Collaboration

June 14, 2019

I wanted to reflect on a continuing education event that I was lucky to attend on Tuesday, June 11, 2019.  The LV Med talk was hosted by Ai Orthodontics.  The amazing speakers I had the pleasure of hearing Tuesday night were: Angie Lehman, RDH, COM from OMT of York https://omtofyork.com/, Dr. Phillip Brinton from Brinton Pediatric Dentistry, https://www.brintonpediatricdentistry.com/, Dr. Ankur Johri from Lehigh Oral and Maxilliofacial Surgery https://www.lehighoms.com/p/dental-implants-Allentown-PA-Home-p30890.asp, Dr. Nadia Afzal from Valley Dental https://valleydentalsmiles.com/our-team/, Dr. Shehzad Malik from The Heart Care Group https://www.heartcaregroup.com/, Dr. Eric Holender from ORL Associates http://www.orlassociates.com/, Dr. Suneel Valla who is a sleep medicine physician at St. Luke’s Quakertown, Miners Memorial and recently Coordinated Health, and Dr. Aejazz Issa from Ai Orthodontics https://www.aiorthodontics.com/.

It was great to see how a group of passionate individuals when working together can end up having great results for a patient outcomes.  It was also nice to hear how since these individuals have started down their paths of there profession how they have learned new ideas which have helped their patients have better results.  The best part of the whole thing is that myofunctional therapy and sleep have been the miss links from their previous treatment plans, but not anymore.

Now that they know about myofunctional therapy they are getting better results because not only are they moving the structure (bones, in cases such as orthognathic surgery), but they are also concentrating on make the muscles stronger.  Because of this they are making sure the patient has the correct oral rest posture, which means they have ruled out if the patient has a tongue tie, tongue thrust, any oral habits or any airway issues.  Did you know that only 20% of tongue ties actually will cause speech issues, but just because the tongue tie isn’t causing speech issues doesn’t mean that the tongue has the correct oral rest posture.  I enjoyed everyone’s presentations.  It is still amazing to me how little people think about how important sleep is but if you are not sleeping and breathing correctly it can be a bad combination.

But there is good news that there is a shift to sleep medicine and people are now paying attention to it.  If you are not breathing through your nose you are not exchanging oxygen and nitric oxide correctly which can influence you to possibly have cardiac events in the future.  As I have stated before, breathing is the first thing they make sure you are doing when you are born and the last thing that is check before you are dead but nobody is talking about it at any other time.  For the benefit of the patient it has to be a collaboration of providers to get the patient where that need to go to get the best outcome.

Being in Balance with having a good oral rest posture

I was at the Pennsylvania Dental Hygienists’ Association Keystone Dental Health Conference this past weekend.  I was able to listen to Angie Lehman, RDH, COM®, owner of OMT of York.  As presented in the course and the certification course I took, this field of study has been around for about 100 years.  Even with what I have learned about oral rest posture so far, it still fascinates me at how important oral rest posture is in maintaining a great arch form on the palate so the tongue fits.  I am learning this first hand, since I was tongue tied and my tongue hasn’t been resting in the proper place for the last 35 years of my life.

A healthy oral rest posture consists of having the lips gently closed, facial symmetry, nasal breathing, and tongue on the roof of the mouth.  This will also help to maintain a great airway space because the roof of the mouth is the floor of the nose!  It is important to have balance or as Dr. William R. Proffit, DDS coined the term ‘oral equilibrium’.  By having balance, this allows someone to breathe and swallow correctly.  We can live weeks without food, a few days without water, but on minutes without air.

If we aren’t breathing correctly overall health can be impacted.  If the correct rest posture is not evaluated, this can impact facial growth and development and sleep.  But facial growth and development has been impacted a lot by the softer diet we have as a society now, use of sippy cups, pouch foods, pacifiers, individuals being tongue tied and oral habits such as thumb/finger sucking habits.  Mouth breathing also has a huge impact on this as well because not exchanging oxygen the way we should creates a longer looking face.  When mouth breathing, this will usually make the tonsils larger, especially in children, which can then block the airway because the nose isn’t filtering what that person is breathing in.  And I was reminded that most malocclusions are not genetic.  Reason being that oral rest posture matters because out genes tell bone how to grow but muscles tell bone where to grow, therefore most malocclusions are not a genetic issue but rather a muscle issue.  I love learning about orofacial myology!

Teddy’s story

Teddy was born on May 16th, which was a Tuesday, by Friday he was diagnosed with Jaundice.  He needed a Wallaby blanket to help his body clear the extra red blood cells that were not being able to be proceeded by his liver.   That is when the pediatrician recommended that we add formula because that was going to help clear up the Jaundice faster since he wasn’t latching correctly and getting enough food.  At the time though, I didn’t know he wasn’t latching correctly.

As a first-time mom, my gut told me something wasn’t right.  And as a new mom, you try to do everything right.  But when learning how to breastfeed and have my child latch, everyone was telling me that I was holding my child the wrong way which is why he couldn’t latch so they would recommend a different way.  But no one looked inside his mouth.

The symptoms I had included: nipple pain while nursing, he had a noisy latch, sore and cracking nipples, he would fall asleep while nursing and he feed for an hour for each feeding, 30minutes each side.  Part of me didn’t know if this had to do with a possible complication from having a breast reduction.  But in June, which was a month later, I noticed that he appeared to have a tongue and lip tie.  This was later confirmed by a periodontist when Teddy was 6months old.  He breastfeed for 4 months and then I pumped until he was 10 ½ months old.  I also noticed that when he would use a bottle, his upper lip would be curled under, which was partly from the lip tie.  Also, looking back at pictures of him breastfeeding, shows how hard he had to work in order to latch.  His face actually looks like he is in pain.  Teddy had his release on Nov 20th, a month after he had it completed, I was watching him play in his one saucer and noticed him sticking his tongue out.  He was almost able to touch his nose with his tongue.  It made me feel great that I was correct in having the lip and tongue tie evaluated for a frenectomy and then having the procedure completed.

My hope is that by making people aware of this issue that they don’t have to go through what I went through.  If there is a problem, I can help get you to a provider that can do the release earlier than I had Teddy’s release done.  By having a frenectomy, it will put your child at better chances of not having health problems such as feeding problems or something severe as sleep apnea.

I look forward to helping you.

Sincerely,

Kristin Good

“You Don’t Know What You Don’t Know”

Greetings from North Carolina!

I attended the 2018 IAOM convention this weekend with my friend, Alyssa Stiles, from Pittsburgh Orofacial Myofunctional Therapy, LLC, https://www.pghomt.com, and it was well worth really long drive together. We have learned SO MUCH about sleep disordered breathing, ankyloglossia (tongue ties), postural issues, fascia, the airway, and new and upcoming research related to our field.

If there’s one thing that was really reinforced at this event, it’s that the tongue is connected to the rest of the body in ways we never knew or learned about in school. But, like one of the presenters said, “you don’t know, what you don’t know.”

We’ve always said that, as dental professionals, we don’t understand why medicine and dentistry are treated as two entirely different things. Without a mouth, we cannot properly eat, sleep, drink, or speak. The mouth is an important part of the head, which is connected to the rest of the body by a neck. The neck encompasses the airway, which many of us take for granted. Like Nicole Archambault Besson mentioned this afternoon, it’s one of the first things checked when a baby is born (as in APGAR score), and it’s one of the last things that is assessed as you age.  It’s something the dental field needs to become more vigilant about, especially since risk factors for airway function disorders can be identified as early as day one. When airway function disorders are identified earlier, life-long challenges can be averted, such as sleep disordered breathing, ADHD, bedwetting, learning disabilities, reading comprehension issues, feeding difficulties, speech sound disorders, TMJD, orthodontic relapse, etc.

What we were taught in school is to throughly check the tongue when performing oral cancer screenings to assess for possible pathology (ex leukoplakic and erythematic lesions), “normal abnormalities” (ex tongue ties, tongue scalloping, etc), and normal tissue. But we didn’t know what we didn’t know at the time. The research is showing that these “normal abnormalities” are actually signs of a problem, like airway dysfunction.

So here’s a special thanks to all of the presenters this weekend, and thanks to everyone who coordinated this event. We’re hoping that we can share this information we learned with other providers to teach them to NOT look past the tongue.

We understand that it takes an interdisciplinary team to best treat our patients, and our goal is to be part of a team, providing evidence-based care to promote health through proper oral rest posture, breathing, and chewing and swallowing mechanics for a lifetime.

Tongue Tie Interview

Tongue-tie: a condition that affects thousands of children and adults

Below is what FOX43 had written on their website for this interview:

YORK COUNTY, Pa.– Ankyloglossia or tongue tie is a little-understood condition                   affects thousands of children and adults.

It is when the tongue is ankylosed or tied to the floor of the mouth by a piece of thin           tissue called a frena.

Today on FOX43 Morning News, Dr. DeLisa Williams and Hygienist Kristin Good                 from Smilebuilderz stopped by the set to offer more on the condition.