversity in our food. 75% of our food comes from only five species of

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plants and 12 species of animals. We're super narrow when we get into these little habits of

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eating chicken nuggets and mac and cheese and hamper. I mean, it's really, really sad.

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So when you think about all of that, we're going to see an increase in allergies.

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Allergies are the number one reason for chronic stuff you know. And you're going to have compensatory

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compensation by popping the mouth open and breathing through the mouth. And that is going to have a

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negative effect. The tongue is low, the facial muscles collapse, the arch. We don't grow a big

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enough tongue box. The entire airway isn't developing up and forward to meet the anterior

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growth and width of the maxilla mandible. And we end up with a thwarted development of the

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growth that we can't get back. So I think this area of pediatric allergy is huge.

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I don't know any while talking about it, but I wish everyone was because I think it's a big

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deal. I think we need to really look at that. I would agree and correct me if I'm wrong, but

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can't these allergies or the allergens themselves impact inflammation, which again,

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is going to go back and impact your airway? Totally. Absolutely. Yes. Absolutely. Yes. And

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then the other part is, you know, we focus on putting anti-inflammatories up the nose like

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xylitol and nasal clearing and things like that. But if you are unaware of a food allergy and you're

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getting chronic rhinitis from the food allergy, like no amount of rinsing is going to get at that

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root cause, we need to go to the root cause of the congestion. And that's what I think we're missing.

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So thank you for asking about that. Absolutely. Sure. And I guess, and then this does kind of

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build on it. And it's kind of where I was leaving before because maybe you had referenced some things

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that Dr. Boyd had mentioned. And one of the things that you mentioned that we really haven't talked

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a lot about, which is surprising, but incorrect swallowing patterns. So as a parent, you know,

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what exactly is this? And what should we be looking for? Well, it's interesting, D, I'm not a

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myofunctional therapist. All three of my hygienists are trained in myofunctional therapy. We have one

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on our team, one who's practicing on our team. So I will tell you that I know something about it.

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I'm not an expert in myofunctional therapy or speech language pathology. But I do know that

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when we look at tongue function, the tongue has to work a lot harder at sucking from a breast

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than a bottle. We need proper latch so that we can give us a child if the mom's willing,

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as much breast time as possible. Okay. And that way, the 16 muscles that come together to make the

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tongue, by the way, the tongue is the tip part that you use for articulation or pointy, the pointy

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part is just fragment of the entire tongue, right? Right. Because it's much longer than I think.

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Thicker, it's like huge, you know, it's a big mass of muscles. And those 16 muscles need to do the

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work to expand that mingpalital suture and grow the tongue box that it lives in. In dentistry, we

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always say muscles always win. So what does that mean? You know, in the scissors paper rock game,

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the paper covers the rock and the scissors cut the paper and the rocks, of course, the scissors.

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So you go like, scissors, paper, rock. In dentistry, I don't care what you put up against

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muscles, muscles win every time, every time. So when you have a muscle group like the tongue,

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if it's strong and robust and has the ability to move the way it's supposed to, and we develop that

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growth of musculature, you will absolutely develop a tongue box that supports nice straight teeth,

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broad nasal base, because remember the roof of the mouth is the floor of the nose. It's a very thin

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hole, right? You drilled a hole through your palate and I don't recommend it. But if you do drill,

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you'll be there in a heartbeat, a quarter of an inch, right? You'll be right there.

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So, but the idea is that we want a broad nasal base, a nice rounded arch form, and a palette

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that mimics our flat tongue so that the tongue can take a neutral resting position suctioned up

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against that palette without effort. That's how we get to sleep with our tongue out of the way.

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I think that's it. With that effort thing, that's the part that I think a lot of us are having

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trouble with. Yeah, because during the day, we can all do it. Not all of us. You're doing it right

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now. So why do you do it now? And then during REM stage sleep, you don't do it. Well, at night,

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during REM sleep, all of our muscles are completely paralyzed, our skeletal muscles.

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And that turns out he has advantages. So you don't kill anyone when you have dreams of doing that.

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All of our spouses are alive for a reason, right? But the disadvantages are that if you're,

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if you can't hold your tongue in its proper, rightful position up on the palette out of the

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airway, if that's not the neutral resting place for the tongue, the tongue will fall back and

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collapse into the throat. And that causes obstruction. Right. So we have to think about the tongue

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as early as possible. Does it, is it able to suction the back of the tongue up against the

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palate? And does the child have the movement to be able to put the tongue out over the lower

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adenchalous ridge, the bony ridge? Kevin, calling me, isn't that funny? You want him to answer the

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Yeah, Dr. Boyd. Dr. Boyd. Anyway, the if you want the tongue to be able to move out over the bony

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ridge onto the lower part of the mom's breast, the alveolar or the region of the breast that produces

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the milk, right, the glands. And you need the baby to be able to swallow that milk.

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You need kind of a front to back movement. But we also want the lateral movement of the tongue

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to develop, which means when we start to move, okay, so let me let me go back for a quick second.

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If the if the baby's tongue cannot suck from a breast efficiently, it's often because of a an

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anterior or posterior tongue tie. Okay, by releasing the tie, we can allow the baby's tongue to

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but releasing the tie and then having parents stretch the wounds during the healing process,

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we can allow the tongue to take its rightful place in the palate and suck efficiently. So it begins

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with a good latch. Okay. All right. Now, from there, I'm a firm believer that we need to start

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as we start to move from breast milk to breast milk and real food, whole food, hopefully,

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not just pureed jarred baby food or pouches, right? Right. What those pureed baby foods are,

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if you think about it, how long ago did we develop blenders in the history of the human race? A quick,

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hot second ago, right? We didn't have blenders. When you blend the food and give it to the baby,

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they literally are mimicking that front to back motion of sucking. And now we have pouches of

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blended. So now they're just sucking from a pouch instead of a breath. Instead of masticating food,

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where they're literally using, this is called baby lead weaning, where you're making food soft enough

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that they can pinch it and squish it and gum it. But they're literally having to navigate food in

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their mouth and use those masticatory muscles, including the lateral motion of their tongue.

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So I'm a big believer that we need to get back to basics, which is introducing whole foods one

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at a time, just like we do, and including the allergenic foods, but also foods that babies

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can mow on, that they're basically learning to navigate in their mouth and that they're able,

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when their teeth come in, they're able to really chew real foods and use that tongue laterally

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to do the expansion. And foods like starting out with there's a lot of books on baby lead weaning,

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but anything sure, avocados and bananas, and you can cook the carrots and give them a carrot to

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mow on it. Like, you know, every food that we eat, you will be surprised that babies can do this.

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And I know the pediatricians are a little, are cautious because of choking, but it turns out

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that research really does support that. I mean, you're not giving kids hot dogs and, you know,

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breadsticks with rounded, you know, corners. We're talking about foods that don't,

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that babies can break down, but also babies tend to gag when they try to swallow something whole.

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It's parents that are going like this that apparently cause the baby to gasp and to do,

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to choke. So I know that that's a fear for people, but watching countless babies of my patients and

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my nieces and nephews and a variety of people really work on this baby lead weaning it,

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it's pretty impressive. It's also easier for parents because they're eating the same foods you are.

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It's very much better for what we talked about earlier, which is allergies because we're introducing

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whole foods and a variety of foods where kids can develop not only a palate where they actually

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prefer a wider range of foods, which is so much better for everything, obesity, diabetes, and,

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you know, all of that, but also that we're introducing a larger diversity of food for

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gut microbiome health. Okay. More fibrous foods, more foods from the vine. The fiber before we

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grind it up with a blender is really, really good for our gut microbiome in the duodenum,

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which we call prebiotics. They feed gut bacteria and they mitigate an insulin response. So they

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really sugar slowly. I'm not suggesting that, you know, if the only way you as an adult get

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your vegetables is through a smoothie that you eliminate your smoothie, but if you eat your food,

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you think about the huge calorie glut you get from drinking a whole bunch of foods blended

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up where you can just suck it right down. That's a bit of an issue for pediatric obesity too,

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is how much they're able to consume without chewing it. All of this part of that whole

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digestive process, right? Right. Right. It was designed that way for a reason. Yes. Anyway,

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yeah. Sure. Most people might think we're off subject for airway, but I don't think we are.

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Nope. I think we're right on on on topic. And you're listening to Airway First with today's

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guest, Dr. Susan Maples. You can find out more about the Children's Airway First Foundation

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and our mission to fix before six on our website at children'sairwayfirst.org.

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The CAF website offers tons of great resources for parents and medical professionals,

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including videos, blogs, recommended reading lists, comprehensive medical research,

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podcast, and so much more. Parents are encouraged to join the Airway Huddle,

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our Facebook support group, which was created for parents of children with airway and sleep-related

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issues. You can access the Airway Huddle support group at facebook.com backslashgroups backslash

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airwayhuddle. If you're a medical professional or parent interested in being on an upcoming episode,

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or if you have an idea or topic you'd like us to cover, shoot us a note via our contacts page

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on our website or send us an email directly at info at childrensairwayfirst.org. As a reminder,

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this podcast and the opinions expressed here are not a medical diagnosis. If you suspect your child

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might have an airway issue, contact your pediatric airway dentist or pediatrician.

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And now let's jump back into my interview with today's guest, Dr. Susan Maples.

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Dr. Maples, I want to build on that a little bit because we did touch, we're talking about these

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kind of habitual complex tasks like chewing and swallowing and you know this proper tongue resting

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position, which we've talked a lot about. We've had myofunctional therapists come on and try to show

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us what it looks like and things we can work with our kids. But how do we identify this earlier?

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Because I know that I've heard that they can see some of these things in utero and obviously

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maybe it's- That's a Kevin Boyd question. That's a Kevin Boyd question exactly. But

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after they get here, how do we identify this and how do we address these issues?

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Dr. Maples, well, I think that we have two problems here. One is the lack of fulfillment

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of the promise, not the promise of the hearty recommendation among all health professionals.

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Let me just go back and say it a little bit differently. The American Medical Association,

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the American Pediatric Association, the American Dental Association, the American Pediatric Dental

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Association, they all state that we should be seeing a dental health professional under the age of one.

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It's not that it's happening, but most physicians, family practice docs and pediatricians,

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are telling the parents their child needs to have a dental home under the age of one.

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I actually think it should be under the age of two weeks, but we'll get there eventually. But

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under the age- Because that way we could really test for these things, right?

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Dr. Maples, okay. Because even the lactation consultants oftentimes don't know really how

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to evaluate a tongue and a lip tie. Even if it's not a tongue tie, it's an anterior tie,

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not a posterior tie, and they're not dealing with the lip at all because the lip function is

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important for sucking too. I find this interesting. I think we've talked about it at least once, but

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because it was kind of a revelation to me that even as a mom, having gone through childbirth

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twice, that new baby exam that they take your baby and they walk away with them,

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they don't look in the mouth. That's not part of the...

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No.

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It looks...

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No one's looking.

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Literally in the late 1700s that we divided the body into systems and gave all the subspecialists a

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system, the dentist got them up and it's the only area they never addressed in medical school.

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No part of the mouth. They literally get right past the lips to the back of the throat and don't

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ask me what they're looking for back there because 80% of pediatricians are not picking up pediatric

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airway problems. By the way, 76% of adult physicians don't pick it up in adults either.

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They don't stop using it for telltale science that we do. That's us to help teach the physicians

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how to do it. In general, part of the problem is that we can't get general dentists to see babies

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under the age of one. If you were told by your pediatrician that your child's to have a dental

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home under the age of one and you said, okay, I'm going to call my dentist and you call on the phone

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and the dentist says, I'm sorry, the receptionist says, we don't see them till three years old.

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You go, huh, I best get on the internet and find out who's going to see my baby.

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And now you end up in a pediatric dental office and you end up there for 16 years while that

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dentist missed out on your child all those years. Now the pediatric dentists are full of normal,

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healthy kids that should be seen by general dentists instead of the kids they're trained to see,

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which are the behavior problems and the, you know, the syndromic kids and the kids that really need

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them. It's really hard to get in with a pediatric dentist now. And it's my contention is because

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of all these babies. But in any event, if we can get babies seen under the age of one, and by the

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way, that was not, that was never supposed to be about airway. That was supposed to be about

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carry's prevention, the number one disease on the planet for children. And it's 100% preventable.

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But we got to see them under the age of one to prevent transmission of strep mutants

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from mom saliva to reduce. But anyway, if we could, going back to that statement, if we

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get kids seen under the age of one, and we could incorporate an early airway exam by every dentist,

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we would be able to identify us boatload of kids. Wow. Yeah. And that's kind of what we're working

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towards. Steve Carson has been really instrumental with the ADA and helping make dentistry the

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gatekeepers for pediatric airway. And along with that, trying to develop a very short

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qualified or validated screening tool for pediatric airway. I'm not one to love these very

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short screening tools. I'd rather have more, more parent signs and symptoms talked about so the

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parents can really identify that their house significant, the problem is in their child. But

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that's another question altogether. So the first thing, an answer to your question, the first

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problem we have is the lack of identification. And you asked how we could do it. We can try to

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get every dentist in the United States seeing babies under the age of one and doing a really

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good infant oral health exam that includes not only growth and development stuff, but not only

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looking at food and dentistry and at Carey's disease. I got sidetracked in my mind because I

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think about the fact that by two years old, 20% of kids have tooth decay and process already. So

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sad. Anyway, back to that, talking about what to do if there's an emergency, if a child breaks a

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tooth or evolves to a tooth, what to do, how to, what about fluoride in your water? All of these

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things that need to come up at that infant oral health exam could include a really good airway

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exam. But let's say we did that overnight. Okay. What, where do these kids get treated? That's

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another issue altogether. Just to ask people for early identification means now we have,

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we have a call to action with no action. And that's a problem. That's the part that our

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endeavor group, but part of AAPMD is really working on building globally, which is some

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access to help to care for these kids. So, and I guess that kind of segues into, and I'd love

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your opinion on this because I've asked other guests this, you know, so the parents read your

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book and, and you know, they read Dr. Lim's book and they come on our website and they're seeing

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these symptoms in their children. Yep. And they go to their pediatrician and they either get,

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they're going to grow out of it or no, there's nothing wrong or, or they have ADHD.

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Or they have ADHD here, have a pill, right? So, how do we, as parents, and again,

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they don't know what they don't know. We understand they weren't taught this in medical school. So,

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again, we're not attacking the medical profession. We're just saying as parents,

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we're becoming more aware. We have this information now. How do we better educate

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our pediatricians or advocate for our child if we see these things and we're hitting these walls?

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Well, that's a really good question. I think one of the ways that we can impact the entire movement

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is to arm parents with not only symptoms, physical signs, so that they can do an examination

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on their child to look for the low hanging fruit and then be able to ask more of their pediatricians

380
00:42:38,640 --> 00:42:45,520
and more of their dentists to say, here's what I know. What do you see so that the dentist or

381
00:42:45,520 --> 00:42:51,680
the pediatrician can say, oh, I didn't know that. Let me do some more learning because it does take,

382
00:42:52,560 --> 00:42:57,360
and I don't, I don't want to be dismissive because the people who listen to this podcast

383
00:42:57,360 --> 00:43:02,640
are the people who are astute. So, I don't want anyone to feel like, oh, she's really down on us,

384
00:43:02,640 --> 00:43:10,640
but there are so many who aren't, and they need our help. They don't need our judgments. They need

385
00:43:10,640 --> 00:43:18,480
our help. They need us to help them see it. But I believe that, you know, mama bears and daddy

386
00:43:18,480 --> 00:43:24,640
bears, people that are protecting their kids can also be that help. They can be part of that change

387
00:43:24,640 --> 00:43:29,360
they want to see by saying, all right, I've got a list of physical symptoms here, and I've got a list

388
00:43:29,360 --> 00:43:34,560
of physical signs. And from what I can see, this is an issue. Tell me what you see it and show those

389
00:43:34,560 --> 00:43:43,360
signs and symptoms to them. So the symptoms are things like ADD and ADHD type behaviors,

390
00:43:43,360 --> 00:43:51,520
snoring, audible breathing, open mouth breathing, headaches, behavior problems in general, learning

391
00:43:51,520 --> 00:44:01,440
deficits, sometimes speech deficits, bedwetting, bruising, and hormonal imbalances. The physical

392
00:44:01,440 --> 00:44:09,120
signs, now I differentiate symptoms from signs. Signs are what parents report in terms of behavior

393
00:44:09,120 --> 00:44:14,640
or what they've, you know, what they're seeing, maybe the behavioral imbalances diagnosed by the

394
00:44:14,640 --> 00:44:20,400
pediatrician, but bruising, bedwetting, a learning deficit, headaches, these are things that parents

395
00:44:20,400 --> 00:44:26,080
notice, right? The physical signs are things that we see as we examine them. And I believe we can

396
00:44:26,080 --> 00:44:33,040
teach parents to see this too. Large tonsils, you could just look at a diagram and look at the

397
00:44:33,040 --> 00:44:37,120
grading of tonsils and be able to go because that's all subjective anyway, right?

398
00:44:38,320 --> 00:44:45,600
Nazal congestion, easy thing for parents to figure out. Forensial opening, it might be a little bit

399
00:44:45,600 --> 00:44:53,120
more difficult, but again, if you look at the melanpati classification, that's just four choices,

400
00:44:53,120 --> 00:44:59,360
right? And I'm going to go, which one does my child look like? Retrognathia, which means the lower

401
00:44:59,360 --> 00:45:07,040
jaw seems to be retreated or back, you know, the lip curl and the lower jaw setback. Maxillary

402
00:45:07,040 --> 00:45:14,000
deficiency, especially the transverse width. So are the upper teeth inside the lower teeth, or are

403
00:45:14,000 --> 00:45:20,480
the outside the lower teeth? You know, we could teach parents that by looking at a diagram. The

404
00:45:20,480 --> 00:45:27,760
tethered tongue, again, how do, because we have a hard time even teaching lactation consultants

405
00:45:28,880 --> 00:45:36,960
and OBs and midwives, you know, baby docs to be able to do this, but you know, what is it that

406
00:45:36,960 --> 00:45:41,280
they look for? What is an anterotide and posterior tie? Those are things that we could easily teach.

407
00:45:41,280 --> 00:45:48,560
Narrow vaulted palate, if the palate doesn't have the shape of the child's flat tongue, why not?

408
00:45:49,840 --> 00:45:55,440
And by the way, we haven't talked about pacifiers and thumbs, but when you put a tongue underneath

409
00:45:55,440 --> 00:46:02,560
a pacifier or a thumb and push up with it, you're literally shaping the palate around the object,

410
00:46:02,560 --> 00:46:08,960
right? Yeah. All right. So back to narrow vaulted palate and tongue thrust,

411
00:46:08,960 --> 00:46:13,760
which is when they're breathing, it's that open, sorry, when they're swallowing, if that

412
00:46:13,760 --> 00:46:21,120
tongue is pushing through an opening in the, in the front of the teeth. And then the dark circles

413
00:46:21,120 --> 00:46:29,840
under the eyes, which is literally the pooling of venous blood from the maxilla being too far back

414
00:46:29,840 --> 00:46:39,760
and pressing on the sphenoid plexus of, of, of vessels. So you get a pooling of unoxygenated

415
00:46:39,760 --> 00:46:45,680
blood that is underneath the eyes, we call it venous pooling. So if parents could notice some of

416
00:46:45,680 --> 00:46:51,360
these signs along with some of the symptoms and go, Oh my gosh, because when you read a book like

417
00:46:51,360 --> 00:46:57,680
Shereen Limbs or read a book like mine, Brave Parent, the parents would be like, you are describing

418
00:46:57,680 --> 00:47:03,680
my child. And then I described the physical science and they're like, Oh my goodness, I've had

419
00:47:03,680 --> 00:47:08,560
people coming to me like, I read your book, my child has an airway problem. I need help. Like,

420
00:47:08,560 --> 00:47:17,280
it's not that hard. Yeah. Hard for parents to get it, you know? No, no, and I can also, we have

421
00:47:17,280 --> 00:47:22,560
in our recommended reading, we have about 14 books, 15 books that, you know, we've put out there

422
00:47:22,560 --> 00:47:26,720
that we say, you know, we've read it, you're going to get something from it. But when it comes to

423
00:47:26,720 --> 00:47:33,600
parents, anytime I get an email from a parent, what do I read? Yours and Dr. Limbs are the first

424
00:47:33,600 --> 00:47:39,600
two that we cannot have a gate with because the way it's explained and detailed out, it's just,

425
00:47:40,320 --> 00:47:47,680
as a parent, you go, Oh, like, I'm not the parent that has these tags. So I'm just going to go in

426
00:47:47,680 --> 00:47:51,840
and go, Okay, see this page and then this page, I mean, I'll tell you what you do.

427
00:47:51,840 --> 00:47:57,200
I tell you what you do. Shareen Limbs is a good friend of mine. And I have a book coach who I

428
00:47:57,200 --> 00:48:03,040
love to write and I love to write for the public, but she and reading my book as she was putting

429
00:48:03,040 --> 00:48:08,240
together the whole manuscript, she was like, my child has a reading disorder. Great. Oh, you know,

430
00:48:08,240 --> 00:48:14,000
and, and so Lauren became, I was gonna say Lauren. Yeah, became an advocate. And then Shareen was

431
00:48:14,000 --> 00:48:18,880
having trouble with her book because her book, Shareen is very analytical and very, very much

432
00:48:18,880 --> 00:48:25,200
into the research. And she wanted a book that was really relatable to parents. And I said,

433
00:48:25,200 --> 00:48:30,800
you need to work with Lauren, she'll help you with this because, and so if that's a real honor that

434
00:48:30,800 --> 00:48:37,520
you would say that, that my book and Shareen's are more easy, easily digested for the public,

435
00:48:37,520 --> 00:48:43,920
I actually think Shareen Moore's book is also phenomenal, right? Absolutely phenomenal. You

436
00:48:43,920 --> 00:48:49,280
know, she's a health therapist and she's really good at speaking to the public as well. So,

437
00:48:50,640 --> 00:48:56,240
yeah, so thank you for the, for that. Oh, absolutely. So let's just, you know, as we're

438
00:48:56,240 --> 00:49:01,520
getting kind of towards the end, I really wanted to shift gears because we talked a lot about

439
00:49:03,120 --> 00:49:09,280
information for parents. And we touched briefly on the fact that, you know, there's this huge gap

440
00:49:09,280 --> 00:49:17,600
just on the medical side. And obviously, you are a huge advocate for sleep education and

441
00:49:17,600 --> 00:49:23,760
airway education. And, you know, obviously, because you're on our board, we're well aware of that and

442
00:49:23,760 --> 00:49:30,080
very appreciative of what you bring to the table. So honor. Why are these causes so important to

443
00:49:30,080 --> 00:49:35,840
you? I mean, you travel the world speaking and you're, you still have your practice and you're,

444
00:49:35,840 --> 00:49:42,320
you know, you're leading these discussions and you're 24 seven. Where does this drive from?

445
00:49:42,320 --> 00:49:47,920
I am. You know my personal story, Rebecca? I don't. I'm sure. It's written in the

446
00:49:47,920 --> 00:49:54,560
preface of the book. So in Marty. But I was born of two parents who smoke two packs of eight each

447
00:49:54,560 --> 00:50:00,400
and born with bad lungs premature lungs and in an oxygen tent for three months, my lips would turn

448
00:50:00,400 --> 00:50:07,760
blue as I go home. Remember? I do. Yes. Okay. That's when I got the allergies and I had allergy

449
00:50:07,760 --> 00:50:15,200
shots twice a week and I had a seven hospitalizations for pneumonia under the age of 12.

450
00:50:16,000 --> 00:50:23,120
So it wasn't until I met an internist at the age of my early teens that I began to,

451
00:50:23,120 --> 00:50:30,560
um, she helped me reframe my life and reshift shift what I was doing and I started focusing on

452
00:50:31,120 --> 00:50:38,640
exercising, um, for lung health and, and diet and sleep. Uh, I was not, I had

453
00:50:39,600 --> 00:50:46,000
asthmatic bronchitis. I was pre-diabetic. I mean, this were all because of my situation,

454
00:50:46,000 --> 00:50:52,240
but I don't need to go on and on about myself only to say that I know what we're capable of

455
00:50:52,240 --> 00:50:57,840
as health professionals because I know that my life is very much impacted by some really good

456
00:50:57,840 --> 00:51:04,880
health professionals that my mom helped choose and my mom, um, I was just lucky enough that my mom

457
00:51:04,880 --> 00:51:10,400
was getting a PhD in Calcium Psychology and took her first major job as a psychologist inside the

458
00:51:10,400 --> 00:51:15,280
College of Osteopathic Medicine at Michigan State University and navigated those systems to find

459
00:51:15,280 --> 00:51:23,360
good doctors for me. But I will say, um, I wouldn't be here without health professionals and I know

460
00:51:23,360 --> 00:51:28,880
that we're capable of more than we're doing and it is a joy for me to turn health professionals

461
00:51:28,880 --> 00:51:35,920
on to what we can do for kids, um, early, early. I teach a whole bunch of things, you know, I teach

462
00:51:35,920 --> 00:51:45,120
oral systemic health for, uh, adults, you know, cardiovascular disease, diabetes, acid reflux,

463
00:51:45,120 --> 00:51:52,880
food, uh, nutrition deficits, uh, food sensitivities, HPV, oral, pharyngeal, cancer,

464
00:51:52,880 --> 00:51:58,960
the acid reflux, the list goes on and on. But pediatric health and more in particular, I mean,

465
00:51:58,960 --> 00:52:04,560
I do everything from obesity and autoimmune problems to airway, but pediatric airway,

466
00:52:04,560 --> 00:52:10,720
super special to me. And it's, it's an area that so many, uh, dentists have gotten involved in,

467
00:52:10,720 --> 00:52:18,720
uh, sleep treatment or diagnosis for adults, but they have no idea that they could prevent all that

468
00:52:20,080 --> 00:52:26,240
and people that if we look at children a little differently, and I also say we can fix under

469
00:52:26,240 --> 00:52:32,880
six, let's get these kids before they end up at North and Honors office, right? You can change the

470
00:52:32,880 --> 00:52:38,400
shape of the inside of their mouth, teach them through myofunctional therapy, how to use their tongue,

471
00:52:38,400 --> 00:52:45,520
release other tissues if they have them. Like we can do this without having the need for,

472
00:52:46,240 --> 00:52:54,160
um, braces. And by the way, braces really, really, uh, for often kids are retracted during braces,

473
00:52:54,160 --> 00:53:02,320
so they move things back and smaller, not right into the airway. Yeah. Yeah. Yeah. So it's a passion

474
00:53:02,320 --> 00:53:07,280
for me. And I think the other passion for me is connecting the dots in my community really,

475
00:53:07,280 --> 00:53:15,840
um, establishing networks of physicians that support this in all aspects of subspecialty.

476
00:53:15,840 --> 00:53:21,920
I did a great big seminar for all aspects of physicians in our, in our community called Breathe

477
00:53:21,920 --> 00:53:29,040
Well, Little One. And we brought a pediatric ENT, a pediatric sleep doctor and myself to speak

478
00:53:30,080 --> 00:53:36,240
to a group of, of health professionals represented by 17 different varieties. There were about a

479
00:53:36,240 --> 00:53:44,640
hundred and fifty people there. It was a big deal. And those are the kind of things that our

480
00:53:44,640 --> 00:53:53,200
communities need. They need us to be together, uh, aborating, building friendships, uh, having each

481
00:53:53,200 --> 00:53:59,360
other on a text thread, being able to create co-referral relationships. You had asked, one of

482
00:53:59,360 --> 00:54:03,520
these questions you had asked, like, it's a lot of people have a hard time, you know, getting their

483
00:54:03,520 --> 00:54:10,240
referrals taken seriously among the medical profession. Yeah. We need to continue to write

484
00:54:10,240 --> 00:54:17,520
letters of advocacy to their docs, even when they aren't referred by their docs, especially when

485
00:54:17,520 --> 00:54:24,480
they're not referred by the docs. Let's say they come to you from their, um, from their midwife or

486
00:54:24,480 --> 00:54:30,960
their doula or their lactation consultant or whatever. We need to write letters to the pediatricians

487
00:54:30,960 --> 00:54:36,800
to say, we saw your patient. Here are the parent reported symptoms. Here are the physical signs.

488
00:54:36,800 --> 00:54:41,680
Here's what we did or are planning to do. And we just wanted to keep you in the loop.

489
00:54:41,680 --> 00:54:46,560
That's how we educate them. We don't need to like knock on the door at the time, but you can't just

490
00:54:46,560 --> 00:54:51,520
do it when you want something from them. You need to know you're playing for keeps here.

491
00:54:52,160 --> 00:54:57,680
And we have a health relationship coordinator in our practice who's, who's part of a big part

492
00:54:57,680 --> 00:55:04,160
of her role is to be the liaison between our patients and the medical, the medical world.

493
00:55:04,160 --> 00:55:09,040
So it's a pretty much phenomenal. And you know, and some of the groups that you mentioned are also,

494
00:55:09,040 --> 00:55:11,840
you know, groups that we support and we work with and I want to make sure

495
00:55:12,480 --> 00:55:17,440
for any of the medical professionals listening, you know, check some of these groups out like the,

496
00:55:17,440 --> 00:55:24,000
like the endeavor group, like sleep education consortium, airway revolution,

497
00:55:24,000 --> 00:55:29,680
airway health solutions, and they just had airway, Palooza in December. I mean, these are,

498
00:55:30,240 --> 00:55:35,440
that was, wow, they were, and they're just phenomenal groups. So, and we'll make sure we

499
00:55:35,440 --> 00:55:38,880
put links to all of those and our showings as well.

500
00:55:38,880 --> 00:55:40,560
And collaboration cures, which is in,

501
00:55:41,600 --> 00:55:46,160
Oh, that's right. AP and D. Yes. Yep. And we'll put a link to that as well. That's right.

502
00:55:46,160 --> 00:55:51,440
I've raised in cures. Yep. Where a, a, p, and d come together, which is massive.

503
00:55:51,440 --> 00:55:56,320
Yeah, it's awesome. And I will say it's this, none of this is a thankless job. I was very proud

504
00:55:56,320 --> 00:56:00,800
of my community. I practice in a small town adjacent to the capital city and the capital

505
00:56:00,800 --> 00:56:05,840
city of Michigan is called Lansing. And in our area, we had these entrepreneur of the year awards

506
00:56:05,840 --> 00:56:12,080
for businesses, young businesses, mostly, but they're really celebrated with all of the business

507
00:56:12,080 --> 00:56:18,240
owners in the, in the area. My practice is 37 and a half years old. And we, we want to

508
00:56:18,240 --> 00:56:24,560
Panera the year award in influence and impact this year. So I will tell you, it's not unnoticed

509
00:56:24,560 --> 00:56:31,440
what we're doing. Continue to reach out, continue to build bridges, continue to help people understand

510
00:56:31,440 --> 00:56:37,280
without diminishing or complaining about anybody. Don't just, just, you know, you just need to

511
00:56:37,280 --> 00:56:42,880
breathe in some confidence and breathe out some fear and allow yourself to call people and

512
00:56:42,880 --> 00:56:48,720
write letters to them and learn to speak their language and help them speak yours, help them

513
00:56:48,720 --> 00:56:53,680
learn the mouth. They're very appreciative. Literally, physicians have no idea what they're

514
00:56:53,680 --> 00:56:58,240
doing with the mouth and using the mouth, the tactile science of sleep related breathing

515
00:56:58,240 --> 00:57:07,120
disorders and children is huge. Just, it is, it's absolutely huge. Well, at the end of every podcast,

516
00:57:07,120 --> 00:57:14,560
and I know we've covered, we covered a lot. So I always like to turn the floor back over to the

517
00:57:14,560 --> 00:57:21,200
guests. Cause again, you know, y'all are the experts. Final words for either parents or medical

518
00:57:21,200 --> 00:57:27,200
professionals that you would like to just leave with our listeners. I just like Margaret Mead's

519
00:57:27,200 --> 00:57:32,480
words. Never doubt that a small group of committed citizens can change the world because indeed it

520
00:57:32,480 --> 00:57:40,320
is the only thing that ever has. So your children's foundation is really a first foundation is really

521
00:57:41,360 --> 00:57:47,600
that group and, and there are many others, but I believe that we can do this. I don't know how

522
00:57:47,600 --> 00:57:53,200
many people listen to this podcast, but I do know that you're listening for a reason and that you are

523
00:57:53,200 --> 00:57:58,720
chosen because of your interest to help spread the word. So if you like something on this,

524
00:57:58,720 --> 00:58:04,640
I repeat it to someone and just continue to be the change you want to see in the world.

525
00:58:04,640 --> 00:58:09,840
In a world that's lacking prevention, we circle around to how we started. In the world that's

526
00:58:09,840 --> 00:58:14,080
paid for prevention, we're doing it out of the goodness of our heart to make a better tomorrow.

527
00:58:14,080 --> 00:58:22,000
And it's important that we continue to talk about it. Absolutely. Thank you. Thank you for,

528
00:58:22,000 --> 00:58:28,160
for, and I was probably one of the most profound and just, thank you. Yeah. Thank you for that.

529
00:58:28,160 --> 00:58:33,040
For all the work you're doing, Rebecca, and we're enabled. And so I know we are. Yeah, Michigan.

530
00:58:34,880 --> 00:58:42,000
Thank you. Yes. Have a great evening. Thank you again for having me on. Thank you. Thanks again

531
00:58:42,000 --> 00:58:47,920
to today's guest, Dr. Susan Maples for sharing her medical insight and each of you for listening

532
00:58:47,920 --> 00:58:53,440
to today's episode. If you're new to our podcast, please don't forget to subscribe. And if you

533
00:58:53,440 --> 00:58:58,240
enjoyed today's episode, leave us a review or comment telling us about what you enjoyed most.

534
00:58:59,840 --> 00:59:04,080
You can stay connected with the Children's Airway First Foundation by following us on

535
00:59:04,080 --> 00:59:10,000
Instagram, Facebook, Twitter, and LinkedIn. Parents can also join us via our Facebook

536
00:59:10,000 --> 00:59:16,960
Parents Support Group, the Airway Huddle, at facebook.com backslashgroups backslashairwayhuddles.

537
00:59:16,960 --> 00:59:23,360
Looking for more from CAV? Then check out our YouTube channel. You can find a variety of

538
00:59:23,360 --> 00:59:28,480
informative original video content pieces as well as other video recordings and excerpts

539
00:59:28,480 --> 00:59:34,400
from selected Airway First podcast episodes. If you'd like to be a guest or have an idea for

540
00:59:34,400 --> 00:59:39,840
an upcoming episode, shoot us a note via the contacts page on our website or send us an

541
00:59:39,840 --> 00:59:47,040
email directly at infoatchildrensairwayfirst.org. And finally, thanks to all the parents and

542
00:59:47,040 --> 00:59:51,440
medical professionals out there that are working to help make the lives of kids around the globe

543
00:59:51,440 --> 01:00:10,800
just a little bit better. Take care, stay safe, and happy breathing, everyone!