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Episode 89 - Dr. Nora Ghodousi-Zaghi - Helping Kids Breathe

1:06

Hey everyone, it’s Emma Cooksey here and I'm your host.

I'm joined by Dr. Nora good.

Do sees a key and she was born and raised in Los Angeles.

She received her undergraduate degree from UCLA and then went on to study Dentistry from the University of Southern California and she specializes in pediatric dentistry at the University of Nevada and she's a board-certified diplomat of the American Board of Pediatric, dentist.

1:36

Dr. Nora offers functional and integrative oral health care and interceptive Orthodontics with a focus on whole body, health and well-being.

So if you're not sure what any of those things mean, don't worry because we're going to get to it in our conversation.

So here's my conversation with Doctrine or good news.

1:53

He's a key.

Thank you so much for joining me, Dr. Zaki

Thank you.

I'm excited to be here.

Do you want to start off by telling people where about you are in the world?

Yeah.

So my name is Is dr.

Nora's good ducey's Auggie.

2:08

I am a board-certified pediatric, dentist.

And I have advanced expertise in sleep breathing, early, interceptive, Orthodontics, and ankyloglossia I am here in sunny Los Angeles.

2:24

We have a location in Calabasas and in Westwood Los Angeles, right?

Near UCLA, which is the brick called the breathe Institute, and I have my department called the breathe kids.

Center, which focuses on these issues that I've highlighted here the program of all ages.

2:42

Is that right?

Yes.

Children of all ages and there's also adults that are treated here with the other specialist here at the read Institute as well.

I think of what you do, as more like early intervention to make sure that children don't develop into teens and adults with sleep apnea like I think that sometimes like I've had other specialist on who are talking about kids, but in terms of, when they've already developed sleep apnea and it's quite severe and they have to have like a sleep study and sometimes they end up on CPAP and that kind of thing.

3:21

But what I think of, when I think of what you're doing at the breathe Institute, you're treating more like the root causes of these problems before they really get bad, right?

The great thing about being a functional and Airway Centric perv, Ryder are a focus providers, really having that expertise or understanding of the diff the spectrum of sleep disorder breathing and the red flags that might be associated with sleep disorder breathing.

3:48

So when you're talking about what it is and the root causes and how are able to screen.

We're really talking about an are functional Airway evaluation screening this more recently.

There was a developed Fair six that was published by the breathe Institute.

4:05

Alongside other providers and Cynthia Peterson.

We were able to actually pin it down to six points.

Initially, there was like 20, 30 40 points, I believe and the most statistically significant points light upon this para 6.

So now the American Dental Association and other Dental association's have now made it.

4:25

The standard of care to screen for Sleep Disorder breathing.

And the great thing about being a dentist is that especially a Pete Adonis is that we're able to see kids right around the first tooth of 23 option and we're even able to see these kids even earlier if we're doing, for example, treatment for tethered oral tissues, which we can get into later.

4:47

But what we found is that these six determinants are red flags for six, sleep disorder breathing and these include mouth-breathing, having a mint Alice strain, which is a straight strain underneath the lower lip.

That's developing Incompetence to close the lips together tonsillar hypertrophy, which is the tonsils, which is the posterior portion of the air with it.

5:12

When you open your mouth and you see those two structures on the side of the airway, if those are large run comp and compassing more than 50% of the airway.

When you're looking at the airway in the mouth is open, the tongue is out.

That would be a red flag if we're seeing something called ankyloglossia or tongue-tied which we'll talk about soon.

5:30

Dental where bruxism is another is another Red flag.

So high wind and clenching of the tea.

Yeah, we can get into the all of these individually because I think they're each.

So important narrow pahlaj pallets, which is when look opening up the mouth, looking at the roof of the mouth.

5:48

And seeing if there's a shape that's more like a V versus are you and dental crowding and in addition to looking at the inner molar with.

So this is when we as dentist look into the mouth and we measure how much many millimeters are between the first molar.

6:05

Which is the faculty room or that wraps around 6 years old to the other side, okay.

And we have different measuring tools to determine what the severity is for that.

So having a good understanding, as to what we can screen for a really early on, can save, you know, the quote can save not only a child or an adult's life but also the quality of their life for a lifetime.

6:30

So it's worth just saying, I think the fairest 6 is amazing I'm going to Put a link to that resource in the show notes so people can go and actually download it for themselves but you've put together like it's just two pages and you have pictures of what you're looking for.

6:47

Like if you are looking at your child and you're not sure if maybe, you know they're Restless at night or you're not sure of their mouth breathing and if it's normal you can look down all of these different pictures and it has a descriptor of what you're looking for and that's going to help parents right along with.

7:05

You know, dentists are other clinicians to be able to spot these things.

Absolutely, it really does help parents in something unique that I do.

In my practice is I actually include the fairest six in my intake.

So some parents are like, wow, I didn't even know and you're not, it's not for families, it's not forfeit, it's not for app.

7:26

It's not patient-facing, it's probably just right, but I include it and that gives parents the opportunity to go ahead and review, what what I'm looking at, and what I'm looking for what I'm screening for and to learn and research.

7:42

What it is that we're we are looking for at the pediatric dental office.

And what we find is that parents were like, you know what, I didn't think my child is a mouth breather, but I did.

I looked at them at night and I peeked in the crib and I saw that my child's mouth was open and the tongue was down and now Worried, can he tell me what this means Y, and we come up with the most minimally invasive options and treatment plans to help them get to nasal breathing with the tongue up in the lips closed.

8:17

That's our ultimate goal.

So talk about.

So you mentioned it before and about sleep disorder breathing.

And I think sometimes people misunderstand that and they think that they have to be observing like a child pausing and breathing light, you wouldn't sleep apnea.

8:34

But actually this goes all the way like to.

It could be a child that you just explained with just that they have an open mouth and their tongue is not in the correct position.

So can you talk a little bit about that big spectrum and what's like, you know, that it's all not normal.

8:52

And so, and yes, and it's unhealthy.

And that's what we really have to look at its unhealthy parents, just look at their child and they think, wow, you know, and I have a two-year-old, right?

And I have parents You know, we hang out, we do mom's day, and we chat, and they're like, what is it that you do?

9:09

Exactly.

I'm like, yeah, I help kids with I sleep disorder, breathing, I can pediatric dentist, I do growth and development.

I do functional Dentistry though.

Oh, that sleep disorder, breathing my kid only snores.

Sometimes, you know, it's just here and there and I just talk a little bit more about it.

9:27

And I explained the here and there is, is it just here and there because that's when you're peeking in, and it's here.

And there or is it more frequent and you're unaware.

So having that awareness of the spectrum.

So sleep disorder, breathing is a spectrum and usually the first red flag of sleep disorder.

9:46

Breathing is mouth, breathing.

And yes, you can spot that very young and life almost in infancy.

And what you can see is that, we'll see.

Frequent drooling, mouth open.

The tongue is down.

You could see that the nose might be always congested And that could be due to under development of the nasal passage and we can talk about that more with its family.

10:11

That's what we're seeing.

It could be due to having low tongue posture, due to potential tether or tissues, or it could be due to an atomic reasons.

Structural reasons are the tonsils.

Hi are hypertrophied.

Is there a mid-face deficiency?

10:26

Are the Jaws underdeveloped, because these can also lead to this snoring issues, and these are all things that could be treatable especially very early on in life.

Life these.

So I know that the fairest 6 is you were saying it's more.

It's not supposed to necessarily be patient facing.

10:41

It's more for dentist to actually use in their own practice for screening but I just want to be real with people listening, right?

Because I'm a parent and I live in Northeast Florida in Suburbia and I'm not close to any providers, really like you.

11:02

And so I want to help.

People to try and like start navigating this for their kids because you're going to have to advocate for your child and most places, right?

So there are some people that maybe live down the street from your wonderful facility and they just go to the breathe Institute and, and it all works out, and that's great.

11:24

But for most people, they will go to a pediatric dentist, a pediatrician and be told, oh, well, there might breathing like that.

Seems normal because it just purely because even if those people are great dentists and doctors, they just haven't been trained in craniofacial development and Airway, right?

11:46

And you want to explain a little bit about that, that sure.

So any might be slightly different from what people are seeing in their own Community.

Absolutely.

And you know, so there there are courses that many dentist take and that's continuing education if they find interest and passion and having a great Understanding on Dental facial development craniofacial development, what?

12:10

The greater implications of underdeveloped, Jaws can create.

And how that the consequences of that in addition to, what's what treatment methods that dentist can provide for patients with sleep disorder breathing.

There's so many different Avenues and the breathe Institute has courses, that many providers take.

12:29

So we do have at the reasons to to.com a list of providers that have taken our courses.

That have this understanding and training in relationship to sleep breathing and tongue-tie of people in the United States, but also outside of the country.

Like yes and other places in the world.

12:46

Yes.

And people can go and search in their area to see if anybody has been trained in that way.

Yeah.

And I would love to touch a little bit on what you can do as a parent because I think that's so important.

One thing that I always ask my parents to do is wait about 90 minutes after your child goes to sleep.

13:05

And just take a video of them.

Two minute video and show me.

How does your child sleeping?

Are they sleeping on their back on their side, or on their face is their mouth open or closed?

How does their chest?

Look are their chest retractions, do you hear any audible breathing?

13:23

Do you hear like they're strain?

Apneas is there any sign of this noisy breathing that we might find or snoring?

Just go ahead and do that.

If you want like what I would recommend is reviewing that video as a parent.

13:39

And then the very next day start working on Hazel hygiene and nasal hygiene would be going ahead and getting something like X Li ER or Anil MD neti pot and working with your child on using this to improve nasal hygiene.

13:55

Because yes if there's any obstruction in the nasal passages there's going to be difficulty for your child to breathe.

Then I would go ahead and Examine air quality in the home.

And this is something that I would tell any parent go ahead and look and see.

14:11

When were the lot one of the vents last change.

What's the humidity in my home?

The vents should be changed every eye.

Every three months, in my opinion, the humidity shouldn't be more than fifty percent.

Thirty to fifty percent is ideal more than 50%.

There's a risk of mold.

14:26

We should get are consider air filters.

I like there's so many different ones, but go ahead and air filters for your whole highs.

Is what?

You're talking about it like attached.

I don't get air filters through the house.

Personally, I have like a pod like a little oh, okay.

14:42

That I could put nearer on the child's room and then you can go ahead and look through what they are sleeping with.

Like maybe there's some shredding.

Exactly.

Old is their mattress and especially dust mites are huge with this stuff.

Won't really get the carpet out of their room.

14:58

Try that.

Get the get, the get the stuffed animals butts in the bed, washed, maybe only a One stuffed animal on the bed or no stuffed animals if they're really, you know, filled with dust and they're more prone to having that these are things that a parent can easily do.

15:16

In addition, sometimes kids have dairy intolerance or gluten allergies, and this is something that a parent can just give like pay attention to noticing how they are breathing, or their Airway might change based on what they're eating.

15:32

Just basically take mental notes, or Dietary logs to see how the breathing might shift or change based on their diet.

And then once you have this data, you can easily go to an ENT or a dentist or a physician and tell them.

Look, I did X Y & Z.

15:49

I have documentation of what I've done.

I need help.

Okay, still persists, I need help.

What can I do to get my child healthier?

And why do they need to be healthier?

Well, if they're having poor sleep for the way, Hang out of REM sleep.

16:06

They're not releasing growth hormone, they're not getting deep sleep.

So that means and deep sleep where we we get memory consolidation throughout throughout the day, they're not going to be able to remember it as well.

They're not gonna be able to do as well on their tests in school, they might have ADHD like symptoms.

16:22

Imagine you and me as adults, and we only had one hour of sleep or me.

I, let's say, I only had one or two hours sleep.

I'm jittery, I'm shaky.

I forget a fall asleep in school.

I don't think I would do well in school.

School as an adult.

And I've had with one or two hours of sleep.

16:38

So we need to advocate for our children especially before we go ahead and put them on medications like ADHD like medications and this is something that's a different conversation.

But I think that parents should be aware.

They should have access to this easy free way of almost, you know, very minimally, invasive, way of helping treat their child.

16:57

And if there's still an issue that's something that they have to, they have, they should be talking to Providers about.

Yeah.

And so, can you just drill down a little bit on that whole thing?

I think a lot of people are not aware of disruptive, sleep and children actually showing up more like ADHD.

17:17

You would expect, it's almost counterintuitive, right?

Because a lot of adults they would just look really tired and be really low energy.

But you want to explain how that can sometimes show up in children and look quite different to adults.

Yeah.

17:32

So for kids like you mentioned when a dog's don't have a lack of sleep, you might have an idea like I didn't sleep.

Well I'm not doing well today but when a child isn't breathing properly, what is physically happening?

That means for example, what is there must be an obstruction in the airway that's not allowing them to breathe.

17:56

That's potentially waking them up throughout the area and causing them to get out of these different.

Stages of sleep and waking them up out of sleep and causing them to not get that deep sleep, that we need to grow, for example, to release the growth hormone because that does happen in certain stages of sleep.

18:13

So in children that might look like.

For example, I've had a patient that didn't grow over a course of one year, they didn't grow no growth in a year, like no inches.

Then chat child is like a three or four years old and didn't grow at all on a year, of course, of one year.

18:29

They started putting him on.

Growth hormone and see.

He was seeing an endocrinologist and the root cause was sleep disorder, breathing and children.

It can also look like for example, children falling asleep at school.

Having hyperactivity not doing well.

18:46

It might also seem like the patient like a child.

It might be restless rolling around significantly throughout that get waking up out of the bed wetting, the bed bed, wetting significant bedwetting could cause could cause be a sign of Not having that deep sleep or having sleep apnea, and we have to understand why, but what's happening is is, for example, let's say there's an obstruction.

19:09

In the airway, what you're doing is you're pulling the lower jaw forward and out, and you potentially an apnea waking up out of your sleep, to help save you.

To take that deep breath, that is Shifting you out of that deep sleep and into an Awakening, you and not allowing you to have that growth hormone release and potentially have that memory consolidation that we need for our children.

19:32

To have have that ability to be able to function properly throughout the day.

Thank you for explaining that because I think sometimes parents get all these different messages and they're just like, but if my kids showing ADHD signs that must be ADHD like, you know, and I think that sometimes it's just a by asking more questions looking more closely.

19:52

And so the next part I want you to just talk us through.

I know that you're really this really always involves collaboration between Tween different Specialists.

So I thought maybe you could talk a little bit about when a parent brings their child to see you and do they start with you and then who are the other specialist you work with and who might be involved?

20:17

Depending on what's going on?

Yeah, so depending on what's going on for sure so we work in an interdisciplinary setting.

Where are we have myself?

Who trades children PDF and the Pediatric arm, we also have a speech and language pathologist.

Who's also an oral motor therapist that helps with increasing jog, draw, strength, muscle, tone and children, and also helps with speech sounds and and more.

20:42

And she also does lactation counseling.

We have another provider that is an oral maxillofacial surgeon and he helps focus on patients that are at the end stage.

You know, that might need adults.

That might need maxillary skeletal extension Mark be or how s fots or Potentially MMA surgery, which is double jaw surgery for patients with narrow Airways, in addition to my husband who's

21:09

Dr. Seuss soggy, and he is an ear.

Nose and throat, physician and sleep surgeon.

And he basically navigates children through adulthood to help with these sleep disordered breathing issues.

And so but you can lean on these other specialist depending on what you see when you first look at a child.

21:28

Yeah, absolutely.

And we A lot with one another.

I know that we can't treat one child alone.

There are so many pieces to the puzzle.

We also have a team of myofunctional therapist that we work with here in our office we have and other providers throughout the cities that we work with in.

21:49

We also have it integrated pharmacist to sleep psychologist that we work with sleep hygienist.

There's so many different pieces to the puzzle animals happening.

Yeah, depending on what's Happening?

So do you want to get onto this whole tongue-tie thing?

22:07

I feel like a lot of people ask me questions about their kids and tongue ties and I quite often, send them with your way.

You want to take us into that and just talk a little bit about what a tongue tie is like, what it would look like.

22:25

And also what it had that impacts people a child sleep.

I don't think I think a lot of people are not really Getting the connection between those two things.

Yeah, absolutely.

So so what is the tank I first?

Do under our tongues, there's this band of tissue and it's connecting the tongue to the floor of the mouth is known as a lingual frenulum.

22:47

And sometimes that band of tissue may be unusually short or thick making it restricted or tied down.

So, tongue ties and other restrictive for any lumps in the mouth can affect in infancy.

For example, breastfeeding.

They're causing mouth breathing, and when children get a little bit older, it can impair speech.

23:07

It could also predispose your child to more dental disease and it could cause issues such as bruxism and restrict, the growth of the dental arches.

And I would love to talk a little bit about how this a breathing and how it affects breathing.

So for example, if your tongue the is tied down either from the back of the tongue or the front of the tongue, we need the tongue to be fully up and sealed to the roof of the mouth.

23:31

To be able to breathe through our nose.

Our goal is to breathe through our notes and if we breathe through our mouths, what happens is that all the viruses and bacteria in the air?

Go straight into our Airway which causes tonsillar hypertrophy because everything's going right back there and it's not filtered through our nose hairs so that can cause acne and other issues but again a breathing but in addition if that tongue is not able to seal up on the palette, what happens is more than likely having a laugh.

24:01

Gov tone.

So when the tongues tone is low what happens is it makes it very easy for the tongue to fall back into the airway.

So when you're asleep all the muscles in your body, relax including the 16 muscles of our tongue so far tongue is tied down or its law because of a tongue tie or tone issues.

24:24

What happens is when we're asleep and all the muscles of our body relax, it's very easy for the tongue to fall back into the airway.

And when we're asleep and that might result in us trying to push the tongue out of the airway either through potential store like potential apneas, or for example, bruxism and grinding are pushing that lower jaw forward.

24:48

So can you explain a little bit?

So when when people are clenching and grinding their teeth, can you explain about what is causing that?

Because I think often times especially Lee not as much in children.

But sometimes in children, you will hear about like, you know, my child went to the dentist and they're saying that they're grinding their teeth and why should people think like, oh, there must there might be something wrong with their breathing.

25:18

Rather than oh, they just grind their teeth or not.

I think that this is one of my favorite topics to talk about the same.

Why are my eyes?

My child grinding?

Well, grinding, and This is emits a it's multifactorial.

There are many different wheat and why child can grind this pair functional have it can be cut be because of sleep disorder breathing and is also now based on our most recent paper that we published we published, we found that it has a statistically significant Association to tongue time.

25:51

Meaning that if a patient is tongue-tied they more than likely have a have an association to grinding and what we theorize, your Precise is the very fact that the tongue is tied and it's down and then they're pulling that lower jaw forward to get the tongue out of the airway, which is resulting and the teeth, and the teeth hitting against each other causing tooth wear and bruxism.

26:16

It can also be due to just as stress.

For example, grinding can be related to to stress and lots of other reasons.

But there is a statistically significant Association to this.

And we found in our, in our paper, in the paper.

Auggie published that about 79% of clenching and grinding was resolved after tongue-tie release.

26:39

So it's just validating.

Very fact that tongue-tied release does have a sadistic statistically significant Association to grain.

So I guess I sound like a broken record a little bit, but I guess speaking to people who don't live close to you and if they have taken their child, their child, their suspect, A child has a tongue tie.

27:03

They've kind of looked and they their child is may be dealing with some of these other things.

How do you like, I've heard so many people be like, well, I checked with my pediatrician, they said it was fine.

Gosh, I hate when I hear that.

So how do we then?

27:21

Add 4?

So we basically would be looking for a dentist who has been specifically trained in releasing tongue ties, right?

Like where do you go now?

Like I did.

They then like if they go to a pediatrician or their pediatric dentist and they say I don't really think it's a problem then but the parents intuition is saying this doesn't seem normal to me.

27:48

There's some other things going on, too.

I really want to have somebody else.

Evaluate this tongue-tie.

What's the best way to find a specialist?

Who's really trained in this?

I would say doable if your I would if your parent and it's hard to find a provider near by.

28:04

I would do a virtual consultation with a provider that might be close by Breathe Institute does Fault virtual consultations.

We do virtual myofunctional therapy session so that's four people anywhere can I can do that anyway and even if you're not able to come out and get really slick right away, we find a lot of patients, get better with myofunctional therapy.

28:26

And for those of you that have might know, not know what myofunctional therapy is myofunctional.

P is like Physical Therapy but for the muscles of the face and the neck and the jaws.

And what we find is that pain patients, strengthen these muscles and get rid of and eliminate these dysfunctional habits.

28:44

For example, if a patient has a dysfunctional swallow pattern or low tongue posture and they need to work on tongue strength or having compensations of using the muscles of the neck to do.

Certain sounds.

For example, what we find is that when patients eliminate these function, d.c.

29:01

Is functions.

They start to feel better.

So by working on these things, even with your little ones like we find that patients tend to get a lot better.

So is there a particular order?

People should do things in or does it just depend on the individual child?

29:19

I really think it's important for a patient to establish a dental home for kids specifically as early as possible in a setting if possible.

Either even virtually with a functional dentist or and one that has Airway training because there's so much that you can see early on and so so much that you can, you can do to prevent.

29:43

And I think, prevention is key.

It's important.

And we don't want it.

We don't want to put out the fire.

Once it's already there, we want to just see the smoke put it out when the fire is blazing.

That's not what we want to run in and treat.

We see the signs.

29:58

We can jump in and do so.

So I would say find it Airway centered provider whether I would prefer to be somebody that can do a screening and assess are assessed the assess the different structures.

For example, the Jaws look up.

30:14

The I look in the nose, I look inside, I look and see the function of the tongue.

I'll I can see the development of the Jaws.

I'm looking to see the back of it, you know, how the tonsils appear.

There's so many how you're even walking that tells us If Ever I wanted you to talk about pal expansion because you mentioned earlier.

30:31

About tongue posture and the children should have their tongue up to the roof of their palate and you know, all the time when their nasal breathing properly.

So do you want to talk a little bit about what happens with the dental Arch?

30:48

And then what you can do to solve that and what kind of Ages kids are when you do that?

So yes, we so when you see a high palette Or a pallet that or arches that are not fully developed or crowding.

31:06

For example, these are all signs of something greater and dental crowding.

For example, it's a sign that the bones are small, secondary to an airway or tongue issue, and this can lead to sleep disorder, breathing in and of itself.

So functional, pediatric, dentist, functional dentist, there in the ideal position to be able to examine the root cause and to help the child or adult sleep and breathe better.

31:30

So what can that look like?

And why?

Why is this happening?

Well, When the tongue is tied down, what we see is that form follows function for example, or if there's an enlarged tonsils and the tongue is low because the patient is opening up their mouth to get better.

31:46

Breathing, what we find is that the tongue is not sealed on the roof of the mouth to create that beautiful u-shaped Arch, right?

That's going to help the teeth come in the correct position and the dot job to develop beautifully.

So, if the tongue is down, what we see about a v-shaped arch or when we see that crowding, And what we also see is that patients might develop some difficulties breathing through the nose.

32:11

And the reason is, is that the roof of the mouth is the floor of the nose.

So if there's underdeveloped, Jaws, what we find is that can affect directly the nasal passageway.

So, the airway is comprised, the nose, the mouth, and three friend real walls, and the back of the tongue.

32:30

If we what we found in the recent paper by Audrey you know and Rebecca back?

How is that when we make the Jaws wider that can actually help shrink the tonsils?

Make the tonsil smaller incredible, right?

32:46

If these are patients that are considering potentially surgery when what this is in patients that, it's some children.

Do we do?

Yeah, yeah.

Children what we found is that by making the Jaws wider.

Can actually help shrink the tonsils.

33:02

Why is because we're able to get your able to get patients to breathe better through the nose, because the roof of the mouth, is the form of the nose.

And since when they breathe better, what happens is that they're breathing through the nose and not the mouth, which less, viruses and bacteria are entering the back of the throat and less inflammation in the airway.

33:21

So what we find and this actually confirms what we have found throughout years of doing this treatment is that patients really are breathing better there.

Are sleeping better and they're getting room for their permanent teeth to erupt if they're in the primary dentition or if they're in, they have mixed dentition meaning that they have some baby teeth, some permanent teeth there, right?

33:42

In between we also find that they becomes more space for those permanency to come in and they gain more access to breathing better and having better abilities to sleep.

Yeah.

So that is what.

So when people go to their pediatric dentist and are told wait till your child is. 12 or when all of the babies have fallen, a before even looking at any sort of expansion or Orthodontics what do we think about that?

34:11

So you know I think that every doctor is doing what they think is best for the absolutely.

And I think there's just like like we talked about earlier I'll not so much.

Continued education may be available to many doctors that I've been practicing practicing a certain In way for X many years, in addition to doctors, don't like to treat kids because kids are kind of hard to treat and that's just the reality.

34:39

It requires a lot of like coaxing and talking and maybe extra chair time.

So, you know, there's a combination of reasons.

Why doctors might not want to treat until permanent teeth, come in.

However, we have to understand that the maxillary halves was just the to the upper jaw.

35:00

Connected.

There's something called the maxillary suture, okay?

As the child gets towards puberty.

What we find is that suture?

It's more used making it more difficult for somebody to have the ability to, to create the expansion that we need.

35:16

Because if it's too, if we find that the Jaws are not as malleable as if they're, they were, when they were young, it makes it more difficult for us to provide that expansion that we need.

So when we treat earlier, Our and I treat for example kids that was going to be my next question.

35:36

So I treat.

I have this like saying that you can do palette expansion from birth and Beyond, that's just my thing.

Am I saying?

And there's so much that you can do at home?

For example, getting the tongue up getting age, age appropriate, teethers that have proper extensions that Aid in chewing so that we could get the job.

36:00

As to strengthen and get the tongue up and the lips clearing hard things is a thing as well.

Right now chewing hard things like for example harder Foods rather than baby foods because when the tongue is up and it's elevating and there's transverse movement of the tongue, what we find is that their jaws are going to develop more properly, whereas if you're using, for example, pouches day in and day out, what we're finding is that the form follows function.

36:27

So the sucking motion day and night will will cause the Jaws to stay under the developed and I'll grow appropriately.

So their appliances that you can provide for kids as young as six months actual appliances.

Wow.

And and some I know there are some fish.

36:45

Some doctors that do it even earlier.

Yeah.

And guided by your doctor and your the parent is educated and taught as well.

We do appliances that not all and they don't sleep in it.

But we do things that they can help develop the jaws and Guide them in the prayer in the correct manner.

37:03

So, these things are, it's not impossible, but it's very difficult to reverse them, right?

So, trying to do myofunctional therapy as an adult know that it's not going to help it.

Absolutely has helped me and having my tongue tie released help me and and all the things, but compared with your strategy of treating, this in very small children is like so much easier to me.

37:30

Me like, you know, just do it quickly and then they'll just be on the road to developing healthily.

They will ever need to worry about sleep apnea, right?

I had a patient.

Like you're reminding me of a patient that I saw.

If you don't mind me sharing, I have a phone.

37:46

Oh yeah.

I saw a patient her follow-up like last week or two weeks ago and they come from far away and I'm very, very grateful that my patients.

I very very blessed that I have families that are willing to travel meet to me from a distance and this child wasn't growing for like a year and a half.

38:09

If you hear this parents story will cry for her.

Went looking everywhere for an answer.

Yeah thumb down, doctors, Augie discovered.

Her child had a tongue tie release needed.

The tongue time-release did the myofunctional therapy he improved got the release, he proved even more then he in addition to Needing he had a bilateral cross B.

38:32

Meaning that his upper jaw was completely underdeveloped.

So what you see is, his upper jaw is small, his lower jaw was bigger than his upper jaw.

So, in one month, we got in completely out of a, by a bilateral posterior, bilateral, cross B.

38:48

Which means that we were able to get his upper jaw bigger than his lower jaw in one month.

Can you imagine the mom?

I looked at him and like, That honestly makes me want to cry.

So God and the mom was like, you don't even understand.

39:06

He's sleeping better breathing better.

He grew his fate entire face change in one month.

I'm like this is uh, knife seen it but when I see when I see how much it changes the physical this child someone's life, how can literally change that quality child's life, it's it's unfathomable.

39:27

What what Distorted breathing and narrow jobs and their Airway can do to a person's quality of life and I'm so can you explain a little bit about facial development as well?

Because I think like this whole thing of like like obviously I also along with all those things developed a really long narrow face and didn't really think too much about it until I started getting really into this stuff and then I was like, oh gosh it's really a thing.

39:56

So do you want to explain How it's not only to do with breathing and you know, your jaws not developing properly, can you explain how that affects people's faces?

Yeah, gorgeous.

So what happens is that form?

40:12

So like I mentioned before form follows function.

So like, let's say, for example, you cannot breathe from your nose.

There's like something physically wrong with in the neighs.

There's like something there, polyps, something, or another.

Very large prints.

You can't breathe through the nose.

40:28

I was at all.

What happens is that?

We see, no matter what you're going to need to breathe from your.

Now, if you can't breathe from your nose, you breathe from your mouth.

If you breathe from your mouth, the tongue is down by happens, is you start to develop and increase lower third of your face.

40:43

So the dot jaw is going to start to grow downward rather than go going forward, right?

And and what we see is because of, that will see allergy Shadows under the eyes will see narrow faces.

We might see more forward head.

Posture because we're pulling everything for example, to breathe.

41:02

And we see that the children might have other issues.

Like we mentioned, like ADHD, like symptoms and so on.

So form follows function.

It only takes about 1.5 grams of force to move the tooth and the tongue provides 700 grams of force.

41:18

And this is research that has shown this.

There are studies that - so we need the tongues to stay up for us and the mouth to stay closed and as to breathe through the As for us to be able to have that that forward job bro, transfer grow and for us to be able to breathe, through our nose, to be able to have this appropriate growth of our faces, is that fair?

41:42

Yeah, that makes perfect sense.

Thank you for explaining.

And so I'm definitely going to do links to the first six thing and links to the breathe Institute.

So people can search whether people have been trained by you guys.

Anything else like it, can you Tell people like where should they find?

42:00

You can they follow you on Instagram?

Things like that?

Yeah, so my name is Dr. Not Nora.

This doggy on Instagram, my website is breathe Kids Dental.com.

I could be reached to directly through their, or through the V.

42:17

It read Institute.

I just have my direct line on my actual website just to make it easier for families to navigate and Just wanted to give a message to families.

You know, if you see something that doesn't sit right with you, the way that your child is breathing the way that they're sleeping, the way that they're behaving, don't stop there.

42:39

If it doesn't seem like it's healthy, it's probably unhealthy and these beginning signs.

Really?

And I would say, most of the families that find us, it's not because it's really because they did that extra research, they did the reading, they looked, they looked at the signs.

42:56

They did the Extra homework and with the extra mile because they were like I need to find the root cause and just like anything for her for your child, finding the root cause is the only way to create a solution.

Yeah.

Managing symptoms is not the answer.

43:12

We have to find the root cause and put out the fire.

Well, wasn't thank you so much for your time.

This has been an absolute Delight.

Thank you.

Had a great time too.

Thanks for having me.


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