Hi everybody and welcome back to Airway First, the podcast from the Children's Airway First
Foundation.
I'm your host Rebecca Downing.
My guest today is the owner of CT Oral Facial Myology, Brittany Murphy.
She is a certified oral facial myologist and butaiko breathing educator.
Brittany received her degree from the Forsyth School of Dental Hygiene at MCPHS and postgraduate
training in myofunctional therapy through the AOMT and IAOM.
Brittany is an educator and mentor for the Dental Sleep Toolbox and Airway Health Solutions,
joining other registered dental hygienists who share the same passion in becoming myofunctional
therapist.
Brittany is also the face behind the podcast, I Spy with My Myo Eye.
You can find out more about Brittany at CTOralFacialMyology.com.
And now let's jump into my interview with Brittany Murphy.
Thanks so much for joining us on the podcast today, Brittany.
Absolutely.
Thank you for having me, Rebecca.
I appreciate it.
Of course, of course.
All right, so in a lot of our previous podcasts, not a lot, in several of our previous podcasts,
we've talked a lot about myofunctional therapy.
But one thing that we've never really talked about are what are the goals.
How does myofunctional therapy tie into this concept that we're hearing a lot about about
whole body health?
Yeah, absolutely.
So our goal, regardless of who we're working with, is we want to establish correct oral
rest posture.
So that is the lips being closed all day and all night, the tongue resting up in the roof
of the mouth, the tip of the middle and the back of the tongue lightly suctioned in the
roof of the mouth all day and all night.
And we want to establish dominant nasal breathing patterns all day and all night.
Now when you're in that typical oral resting posture, we also want to talk about where the
teeth are.
The back teeth should be ever so slightly apart, like pretty much hovering over each other.
The only time those back teeth should really ever come into contact is when we swallow
and that's to help stabilize the jaw.
Okay, so if, and I'm sure everybody else does this whenever somebody mentions this, you
check your own mouth.
So if your back teeth are together naturally, what does that mean?
Probably a clencher would be my guess.
Some clenching and grinding going on, some tension in those masticatory muscles.
So we would definitely want to change that, get you into a dental freeway space.
So a dental freeway space is exactly that little tiny space between your back teeth,
which should be about two to three millimeters.
And, you know, your other question was how does that tie into whole body health?
And, you know, our oral cavity is the gateway to our overall health and having that tongue
resting up in the roof, the mouth does a lot for the rest of the body.
You know, it turns on the vagus nerve.
It helps, you know, that parasympathetic nervous system to take over that rest and digest
nervous system.
When you have your tongue up, you're more likely to be a nasal breather.
And I'm sure you've had people on here talking about, you know, the benefits of nasal breathing.
So we don't have to get into that.
But once that tongue posture drops, that mouth is going to open, right?
And when that mouth opens, that jaw is going to swing back.
So you have to think about what that's going to do to your jaw joints.
Even if you were just sitting here right now, if you had your tongue resting up in the roof
of your mouth and your lips closed, and then you just simply parted your lips and dropped
your tongue, you could see what that does to your body.
It almost literally starts to, you know, close your body.
You'll feel your shoulder start forward.
So it really has an impact on the rest of our body.
You probably also had somebody on here talking about that piece of fascia that runs from
the tip of our tongue all the way down to our toes.
So you can think if there's issues going on in that upper part of that fascial system,
that you're going to see these other things happen.
And I think the biggest thing is really just talking about that wanting to be in that dominant
parasympathetic state, in that state of rest and digest and not in sympathetic overdrive,
which is fight or flight.
And you're going to have that if you are doing some mouth breathing, you will be in that
sympathetic overdrive.
Right.
And then so mouth breathing, I think we kind of all understand, you know, how that falls
into all of this.
But one of the things that I saw on your website, and actually let's go to a podcast where
you discuss this about how myofunctional therapy and sleep issues and TMJ all kind of go together.
Yes.
Which my hair may not be completely instinctive to some people.
So I was wondering if we could just unpack that a little bit and talk about that.
Yeah, absolutely.
So I think that your tongue is a big stabilizer when it comes to your jaw joint.
And in a course that I took before, so it was Sarah Hornsby's course, who's another
myofunctional therapist, and she put this analogy up and she heard it from somebody
else.
And I don't think she could remember who she heard it from or maybe I can't remember
who she heard it.
So whoever made that analogy, we're giving credit to you.
This is not my analogy.
It wasn't your analogy.
But she put a picture up of a stool, a three-legged stool.
And if you think about the three-legged stool and two of those legs being your joints, your
TMJ joints, right, your left and your right one, and that third one being overall good
oral rest posture.
So that tongue being up in your lips together.
Now that stool would be nice and steady.
You can totally sit on that stool.
But if you knock off that tongue posture, that lip competence, how shaky, how steady
is that stool going to really be now?
And so when we have that lower tongue rest posture, we tend to see a lot more TMD issues.
And the other thing that, now I can just hypothesize this from clinical experience.
I don't, there's not, I mean, there's some research, but there's not tons of research
supporting this.
A lot of times I find that my TMD patients have tongue restriction or decrease in their
tongue mobility.
Whether it's a tongue tie or just something we have to work through functionally with
myofunctional therapy, I find that quite often that there is a restriction there.
And that's why they're not really able to get that really solid tongue rest posture.
Because I think when people hear about myofunctional therapy, they hear a lot about like tongue
to spot.
Like everybody learns what your tongue to the spot.
And the spot is right behind your upper front teeth.
So like if you were to say the letter N, if you produce that sound correctly, your tongue
would hit behind your upper front teeth, not touching your upper front teeth.
Now that is where you want the tip of your tongue to go, but that's not enough.
You can't just have, I'm going to use my hands here, the tip of the tongue up there and the
rest of the tongue kind of hanging down.
You need that whole tongue up there in contact, lightly suction, the tip, the middle and the
back of the tongue to really have what we consider functional tongue rest posture.
And when you don't have that, I think it really creates a lot of issues in that jaw stability.
Even talking about that swallowing pattern that we talked about, when you don't have
that teeth together swallowing pattern, that good tongue to palate elevation of the back
part of the tongue to complete that peristaltic motion of the swallow.
Typically what happens is your body will learn to compensate.
Your body is a beautiful thing.
You have to swallow.
You have to swallow all day long.
You're saliva, your liquids, your solids.
Body learns to compensate and you tend to have more of a tongue thrust swallowing pattern.
And with that tongue thrusting forward, that's going to cause some disruption on those joints
rubbing against each other.
So we're going to see function in the jaw joints due to an incorrect swallowing pattern.
So then you want to think, well, where did that incorrect swallowing pattern come from?
Like what's the root cause of it?
Could it be a tongue tie maybe?
Not all the time, but if there is a tongue tie, typically there's a dysfunctional swallowing
pattern associated with that.
So we always want to dig deep.
Myofunctional therapists are like detectives.
Patients come in and it's like some of the stuff we ask them, they're like, why do you
want to know this?
Why do you want to know if I was born vaginally or if I had an assisted birth?
Why is this stuff important to you?
I thought you were just here to fix my mouth.
Right.
But it is all connected.
So I'm not going to go down to breastfeeding, whether or not you were breastfed and for
how long, right?
Absolutely.
Because it's building the muscles.
So one thing on your website that I would really love to chat about, because it was the
first time I'd ever heard this phrase, primitive reflex integration.
Yes.
What is this?
So I learned about this.
I recently networked with a wonderful pediatric therapist, occupational therapist, I'm sorry,
in my area, and she's wonderful.
And she specializes in retained primitive reflexes.
And I learned so, so much from her.
So primitive reflexes are, it's a specific set of reflexes that all babies are born with.
And they basically just help like natural survival for babies.
They're like natural instincts.
It helps with brain development.
It gets babies moving.
It helps with the way they move their hands, the way they move their feet, muscle tone,
head control vision.
Like it helps with a lot of developmental things.
And these primitive reflexes should integrate within the first six to 12 months of life.
And when they don't, which is what is a retained primitive reflex is a primitive reflex that
hasn't integrated, it's retained still.
That's what we consider formal.
And you can see some developmental delays from having that.
Now what's interesting is when I have this lunch meeting with this occupational therapist,
we're talking about symptoms of myofunctional disorders and symptoms of retained primitive
reflexes and a lot of them overlap.
So what I'm finding with a lot of the kiddos that I'm working with, and even adults can
have retained reflexes, is that we really need to work together because sometimes if
there is a retained reflex, it can inhibit the amount of progress I can make.
So examples of symptoms of retained primitive reflexes, difficulty reading or writing, like
when kids hold the pencil more in like a grasp versus how you should hold the pencil when
you write.
If they have issues regulating their emotions, any sensory processing difficulties, finer
gross motor delays, bedwetting can be a symptom of a retained primitive reflex, low tone,
speech delay.
So again, these are overlapping a lot of the things that I see in my patients.
So I found this really interesting.
And so just to give you guys an example of a reflex is the rooting reflex.
So the rooting reflex for an infant, if you were to touch their cheek or if the infant
was near mom and the mom's breast was to rub up on their cheek, their instinct is to turn
their head.
And that is to find their food source.
So again, what they're for, it's for babies' natural survival.
So again, that should be integrated.
But if it's not, what we would see in an older child or a toddler is maybe some feeding difficulties
or some speech difficulties or an oral habit, like a thumb sucking habit.
So there's a whole bunch of different reflexes.
When I met with the OT, she gave me some ones just to be on the lookout for in my patients.
But it's a really interesting topic.
And that's why, especially when you're working with that younger population, to have that
collaboration with an occupational therapist that can really help these kids.
And a lot of the stuff they do to integrate this, it's a lot of play-based.
I mean, she's somebody actually even awesome to have on your podcast and I can share her
contact information with you after.
But for anybody that wants to follow her on social media, her name is Ann Marie DeMarco.
And she puts a bunch of videos out on her Instagram page showing all the work and the
fun that she does with these kids that is helping them integrate these reflexes.
So we've been referring patients back and forth to each other.
So it's been really cool to start working with her because there's just some kids where
sometimes you reach this roadblock and you're like, ah, there's something missing here.
Like, what is it?
And that's why that collaboration is so important.
Like, Mayo is important.
It is 100% totally a piece to the airway puzzle.
But it is not the only answer.
Yeah.
And I absolutely agree with that.
And I want to talk a little bit more about that in a minute.
As parents, what are things, I guess it's twofold, right?
So what are some things that we can do?
Obviously, it's going to be a little easier when they're younger to help prevent some
of this oral dysfunction.
But what can we do with older kids?
We don't really talk about them very often.
What can we do to help open bites or mouth breathing things that we're seeing?
Yeah.
So I think when you talk about older kids, the dysfunction you're seeing is a result
of the dysfunction that probably started very, very early on, right?
So we talk about open bites.
So let's talk about that first.
So things that you can do.
So oral habits are definitely a big one.
So like, thumb sucking, finger sucking, nail biting, prolonged sippy cup use.
I mean, really getting these kids less, you know, not using those sippy cups or at least
getting one that is a little bit better to promote good as best of function as you can.
Sippy cups do not have good oral facial function in mind.
But you can do, you know, you can start sipping out of a straw at six months.
You can start sipping out of a cup, single sips, you know, at six months.
Now of course sipping out of a cup, yes, they can spill it much easier than if it wasn't
a sippy cup.
But we have to think about what the benefits of this are, right?
So those are things that you can definitely do.
The oral habits, like I said, just being mindful, you know, there's so much more awareness.
I feel like we get a lot of moms reaching out to us through Instagram, like sending me
pictures of their babies, you know, with their mouth open, like baby babies, like new babies.
And like, what can I do?
And one of the things that you can do is literally just close their jaw.
Keep reiterating that lip close, lips close, lips close.
You're listening to Airway First with today's guest, Brittany Murphy.
You can find out more about the Children's Airway First Foundation and our mission to
fix before six on our website at childrensairwayfirst.org.
The CAF website offers tons of great resources for parents and medical professionals, including
videos, blogs, recommended reading, comprehensive medical research, podcasts, and so much more.
We also encourage parents to join the Airway Huddle, our Facebook support group, which
was created for parents of children with airway and sleep-related issues.
You can access the Airway Huddle support group at facebook.com backslashgroups backslashairwayhuddle.
Are you a medical professional or parent that's interested in being a guest on our show?
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Then shoot us a note via our contacts page on our website, or send us an email directly
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As a reminder, this podcast and the opinions expressed here are not a medical diagnosis.
If you suspect your child might have an airway issue, contact your pediatric airway dentist
or pediatrician.
And now, let's jump back into my interview with today's guest, Brittany Marchie.
Now of course, if you're hearing the child very congested or they're snorting or they're
wheezing or something like that, then that's a sign that there's some kind of nasal obstruction
going on.
And we want to take care of that.
So oftentimes, you know, referring to an ENT.
And you know, I think the biggest thing is I'm not a mom yet.
I hope soon to be.
We just got married in June, but moms have that gut feeling like that instinct, right?
Like this isn't.
And you go to the pediatrician and the pediatrician says it'll grow out of it or you go somewhere
normal.
Like something just because it's common doesn't mean it's normal, right?
Exactly.
So just following that instinct and keep going until you meet somebody that is going to listen
to you.
And there's so much more access to people in the airway field now than there ever were
with all of the groups and the directories and things like that.
But just for moms to follow their instinct, like, you know, it's not normal that your
kid is snoring.
It's not normal that they're clenching and grinding their teeth.
And these are all things that if we can get to them earlier, the better, because by age
four, you know, 60% of craniofacial development is already complete.
I mean, that's crazy when you think about it by age four, and is already complete.
So why wouldn't we want to start working with these kids earlier?
Myo munchies, myo munchies are really great for younger populations, you know, to start
using moms can order those online.
You can't order the baby one, but you can order, you know, what would it be?
I don't even know what years it would be.
I know you can't order the baby one.
Like two to four.
Yeah, maybe even smaller, it might start maybe at 12 months.
I can't remember what the smallest one starts out as.
You can order that off of the Myo Munchie website and start introducing that to them.
You can work with a myofunctional therapist, you know, at a young age, 18 months to two
years.
It's going to look a lot different than working with like a five or six year old, but there's
still things we can do to help promote better foundations and help to, you know, put them
on a better trajectory to having better habits.
And one of the things that I saw and I can't remember where I saw this, but just to clarify,
you know, when you're looking at your child, is it okay if you notice they only chew on
one side of their mouth?
Is that just, I don't know, like, is that just a habit thing?
When that throw things off with their oral development?
Yeah, so yes, you know, chewing on one side, think about, you know, if you went to the
gym and you only did bicep curls on your right arm, like your left arm, what's going to happen
to you?
Nothing, you're not going to get bigger muscles.
The muscles might even even atrophy, right?
Or get smaller.
Sure.
It's kind of the same idea.
I mean, muscles, you have to use them in order to really develop that good, strong, you
know, foundation.
So sometimes with one unilateral chewing or one side chewing, we can see some facial
asymmetry due to the difference in those muscles.
The other thing I'd want to know if a kiddo was only chewing on one side was do they have
difficulties bringing the food to the other side?
Because sometimes with a tongue tie or restricted range of motion, sometimes even just, you
know, lack of muscle coordination or low tone or things like that, they can't get that
tongue to move side to side.
They can't lack of muscle coordination.
So that's what I'd want to make sure that there wasn't a tongue tie involved.
And definitely something, you know, a feeding therapist can assist with if there's like
actual feeding difficulties associated with that, like any choking, gagging, spitting
up, things like that.
Awesome.
That's good.
So and it makes total sense.
It's just funny.
I'd never heard that and I saw that.
Yeah.
I had one.
So my very first myofunctional therapy patient ever and like looking back, now we got tremendous
results.
Like I'll never forget taking her final photos and being like, wow, like this, this really
does work.
Like I knew it worked, but like now I'm really seeing it.
Yeah, to see it.
It's funny, right?
So looking back though, I would have done her case so much differently.
I mean, at that point, I didn't have the connections I have now.
There weren't as many airway dentists in Connecticut that there are now.
She was a four premolar extraction case.
She definitely needed expansion.
She probably could have used, you know, actually at that point, I don't know if she really
had a true tongue tie.
I think it was more just lack of space.
She was so narrow.
But anyways, her initial chief complaint when she came to see me was asymmetry in her face.
It almost looked like she had some, something went on if she had like Bell's palsy or something
like that.
One side of her face was significantly bigger than the other.
And through myofunctional therapy and normalizing that bilateral chewing process that she had,
we were really able to gain some good symmetry.
Now that's not technically one of our goals as myofunctional therapists.
Remember, our goal is to restore correct oral arrest posture, but through that, we see these
other changes.
So that was really cool with her.
And one of the things was she had dental work done on her lower right area and at her.
So she started chewing on the other side and she only chewed on that left side for years.
Years.
Wow.
Yeah.
It was really cool.
It's always amazing when you've got some on yours and you can see them on some other
websites where you see these before and after.
I mean, even just in posture, it's just, it's just so amazing to me to see them.
Yeah.
I mean, like I said, the second that you get that tongue resting up in the roof of the
mouth, it's just going to help open this area.
And that, you know, myofunctional therapy is so much more than just giving mouth exercises,
tongue exercises, jaw exercises, you know?
I have a close colleague of mine and she was actually on the podcast, Karise Laguerre,
who she likens myofunctional therapy to personal training.
And I love this analogy twofold.
As the trainer or the therapist, you know, you're not just talking about, okay, do this
bicep curl, do this tricep dip and have good form, but you also have to help your client
make good lifestyle changes or have good lifestyle habits.
And it's the same as us for myofunctional therapists with our patients.
I mean, we're talking about nasal hygiene.
We're talking about sleep hygiene.
We're talking about diet.
You know, we're talking about all these different things.
If you're posture, you know, we'll do some posture exercises with patients, give them
tips.
You know, if you're somebody that works at a computer, okay, well, make sure your monitor
is raised up.
Make sure you have, you know, all these a cheer where your, you know, your legs are
at a 90 degree angle.
Different things that we're helping them to just incorporate better habits, even for kids,
kids that play video games.
I mean, yes, we should lessen the amount we play video games, but play that lessened
amount of video games on a medicine ball.
Don't sit on the couch where you're like all hunched over on that medicine ball.
You can help engage that core.
We can support better posture, you know, making sure the screen is directly in front of you
instead of like up or I guess it wouldn't be down for any reason, but we're doing all
of this outside of just the exercises.
The exercises are a small part of it.
That overall awareness is key to creating changes.
You could do your myofunctional therapy exercises twice a day, just like they're prescribed.
But if you add up the time you're doing it, let's say it takes 30 minutes a day, which
usually it doesn't, but let's just say for the sake of math, what are you doing the other
23 and a half hours of the day?
If that mouth is slumped open, if you're mouth breathing, if you're not paying attention
to the way you're chewing, you're not paying attention to where your tongue is, how are
we really going to be able to reach the goals we want to?
So as therapists, it's really our job to help our patients or clients regardless of their
age to integrate these like check-ins with themselves.
So like for instance, if I was working with like a eight-year-old girl, I would say, okay,
I want you and mom to go to the store.
I want you to get a new scrunchie, a really cool scrunchie.
And I want you to wear it on your wrist.
And when you go to school and you look down and you see this new scrunchie, I want you
to think, where is your tongue?
Where are your lips?
And how are you breathing?
So now, around our school day, she has something to serve as a reminder.
So it's not just when she's doing her exercises that it's on her mind, we're having it on
her mind more consistently.
Continuously.
I like that.
I love that.
And you touched on this a little bit earlier.
And so I'd like to dive into this a bit more.
What are your thoughts on why this whole cross-functional, I say cross-functional team, but approach is
so important.
And it sure feels like it's just all of a sudden, right?
Everybody's in the forefront, we're talking about this and we're talking about the benefits
of this cross-functional approach.
What's driving this movement?
I think it's a mixture of there's a lot more professionals getting trained and educated
on understanding the importance of airway and collaboration.
I think that James Nestor's book had a lot to do with it because that was somebody completely
out of the field that wrote this amazing book that brought so much attention to what it
is we do from every aspect, from breathing, from myofunctional therapy to structure.
He literally talked about everything in his book.
So I think that was huge.
I think that, and we all, we thank him so much, it really helped the general public just become
more aware of these things.
And then that importance of the collaboration, I think people are just realizing it's not
a one-stop shop.
You can't just go to the orthodontist, right?
It's not just about having straight teeth.
It's about the airway.
And we have to think, when I go and do a lunch and learn an orthodontic office and they're
like, look, we know about myofunctional therapy, we want to refer you patients, who do we send
to you?
And I kind of feel like a jerk because I'm like everybody because they're literally in
your chair because there's some kind of dysfunction that's going on.
So we can't have one without the other.
I mean, you can put somebody in braces, you can expand them.
Yes, things are going to move and shift while they're literally in these appliances.
But what's going to happen when those appliances are out?
When they're having that, those muscles working in their dysfunctional way, where they're,
the cheeks are pressing against the teeth and collapsing those arches again after this
beautiful expansion you gave to a patient.
And I always explain it to parents.
I have this slide that I put up that has like three triangles and one is function, which
is me.
One is structure, which is an airway dentist or an orthodontist.
And the other one says limitations because even you could even see me and even see that
airway dentist or that orthodontist and sometimes that's not enough because if we have a limitation,
if we have a tongue tie, if we have nasal incompetency, how successful are we going
to be?
Most of what I do, my patients have to be able to breathe through their nose.
I can't, if somebody's main route is orally because they literally can't breathe through
their nose, I'm never going to get them to keep their lips closed and their tongue up.
It's just, I could be the best my own functional therapist in America.
It's just not going to happen.
So we have to be sure that all these moving parts are all working together.
It's just, it is literally so important.
And I'll say to my patients, and I'm very upfront with them because again, I love my
functional therapy, but we're not magic workers.
So you know, if this is the start and this is the finish line, if you don't do the other
things we suggest, maybe we'll get here.
But if you want to get to that finish line, you have to see the ENT.
You have to see the release provider.
You have to see the orthodontist and you have to see me and maybe even a body worker or
big proponents of body workers.
I love that.
I absolutely love that.
So one of the things I like to do, Dan, of every podcast is just completely turn the
floor back over to our guests.
It's whatever you feel that we haven't covered, whatever you'd like to reiterate to parents
in the floor is totally yours.
Yeah.
I would say, I mean, I don't know, we covered a lot and I know you've interviewed such great
people on this podcast.
So throughout all the episodes, I'm sure you've covered like everything, you know, to its
entirety, but I think one of the things I would say, especially this happens more with
the pediatric population than I feel like with our adults, they come to us or they come
to an airway dentist and then they go back and ask the advice from their ENT, their pediatrician,
their general dentist that isn't trained in airway and they become very, very confused.
And sometimes of course you've been with this pediatrician for however old your child is,
you trust this pediatrician.
Yes, you should.
They're your child life for the last however many years, but especially pediatricians, you
know, they have to know so much about everything.
They aren't specialists of this area.
And that's literally not their job and I think that my biggest advice would be, and I always
say to parents when I have clients come back and they're like, oh, you know, we talked
to our ENT and the ENT doesn't really think that there's a restriction.
So I'll say, okay, well, I would love if me, you and the ENT could have a conference call.
I love for the three of us to all get on the same page so that the ENT understands what
I'm seeing from my perspective and I can see what the ENT is seeing from their perspective.
Don't take it's not that bad or it's not that good as an answer because the opposite of that
is what?
Do you want your child just walking around with it?
It's not that bad.
It's not that bad, right?
Or they'll grow out of it.
Like you don't want that.
You want your child to thrive.
So I would just keep asking more questions.
You know, when the ENT disagrees with a tongue-tie diagnosis, why?
Tell me why you disagree with this.
Don't just take what they say as gospel because we don't, I don't know everything.
I learned something new every day.
I mean, that is the biggest thing.
Like we're lifelong learners.
And if you have it in your head that you know it all and you're somebody with that big ego,
you're putting your patients at risk, right?
We always should be, there should be no reason that somebody's pediatrician or ENT doesn't
want to have a conversation with me.
And it does happen.
And it's one of my pet peeves because at the end of the day, like we're all in this for
the same reason.
We're just trying to help our patients and help them thrive.
So let's communicate, let's collaborate, let's learn from each other.
I absolutely love that.
Thank you so much for being on today.
And you mentioned we've had so many great people, but that's why we continue to have
so many of you on here is because you all bring different perspectives and you all are
adding to the conversation and we really appreciate your time.
So thank you.
Thank you.
Thanks for having me.
It was fun.
Thanks again to today's guest, Brittany Murphy for sharing her medical insight and to each
of you for listening to today's episode.
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Take care, stay safe, and happy breathing everyone!