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Hi everybody, and welcome back to Airway First, a podcast from the Children's Airway First

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Foundation.

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I'm your host, Rebecca Downing.

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In today's episode, I'm joined by Dr. Ben Moralia.

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Dr. Moralia is a graduate of SUNY at Buffalo School of Dental Medicine.

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He's a member of the American Dental Association, the New York State Academy of General Dentistry,

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the American Academy of Dental Sleep Medicine, and the Ninth District Dental Society.

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He has 26 years general practice experience in Mount Kisco, New York, including 17 years

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interceptive orthodontic experience, where his focus has been on early childhood growth

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and development.

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Dr. Moralia lectures nationally on sleep disorder breathing, clariliner therapy, and cranial

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facial development.

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He is on the board of directors of the American Academy of Physiological Medicine and Dentistry,

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and the President's Council of Northern Westchester Hospital, out Mount Kisco, New York.

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Dr. Moralia has been recognized multiple times as a leader in continuing education

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by Dentistry Today Magazine.

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You can find out more about Dr. Moralia at bgmtental.com and airwayhealthsolutions.com.

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And now, let's jump into my interview with Dr. Ben Moralia.

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Thank you so much for joining us, Dr. Moralia.

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I really appreciate it.

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It's my pleasure to be here.

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Thank you for having me.

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Absolutely.

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So let's just dive right in.

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Airway Dentistry, for a lot of our listeners, parents especially, this is a newer term.

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We're kind of hearing it, but still don't really understand what that means.

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So what all does that encompass as far as what's the difference between an airway dentist

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and a regular dentist, and then what your practice might look like compared to traditional

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dentistry?

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Right, right.

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Yes, excellent.

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And so, yeah, airway dentistry and those kind of terms are kind of newer.

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But the idea is that if you think about dentistry, you think about teeth.

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And so dentistry has almost a tooth first philosophy, foundation, and history.

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And that's fine.

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We do have to pay attention to the teeth.

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The teeth are part of dentistry, however.

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There is a different way to look at it.

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And so we're looking at things a little bit differently now because while we see the teeth

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first, the teeth are held in by the jaws, and we have this upper and lower jaw.

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So the upper and lower jaw, it turns out that their development affects how well we can

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breathe through our nose.

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So nose breathing isn't just automatic.

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It has to do with how well your jaws grew when you were little.

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And the way we think about it now is maybe dentistry should have a little bit of a paradigm

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shift to being growth and development first or foundation first, teeth second.

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So in the previous rendition of thinking about dentistry, you're thinking teeth first.

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But in what we're trying to accomplish is dentistry, thinking about jaw growth and development

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first, foundation first.

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So when the word airway dentistry kind of pops into play, what you're thinking about

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there is, well, if you hear airway dentistry or airway dentist or airway anything like that,

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now you know you're probably dealing with someone who's paying attention to the foundation

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first.

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And when I say foundation, I mean jaws, the jaw structure first and the teeth second.

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So just like you would build a house on a foundation, you don't try to build the house

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and then slide the foundation under it.

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You want to put the foundation down and you have to have it mapped out perfectly, then

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everything goes up beautifully from there.

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So we think about dentistry going forward and we're thinking about airway dentistry.

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What it means to me and others as we're trying to spread the word is that we're more focused

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on the foundation and its growth and development so that you would have a better breather as

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well as really nice teeth where they belong.

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So the good news is if you guide the foundation to grow properly and you're focused on the

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airway that's the resulting benefit of foundation first philosophy, it turns out when your foundation

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grows better and you have better jaw growth and development, your teeth go closer to where

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they belong.

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So even though we say teeth are second, they're going to be in better shape when you focus

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on the foundation first.

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So airway dentistry typically means that you have a focus on the foundation, the jaw growth

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and development early, and then we kind of focus on the teeth second.

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And when you say early, how early are you talking?

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So yes, in my world, it begins about three to four years old and we have others in the

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industry who start even earlier.

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So as a general dentist, I'm comfortable with children three to four years old and we can

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work on them then because by then we already have the signs and symptoms of underdeveloped

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jaws and poor breathing and other symptoms that come with that.

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So I'm comfortable three to four, but that doesn't mean that's where you could start.

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Some of the symptoms do appear between one and two.

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There are even early symptoms right at birth or just after that could be picked up.

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So when you're thinking about that age range, I think about some of my early mentors like

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a Dr. Kevin Boyd, who is a pediatric dentist and he certainly can begin early, pretty much

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at birth and on.

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And some other ones would be like Dr. Lawrence Kotlow, who is like a frenem revision specialist

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that I know will get into tongue tie at some point.

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So then these are two gentlemen who has pediatric dentists.

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They start even before me and it could be at birth if there was difficulty with a tight

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tongue or a frenem, tongue tie as people call it.

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So yeah, the indication to help a child grow and develop could begin right after birth,

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depending upon what we see and find.

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And I think the pediatric dental specialty gets them earlier than me.

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I jump in around three to four.

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And then by perspective, some people think I'm early.

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I'm not the earliest.

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Right.

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And it's funny.

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I believe it's Dr. Boyd.

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I've heard him refer to, I think it was like a nine-year-old or 11-year-old as geriatric

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and I'm thinking, I'm sorry, wait, what?

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You can't get to him so early.

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It just, you have to kind of realign the way you think about things.

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Yes.

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What are you thinking about?

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Because obviously the earlier you're getting involved, there's less to think about as the

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teeth are concerned, but more to think about with the foundation.

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And that's where that whole airway dentistry comes from.

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Let's focus on the growth and development of the jaws because that's where our airway

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results from.

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You know, you get your best airway when you have great jaw growth and development.

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But if you don't have great jaw growth and development, if the jaws are a little undersized,

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there's less room for the air to flow beautifully.

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So basically how easily we breathe through our nose is dependent upon how well the jaws

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are growing.

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Got it.

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And I saw something, I'll put a link in the show notes to this, but I saw you explain

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this and I'd like to ask for you to just do that for the parents that are listening.

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Now, the difference really between normal and abnormal when it comes to the foundation

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and the growth.

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Sure.

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The idea behind normal growth and development is it's something that we don't see very often.

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So if we're thinking about normal childhood growth and development in the jaw region,

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because we're talking about the head and neck for the jaws to grow.

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It used to be the case that a child would grow up and have their jaw growth be perfectly

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happening along the way so that all of their teeth would go to place and they would never

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need braces and they would have all 32 land, meaning the wisdom teeth would pop in when

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they were 18 to 20.

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So that used to be the normal.

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Now that goes back several hundred years.

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Now today, the normal is that the jaw growth is underdeveloped, the teeth are crowded with

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a bad bite, so teeth that aren't where they belong.

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And almost rare is it that a child could not need orthodontics to fix their teeth and very

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rare that they can fit their wisdom teeth.

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So we think about what we consider today normal childhood growth and development to have all

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of your teeth go to place, avoid having braces and get your wisdom teeth to come in.

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That's still considered normal growth and development, but it doesn't happen very often.

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In other words, that kind of child who grows perfectly, all the teeth go to place, they

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never get braces and they get their wisdom teeth to come in.

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I call that a unicorn today.

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We see that child one in several hundred.

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So I see a lot of children, several hundred children a year.

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We only meet one child out of several hundred who will on their own grow all the way up

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to have their wisdom teeth come in and not have any braces.

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So that's really still normal growth and development, but it's not common.

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So we start thinking about normal versus common.

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Now today it is common that children have underdeveloped jaws, crowded and or bad bites,

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so crowded teeth and bad bites, common to need braces and common to have their wisdom

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teeth out, meaning the maximum you would have is 28 teeth.

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And if you have four teeth taken out during braces and your wisdom teeth out, you might

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only have 24 teeth.

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So the idea is while all of that is very common, that doesn't make it normal.

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So common and normal are two different things.

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Today it is common for children to have their baby teeth be very tight together, no spaces

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between them, and then a recognizable poor bite at a young age so that when they become

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a kid in the middle, like somewhere between six and 12, the new teeth come in crowded or

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out of place in a bad bite.

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And then the braces are going to go on for years and rubber bands are going to get used

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and next thing you know, the wisdom teeth have to come out at minimum.

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So that's a common thing to see.

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And in my world, that is most children have that pathway.

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Now the normal growth and development pattern we described as being incredibly rare today,

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I call it a unicorn.

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When you go back several hundred years ago, that was the common as well.

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It was normal, it was common, where people would just kind of grow up and have all of

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their teeth go where they belong, and there's wonderful anthropology research to show that

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you know, pre-industrial, pre-western living, the infants graduated to a harder diet earlier.

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And so when you do have cultures that are pre-industrial, pre-western living, and we're

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talking about several hundred years ago, all of society's basically all of humanity had

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jaw growth and development that was excellent with 32 teeth going where they belong.

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And with big jaw growth, appropriate normal jaw growth comes better breathing.

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So while that used to be common and normal being the same thing, today normal growth

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and development, it still exists.

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It's just incredibly rare.

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So we call it a unicorn, whereas the common today is underdeveloped jaws, crowded teeth,

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bad bites, and that comes with then the need for braces, the need for wisdom teeth extractions.

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But more so than that, the bigger problem with underdeveloped jaws is that you don't

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breathe as well.

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Right.

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Right.

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So basically we're doing this to ourselves.

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It is a self-inflicted wound.

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Yeah, unfortunately, sadly, when you read through the anthropology research on introducing

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an early soft diet, it creates the turning point.

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And it starts with food trade, and we start trading food.

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And when you go back, you're going back hundreds of years ago, where all of a sudden everything

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starts to shift towards this industrial Western mode.

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Then all of a sudden we get into what is considered the baby food, which is pureed and mushed.

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And we do it out of love because we think we're doing the right thing always.

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And I did it.

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I did the same thing for my three kids.

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So you know, anyone listening, don't worry, I did it wrong too.

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Because I didn't know what I was doing.

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Right.

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You don't know what you don't know.

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Don't have no idea back then in minor 21, 20 and 16.

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So you go back then.

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And I was just getting started on this pathway.

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I'm about 19 years into growth and development for children.

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And it's been a full swing since then.

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And my children had the pureed meals.

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And even if we went to get natural hard food from the farmer's market, because you're thinking,

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oh, let's get the freshest, greatest stuff, we put it in the blender.

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And we, magic, bulleted it to death.

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So we basically had a liquid diet.

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And so the cascade effect is that when you transition early to this softer diet, well,

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then you're not using the muscles appropriately.

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So if we're not going to use the facial muscles and the oral muscles appropriately, meaning

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we're having a liquid diet, basically, those muscles, when they're weak, then they don't

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grow the bone because we, the bone needs to yield to the muscle.

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So the way a human works is that the muscle will actually dictate the bone growth and

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it has to be used properly.

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So with the early saw food, we have weaker muscles and weaker muscles don't promote good

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bone growth.

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And the jaws don't grow enough.

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What we see down the road is, hey, my teeth are crowded and I have a bad bite.

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But it is all the result of an early soft diet.

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Saley, we did this to ourselves.

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Yes.

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Right.

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So we're getting more of that kind of retracted, retreated jaw.

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Like when you turn sideways, you can actually see it slanting in the profile.

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Yes.

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You know, that's exactly right.

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The profile is a telltale kind of view of the face, its growth and what it means.

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And so when we have normal growth and development, we're usually getting wide and forward, really

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nice, wide and forward growth.

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That's how the jaw should grow, wide and forward.

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And when the jaws grow wide and forward and we breathe in our nose, that air gets, it

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goes up and down.

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It's like an upside down letter J, the airway kind of thing.

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So the air goes in our nostril and it goes around a little curve and goes right back

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down behind the tongue into our lungs.

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So that space is bigger when the jaws grow wider and forward.

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So jaw growth that's wider and forward is excellent for us.

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And it delivers a profile that I like to describe when we look at someone's profile, their lips

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are well ahead of their eyes.

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If we look at a profile and we see today, it's more common that the lips and the eyes

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are almost in the same plane.

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But that profile is labeled as a straight or flat profile.

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And it's interesting though, that wording because a straight or flat profile when the

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eyes down to the lips are in the same plane, those are the words that we find in the sleep

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disorder, breathing and obstructive sleep apnea literature that show you're at risk

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for bad breathing and sleeping when you have a straight or flat profile.

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Then line.

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Yeah.

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So and that like you said, when the lips are below the eyes, then the chin is usually

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recessed or retrooted and it's back.

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So we kind of, you know, in late terms, we might think of it as, oh, the person doesn't

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really have a chin.

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But when the chin is really far back, then what happens is we get compensation in the

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neck and the neck starts to look like it's coming forward or more of a ramp than a jaw

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line.

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Because as we push the jaw back, then the neck kind of pops out, it's compensation to

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help the air go by.

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So believe it or not, that look is someone who's compensating to breathe better.

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And that's the whole thing of collapse because we're not growing wide and forward, we're

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narrowing back.

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So narrowing back leads to that type of profile we see where the lips and eyes are lined up

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and it does lead to compensation where there's worse breathing going on and that can be,

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you know, a cascade of trouble.

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Yeah, absolutely.

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So we've talked a lot in another podcast and on our website about signs, things that parents

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can look for.

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Yes.

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And I can't remember, I saw this on the Airway Health website or if this was in one of your

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videos I was watching, but you mentioned some symptoms that we don't really talk about.

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And I thought I'd bring those up so we could really talk about those and how, you know,

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what the connection is because to me, not all of them are intuitive.

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So specifically GI distress or reflux, small or delayed growth, air infections and emotional

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instability.

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How do these play into signs or symptoms?

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Oh, definitely.

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So we think about this cascade of this early soft diet delivers weaker muscles.

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The weaker muscles fail to develop the jaws.

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When the jaws don't develop well, we start breathing poorly.

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What that means is that we don't breathe easily through our nose.

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So one of the first things that happens when the jaws aren't growing well is if there's

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resistance to nose breathing, we can't breathe through our nose well.

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What the body does to compensate, it opens the mouth a little.

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And so when people think about mouth breathing, it is seen as a negative kind of word in a

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way, you know, we don't look at that in a kind way, but you know, mouth breathing doesn't

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have to mean that your mouth is hanging open or you're dragging your chin on the floor.

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Only just as little as lip separation.

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So when we don't breathe well through our nose, our lips will separate and we'll be

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breathing through our mouth.

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This is really the step that starts to trigger unhealthy.

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So when we think about the items you mentioned, what happens is when we are poorly breathing

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through the nose, the mouth will do some breathing.

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So we could talk about some of the first little things a parent might notice.

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One of the things earliest really is mouth breathing.

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In other words, the lips are apart.

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And how often during the day and night are the lips apart because a human being is an

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obligate nose breather.

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We are supposed to be breathing through our nose all day and night.

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It's a, you know, 24, 7, 365, the whole thing, nose breathing.

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And now once we have this underdeveloped jaws and we're not breathing well through our

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nose and our lips separate, when we're breathing through our mouth, this changes how we work

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because the nose was built to filter, to warm, to humidify, to accelerate, to prepare this

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air for the lungs.

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So when the nose is doing the breathing beautifully, the air gets purified and, you know, basically

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prepared for the lung, then the lung can do its job perfectly, which makes the exchanges

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of things.

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We have to get rid of some things.

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We have to add some things in.

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So the idea is if the nose is doing the breathing all the time, we're going to remain healthy

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and we'll be functioning beautifully.

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But then when the mouth starts to do the breathing, this is where we start to break down.

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Now knowing that the mouth breathing is the trigger for some of this, let's go through

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that list of the items you mentioned.

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I think the first one was the GI distress or reflux.

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Yes.

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Okay.

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So let's talk about that one.

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So the, basically we're talking about the digestive system.

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Okay.

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Now the digestive system is interesting in that we loosely think about having a nervous

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system that runs two general components.

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We have a sympathetic nervous system and we have a parasympathetic nervous system.

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I know those are fancy, but people will remember these words coming up.

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The sympathetic nervous system generally is fight or flight.

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Everybody knows fight or flight.

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You know, it happens in a car accident.

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You know, you're in fight or flight.

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If a dog was loose chasing you all of a sudden, if somebody's dog got out of the yard and

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was chasing you and barking at you and you'd be in fight or flight, you'd get a reaction

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to change.

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So there are ways that we think about fight or flight naturally.

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Well, it's a sympathetic nervous system runs fight or flight.

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Now the parasympathetic nervous system does the opposite of that.

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It does rest and digest.

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So now we've got sympathetic running fight or flight, parasympathetic running digest,

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rest and digest.

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So here's how this works.

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It's at night.

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When we go to bed and lay down, we're supposed to be in the parasympathetic component so

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that we get our rest and digest.

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Basically parasympathetic is mostly overnight when we're sleeping.

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So if we go to bed and we're breathing well through our nose, then of course parasympathetic

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runs smoothly and we get all of the rest and digestion happening that we're supposed to

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get.

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But the funny thing is it's the breathing pattern that can upset the balance of the sympathetic

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and parasympathetic nervous system.

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So if we're breathing through our nose, the parasympathetic nervous system, rest and digest

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runs beautifully.

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But if we lay down and go to sleep and our lips separate and we start breathing through

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our mouth, what happens is your brain knows that's not good breathing.

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You're supposed to be breathing through your nose and the brain tries to fix it for you

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when you're sleeping.

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But in order for the brain to shift gears instead of doing the rest and digest, and

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by rest we mean clean and rejuvenate you for the next day.

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Because when that parasympathetic system is running beautifully at night, your brain is

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very busy and active.

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It's actually awake doing all of the things that clean and reset you and recharge you for

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the next day.

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So that's in the rest and digest category.

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But the moment we start breathing poorly, mouth breathing or worse, because if the lips

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separate and we're doing some mouth breathing, that's one category.

356
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But then you know worse would be snoring.

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And worse than snoring would be apnea where you actually pause or you notice that, oh,

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there's a hold of the breath and then a gasp like, oh, you catch your breath again.

359
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That those are like the three categories.

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Mouth breathing is the least, the mild version, then snoring is a little worse and apnea is

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even worse.

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Well, once the mouth opens and we start breathing through the mouth, the brain knows, well,

363
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that's not good for us.

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Well, I have to fix that.

365
00:20:22,120 --> 00:20:25,840
So in order to fix the mouth breathing and help you with your breathing, the brain has

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to enter fight or flight.

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It's a protective mechanism.

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So basically, if you're not breathing well, the brain activates fight or flight.

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And when you activate fight or flight, it's kind of to save you, to rescue you because

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poor breathing can lead to bad things.

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The body needs oxygen in certain levels and you have very little time.

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We think about it this way.

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Oxygen is the body's number one need.

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So if you think about how we get fuel to run ourselves, well, food, if we talk about food,

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you can go three weeks without food before you're really in serious trouble.

376
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You can go three days without water, you're in serious trouble, but oxygen, you get three

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00:21:00,280 --> 00:21:01,280
minutes.

378
00:21:01,280 --> 00:21:06,240
So we don't get a lot of time without oxygen or having decreases in oxygen is so harmful

379
00:21:06,240 --> 00:21:10,000
that the brain tries to protect us from that happening and it has to do so quickly.

380
00:21:10,000 --> 00:21:14,440
So it knows mouth breathing, snoring, apnea, those are so bad, the brain has to kick into

381
00:21:14,440 --> 00:21:16,760
fight or flight to make you breathe better.

382
00:21:16,760 --> 00:21:20,000
Now the problem is you can't do both things at the same time.

383
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You can't be in fight or flight and have rest and digest at the same time.

384
00:21:23,240 --> 00:21:27,240
So when fight or flight, yeah, bad breathing at night when you're sleeping means fight

385
00:21:27,240 --> 00:21:31,200
or flight is active, but then the other one, rest and digest is turned off.

386
00:21:31,200 --> 00:21:34,720
But when that's turned off, we don't digest properly.

387
00:21:34,720 --> 00:21:39,360
Now the way that works is during fight or flight, there's oxygen redistribution.

388
00:21:39,360 --> 00:21:44,320
I know it's fancy words, but in fight or flight, let's say if you're thinking about you're

389
00:21:44,320 --> 00:21:49,200
being attacked, oh, you go to the zoo, you go to the zoo and it's a beautiful day and

390
00:21:49,200 --> 00:21:52,840
you got your family and you're looking at this lion, which is in its cage.

391
00:21:52,840 --> 00:21:54,840
Okay, so you're safe.

392
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But if the lion jumped over the fence and landed in front of you and your family, your body

393
00:21:59,200 --> 00:22:02,040
is going to react and go into fight or flight mode.

394
00:22:02,040 --> 00:22:06,840
And all of a sudden you'll be best vision, best hearing, best senses, stronger, your

395
00:22:06,840 --> 00:22:09,720
musculature is going to get a lot of flood of oxygen.

396
00:22:09,720 --> 00:22:12,480
Basically you get this burst for a short time to do your fight or flight.

397
00:22:12,480 --> 00:22:13,880
It's a survival mechanism.

398
00:22:13,880 --> 00:22:15,200
You would change in an instant.

399
00:22:15,200 --> 00:22:21,680
Well, the reason that all happens is because of redirecting things to give you things where

400
00:22:21,680 --> 00:22:22,840
you need it.

401
00:22:22,840 --> 00:22:26,040
So you don't need your digestive system during fight or flight.

402
00:22:26,040 --> 00:22:30,560
If the lion jumps over the fence, you're going to need all the oxygen you can get into your

403
00:22:30,560 --> 00:22:31,880
muscles to fight or flight.

404
00:22:31,880 --> 00:22:35,080
So what happens is you draw from the areas you don't need.

405
00:22:35,080 --> 00:22:38,920
Well, the digestive system is in the parasympathetic or the rest and digest.

406
00:22:38,920 --> 00:22:42,320
If you take the oxygen out of the digestive system, it's not functioning properly.

407
00:22:42,320 --> 00:22:46,960
Now you have anything that is called gastrointestinal or digestive issues.

408
00:22:46,960 --> 00:22:55,280
It could be anything from reflux to upset stomach, to diarrhea, to constipation.

409
00:22:55,280 --> 00:22:59,960
Basically anything that is a malfunction of the digestive system could be related to how

410
00:22:59,960 --> 00:23:02,760
you're breathing at night because your system is in functioning right.

411
00:23:02,760 --> 00:23:06,080
You're spending more time in fight or flight trying to fix your breathing than you are

412
00:23:06,080 --> 00:23:07,400
in the digestive category.

413
00:23:07,400 --> 00:23:12,560
So you have a pathway to have digestive issues in any category, reflux being one of them.

414
00:23:12,560 --> 00:23:15,480
And next thing you know, you're malfunctioning in the digestive category.

415
00:23:15,480 --> 00:23:17,000
So there's a pathway.

416
00:23:17,000 --> 00:23:21,080
There's a second pathway for reflux, which it has to do with the mouth breathing and

417
00:23:21,080 --> 00:23:22,080
the musculature.

418
00:23:22,080 --> 00:23:27,160
So we talk about that as well because when the early soft diet is so soft and loose and

419
00:23:27,160 --> 00:23:31,520
we're just swallowing liquids basically, and we have these weaker muscles.

420
00:23:31,520 --> 00:23:35,800
The weaker muscles for swallowing all of a sudden don't do their job appropriately.

421
00:23:35,800 --> 00:23:39,240
And because we're mostly swallowing liquid and not having to chew harder foods and work

422
00:23:39,240 --> 00:23:43,440
those stronger muscles, what happens is we start to swallow some air.

423
00:23:43,440 --> 00:23:47,080
So when the muscles are weaker, we use the word dysfunctional.

424
00:23:47,080 --> 00:23:51,880
So weaker muscles are usually dysfunctional, meaning they don't function properly.

425
00:23:51,880 --> 00:23:56,600
So when weaker muscles function poorly, we don't have a full compression of the tongue

426
00:23:56,600 --> 00:23:59,520
to the palate and we don't make a vacuum swallow.

427
00:23:59,520 --> 00:24:04,520
So a perfect human swallow is by vacuum, meaning you seal everything off.

428
00:24:04,520 --> 00:24:09,240
The tongue goes to the roof of the mouth and then there's a vacuum to make the good swallow.

429
00:24:09,240 --> 00:24:12,960
You're only swallowing the contents that are there because it's been sealed off.

430
00:24:12,960 --> 00:24:17,560
But with some mouth breathing and weaker musculature, all of a sudden a child or a teenager and

431
00:24:17,560 --> 00:24:20,000
adult, they might swallow some air.

432
00:24:20,000 --> 00:24:24,200
Now swallowing some air is trouble because now the air starts filling up in the belly.

433
00:24:24,200 --> 00:24:28,640
And when the air fills up in the belly, it's going to go both ways, of course.

434
00:24:28,640 --> 00:24:31,360
One pathway is through, of course, flatulence.

435
00:24:31,360 --> 00:24:35,080
The other pathway is that it comes back out the top because it's almost like filling up

436
00:24:35,080 --> 00:24:36,640
a balloon too much.

437
00:24:36,640 --> 00:24:40,520
So you swallow so much air and there's a valve at the top because our mouth leads to our

438
00:24:40,520 --> 00:24:43,200
esophagus, which leads to our stomach.

439
00:24:43,200 --> 00:24:46,920
And the esophagus, that long tube where it connects to the stomach has a little valve.

440
00:24:46,920 --> 00:24:51,160
If you fill up the stomach with too much air and it exceeds the pressure that valve can

441
00:24:51,160 --> 00:24:53,600
hold, some air will pop out of the top.

442
00:24:53,600 --> 00:24:57,240
But as the air pops out of the top, so does the stomach acid.

443
00:24:57,240 --> 00:25:02,680
So swallowing air is a pathway to getting reflux just because you're swallowing too

444
00:25:02,680 --> 00:25:06,640
much air and the stomach can't hold it or pass it along the other end fast enough.

445
00:25:06,640 --> 00:25:10,280
So if it can't go out the other end fast enough, it has to come back out of the top, which

446
00:25:10,280 --> 00:25:11,400
gives you some reflux.

447
00:25:11,400 --> 00:25:17,480
So reflux can be the direct result of swallowing air, which happens from swallowing poorly

448
00:25:17,480 --> 00:25:22,720
thanks to having a weaker and dysfunctional set of muscles in the oral cavity.

449
00:25:22,720 --> 00:25:28,040
So we can think about that GI distress and or reflux being part of the balance of our

450
00:25:28,040 --> 00:25:32,200
nervous system, the sympathetic fight or flight or the parasympathetic rest and digest

451
00:25:32,200 --> 00:25:36,760
pathway, or we can think about it in just a swallowing mechanism related to how we might

452
00:25:36,760 --> 00:25:37,760
be swallowing air.

453
00:25:37,760 --> 00:25:40,440
There's two pathways to upset the digestive tract.

454
00:25:40,440 --> 00:25:41,440
Wow.

455
00:25:41,440 --> 00:25:42,440
Okay.

456
00:25:42,440 --> 00:25:45,320
So how does smaller delayed growth?

457
00:25:45,320 --> 00:25:48,680
How does that become a sign or symptom?

458
00:25:48,680 --> 00:25:54,160
Then similar to the sympathetic fight or flight and parasympathetic rest and digest,

459
00:25:54,160 --> 00:25:59,680
the idea is most children went, well, most of the growth hormone for children is released

460
00:25:59,680 --> 00:26:01,280
when we're sleeping.

461
00:26:01,280 --> 00:26:05,840
So it turns out growth hormone is released when growth hormones released were in parasympathetic

462
00:26:05,840 --> 00:26:06,840
drive.

463
00:26:06,840 --> 00:26:10,160
In other words, if we're in the rest and digest appropriately, we're getting our growth hormone,

464
00:26:10,160 --> 00:26:12,040
so we would be growing normally.

465
00:26:12,040 --> 00:26:16,120
But for children who are undersized or have smaller or delayed growth and maybe aren't

466
00:26:16,120 --> 00:26:18,560
on the higher weight chart, but everything else is correct.

467
00:26:18,560 --> 00:26:21,000
They have a good diet and they seem to be going to bed on time.

468
00:26:21,000 --> 00:26:26,120
Well, if the breathing isn't correct, if we have bad breathing going on, mouth breathing

469
00:26:26,120 --> 00:26:31,000
or worse can disrupt the parasympathetic or rest and digest and we could be in fight or

470
00:26:31,000 --> 00:26:32,000
flight.

471
00:26:32,000 --> 00:26:34,720
Now, when we're in fight or flight, we don't get the growth hormone released.

472
00:26:34,720 --> 00:26:38,880
Fight or flight actually triggers cascades to release cortisol and other things that

473
00:26:38,880 --> 00:26:40,800
are meant to kind of save you in the short term.

474
00:26:40,800 --> 00:26:45,320
So it's more inflammatory by nature and we might get cortisol released during fight or

475
00:26:45,320 --> 00:26:47,680
flight because we're trying to breathe better.

476
00:26:47,680 --> 00:26:52,160
So the poor breathing activating the nervous system that does fight or flight at night

477
00:26:52,160 --> 00:26:55,080
can shut down and reduce the amount of growth hormone a child gets.

478
00:26:55,080 --> 00:27:00,680
So there are children who are undersized because they don't get enough growth hormone and it

479
00:27:00,680 --> 00:27:03,880
could be directly related to how they're breathing and sleeping.

480
00:27:03,880 --> 00:27:05,240
Which system is running?

481
00:27:05,240 --> 00:27:09,000
Are we trying to protect ourselves from bad breathing or are we actually in the parasympathetic

482
00:27:09,000 --> 00:27:10,000
drive?

483
00:27:10,000 --> 00:27:13,720
So we think about small growth as a possibility, especially when everything else is ruled out

484
00:27:13,720 --> 00:27:18,840
because if the child goes maybe to the pediatrician and endocrinologist, let's say everything else

485
00:27:18,840 --> 00:27:19,840
checks out.

486
00:27:19,840 --> 00:27:24,720
We don't have anything going on with the pituitary or the thyroid or let's say everything else

487
00:27:24,720 --> 00:27:28,080
checks out but we're just like deficient in growth hormone.

488
00:27:28,080 --> 00:27:30,280
It may very well be the sleeping pattern.

489
00:27:30,280 --> 00:27:35,680
So a sleep study and sleep observation could help because we would want to know is that

490
00:27:35,680 --> 00:27:38,600
child nasal breathing through the whole night?

491
00:27:38,600 --> 00:27:42,320
And when we say nasal breathing, it should be silent and invisible.

492
00:27:42,320 --> 00:27:44,960
So when a parent is thinking about, well, how are we breathing?

493
00:27:44,960 --> 00:27:46,080
Are the lips together?

494
00:27:46,080 --> 00:27:47,520
That's one level.

495
00:27:47,520 --> 00:27:49,880
Certainly good to have the lips closed all night long.

496
00:27:49,880 --> 00:27:51,160
Then we're in good shape.

497
00:27:51,160 --> 00:27:56,040
The next level would be is the breathing silent and invisible because it should be.

498
00:27:56,040 --> 00:28:00,280
In other words, if we have the right jaw growth and great size for the air to flow, when we're

499
00:28:00,280 --> 00:28:02,840
nose breathing, it should be silent and invisible.

500
00:28:02,840 --> 00:28:07,240
Meaning the parent who's looking in on their child should basically not even be able to

501
00:28:07,240 --> 00:28:09,760
hear or see that they're breathing.

502
00:28:09,760 --> 00:28:10,760
That's beautiful breathing.

503
00:28:10,760 --> 00:28:14,520
The lips are closed and it's silent and invisible.

504
00:28:14,520 --> 00:28:18,000
If the lips are closed, but you can see and hear the breathing, what you have is you have

505
00:28:18,000 --> 00:28:22,560
nasal obstruction, but not enough to open the mouth yet, but it's coming.

506
00:28:22,560 --> 00:28:25,360
Eventually that'll get bad enough that the mouth will start to open.

507
00:28:25,360 --> 00:28:30,560
So the first level of trouble would be the lips are closed, but the nose is breathing,

508
00:28:30,560 --> 00:28:31,840
but I can hear it and see it.

509
00:28:31,840 --> 00:28:32,840
So it's struggling.

510
00:28:32,840 --> 00:28:35,400
So there's a point, there's like a trigger.

511
00:28:35,400 --> 00:28:38,440
The nose will struggle to breathe for a certain amount, but then when it gets really bad,

512
00:28:38,440 --> 00:28:39,440
the body will open the mouth.

513
00:28:39,440 --> 00:28:41,120
The brain will say, Hey, that's enough of that.

514
00:28:41,120 --> 00:28:42,120
I've tried that.

515
00:28:42,120 --> 00:28:43,120
It doesn't work.

516
00:28:43,120 --> 00:28:44,280
Let me open the mouth and get some air in there.

517
00:28:44,280 --> 00:28:46,680
So we get that compensation.

518
00:28:46,680 --> 00:28:50,320
So if we can see and hear nasal breathing, we know we're bad.

519
00:28:50,320 --> 00:28:53,680
And if of course the mouth is open, anything with mouth open breathing is going to be trouble

520
00:28:53,680 --> 00:28:54,840
for us.

521
00:28:54,840 --> 00:28:56,400
That's how we're starting to get unhealthy.

522
00:28:56,400 --> 00:28:58,560
So we covered the gastrointestinal system.

523
00:28:58,560 --> 00:29:00,160
We covered the small growth and development.

524
00:29:00,160 --> 00:29:02,360
What was that next item you had?

525
00:29:02,360 --> 00:29:04,880
The ear infections or tubes.

526
00:29:04,880 --> 00:29:05,880
Yes.

527
00:29:05,880 --> 00:29:06,880
Ear infections.

528
00:29:06,880 --> 00:29:07,880
So multiple ear infections.

529
00:29:07,880 --> 00:29:12,080
So we think about children who get ear infections and of course you get chronic.

530
00:29:12,080 --> 00:29:17,240
Oh yeah, multiple because you get multiple of these things because antibiotics don't

531
00:29:17,240 --> 00:29:20,000
treat the cause of the ear infection.

532
00:29:20,000 --> 00:29:24,560
It treats the overgrowth or the imbalance in the bacteria that has occurred to give

533
00:29:24,560 --> 00:29:25,600
the child the infection.

534
00:29:25,600 --> 00:29:31,320
So what happens is we get the ear infection, we get an antibiotic and it basically it then

535
00:29:31,320 --> 00:29:34,720
kills the bad bugs and it reduces the quantity.

536
00:29:34,720 --> 00:29:38,000
So you have balance again, but if you don't treat the cause of the ear infection, these

537
00:29:38,000 --> 00:29:41,840
come back because you still have the same conditions that gave you the ear infection

538
00:29:41,840 --> 00:29:42,840
in the first place.

539
00:29:42,840 --> 00:29:43,840
Right.

540
00:29:43,840 --> 00:29:46,920
So you get another antibiotic and another antibiotic and then whatever the formula is,

541
00:29:46,920 --> 00:29:50,560
if it's three infections in six months or nine months, the pediatricians have a formula

542
00:29:50,560 --> 00:29:53,000
for then tubes have to go in.

543
00:29:53,000 --> 00:29:54,280
Tubes hold open this little tube.

544
00:29:54,280 --> 00:29:55,280
Well, we think about the ear.

545
00:29:55,280 --> 00:29:58,480
Well, on the outside, the outside of the ear has an opening where you put your Q-tip.

546
00:29:58,480 --> 00:29:59,600
That's where you clean it.

547
00:29:59,600 --> 00:30:02,720
But all the way on the inside, there is a little opening at the back of the throat.

548
00:30:02,720 --> 00:30:05,560
It has a fancy name for it, the Eustachian tube.

549
00:30:05,560 --> 00:30:09,760
The Eustachian tube is where the inside of the ear kind of drains into the back of the

550
00:30:09,760 --> 00:30:10,760
throat.

551
00:30:10,760 --> 00:30:15,640
Now, it's supposed to be draining and if the fluid drains, it doesn't sit, it won't get

552
00:30:15,640 --> 00:30:16,720
infected.

553
00:30:16,720 --> 00:30:20,160
So the way for the fluid to get infected is it has to sit for a longer period of time.

554
00:30:20,160 --> 00:30:24,400
So like if it sits too long, you have a better opportunity to get an infection.

555
00:30:24,400 --> 00:30:27,920
Well, then the real question is, well, why isn't it draining?

556
00:30:27,920 --> 00:30:31,640
Because that's where we start thinking about having the opportunity for the ear infections.

557
00:30:31,640 --> 00:30:36,040
So when we think about why isn't it draining, we think about, well, what is the course or

558
00:30:36,040 --> 00:30:39,280
the mechanism by which it would drain in the first place?

559
00:30:39,280 --> 00:30:43,080
So it does revert back to a proper vacuum swallow.

560
00:30:43,080 --> 00:30:46,160
So I brought up the vacuum swallow earlier because we were going to build on it with

561
00:30:46,160 --> 00:30:47,160
this one.

562
00:30:47,160 --> 00:30:50,480
When a human being closes their mouth and their tongue compresses to the roof of their

563
00:30:50,480 --> 00:30:56,640
mouth and they make a perfect swallow by vacuum, that vacuum as it goes down, draws the fluid

564
00:30:56,640 --> 00:30:59,480
out of that tube into the throat for swallowing.

565
00:30:59,480 --> 00:31:03,720
So a perfect vacuum swallow drains that fluid out.

566
00:31:03,720 --> 00:31:08,040
And it's almost like if you're thinking about swallowing in a vacuum, you have to kind of

567
00:31:08,040 --> 00:31:11,360
just think for a moment about the difference between positive and negative pressure.

568
00:31:11,360 --> 00:31:14,400
I know it's fancy, but it's easy to understand.

569
00:31:14,400 --> 00:31:16,480
It would be easy to understand thinking about a balloon.

570
00:31:16,480 --> 00:31:17,840
So let's think about a balloon first.

571
00:31:17,840 --> 00:31:21,920
When you blow up a balloon, that's positive pressure.

572
00:31:21,920 --> 00:31:25,400
So you blow up the balloon with positive pressure, you're pushing the air into the balloon, positive

573
00:31:25,400 --> 00:31:26,920
pressure builds the balloon bigger.

574
00:31:26,920 --> 00:31:32,040
Well, the negative pressure is easy to understand because most people understand, hey, if I found

575
00:31:32,040 --> 00:31:34,440
a helium balloon and I want to sound like Mickey Mouse.

576
00:31:34,440 --> 00:31:35,440
Right.

577
00:31:35,440 --> 00:31:36,440
Yeah.

578
00:31:36,440 --> 00:31:38,280
So what do you do with the helium balloon to sound like Mickey Mouse?

579
00:31:38,280 --> 00:31:41,800
Well, you put the balloon in your mouth and you suck the air out of it.

580
00:31:41,800 --> 00:31:45,400
But when you're sucking the air out of the balloon, it shrinks.

581
00:31:45,400 --> 00:31:46,400
Negative pressure.

582
00:31:46,400 --> 00:31:48,280
Positive pressure blows up the balloon.

583
00:31:48,280 --> 00:31:52,200
Negative pressure empties the balloon, collapses it, and you sound like Mickey Mouse if it

584
00:31:52,200 --> 00:31:53,200
was helium, right?

585
00:31:53,200 --> 00:31:54,200
Okay.

586
00:31:54,200 --> 00:31:55,200
Right.

587
00:31:55,200 --> 00:31:56,680
Well, negative pressure is what would drain fluid.

588
00:31:56,680 --> 00:31:58,400
So if we think about the balloon has air in it.

589
00:31:58,400 --> 00:32:01,200
So when we're sucking the air out of the balloon, the air is emptying.

590
00:32:01,200 --> 00:32:07,000
When we swallow by vacuum, that swallow by vacuum, it almost like the eustachian tube,

591
00:32:07,000 --> 00:32:09,240
which has the fluid, is the balloon, so to speak.

592
00:32:09,240 --> 00:32:10,240
Okay.

593
00:32:10,240 --> 00:32:14,920
So as we swallow by vacuum, that fluid's being pulled out into our throat to swallow.

594
00:32:14,920 --> 00:32:19,320
So basically every single proper swallow by vacuum drains the fluid, keeps the system

595
00:32:19,320 --> 00:32:20,680
running well.

596
00:32:20,680 --> 00:32:26,560
And as soon as a child has that early soft diet, then a weaker and dysfunctional tongue

597
00:32:26,560 --> 00:32:30,600
muscle, then the oral cavity doesn't behave properly and we're mostly drinking our early

598
00:32:30,600 --> 00:32:31,600
food.

599
00:32:31,600 --> 00:32:35,920
So now we have a set up where we swallow air, but swallowing some air without a vacuum

600
00:32:35,920 --> 00:32:38,320
swallow, then the fluid never leaves the eustachian tube.

601
00:32:38,320 --> 00:32:42,400
It stays in there and then welcome to fluid sitting too long in one place.

602
00:32:42,400 --> 00:32:43,400
Wow.

603
00:32:43,400 --> 00:32:46,320
It increases the odds or risk of getting ear infections.

604
00:32:46,320 --> 00:32:50,280
What ear tubes do then is they just hold it open because that little tube, that little

605
00:32:50,280 --> 00:32:54,000
tube has a sphincter at the end or a little closure at the end, but when you're swallowing

606
00:32:54,000 --> 00:32:56,120
perfectly, the fluid will come out of it.

607
00:32:56,120 --> 00:32:57,360
A tube just holds it open.

608
00:32:57,360 --> 00:33:00,240
So they put the tubes in there so the fluid just leaks out.

609
00:33:00,240 --> 00:33:01,480
That doesn't treat the cause either.

610
00:33:01,480 --> 00:33:02,480
That treats the symptoms.

611
00:33:02,480 --> 00:33:06,080
So antibiotics and tubes treat the symptom.

612
00:33:06,080 --> 00:33:10,000
If you could correct the swallowing pattern, it treats the cause.

613
00:33:10,000 --> 00:33:11,000
The cause, yeah.

614
00:33:11,000 --> 00:33:12,000
Yeah.

615
00:33:12,000 --> 00:33:14,920
So we think about in that world, if we want to have jaw growth and development, we have

616
00:33:14,920 --> 00:33:18,640
appliances and things we can do to help the children grow their jaws better to fit their

617
00:33:18,640 --> 00:33:19,640
teeth.

618
00:33:19,640 --> 00:33:25,560
We also have the other world, which is to get the muscles corrected and why not strengthen

619
00:33:25,560 --> 00:33:27,720
and train the muscles to function properly?

620
00:33:27,720 --> 00:33:30,440
It's like physical therapy for the oral cavity.

621
00:33:30,440 --> 00:33:35,800
So when you go through myofunctional therapy, fancy words, or facial myofunctional therapy,

622
00:33:35,800 --> 00:33:39,920
it just teaches the tongue and the other muscles how to do it right.

623
00:33:39,920 --> 00:33:44,200
So you graduate out of this early soft diet delivering these muscles that only work one

624
00:33:44,200 --> 00:33:46,360
way, which isn't exactly good for us.

625
00:33:46,360 --> 00:33:49,360
Then we can train the muscle and strengthen it to function properly and you never have

626
00:33:49,360 --> 00:33:51,760
to get an ear infection to get a huge swallow properly.

627
00:33:51,760 --> 00:33:52,760
Nice.

628
00:33:52,760 --> 00:33:53,760
Ear infections, yeah.

629
00:33:53,760 --> 00:34:08,320
You are listening to Airway First with today's guest, Dr. Ben Morellio.

630
00:34:08,320 --> 00:34:11,880
You can find out more about the Children's Airway First Foundation and our mission to

631
00:34:11,880 --> 00:34:16,880
ensure that every child has access to screening, evaluation, and treatment of all children's

632
00:34:16,880 --> 00:34:23,040
airway disorders before the age of six on our website at childrensairwayfirst.org.

633
00:34:23,040 --> 00:34:28,440
The CAF website offers tons of great resources for parents including videos, blogs, recommended

634
00:34:28,440 --> 00:34:32,200
books, comprehensive medical research, and so much more.

635
00:34:32,200 --> 00:34:36,840
We've also recently launched the Airway Huddle, a Facebook support group for parents of children

636
00:34:36,840 --> 00:34:39,720
with airway and sleep-related issues.

637
00:34:39,720 --> 00:34:47,200
You can access the Airway Huddle support group at facebook.com backslash groups backslash

638
00:34:47,200 --> 00:34:48,200
airwayhuddle.

639
00:34:48,200 --> 00:34:51,560
Are you interested in becoming a guest or do you have an idea for an upcoming episode?

640
00:34:51,560 --> 00:34:55,880
Then shoot us a note via the contacts page on our website or send us an email directly

641
00:34:55,880 --> 00:35:00,680
at info at childrensairwayfirst.org.

642
00:35:00,680 --> 00:35:05,880
As a reminder, this podcast and the opinions expressed here are not a medical diagnosis.

643
00:35:05,880 --> 00:35:10,160
If you suspect your child might have an airway issue, contact your pediatric airway dentist

644
00:35:10,160 --> 00:35:12,480
or pediatrician.

645
00:35:12,480 --> 00:35:17,320
And now let's pick up the conversation again with today's guest, Dr. Ben Moraglio.

646
00:35:17,320 --> 00:35:36,440
That was another one.

647
00:35:36,440 --> 00:35:39,640
Totally related to the fight or flight.

648
00:35:39,640 --> 00:35:43,840
Once we're breathing poorly and the brain has to shift its gears to try to improve the

649
00:35:43,840 --> 00:35:46,920
breathing and we don't have proper rest and digest.

650
00:35:46,920 --> 00:35:52,200
In the parasympathetic column where there's this rest component, what the brain does all

651
00:35:52,200 --> 00:35:57,920
night is it totally cleans and organizes you for the next day.

652
00:35:57,920 --> 00:36:02,040
The analogy I like to describe this is like the show hoarders.

653
00:36:02,040 --> 00:36:07,360
If you think about redirecting to hoarders, most people get an idea even if you haven't

654
00:36:07,360 --> 00:36:10,560
seen all the episodes.

655
00:36:10,560 --> 00:36:14,640
Someone will collect every thing they see or touch or get their hands on and put it in

656
00:36:14,640 --> 00:36:16,160
their house and forever.

657
00:36:16,160 --> 00:36:20,000
The next thing you know when you walk in their house, there's no room anywhere.

658
00:36:20,000 --> 00:36:22,600
Wall to wall, floor to ceiling filled up.

659
00:36:22,600 --> 00:36:27,120
You barely have space to get around and it's just been collecting, collecting, collecting

660
00:36:27,120 --> 00:36:28,600
and it's a big disaster in there.

661
00:36:28,600 --> 00:36:31,240
So very difficult to live in that house.

662
00:36:31,240 --> 00:36:33,960
Now here's what's happened during the day.

663
00:36:33,960 --> 00:36:39,480
During the day, a human being collects information all day long and it's basically every single

664
00:36:39,480 --> 00:36:41,800
thing that you collect from your senses.

665
00:36:41,800 --> 00:36:48,720
So everything you see, everything you touch, everything you smell, you hear, you taste,

666
00:36:48,720 --> 00:36:51,880
all of the senses collect all this information.

667
00:36:51,880 --> 00:36:55,560
During the daytime, it's kind of like hoarding.

668
00:36:55,560 --> 00:36:56,880
Everything gets put into your brain.

669
00:36:56,880 --> 00:37:00,840
So whatever your senses, your hands can grab it, your mouth can taste it, your nose can

670
00:37:00,840 --> 00:37:03,520
smell it, your eyes can see it, your ears can hear it.

671
00:37:03,520 --> 00:37:06,800
Whatever your senses all day long, they collect and they pile it into your brain.

672
00:37:06,800 --> 00:37:11,120
Your brain now looks like the hoarder's house during the day.

673
00:37:11,120 --> 00:37:12,760
Now what happens during rest?

674
00:37:12,760 --> 00:37:17,760
When you go to bed at night, if you're breathing well and you have a beautiful parasympathetic

675
00:37:17,760 --> 00:37:22,880
or rest and digest cycle going, during rest as soon as you fall asleep, part of the brain's

676
00:37:22,880 --> 00:37:25,520
function at night is to file all of it.

677
00:37:25,520 --> 00:37:29,320
So we have this like never ending file system in our brain.

678
00:37:29,320 --> 00:37:32,960
It's not like the house where you're confined to these walls and you have nowhere to put

679
00:37:32,960 --> 00:37:33,960
anything.

680
00:37:33,960 --> 00:37:38,280
The brain can file everything you accumulate all day long for your whole life.

681
00:37:38,280 --> 00:37:43,280
So if you're in rest and digest, what the brain does at night is it sets up and it almost

682
00:37:43,280 --> 00:37:47,520
looks like a scene out of the matrix with Keanu Reeves where all of a sudden there's

683
00:37:47,520 --> 00:37:50,680
an endless aisles of things he can choose from.

684
00:37:50,680 --> 00:37:52,520
In some cases, it's bad things he's choosing.

685
00:37:52,520 --> 00:37:56,840
But the idea is it's endless files of things he can go and grab things.

686
00:37:56,840 --> 00:37:59,760
Well, your brain can file it all away.

687
00:37:59,760 --> 00:38:03,200
And when you wake up in the morning, you're clean and empty, so to speak.

688
00:38:03,200 --> 00:38:05,640
You're ready for the next day of accumulating.

689
00:38:05,640 --> 00:38:12,000
If we are breathing poorly and we're in this fight or flight mode at night, that that organization

690
00:38:12,000 --> 00:38:16,240
and assimilation and accumulation and filing, all that cleaning of the information doesn't

691
00:38:16,240 --> 00:38:17,360
get done.

692
00:38:17,360 --> 00:38:20,040
So now your brain is loaded with all the piles.

693
00:38:20,040 --> 00:38:24,200
You're a full hoarder up there and you didn't get to clean it and organize it at night.

694
00:38:24,200 --> 00:38:27,360
So when you wake up the next day, all you have is a big garbage pile from the day before

695
00:38:27,360 --> 00:38:29,080
and you're going to add to it.

696
00:38:29,080 --> 00:38:32,680
So your brain does become the hoarder house when you don't sleep and breathe well because

697
00:38:32,680 --> 00:38:37,960
the brain doesn't get to do its job of finishing filing and assigning and putting away all

698
00:38:37,960 --> 00:38:41,520
that stuff, which it should be doing when we're breathing and sleeping well.

699
00:38:41,520 --> 00:38:46,520
So that poor breathing pattern does disrupt how we put away all that good information.

700
00:38:46,520 --> 00:38:51,040
So filing it all away can mean good things because when you do put it all away nicely,

701
00:38:51,040 --> 00:38:53,080
it builds better memory.

702
00:38:53,080 --> 00:38:54,660
And then you can recall things nicely.

703
00:38:54,660 --> 00:38:58,600
So all of these things build into your long and short term memory.

704
00:38:58,600 --> 00:39:02,840
All of it builds into your focus and your attention because as you're not resting well

705
00:39:02,840 --> 00:39:04,160
enough, that's one component.

706
00:39:04,160 --> 00:39:07,920
But the next thing is you have this massive pile of information from the day before that

707
00:39:07,920 --> 00:39:09,440
did not get filed appropriately.

708
00:39:09,440 --> 00:39:11,120
And now you're just adding on to it.

709
00:39:11,120 --> 00:39:14,600
It's kind of like walking around all day in the hoarder's house.

710
00:39:14,600 --> 00:39:19,160
You're walking around all day in the hoarder house and it's awful and uncomfortable and

711
00:39:19,160 --> 00:39:22,520
it's a disaster and you can't get anything done because you're tripping on everything.

712
00:39:22,520 --> 00:39:23,520
All right.

713
00:39:23,520 --> 00:39:24,520
It's stressful.

714
00:39:24,520 --> 00:39:25,520
It's very stressful.

715
00:39:25,520 --> 00:39:27,040
It can be a very stressful day.

716
00:39:27,040 --> 00:39:28,040
And that's just one component.

717
00:39:28,040 --> 00:39:32,640
I mean, the other obvious component is when you're in fight or flight in your sleep, you're

718
00:39:32,640 --> 00:39:35,720
definitely not getting a good quality night's sleep.

719
00:39:35,720 --> 00:39:39,720
So you basically don't get the rest you were supposed to get because you're in this struggle

720
00:39:39,720 --> 00:39:41,840
all night long to be breathing better.

721
00:39:41,840 --> 00:39:45,640
So you almost have the sleep deprivation component going on.

722
00:39:45,640 --> 00:39:47,120
So you've got to sleep.

723
00:39:47,120 --> 00:39:49,880
The fancy words for it are really sleep fragmentation.

724
00:39:49,880 --> 00:39:55,320
So most parents understand sleep deprivation, especially when a parent has a newborn because

725
00:39:55,320 --> 00:39:57,520
the first few weeks of a newborn when it has to.

726
00:39:57,520 --> 00:40:00,120
You have to attend to it like every hour and a half.

727
00:40:00,120 --> 00:40:04,360
And so every hour and a half for the first few weeks, that is sleep deprivation at the

728
00:40:04,360 --> 00:40:05,920
worst that it could be.

729
00:40:05,920 --> 00:40:09,160
Well, that is kind of what's going on when your poor breathing is happening.

730
00:40:09,160 --> 00:40:15,520
Poor breathing means your body is being they use the word arousal, but it's like a awakening,

731
00:40:15,520 --> 00:40:17,520
but not getting up and not totally awake.

732
00:40:17,520 --> 00:40:18,520
Yeah.

733
00:40:18,520 --> 00:40:19,520
Yes.

734
00:40:19,520 --> 00:40:20,640
Not totally awake, but you're in the state of alert.

735
00:40:20,640 --> 00:40:25,200
And so the idea is when you don't, when you have fight or flight running to try to help

736
00:40:25,200 --> 00:40:29,240
you instead of rest and digest, you're basically in an agitated state all night long.

737
00:40:29,240 --> 00:40:30,240
You're not getting proper rest.

738
00:40:30,240 --> 00:40:35,440
So you're in now we, we can loosely say sleep deprived, but fancy word or technical words

739
00:40:35,440 --> 00:40:37,320
are sleep fragmented.

740
00:40:37,320 --> 00:40:39,120
So now your sleep is broken up.

741
00:40:39,120 --> 00:40:43,400
So you have this sleep deprived child who has this massive information every day piling

742
00:40:43,400 --> 00:40:46,040
on each other, living in a hoarder's life in their head.

743
00:40:46,040 --> 00:40:51,240
And of course that's where the attention, the focus, the school troubles, behavior,

744
00:40:51,240 --> 00:40:55,680
all of this stuff stems from those two things that are happening because of the poor breathing,

745
00:40:55,680 --> 00:41:00,480
triggering the change from resting to fighting or struggling to fix it.

746
00:41:00,480 --> 00:41:01,800
Got it.

747
00:41:01,800 --> 00:41:02,800
Got it.

748
00:41:02,800 --> 00:41:03,800
All right.

749
00:41:03,800 --> 00:41:07,040
So, and you also touched on something briefly.

750
00:41:07,040 --> 00:41:12,480
A grow and fit teeth is the phrase you use.

751
00:41:12,480 --> 00:41:18,880
So I'm guessing that now we're talking a little bit more about expansion, how you expand.

752
00:41:18,880 --> 00:41:19,880
Certainly.

753
00:41:19,880 --> 00:41:24,720
So yes, when we recognize these symptoms, like in a parent's world, the easiest things

754
00:41:24,720 --> 00:41:31,440
for them to see would be things like the lips are separated or mouth breathing, crooked

755
00:41:31,440 --> 00:41:34,160
teeth, crowded teeth, a bad bite.

756
00:41:34,160 --> 00:41:38,400
You know, if the teeth aren't perfectly aligned, then you know you have something going on.

757
00:41:38,400 --> 00:41:43,040
And then certainly downstream from all of that would be the symptoms of the child who's

758
00:41:43,040 --> 00:41:48,460
struggling in the categories, whether it's gastrointestinal or behavioral or academically,

759
00:41:48,460 --> 00:41:52,120
or even things like headaches or bedwetting or nightmares.

760
00:41:52,120 --> 00:41:55,920
Like these are all stemming from that fight or flight reaction overnight.

761
00:41:55,920 --> 00:41:57,520
Those are the signs and symptoms.

762
00:41:57,520 --> 00:42:02,280
What we look in the mouth for is kind of markers for growth and development measurements and

763
00:42:02,280 --> 00:42:06,040
where teeth should be positioned because we do know where they should be ideally.

764
00:42:06,040 --> 00:42:08,200
So a set of baby teeth should have certain credentials.

765
00:42:08,200 --> 00:42:10,440
Then we would know, hey, that child's growing and developing well.

766
00:42:10,440 --> 00:42:12,600
We can just kind of watch and let it go.

767
00:42:12,600 --> 00:42:16,240
And that child who is growing and developing well in the jaw is usually has little to no

768
00:42:16,240 --> 00:42:17,480
symptoms to go with it.

769
00:42:17,480 --> 00:42:18,920
So it's a good match.

770
00:42:18,920 --> 00:42:20,360
And they'll have space, right?

771
00:42:20,360 --> 00:42:21,360
Between their teeth.

772
00:42:21,360 --> 00:42:22,360
Yes.

773
00:42:22,360 --> 00:42:23,360
That's like the number one sign in the baby teeth.

774
00:42:23,360 --> 00:42:24,440
There's gaps between them.

775
00:42:24,440 --> 00:42:27,760
And interestingly, we're supposed to have gaps between all of the baby teeth.

776
00:42:27,760 --> 00:42:32,440
So that research was done by Dr. Edward Bogue a long time ago, and he basically taught

777
00:42:32,440 --> 00:42:37,800
us that if all of the baby teeth have spaces between them, that's a good start.

778
00:42:37,800 --> 00:42:41,920
But if you don't have gaps between all the baby teeth, well, the chances are the permanent

779
00:42:41,920 --> 00:42:44,820
teeth are going to come in crowded and not fit.

780
00:42:44,820 --> 00:42:48,520
And then progressively as it gets worse, but then the wisdom teeth don't fit.

781
00:42:48,520 --> 00:42:49,760
So you end up with less teeth.

782
00:42:49,760 --> 00:42:55,040
So the idea is sometimes we see a child who has baby teeth and they're so well placed

783
00:42:55,040 --> 00:42:56,040
and perfectly aligned.

784
00:42:56,040 --> 00:42:57,600
It looks like a little doll's teeth.

785
00:42:57,600 --> 00:42:58,600
They're connected.

786
00:42:58,600 --> 00:42:59,600
They're all connected.

787
00:42:59,600 --> 00:43:00,600
Yeah.

788
00:43:00,600 --> 00:43:01,600
That's bad.

789
00:43:01,600 --> 00:43:03,000
That's bad because there's no space in those teeth.

790
00:43:03,000 --> 00:43:06,760
While it looks amazing when you're three and four, the permanent teeth are really going

791
00:43:06,760 --> 00:43:07,760
to be crowded.

792
00:43:07,760 --> 00:43:10,000
That's a very crowded mouth coming.

793
00:43:10,000 --> 00:43:14,040
So the parent not seeing gaps between the teeth and any other symptoms that go along

794
00:43:14,040 --> 00:43:18,720
with this kind of poor breathing and sleeping, we would recognize by measurement and by teeth,

795
00:43:18,720 --> 00:43:21,680
oh, there's no gaps in the baby teeth or here come the permanent teeth and they don't fit

796
00:43:21,680 --> 00:43:22,680
already.

797
00:43:22,680 --> 00:43:27,320
And then our next step would be identifying that it is not about the teeth.

798
00:43:27,320 --> 00:43:28,840
So we don't try to force the teeth straight.

799
00:43:28,840 --> 00:43:31,120
We got to work on growing the foundation.

800
00:43:31,120 --> 00:43:35,480
So the pathway to really help a child is to grow the foundation because the two jaws,

801
00:43:35,480 --> 00:43:37,240
we're talking about the upper and lower jaws.

802
00:43:37,240 --> 00:43:40,400
Well, the upper jaw, it doesn't just hold the top teeth in it.

803
00:43:40,400 --> 00:43:42,200
It actually makes your nose.

804
00:43:42,200 --> 00:43:44,920
So the fancy word for the upper jaw is the maxilla.

805
00:43:44,920 --> 00:43:49,040
Well, the maxilla is the bone that holds our top teeth in, but it turns out the maxilla

806
00:43:49,040 --> 00:43:51,280
also is what builds your nose.

807
00:43:51,280 --> 00:43:56,400
So when the maxilla is really big and wide and forward, as it should be, the nose, the

808
00:43:56,400 --> 00:43:57,400
internal chambers bigger.

809
00:43:57,400 --> 00:43:58,920
So you have better breathing.

810
00:43:58,920 --> 00:43:59,920
Okay.

811
00:43:59,920 --> 00:44:04,400
So we jump in early because when we have symptoms and measurements of underdevelopment, what

812
00:44:04,400 --> 00:44:06,800
we're looking at is let's grow the jaws better.

813
00:44:06,800 --> 00:44:08,120
So we talk about expanders.

814
00:44:08,120 --> 00:44:09,360
We talk about expanders.

815
00:44:09,360 --> 00:44:10,840
We talk about guidance appliances.

816
00:44:10,840 --> 00:44:13,280
We talk about myofunctional therapy.

817
00:44:13,280 --> 00:44:14,480
We talk about nasal hygiene.

818
00:44:14,480 --> 00:44:17,520
We talk about things that can help a child to grow and develop properly.

819
00:44:17,520 --> 00:44:19,880
Let's get caught up to where we should be and keep going correctly.

820
00:44:19,880 --> 00:44:25,680
Because if you address the foundation early, when the child still can do that easily, all

821
00:44:25,680 --> 00:44:28,680
of a sudden when the foundation starts growing better, the teeth start going where they belong

822
00:44:28,680 --> 00:44:30,400
so they can correct themselves.

823
00:44:30,400 --> 00:44:34,240
So you get some auto-correction in the teeth just getting the foundation going well.

824
00:44:34,240 --> 00:44:38,320
But the bigger difference is when the foundation starts getting wider and forward, all of a

825
00:44:38,320 --> 00:44:41,960
sudden it looks nice because the teeth look good, but the symptoms start to fade away,

826
00:44:41,960 --> 00:44:45,280
meaning, hey, all of a sudden the child sleeps with their mouth shut and they breathe through

827
00:44:45,280 --> 00:44:46,680
their nose.

828
00:44:46,680 --> 00:44:48,200
All of a sudden they do sleep through the whole night.

829
00:44:48,200 --> 00:44:50,120
They don't even wake up in the middle of the night.

830
00:44:50,120 --> 00:44:51,200
They stop wetting the bed.

831
00:44:51,200 --> 00:44:52,840
They stop having nightmares.

832
00:44:52,840 --> 00:44:54,320
They wake up refreshed in the morning.

833
00:44:54,320 --> 00:44:56,280
We don't have a morning struggle going on.

834
00:44:56,280 --> 00:44:58,200
And all of a sudden school improves.

835
00:44:58,200 --> 00:45:02,800
So we see a lot of academic performance increases when the children all of a sudden have better

836
00:45:02,800 --> 00:45:04,240
breathing and sleeping at night.

837
00:45:04,240 --> 00:45:09,560
So the downstream effect of growing the foundation first is tremendous because it not only helps

838
00:45:09,560 --> 00:45:13,480
the teeth go where they belong, which is like 10th on the list of things we need.

839
00:45:13,480 --> 00:45:17,560
It really helps the child to breathe well, sleep well, and then function better.

840
00:45:17,560 --> 00:45:22,360
So we're excited about the things that changes we see when we use expansive techniques to

841
00:45:22,360 --> 00:45:24,280
grow the foundation first.

842
00:45:24,280 --> 00:45:26,720
We're going to leave the teeth alone till later on.

843
00:45:26,720 --> 00:45:29,040
We really don't address the teeth till we're 12 or 13.

844
00:45:29,040 --> 00:45:32,200
That's when alignment for the teeth is appropriate.

845
00:45:32,200 --> 00:45:34,800
But that goes a whole lot better if you did the foundational growth first.

846
00:45:34,800 --> 00:45:39,680
It turns out the early years, I know we think about the jaw bones as bones and we hear the

847
00:45:39,680 --> 00:45:41,880
word bones and we think it's hard.

848
00:45:41,880 --> 00:45:44,240
But in a child, it's like a wet sponge.

849
00:45:44,240 --> 00:45:45,240
It's kind of moldable.

850
00:45:45,240 --> 00:45:46,240
It's still malleable.

851
00:45:46,240 --> 00:45:47,240
Yeah.

852
00:45:47,240 --> 00:45:52,400
The jaw bones in a child can be guided and kind of nudged and teased and coerced and pushed

853
00:45:52,400 --> 00:45:54,480
and they can be redirected.

854
00:45:54,480 --> 00:45:58,760
And so a lot of that happens when you redirect the musculature because it's the muscles that

855
00:45:58,760 --> 00:45:59,960
should be doing it in the first place.

856
00:45:59,960 --> 00:46:02,360
So why not recruit them to work with us?

857
00:46:02,360 --> 00:46:06,000
So we have a combination of, well, there's appliances we could use, but there's also

858
00:46:06,000 --> 00:46:10,080
techniques where we can strengthen and redirect the muscles because if they behave properly,

859
00:46:10,080 --> 00:46:11,920
it produces the bone growth that should have done.

860
00:46:11,920 --> 00:46:14,000
You can catch up when you're younger.

861
00:46:14,000 --> 00:46:17,960
So it's a huge advantage to work with the muscles and that's why the oral facial myofunctural

862
00:46:17,960 --> 00:46:22,680
therapist is a key part of treatment and should be part of every child's growth and development

863
00:46:22,680 --> 00:46:27,560
because then if you get at the musculature, you're really going after the cause.

864
00:46:27,560 --> 00:46:28,560
Right.

865
00:46:28,560 --> 00:46:29,560
Right.

866
00:46:29,560 --> 00:46:32,880
So it makes sense that they're younger and they're more malleable.

867
00:46:32,880 --> 00:46:34,520
They're going to respond.

868
00:46:34,520 --> 00:46:38,760
Can you use these kind of techniques on adults?

869
00:46:38,760 --> 00:46:41,560
There are different appliances and techniques for adults.

870
00:46:41,560 --> 00:46:45,620
So when we get to adults, we are talking about mature bone.

871
00:46:45,620 --> 00:46:49,440
So when you have mature bone, it can be guided.

872
00:46:49,440 --> 00:46:51,320
It's just going to be different appliances.

873
00:46:51,320 --> 00:46:53,000
It'll take a lot more time.

874
00:46:53,000 --> 00:46:56,280
And of course, we're talking in the non-surgical category.

875
00:46:56,280 --> 00:47:00,040
In an adult, if we were thinking about doing something rapidly, we'd be talking about surgical

876
00:47:00,040 --> 00:47:03,480
intervention because then you get in there, you do some jaw surgeries, you can do big

877
00:47:03,480 --> 00:47:05,240
changes in short times.

878
00:47:05,240 --> 00:47:08,960
But if we're thinking about in the growth and development category, well, for an adult

879
00:47:08,960 --> 00:47:15,280
with mature bone, it's going to be different appliances over extended periods of time,

880
00:47:15,280 --> 00:47:18,480
still involving the myofunctural therapy because you still want to have the musculature

881
00:47:18,480 --> 00:47:21,720
behaving itself properly to help you along the way.

882
00:47:21,720 --> 00:47:27,280
It's not as rewarding in adults because it does take a very long time and a lot of adults

883
00:47:27,280 --> 00:47:32,520
are so far into their sleep apnea that a lot of their health issues are significant.

884
00:47:32,520 --> 00:47:37,400
And so it's much more rewarding in the children because you can have the effect in a short

885
00:47:37,400 --> 00:47:40,840
time and you can deliver from unhealthy to healthy.

886
00:47:40,840 --> 00:47:44,440
In some times, it's just days or weeks in children.

887
00:47:44,440 --> 00:47:47,000
So I work on all this other.

888
00:47:47,000 --> 00:47:48,000
Yes.

889
00:47:48,000 --> 00:47:50,440
Why am I getting worse and worse and worse?

890
00:47:50,440 --> 00:47:55,920
So the whole idea behind getting involved in a child early is that because the bone

891
00:47:55,920 --> 00:48:01,200
is immature and kind of softer, you can make the effect bigger in a shorter amount of time

892
00:48:01,200 --> 00:48:07,760
and get good jaw growth, better breathing, better sleeping and basically heal that child.

893
00:48:07,760 --> 00:48:10,760
Whereas in an adult, now we've got mature bone.

894
00:48:10,760 --> 00:48:11,760
It's hard.

895
00:48:11,760 --> 00:48:13,400
It thinks it's done growing.

896
00:48:13,400 --> 00:48:18,200
And then there are very particular and technique sensitive pathways to try to help that bone

897
00:48:18,200 --> 00:48:23,320
grow a little more and while it is possible by some research, it's much more difficult

898
00:48:23,320 --> 00:48:28,360
time consuming and almost a struggle because some of the appliances you have to wear, they're

899
00:48:28,360 --> 00:48:32,200
difficult to speak with, then you're trying to wear them during the day and at night.

900
00:48:32,200 --> 00:48:36,720
It can be inconvenient and not painful in any way when we're talking about non-surgical

901
00:48:36,720 --> 00:48:40,280
therapy for the adults, but not as rewarding and much more of a struggle.

902
00:48:40,280 --> 00:48:45,640
It's the kind of thing that you want to fix early because later, later is much more trouble.

903
00:48:45,640 --> 00:48:47,640
Later, later is tough.

904
00:48:47,640 --> 00:48:48,640
Got it.

905
00:48:48,640 --> 00:48:51,280
Got it.

906
00:48:51,280 --> 00:48:54,000
We referenced earlier tongue tie.

907
00:48:54,000 --> 00:48:57,880
So I'd like to go ahead and chat about that just for a few minutes if we could.

908
00:48:57,880 --> 00:48:59,760
First of all, exactly.

909
00:48:59,760 --> 00:49:04,880
What is a tongue tie or elliptide or a cheek tie, which I learned about a month ago, what

910
00:49:04,880 --> 00:49:06,800
that actually was.

911
00:49:06,800 --> 00:49:14,480
And how do those, because when you think about a tongue relaxes, it falls back.

912
00:49:14,480 --> 00:49:18,080
I get it, it blocks the airway, but logically you think a tongue tie, it's going to hold

913
00:49:18,080 --> 00:49:19,080
it in place.

914
00:49:19,080 --> 00:49:20,080
It's going to keep it from doing that.

915
00:49:20,080 --> 00:49:24,080
So as a layperson, that's what you think.

916
00:49:24,080 --> 00:49:26,680
So how do these actually impact the airway?

917
00:49:26,680 --> 00:49:27,680
Yes.

918
00:49:27,680 --> 00:49:32,160
So the tongue, it's kind of shaped like an L almost.

919
00:49:32,160 --> 00:49:35,680
So when we think about someone who opens their mouth and the piece that we see is like the

920
00:49:35,680 --> 00:49:39,080
top piece, but then the tongue kind of rolls back and goes down a little.

921
00:49:39,080 --> 00:49:41,360
So it has this curve shape to it.

922
00:49:41,360 --> 00:49:44,360
Well, the tie we're talking about is under the tongue.

923
00:49:44,360 --> 00:49:48,320
So if you lift your tongue up, it would be like a little, and it's a frenem.

924
00:49:48,320 --> 00:49:50,160
The fancy word is frenem.

925
00:49:50,160 --> 00:49:54,160
In my office, when we're talking to parents or kids, we call it a leash and leash like

926
00:49:54,160 --> 00:49:55,800
you walk your dog on a leash.

927
00:49:55,800 --> 00:49:58,240
So you know, you have the movement.

928
00:49:58,240 --> 00:49:59,240
Yeah.

929
00:49:59,240 --> 00:50:00,240
There are different kinds of leashes.

930
00:50:00,240 --> 00:50:02,040
Now there are some, some dogs need a short leash.

931
00:50:02,040 --> 00:50:03,840
So they stay right next to your side.

932
00:50:03,840 --> 00:50:07,160
But then there are other dogs that can have a 30 foot leash because they behave themselves

933
00:50:07,160 --> 00:50:08,640
and they can be further away from the owner.

934
00:50:08,640 --> 00:50:10,400
So you have these different length leashes.

935
00:50:10,400 --> 00:50:11,400
Okay.

936
00:50:11,400 --> 00:50:13,320
Well, we have different lengths of frenems.

937
00:50:13,320 --> 00:50:17,040
So if you have a shorter frenem, it restricts the movement of the tongue.

938
00:50:17,040 --> 00:50:19,360
But when the frenem is short, it's under your tongue.

939
00:50:19,360 --> 00:50:20,360
It's holding it down.

940
00:50:20,360 --> 00:50:25,760
But holding, holding the top part down means that the back part gets pushed back.

941
00:50:25,760 --> 00:50:28,600
So the way the tongue works, because it's this, it's kind of a massive tissue.

942
00:50:28,600 --> 00:50:32,520
If you, if you press down on the top part, the back goes backwards.

943
00:50:32,520 --> 00:50:35,120
So you have this L shape of the tongue kind of thing.

944
00:50:35,120 --> 00:50:38,840
And if the top is lower than the back part is back farther, that interferes with the

945
00:50:38,840 --> 00:50:39,840
airflow.

946
00:50:39,840 --> 00:50:43,400
So a tighter frenem doesn't help with airflow.

947
00:50:43,400 --> 00:50:48,360
It makes it worse because holding the top or front part down keeps the back part back.

948
00:50:48,360 --> 00:50:49,360
Yeah.

949
00:50:49,360 --> 00:50:53,120
And the bigger trouble with the tight frenem is that the tongue can't elevate to the top

950
00:50:53,120 --> 00:50:55,360
so it can't seal off and make a vacuum swallow.

951
00:50:55,360 --> 00:50:57,480
So right away, the swallow is poor.

952
00:50:57,480 --> 00:51:00,920
With the tighter frenem, the tongue can't really press into the maxilla or upper jaw.

953
00:51:00,920 --> 00:51:02,800
It can't help grow the upper jaw.

954
00:51:02,800 --> 00:51:06,640
So a lot of times with a tight frenem, you see cross bites, meaning the top teeth are

955
00:51:06,640 --> 00:51:08,360
actually narrower than the bottom teeth.

956
00:51:08,360 --> 00:51:10,320
And that's the opposite of how we work.

957
00:51:10,320 --> 00:51:13,120
You know, our teeth are supposed to come together kind of like a shoe box works where the lid

958
00:51:13,120 --> 00:51:14,520
is over the bottom.

959
00:51:14,520 --> 00:51:17,240
So our top teeth should be the lid and the bottom teeth would be the bottom of the shoe

960
00:51:17,240 --> 00:51:19,040
box and the top teeth surround the bottom teeth.

961
00:51:19,040 --> 00:51:21,000
So we kind of fit together like that.

962
00:51:21,000 --> 00:51:25,560
But with a tight frenem, the top could have less growth and development than the bottom.

963
00:51:25,560 --> 00:51:27,240
And it could be inside of the bottom teeth.

964
00:51:27,240 --> 00:51:29,640
That's like a reverse or cross bite.

965
00:51:29,640 --> 00:51:32,080
That's you know, one of the results of having that tight frenem.

966
00:51:32,080 --> 00:51:35,280
So you know, the tight frenem interferes with certainly the growth and development.

967
00:51:35,280 --> 00:51:37,600
It interferes with the breathing, the swallowing.

968
00:51:37,600 --> 00:51:41,120
It basically a tight frenem helps a human being malfunction.

969
00:51:41,120 --> 00:51:46,080
And that malfunction could be seen as early as birth because the tighter the frenem is,

970
00:51:46,080 --> 00:51:49,640
the more restricted the tongue is, the more difficult the breastfeeding would be.

971
00:51:49,640 --> 00:51:52,040
So you could gauge it early by the breastfeeding.

972
00:51:52,040 --> 00:51:57,720
In other words, was there any difficulty in breastfeeding and or pain associated with

973
00:51:57,720 --> 00:51:58,720
it?

974
00:51:58,720 --> 00:52:03,280
Because the more painful it is and the more unsuccessful it is, usually there's a tighter

975
00:52:03,280 --> 00:52:04,280
frenem involved.

976
00:52:04,280 --> 00:52:07,720
And so, you know, frenem is because they come in different length, you could have a mild,

977
00:52:07,720 --> 00:52:09,840
moderate or severe problem with the frenem.

978
00:52:09,840 --> 00:52:12,600
It doesn't have to be, it's not like a light switch where it's on or off.

979
00:52:12,600 --> 00:52:14,600
It's kind of like a light switch with a dimmer.

980
00:52:14,600 --> 00:52:16,520
You have a whole range of what's going on.

981
00:52:16,520 --> 00:52:20,720
So since you have these different frenems, you could have someone who, okay, the breastfeeding

982
00:52:20,720 --> 00:52:24,960
is successful, but it's a bit of a struggle and painful.

983
00:52:24,960 --> 00:52:28,760
And then you could have the other end of it where, oh my goodness, the breastfeeding is

984
00:52:28,760 --> 00:52:31,520
perfectly successful and it's not painful.

985
00:52:31,520 --> 00:52:34,800
And then there's the one where, oh my God, it's totally unsuccessful, the baby can't

986
00:52:34,800 --> 00:52:36,320
even latch at all.

987
00:52:36,320 --> 00:52:39,760
And it's very uncomfortable, very painful and nothing's happening.

988
00:52:39,760 --> 00:52:42,520
So there's this range of what could go on.

989
00:52:42,520 --> 00:52:45,760
The lingual frenem, the lingual meaning tongue.

990
00:52:45,760 --> 00:52:48,080
We talk about that one, the most one, because it's the most common.

991
00:52:48,080 --> 00:52:50,960
So the lingual frenem or the one on the tongue is the most common.

992
00:52:50,960 --> 00:52:55,080
And you mentioned the other ones, the lip, the lip tie, like the upper lip has a little

993
00:52:55,080 --> 00:52:57,200
tie connecting it to the bone there.

994
00:52:57,200 --> 00:52:59,360
And the cheek ties are on the sides.

995
00:52:59,360 --> 00:53:01,080
The cheek ties are on the sides.

996
00:53:01,080 --> 00:53:06,000
Well the significance of those is that if the lip tie is too tight, it holds the upper

997
00:53:06,000 --> 00:53:09,520
lip tightly in, holding the upper lip tightly in.

998
00:53:09,520 --> 00:53:11,600
Now you have a barrier against forward growth.

999
00:53:11,600 --> 00:53:16,400
Because the tighter the upper lip, yeah, the tighter the upper lip is held back, the harder

1000
00:53:16,400 --> 00:53:17,480
it is to grow forward.

1001
00:53:17,480 --> 00:53:20,360
So you're growing forward if there's freedom to grow forward.

1002
00:53:20,360 --> 00:53:25,320
But if there's something working against you, it could delay or basically reduce the amount

1003
00:53:25,320 --> 00:53:26,840
of forward growth you get.

1004
00:53:26,840 --> 00:53:31,320
So we do check second for the upper lip to see if it's being held back by a frenem that's

1005
00:53:31,320 --> 00:53:33,320
too tight, that's the lip frenem.

1006
00:53:33,320 --> 00:53:36,640
The cheek ones, there are four on the side, there's two on top, two on the bottom on the

1007
00:53:36,640 --> 00:53:37,880
sides.

1008
00:53:37,880 --> 00:53:41,640
Those frenems, when they're too tight, they hold the cheeks in tight.

1009
00:53:41,640 --> 00:53:46,080
But when you hold the cheeks in tight, basically that's resistance to growing wider.

1010
00:53:46,080 --> 00:53:50,480
So if we want to grow wide and forward, we don't want any resistance on the outside working

1011
00:53:50,480 --> 00:53:51,480
against us.

1012
00:53:51,480 --> 00:53:55,080
So we look for those ties to see, hey, are those interfering with what should be good

1013
00:53:55,080 --> 00:53:56,720
wide and forward growth?

1014
00:53:56,720 --> 00:54:00,320
Some kids have tight frenem on the cheeks and or lip.

1015
00:54:00,320 --> 00:54:04,920
Releasing them means that it takes the lip and releases that pressure and the cheeks releases

1016
00:54:04,920 --> 00:54:09,640
so that you can be growing wider and forward without an opponent, let's say working against

1017
00:54:09,640 --> 00:54:10,640
you.

1018
00:54:10,640 --> 00:54:11,960
So the most common is the tongue one.

1019
00:54:11,960 --> 00:54:12,960
The tongue is most common.

1020
00:54:12,960 --> 00:54:15,000
Then second is the lip and third are the cheeks.

1021
00:54:15,000 --> 00:54:16,000
Got it.

1022
00:54:16,000 --> 00:54:17,480
So in that order we check.

1023
00:54:17,480 --> 00:54:19,200
Some kids have one of them that's trouble.

1024
00:54:19,200 --> 00:54:20,640
Some kids have all of them that's trouble.

1025
00:54:20,640 --> 00:54:24,680
So we think about, you know, we've got this early soft diet working against us because

1026
00:54:24,680 --> 00:54:27,120
now we have this weak and dysfunctional muscles.

1027
00:54:27,120 --> 00:54:28,120
That's not growing as well.

1028
00:54:28,120 --> 00:54:32,280
But then the second part of the fire that's going on is that we might even have tight

1029
00:54:32,280 --> 00:54:34,560
frenem working against us.

1030
00:54:34,560 --> 00:54:35,680
And it could be more than one.

1031
00:54:35,680 --> 00:54:39,120
You combine the two and it can really be for some bad growth and development and a childhood

1032
00:54:39,120 --> 00:54:40,120
struggling.

1033
00:54:40,120 --> 00:54:41,120
Wow.

1034
00:54:41,120 --> 00:54:42,120
All right.

1035
00:54:42,120 --> 00:54:44,120
Thank you for that.

1036
00:54:44,120 --> 00:54:46,680
By the way, that was very, that was helpful.

1037
00:54:46,680 --> 00:54:50,000
I like, I just, I couldn't, you know, for the life of maintenance and you're trying to

1038
00:54:50,000 --> 00:54:53,560
figure out cheek ties, how that could impact it, but they can't see you visually.

1039
00:54:53,560 --> 00:54:55,800
I'm watching you explain how it pushes it in.

1040
00:54:55,800 --> 00:54:58,000
And soon as you put your hands up, it's this light bulb.

1041
00:54:58,000 --> 00:55:00,400
Oh, that's, that's what does it.

1042
00:55:00,400 --> 00:55:01,400
Right.

1043
00:55:01,400 --> 00:55:02,400
Right.

1044
00:55:02,400 --> 00:55:10,560
When we're talking parents, especially parents of newborns or first time parents, especially

1045
00:55:10,560 --> 00:55:14,120
I didn't know this as a first time parent myself.

1046
00:55:14,120 --> 00:55:16,640
When should you start bringing them into a dentist?

1047
00:55:16,640 --> 00:55:19,640
And then does everybody need an airway dentist?

1048
00:55:19,640 --> 00:55:24,040
Is just at this point a good rule of thumb and something as parents we should be looking

1049
00:55:24,040 --> 00:55:25,040
for.

1050
00:55:25,040 --> 00:55:31,920
It probably is something we should be looking for because that early soft diet is, you know,

1051
00:55:31,920 --> 00:55:34,000
the word is ubiquitous, but everywhere.

1052
00:55:34,000 --> 00:55:35,000
Yeah.

1053
00:55:35,000 --> 00:55:36,000
It's everywhere.

1054
00:55:36,000 --> 00:55:40,480
We basically transition from breastfeeding to soft foods and soft foods between zero

1055
00:55:40,480 --> 00:55:45,440
and one years old or one to two, it really sets the tone for the muscles of the jaws

1056
00:55:45,440 --> 00:55:46,440
being weaker.

1057
00:55:46,440 --> 00:55:51,560
So we're going to have underdeveloped kids and, you know, almost all of the kids we see

1058
00:55:51,560 --> 00:55:53,960
will not grow fully to 32 teeth.

1059
00:55:53,960 --> 00:55:58,040
You know, that's kind of how you know that the muscles and the are weaker and the jaws

1060
00:55:58,040 --> 00:56:01,960
are underdeveloped is that almost no child is going to grow on their own to 32 teeth

1061
00:56:01,960 --> 00:56:02,960
with full grown jaws.

1062
00:56:02,960 --> 00:56:07,560
So now that we know we've got this, we've got this societal pattern in place, but now

1063
00:56:07,560 --> 00:56:10,800
we know, you know, at an early age, there's going to be this issue.

1064
00:56:10,800 --> 00:56:16,240
Well, if you have a really good pediatric dentist that is in the airway space or in

1065
00:56:16,240 --> 00:56:21,140
this philosophy, they would know basically at birth that you could attend to the frenem

1066
00:56:21,140 --> 00:56:22,520
if there were breastfeeding issues.

1067
00:56:22,520 --> 00:56:27,840
So, you know, number one would be if a parent would like to breastfeed, but is having difficulty,

1068
00:56:27,840 --> 00:56:33,080
then you're hopeful that either a nurse or lactation consultant would guide you to a pediatric

1069
00:56:33,080 --> 00:56:35,560
dentist, someone who could release the frenem.

1070
00:56:35,560 --> 00:56:39,240
So you could be successfully breastfeeding if you choose.

1071
00:56:39,240 --> 00:56:43,440
And if it's the tongue or the lip, that would be the earliest way to get involved if you're

1072
00:56:43,440 --> 00:56:44,680
having that difficulty.

1073
00:56:44,680 --> 00:56:49,120
Other than that, well, now you have breastfeeding beginning and then after that the soft diet.

1074
00:56:49,120 --> 00:56:53,640
So it would be, you know, in my world, I'm seeing the children at age three on up, but

1075
00:56:53,640 --> 00:56:58,520
in Dr. Kevin Boyd, who's a pediatric dentist in Chicago area, he sees them, you know, it

1076
00:56:58,520 --> 00:57:02,760
could be after birth because of the frenem revisions needed and as little as six months

1077
00:57:02,760 --> 00:57:07,720
and 12 months to evaluate, do we need to help that child with their frenem and or sleeping

1078
00:57:07,720 --> 00:57:08,720
and breathing?

1079
00:57:08,720 --> 00:57:12,480
Then of course, by 18 months to two years, he can treat them already because in the pediatric

1080
00:57:12,480 --> 00:57:14,160
model, you can start treating.

1081
00:57:14,160 --> 00:57:17,200
So yep, there are doctors who treat them very early.

1082
00:57:17,200 --> 00:57:18,800
Dr. Kevin Boyd is one of them.

1083
00:57:18,800 --> 00:57:20,680
Dr. Lawrence Kotlow is another.

1084
00:57:20,680 --> 00:57:22,280
Those are two early mentors of mine.

1085
00:57:22,280 --> 00:57:23,680
They're both pediatric dentists.

1086
00:57:23,680 --> 00:57:27,320
Dr. Kotlow is in Albany, New York.

1087
00:57:27,320 --> 00:57:29,160
There are many others like this.

1088
00:57:29,160 --> 00:57:33,920
So the idea would be short today because of that early soft diet, a parent should be thinking

1089
00:57:33,920 --> 00:57:40,000
that as they recognize symptoms of poor breathing or mouth breathing, they probably should think

1090
00:57:40,000 --> 00:57:42,480
about finding an airway dentist.

1091
00:57:42,480 --> 00:57:47,120
Someone who's more focused on the growth and development of the jaws than the actual teeth.

1092
00:57:47,120 --> 00:57:50,760
Then you kind of know you're in the right space if they're talking jaw growth and development,

1093
00:57:50,760 --> 00:57:52,360
sleeping and breathing.

1094
00:57:52,360 --> 00:57:53,640
They want to help you in that direction.

1095
00:57:53,640 --> 00:57:54,640
You're in the right place.

1096
00:57:54,640 --> 00:57:58,840
If they start talking more about teeth being moved around, you might have to look a little

1097
00:57:58,840 --> 00:57:59,840
further.

1098
00:57:59,840 --> 00:58:01,560
Got it.

1099
00:58:01,560 --> 00:58:06,280
And how do you find an airway dentist?

1100
00:58:06,280 --> 00:58:10,360
So there are different ways to find, you know, obviously there's, you know, Google and you

1101
00:58:10,360 --> 00:58:14,400
can start searching and you start asking, you know, I do teach a lot of this.

1102
00:58:14,400 --> 00:58:20,680
And so as part of the educational process, I have a partner, Lauren Gates, and we founded

1103
00:58:20,680 --> 00:58:24,040
a little company called Airway Health Solutions.

1104
00:58:24,040 --> 00:58:27,320
Basically with that company, what we do is we do teach doctors.

1105
00:58:27,320 --> 00:58:31,360
We teach dentists who want to learn how to treat children through teams, through adults

1106
00:58:31,360 --> 00:58:33,800
in this, you know, philosophy.

1107
00:58:33,800 --> 00:58:35,760
And then we mentor them as well.

1108
00:58:35,760 --> 00:58:39,880
And with the last three to four years, we've trained over 250 offices.

1109
00:58:39,880 --> 00:58:41,800
And so we have a doctor locator.

1110
00:58:41,800 --> 00:58:47,200
And if you went to airwayhealthsolutions.com, you would find a doctor locator map and it

1111
00:58:47,200 --> 00:58:50,040
has little dots on that map all over the country.

1112
00:58:50,040 --> 00:58:53,960
And if you pull up one of those offices from that website, you would know they were trained

1113
00:58:53,960 --> 00:58:54,960
by me.

1114
00:58:54,960 --> 00:58:56,800
And I have now 19 years experience.

1115
00:58:56,800 --> 00:59:01,080
I've been treating children for the last 19 years in their growth and development.

1116
00:59:01,080 --> 00:59:07,200
And it turns out we've had such a nice success at helping those children heal and lose their

1117
00:59:07,200 --> 00:59:11,800
symptoms as well as, you know, grow and develop beautifully into all of their teeth that we

1118
00:59:11,800 --> 00:59:12,800
started to teach it.

1119
00:59:12,800 --> 00:59:18,440
And it's one level that I could do this in my own community where you help an X number

1120
00:59:18,440 --> 00:59:19,760
of kids per year.

1121
00:59:19,760 --> 00:59:24,920
If I then trained another office to do it somewhere else, now things can become exponential.

1122
00:59:24,920 --> 00:59:25,920
Yeah.

1123
00:59:25,920 --> 00:59:28,280
So it made sense that I needed to teach it more.

1124
00:59:28,280 --> 00:59:30,680
So that's one pathway to learn.

1125
00:59:30,680 --> 00:59:37,400
You could go directly to airwayhealthsolutions.com and look at the doctor locator.

1126
00:59:37,400 --> 00:59:40,960
And then you would be rest assured you'd have a doctor in there that would be able to help

1127
00:59:40,960 --> 00:59:41,960
you out.

1128
00:59:41,960 --> 00:59:43,120
Perfect.

1129
00:59:43,120 --> 00:59:48,400
And I will make sure there's a link to that in the show notes and on our website in our

1130
00:59:48,400 --> 00:59:51,720
section for helping parents where to start.

1131
00:59:51,720 --> 00:59:53,320
Just full transparency.

1132
00:59:53,320 --> 00:59:56,160
We already have that link in there.

1133
00:59:56,160 --> 00:59:58,960
That's one of the tools we use to help parents.

1134
00:59:58,960 --> 00:59:59,960
Terrific.

1135
00:59:59,960 --> 01:00:06,120
So at the end of every episode, I always like to just turn the floor over to the guest so

1136
01:00:06,120 --> 01:00:10,480
that you can have the final thought if there's anything that we didn't cover or if there's

1137
01:00:10,480 --> 01:00:13,400
just a message you want to leave with parents.

1138
01:00:13,400 --> 01:00:15,040
Oh, sure.

1139
01:00:15,040 --> 01:00:16,520
Thank you very much for having me.

1140
01:00:16,520 --> 01:00:17,520
So wonderful session.

1141
01:00:17,520 --> 01:00:20,760
And I hope it helps a lot of people get some earlier attention.

1142
01:00:20,760 --> 01:00:25,320
So yeah, I think the most important thing I'd like parents to take away from it is that

1143
01:00:25,320 --> 01:00:28,840
it is very helpful to treat the child earlier.

1144
01:00:28,840 --> 01:00:33,800
And so part of what a parent might hear is that, oh, don't worry now.

1145
01:00:33,800 --> 01:00:34,800
It's normal.

1146
01:00:34,800 --> 01:00:35,800
That's fine.

1147
01:00:35,800 --> 01:00:36,800
They'll outgrow it.

1148
01:00:36,800 --> 01:00:41,040
There's a lot of things that are thrown out there because so many kids have these symptoms.

1149
01:00:41,040 --> 01:00:43,640
They start calling it normal or they'll outgrow it.

1150
01:00:43,640 --> 01:00:46,560
But usually when you're hearing things like that, you're hearing it from people who don't

1151
01:00:46,560 --> 01:00:48,640
know how to treat the cause.

1152
01:00:48,640 --> 01:00:51,320
They only know how to work on the symptoms or maybe not even that.

1153
01:00:51,320 --> 01:00:53,520
And so they guide you towards doing nothing.

1154
01:00:53,520 --> 01:00:54,560
That doesn't help the child.

1155
01:00:54,560 --> 01:01:01,280
So I would encourage parents to dig deeper and look more when you realize or think about,

1156
01:01:01,280 --> 01:01:06,000
you know, there's something with my child has these symptoms and it is not normal and

1157
01:01:06,000 --> 01:01:07,280
it's not okay.

1158
01:01:07,280 --> 01:01:09,000
And it can be fixed early.

1159
01:01:09,000 --> 01:01:10,520
You just need to go in the right direction.

1160
01:01:10,520 --> 01:01:16,840
So generally speaking, parents who recognize sleeping, breathing, or even just crowded

1161
01:01:16,840 --> 01:01:21,760
teeth and bad bites kind of thing, those symptoms that are related to the behavior, the school

1162
01:01:21,760 --> 01:01:22,760
performance.

1163
01:01:22,760 --> 01:01:26,920
So these little things we talked about over the hour, you want to start consulting with

1164
01:01:26,920 --> 01:01:32,160
an airway trained dentist so that you could have help early and early is better.

1165
01:01:32,160 --> 01:01:36,800
It is much harder to fix an adult in this space and why let the child kind of struggle

1166
01:01:36,800 --> 01:01:43,240
all the way through only to have difficult options to fix later when actually if you're

1167
01:01:43,240 --> 01:01:45,200
working on the kids early, it's easy.

1168
01:01:45,200 --> 01:01:48,320
So to help a child grow and develop early is appropriate.

1169
01:01:48,320 --> 01:01:51,440
I wouldn't accept it's normal or they'll outgrow it anymore.

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01:01:51,440 --> 01:01:55,280
I would just pursue a different line for someone who's focused on the foundation.

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01:01:55,280 --> 01:02:00,520
You can help your child with a long list of symptoms that we touched on many of them today

1172
01:02:00,520 --> 01:02:02,080
and it's that's not even exhausting.

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01:02:02,080 --> 01:02:05,880
You know, in one hour we touch on the tip of the iceberg, but anything that your child

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01:02:05,880 --> 01:02:10,960
might be struggling with if there is a sleeping or breathing issue related to it as we described,

1175
01:02:10,960 --> 01:02:14,640
you have opportunities to help your child and they can be cured because you're dealing

1176
01:02:14,640 --> 01:02:16,560
with treating the cause early.

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01:02:16,560 --> 01:02:17,560
Perfect.

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01:02:17,560 --> 01:02:18,560
All right.

1179
01:02:18,560 --> 01:02:19,560
Thank you so much.

1180
01:02:19,560 --> 01:02:20,560
I really appreciate it.

1181
01:02:20,560 --> 01:02:22,080
Oh, it's my pleasure.

1182
01:02:22,080 --> 01:02:23,080
Thank you.

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01:02:23,080 --> 01:02:29,520
Thanks again to today's guest, Dr. Ben Moralia for sharing his medical insight into each

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01:02:29,520 --> 01:02:33,160
of you for listening to today's episode.

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01:02:33,160 --> 01:02:35,760
If you're new to our podcast, please don't forget to subscribe.

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01:02:35,760 --> 01:02:40,240
And if you enjoyed today's episode, leave us a review or comment telling us about what

1187
01:02:40,240 --> 01:02:42,400
you enjoyed most.

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01:02:42,400 --> 01:02:46,200
You can stay connected with the Children's Airway First Foundation by following us on

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01:02:46,200 --> 01:02:49,760
Instagram, Facebook, Twitter and LinkedIn.

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01:02:49,760 --> 01:02:55,640
You can also join us via our Facebook parent support group, The Airway Huddle, at facebook.com

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01:02:55,640 --> 01:02:58,360
backslash groups backslash airwayhuddle.

1192
01:02:58,360 --> 01:03:03,760
If you'd like to be a guest or have an idea for an upcoming episode, shoot us a note via

1193
01:03:03,760 --> 01:03:11,480
the contacts page on our website or send us an email directly at info at childrensairwayfirst.org.

1194
01:03:11,480 --> 01:03:16,560
Remember this podcast and the opinions expressed here are not a medical diagnosis.

1195
01:03:16,560 --> 01:03:20,800
If you suspect your child might have an airway issue or sleep-related disorder, contact your

1196
01:03:20,800 --> 01:03:24,680
pediatric airway dentist or pediatrician.

1197
01:03:24,680 --> 01:03:28,320
And finally, thanks to all the parents and medical professionals out there that are working

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01:03:28,320 --> 01:03:32,480
to help make the lives of kids around the globe just a little bit better.

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01:03:32,480 --> 01:04:02,320
Take care, stay safe and happy breathing everyone.