The Root Cause Was Breathing: A Doctor’s Story of Missed Diagnoses & Breakthrough Healing [S1, E8]

Transcript

Speaker: She was crying and and immediately that made me really nervous because I was like, oh my goodness, what what did we do? And um she threw her arms around me and she had ah had a note in her hands and and it was this note about, I don't know what you did, but you you changed change your kiddo's life and and totally different kid in school. And the mom was just just just thanking me and I was like, don't know what I did to be thanked.

Speaker: But then it all just kind of hit me right then. I was like, holy cow. And just how powerful that was. i mean, i still remember that that moment. and And I thought that that's what I want to do the rest of my life.

Speaker: Hi, I'm Grace Gerk, former emergency room nurse, turned physician associate and mom to five active boys, equipping moms with tools for wholehearted living.

Speaker: Welcome to Skills for Moms.

Speaker: Hi, Dr. Capps. I just want to welcome you to the Skills for Moms podcast. Yes, ma'am. Glad to be here. Well, before we get going, I just wanted to give a brief intro to our guest and kind of give them a little framework about why what you're going to share today, I feel like really applies to all moms, whether, you know, you have a baby or a grade school kid, teenager, or even just for adult health.

Speaker: And so I wanted to share a little bit about your bio and background within, them and then we can just dive right in. Sound good? Perfect. Perfect. Okay. Yeah.

Speaker: So Dr. Capps, he has a background in restorative dentistry and got his degree from Baylor College of Dentistry, which is now called Texas A&M Dental School. is that right?

Speaker: It is. Yeah. The Aggies out while back. That's right. And then you went on from there. You worked in restorative dentistry for four years before getting advanced training in orthodontics and dentifacial orthopedics, as well as a master's degree in oral biology.

Speaker: Also doing extensive research on expansion and why that matters as kids are developing. You have a holistic and interdisciplinary approach to care.

Speaker: You have two private practices in Rockwell and Greenville, Texas. and also speak on a national level about these topics as really a thought leader in the field and also balance that with time with your family. I know faith is important to you, your kids' sports teams and just being connected in their lives.

Speaker: Yeah. Again, we are so glad that today. I don't know if balance is a good word. i don't know. My wife might not agree that, that i balance it well, but, but I try, I try really hard and it's, it's, i think it's a, a struggle for, for everybody to find some balance, but it's definitely something that I'm passionate about. So it makes it a lot easier to go to work whenever you love what you do.

Speaker: Yes. Yeah. I, I can relate. And you're as a, you know, parent of a patient of yours, I can feel that intentionality you put towards your patients of making sure the work you do is excellent.

Speaker: And i feel that in your office setting and the care that you have for each kid. So I'd like to start. Yeah. Just hearing a little bit more about your story and how you entered this world. That's a grow, a huge growing field with the airway orthodontics.

Speaker: Yes. So, think a good place to start, I was practicing aesthetic and restorative dentistry in North Dallas at a great, really great office with with Tom McDougall.

Speaker: And i was taking a lot of CE and I was i was really wanting to be a fellow in the Academy of General Dentistry. And so After you know a year or so in practice, every CE event that I was kind of drawn to was was more in the holistic nature. The negative thing about restorative dentistry is a lot of times you have patients that they come in and and it's like this one tooth hurts. And you say, well...

Speaker: you got all these other things going on in your mouth. And they're like, yeah, but this one tooth hurts. And, and so there's some frustration there. Oftentimes whenever people want take a big picture view and just doing a lot of work with occlusion and, and, um,

Speaker: and really loving it, but everything kind of seemed to to drive me back towards orthodontics. And then I had, I was checking a patient in hygiene one day and and we we didn't see a whole lot of kiddos, but We did see a fair amount. And I had had two kiddos, a brother and a sister that were in on that Friday in and went to check them. And they had terrible, terrible hygiene. Plaque built up, a red and flame gum tissue, narrow. You could tell they were mouth breathers. and And I didn't think a whole lot of it back then. You know, airway, this was 2008-ish.

Speaker: and and maybe 2009. But it wasn't really ah thing that was talked about in dentistry. But I sent i sent those two patients over for a local orthodontist to look at. And there's a guy by the name of of George Adams. And he was He was ahead of his time when, whenever it came to understanding some of the the nuances with airway and, and how we can help people with orthodontics. And he started doing some expansion on both of the kiddos, got them over to the ENT, both of them needed adenoids and tonsils out. And then they came back fast forward three months. Cause we got them back ah on a three month check to just to make sure that the hygiene was good and the inflammation had gone down.

Speaker: And I remember walking in, I was in the middle of a root canal and a crown prep, and I was stressed out and ran over to the hygienist had buzzed for me to come over. And so I ran over and saw that it was them and, and i was thinking, oh, perfect. This will be quick in and out and I can get back over to what I was doing and saw the mom walking down the hallway and I thought, oh, man, yeah this is not going to be a short, short discussion. But she was crying. And and immediately that made me really nervous because was like, oh, my goodness, what but what did we do? And she threw her arms around me and she had her had a note in her hand it was from. one of the kiddos teachers and and it was this note about I don't know what you did but you you changed change your kiddos life and and totally different kid in school and the mom was just just just thanking me and how really I really was like I don't know what I did to be thanked but but it then it all just kind of hit me right then I was like holy cow and

Speaker: And just just how powerful that was. i mean, I still remember that that moment. And and I thought that that's what I want to do the rest of my life. And so had a lot of really, really great mentors. um Moody Alexander was one of them and and met with him and I actually tried to pray it away because I was in a really great, great office and set up to buy it. And was a situation to where it would have been so wonderful for me to stay there.

Speaker: Obviously, God put it on my heart and ended up going back. And and it was a huge blessing that it it turned out that way because I was able to go into the orthodontic residency knowing that I wanted to learn everything that I could about growth and development and and how we can alter that, what we can do to enhance growth, what we can do to inhibit growth, different things that modify growth, and then you know how we can utilize expansion and all sorts of other things. and

Speaker: And i think that that perspective allowed me to have just an incredible experience in the residency where I got as much as as you know you possibly could out of it. I was at at Baylor at a time whenever there was a guy named Dr. Bouchang, who is an anthropologist and incredible in growth and development, probably one of the most published people in growth and development in orthodontics. And so got to learn a ton of stuff from him. and then Got out of practice and and finally ended up again.

Speaker: You know, God has a way of of putting you in the right spot and yeah ended up in a practice in Rockwall and also have an office in Greenville. But what's crazy along the way is ah a my eyes were open to my own airway issues. And I know that's one of the things that that we were gonna talk about, but.

Speaker: I realized, know, how i was that kiddo that that wet the wet the bed way, way later than I should have had to have a glass of water by my bed and chapstick all the time and and, you know, allergy shots. We we used to to rodeo growing up. And so whenever we went out, tried horses, I'd have to get a shot before I before I got on the horses or or my allergies would be too terrible. But So, yeah, just struggle with that my entire life. And I can remember in high school being exhausted all the time and not sleeping well. My mom always laughs because I was the kiddo that woke up at four zero in the morning and wanted to watch Ewoks and, you know, and never sleep. And and yeah so, you know, I was that way my entire life. And then my freshman year in college, I went out to Hardin Simmons to play play football out there. and

Speaker: On my way back one Sunday afternoon, i fell asleep at the wheel driving 65 and wrecked my truck. And I was went in, they they sent me in for a polysomnography in-house sleep study. and back then they didn't yeah Back then they didn't know what, you know, i didn't fit the bill of this 65-year-old overweight guy sitting in his armchair, you know, snoring and, you know, choking on us on his you know tongue. and And so they didn't really know what category to put me in. And they ended up diagnosing me with narcolepsy.

Speaker: And, you know, really wasn't narcolepsy. It was UARS. Yeah. And, but, you know, I didn't, I didn't fit any of those, those categories. So I ended up really not doing anything about it and just always managed it with trying to stay healthy and, and taking a little cat naps here and there.

Speaker: UARS for those who might not know that abbreviation, you want to just share what that is? Yes. Yes. So UARS is upper area resistance syndrome and, There's some people that think that that there's this continuum of airway issues that kind of starts with UARS snoring and then it progresses into mild and moderate and severe sleep apnea.

Speaker: Yeah. Dr. Guimano, who is out at Stanford, is actually the one that that coined the term term um mild to moderate and severe sleep apnea. In his later years, he talks about how he really regrets doing that. And and I think it it it makes us think that it's it's a progression. And while sleep apnea and airway issues can progressively get worse,

Speaker: it's really not necessarily a progression. I've seen lots of of patients and in fact, kiddos, kiddos, and then, you know, young, the UARS patient, the typical one is they call it the young fit female, but they're that, that patient that's, you know, 25, 30 years old, and they're always stuck in sympathetic tone and they have this fight or flight response going on all the all the time. And so all of the organ systems,

Speaker: that are involved in parasympathetic start having issues because blood is shunted away from those organ systems. And so they're always kind of in the stress response. fine Yes. Yeah. so they're So they don't get into the rest and digest mode. and And so they start having issues with those organ systems. You know, sleep isn't good. and That's usually the patient that's waking up at three or four in the morning and can't go back to bed.

Speaker: um And a lot of the kiddos have those similar type of symptoms, Because the majority of kiddos, in fact, won't actually obstruct. So if you're calling it an obstruction, then you have to have an oxygen desaturation and and for that to technically be an obstruction.

Speaker: So it basically, UARS, it kind of has flown underneath the radar for a really long time because it's not... you know you can pick it up as far as you know heart rate and and some things like that but you know sometimes even on uh an at-home sleep study you know someone that'll that'll be missed and so you know that's that's basically what you know what i had and and then i just figured out how to live with it and so

Speaker: I can remember, you know, I ended up transferring to A&M. hurt my back, transferred A&M and finished up down there. But I mean, there would be times whenever I'd ride the bus to school and start walking to class and get kind of sleepy and peel off and go to the library and take a nap and realize the class was over, get back on the bus and go back home. And, you know, fortunately, in a lot of those classes, you can just read the textbook and be just fine. But but kind of figured out how to how to handle it.

Speaker: and And it has influenced my health dramatically. the the In dental school, i had an ulceration on the side of my tongue and a it, long story short, what ended up being squamous cell carcinoma, which again, I'm not the typical patient that falls into that. It wasn't HPV, it it wasn't obviously smoking or drinking, but had this lesion pop up and had it excised and then it came back. And in over time, I've had three surgeries at MD Anderson and four up here in Dallas ah to remove large sections of, of, of the soft tissue. And really anybody that at MD Anderson, they feel like it's,

Speaker: It's chronic reflux, which we know, obviously, and we can get into that a little bit later of how that that is actually related to the airway. But we know that's an airway airway issue for a lot of a lot of people. And really, that's the only thing that they have.

Speaker: to to make sense of it, which makes sense because it's always been on my left side, which I'm a left side sleeper, which a lot of people with chronic leaf reflux will will sleep on their left side. And we see that, you know, routinely with with patients that come in that have narrow narrow arches and not everybody, but but a lot of them you'll see you'll see erosion on these kiddos that are, you know, five, six, seven years old erosion on their dentition. And you start looking, know, And they've had eight cavities fixed and they're all on the left side. And it's like, okay, well, you know, maybe this is just a piece piece of puzzle and we need to do more digging. But had that. And then the a year and a half ago, so I've always had fluttering, atrial flutter. And about a year and a half ago, started going into full-on atrial fib and, you know, exercise all the time in great shape. Yeah.

Speaker: eat well, uh, fitness is important to me and there's really no reason that I should have fib. But again, if you look at all the literature on a fib, it's highly, highly, highly correlated with, with sleep issues. And again, it goes back to nasal breathing and airway. So, you know, sometimes I feel like that dad on, on, um,

Speaker: My Big Fat Greek Wedding. So he thinks everything, Windex fixes everything. yeah and yeah And, you know, we have to tap the brakes sometimes because airway is not the reason for everything. But yeah but it does play a very significant role in a lot of things. And it can it can be a part of the puzzle.

Speaker: so Yeah, I mean, that makes a lot of sense. We haven't even talked about tongue ties at all, which I know you look at and address in your practice. But, you know, you see with a child who has a tongue tie, it's kind of a symptom of something going on, right, systemically. Like there's a tension in that fascia, right, that's going from the mouth all the way through to the to the tip of the toes. Yeah, yeah. Yeah, and so...

Speaker: you can't just say, oh, we snipped a tongue tie. We're all good. It's like the body's showing something, right? Yes. Yeah. And that's the thing. That's the thing that, and I know you being a PA a and a provider, you know, you,

Speaker: medicine and dentistry has gotten to be so siloed. And so you go into an ENT and they, they look at the nose, you go into, you know, pediatrician's office and, you know, they're looking at at this subset of things and, you know, you go into the dentist or the orthodontist and the orthodontist says, okay, well you have crowded teeth. Let's straighten your teeth. Well, sure You know, is that is that just like you said, is that a symptom of something bigger going on? And and what we found in orthodontics is if you don't figure out the why, you.

Speaker: the your your correction is is going to have a high likelihood of relapse because those teeth are there for a reason. And so thinking, doing the deeper dive, and that's you know part of part of our practice and my passion is is you have to take the bigger picture look. And you can't just walk in and say, yes, we have crooked teeth. Let's do some braces. Well, you have to, to to and and that's part of what is so much fun about it because when you When you act like that detective and you're looking and you're saying, okay, this and this and this, we've got all these clues. Well, what are the clues mean?

Speaker: And what all do we have to do to be able to correct it? And then at that point, it's not, it's more about, you know, not just straightening the teeth or making room for the teeth.

Speaker: And it's the difference between, you know, straight teeth and a great smile and a great occlusion, which yes, that is very, very, very important, but it's, it's thriving. I mean, it's, it's,

Speaker: really you know great health and getting over humps and problems that maybe have been issues for a long time and you haven't ever realized what is the root cause of it.

Speaker: Sure. we're so glad to have you listening in today with the Dr. Capps interview. Just want to invite you to go back and listen to some of our other shows if you have a moment.

Speaker: We have the interview with Dr. Zach Morgan, who's an internal medicine physician and a functional medicine practitioner with his wife, Taylor, talking about their journey into holistic health.

Speaker: There's also an interview with Robin, who is an organizational expert out in East Texas. And then Misty Bridges, who's a mild functional therapist and has a practice in Tyler. So hope you can listen into those. Yeah. I mean, it reminds me of the story kind of that got you into this, where you're talking about these kids with, they did have the malacalusia and dental decay, but then once their airway was improved, I mean, their school's getting better, their yeah quality of life, everything is getting better.

Speaker: Absolutely. Yeah. yeah And if we would have, you know, you what if we had have just looked and said, oh, well, you've got plaque on your teeth. You need to brush better.

Speaker: And then you get them back in three or four months and it's like, oh, you got plaque on your teeth. You need to brush better. Mom's like, we brush 15 times a day. Like how much better can you get? and And you don't take the time to think, oh, well, maybe we're mouth breathing and those teeth are dry and the saliva is not bathing the teeth, which God designed the saliva to be a natural lubricant. And if you don't have that, then now the plaque is sticking.

Speaker: And the dry environment causes the tissue to be more inflamed and the mouth breathing alters the pH of the saliva and it changes the the bacterial composition of the mouth. And so now we're more prone to cavities and you get this snowball that's rolling in the wrong direction and you can beat your head against the wall and just say, hey, let's brush better.

Speaker: Or we can figure out, OK, what is the real issue? Mom, OK, yeah, y'all are brushing 15 times a day. Perfect. So let's rule that out as is what's going on and figure out figure out the root issue.

Speaker: Yeah. Let's see. What do you feel like was the moment that you kind of, for your own personal journey, had this click that you know, it was related to your airway and that all of this kind of these different issues that have been popping up along the way, you know, all are related to now the field that you're deeply passionate about.

Speaker: So, um I think I had one revelation whenever I treated my my son. He had a lot of the classic airway symptoms and and we did, he had adenoids and tonsils out and and that helped a lot, but it didn't completely solve the issue.

Speaker: And then we went in and and treated him and did some expansion. And there were some things that that clicked whenever we did that. in looking at myself and and some of the things that that I'd gone through.

Speaker: and And really, you know, in the very beginning, whenever I first decided to go back to deep to the residency, you know, what there I had an inkling that, you know, some of my stuff as a kiddo was probably due due to the airway and some of my sleep issues were, you know, definitely due to the airway.

Speaker: Going through a lot of the, the squamous cell stuff in MD Anderson, that really opened my eyes to the kind of damage that, that reflux and mouth breathing and, and all of that, that can, can do, you know, we, we always were taught that patients that had different issues where they had xerostomia or dry mouth were way higher likely to have have, you know, cancers and other other issues pop up. And, you know, there was never really

Speaker: there's the The problem with a lot of that is is we know it. You know, you know it as a PA going through you know your training, you're taught all of these things, but they're not put in this this environment where you can put the pieces together. And so, you know you know this about this issue and this about this issue and this about that, but you don't think about how it works in a holistic fashion.

Speaker: And then whenever I started having the AFib stuff, that that is really when when things clicked. And, um yeah know, there's ah there's a thing called Bernoulli's principle, which is so physics principle, but it talks about basically it's airflow or or or liquid flow. Yes, yes. And so, you know, when you have...

Speaker: difficulty nasal breathing and you have turbulence whether that's from you know turbinates that are enlarged or adenoids and tonsils or allergies or jaw structure that is underdeveloped then then it creates it creates negative pressure in your thoracic cavity. And, in you know, if you if you pinch your nose and breathe in, try to breathe in real hard through your nose, you can feel that that pressure.

Speaker: And so, you know, when you think about the high correlation of AFib and, you know, airway issues, i think I think that that is one of the critical one of the critical components, yes, it's the sleep, but that negative pressure all the time. And it really, and and honestly, I don't know, ah love having research and being able to back things up with with specific research. and And i I don't know of any research on this. I know of a lot of research that links the two, but not anything that directly explains it. But like, if you think about a kiddo that is wetting the bed and you know, there's a, there's tissue in your atria that that picks up on pressure.

Speaker: And that tissue, when it picks up on pressure, it's designed to sense if you have high blood pressure or not. And it releases hormones that cause your kidneys to function, which the concept is to decrease the blood pressure.

Speaker: And so there's several theories, again, I haven't ever seen anything to prove this, but there are several theories that say that the reason why some kiddos will wet the bed is because of that intrathoracic pressure that is created and it triggers that tissue in the atria and releases the hormones and the kidneys over function or over work. And then that causes them because, you know,

Speaker: those kiddos even if you can stop wetting the bed a lot in and adults too still wake up at night and go to the restroom well you know your kidneys should not function that much if your body is is operating in the way that god designed it to operate your kidneys should shut shut down in a way where you don't have to use the restroom for you know eight to ten hours and so if you're having to get up to use the restroom then there there is something else going on and and What really hit me is i noticed that my i would start going into AFib whenever I wore my mask a lot.

Speaker: And so i would go throughout the day and in the mornings be fine and run four or five miles and be feeling great. And then two thirty or three o'clock in the afternoon after I've been wearing my mask and couldn't breathe real well, I would start to go into AFib. And it's like, well, why in the world did I just now start going into what what is it?

Speaker: And I really think that has had a lot lot to do with it. So that, you know, God puts things in our path to help us on our journey. and And I think that was one of the biggest things.

Speaker: Yeah. And I mean, lot of our audience today, I know for me personally, you know, I take my kids to the pediatrician. They've always checked out, yep. wait right development but then i could just tell it's not normal like my kid's mouth is right more than it should they're you know seven and their food's coming out of their mouth when they're eating yes what are some of those things you know again a kid's gonna pass with flying colors they're well child checked but signs that they're still not thriving yes so first of all i think a mother's intuition is

Speaker: way undervalued moms are usually spot on. So if you have a gut feeling, then, then I encourage all moms to keep asking questions until you figure out a really good answer because you guys were given that sense to pick up on things in your kiddos.

Speaker: and And I've had a gazillion you know moms come in and be like, I just don't think this is right. I've had a few people say, don't worry about it. but and And so that that sense is usually spot on.

Speaker: the The other thing that i would I would think about, really, when you start a growth direction, then that is something that is going to persist. There's a lot of orthodontic literature that says when we have malocclusion, that malocclusion is not going to self-correct, especially after a certain point.

Speaker: And so if they're... genuine you need the teeth are Yes, so correct. Misaligned.

Speaker: that there is misalignment of the jaw structure or the teeth or excessive crowding or even excessive spacing, because sometimes to it looks like they're spacing when it's really, you know, the the jaw structure is small, but the tongue is pushing out and it's flaring the teeth and it makes it look like they're spacing. So when you see things that don't look quite right,

Speaker: that that is not something that is going to spontaneously get better 99% of the time. And in fact, it will only get worse. And there's a lot of studies that talk about, I mean, if you look at any of the growth, you know, literature from, you know, Bjork did a ton of of growth literature back in the fifties. If you look at all of his stuff, you know, you continue along a similar growth direction.

Speaker: direction And so I would i would say if if you see a deviation that you think you know might not be normal.

Speaker: Looking at your kiddo from the profile view and looking at facial convexity. and And yes, whenever you're younger, so there's a certain time period up until you're about it early teens when the mandible is a little bit further behind the maxillin growth.

Speaker: And yeah, and so that's normal. So you should have just a little bit of facial convexity you know up up until you're 12, 13. but you know, excessive facial convexity, look at gonial angle. So if you get, you know, a super obtuse gonial angle, and we've got an open mouth lip posture that indicates that you have a lot of, of vertical growth, elongation of the face, difficulty getting the lips together.

Speaker: You should be able to rest your lips together comfortably and breathe through your nose, watching your with your tongue up into the roof of the mouth and, and watching your kiddos, watching kiddos breathe. You know, if they can sit there while they're watching TV and they don't know you're looking at them and the mouth is open, then you probably got an issue. If the lips are together and the tongue is up and they're nasal breathing,

Speaker: then you're probably just fine. One of the things that you can look at so that you know, tongue posture is the tissue, the sublingual tissue. So the tissue, yep, right down here, my kids call it, call it my gobbler. And so if you, if you look at your turkey gobbler and, and, and it's way low, then that means that the tongue is probably resting low.

Speaker: If it's up, you know, and you can see the difference between this and, you know, the, that, that moving up and, and tongue posture plays a huge role.

Speaker: And it is, it is, it is way the, the emphasis that needs to be on tongue posture is still not there. And and we have made leaps and bounds of our understanding of how the tongue affects facial growth you know, with myofunctional therapists, you know, being more active in a bigger voice, you know, with with a lot of dentists and pediatric dentists checking that now we are headed in the right direction.

Speaker: But a tongue tie even a partial tongue tie or mid-body tongue tie, which we you know used to call posterior tongue ties, that can alter facial growth dramatically, can cause deep bites, it can cause open bites, and it can cause narrow narrow arch development.

Speaker: And so looking at a kiddo's tongue posture, watching them eat, can they eat with their lips closed? Because if you can't chew with your lips closed, then you have an issue with nasal breathing.

Speaker: If you see a lot of movement when you're trying to chew, then they're compensating for a tongue that cannot adequately move the food around. If you have a kiddo that when they swallow, it's and you see all of this you know movement, then they're probably trying to compensate. You know, if you have a kiddo that is really slow to say their R's and S's, which I was that kiddo because I had a mid-body restriction, you know, that kiddo a lot of times has a mid-body restriction and there's a reason why they can't get the middle and posterior portion of the tongue up to the roof of the mouth to enunciate that. And so,

Speaker: you know, if a few months of of speech doesn't get you over the hump, then maybe doing a deeper dive into that. And and there's some things, you know, ideally, if if you hold your finger in in the floor of the mouth, you know, say this is the tongue and you hold your finger in the floor of the mouth, the kiddo should be able to to lift their tongue and do this. But if you hold it in the floor of the mouth and the tongue does that and it dimples down,

Speaker: then it's more than likely that there is some sort of restriction that does not allow that middle and posterior portion of the tongue to rest up in the roof of the mouth, which, you know, by the age of seven-ish, you know, Edwards back in 2000 published a great study where they looked at, you know, at around the age of seven,

Speaker: you have 90% of your transversal width growth set. And so, you know, we know that problems in that width dimension aren't going to self-correct, you know, after that age. And so then getting the kiddo into the, the you know, appropriate places to to try to address that is is ideal.

Speaker: Because, yeah, the the tongue is what actually does the expansion on Yes. Yes. It's more our tongue than it is genetics. And then we do have some genetic component on our lower jaw, the mandible, but still it's ah about tongue posture as well. Is that correct? Yes. So a great way to think about it. And and this is how I break it down a lot because I think that it is It is an easy way to get, understand it as well as share it with spouses because a lot of times mom's bringing the kiddo in or the dad.

Speaker: And it's also a really great way to understand why we do what we do when we do it. Because, expansion is not a one size fits all thing. They're very appropriate things that should be done or can be done at a super early age.

Speaker: And then there's things that can be done, you know, when you're five, six, seven, there's things that can be done nine, 10, 11. And then when you get older, there's ways that those issues need to be addressed that if you do something you know,

Speaker: Another way it's it's just not going to work. So a great way to think about it is upper jaw and lower jaw are two different types of bone. Okay. So the lower jaw is endochondral bone, upper jaw intramembranous bone. So those two bone types grow totally differently.

Speaker: Lower jaw. So a good, good way to think about it, everything from here down to lower jaw, arm bones, leg bones, those bones are endochondral. They grow primarily from a genetic basis. So you think about your arm, you have a growth plate, Written in the DNA at that growth plate is about how long the arms are going to be. And God designed it that way to maintain symmetry.

Speaker: Or one of the reasons is to maintain symmetry because you want the right to be the same length as the left. And unless you have a way to pre-describe that, then then you can't maintain that symmetry. So mandible, for the most part, in the TMJ, you have an area that is very similar to a growth plate.

Speaker: that causes mandibular growth and there's some remodeling and other things that are altered by epigenetic factors but the mandible to a large extent is the stimulation of growth is primarily genetic it's what dr boucher was talking about he he would always call it it's a growth center so the mandible is a growth center the maxilla is intramembranous bone.

Speaker: um And a great way to think about it is is the skull bones are also intramembranous bones. And if you think about a baby, you can run your hand across a baby's head and you can feel that the skull is made up of a lot of little bones that are separated by soft spots or sutures.

Speaker: And what stimulates the growth of the skull is the pressure from the brain growing. So the brain grows and as the brain grows, it stretches those soft spots and sutures, which causes more bone to be laid down. And then the skull gets bigger and bigger and bigger in response to the brain growing. That is why helmets work. So a helmet puts pressure on that skull system and not on other areas so that we can get skulls growing symmetrically.

Speaker: it's why they worry about if you have intracranial pressure, you know, on a kiddo, you can have abnormal skull growth. And, and so skull grows primarily from that pressure. And it's also, if you think about it, if the skull grew based on genetics, then you, you're creating the potential for a huge skull and a little bitty brain or big brain and a little skull, which obviously that doesn't match. so there's a process for the skull to protect the brain by intimately matching it and growing as it grows. So upper jaw, maxilla, same type of bone, instrument, brace, have right, maxilla, left maxilla, separated by a soft spot or suture and what drives the growth of the upper jaw primarily. And there is some growth that comes from displacement and, you know, growth of the cranial base and things like that. But primarily,

Speaker: tongue posture and nasal breathing play huge role in the growth of the maxilla so if anything that causes the tongue to drop out of the roof of the mouth or causes you to not be able to breathe through your nose so that could be allergies asthma enlarged adenoids and tonsils you know, chronic sinus congestion or a tongue tie or a low resting tongue posture or poor muscle tone or a syndrome, which causes you to have poor muscle tone. All of those things will cause that tongue to drop down and then you don't reach the full potential.

Speaker: And what happens in a kiddo, is then that starts a cycle and the cycle causes the tongue to rest low and keeps you from breathing the through the nose, which keeps the maxilla from growing the way that we want.

Speaker: And now teeth are veering off in weird directions and the bite is developing abnormally. And the lower jaw, even though it grows predominantly from a genetic basis, the shape of it can change. So the gonial angle starts to become more obtuse and you start growing down more than forward and you don't get the chin projection. And there's all sorts of variations with that based on, you know, tongue ties and, and genetic genetics that, you know, sometimes that manifests is and in in different manners, but,

Speaker: It again, all the literature shows that that's not something, unless there is intervention that is going to get better. And so really what we have to figure out is, okay, well, what is an age appropriate intervention?

Speaker: And all of that goes back to, okay, how much growth do you have left in that dimension at that time, how far off from the natural or normal growth, which is another thing we talk about normal, normal growth.

Speaker: There's a big difference between normal and ideal. And unfortunately in our society with, I mean, food changing and environmental influences,

Speaker: and all sorts of things that are in the air and things that we're exposed to which, you know, cause abnormal growth. Normal is definitely not ideal.

Speaker: And so you have to think about more ideal, but, but it starts, you know, you have to think about what, what, how much growth do we have left? How far off are we from ideal? and and so what treatment looks like for maybe a two or three year old is way different than what it looks like for a 60 year old.

Speaker: And, and the problem right now is, is okay. Where, where do you go? You know, where do you go?

Speaker: and and, and, you know, that was one question that you had asked me before is okay. What, like, What is a good way to navigate all of this? And I think that, you know, the internet, podcasts and stuff like this, because you have to be your own advocate and and you have to take ownership of your own health. And and there's not a perfect place to go, but you you you have to seek treatment and then be wise about, okay, is this really makes sense?

Speaker: And this this is our quote wall and somewhere on our quote wall, we've got inspirational stuff and proverbs and all sorts of things. But there's an Albert Einstein quote that I love that's, if you can't explain it to a six-year-old, then you may not understand it yourself.

Speaker: and And so it is it is okay for people patients and and parents to question, you know, the provider to ask like, okay, well, can you explain that a little bit more?

Speaker: What really? Okay. That's not making sense to me. You know what, because it should make sense. If you, if you, if you can't explain it and why you're doing what you're doing, then maybe you shouldn't be doing it and have And you you don't you can't always have literature to back up every single thing, but you should have some evidence and you should know because there's a lot of things that are coming out, especially in dentistry, treating airway and there are things

Speaker: that there's literature on what that does that that has been around for 50 plus years. It's not a new, you know, there's most things aren't new. They're just kind of reinvented.

Speaker: And you can look at that literature and say, okay, we know what that appliance does. We have the literature that shows exactly what that does. Is it really helping in correcting the underlying issue?

Speaker: And so I think, you know, there, there are definitely some pediatricians that are all over this that, that understand, you know, they all understand growth.

Speaker: I think they're in a tough spot sometimes because, you know, if they're in and out and, and having to see a lot of sick kids and then they're trying to treat this and that, and they're making sure that kids are hitting, you know, global benchmarks.

Speaker: And so, checking for a tongue ties and always like something that, that maybe is on the radar or even needs to be on their radar.

Speaker: There's a ton of pediatric dentists that that evaluate this stuff. And most pediatric dentists are are very proactive in in evaluating for needing to go see an orthodontist. and And there's a huge shift in the pediatric dental community on timing for treatment, trying to understand that and and like when is ideal and what you can do and what is beneficial and And so, you know, I think there's a lot of pediatric dentists that, that, you know, are excellent resources for this myofunctional therapists that are excellent.

Speaker: they're There, there lot of people, you know, we have a couple of ENTs around that really have an understanding of facial growth and what they can do and what we need to do.

Speaker: And so like they'll tell, patients, Hey, you know, you really need to get these adenoids and tonsils out because they're completely obstructing your airway, but your airway is tiny. Like you need volume increase and some expansion so they can see what all it entails. Because you mentioned this in the very beginning, it's not, it's not usually one thing.

Speaker: And, and that is one thing that I will say from the orthodontic perspective, You know, I think that a lot of orthodontists, I think that they're doing a really great job with this. And and i think that some are using it as a marketing thing, which is is terrible.

Speaker: But there's there's people that will abuse things, you know, and in every area. And i think that I think that some also just say that it's not a thing.

Speaker: And they point to a few articles and they say, well, we can't, you know, you can't expand your way to perfect health and nasal breathing. And nobody's saying that.

Speaker: I mean, the people that are really doing this well or what i would consider doing this well they are taking a very holistic approach to it and understand the limitations that we have as an orthodontist on growth and development which our limitations i mean they're way different than they were five or ten years ago i mean we we can do some really really awesome things you know on on patients, got a 72 year old that that is doing expansion right now, sutural expansion with an adult expander, a Marpi.

Speaker: But, but and that totally changes nasal volume and there's zero, you can't argue that there is, there is zero argument with that. You can, you can look at the CBCTs and see, you know, significant changes in, yeah, an internal nasal valve and, and, you know, nasal volume, the back of the throat and no, I'm not.

Speaker: doing MarP on that patient because I'm correcting their airway. I'm fixing their skeletal malocclusion. And I'm also working with an ENT and their sleep physician to get them to ideal health because there are things that are way out of my scope of practice that are in their scope of practice. And unless you have a holistic approach to this and have the team in place where you can navigate it appropriately,

Speaker: then you you really can't can't help patients get to where they need to be for ideal health.

Speaker: Okay, we're just gonna pause right there for a minute to tell you about another resource we have available. ah You can see the link in our show notes for our link tree, but it's a cold and flu handout that gives a lot of helpful tips if you're wanting to try to beat an upper respiratory infection or a mild sickness, kind of with natural remedies instead of having to go straight to the doctor. So I hope that helps you guys out.

Speaker: Have a good one.

Speaker: Just getting back to what we were just talking about with a mom who's in the overwhelm, noticing her child has a problem maybe with the mouth breathing or a narrow jaw, concerns about tongue thrust. Where do where does that mom go?

Speaker: i know I've been there and it's hard to know. It is. think the first thing I would say is to give yourself some grace. they're there' we We put a lot of parent guilt on ourselves.

Speaker: And we think think that we've got to got be perfect and give our kiddos as perfect. And we all want to. I mean, we we all want to, but...

Speaker: it's it's okay, you're gonna figure it out and you're way, way ahead of the curve because they're there's a lot of of moms that come in and dads that come in that this isn't even anywhere on their radar. And so if it's on your radar,

Speaker: you're way ahead of the curve and you need to give yourself a pat on the back. So the first thing I would say is, is try not to stress and then try to start networking and looking around a little bit.

Speaker: There's, there's in most metropolitan areas, you know, DFW, Houston area, San Antonio, there's, there's good providers. And that's just in Texas, you know, and there's ton across the United States and looking at at people who have done this a while is good. Myofunctional therapists are are a great resource. um And so sometimes I think it's maybe more beneficial to start there sure and let them guide you

Speaker: to a provider that that they have seen delivers great results because again i think that sometimes there can be a little bit of a of a marketing ploy bait and switch thing that happens unfortunately and and it's really hard to it's really hard whenever you are so eager for your kid to be well yeah and and you know there's an issue, it is hard to weigh is this you know is this something that is that we need to do or is it not something we need to do

Speaker: And some of the stories that we get of of the crazy amounts of money that people and time that people have spent seeking great care and then they fast forward three or four years and they haven't gotten anywhere there may be worse off than they were before yeah those there's a lot of stories like that so i would say my functional therapist um are a great great resource um asking around i'm i'm terrible at social media I don't think that's bad. Yeah. So I somehow missed that train. And, um but so like, for instance, our office doesn't do a whole lot on social media, but I know that a lot of people find us because they ask on social media who to go to and, and then people direct them our, our way, which we're eternally grateful for.

Speaker: But I think that, you know, a long time ago, I decided that, that if you take care of people, they will take care of you. And, and so I think, you know, in whatever city that you're in, if there's somebody that's doing really great work, if you just start asking around, you know, therere their, their parent, their patients are gonna, and the the parents, they're going to be able to kind of steer you in the right direction. And, and, and don't,

Speaker: you can be patient with some of those decisions. Sometimes people are feel like they're, you know, they go into a situation and they're it's some crazy hard sell that a dentist or orthodontist or as someone is doing that pressures them in. If you feel pressured, walk walk away from it. yeah Walk away from it. Take a deep breath. and And then just ask some more questions. And so it it should never be a situation where you feel like,

Speaker: you were pressured into starting something. if If that's the case, you're you it's more of a like guilting you into it rather than truth leading you yeah leading you into it. And then then then do do research, but also at the same time when you're doing your research,

Speaker: you know weigh it with some wisdom because there's some things out there that make claims that don't make sense and you know go back to the anatomy and and if you understand the way that the jaw structure grows then whatever appliance you're using and when you're using it should make perfect sense and if it doesn't make any sense then that's the situation where you ask a few more questions and if if somebody is super defensive and gets angry and can't answer the questions, then maybe that's not the best best best place to to to be. And so I think the biggest thing that I can encourage people, because, man, I see it. I see parents come in and they are just –

Speaker: They're exhausted yeah and, and they're stressed and they feel like they're letting their kid down and they're probably also not getting sleep because whenever your kiddo's not sleeping, you're not sleeping. And so they're sleep deprived. And some of them have the same airway issues as their kiddos do. And, you know, I've never really slept well. And, and so.

Speaker: Yeah. And then if you know, i mean, like Grace, you guys, you're such a wealth of knowledge and you've navigated it before. So, you know, tap those people that have been through the journey and then get connected. And then usually...

Speaker: You know, there's, we get asked all the time. Do y'all know someone in Houston? Do y'all know someone in Austin? And, and so we know some, and there's also areas where we don't know anybody and, you know, we can, can ask around and try to connect. And it's also things, you know, we have people that drive a distance and, you The cool thing about what what we do is you don't have to come in every week. yeah And like I had a patient today, they drive in from three hours away and and we can do that. They they can make it every 10 or 12 weeks and we can do things to make that super efficient and to to progress. Now, is that ideal? No, it's not ideal. It'd be ideal if there was somebody right next door to them that they could go to, but...

Speaker: It's not always, it's not always the case. So yeah, that answered the answers the question. I think I also want to just encourage moms if it's not,

Speaker: the first person you talk to is not, does have to be the right fit. You know, I think people pressure, I'm going to try this one doctor or police. I heard, and you know, that's our own story. We knew one of our children had an issue.

Speaker: We first went, we did, we paid and did a healthy start program, which is like a, you know, yeah might know about it yes ma' yeah seeing results because he spit it out. He needed something to actually stay in his mouth and,

Speaker: help his palate expand. You know, we went kind to the opposite extreme. We saw an orthodontist, just a traditional orthodontist who kind of blew me off and was like, Oh no, you're, he's totally fine. You can wait a long time.

Speaker: You know, and I'm telling him my own story. Hey, I had jaw surgery for an open site, a failed orthodontist. When I was 15, I don't want that for my son. I see the same growth pattern he i had that had. Mm-hmm. So, you know, again, that second opinion was like, okay, that's not totally right.

Speaker: You know, we went to beyond pediatrics, which specializes in like, even younger expansion in Dallas. So it could be like a three year old. And that was reassuring to hear some of my kids that do have some narrowing, it's not severe enough to need that early of expansion.

Speaker: expansion, but they're the ones, you know, they told us about you. And then again, your mouth is powerful. Like several oh absolutely have stepped into this space, you know, hearing a good report from someone you trust.

Speaker: And then again, api a functional therapist that speaks volumes, you know, cause she's the one who's, you know, pre having kids before tongue tie revisions and then rehabbing them.

Speaker: And so she's like, which tongue tie people work out, which is working and which isn't. Yeah. Or which sure person's orthodontic care is actually giving good results and which isn't, you know, cause it's team, you know, team approach. Yeah. For sure. Yeah. And beyond, beyond, they do such a great job. They're, they're, man, they're, they've got an incredible office and, and their education, what they do with soft tissue and releases, what they do with the younger kiddos with expansion. And then,

Speaker: you know, things that don't fit into their, they're you know, expertise and what they're excellent at, and which they're excellent at a crazy amount of things, then then they say, hey, you need to go see, you know, go see this person. Just just like if, you know, if a kiddo walks into my office and they're three or four years old and, you know, they have terrible issues,

Speaker: you know, we, we may not be the right fit for them. We, in fact, we, we've sent, I've sent a whole lot of patients to beyond, you know, for them to treat orthodontically. And even though I'm an orthodontist, but, but it, you know, there are things and that's where,

Speaker: Again, just like you said, going back to the team approach and and finding what is the best spot for the patient and where is the best place to start. And sometimes that's with expansion. Sometimes it's with an ENT visit. Sometimes it's with myofunctional therapist. Sometimes it's body work. Sometimes, you know, there there's a, sometimes it's looking in and saying, oh my goodness,

Speaker: you know what environmental factors are in our house. we've We've had countless patients where we talk about We're like, oh yeah, we there's something that that we're missing. And then they go back and they find find a crazy amount of mold in their house and then get that cleaned up. And then the kiddo comes back and it's like a different kiddo.

Speaker: And so that, again, that goes back to, It's not always one thing in the majority of the time. It's multiple things, but unless you're looking at it from that, and that's where the parents can start kind of peeling back the layers. And think the other thing that I would encourage parents to do is just take a step.

Speaker: Just you see an issue, you see a problem, then take a step. And, you know, whether that's a visit with an ENT and maybe you don't hear what you want to hear and then you go see another one, or maybe it's a visit.

Speaker: with a dentist that that has some airway knowledge or with an orthodontist or with a malfunctional therapy. But if you see a problem, just take a step and, and then, you know, try to navigate it from there and don't hesitate to reach out to other people because you're not the only one going on this journey. It is a,

Speaker: It is a super common thing. and And lots of people struggle. A lot of people, like I said, don't even realize that they're struggling. And because this is not, it's not a new thing. A lot of people think that this is a new thing. It's it's not a new thing. Like I was reading an some research a couple of days ago i mentioned this to you before but it's an article from over or right around 40 years ago i think it's 1987 um by warren in in the the journal um the aj odio which is the american journal of orthodontics and

Speaker: The article was specifically, do we, should we expand for airway issues? I mean, this, that article was written 40 years ago. And what's crazy is in that article, it showed that, that two thirds of the time you have a significant and increase in cross-sectional area, which they weren't doing obviously three-dimensional experts at the time, but the, the airway increased, um,

Speaker: in two thirds of the patients and they saw a significant decrease in, in mouth breathing. But the conclusion was that because it didn't, didn't correct a hundred percent that there were one third that did not have significant improvement. Expansion should not be considered as the treatment for the airway and, and like articles like that, you think, Oh, well,

Speaker: Maybe you should just figure out why those that one third yeah you know didn't improve. And maybe it's more than just the expansion. Maybe there's other things involved.

Speaker: And so it you can, you can, and you know, AI is good. It's good and it's bad, but but you can you can tap and you can top in symptoms into AI and and it it does a really pretty good job.

Speaker: You know, I typed in all of my health symptoms about a week ago into AI and it it literally said, without a doubt, you have airway issues. It was crazy. is the It was like everything that you're describing, the one thing that links it all together is is airway. So, yeah, it... it I would just say, keep, keep trying and keep knocking on those doors and, and you'll, you'll figure it out.

Speaker: Yeah. And it's not like necessarily an arrival thing. Like I just no had a cold recently, you know, and then I'm starting to breathe more through my mouth. So then it's like, okay, I need to mouth tape at night. So I'm not propping my mouth. Absolutely. Right. Right.

Speaker: or just like, and developing natural rhythms that that are healthy for your airway. So nasal rinses and, you know, being aware of of like, I still have terrible allergies. And so when pollen's off the chart, mean, last week I couldn't talk because I lost my voice because because of all this stuff in the air.

Speaker: and And so just having an awareness of that and what you can do i mean you you gave you gave me an awesome nasal rinse and so you know like just some of the things adjunctively that can be done and what's really really cool is if you get a patient that that will help you include some of these other things into treatment, their treatment is dramatically better. yeah The expansion is better. The teeth respond more. their Their habits go away easier. Their posture improves, muscle tone improves, growth direction improves even even faster. Because one of the best things about doing airway treatment is the earlier you do it,

Speaker: the more the natural growth takes over in an ideal way. huh And so you can totally redirect growth, but you really need a patient that is and a parent that is willing to be a partner with you because there's only so much that we can do. You know, if say we're doing expander and a functional appliance or, you know, but they also need myofunctional therapy or they also need a lingual release or they also need to see the ENT or they also need to do these stretches or exercises or they need some body work. Like, you know, you, unless you get somebody that is willing to kind of navigate that with you, then it you're, you're not going to be as successful as, as most people want to be. And on the flip side, that can get pretty expensive and timely and overwhelming, like we said. And so you just have to take it in pieces and, and,

Speaker: getting the low hanging fruit first tes yeah is really important. and So again, take take a step. yeah You know, like if if you, if if you know, mouth tape or a breather out strip, yeah which, you know, a breather out strip can do crazy good things for a lot of adults and kiddos.

Speaker: And there's not a lot of battles that can, you know, you put on a breather out strip, your kiddo puts on a breather out strip, everybody sleeps better. They think it's cool because mom or dad has it on.

Speaker: And yeah, and then you go to sleep and now people are sleeping better. Well, that's a low hanging fruit. Stasha Gomenak is an incredible resource. She, she's a neurologist that, that lectures a lot on vitamin D deficiency and she has a free website and like that, you can go to her website and get a crazy amount of information.

Speaker: And vitamin D deficiency plays a huge role in in sleep. And so if you get a kiddo that's crazy vitamin D deficient, then they're going to have poor quality sleep. but Now,

Speaker: My wife who's in dermatology will, well, you know, yes some of that needs to be supplemental and we still have to wear our sunscreen and, and, you know, our kids are the ones with the sombrero yes and the zinc and the sunscreen so thick that you can't, you can't see them. But I mean, you, there's all sorts of things that, that play into it And that's one of the cool things about like y'all's, your podcast is,

Speaker: that you're trying to get that information out there and and and honestly if you if you find a place an orthodontic office or myofunctional therapist or an osteopath or an ent that is really passionate about this they're going to be able to help you connect the dots and get you in the right spot to to to really fix it, but you have to communicate it. yeah So like, you know, we try to do, sometimes parents won't tell us, you know, and some parents will, some parents give you an update every single time they're in, which is awesome. Some parents, they don't. So

Speaker: you know you know if you don't ask then you don't know and so like we do we do periodic psqs which is a pedric pediatric sleep questionnaire and quality of life surveys because we want to know okay if we've if we've done this expansion and you're still struggling with sleep and snoring, then maybe we should revisit looking at those adenoids and tonsils. yeah Because there are some really great studies.

Speaker: Audrey Yoon put out a really great study that showed when you do the expansion, adenoid and tonsillar tissue you know, has the potential to decrease in a lot of patients. And so that doesn't always have to be the first step. yeah And so you may, you may go into the expansion and say, okay, well, we're going to do the expansion and see if some of that gets better. And if it does wonderful, you know, we don't have to do anything and, and, but maybe it doesn't. And so maybe you have to revisit that, but unless you're,

Speaker: asking the questions and doing some of these quality of life surveys and revisiting things and, hey, have we gotten better? Or the parents are proactive about it. It's like we were saying, you've got to be an advocate for your own health and for your kiddo. And you should be in a practice where it's okay to ask those questions. yeah And it's okay to press the provider a little bit and say, hey, we're not...

Speaker: we're still wetting the bed or we're still having issues. Well, okay. You know, is there something else that we can do? Is there something in the puzzle that we're missing? Let's put our detective hat it back on and, and try to figure, okay, well, do we need to do some myofunctional therapy? Myofunctional, you know, you guys had Misty Bridges on last week, myofunctional therapy alone, statistically looking at hard evidence like polysomnographies,

Speaker: You can reduce sleep sleep symptoms by 50% in adults and 60, I think it's 65% in kiddos just doing myofunctional therapy. So like it is extremely powerful. And sometimes you know you you need to revisit that or tongue posture or tongue tie or nasal breathing, or do we need to see an allergist?

Speaker: So you know it is something it's a journey, just like you said. Yeah, definitely. It is a journey and, but it's an awesome journey and, you know, just a general striving for, for health and, and wellness and being able to share that with others is, is awesome.

Speaker: Yeah, man. Well, it's been so great to have you on today and, you know, you've just shared such a wealth of information with our listeners. We'll be sure to include your contact information, you know,

Speaker: in the show notes. So people who are close to Dallas, we're not even in Dallas, but we drive for two hours to come see you can connect. And then, you know, people can look in their area for like an airway specific provider if they need that.

Speaker: um Is there anything just imparting you'd want to share with our audience today? No, this has been awesome. It's been a blessing. I love, love talking about it.

Speaker: You know, I've, I've really loved getting to know you guys and your fam. And so thank you for letting me be a part and, and i commend you for, for spreading the word and, and having a passion for it. And just thank you for, for, you know, helping out all these moms and dads that are, that are trying to help their kiddos. So yeah keep up the good work.

Speaker: Well, thank you so much. You're the real deal. And we're just well thank you thankful to have you come on the show today. Awesome. Well, hey, it was fun. Yeah, I'll have to do it again sometime. Yeah. Thanks, Grace.

Speaker: This is not medical advice and is for general, educational, and informational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment.

Speaker: Listeners are advised to always consult with a qualified healthcare provider regarding any medical condition or treatment plan. This information is for personal use only.

Speaker: Rather than asking you to comment or subscribe, we want to encourage you to share our channel with others if you found this helpful. We are committed to nurturing face-to-face relationships and encourage you to be known and seen by those in your world.