Hi everybody, and welcome back to Airway First, a podcast from the Children's Airway First
Foundation.
I'm your host, Rebecca Downing.
In today's episode, I'm joined by Dr. Ben Moralia.
Dr. Moralia is a graduate of SUNY at Buffalo School of Dental Medicine.
He's a member of the American Dental Association, the New York State Academy of General Dentistry,
the American Academy of Dental Sleep Medicine, and the Ninth District Dental Society.
He has 26 years general practice experience in Mount Kisco, New York, including 17 years
interceptive orthodontic experience, where his focus has been on early childhood growth
and development.
Dr. Moralia lectures nationally on sleep disorder breathing, clariliner therapy, and cranial
facial development.
He is on the board of directors of the American Academy of Physiological Medicine and Dentistry,
and the President's Council of Northern Westchester Hospital, out Mount Kisco, New York.
Dr. Moralia has been recognized multiple times as a leader in continuing education
by Dentistry Today Magazine.
You can find out more about Dr. Moralia at bgmtental.com and airwayhealthsolutions.com.
And now, let's jump into my interview with Dr. Ben Moralia.
Thank you so much for joining us, Dr. Moralia.
I really appreciate it.
It's my pleasure to be here.
Thank you for having me.
Absolutely.
So let's just dive right in.
Airway Dentistry, for a lot of our listeners, parents especially, this is a newer term.
We're kind of hearing it, but still don't really understand what that means.
So what all does that encompass as far as what's the difference between an airway dentist
and a regular dentist, and then what your practice might look like compared to traditional
dentistry?
Right, right.
Yes, excellent.
And so, yeah, airway dentistry and those kind of terms are kind of newer.
But the idea is that if you think about dentistry, you think about teeth.
And so dentistry has almost a tooth first philosophy, foundation, and history.
And that's fine.
We do have to pay attention to the teeth.
The teeth are part of dentistry, however.
There is a different way to look at it.
And so we're looking at things a little bit differently now because while we see the teeth
first, the teeth are held in by the jaws, and we have this upper and lower jaw.
So the upper and lower jaw, it turns out that their development affects how well we can
breathe through our nose.
So nose breathing isn't just automatic.
It has to do with how well your jaws grew when you were little.
And the way we think about it now is maybe dentistry should have a little bit of a paradigm
shift to being growth and development first or foundation first, teeth second.
So in the previous rendition of thinking about dentistry, you're thinking teeth first.
But in what we're trying to accomplish is dentistry, thinking about jaw growth and development
first, foundation first.
So when the word airway dentistry kind of pops into play, what you're thinking about
there is, well, if you hear airway dentistry or airway dentist or airway anything like that,
now you know you're probably dealing with someone who's paying attention to the foundation
first.
And when I say foundation, I mean jaws, the jaw structure first and the teeth second.
So just like you would build a house on a foundation, you don't try to build the house
and then slide the foundation under it.
You want to put the foundation down and you have to have it mapped out perfectly, then
everything goes up beautifully from there.
So we think about dentistry going forward and we're thinking about airway dentistry.
What it means to me and others as we're trying to spread the word is that we're more focused
on the foundation and its growth and development so that you would have a better breather as
well as really nice teeth where they belong.
So the good news is if you guide the foundation to grow properly and you're focused on the
airway that's the resulting benefit of foundation first philosophy, it turns out when your foundation
grows better and you have better jaw growth and development, your teeth go closer to where
they belong.
So even though we say teeth are second, they're going to be in better shape when you focus
on the foundation first.
So airway dentistry typically means that you have a focus on the foundation, the jaw growth
and development early, and then we kind of focus on the teeth second.
And when you say early, how early are you talking?
So yes, in my world, it begins about three to four years old and we have others in the
industry who start even earlier.
So as a general dentist, I'm comfortable with children three to four years old and we can
work on them then because by then we already have the signs and symptoms of underdeveloped
jaws and poor breathing and other symptoms that come with that.
So I'm comfortable three to four, but that doesn't mean that's where you could start.
Some of the symptoms do appear between one and two.
There are even early symptoms right at birth or just after that could be picked up.
So when you're thinking about that age range, I think about some of my early mentors like
a Dr. Kevin Boyd, who is a pediatric dentist and he certainly can begin early, pretty much
at birth and on.
And some other ones would be like Dr. Lawrence Kotlow, who is like a frenem revision specialist
that I know will get into tongue tie at some point.
So then these are two gentlemen who has pediatric dentists.
They start even before me and it could be at birth if there was difficulty with a tight
tongue or a frenem, tongue tie as people call it.
So yeah, the indication to help a child grow and develop could begin right after birth,
depending upon what we see and find.
And I think the pediatric dental specialty gets them earlier than me.
I jump in around three to four.
And then by perspective, some people think I'm early.
I'm not the earliest.
Right.
And it's funny.
I believe it's Dr. Boyd.
I've heard him refer to, I think it was like a nine-year-old or 11-year-old as geriatric
and I'm thinking, I'm sorry, wait, what?
You can't get to him so early.
It just, you have to kind of realign the way you think about things.
Yes.
What are you thinking about?
Because obviously the earlier you're getting involved, there's less to think about as the
teeth are concerned, but more to think about with the foundation.
And that's where that whole airway dentistry comes from.
Let's focus on the growth and development of the jaws because that's where our airway
results from.
You know, you get your best airway when you have great jaw growth and development.
But if you don't have great jaw growth and development, if the jaws are a little undersized,
there's less room for the air to flow beautifully.
So basically how easily we breathe through our nose is dependent upon how well the jaws
are growing.
Got it.
And I saw something, I'll put a link in the show notes to this, but I saw you explain
this and I'd like to ask for you to just do that for the parents that are listening.
Now, the difference really between normal and abnormal when it comes to the foundation
and the growth.
Sure.
The idea behind normal growth and development is it's something that we don't see very often.
So if we're thinking about normal childhood growth and development in the jaw region,
because we're talking about the head and neck for the jaws to grow.
It used to be the case that a child would grow up and have their jaw growth be perfectly
happening along the way so that all of their teeth would go to place and they would never
need braces and they would have all 32 land, meaning the wisdom teeth would pop in when
they were 18 to 20.
So that used to be the normal.
Now that goes back several hundred years.
Now today, the normal is that the jaw growth is underdeveloped, the teeth are crowded with
a bad bite, so teeth that aren't where they belong.
And almost rare is it that a child could not need orthodontics to fix their teeth and very
rare that they can fit their wisdom teeth.
So we think about what we consider today normal childhood growth and development to have all
of your teeth go to place, avoid having braces and get your wisdom teeth to come in.
That's still considered normal growth and development, but it doesn't happen very often.
In other words, that kind of child who grows perfectly, all the teeth go to place, they
never get braces and they get their wisdom teeth to come in.
I call that a unicorn today.
We see that child one in several hundred.
So I see a lot of children, several hundred children a year.
We only meet one child out of several hundred who will on their own grow all the way up
to have their wisdom teeth come in and not have any braces.
So that's really still normal growth and development, but it's not common.
So we start thinking about normal versus common.
Now today it is common that children have underdeveloped jaws, crowded and or bad bites,
so crowded teeth and bad bites, common to need braces and common to have their wisdom
teeth out, meaning the maximum you would have is 28 teeth.
And if you have four teeth taken out during braces and your wisdom teeth out, you might
only have 24 teeth.
So the idea is while all of that is very common, that doesn't make it normal.
So common and normal are two different things.
Today it is common for children to have their baby teeth be very tight together, no spaces
between them, and then a recognizable poor bite at a young age so that when they become
a kid in the middle, like somewhere between six and 12, the new teeth come in crowded or
out of place in a bad bite.
And then the braces are going to go on for years and rubber bands are going to get used
and next thing you know, the wisdom teeth have to come out at minimum.
So that's a common thing to see.
And in my world, that is most children have that pathway.
Now the normal growth and development pattern we described as being incredibly rare today,
I call it a unicorn.
When you go back several hundred years ago, that was the common as well.
It was normal, it was common, where people would just kind of grow up and have all of
their teeth go where they belong, and there's wonderful anthropology research to show that
you know, pre-industrial, pre-western living, the infants graduated to a harder diet earlier.
And so when you do have cultures that are pre-industrial, pre-western living, and we're
talking about several hundred years ago, all of society's basically all of humanity had
jaw growth and development that was excellent with 32 teeth going where they belong.
And with big jaw growth, appropriate normal jaw growth comes better breathing.
So while that used to be common and normal being the same thing, today normal growth
and development, it still exists.
It's just incredibly rare.
So we call it a unicorn, whereas the common today is underdeveloped jaws, crowded teeth,
bad bites, and that comes with then the need for braces, the need for wisdom teeth extractions.
But more so than that, the bigger problem with underdeveloped jaws is that you don't
breathe as well.
Right.
So basically we're doing this to ourselves.
It is a self-inflicted wound.
Yeah, unfortunately, sadly, when you read through the anthropology research on introducing
an early soft diet, it creates the turning point.
And it starts with food trade, and we start trading food.
And when you go back, you're going back hundreds of years ago, where all of a sudden everything
starts to shift towards this industrial Western mode.
Then all of a sudden we get into what is considered the baby food, which is pureed and mushed.
And we do it out of love because we think we're doing the right thing always.
And I did it.
I did the same thing for my three kids.
So you know, anyone listening, don't worry, I did it wrong too.
Because I didn't know what I was doing.
Right.
You don't know what you don't know.
Don't have no idea back then in minor 21, 20 and 16.
So you go back then.
And I was just getting started on this pathway.
I'm about 19 years into growth and development for children.
And it's been a full swing since then.
And my children had the pureed meals.
And even if we went to get natural hard food from the farmer's market, because you're thinking,
oh, let's get the freshest, greatest stuff, we put it in the blender.
And we, magic, bulleted it to death.
So we basically had a liquid diet.
And so the cascade effect is that when you transition early to this softer diet, well,
then you're not using the muscles appropriately.
So if we're not going to use the facial muscles and the oral muscles appropriately, meaning
we're having a liquid diet, basically, those muscles, when they're weak, then they don't
grow the bone because we, the bone needs to yield to the muscle.
So the way a human works is that the muscle will actually dictate the bone growth and
it has to be used properly.
So with the early saw food, we have weaker muscles and weaker muscles don't promote good
bone growth.
And the jaws don't grow enough.
What we see down the road is, hey, my teeth are crowded and I have a bad bite.
But it is all the result of an early soft diet.
Saley, we did this to ourselves.
Yes.
Right.
So we're getting more of that kind of retracted, retreated jaw.
Like when you turn sideways, you can actually see it slanting in the profile.
Yes.
You know, that's exactly right.
The profile is a telltale kind of view of the face, its growth and what it means.
And so when we have normal growth and development, we're usually getting wide and forward, really
nice, wide and forward growth.
That's how the jaw should grow, wide and forward.
And when the jaws grow wide and forward and we breathe in our nose, that air gets, it
goes up and down.
It's like an upside down letter J, the airway kind of thing.
So the air goes in our nostril and it goes around a little curve and goes right back
down behind the tongue into our lungs.
So that space is bigger when the jaws grow wider and forward.
So jaw growth that's wider and forward is excellent for us.
And it delivers a profile that I like to describe when we look at someone's profile, their lips
are well ahead of their eyes.
If we look at a profile and we see today, it's more common that the lips and the eyes
are almost in the same plane.
But that profile is labeled as a straight or flat profile.
And it's interesting though, that wording because a straight or flat profile when the
eyes down to the lips are in the same plane, those are the words that we find in the sleep
disorder, breathing and obstructive sleep apnea literature that show you're at risk
for bad breathing and sleeping when you have a straight or flat profile.
Then line.
Yeah.
So and that like you said, when the lips are below the eyes, then the chin is usually
recessed or retrooted and it's back.
So we kind of, you know, in late terms, we might think of it as, oh, the person doesn't
really have a chin.
But when the chin is really far back, then what happens is we get compensation in the
neck and the neck starts to look like it's coming forward or more of a ramp than a jaw
line.
Because as we push the jaw back, then the neck kind of pops out, it's compensation to
help the air go by.
So believe it or not, that look is someone who's compensating to breathe better.
And that's the whole thing of collapse because we're not growing wide and forward, we're
narrowing back.
So narrowing back leads to that type of profile we see where the lips and eyes are lined up
and it does lead to compensation where there's worse breathing going on and that can be,
you know, a cascade of trouble.
Yeah, absolutely.
So we've talked a lot in another podcast and on our website about signs, things that parents
can look for.
Yes.
And I can't remember, I saw this on the Airway Health website or if this was in one of your
videos I was watching, but you mentioned some symptoms that we don't really talk about.
And I thought I'd bring those up so we could really talk about those and how, you know,
what the connection is because to me, not all of them are intuitive.
So specifically GI distress or reflux, small or delayed growth, air infections and emotional
instability.
How do these play into signs or symptoms?
Oh, definitely.
So we think about this cascade of this early soft diet delivers weaker muscles.
The weaker muscles fail to develop the jaws.
When the jaws don't develop well, we start breathing poorly.
What that means is that we don't breathe easily through our nose.
So one of the first things that happens when the jaws aren't growing well is if there's
resistance to nose breathing, we can't breathe through our nose well.
What the body does to compensate, it opens the mouth a little.
And so when people think about mouth breathing, it is seen as a negative kind of word in a
way, you know, we don't look at that in a kind way, but you know, mouth breathing doesn't
have to mean that your mouth is hanging open or you're dragging your chin on the floor.
Only just as little as lip separation.
So when we don't breathe well through our nose, our lips will separate and we'll be
breathing through our mouth.
This is really the step that starts to trigger unhealthy.
So when we think about the items you mentioned, what happens is when we are poorly breathing
through the nose, the mouth will do some breathing.
So we could talk about some of the first little things a parent might notice.
One of the things earliest really is mouth breathing.
In other words, the lips are apart.
And how often during the day and night are the lips apart because a human being is an
obligate nose breather.
We are supposed to be breathing through our nose all day and night.
It's a, you know, 24, 7, 365, the whole thing, nose breathing.
And now once we have this underdeveloped jaws and we're not breathing well through our
nose and our lips separate, when we're breathing through our mouth, this changes how we work
because the nose was built to filter, to warm, to humidify, to accelerate, to prepare this
air for the lungs.
So when the nose is doing the breathing beautifully, the air gets purified and, you know, basically
prepared for the lung, then the lung can do its job perfectly, which makes the exchanges
of things.
We have to get rid of some things.
We have to add some things in.
So the idea is if the nose is doing the breathing all the time, we're going to remain healthy
and we'll be functioning beautifully.
But then when the mouth starts to do the breathing, this is where we start to break down.
Now knowing that the mouth breathing is the trigger for some of this, let's go through
that list of the items you mentioned.
I think the first one was the GI distress or reflux.
Yes.
Okay.
So let's talk about that one.
So the, basically we're talking about the digestive system.
Okay.
Now the digestive system is interesting in that we loosely think about having a nervous
system that runs two general components.
We have a sympathetic nervous system and we have a parasympathetic nervous system.
I know those are fancy, but people will remember these words coming up.
The sympathetic nervous system generally is fight or flight.
Everybody knows fight or flight.
You know, it happens in a car accident.
You know, you're in fight or flight.
If a dog was loose chasing you all of a sudden, if somebody's dog got out of the yard and
was chasing you and barking at you and you'd be in fight or flight, you'd get a reaction
to change.
So there are ways that we think about fight or flight naturally.
Well, it's a sympathetic nervous system runs fight or flight.
Now the parasympathetic nervous system does the opposite of that.
It does rest and digest.
So now we've got sympathetic running fight or flight, parasympathetic running digest,
rest and digest.
So here's how this works.
It's at night.
When we go to bed and lay down, we're supposed to be in the parasympathetic component so
that we get our rest and digest.
Basically parasympathetic is mostly overnight when we're sleeping.
So if we go to bed and we're breathing well through our nose, then of course parasympathetic
runs smoothly and we get all of the rest and digestion happening that we're supposed to
get.
But the funny thing is it's the breathing pattern that can upset the balance of the sympathetic
and parasympathetic nervous system.
So if we're breathing through our nose, the parasympathetic nervous system, rest and digest
runs beautifully.
But if we lay down and go to sleep and our lips separate and we start breathing through
our mouth, what happens is your brain knows that's not good breathing.
You're supposed to be breathing through your nose and the brain tries to fix it for you
when you're sleeping.
But in order for the brain to shift gears instead of doing the rest and digest, and
by rest we mean clean and rejuvenate you for the next day.
Because when that parasympathetic system is running beautifully at night, your brain is
very busy and active.
It's actually awake doing all of the things that clean and reset you and recharge you for
the next day.
So that's in the rest and digest category.
But the moment we start breathing poorly, mouth breathing or worse, because if the lips
separate and we're doing some mouth breathing, that's one category.
But then you know worse would be snoring.
And worse than snoring would be apnea where you actually pause or you notice that, oh,
there's a hold of the breath and then a gasp like, oh, you catch your breath again.
That those are like the three categories.
Mouth breathing is the least, the mild version, then snoring is a little worse and apnea is
even worse.
Well, once the mouth opens and we start breathing through the mouth, the brain knows, well,
that's not good for us.
Well, I have to fix that.
So in order to fix the mouth breathing and help you with your breathing, the brain has
to enter fight or flight.
It's a protective mechanism.
So basically, if you're not breathing well, the brain activates fight or flight.
And when you activate fight or flight, it's kind of to save you, to rescue you because
poor breathing can lead to bad things.
The body needs oxygen in certain levels and you have very little time.
We think about it this way.
Oxygen is the body's number one need.
So if you think about how we get fuel to run ourselves, well, food, if we talk about food,
you can go three weeks without food before you're really in serious trouble.
You can go three days without water, you're in serious trouble, but oxygen, you get three
minutes.
So we don't get a lot of time without oxygen or having decreases in oxygen is so harmful
that the brain tries to protect us from that happening and it has to do so quickly.
So it knows mouth breathing, snoring, apnea, those are so bad, the brain has to kick into
fight or flight to make you breathe better.
Now the problem is you can't do both things at the same time.
You can't be in fight or flight and have rest and digest at the same time.
So when fight or flight, yeah, bad breathing at night when you're sleeping means fight
or flight is active, but then the other one, rest and digest is turned off.
But when that's turned off, we don't digest properly.
Now the way that works is during fight or flight, there's oxygen redistribution.
I know it's fancy words, but in fight or flight, let's say if you're thinking about you're
being attacked, oh, you go to the zoo, you go to the zoo and it's a beautiful day and
you got your family and you're looking at this lion, which is in its cage.
Okay, so you're safe.
But if the lion jumped over the fence and landed in front of you and your family, your body
is going to react and go into fight or flight mode.
And all of a sudden you'll be best vision, best hearing, best senses, stronger, your
musculature is going to get a lot of flood of oxygen.
Basically you get this burst for a short time to do your fight or flight.
It's a survival mechanism.
You would change in an instant.
Well, the reason that all happens is because of redirecting things to give you things where
you need it.
So you don't need your digestive system during fight or flight.
If the lion jumps over the fence, you're going to need all the oxygen you can get into your
muscles to fight or flight.
So what happens is you draw from the areas you don't need.
Well, the digestive system is in the parasympathetic or the rest and digest.
If you take the oxygen out of the digestive system, it's not functioning properly.
Now you have anything that is called gastrointestinal or digestive issues.
It could be anything from reflux to upset stomach, to diarrhea, to constipation.
Basically anything that is a malfunction of the digestive system could be related to how
you're breathing at night because your system is in functioning right.
You're spending more time in fight or flight trying to fix your breathing than you are
in the digestive category.
So you have a pathway to have digestive issues in any category, reflux being one of them.
And next thing you know, you're malfunctioning in the digestive category.
So there's a pathway.
There's a second pathway for reflux, which it has to do with the mouth breathing and
the musculature.
So we talk about that as well because when the early soft diet is so soft and loose and
we're just swallowing liquids basically, and we have these weaker muscles.
The weaker muscles for swallowing all of a sudden don't do their job appropriately.
And because we're mostly swallowing liquid and not having to chew harder foods and work
those stronger muscles, what happens is we start to swallow some air.
So when the muscles are weaker, we use the word dysfunctional.
So weaker muscles are usually dysfunctional, meaning they don't function properly.
So when weaker muscles function poorly, we don't have a full compression of the tongue
to the palate and we don't make a vacuum swallow.
So a perfect human swallow is by vacuum, meaning you seal everything off.
The tongue goes to the roof of the mouth and then there's a vacuum to make the good swallow.
You're only swallowing the contents that are there because it's been sealed off.
But with some mouth breathing and weaker musculature, all of a sudden a child or a teenager and
adult, they might swallow some air.
Now swallowing some air is trouble because now the air starts filling up in the belly.
And when the air fills up in the belly, it's going to go both ways, of course.
One pathway is through, of course, flatulence.
The other pathway is that it comes back out the top because it's almost like filling up
a balloon too much.
So you swallow so much air and there's a valve at the top because our mouth leads to our
esophagus, which leads to our stomach.
And the esophagus, that long tube where it connects to the stomach has a little valve.
If you fill up the stomach with too much air and it exceeds the pressure that valve can
hold, some air will pop out of the top.
But as the air pops out of the top, so does the stomach acid.
So swallowing air is a pathway to getting reflux just because you're swallowing too
much air and the stomach can't hold it or pass it along the other end fast enough.
So if it can't go out the other end fast enough, it has to come back out of the top, which
gives you some reflux.
So reflux can be the direct result of swallowing air, which happens from swallowing poorly
thanks to having a weaker and dysfunctional set of muscles in the oral cavity.
So we can think about that GI distress and or reflux being part of the balance of our
nervous system, the sympathetic fight or flight or the parasympathetic rest and digest
pathway, or we can think about it in just a swallowing mechanism related to how we might
be swallowing air.
There's two pathways to upset the digestive tract.
Wow.
Okay.
So how does smaller delayed growth?
How does that become a sign or symptom?
Then similar to the sympathetic fight or flight and parasympathetic rest and digest,
the idea is most children went, well, most of the growth hormone for children is released
when we're sleeping.
So it turns out growth hormone is released when growth hormones released were in parasympathetic
drive.
In other words, if we're in the rest and digest appropriately, we're getting our growth hormone,
so we would be growing normally.
But for children who are undersized or have smaller or delayed growth and maybe aren't
on the higher weight chart, but everything else is correct.
They have a good diet and they seem to be going to bed on time.
Well, if the breathing isn't correct, if we have bad breathing going on, mouth breathing
or worse can disrupt the parasympathetic or rest and digest and we could be in fight or
flight.
Now, when we're in fight or flight, we don't get the growth hormone released.
Fight or flight actually triggers cascades to release cortisol and other things that
are meant to kind of save you in the short term.
So it's more inflammatory by nature and we might get cortisol released during fight or
flight because we're trying to breathe better.
So the poor breathing activating the nervous system that does fight or flight at night
can shut down and reduce the amount of growth hormone a child gets.
So there are children who are undersized because they don't get enough growth hormone and it
could be directly related to how they're breathing and sleeping.
Which system is running?
Are we trying to protect ourselves from bad breathing or are we actually in the parasympathetic
drive?
So we think about small growth as a possibility, especially when everything else is ruled out
because if the child goes maybe to the pediatrician and endocrinologist, let's say everything else
checks out.
We don't have anything going on with the pituitary or the thyroid or let's say everything else
checks out but we're just like deficient in growth hormone.
It may very well be the sleeping pattern.
So a sleep study and sleep observation could help because we would want to know is that
child nasal breathing through the whole night?
And when we say nasal breathing, it should be silent and invisible.
So when a parent is thinking about, well, how are we breathing?
Are the lips together?
That's one level.
Certainly good to have the lips closed all night long.
Then we're in good shape.
The next level would be is the breathing silent and invisible because it should be.
In other words, if we have the right jaw growth and great size for the air to flow, when we're
nose breathing, it should be silent and invisible.
Meaning the parent who's looking in on their child should basically not even be able to
hear or see that they're breathing.
That's beautiful breathing.
The lips are closed and it's silent and invisible.
If the lips are closed, but you can see and hear the breathing, what you have is you have
nasal obstruction, but not enough to open the mouth yet, but it's coming.
Eventually that'll get bad enough that the mouth will start to open.
So the first level of trouble would be the lips are closed, but the nose is breathing,
but I can hear it and see it.
So it's struggling.
So there's a point, there's like a trigger.
The nose will struggle to breathe for a certain amount, but then when it gets really bad,
the body will open the mouth.
The brain will say, Hey, that's enough of that.
I've tried that.
It doesn't work.
Let me open the mouth and get some air in there.
So we get that compensation.
So if we can see and hear nasal breathing, we know we're bad.
And if of course the mouth is open, anything with mouth open breathing is going to be trouble
for us.
That's how we're starting to get unhealthy.
So we covered the gastrointestinal system.
We covered the small growth and development.
What was that next item you had?
The ear infections or tubes.
Yes.
Ear infections.
So multiple ear infections.
So we think about children who get ear infections and of course you get chronic.
Oh yeah, multiple because you get multiple of these things because antibiotics don't
treat the cause of the ear infection.
It treats the overgrowth or the imbalance in the bacteria that has occurred to give
the child the infection.
So what happens is we get the ear infection, we get an antibiotic and it basically it then
kills the bad bugs and it reduces the quantity.
So you have balance again, but if you don't treat the cause of the ear infection, these
come back because you still have the same conditions that gave you the ear infection
in the first place.
Right.
So you get another antibiotic and another antibiotic and then whatever the formula is,
if it's three infections in six months or nine months, the pediatricians have a formula
for then tubes have to go in.
Tubes hold open this little tube.
Well, we think about the ear.
Well, on the outside, the outside of the ear has an opening where you put your Q-tip.
That's where you clean it.
But all the way on the inside, there is a little opening at the back of the throat.
It has a fancy name for it, the Eustachian tube.
The Eustachian tube is where the inside of the ear kind of drains into the back of the
throat.
Now, it's supposed to be draining and if the fluid drains, it doesn't sit, it won't get
infected.
So the way for the fluid to get infected is it has to sit for a longer period of time.
So like if it sits too long, you have a better opportunity to get an infection.
Well, then the real question is, well, why isn't it draining?
Because that's where we start thinking about having the opportunity for the ear infections.
So when we think about why isn't it draining, we think about, well, what is the course or
the mechanism by which it would drain in the first place?
So it does revert back to a proper vacuum swallow.
So I brought up the vacuum swallow earlier because we were going to build on it with
this one.
When a human being closes their mouth and their tongue compresses to the roof of their
mouth and they make a perfect swallow by vacuum, that vacuum as it goes down, draws the fluid
out of that tube into the throat for swallowing.
So a perfect vacuum swallow drains that fluid out.
And it's almost like if you're thinking about swallowing in a vacuum, you have to kind of
just think for a moment about the difference between positive and negative pressure.
I know it's fancy, but it's easy to understand.
It would be easy to understand thinking about a balloon.
So let's think about a balloon first.
When you blow up a balloon, that's positive pressure.
So you blow up the balloon with positive pressure, you're pushing the air into the balloon, positive
pressure builds the balloon bigger.
Well, the negative pressure is easy to understand because most people understand, hey, if I found
a helium balloon and I want to sound like Mickey Mouse.
Right.
Yeah.
So what do you do with the helium balloon to sound like Mickey Mouse?
Well, you put the balloon in your mouth and you suck the air out of it.
But when you're sucking the air out of the balloon, it shrinks.
Negative pressure.
Positive pressure blows up the balloon.
Negative pressure empties the balloon, collapses it, and you sound like Mickey Mouse if it
was helium, right?
Okay.
Right.
Well, negative pressure is what would drain fluid.
So if we think about the balloon has air in it.
So when we're sucking the air out of the balloon, the air is emptying.
When we swallow by vacuum, that swallow by vacuum, it almost like the eustachian tube,
which has the fluid, is the balloon, so to speak.
Okay.
So as we swallow by vacuum, that fluid's being pulled out into our throat to swallow.
So basically every single proper swallow by vacuum drains the fluid, keeps the system
running well.
And as soon as a child has that early soft diet, then a weaker and dysfunctional tongue
muscle, then the oral cavity doesn't behave properly and we're mostly drinking our early
food.
So now we have a set up where we swallow air, but swallowing some air without a vacuum
swallow, then the fluid never leaves the eustachian tube.
It stays in there and then welcome to fluid sitting too long in one place.
Wow.
It increases the odds or risk of getting ear infections.
What ear tubes do then is they just hold it open because that little tube, that little
tube has a sphincter at the end or a little closure at the end, but when you're swallowing
perfectly, the fluid will come out of it.
A tube just holds it open.
So they put the tubes in there so the fluid just leaks out.
That doesn't treat the cause either.
That treats the symptoms.
So antibiotics and tubes treat the symptom.
If you could correct the swallowing pattern, it treats the cause.
The cause, yeah.
Yeah.
So we think about in that world, if we want to have jaw growth and development, we have
appliances and things we can do to help the children grow their jaws better to fit their
teeth.
We also have the other world, which is to get the muscles corrected and why not strengthen
and train the muscles to function properly?
It's like physical therapy for the oral cavity.
So when you go through myofunctional therapy, fancy words, or facial myofunctional therapy,
it just teaches the tongue and the other muscles how to do it right.
So you graduate out of this early soft diet delivering these muscles that only work one
way, which isn't exactly good for us.
Then we can train the muscle and strengthen it to function properly and you never have
to get an ear infection to get a huge swallow properly.
Nice.
Ear infections, yeah.
You are listening to Airway First with today's guest, Dr. Ben Morellio.
You can find out more about the Children's Airway First Foundation and our mission to
ensure that every child has access to screening, evaluation, and treatment of all children's
airway disorders before the age of six on our website at childrensairwayfirst.org.
The CAF website offers tons of great resources for parents including videos, blogs, recommended
books, comprehensive medical research, and so much more.
We've also recently launched the Airway Huddle, a Facebook support group for parents of children
with airway and sleep-related issues.
You can access the Airway Huddle support group at facebook.com backslash groups backslash
airwayhuddle.
Are you interested in becoming a guest or do you have an idea for an upcoming episode?
Then shoot us a note via the contacts page on our website or send us an email directly
at info at childrensairwayfirst.org.
As a reminder, this podcast and the opinions expressed here are not a medical diagnosis.
If you suspect your child might have an airway issue, contact your pediatric airway dentist
or pediatrician.
And now let's pick up the conversation again with today's guest, Dr. Ben Moraglio.
That was another one.
Totally related to the fight or flight.
Once we're breathing poorly and the brain has to shift its gears to try to improve the
breathing and we don't have proper rest and digest.
In the parasympathetic column where there's this rest component, what the brain does all
night is it totally cleans and organizes you for the next day.
The analogy I like to describe this is like the show hoarders.
If you think about redirecting to hoarders, most people get an idea even if you haven't
seen all the episodes.
Someone will collect every thing they see or touch or get their hands on and put it in
their house and forever.
The next thing you know when you walk in their house, there's no room anywhere.
Wall to wall, floor to ceiling filled up.
You barely have space to get around and it's just been collecting, collecting, collecting
and it's a big disaster in there.
So very difficult to live in that house.
Now here's what's happened during the day.
During the day, a human being collects information all day long and it's basically every single
thing that you collect from your senses.
So everything you see, everything you touch, everything you smell, you hear, you taste,
all of the senses collect all this information.
During the daytime, it's kind of like hoarding.
Everything gets put into your brain.
So whatever your senses, your hands can grab it, your mouth can taste it, your nose can
smell it, your eyes can see it, your ears can hear it.
Whatever your senses all day long, they collect and they pile it into your brain.
Your brain now looks like the hoarder's house during the day.
Now what happens during rest?
When you go to bed at night, if you're breathing well and you have a beautiful parasympathetic
or rest and digest cycle going, during rest as soon as you fall asleep, part of the brain's
function at night is to file all of it.
So we have this like never ending file system in our brain.
It's not like the house where you're confined to these walls and you have nowhere to put
anything.
The brain can file everything you accumulate all day long for your whole life.
So if you're in rest and digest, what the brain does at night is it sets up and it almost
looks like a scene out of the matrix with Keanu Reeves where all of a sudden there's
an endless aisles of things he can choose from.
In some cases, it's bad things he's choosing.
But the idea is it's endless files of things he can go and grab things.
Well, your brain can file it all away.
And when you wake up in the morning, you're clean and empty, so to speak.
You're ready for the next day of accumulating.
If we are breathing poorly and we're in this fight or flight mode at night, that that organization
and assimilation and accumulation and filing, all that cleaning of the information doesn't
get done.
So now your brain is loaded with all the piles.
You're a full hoarder up there and you didn't get to clean it and organize it at night.
So when you wake up the next day, all you have is a big garbage pile from the day before
and you're going to add to it.
So your brain does become the hoarder house when you don't sleep and breathe well because
the brain doesn't get to do its job of finishing filing and assigning and putting away all
that stuff, which it should be doing when we're breathing and sleeping well.
So that poor breathing pattern does disrupt how we put away all that good information.
So filing it all away can mean good things because when you do put it all away nicely,
it builds better memory.
And then you can recall things nicely.
So all of these things build into your long and short term memory.
All of it builds into your focus and your attention because as you're not resting well
enough, that's one component.
But the next thing is you have this massive pile of information from the day before that
did not get filed appropriately.
And now you're just adding on to it.
It's kind of like walking around all day in the hoarder's house.
You're walking around all day in the hoarder house and it's awful and uncomfortable and
it's a disaster and you can't get anything done because you're tripping on everything.
All right.
It's stressful.
It's very stressful.
It can be a very stressful day.
And that's just one component.
I mean, the other obvious component is when you're in fight or flight in your sleep, you're
definitely not getting a good quality night's sleep.
So you basically don't get the rest you were supposed to get because you're in this struggle
all night long to be breathing better.
So you almost have the sleep deprivation component going on.
So you've got to sleep.
The fancy words for it are really sleep fragmentation.
So most parents understand sleep deprivation, especially when a parent has a newborn because
the first few weeks of a newborn when it has to.
You have to attend to it like every hour and a half.
And so every hour and a half for the first few weeks, that is sleep deprivation at the
worst that it could be.
Well, that is kind of what's going on when your poor breathing is happening.
Poor breathing means your body is being they use the word arousal, but it's like a awakening,
but not getting up and not totally awake.
Yeah.
Yes.
Not totally awake, but you're in the state of alert.
And so the idea is when you don't, when you have fight or flight running to try to help
you instead of rest and digest, you're basically in an agitated state all night long.
You're not getting proper rest.
So you're in now we, we can loosely say sleep deprived, but fancy word or technical words
are sleep fragmented.
So now your sleep is broken up.
So you have this sleep deprived child who has this massive information every day piling
on each other, living in a hoarder's life in their head.
And of course that's where the attention, the focus, the school troubles, behavior,
all of this stuff stems from those two things that are happening because of the poor breathing,
triggering the change from resting to fighting or struggling to fix it.
Got it.
All right.
So, and you also touched on something briefly.
A grow and fit teeth is the phrase you use.
So I'm guessing that now we're talking a little bit more about expansion, how you expand.
Certainly.
So yes, when we recognize these symptoms, like in a parent's world, the easiest things
for them to see would be things like the lips are separated or mouth breathing, crooked
teeth, crowded teeth, a bad bite.
You know, if the teeth aren't perfectly aligned, then you know you have something going on.
And then certainly downstream from all of that would be the symptoms of the child who's
struggling in the categories, whether it's gastrointestinal or behavioral or academically,
or even things like headaches or bedwetting or nightmares.
Like these are all stemming from that fight or flight reaction overnight.
Those are the signs and symptoms.
What we look in the mouth for is kind of markers for growth and development measurements and
where teeth should be positioned because we do know where they should be ideally.
So a set of baby teeth should have certain credentials.
Then we would know, hey, that child's growing and developing well.
We can just kind of watch and let it go.
And that child who is growing and developing well in the jaw is usually has little to no
symptoms to go with it.
So it's a good match.
And they'll have space, right?
Between their teeth.
Yes.
That's like the number one sign in the baby teeth.
There's gaps between them.
And interestingly, we're supposed to have gaps between all of the baby teeth.
So that research was done by Dr. Edward Bogue a long time ago, and he basically taught
us that if all of the baby teeth have spaces between them, that's a good start.
But if you don't have gaps between all the baby teeth, well, the chances are the permanent
teeth are going to come in crowded and not fit.
And then progressively as it gets worse, but then the wisdom teeth don't fit.
So you end up with less teeth.
So the idea is sometimes we see a child who has baby teeth and they're so well placed
and perfectly aligned.
It looks like a little doll's teeth.
They're connected.
They're all connected.
Yeah.
That's bad.
That's bad because there's no space in those teeth.
While it looks amazing when you're three and four, the permanent teeth are really going
to be crowded.
That's a very crowded mouth coming.
So the parent not seeing gaps between the teeth and any other symptoms that go along
with this kind of poor breathing and sleeping, we would recognize by measurement and by teeth,
oh, there's no gaps in the baby teeth or here come the permanent teeth and they don't fit
already.
And then our next step would be identifying that it is not about the teeth.
So we don't try to force the teeth straight.
We got to work on growing the foundation.
So the pathway to really help a child is to grow the foundation because the two jaws,
we're talking about the upper and lower jaws.
Well, the upper jaw, it doesn't just hold the top teeth in it.
It actually makes your nose.
So the fancy word for the upper jaw is the maxilla.
Well, the maxilla is the bone that holds our top teeth in, but it turns out the maxilla
also is what builds your nose.
So when the maxilla is really big and wide and forward, as it should be, the nose, the
internal chambers bigger.
So you have better breathing.
Okay.
So we jump in early because when we have symptoms and measurements of underdevelopment, what
we're looking at is let's grow the jaws better.
So we talk about expanders.
We talk about expanders.
We talk about guidance appliances.
We talk about myofunctional therapy.
We talk about nasal hygiene.
We talk about things that can help a child to grow and develop properly.
Let's get caught up to where we should be and keep going correctly.
Because if you address the foundation early, when the child still can do that easily, all
of a sudden when the foundation starts growing better, the teeth start going where they belong
so they can correct themselves.
So you get some auto-correction in the teeth just getting the foundation going well.
But the bigger difference is when the foundation starts getting wider and forward, all of a
sudden it looks nice because the teeth look good, but the symptoms start to fade away,
meaning, hey, all of a sudden the child sleeps with their mouth shut and they breathe through
their nose.
All of a sudden they do sleep through the whole night.
They don't even wake up in the middle of the night.
They stop wetting the bed.
They stop having nightmares.
They wake up refreshed in the morning.
We don't have a morning struggle going on.
And all of a sudden school improves.
So we see a lot of academic performance increases when the children all of a sudden have better
breathing and sleeping at night.
So the downstream effect of growing the foundation first is tremendous because it not only helps
the teeth go where they belong, which is like 10th on the list of things we need.
It really helps the child to breathe well, sleep well, and then function better.
So we're excited about the things that changes we see when we use expansive techniques to
grow the foundation first.
We're going to leave the teeth alone till later on.
We really don't address the teeth till we're 12 or 13.
That's when alignment for the teeth is appropriate.
But that goes a whole lot better if you did the foundational growth first.
It turns out the early years, I know we think about the jaw bones as bones and we hear the
word bones and we think it's hard.
But in a child, it's like a wet sponge.
It's kind of moldable.
It's still malleable.
Yeah.
The jaw bones in a child can be guided and kind of nudged and teased and coerced and pushed
and they can be redirected.
And so a lot of that happens when you redirect the musculature because it's the muscles that
should be doing it in the first place.
So why not recruit them to work with us?
So we have a combination of, well, there's appliances we could use, but there's also
techniques where we can strengthen and redirect the muscles because if they behave properly,
it produces the bone growth that should have done.
You can catch up when you're younger.
So it's a huge advantage to work with the muscles and that's why the oral facial myofunctural
therapist is a key part of treatment and should be part of every child's growth and development
because then if you get at the musculature, you're really going after the cause.
Right.
So it makes sense that they're younger and they're more malleable.
They're going to respond.
Can you use these kind of techniques on adults?
There are different appliances and techniques for adults.
So when we get to adults, we are talking about mature bone.
So when you have mature bone, it can be guided.
It's just going to be different appliances.
It'll take a lot more time.
And of course, we're talking in the non-surgical category.
In an adult, if we were thinking about doing something rapidly, we'd be talking about surgical
intervention because then you get in there, you do some jaw surgeries, you can do big
changes in short times.
But if we're thinking about in the growth and development category, well, for an adult
with mature bone, it's going to be different appliances over extended periods of time,
still involving the myofunctural therapy because you still want to have the musculature
behaving itself properly to help you along the way.
It's not as rewarding in adults because it does take a very long time and a lot of adults
are so far into their sleep apnea that a lot of their health issues are significant.
And so it's much more rewarding in the children because you can have the effect in a short
time and you can deliver from unhealthy to healthy.
In some times, it's just days or weeks in children.
So I work on all this other.
Yes.
Why am I getting worse and worse and worse?
So the whole idea behind getting involved in a child early is that because the bone
is immature and kind of softer, you can make the effect bigger in a shorter amount of time
and get good jaw growth, better breathing, better sleeping and basically heal that child.
Whereas in an adult, now we've got mature bone.
It's hard.
It thinks it's done growing.
And then there are very particular and technique sensitive pathways to try to help that bone
grow a little more and while it is possible by some research, it's much more difficult
time consuming and almost a struggle because some of the appliances you have to wear, they're
difficult to speak with, then you're trying to wear them during the day and at night.
It can be inconvenient and not painful in any way when we're talking about non-surgical
therapy for the adults, but not as rewarding and much more of a struggle.
It's the kind of thing that you want to fix early because later, later is much more trouble.
Later, later is tough.
Got it.
We referenced earlier tongue tie.
So I'd like to go ahead and chat about that just for a few minutes if we could.
First of all, exactly.
What is a tongue tie or elliptide or a cheek tie, which I learned about a month ago, what
that actually was.
And how do those, because when you think about a tongue relaxes, it falls back.
I get it, it blocks the airway, but logically you think a tongue tie, it's going to hold
it in place.
It's going to keep it from doing that.
So as a layperson, that's what you think.
So how do these actually impact the airway?
Yes.
So the tongue, it's kind of shaped like an L almost.
So when we think about someone who opens their mouth and the piece that we see is like the
top piece, but then the tongue kind of rolls back and goes down a little.
So it has this curve shape to it.
Well, the tie we're talking about is under the tongue.
So if you lift your tongue up, it would be like a little, and it's a frenem.
The fancy word is frenem.
In my office, when we're talking to parents or kids, we call it a leash and leash like
you walk your dog on a leash.
So you know, you have the movement.
Yeah.
There are different kinds of leashes.
Now there are some, some dogs need a short leash.
So they stay right next to your side.
But then there are other dogs that can have a 30 foot leash because they behave themselves
and they can be further away from the owner.
So you have these different length leashes.
Okay.
Well, we have different lengths of frenems.
So if you have a shorter frenem, it restricts the movement of the tongue.
But when the frenem is short, it's under your tongue.
It's holding it down.
But holding, holding the top part down means that the back part gets pushed back.
So the way the tongue works, because it's this, it's kind of a massive tissue.
If you, if you press down on the top part, the back goes backwards.
So you have this L shape of the tongue kind of thing.
And if the top is lower than the back part is back farther, that interferes with the
airflow.
So a tighter frenem doesn't help with airflow.
It makes it worse because holding the top or front part down keeps the back part back.
Yeah.
And the bigger trouble with the tight frenem is that the tongue can't elevate to the top
so it can't seal off and make a vacuum swallow.
So right away, the swallow is poor.
With the tighter frenem, the tongue can't really press into the maxilla or upper jaw.
It can't help grow the upper jaw.
So a lot of times with a tight frenem, you see cross bites, meaning the top teeth are
actually narrower than the bottom teeth.
And that's the opposite of how we work.
You know, our teeth are supposed to come together kind of like a shoe box works where the lid
is over the bottom.
So our top teeth should be the lid and the bottom teeth would be the bottom of the shoe
box and the top teeth surround the bottom teeth.
So we kind of fit together like that.
But with a tight frenem, the top could have less growth and development than the bottom.
And it could be inside of the bottom teeth.
That's like a reverse or cross bite.
That's you know, one of the results of having that tight frenem.
So you know, the tight frenem interferes with certainly the growth and development.
It interferes with the breathing, the swallowing.
It basically a tight frenem helps a human being malfunction.
And that malfunction could be seen as early as birth because the tighter the frenem is,
the more restricted the tongue is, the more difficult the breastfeeding would be.
So you could gauge it early by the breastfeeding.
In other words, was there any difficulty in breastfeeding and or pain associated with
it?
Because the more painful it is and the more unsuccessful it is, usually there's a tighter
frenem involved.
And so, you know, frenem is because they come in different length, you could have a mild,
moderate or severe problem with the frenem.
It doesn't have to be, it's not like a light switch where it's on or off.
It's kind of like a light switch with a dimmer.
You have a whole range of what's going on.
So since you have these different frenems, you could have someone who, okay, the breastfeeding
is successful, but it's a bit of a struggle and painful.
And then you could have the other end of it where, oh my goodness, the breastfeeding is
perfectly successful and it's not painful.
And then there's the one where, oh my God, it's totally unsuccessful, the baby can't
even latch at all.
And it's very uncomfortable, very painful and nothing's happening.
So there's this range of what could go on.
The lingual frenem, the lingual meaning tongue.
We talk about that one, the most one, because it's the most common.
So the lingual frenem or the one on the tongue is the most common.
And you mentioned the other ones, the lip, the lip tie, like the upper lip has a little
tie connecting it to the bone there.
And the cheek ties are on the sides.
The cheek ties are on the sides.
Well the significance of those is that if the lip tie is too tight, it holds the upper
lip tightly in, holding the upper lip tightly in.
Now you have a barrier against forward growth.
Because the tighter the upper lip, yeah, the tighter the upper lip is held back, the harder
it is to grow forward.
So you're growing forward if there's freedom to grow forward.
But if there's something working against you, it could delay or basically reduce the amount
of forward growth you get.
So we do check second for the upper lip to see if it's being held back by a frenem that's
too tight, that's the lip frenem.
The cheek ones, there are four on the side, there's two on top, two on the bottom on the
sides.
Those frenems, when they're too tight, they hold the cheeks in tight.
But when you hold the cheeks in tight, basically that's resistance to growing wider.
So if we want to grow wide and forward, we don't want any resistance on the outside working
against us.
So we look for those ties to see, hey, are those interfering with what should be good
wide and forward growth?
Some kids have tight frenem on the cheeks and or lip.
Releasing them means that it takes the lip and releases that pressure and the cheeks releases
so that you can be growing wider and forward without an opponent, let's say working against
you.
So the most common is the tongue one.
The tongue is most common.
Then second is the lip and third are the cheeks.
Got it.
So in that order we check.
Some kids have one of them that's trouble.
Some kids have all of them that's trouble.
So we think about, you know, we've got this early soft diet working against us because
now we have this weak and dysfunctional muscles.
That's not growing as well.
But then the second part of the fire that's going on is that we might even have tight
frenem working against us.
And it could be more than one.
You combine the two and it can really be for some bad growth and development and a childhood
struggling.
Wow.
All right.
Thank you for that.
By the way, that was very, that was helpful.
I like, I just, I couldn't, you know, for the life of maintenance and you're trying to
figure out cheek ties, how that could impact it, but they can't see you visually.
I'm watching you explain how it pushes it in.
And soon as you put your hands up, it's this light bulb.
Oh, that's, that's what does it.
Right.
When we're talking parents, especially parents of newborns or first time parents, especially
I didn't know this as a first time parent myself.
When should you start bringing them into a dentist?
And then does everybody need an airway dentist?
Is just at this point a good rule of thumb and something as parents we should be looking
for.
It probably is something we should be looking for because that early soft diet is, you know,
the word is ubiquitous, but everywhere.
Yeah.
It's everywhere.
We basically transition from breastfeeding to soft foods and soft foods between zero
and one years old or one to two, it really sets the tone for the muscles of the jaws
being weaker.
So we're going to have underdeveloped kids and, you know, almost all of the kids we see
will not grow fully to 32 teeth.
You know, that's kind of how you know that the muscles and the are weaker and the jaws
are underdeveloped is that almost no child is going to grow on their own to 32 teeth
with full grown jaws.
So now that we know we've got this, we've got this societal pattern in place, but now
we know, you know, at an early age, there's going to be this issue.
Well, if you have a really good pediatric dentist that is in the airway space or in
this philosophy, they would know basically at birth that you could attend to the frenem
if there were breastfeeding issues.
So, you know, number one would be if a parent would like to breastfeed, but is having difficulty,
then you're hopeful that either a nurse or lactation consultant would guide you to a pediatric
dentist, someone who could release the frenem.
So you could be successfully breastfeeding if you choose.
And if it's the tongue or the lip, that would be the earliest way to get involved if you're
having that difficulty.
Other than that, well, now you have breastfeeding beginning and then after that the soft diet.
So it would be, you know, in my world, I'm seeing the children at age three on up, but
in Dr. Kevin Boyd, who's a pediatric dentist in Chicago area, he sees them, you know, it
could be after birth because of the frenem revisions needed and as little as six months
and 12 months to evaluate, do we need to help that child with their frenem and or sleeping
and breathing?
Then of course, by 18 months to two years, he can treat them already because in the pediatric
model, you can start treating.
So yep, there are doctors who treat them very early.
Dr. Kevin Boyd is one of them.
Dr. Lawrence Kotlow is another.
Those are two early mentors of mine.
They're both pediatric dentists.
Dr. Kotlow is in Albany, New York.
There are many others like this.
So the idea would be short today because of that early soft diet, a parent should be thinking
that as they recognize symptoms of poor breathing or mouth breathing, they probably should think
about finding an airway dentist.
Someone who's more focused on the growth and development of the jaws than the actual teeth.
Then you kind of know you're in the right space if they're talking jaw growth and development,
sleeping and breathing.
They want to help you in that direction.
You're in the right place.
If they start talking more about teeth being moved around, you might have to look a little
further.
Got it.
And how do you find an airway dentist?
So there are different ways to find, you know, obviously there's, you know, Google and you
can start searching and you start asking, you know, I do teach a lot of this.
And so as part of the educational process, I have a partner, Lauren Gates, and we founded
a little company called Airway Health Solutions.
Basically with that company, what we do is we do teach doctors.
We teach dentists who want to learn how to treat children through teams, through adults
in this, you know, philosophy.
And then we mentor them as well.
And with the last three to four years, we've trained over 250 offices.
And so we have a doctor locator.
And if you went to airwayhealthsolutions.com, you would find a doctor locator map and it
has little dots on that map all over the country.
And if you pull up one of those offices from that website, you would know they were trained
by me.
And I have now 19 years experience.
I've been treating children for the last 19 years in their growth and development.
And it turns out we've had such a nice success at helping those children heal and lose their
symptoms as well as, you know, grow and develop beautifully into all of their teeth that we
started to teach it.
And it's one level that I could do this in my own community where you help an X number
of kids per year.
If I then trained another office to do it somewhere else, now things can become exponential.
Yeah.
So it made sense that I needed to teach it more.
So that's one pathway to learn.
You could go directly to airwayhealthsolutions.com and look at the doctor locator.
And then you would be rest assured you'd have a doctor in there that would be able to help
you out.
Perfect.
And I will make sure there's a link to that in the show notes and on our website in our
section for helping parents where to start.
Just full transparency.
We already have that link in there.
That's one of the tools we use to help parents.
Terrific.
So at the end of every episode, I always like to just turn the floor over to the guest so
that you can have the final thought if there's anything that we didn't cover or if there's
just a message you want to leave with parents.
Oh, sure.
Thank you very much for having me.
So wonderful session.
And I hope it helps a lot of people get some earlier attention.
So yeah, I think the most important thing I'd like parents to take away from it is that
it is very helpful to treat the child earlier.
And so part of what a parent might hear is that, oh, don't worry now.
It's normal.
That's fine.
They'll outgrow it.
There's a lot of things that are thrown out there because so many kids have these symptoms.
They start calling it normal or they'll outgrow it.
But usually when you're hearing things like that, you're hearing it from people who don't
know how to treat the cause.
They only know how to work on the symptoms or maybe not even that.
And so they guide you towards doing nothing.
That doesn't help the child.
So I would encourage parents to dig deeper and look more when you realize or think about,
you know, there's something with my child has these symptoms and it is not normal and
it's not okay.
And it can be fixed early.
You just need to go in the right direction.
So generally speaking, parents who recognize sleeping, breathing, or even just crowded
teeth and bad bites kind of thing, those symptoms that are related to the behavior, the school
performance.
So these little things we talked about over the hour, you want to start consulting with
an airway trained dentist so that you could have help early and early is better.
It is much harder to fix an adult in this space and why let the child kind of struggle
all the way through only to have difficult options to fix later when actually if you're
working on the kids early, it's easy.
So to help a child grow and develop early is appropriate.
I wouldn't accept it's normal or they'll outgrow it anymore.
I would just pursue a different line for someone who's focused on the foundation.
You can help your child with a long list of symptoms that we touched on many of them today
and it's that's not even exhausting.
You know, in one hour we touch on the tip of the iceberg, but anything that your child
might be struggling with if there is a sleeping or breathing issue related to it as we described,
you have opportunities to help your child and they can be cured because you're dealing
with treating the cause early.
Perfect.
All right.
Thank you so much.
I really appreciate it.
Oh, it's my pleasure.
Thank you.
Thanks again to today's guest, Dr. Ben Moralia for sharing his medical insight into each
of you for listening to today's episode.
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Remember this podcast and the opinions expressed here are not a medical diagnosis.
If you suspect your child might have an airway issue or sleep-related disorder, contact your
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And finally, thanks to all the parents and medical professionals out there that are working
to help make the lives of kids around the globe just a little bit better.
Take care, stay safe and happy breathing everyone.