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Dr. Piya Gandhi On Why You And Your Kids Are Breathing Wrong - How It's Affecting Your Jawline, Sleep & Overall Health
01:14:54
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- [00:02]
A
Welcome to the Bostics, starring Lauren Bostic and Michael Bostic. Together, they are the Bostics. Hello, everybody. Welcome back to another episode of the Bostics. Today we have Dr. Pia Gandhi, who is a board certified pediatric dentist with a focus on functional pediatric dentistry. Her practice is primarily dedicated to thorough screenings for various disorders, including airway issues, sleep, speech, feeding, and growth and development issues. Dr. Gandhi also specializes in the diagnosis and treatment of tongue and lip ties, particularly in infants and children with airway disorders. This episode is not only for parents of children or for children. It is also for the adults out there. We talk heavily about the airway breathing, jaw position, sleeping disorders, what we can do as adults, what we can do for our children. And this episode's really for people to understand something that's very basic that many of us look over. We spend so much time focusing on sleep and jaw structure and anxiety and stress management, but many of us are unaware that it could be a root cause of the way our jaw is positioned or whether our tongue's positioned, the way that our jaw is structured from birth, and things that we can do as adults to change it. So this episode, again, is not just for the parents out there looking to help their children, which this episode definitely does. It's also for the adults that are thinking they may have an airway issue, that they may have tongue posture issues, that they want to breathe better and get their jaw more in alignment so that they can live better. We could have kept talking to Dr. Gandhi, on and on with that. Dr. Pia Gandhi, welcome to the Bostics.
- [01:32]
B
I'm so excited for this episode personally, because of what I have gone through in my own experience, which we'll get to, but I want everyone to know this information. So you are our child's dentist. Dr. I think we'll start with getting a lay of the land, which is if there is a parent who's listening, how do they identify a potential airway issue in their child?
- [01:57]
C
The golden rule for pediatric sleep is that children should be silent and still with their mouth closed while they're sleeping. So if there is anything else going on more than 50% of the time, then you wanna pay attention to it. I would say the most common things that we see are teeth grinding, which parents pick up on all the time, because you can hear it and it sounds awful. Mouth open posture or helicoptering in the bed, like just lots of movement. Those are really some of the first signs that we see for kids that are already starting to struggle with sleep.
- [02:33]
B
What are you seeing? The Mistakes that are being made when they see that. Cause I'm sure there's people go to their dentist right away, what are the mistakes?
- [02:42]
C
So some of it, I should say, a lot of it has been a lack of education in the dental and medical field in general about what's normal and what's common. And the detriment of mouth breathing has not been talked about enough. So so many parents will go, myself included. That's how I ended up here. And bring up a concern to their pediatrician or their dentist. My child is snoring or, you know, I can hear them grinding. And so many times the answer is, oh, don't worry, they'll grow out of it. Or that's normal, you know, don't worry about it. And to me, that's the killer is the don't worry about it as a parent, you know, whether there's something going on with your child or not. And too often it's just dismissed. Oh, you're worrying too much. You know, when really most of these parents have the right pulse on what's going on, unfortunately, the conversation is just brushed off. And I know I didn't learn this in dental school. I didn't learn it in pediatric residency. I learned it because I needed it for my own child. And so like the expander that we use now, I came up with that through iterations of what I needed for my own three year old. And we got. I had the same story. She didn't breastfeed. Oh, don't worry about it. Just give her a bottle. She started snoring at three. Oh, don't worry about it, she'll grow out of it. And then it was like, okay, then take out her adenoids and tonsils. We did that. And guess what? It still didn't work. You know, and it was just like, don't worry about it, she's fine, she's fine. I knew she wasn't fine, so I had to start looking for answers.
- [04:22]
A
So what happened to so say our age group, our generation? You know, I think it was very common when we were kids to see many children in braces. Still is. And that. And basically if you went in and you had a tight airway or crooked teeth, that was it. Like, I didn't hear, basically, I didn't hear anything about expanding back then. And I wonder for those of us that became adults that had these issues, maybe they had to get braces or maybe had an airway issue. Like, what does that look like later in adult life if you don't address it?
- [04:52]
C
There are many adults our age in our generation that have poor sleep and sleep apnea. We've somewhat normalized that for adults as well. You know, oh, you're just getting older, you have poor sleep, you're tired all the time. I have four kids. Really, what the struggle has become is now as an adult, restructuring your jaw is jaw surgery, which is much more extensive. And then just talking about the mouth breathing component of it. Mouth breathing is habitual. So if you've been doing it for 40 years, yes, you can get your jaw restructured, but then you also have to retrain those muscles that have been doing the wrong thing. But really what's happening is our overall health is declining because poor sleep is going to impact your entire body function as an adult. Cardiovascularly. You know, weight loss, anxiety, like mental health is huge. And so we're seeing our generation on a lot of anxiety meds, on a lot of, you know, blood pressure meds. And what we're doing is we're just like slapping band aids on all of these symptoms. And the root cause is poor sleep and a poor airway.
- [06:03]
B
Let's give the audience a visual perspective of exactly what we're talking about here. We've all seen the meme of someone who is a mouth breather and a nose breather, and the. It's a drastic difference in the way they look. Yes. If you could describe to the audience what that each looks like, how would you describe it?
- [06:20]
C
Yeah. So a mouth breather, because their posture, their resting posture is like this. Everything starts to go really long.
- [06:28]
B
Like, their mouth is hanging open.
- [06:30]
C
Their mouth is hanging open. But mouth breathing doesn't even have to be fully hanging open, even if there's just a little space. You are now removing the pressure of your tongue on the roof of your mouth. So we're not getting growth this way, we're getting growth this way. We call it like your face is melting, essentially, you start to lose your chin. Because now we have this open posture. The nose becomes very pronounced. You don't have great cheekbone structure. And then even if you look at the eyes, they're kind of downward slanted. So literally everything is melting this way when really there should be great structure growing this way. So when we start to put pressure this way, it starts to support our cheekbones. It evens out our facial proportions. We have nice defined, like, jaw structure.
- [07:17]
B
It's harmonious.
- [07:19]
C
Yes, yes, exactly.
- [07:21]
A
A lot of people are starting to talk about this a lot more now. Right. Like, you are way ahead of the curve. But, you know, Lauren's, got her mouth taped. Because we've addressed the sleep issues. We've had people come on and talk about nasal breathing. There's that book Breath by James Nesters. Right. So, like, this is now starting to become more discussed. But I think, again, our generation was of the generation where when you looked like that or had these issues like, oh, I need the chin implant, or I need the nose job, or I need whatever, like, cosmetic surgery to fix some of the things you're talking about. But to your point, none of that addresses the root health cause or the root issue around health, because you may look different esthetically, but you still have the sleep issue and the blood pressure issue and the anxiety issue because you haven't actually fixed the structure well.
- [08:08]
C
And those other structural surgeries, you know, chin implants, septal surgery, those things are limited by the underlying jaw bone structure. So there's only so much, even esthetically, that you can get away with with that. But to your point, you're not actually fixing the function. So adults that have had good jaw surgery, they look like they've had a chin implant and a nose job because we fixed.
- [08:36]
B
Can you say this to the freaking Internet, please? Can you say this to the Internet
- [08:43]
A
for new listeners and viewers? Yes, for new listeners and viewers. Lauren documented she had jaw. What do you even call the jaw mass? Jaw. She had massive jaw surgery in 2015 where they literally broke. As I was there, they broke her whole jaw. Moved it forward. It's a brutal surgery.
- [09:00]
C
Yes.
- [09:01]
B
Top and bottom.
- [09:01]
A
It's a brutal surgery. I couldn't believe it. And then they basically wired her back shut. But I think. But after that, everyone's like, oh, did you get a nose job? You get a chin? It's like, no. But literally, they moved her face in her jaw into a different place in her skull. Yeah, but is that. And so if you're an adult and you don't address this as a kid, is that the only option, or are the things you can do to start moving the jaw back in place really
- [09:23]
C
to make significant difference? The surgery is the way to go.
- [09:27]
A
So if you're way off, that's kind of.
- [09:29]
C
So I see some adults, and many of them are, you know, my patients, parents, and they're seeing that that is what brings the them in with their child is they're experiencing some of this as an adult. And so when I assess their airway, you know, some of them do ask, like, is there something else I can do? Can I put an expander in? Can I, you know, wear A sleep appliance. The sleep appliances will help temporarily because they posture your jaw forward during sleep, so they open up the airway a little bit. But it's not gonna be a long term fix. Same with things like septal surgery or turbinate reduction and expansion. Unfortunately, even if it's just width wise, so not a double jaw surgery, it's still surgical because everything is fixed at this point. So there are different levels of surgical intervention. But if you are deficient in what we call like the. Which is called the posterior airway space, which is when everything is set too far back, the only way to advance forward permanently is with jaw surgery.
- [10:32]
B
So you mentioned chin implant. And the reason that I was against actually doing plastic surgery to my face and I chose the jaw surgery was because I have seen people get a chin implant instead of do the surgery. And what happens if anyone's listening and decides to get a chin implant that I've seen is it gives you this, this chin, but then your upper part of your mouth is back. So now you've created almost this synthetic face. Literally.
- [10:59]
C
Yes.
- [11:00]
B
That. Where the chin's forward, but the. But the upper is back. What? I don't know if there's a word for that. Is there a word?
- [11:05]
C
I mean, it's really with the upper jaw being back. It's called maxillary retrusion. Yes, yes. But it becomes much more pronounced when you start messing with the other things. What you had just talked about is creating balance. When we expand, we create a balanced looking face. And if you look at celebrities or models or, you know, anyone that is just aesthetically pleasing to almost everybody or the, you know, the naked eye, they all have very balanced faces. So those, those are the people that are more likely to also have the healthy airways.
- [11:38]
B
I noticed in other countries that there is a different diet where they're working out their jaw on a daily basis based on what they're eating. In America, I notice a difference. And this is maybe because I've become a practitioner of the jaw. Have you seen this?
- [11:55]
C
Yes. And this is why the majority of children that are in my office have underdeveloped jaws. Our diet is a huge part of this, and baby food is where it all starts. So we have this huge culture of purees and pouches and dissolvable crackers and even convenient vessels to drink out of that are all working against a natural swallow pattern. Good chewing skills. And that is how our face develops is by chewing. So when we have young patients, and let's say I do a tongue tie, Release on an infant at their last checkup visit. The big thing we're talking about is how do we continue good jaw development moving forward. And a big part of that is baby led weaning. So baby led weaning is the technique of introducing baby food and skipping over the purees. So we go straight to table food. Squishable solids that you can stir, squeeze between fingers because jaws are really tough. Like you can chew through a lot with no teeth. And so what that does is it starts stimulating the growth right away. When we chew, we also exercise our tongue. So we move our tongue side to side. And that is a great way to get tongue strength is by chewing. So when our little ones go to therapy, that's how they get the tongue moving is through food. And then there's this product that you guys are familiar with, the myo Munchie. Essentially what the creation of the myo munchie has fit a place in our society because we're not chewing our food. Normally we would just get normal growth from chewing. But our food is so processed that we have lost a lot of that. When I ask parents about their child's eating habits, you know, the generic question is, is your child a picky eater? That's too generic. And we've normalized picky toddler eating. The other thing we've done is we've made a lot of pre chewed food. So when I ask parents, does your child eat meat? I ask them meat that's not in a hot dog nugget, shredded or ground form. Because essentially all of those things we've pre chewed. So they're not using those skills. And so it's a, it's a poor assessment of actual oral motor skills. And it's also, we're not getting any growth out of those things with that.
- [14:14]
A
Also as adults age too, it's a lot of adults with smoothies and soft foods, potatoes, like. Yeah, so grab a meat stick.
- [14:21]
B
Yeah, well not a meat stick either though, because they're now saying that those have.
- [14:26]
A
Well no, no, not the, not like,
- [14:28]
C
I mean the more whole raw food that you can get, the better. Eat the apple, not the applesauce. You know, it's, it's small substitutions but they're not as convenient. That's, that's the thing is we're a culture of convenience. And so Even these like 360 Miracle Cups or whatever, you know that kids drink out of that, if you turn them upside down, nothing comes out because you have to bite on them to actually drink that Is teaching a totally abnormal swallow pattern. Well, how does our upper jaw expand? By swallowing thousands of times a day. So if we're doing it incorrectly, we're not getting the appropriate pressure and we're not expanding.
- [15:06]
B
What's the brand of the water bottle the kids should be drinking out of?
- [15:09]
C
So it's, it doesn't have to be a specific brand. It is a flexible straw cup or an open cup. That's it. Millions of brands out there.
- [15:19]
A
So just like a normal, normal, normal straw.
- [15:22]
B
I want to pick on us for a second and hopefully you can help with this. Obviously our baby just started eating solids. We're trying to strengthen his tongue posture because he got a tongue tie release, which we'll talk about. What are the foods that you would introduce to him? He's so little. We obviously want to be careful of choking. What are the foods?
- [15:43]
C
So like sweet potato and avocado. The rule generally is anything, even if it's a carrot, you're going to take it to a consistency where you can squish it between your thumb and your index finger. That's kind of the rule.
- [15:58]
B
What about meat? How do I give him meat?
- [16:00]
C
Yeah, so meats, Meat's a tricky one. You're gonna make it small and you're gonna cut it small. And I would start with softer meats. You know, I'm not a feeding therapist, so like a lot of this I defer to our in house feeding therapist when I identify that we're not chewing correctly. But generally with baby led weaning, the rule is if you can squish it between your fingers. And meat is not the first thing I would go to on a, on a kid. Like a little kid that age, like avocado, but avocado. Yes. And then once we get some more, like he's got two bottom teeth, but once we get our molars, then we can move on to things like meat where we can actually chew a little bit better. But initially I would start with the veggies that you can squish between your fingers. Carrots, sweet potato, broccoli, like cooked carrot. Yeah, cooked, yeah, all of this cooked. Anything you can't squish, don't give them.
- [16:49]
B
I am getting rid. I'm gonna go on a fucking rampage after this. And I am getting rid. We were puring liver. I was like, oh, I'm being healthy with the liver.
- [16:57]
C
So it's like you can probably give him liver. It's, you know, if it's soft enough, just give it to, don't puree it.
- [17:03]
A
But Is it, is it a, you know, if you wanted to give them some of the like. So right now if we want him to give him some pureed, is it okay to do that? If in combination you're first giving him the other stuff? You just want the exercise of the tongue and the chewing.
- [17:15]
C
Yes. The other thing with.
- [17:16]
A
Because what you don't want to do is like underfeed them if they're right.
- [17:19]
C
And the, the other thing is with baby led weaning is it's about the chewing, but it's also about teaching them like self feeding and self regulation. So like when they are done eating, you know, we're not just shoving food in their face constantly. So it just teaches them to listen to their bodies. Also just healthy habits for eating from the beginning, you know, how do you
- [17:40]
B
know and how did you know with our baby that they need a tongue tie release? Because when we were in the hospital, they say, oh, you don't need one. But I said, I'm calling Dr. Gandhi.
- [17:49]
C
Yeah, so I think that's a common
- [17:51]
A
thing for a lot of parents.
- [17:51]
C
It's a huge thing.
- [17:52]
A
A lot of parents are told and I could say that we've had three. So I can, I'm going to confidently say a lot of times you're told that they don't have a tongue tie when in fact they do.
- [18:01]
C
So it's a complicated situation, some of it being hospital politics. Lactation providers are in a lot of hospitals not allowed to say if there's a tongue tie or not. I have parents that come in that say, yeah, I got your name like on the sly in the hospital. Because there's a lot of medical practitioners that still, I hate to say, don't believe in this because it's not a thing to believe in, it's an actual thing. But they didn't learn it in medical school. They don't know enough about it. They say there's no research, except now there's tons of research that they just haven't read. So it's a, it's sort of a taboo thing that in the hospital, like you can't really talk about it and how we know in our office, well, you have to do a thorough diagnosis. And again, even sometimes when parents are sent to a practitioner to look at a tongue tie, they're sent to ents commonly that just take a quick look and say, oh no, they're fine. Well, what it looks like is one piece of it. It's really what it's doing in terms of movement and function. So when you guys came in, we have you fill out like a symptom form. What are you seeing? How are we feeding? Is there already mouth breathing? You know, are we having trouble on the breast or the bottle? Are we gassy? Tension in the body is also very much related to ties. So babies that are colicky, you know, they tend to have more tension and some of it is because of the tongue tie. So when we do our assessment, yes, we look at what that tie looks like or the frenulum. We also have you fill out what's at home. And then lastly I do a comprehensive movement assessment, which is the most important part. We're going to see how they're sucking, we're going to see how the tongue is elevating, how it's moving side to side. That is our biggest tell of what's going on. And it's, you have to put all those pieces together because some babies will have no symptoms feeding, especially if they're breastfeeding and mom has this amazing milk supply. Well, guess what, your tongue doesn't need to work very well, very much.
- [19:54]
A
You know, I think we're hypersensitive to it because Lauren, again, going back to her, had to have later in life massive jaw surgery. My follow up question to that is if you're a parent that has an airway issue, maybe you're a mouth breather or, you know, you're like you, you've got a narrow pathway. Are your kids more susceptible or, or not.
- [20:12]
C
Genes play a role in this for sure. Tongue tie is definitely genetic. I mean, I see parents with it and then all the siblings. The exact inheritance pattern, we don't really know, but it's a very high likelihood that if you've had one child with it or you have a tongue tie, that you should really just get all your kids checked for it.
- [20:35]
B
I got your name on the sly from Allison of Branch Basics. She told me to go to you. So that's so interesting that you say that. And the person that told me that Bond had a tongue tie was my cranial sacral doctor, Dr. Maria, who I love. Why is cranial sacral so important to this equation?
- [20:54]
C
Yeah, so again, it's going back to full body function. So when we look at things like a tongue tie, it's going to impact the tension in the body, the swallow pattern. Craniosacral therapy is really working on the connection between the head and the pelvis. And so if we have a tongue tie, we are more likely to have underdevelopment of the cranial bones which is attached to the rest of the head. And then if there's tension here, it actually is pinching on our cranial nerves, and then our cranial nerves are not firing correctly. Well, guess what's controlled by those cranial nerves? Suck, swallow, digestion, movement, breathing, diaphragmatic movement. All of it is connected. So when we do cranial work, with or without a tongue tie release, we're going to get better alignment of those bones, better pumping of the CSF fluid in the spine, which is the way we nourish our nerves and have them fire correctly. So all of this comes back to the fact that when we're dealing especially with airway breathing, sleep, tongue movement, we have to look at a whole body. We can't just, like, look right here.
- [22:04]
B
Someone told me, off air, that colic is actually not even a real thing, that it was created because people wanted to sell medicine for it, and that what colic actually is, and I want your opinion on this, is when the baby's coming through the birth canal or being pulled out through C section, that the body is out of whack, and that is a traumatic experience for the baby. And cranial sacral helps make the energy flow and fixes that, which then takes away the colic.
- [22:36]
C
Yes. So I. I don't know that I'll go all the way to say it's not a thing at all. But what I will say is I have many babies that have colic, and when we address cranial strains and tongue movement, that the colic goes away. Now, we touched on something about the birthing process. So it's called birth tension. And birth tension is exactly what you said is when we have a baby delivered via C section, there is so much pressure put on their head when they're coming out that it causes what's called subluxations. And that is when your vertebrae go slightly out of line. When your vertebrae are slightly out of line, that affects the nerve firing. Well, again, those nerves control digestion, which is going to impact gassiness. So it's all connected. So, you know, chiropractic care, cranial sacral therapy. I mean, I wish I knew about these things when my daughters were born, because. Because I think every baby, tongue tied or not, no matter how they're delivered, should see a craniosacral therapist and a chiro immediately after birth.
- [23:41]
B
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- [26:48]
A
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- [27:10]
B
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- [27:24]
A
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- [27:50]
B
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- [28:02]
A
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B
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A
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- [29:41]
B
Do you think that Michael, who has delivered a C section, could have headaches and migraines from his birth?
- [29:48]
C
I would say that the impacts of it probably created a domino effect that we're still seeing.
- [29:53]
A
Yeah, well, I mean, and my mom talked about this like I think she, they, I was the first one in my family and they tried naturally and then vaginally, whatever, and then could not and then a C section. And I heard it was like a bit traumatic. But what I think to your point is it sounds like the symptoms of colic are obviously very real, but maybe the root cause people do not understand. And so to clarify, like I don't think we're saying colic symptoms are not real, but people may not be aware of why they originate and what to do about it.
- [30:25]
C
Well, and the way we're told to treat it is with gripe Water or whatever that. I mean, it doesn't really work.
- [30:32]
A
And if you're talking about what all the things you just described, the gripe water is. A little burp's not gonna solve all of that.
- [30:38]
C
Right.
- [30:38]
A
If I could just take some gripe water for my headaches, that would be wonderful.
- [30:41]
B
But gripe water also has natural flavors,
- [30:46]
C
just so everyone knows. But this is also what we're doing with everything. That's a dream, that's a effect of a poor airway and poor oral motor function. We're just throwing a medicine at it, or, you know, like, we're treating the symptom. We're not looking at the why.
- [31:02]
A
So I want to focus. And again, we'll go back. I will keep going back to the kids. But for adults in their 20s, 30s, 40s, older, and they're dealing with this, and they know they have an airway issue and they're sleeping poorly and they have anxiety in their mouth breathing. Many of them may be using Lawrence mouth tape. What are some things that they should be thinking about and who are. And who are the people they should start to go and see if jaw surgery is one of those options. What. What are the things in between in the information they need to collect?
- [31:29]
C
So the good thing is, is in the dental field, there are a lot more practitioners that are becoming more airway aware and focused. So trying to find, for an adult, it would be more of a general dentist that is airway focused. And there are lots of great online resources to locators to find these dentists. Airway Health Solutions is one. The Airway Circle is another. The Breathe Institute. So starting there, and they may not find a dental practitioner. What they might find is a myofunctional therapist or a chiropractor, but just someone that is airway aware that can start their journey for them. Because what happens is, yes, there's more people trained in the dental field, but we're still not everywhere. I mean, you guys drive to me, right?
- [32:16]
A
We do the Houston pilgrimage, the Buc ee's journey.
- [32:21]
C
So I don't want people to get paralyzed by the fact of, well, I don't have a dentist right near me. Okay, well, let's start somewhere. And myofunctional therapy is a type of therapy that the goal of myofunctional therapy is lips closed, tongue up, breathing through your nose, proper swallow pattern, all the things that are going to help support a healthy airway. And even if you need jaw surgery, that type of therapy is going to support all that structural change. That you do. And so that is a great place to start and generally more accessible than finding an airway dentist. If you can find an airway dentist in your area, awesome. Or if they do virtual consults, then, like, for me, if people contact me and I know they need jaw surgery, then I'm going to send them to the Houston team of surgeons, if they're in Houston. But you don't need to go from nothing to going all the way to the jaw surgeon first.
- [33:14]
A
So if she would have done some of these therapies before she did her surgery back then, would she?
- [33:18]
C
When I was little, though?
- [33:19]
A
No. But I'm saying even before the surgery, would she have had an easier recovery?
- [33:22]
C
Yes. So myofunctional therapy is, again, not something that oral surgeons are taught about. So they're taught about the surgical techniques of, you know, moving the jaw, but it's almost equivalent to, like, when you get knee replacement, you do pt, right? They don't just replace your knee and say go. So it's the same concept. We have to do some physical therapy for our orofacial region in order to support that structural change that we're going to do. Especially on an adult that has been having this structure for years and years and years, Kids, bodies are a little more forgiving. But even then, we can't just isolatedly start shifting things around and thinking that the rest of the body is just gonna magically adjust to that.
- [34:07]
A
Okay, one more question from an oral health perspective. Say you have two patients that start in the same place, one with a poor airway issue, one with a jaw, a good jaw truck.
- [34:17]
C
Yeah.
- [34:17]
A
What happens from an oral health perspective to each of those people's teeth if they start in the same place?
- [34:22]
C
So it's funny, I was talking about this the other day about how a big thing is cavities. Right. And what we're taught in school is you just have to, you know, brush twice a day and floss, and you won't get cavities. Well, that's really not true. Really. It's more related to our oral function. So the way we breathe, mouth breathing, dries out your mouth and our saliva is what protects us from cavities. And so huge increased risk of cavities with mouth breathing. The other thing mouth breathing is going to do is it's going to change your oral microbiome. And so we all know, like, gut and oral microbiome is huge in terms of disease and inflammation. And lastly, tongue function, if we do not chew well, then we're eating a lot More softer food, a lot more higher carb food. Again, increased risk of cavities. And we clean off our teeth after we eat subconsciously with our tongue. So if the tongue has poor tone or it's not, you know, moving correctly or tied, then we're going to have residual things on our teeth. Longer teeth grinding. All the adults that are fracturing their veneers and crowns. Why is that? It's because they're bruxing really hard at night. And that's not a stress issue. That's a poor airway, poor sleep issue. So when we try to teach, like, general dentists about airway and why they should care about it, one of the big things that we say is it's going to make your dentistry last longer. Your results are going to be better because you're going to be putting these in mounts that are functioning correctly. Otherwise you're just setting these patients up for failure.
- [35:58]
A
So if somebody has. Or they're getting, you know, a ton of cavities, it's also potentially a good indicator that they have an airway issue.
- [36:06]
B
Yeah.
- [36:07]
A
Because it's not. It's not normal to get cavities that frequently if you have a good airway posture with proper survival.
- [36:13]
C
Yeah. Also if you're. If you come in and tell me that you're, like, doing all the things, things, the brushing, flossing, the, you know, for kids, not a lot of juice and all that other stuff, and we're still seeing, like, all these cavities. Something else is going on here.
- [36:25]
B
You know, I want to say, and this is the perfect episode to say mouth taping has changed my life, because, yes, I had jaw surgery and that was great, but I was still. I didn't do the Maya work, so I'm starting to do that now. And the mouth taping has truly changed so many things. And I haven't been able to articulate it until you came on the show, but you're right. Like having the tongue posture and teaching the tongue, and my eyes are brighter. I notice my jaw has gotten stronger and sharper. I notice even my posture has gotten better from mouth taping.
- [37:01]
A
There's things you don't notice as well. When we first started dating, sleeping together, she used to snore so loud, like a wilderness. Like somebody was running a chainsaw next to my head.
- [37:10]
C
Wow.
- [37:10]
A
Like insane. The jaw surgery made it better, but still now when she does, the mouth tape, like, that goes away. But I mean, it was. If you would. If you would walk in, like, I didn't. We don't need a guard dog. So when you hear that, they're just like, they'll run away.
- [37:21]
B
Do you believe in mouth taping? And if so, what are the benefits?
- [37:25]
C
Do I believe in it? Absolutely. You should come to my house at night, and everyone has mouth tape on, including my children. And in fact, they feel such a difference in their own sleep that if they run out of mouth tape, it's like, I mean, the world is ending in our house. And so I 100% believe in mouth tape. With that said, I don't recommend that people just start putting mouse tape on flippantly. Okay? Because some people do not have a healthy enough airway to support mouth taping. So parents ask me, well, you know, should I do it? And I. The first thing I would say, even for an adult, is try it while you're awake, like watching TV or doing something silent, reading a book. Because if your airway can't handle it, you will start to feel a little panicky in your body, and then you definitely don't want to do that at night. That means, okay, your structure is not where it needs to be. But to your point, mouth taping can really help with the habitual side of mouth breathing that even after your jaw surgery, you needed to do some retraining of your lips and where your tongue should go. And the same thing with. With kids that have, like, adenoid and tonsil surgery, the snoring sound will go away, but their sleep quality still may not be where it needs to be because there's still that mouth open, habitual breathing that's happening. I know I feel a difference the nights if I forget to tape.
- [38:47]
B
Oh, yeah.
- [38:48]
C
There's a huge difference in the way I feel in the morning.
- [38:51]
B
Huge.
- [38:51]
C
And obviously, like, I'm not walking around all day with my mouth open. I wouldn't say I'm a mouth breather, but it's at some point of the night, obviously, I'm still opening my mouth. And I think most people are.
- [39:02]
B
They are.
- [39:02]
A
Lorna. She's so annoying.
- [39:04]
B
I take video. His mouth is open.
- [39:06]
A
She's like, you got a millimeter going.
- [39:08]
C
And she's like, still. That's still a thing.
- [39:10]
B
Can you tell him to tape his mouth? Should I keep telling him?
- [39:12]
A
You know, I also.
- [39:13]
C
Have you tried it?
- [39:14]
B
No.
- [39:14]
A
No, I love it. I had a reverse question. I noticed sometimes one of my big problems is clenching.
- [39:20]
B
No, but your lips are still open.
- [39:22]
A
Sure. But what I'm saying, for people that clench and I wear the mouth, the guard, obviously, for. To guard my teeth, but that's an arrow issue. So is that, where does that come from? And is it, and what's the effect of that over time? So I get tension.
- [39:34]
C
So bruxing, grinding, clenching. It is low level stimulation for your body so that you don't fall into an apneic state. So it is your body's way of keeping you breathing. The problem with that is that you're now active during sleep. So your quality of sleep is not great. Also, anyone that has smaller structure or suboptimal function, they're going to have what's called para functions. So things as a result that are not normal for kids, sometimes we'll see like they, they have like oral fixations, nail biting. It's just because the harmony is not there, the systems are not working the way they're supposed to and together. So bruxing is along those lines and clenching. So similarly, what have we done? We've given every adult a night guard to wear. But that's not really fixing the problem that the airway is not functioning well. And then what happens long term we have TM joint issues. Again, there's those joints start degenerating very quickly if you're bruxing and clenching. So like the oral surgeon I work with a lot, he's like, no one needs TM joint surgery. Like, no, we don't need TM joint specialists, we need airway specialists because so
- [40:46]
A
what we really need, what does someone like myself do for that? Is it a, is it trying to expand? Is it a tongue tie issue?
- [40:51]
C
Is it, I mean, I'd have to look at. It might be all of the above. Yeah, it's very rare that it's one thing even for children. So as an adult, if someone thinks they can fix everything with one thing, I would be wary of that because it's multifactorial. This is where working as a team, like having a team of people that you work with is really important. Because as I just said, I mean, you asked me questions about baby led weeding. I'm not a feeding specialist, but I have great feeding specialists that I work with. With adults it's the same thing. I'm not the jaw surgeon, but I release the adult tongue ties and can provide the myofunctional therapy in the office. So usually we're looking at an adult, we're taking a scan of your airway, so we're looking at the anatomy and that's the anatomy of your upper airway. But your nose, your sinuses, all of that, your TM joints and then we're looking at the size of your palate and whether you have a tongue tie or not. So it's all of these things combined. We have to take an overview and then kind of dial in what are the things and in what order do we need to address them.
- [41:58]
A
Our friend, Dr. Jerry Curatola, do you know him? He's. So he did a conal beam scan of me and he did. He said, I have a tongue tie issue. And my big thing is when I was younger, I was probably not as kind as myself that I should have been, and I have broken my nose multiple times and I have sinus issues. And so he's saying I gotta fix that and potentially do the tongue tie. And that would be like, where I need to start mixed with myofascial.
- [42:21]
C
Yeah, yeah. And.
- [42:22]
A
And I would have never thought that I had that issue because it was clenched. But then as I've gotten older, I realized, like, everything you're talking, I'm like, oh, yeah, that's exactly what I'm doing.
- [42:29]
C
Well, the other thing that happens when we age just naturally is our bodies don't compensate as well as when we were children. And that's why looking for the early signs on children of deviation of growth, they may not have the laundry list of symptoms that we know is coming in adulthood. But the point is, is those early symptoms, they don't just disappear on their own. You know, people when commonly pediatricians will say, oh, they'll grow out of it, like us in the airway field. We joke, no, they're going to grow further into this problem. We're just going to start compounding shit on top of this. When their bodies are not resilient like they are right now. And so if. And the way to change their path of growth when they're children, it's not, you know, magic, but it's so much easier than trying to do whatever we're doing as adults.
- [43:23]
A
Oh, our kids get sick and you have the flu and they're down for 14 hours. We're down for like a week.
- [43:29]
C
Yeah.
- [43:30]
A
Can't recover.
- [43:31]
B
If someone wants to expand their palette as an adult, what does that look like? Is the only way to do that through. Is it called Sharpie Marpy?
- [43:39]
C
There's marpy, there's Sarpy. And I don't, I don't have a robust knowledge on the adult expansion. But yes, there's. There are some providers that will do things like, I don't know if you've heard of, like, the Vivos appliances. So they are removable, sort of mouth guard type appliances, historically, those are not going to give you significant expansion. So the difference is when you look at a palate and you expand, you want to make sure that the expansion is actually bone movement, not teeth tipping. So sometimes people will say, oh yeah, I got like 3 more millimeters from this, whatever they're using. And really all they did was they tipped their teeth out. Okay. A couple of things with that is that's not very stable for the teeth. And that type of movement may visually look like you expanded. But what didn't happen is you didn't get any actual bone separation. When you're actually expanding, you want the bone, the palatal bones to actually separate. That is how you get airway improvement, not just a better looking arch. How do you do that on adults? It's surgical. So the palatal bones as an adult, they're already fused.
- [44:59]
B
Got it.
- [44:59]
C
And so they will surgically separate them and then they will put in an expander similar to what the kids get, but they'll be screws into the bone. And then when you turn the expander so it doesn't really. It attaches to your teeth and actually in your bone.
- [45:17]
B
So it's not like surgery like you're put under. It's more of like a procedure that you wear.
- [45:22]
C
And but most of that development is going to be lateral expansion. So if you need forward movement, you're not going to get a lot of it. Just with that. That's where the surgery, the like what you went through really comes in.
- [45:37]
B
Tell us about the process of a mother and father who bring their child in that needs a palate expansion, what that looks like specifically for the audience.
- [45:46]
C
Yes. So we're gonna do what's called an airway consultation. And we do like both parents to be there if possible, so we can show them everything. The first thing we're gonna do is take a CBCT scan of their upper airway. So is it a cone beam thing? That's the cone beam, yep. And it just, it's a 12 to 15 second scan where they stand and the thing goes around their head. Pretty easy. We're going to take pictures of their entire body because as you were saying, like posture is affected, symmetries are affected. Then we're going to take intraoral pictures as well to see what their bite looks like, what their palate looks like.
- [46:25]
B
And they're going to cry and scream. So get over it sometimes.
- [46:27]
C
Yes, yes. But you have to be very gentle
- [46:31]
B
on the tv, there's toys, there's everything.
- [46:33]
C
So we do this starting, you know, two and up. So obviously age range is gonna matter as to what, how they're gonna handle some of these kids.
- [46:41]
A
In a perfect world, if you like, forget how they behave. But in your perfect world, what's your ideal age to get your hands on a kid that has the issue?
- [46:49]
C
Definitely under five, if I can catch them. Two, three, four. That's awesome. Four to me. Well, not just to me, but four is our peak growth of our upper jaw. So if a kid is narrow at 4, they're not catching themselves up. So I don't know why we would wait till 7, 8, 9, 10 to fix it.
- [47:08]
B
So we got our daughter in right away? Yes.
- [47:10]
C
Okay, so we've taken the pictures, we've taken that CBCT scan, then we take an intraoral scan. So if you were. If you're an adult and you had braces or a palatal expander, you probably got those, like, molds taken with the gooey stuff. We don't do that anymore because that's really hard to handle. We have a little intraoral scanner. It looks like, like we call it a magic wand. It takes digital images of the arch. That is what we use to send to our lab to make our custom made expanders. So I put all those pieces together, what the photos look like. I look at the airway during that consultation. I will pull up the airway scan in the consultation room and I will show the parents. These are the adenoids, these are the tonsils. This is what the sinuses look like. Is there already a deviation on the septum? What does the airway space look like? Because images are a thousand words, right? So when I can show them that their child's adenoids are huge and really constricting the airway tube, it's like a traffic jam or a bottleneck on a highway. So if that's sitting right behind the nose, when we're trying to get air through the nose, it's gonna get stuck right there. So what is the child gonna do? Open their mouth? And then we look at mouth breathing. So I show them that image, I walk them through what I'm looking at. I also send that to a radiologist to get a second set of eyes on it. And then I do my clinical exam. During that clinical exam, I'm looking at tonsils, I'm measuring the palate. I'm also looking at their face. You know, what is, what is their profile look like? Do we always. Do we already have a, you know, a retruded bacilla or mandible or upper or lower jaw. I'm screening them for a tongue tie. Mouth breathing is so easy to pick up on if you just look at them in the chair. A lot of them will also have chapped lips chronically, because of the mouth breathing. And then we're putting all those pieces together, so I'm breaking everything down. For the parent, if they need expansion, we're showing them examples of what those expanders look like. Each of them are custom made, so we'll show them a sample, but they're all custom designed, depending on what kind of movement the child needs. The fun part for the kids is, you know, there's colors and glitter that they can choose, like glow in the dark. The great part about this and the question that I get most is, especially on the young ones, are you gonna have to put them under to put this in? It is the easiest insertion because these are custom made. They sit on top of teeth. They're 3D printed. Is there an adjustment? Absolutely. There's something new in the mouth, and we are trying to swallow and speak with it in, but none. Nothing about this is painful, even at home when you're activating it. It's such a slow schedule because we're trying to mimic natural body growth so that we're not putting the body into shock because this is impacting our nervous system. So we try to be really gentle, and that leads to, you know, generally a smooth process. We're dealing with children, so, you know, there's no guarantees. You have to. You have to kind of always be ready to pivot. But generally, this is a much easier process and a simpler process than I think a lot of parents anticipate. And that's really what we're trying to do, is do something that's not traumatic but highly, highly beneficial.
- [50:19]
B
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- [55:20]
A
to have you on and talk about this is what we're, I think as many parents with young children that this could reach. Like, we hope that happens. But what we're also trying to avoid is a situation that Lauren had to face, which is you. You become an adult, you never address this issue. You go through poor airway habits your entire adult life, and then you have to have a massive surgery that's, you know, it's a. That was a traumatic surgery that she had to go through.
- [55:41]
B
People have no, no idea. I had a full identity crisis because I got the surgery. And when. When the surgery's over, it's like, okay, go on your way. I happened to have a couple infections after, so I had to keep going back to get those out. Finally, when I was out, you lose a dramatic amount of weight immediately. Cause you can't really eat. But then you look at your face in the mirror and it's so swollen and you look different and you. I literally had an identity crisis. I couldn't even look people in the eye for about a year and a half. I was insecure, self conscious. I will say, looking back, though, it humbled me. I really realized, like, I don't want to use my looks to lead. I need to use my personality and my knowledge and my intellect. So it did do some great things. But that surgery takes a year or two of your life and makes it very chaotic.
- [56:43]
A
Well, you know how most surgeons are. And I guess they have to do this. Cause or else nobody would get surgery. Everyone's like, yeah, you'll be fine. It'll be easy. And then, like, you get out the other end.
- [56:49]
B
It's a huge surgery.
- [56:51]
C
Huge.
- [56:52]
B
The one that I'm still dealing with. I just had my screws out.
- [56:54]
C
Yes.
- [56:55]
A
It was a six hour. She was under for like six hours.
- [56:58]
C
Yeah. Do you regret it, though?
- [56:59]
B
No.
- [56:59]
C
Okay. Yeah.
- [57:00]
B
I don't. And I want to say that to everybody. I don't regret it for one second. It's. It changed my life. It changed my posture. That with mouth taping and the myofascia that I'm going to do, and the cranial sacral. All of those things have set me up, I think, to be comfortable, aligned and harmonious in my body.
- [57:17]
A
But I guess what I. What I think about is she may. Maybe she still would have needed a surgery, but if she would have done this as a little girl, as you're describing, the preventative stuff, or, or even just the, The. The. The retainer. Would the surgery have had to. Even if she had to get it, would it have been as intense with less.
- [57:35]
C
Yeah, she. I mean, the development would have been better. So even if there needed to be some movement, it may not have to have been as much. And the more movement you have to make, the more dramatic the surgery. And when we talk about early treatment, yes, expansion at 4, but if we can catch babies that have ties, that's the place to start. I mean, because 50 to 55% of that jaw growth is done by age two. And what's doing it. Our tongue, our mouth closed, and the way we're eating. So if we can screen somehow every baby for a tongue tie, that is the best point of entry right there. Because even to that point, some of the babies that I've released, as, you know, their tongue tie as an infant, they. Some of them have still needed expansion.
- [58:22]
A
But.
- [58:22]
C
But to your point, that expansion would have had to be much more drastic if we didn't have a working tongue.
- [58:28]
A
Yeah. And, you know, as we've learned more about this conversation and as we've known you and met you and had more children, you know, like, we brought our son Bond right away.
- [58:37]
B
The second he was born, I was like, Dr. Gandhi, we're coming home.
- [58:39]
A
I mean, you saw him, what, at three months, maybe.
- [58:41]
C
Maybe two months earlier?
- [58:43]
B
And it is traumatic after the tongue tie. It's not fun, but it's worth it. You have to do the stretches.
- [58:49]
C
The stretches, yeah. It's not fun.
- [58:51]
B
No, it's not fun.
- [58:52]
C
It's. But I. I also don't tell parents, oh, this is easy. You know, you gotta prepare yourself, have. Have help. But it's. It's worth it. You know, it's worth it to get that tongue working. And unfortunately, that's another place where parents just get so brushed off about it.
- [59:08]
A
What I'll tell you with him, what I've noticed is before that we could note, you know, just because we pay attention to this stuff now, we're hypersensitive to it. You could see there was a little bit of mouth breathing going on. And. And, you know, every infant and baby has a little bit of a recession, obviously, but we saw. But now as he sleeps, his mouth is closed, he's breathing through the nose, more energy. Immediately after that, like, right away, he started lifting his head up and looking around more.
- [59:31]
C
And like, because of that tension that's related to ties.
- [59:34]
A
Yeah. Before his head was, like, kind of down, then he was, like, up more and, like, more mobile. So. So you could see. It changes things right away, this information
- [59:44]
B
to me, I'm so passionate about getting out to every single parent on the planet. This is a really important ev episode for me, just because of what I've been through, and I know how much it can help. And what I've noticed with you, too, is like, the best thing that you do is you. You make space between the teeth when you expand the palate, which is so helpful to the growth of the child. I do want to say, because my dad's probably listening. This is not my dad and mom's Fault. They took me to the orthodontist, and the orthodontist prescribed a retainer and braces and a headgear, like we were so were prescribed. It's not like I didn't go somewhere to get all the things that you're supposed to get.
- [60:23]
A
That's how we started the episode is, I think that's what we were. That's what we thought we were supposed
- [60:26]
C
to do about that also. Unfortunately, so many children are still getting prescribed that by our orthodontic community. And, you know, you brought up your parent, your parents, and, you know, validating that it was not their fault. It's really heartbreaking when I have parents come into my office and cry about how guilty they feel because they will say, I have taken my child to the dentist every six months, like I'm supposed to. I have brought up the concern to my pediatrician like I was supposed to, and no one, you know, no one was listening, and they feel like it's their fault. And to me, like, I don't know if I've ever told you my story, but that is my. That was my story over and over. And. And that is how I got into this. When I opened my practice, I didn't anticipate doing this kind of work. My older daughter Saira, who will be 13 on Friday at 3, was snoring, showing, like, terrible behavior signs. And her dad is a physician, and he was like, it's fine. She's fine. And I was like, this is not normal. You know, and she would keep it together at preschool and come home and just, like, melt every day. Tantrum. I had no idea what was going on. And I did the things that all these parents do. I went to my pediatrician. I went to. Even as an infant, when she couldn't breastfeed, I went to the lactation consultant. And you're just told, like, you're fine or you're crazy. You know, it was me listening to myself and trying to figure out how I could allow my child to live her best life.
- [62:01]
B
So how did you figure that out?
- [62:03]
C
So I believe in, you know, there's a higher being universe. Whatever you want to. Whatever you want to call it. I had decided to buy a laser for my startup practice. And so I took a course by Dr. Suruj Sagi, the Breathe Institute in California. And I was sitting. This was 2017. I was sitting in his course, and he started talking about children with tongue ties and underdeveloped airways. And literally everything he said was, saira, I started crying during the Course. And I'm thinking in my head, I'm a dental practitioner, and I didn't even know these things. He's an ent, but he's a special ent, because ents don't even look at this. And I went home. I assessed her for a tongue and lip tie, and sure enough, she had a tongue and lip tie. And in 2017, we weren't talking about myofunctional therapy and chiropractic care. We were doing it in a very, like, medical way, like, linear process. See the tie release the tie, and now it should work like your tongue should work. Well, I did a tongue tie release on her, and we got a little bit of improvement, but I didn't do any of the other things. And so at that time, she was about three. And again, I was like, something's still off here. I've missed. I've missed something, you know? And so I went back to the drawing board. I started, honestly, shadowing the lactation consultants in Houston, the chiropractors, some of the therapists, and really trying to get a better understanding of how all these things work together. And then, you know, the whole discussion of palate and how the tongue impacts palatal development. And so that's when I decide, like, when I looked at her and I said, wow, she has no space for her teeth. She is mouth breathing. So my. My poor children have been through every iteration. So we started with kind of more myofunctional appliances, and then I moved on to an expander, not the version that I have now. And it took me from three to about seven and a half for me to get it right with her.
- [64:03]
B
And it's right now.
- [64:04]
C
Oh, my God, she is incredible. She is a point ballerina at the Houston Ballet.
- [64:10]
B
Wow.
- [64:10]
C
She's just full of life, and it's crazy. I still get emotional, and it's, like, for years, but I, like, I truly believe she would not be the person that she is without this, you know, intervention. And I. I feel like I met the true her at seven and a half years old. But no parent should have to wait seven years to see their child thrive. It's. And. And the killer is, is it's a relatively easy fix. Yep. It's all about screening and identifying, and we're just brushing it off, and it. That kills me.
- [64:48]
A
Well, as you're talking, what's crazy is, you know, when you say 2017, that was not very long ago. And sometimes we will get pushback, especially when it comes to topics around medicine or health. On this show because we talk to people, and sometimes we talk to people maybe earlier than, I guess maybe the majority of people are ready to have the conversation. Right. And anytime people start to rock the boat and start talking about alternatives or doing different things in a different way, especially when it comes to medicine, people always get crazy and up in arms. But what I point out if, like, these last few years haven't shown that, like, we're still learning so much as it relates to our health and medicine and the right way to do things.
- [65:29]
C
Absolutely right.
- [65:30]
A
Like, we. We, I think as. As it relates to this field, specifically medicine and health, we have to, as a population, be willing to understand that we just don't know so many things and that there's likely going to be more information that continues to present to do things in a more efficient and better way.
- [65:47]
C
And that is really the hurdle that we're facing with physicians, because there's this complex of we know everything. And as a practitioner that does this, I mean, I'm still learning every day. I mean, I'm saying even on my own daughter, there were so many iterations of things that I tried. And if you're not open to saying, I need to learn this better or this may change, then you're really stunting the growth of yourself as a practitioner, but also what you can provide for your patients. And when I started this and this still goes on, I get a lot of pushback.
- [66:26]
B
Oh, yeah.
- [66:26]
C
Oh, my gosh. I have had to grow some pretty thick skin. But to me, the fact that I've lived this as a parent and I've seen the difference in my child, I will go up against anyone to defend this work.
- [66:41]
A
Yeah, well, you know, and I think the medical community in particular is very critical of other people in the community going outside the box, even just by a little. And again, doing this show for a long time, we've had people come on that are very credentialed, have all the, you know, have all the right degrees, all the right, you know, credentials and all that stuff.
- [67:04]
B
And.
- [67:04]
A
And they come on and say, hey, I was taught this way and used to think this way, but now I've learned this thing, and I'm maybe questioning some of that. And they get a ton of pushback. Sometimes even the medical community threatens them. And funny enough, like, there's one example I think of, and I won't highlight the listeners and viewers will know we had a woman come on and start talking about the way screenings are done for women and kind of saying, hey, there's other ways that are maybe to look at for some of these screenings. She got so much shit and so much pushback. I think she was threatened to have her license stripped and maybe ended up moving to a different world. But then a few, like a year later to the date, we had a doctor come on the show, we haven't released the episode yet, who is a cancer researcher and screener and built his entire career in that line of work saying, hey, some of the things that I've seen, we've seen better alternatives. And there's like direct correlations to some of the things she was talking about. And so I think it's really disheartening because you have somebody who's kind of sounding the alarm bell saying, hey, maybe we should look at this in a different way. Gets a ton of pressure and pushback. And then you have someone that is literally in that field saying, no, she, she was right and we should pay attention. But I think a lot of doctors and people are scared because their livelihood's in jeopardy if they say the wrong thing in the wrong way or what's perceived to be the wrong thing.
- [68:19]
C
I mean, I've experienced some of this myself. It's a scary, it's a scary place to be because a couple of things is, one, it's your livelihood. You've spent your whole life building this, training for it. But the other part is, I think about if this is taken away, who's going to help these children? Who's going to do this? You know, and the problem of physicians not changing, dentists not changing. It's ego related. They would have to admit that they were missing something, that they had been doing something wrong. But we're all learning and human. Like, you have to get off that pathway and think about what you're missing and the detriment that you're doing to your patient.
- [69:02]
B
A sign of intelligence is being able to change your mind. I think we need to get back to that.
- [69:07]
A
Yes, no, but to me, the doctor or the medical personnel that I trust are the people that are saying, like, right now, this is the best information we have. And based on that, I think we do this. But if new information presents and finds a better way, I need that person to be like, hey, we found this, this new thing that we didn't know about before and this is maybe better. Like, that would be insane. Imagine like if you started a business, you're like, we used to do it this way 30 years ago. So we're only going to keep doing it this way. You wouldn't have A business.
- [69:30]
C
But this is. You know, I train other dentists to do this work, and one of the biggest worries that they have is, well, I've had my practice 10 years, and I've been seeing these patients for 10 years. How am I now going to go tell them, oh, you have a tongue tie that needs to be treated or you need palatal expansion. Are they gonna turn around and say, well, why didn't you tell me this 10 years ago when I've been sitting in your chair? And you just have to be honest. This is. You know, we are learning more. I'm learning more. And so I'm trying to bring the best benefit to you and just be honest about it. People appreciate honesty.
- [70:07]
A
Yeah.
- [70:07]
C
I mean, and especially if you're coming from a place where all you're doing is trying to help them.
- [70:11]
A
Yeah. We used to take a horse and buggy when we went across the country. Right. Now we take a plane. Like, we can't imagine those who would be like, listen, we've always done the horse and buggy. Right.
- [70:17]
B
Do you believe in mewing? I mew all day long. I don't mean to brag like, I am the I like. Literally, it should be called boss sticking. I'm you all day long. I am a huge believer in it.
- [70:31]
A
Maybe just call it Lauren. Don't let me into that.
- [70:34]
C
It's a form of myofunctional therapy. Exercise for your face. You're toning.
- [70:39]
B
I think it's mad because I always get told I'm right.
- [70:41]
C
You're toning muscles. Right.
- [70:43]
B
Thank you.
- [70:43]
C
Right. So it's like any other muscle that you would tone. The more you do it, the more toned it get, the more defined it's going to look like, you know, it works.
- [70:51]
B
I'm a prophet. Tell us the real truth about why people are getting their tonsils and adenoids removed so often. Is that essential and necessary?
- [71:00]
C
A lot of tonsil and adenoid inflammation is because of mouth breathing. So when we breathe through our mouth, we take in unfiltered air, and the first thing it's hitting is your tonsils and adenoids. So we know there's research, actually, that if we can get the mouth closed, breathing through our nose, they can shrink. If we expand, they can shrink. But if we remove tonsils, adenoids, and continue to mouth breathe, they will regrow. I've seen kids that have come in that have gotten them removed and they're back. That's because, again, we're not looking at the root Cause the reason kids are getting them removed is because we're not looking at the big picture. And historically that was the first line for pediatric, what's called sleep disordered breathing, which is the precursor to sleep apnea. So that's what, you know, if you go the traditional medical route, that's the first thing they're going to recommend. Let's take out the tonsils and adenoids. And then what happens is, is the snoring sound goes away, the mouth breathing doesn't go away, the structure doesn't change. The sleep architecture really doesn't change either. And so then we haven't solved the issue that we came in to solve. We've just gone through a surgery that is now not gonna work. So again, it's gotta be a comprehensive look at the airway. Yes, the tonsils and adenoids are a part of it, but so is the size of the palate, what the tongue is doing. Are we mouth breathing even like vitamin deficiencies? I mean, is comprehensive the stuff that impacts sleep? Unfortunately, our medical system is so isolated that one person's just like, let's just take these things out. So it's really not the end all, be all. And I, most of my clients are ones that, that don't want to remove tonsils and adenoids. They want to look at the root cause. And so they're coming to me, a lot of them because someone has recommended that they get tonsils and adenoids removed and they want to know what are the alternatives.
- [73:10]
B
I want to make sure that we can secure our appointments after this episode.
- [73:15]
C
Yes.
- [73:16]
B
Can we like be on a like secret? I'm. I think a lot of parents are gonna have an aha moment just from all the knowledge that you've shared. But I just wanna make sure that
- [73:26]
C
we're like on your VIP list.
- [73:29]
A
And last thing first, if someone is not in the Houston or Texas area and they're looking for someone who specializes like you, what should, what resources should they look to?
- [73:39]
C
So a couple of things is, and if you go to my site, drpagandi.com all of those resource pages are there. And also what's on there are lists of red flag symptoms to look for in your child. So if you're wondering or if you're not sure, that's a great place to start. But Airway Health Solutions has a directory of practitioners that have trained with them, which is I teach for them. So expansion for. And that's for pediatrics and adults. The Airway circle is more of a myofunctional resource. But on that site is also dental practitioners and surgeons. And then the Breathe Institute, which is where I've done most of my training. They also have a nationwide. Actually, it's international directory, so those are great places to start.
- [74:24]
B
And you have a show?
- [74:25]
C
I do. It's called the Pediatric Breathing Project. If you want to take a deeper dive and hear more about it, you know, we do bring in, like, the Kairos and the Myos, so you can hear more about those specialties and how they play a role in all of this. And then also just our practice website has a lot of educational videos.
- [74:44]
B
I loved interviewing you. Thank you so much for everything that you've done with my kids. I'm just so appreciative to you to come and spread this message. It's so important.