5 Airway Patients In Your Dental Practice Right Now with Dr Liz Turner – PDP226

Teaser: We as dentists shouldn’t be feeling like we’re putting out fires all the time. We should be patting ourselves on the back for being quarterbacks of not just the oral cavity, but of full body health as well. If you’re looking at things with an airway positive spin.

This is an ENT issue. This is a dental issue, but the body has no idea what you’ve studied. It has no idea what your specialty is. It’s just functioning or dysfunctioning the way it is. 

Jaz’s Introduction:
In this episode, I’m joined by two dentists, Dr. Liz Turner and Dr. Meggie Graham, who started as general dentists, but then they have later niched or pivoted more into airway and health. They still do dentistry, but they’re very much an airway focused passion. I think passion, is the best word, and let me tell you guys, you’re gonna absolutely love the different themes and facets we explore.

The thing I love the most about this episode, which I know you will too, is how it made airway tangible. For example, when I ask my patients, what do you do? They will say something like, oh, I’m in logistics, or I am a project manager, or I am a business consultant. Honestly, I could not even shut my eyes and imagine what they actually do.

Like I wanna know what people do day in, day out. I dunno if it’s just me, but I genuinely cannot imagine what a typical day in their life looks like and how they actually operate. So similarly, when someone says, oh, I’m a dentist, but I have an airway focused practice. I actually didn’t know what that actually looks like day to day.

So one of the questions I asked them is, okay, what does a typical day look like? What interventions do you use? What different tools do you have in your toolbox to help your patient? And I think they both did a wonderful job to explain that. And you’ll see these five patients discussed like five typical patients that they see that we see day in, day out.

These are five real patients, the fifth one being my second son, Sihaan, that we actually discussed who we can help as dentists. But their primary issue is an airway issue, so I love how we made it tangible. Now, this episode is part of the AES takeover. We are shining a big light on the AES conference in Chicago.

That’s in February 2026. The website will all be below, and this is where the creme de la creme come together in occlusion, TMD and Airway. Me and Mahmoud will be speaking at the conference, but honestly, the lineup is insane. I definitely want every single person to click on that link to AES. I’ve got my show notes and have a look.

Does this tickle your fancy? Have you never been to Chicago before? Lemme tell you. It’s an amazing place, great culture, great food, but just comfort the education alone is gonna be mind blowing.

Dental Pearl
Hello, Protruserati. I’m Jaz Gulati, and welcome back to your favorite Dental Podcast. Every PDP episode I give you a Protrusive Dental Pearl, and this one was inspired by my conversation with Liz and Meggie.

Before we actually hit the record button, I was talking about one of the missions. This podcast has is to help dentists fall in love with dentistry again, and we need to remember that the kind of themes we’re talking about, the discipline of dentistry, which is airway that we talk about is growing and is growing for good reason and reminded me of how not only our life, but our career also comes in seasons.

And we need to appreciate that dentistry is a wonderful profession in the sense that we can redefine ourselves or be reborn like every 10 years. Think of it like that, like every 10 years, there could be like a season of your career. For example, for the first 10 years, you could be focused on general dentistry.

The next 10 years you could be general dentistry and facial aesthetics. And maybe in the 10 years into that, it could be just facial aesthetics, for example, should you wish for that. I’m giving quite extreme examples on purpose. For someone else it might be single tooth dense for the first 10 years, then it could be for the next 10 years, full mouth dentistry.

And for the last 10 years it could be periodontally focused alongside full-mouth dentistry. And of course, you can think of every possible combination. You can bring in implants at 10 years, or you can start doing more ortho. The most important thing here, guys, the lesson I’m really trying to share here is don’t stay stagnant.

You’ll get bored. Keep learning, keep growing. Keep pivoting, keep niching. Get rid of the elements of dentistry that you don’t like and do more of what you do like. And give everything a chance though, like sometimes we’re too quick to give things up just ’cause you’re not good at it. Maybe not good at it because you were never taught well.

And so maybe you wanna go on that education to be a good generalist first, and then niche in to the areas that you love. So think of your career as coming in seasons of. Five years or 10 years, however you want to play, and don’t stay stagnant. Keep learning, keep growing. And with that, let’s listen to what Liz and Meggie have to say. I catch you in the outro.

Main Episode:
Dr. Liz Turner and Dr. Meggie Graham, thank you so much for making time on this really important episode for so many reasons, because we get to discuss career and passion and changes in our professional lives and the different facets of dentistry that often we can explore more and more.

And really, I wanna just shine a light on airway in a big way, and I’m so glad you’re here to do this. So Liz, we’ll start with you. Where are you speaking to us from? And tell us about yourself. 

[Liz]
So I’m in Denver, Colorado. I am a general restorative dentist. I have a huge focus on pediatric growth and development because I just think that’s where we can make so much change.

We work with so, so many adults, but at the same time, a lot of what we’re doing at that point is symptom management, and to get across the finish line is just a little more challenging, where if we could just be preventative in our mindset, we can reduce so much hardship that people experience in their health journeys.

So I am just so excited that our paths have crossed, and that’s mainly through AES. So I am just really excited for anybody that’s listening, that is considering coming over across the pond, as you guys call it, to Chicago in February. Our meeting is gonna be awesome, and I’m just so excited to have Jaz and Mahmoud on our lineup.

[Jaz]
It’s an absolute honor. I tell you, it’s crazy when I think about it. I’m very, very excited for that. Liz question, like, do you treat just young people or do you still treat adults, and then do you do any restorative at all? 

[Liz]
Yes, so I have two practices. I have this airway focus practice untethered, which Meggie and I share from Denver and Milwaukee, and hopefully we’ll see that grow in the best way possible. I also have a general restorative practice where I focus heavily on functional restorative, airway focused dentistry, so I am able to utilize my clinical skills on the daily with an airway positive approach. And we’re able to plant the seeds in our hygiene chair and really work hard in educating our patient population who’s just asking for more.

And it’s not uncommon for me to hear, you know what? I asked my dentist about that 10 years ago, and they said I didn’t need to do anything. Or somebody pointed that out to me. I just didn’t think it was a big deal and neither did they. So we’re really running into this time where patients are coming in so much more informed and they’re asking for more of us as clinicians, not just to do the best anterior restorations possible, but why can’t we can’t improve upon the foundation as we’re doing? So it’s just a really, really fun time to be in dentistry and I am just so grateful that, like my personal path has taken me that way. And I think Meggie feels the same. 

[Jaz]
Well, we’ll be discussing the journey, but Meggie, please tell us where you are talking from today and your experience in. Are you like only seeing children now? Do you do any restorative? 

[Meggie]
Hi, I’m Meggie Graham. I’m in Milwaukee, Wisconsin. Also across the pond. Like Liz, I have two practices. One is a restorative practice. Where you come and you have your hygiene visits, you come in for restorative dentistry. But we do have that mindset of getting to the root cause and focusing on functional restorative smile design.

And then we also have the specialty clinic, which is untethered, where everyone that comes to untethered has a dental home where they go and see their hygienist and their general dentist, but they’re coming to us to take out answers to their questions about sleep and breathing and facial development and growth. So we have very parallel situations where there’s a restorative practice and the specialty practice. 

[Jaz]
What I love about everything we’re talking about and everything we will be talking about is it’s a way of putting the mouth and density back into medicine overall. Right? Back into the body, which is such a huge thing.

Like way early on in my sleep journey and airway journey, I have been sleep testing for just two years, but the difference I’ve been able to make already on my adult patients, I don’t see children anymore. I’m especially eager to learn from you both about how you manage your day in, day out, the kind of questions you get from patients, how you’re able to influence and impact and help all your patients.

But I just wanna start from the journey, right? I just wanna spend a couple minutes on the journey because one of the purposes and the missions of this podcast is to help dentists fall in love with dentistry again, and dentistry just doesn’t have to be class twos and crowns, right? The most beautiful thing about our profession is we can pivot and we can niche into a million different ways.

So I would love to hear your niche stories. Something I talk about on the podcast is niche kebab. For every one thing that you wanna add, you remove something and eventually you end up with a little niche kebab of that just defines you. So Liz, tell us about your journey. How did you fall into this scope of dentistry?

[Liz]
So I had some facial trauma when I was a kid and I ended up in the dental chair a lot. And we didn’t talk about prevention. Like I just thought you got cavities. It was not a thing to have my parents, no offense guys, if you’re listening to this, managing my dental hygiene, it was like, you’re 12, you brush your teeth.

I was like, heck yeah, I did. Yeah, right. Did I? No. And in terms of diet and prevention, it just wasn’t a conversation in our household and really like amongst the population. So ended up in the dental chair a lot, had some facial trauma and I’m still managing all of that because the foundation was never appropriate to start.

And so ended up being, having a dentist, I was a distance runner, I guess still am retired, recovering. But I always appreciated the full body approach to health. And so I’m eight years into my career I think to myself, well, okay, another root canal. Another extraction, another crown. But it was single tooth dentistry, like there had never been.

I went to Tufts Dental and I had a great education, but it was basic. It wasn’t heavy on occlusion. And the general consensus was that the occlusion guys were crazy. And really it was the big picture that we needed to look better at and really emphasized to our students. So finally, I think I’m in the wrong space.

I should have been a physical therapist. I should have been a chiropractor. So I’ll admit I was doing well, but I was pretty unhappy with the way that my journey was shaping. And then I had my son and stuff started to shift because I didn’t know much about babies, but he just seemed different. Like he just seemed franky and fussy and uncomfortable, but he was healthy, so nobody really cared.

And I started asking questions about tongue ties to a provider that I knew outta school who had posted some things about a laser. And she goes, I can’t diagnose from a picture. But that baby’s got a pretty significant tongue tie, and I’ve been told in the hospital it was mild. We’ll see if it affects his speech.

He’s gaining weight, don’t have pain. So it was just so dismissed and there was so much gaslighting behind it then. And there still is now. So fast forward a month, I have him treated three days later, my father-in-law has a heart attack due to years of undiagnosed sleep apnea and eventual A-Fib (atrial fibrillation) that he developed.

And months later, I start putting the pieces together and he’s got a bilateral posterior crossbite. He had a speech impediment that still affects him today at the age of he survived miraculously after being put in a medically induced coma. He still got his speech impediment at 80 and it bothered him when he was a kid.

And maybe if we just looked at his growth and development, we could have improved his breathing and ultimately the way the story ends. So we don’t have a crystal ball to say what’s gonna happen for everybody. But as I’ve seen my career evolve, I’ve realized that if we can help children breathe, we can help adults breathe better too.

So it’s been just a really fun progression and a lot of it, Meggie and I self-admittedly that’s how we met, is like we had to figure a lot of it out on our own. And it’s been really fun to develop our own way and our own nuances and share those with ourselves. And now we’re just really excited to share ’em with everyone else.

[Jaz]
The two words I wrote there was health optimization. You are in the health optimization space, which is amazing. And Meggie, your own personal journey, we always love to hear them. So Liz, thanks so much for sharing that. Some personal details really appreciate you sharing that and everything aligned and pointed you, the universe was sending you that sign. Meggie, how does your story go? 

[Meggie]
I mean, so, so many overlaps, so many parallels, and I think a lot of people in this space, in quote unquote airway dentistry have similar, at least some overlap on a venn diagram of similar journeys. But mine started very similarly as a new general dentist. My dad was a dentist and I remember very profoundly, this is one of those memories that stands out.

I was on a walk with him shortly after graduation and I just said, dad, I think I made a huge mistake. I was like this, I cannot imagine doing this for the rest of my career. It is so unfulfilling. It is so high stress. It is, people don’t like to come to see me. I’m causing pain. I’m just, I feel like I’m putting out fires constantly and there’s no real satisfaction.

I was a single tooth dentist and I just kinda sat there for a while in regret and doom and gloom, like you said. I love that phrase. And I just leaned heavily into starting to ask the question why so many patients would come in. And we were taught in dental school, or at least my takeaway from dental school was home care and diet.

Those are the things that patients can control and that’s what causes all of the problems. And that didn’t add up to what I was seeing in my clinical practice, where some of my most fastidious patients coming in on their prescribed recare, every time I saw them, they had another broken tooth or they had another set of caries and something wasn’t adding up.

And so I kept on adding, asking why, and that led me to my CE journey, which really reinvigorated my passion, which is lifelong learning, and that led me to occlusion. And I really laid heavily into learning and understanding the function of occlusion. And then it still didn’t quite add up, like there still was something missing.

And that led me to our mentor and friend Jeff Rouse, who really connected the dots that there is a component to this that is systemic. The mouth is not annexed from the rest of the body. It is related to breathing and sleep. And so then that just kind of kept me going. And my friends thought, maybe they still think I’m crazy, right?

Like the amount of time, energy, and money I was spending on collecting CE for the first decade of my career was insane. I was dragging babies with me and just I couldn’t consume it enough. But like Liz said, there wasn’t a clear cut path for us of how do we take all of this knowledge and then go home and implement it.

And so that’s kind of how I fell into it. And then of course, personal stories, my nephew, myself, I realized I was the airway patient, my own children. And then once something becomes really personal, you can’t help but just grow your passion to figure it out. And then I started to see that in my patients.

And so my shift in focus went very heavily into sleep and breathing and airway, and I let go of the restorative dentistry to the detriment of my practice, to the detriment of my staff. I lost patients. They’re like, I mean, I just want a cleaning. And so I had to kind of find that middle ground where we can create curiosity and ask questions and plant seeds in my patients, because I had consumed all this information, didn’t mean that everyone else had this.

And so really figuring out how can I take all of this and get it to people so I can actually help and not scare them away was that next phase of my journey. And then as I continue to change my focus, I’ve figured out how to kind of marry the two in our own way. And she and I, Liz and I have done so many things in parallel that we finally were like, what if we started doing this together? What if we took your path and my path? We married them and made a bigger impact and also learned from each other and did this faster. 

[Liz]
We just started sharing so much information because we needed to almost teach each other like, oh, I figured this out. Can you teach me how to do this? So even from an administrative standpoint and what type of forms and how do you work with insurance?

And I know you guys are different system, but like that’s one of the biggest questions we get asked by dentist in the US is how do you manage billing? How do you manage this administrative portion? So it’s challenging to know all the things in dentistry, and like you said, Meggie, it can be challenging to not be fulfilled when you’re always putting out fires.

[Jaz]
I mean very much what we are doing with airway is the exact opposite of single tooth dentistry. It is bringing everything together, which is why I love. Now, to explore that common theme that you both have discussed so you know how it’s affected you and your close family members. I love my restorative dentistry, right?

I also get a lot of referrals for TMD and the last few years I’ve implemented airway testing, like sleep tests and I’m looking more and more into this. Very fascinated, my now 6-year-old, when he was about two, three, I noticed that he was not breathing at night. He was holding his breath while he was sleeping.

I was observing him holding his breath and I was like, this something isn’t right here. And went to the doctors and they’re like, yeah, he is growing. He seemed fine. And I was very insistent that look, is there no diagnostic test you can do? And they reluctantly did a sleep test and lo and behold, they found that yes, there is an issue.

He had his adenoids removed and he’s a different boy. And my 2-year-old. He’s now two. But when he was one, he also had the sleep test. He actually got even higher scale, moderate sleep apnea for at that point he was age one and he snorting, he’s disturbed sleeping. Sometimes I have to wake up six times a night to get milk ’cause that was the only thing that would pacify him.

I was like, something’s not right here. He’s like nine months old. Why am I having to go get milk? This is after he stopped breastfeeding at age one and then now he’s being monitored and when he is healthy enough again going down the same path of adenoid removal, potentially tonsils. So I’ve taken a great interest to this, but what this ties into is when I see the dentist Facebook groups and classically they mention about, oh, I have a child patient and the parents are concerned about X, Y, Z.

And then often there’ll be bruxism and then you have a whole 20 different opinions, many of which are okay, ENT, there’s nothing to do ENT. And one of the things I’d love to discuss with you, ’cause you guys are experienced in this, you guys are developing this fantastic niche is at the point of the GDP, we’re very often we’re like, okay, it’s at ENT or a sleep specialist. The misconception is there’s not really much the dentist can do, so please explain about, is this a misconception and then develop that more for me. 

[Meggie]
Can I go? 

[Liz]
Yeah. 

[Meggie]
One of the things we’ve noticed, Jaz, is that we’re both so excited and we’re both so overlapped, like we’re both ready to jump in and talk over each other. So we’ve learned to be like, be very careful at answering questions. Can I take this one? So you know it’s yes, both, right? Like and all of them. It’s not, and I think we’ve done such a disservice to humans and patients to compartmentalize the body and say, this is an ENT issue. This is a dental issue. But the body has no idea what you’ve studied.

It has no idea what your specialty is. It’s just functioning or dysfunctioning the way it is. And so you have to have a really full comprehensive understanding of the whole system, even if you’re not gonna treat all of that. And what I think has made untethered really special is we are really good at quarterbacking or stepping back and seeing the whole picture.

And yes, we offer services to help our patients and we also recognize that sometimes it’s not our services that are needed first. So when I first jumped in, and I mentioned a minute ago that everyone was an airway sleep patient, and I did the detriment of my practice. You know, I was sleep test, I was airway testing, sleep testing, everybody.

And I realized I don’t do that as much anymore. I still do sleep screenings and sleep studies, but now I recognize if we can optimize function, which in an infant or a child might be breastfeeding, speaking, eating. We can optimize breathing, we’re gonna optimize growth. And so if you can just optimize function and the foundational structural components, TMD symptoms fall away, breathing symptoms fall away, bruxism falls away, and then the sequelae, like dental breakdown falls away.

And all the systemic things that come from poor breathing and sleep fall away. So a really long-winded answer to your question is, yes, ENTs are appropriate if the ENT can look at the big picture, because so often if they go and see the ENT and they’re told no, they don’t know where to go next. And that’s where I think we really wanna get providers to is how can you go to 12 different providers across different specialties and get the same information, right? Like the full body understanding. 

[Liz]
I think that’s the hardest thing. And Meggie, what you’re basically saying is you can still just do the dentistry. Like you can still just do dentistry and make positive change because really a lot of this, these systemic problems have dental manifestations or what came first?

Did the dental manifestations cause the systemic problems? So what came first, the chicken or egg, it doesn’t matter because you’re right, the body doesn’t know the difference. So if there’s not space, make space, if the teeth are worn and we’ve lost vertical and we realize there’s an etiology of sleep apnea, doing that full mouth rehab is beneficial to the patient from a health standpoint as well as aesthetics.

So like we as dentists shouldn’t be feeling like we’re putting out fires all the time. We should be patting ourselves on the back for being quarterbacks of not just the oral cavity, but of full body health as well. If you’re looking at things with an airway positive spin. So it’s a challenging time because you’re right, there’s so much disconnect.

And even for me, my most favorite and most understanding of development, craniofacial wise, ENT, I’m finding out now is requiring a sleep test on everyone. And I can’t get people sleep tests for five months and five months if that was my kid, that’s too long for my child to suffer. It’s within, at least in the US, it’s within our ENTs guidelines.

If there’s an alteration, if the adenoids and tonsils are causing an alteration to craniofacial growth in their guidelines, to look more closely at just the structure and not the data on the sleep test ’cause also the data on the sleep test the cognitive effect of if you have an apnea score of 10 or one in a child, the cognitive effect is exactly the same.

The severity doesn’t relate to the fact that negative change is occurring in that little brain. So that’s where I just get a little irritated with medicine in general. But there’s my soapbox. 

[Meggie]
Well, taking it back to your question, Jaz, about your own kiddo and this like these Facebook posts of understanding that there are ways to jump in and do even without a positive sleep test or without an ENT, so like we get a lot of people that are searching for solutions and giving parents the power to know that they can make a ton of little changes. And all of those things can add up while you’re seeking out the more structural, bigger picture things.

You know, looking at function, looking at how they’re chewing, looking at their diet, looking at the quality of the air that they’re breathing. All of those things can impact them very positively while you’re seeking out a provider in your area that has that whole body understanding, whether it’s an ear, nose and throat doctor, an airway focused dentist. But yeah, really starting to understand that it’s just not a yes or no answer. 

[Jaz]
About taking what I’m gathered from that is being more proactive and yeah, the bigger picture and being part of a multidisciplinary team where you can call the shots a bit. Well, again, actually this patient will benefit from an opinion, but working on this together and we’ll talk more about which other specialties are involved.

I’m gonna explain the next two questions ’cause then we’ll revert back to the first question, which is I want to actually know what you actually do. And what I mean by that is it reminds me of patients, right? Like in my mind, I can shut my eyes and imagine what they do, what a typical day looks like.

When a patient tells me, oh, I work in logistics, or I’m a consultant business, whatever, I can’t even close my eyes. And like, what do they actually do? And so the reason I ask that is I would love to know, like if I say restorative dentist. Okay. But I would love to know in a typical day, how do you actually structure your day?

What are you actually doing? What are the different interventions, diagnostic tools, that kind of stuff. I’d love to know, but that is a follow up question to first we need to understand what the signs are, what the symptoms are that you get, parents tell you that children tell you what we actually looking for, which will then help to explain, okay, what then is your role? What tools do you have at your disposal to actually help these patients? 

[Liz]
Do you wanna go with the symptoms? And I’ll go with what a day looks like? 

[Meggie]
Sure. I think that’s great. Well, even in the name, you asked what our journey was before and even in the name of my practice was my practice is now our practice. It started out as untethered tongue tie center, hence the name untethered to untethered tethered tissues. But then realize that is one positive sign of many possible things that we could be dealing with or seeing. So tethered oral tissues is a big one, and it’s going to impact how our muscles function, which is going to impact how we do everyday things like chewing, speaking, swallowing, and that’s going to impact the way our structure grows.

And then that’s gonna lead down to everything else that we deal with. So, tethered oral tissues, we’re looking at facial development, the shape of the face, the position of the jaws. Intraorally, we’re looking for, some of the complaints we might get from patients are TMD pain, facial pain, continually breaking teeth from bruxism or clenching, uncontrolled caries, narrow vaulted pallets that are more- 

[Jaz]
Can you explain uncontrolled caries? Just so, because younger colleagues may be listening to this like, wait, how caries is plaque and sugar? Why is it that an airway patient will be more successful to caries? 

[Meggie]
Yes. Great. Great question. Yeah, and it took me actually some time to get there too, is so, like in my journey in school, it was home care and diet. You brush your teeth and you have a clean diet and you avoid sugar, you’re gonna have a healthy mouth. And that is very true. Home care and diet are essential, and they’re very important. I don’t want to say that that’s not the case. And if you don’t optimally breathe through your nose, if you are somebody that has restricted nasal breathing, you’re gonna have an airway that’s more collapsible, and that creates a vacuum pressure.

And that vacuum pressure brings up acid. And that acid is not like gastro acid where we feel heartburn or feel discomfort. It’s a mist and it’s asymptomatic, it’s laryngeal pharyngeal acid, and that creates a constant acidic environment in our mouth, which is what cavities or decay thrive in. It also produces a signal to our body that we have an acidic environment and we start to brux our teeth, and that bruxism is to produce saliva to buffer the acid.

So now we’re bruxing in an acidic environment and that’s causing significant erosion and attrition in the mouth. So uncontrolled caries is that there’s a breakdown despite the effort going in by the patient’s own accord. 

[Jaz]
How about the fact that mouth breathing, like the sliva quality would be less dry mouth? Is that part of the- 

[Meggie]
Totally. So that’s one part. So like let’s say, ’cause some people are like, oh, I don’t mouth breathe. I breathe through my nose, and yet they’re still showing signs of acid and erosion. Those are still airway patients. Then there’s more overt patient that is mouth breathing. They’re bypassing their nasal system.

They’re not filtering their air, they’re making their saliva a different quality. They’re drawing out the mouth, they’re creating an an acidic environment that also increases the cavity risk as well. So it’s coming at it from two different mechanisms. 

[Jaz]
And you are listing all these symptoms. I’ll let you finished for any more, but then I would love to for you to tell our listeners and watchers which ones are perhaps specific for younger patients, children, and which ones are more specific to adults.

[Meggie]
So as we grow and as we age, and as we mature, we adapt and the symptoms can change. And so the common thing that Liz will talk much more articulately about than I can is many providers, myself included years ago, would say, oh, they’ll grow out of it. Don’t worry. It’s not a grow out of it, it’s a symptom adaptation and a dysfunctional change, and the compensations change.

So we can see increased caries or decay in children and adult. We can see erosion and attrition in adults and children. So that doesn’t really line up with age specifically to those types of symptoms. In a child, though, we’re more like somebody that is a child that can’t breathe and therefore can’t sleep very well, is more likely to show signs of hyperactivity and behavioral issues.

Because when they’re underslept, that’s how that manifests. Whereas an adult, it’s more common to see, not always, but more common in an adult than a child to see profound fatigue, excessive daytime sleepiness, just this wrecked, crushed fatigue. So those symptoms do show differently between adults and kids. And then like you experienced with your own son in a baby, it’s cranky. It’s fussy. It’s in a hyperactive fight or flight state all the time. 

[Jaz]
Absolutely. So Liz. 

[Liz]
So I’m gonna give you four patients because I think when you look at the patients, you can look at the treatment options and also understand the symptoms a little bit more and kind of how a day operates.

And think about it like this, Meggie and I both started our practices untethered was within the dental practice, and that’s no longer, but this stuff is possible in a dental setting. But what I would encourage you if you’re listening, is to start to compartmentalize your brain a little bit of you don’t, and like Meggie said, losing patients, losing friends.

You don’t have to go all in all the time. Like we can plant seeds in our hygiene operatories, and that’ll be patient four for us today. But you can actually do this well within the walls of your own practice without having to have two facilities and a whole separate team and all these things. So, okay, so baby number one.

Referred over by a lactation consultant and a chiropractor had been seeking and asking questions about why the baby took so long to feed and why they would fall asleep. The pediatrician says, oh, just flick ’em on the foot or take their blanket off so they’re cold, so they’ll stay awake. Okay, so you got a really, really sleepy baby while they’re feeding at three and a half months- 

[Jaz]
That was my first born, by the way, my wife tried her best to breastfeed about four to five months. She did it. So well done to her. But then it was like this issue of him falling asleep and not thriving, not doing so long. When my second born was a fantastic breast feeder. We had to force him off to boob ’cause my wife needed to go back to work after a year. So yeah- 

[Liz]
He’s your one that wanted the milk it a little too late because he’s keeping that tube open with suction. So that’s why breastfeeding slowed down at four or five months. Baby comes to us three and a half months supplies tanked, baby super frustrated at the breasts, were starting to decline and wait and using the bottle is working to keep the weight up, but the baby’s super uncomfortable because they’re taking in so much air.

Moms supply tanked because it switched from hormonally driven to supply and demand, vacuum driven. And since the vacuum wasn’t good because the oral cavity wasn’t working, maybe there’s a tongue tie or lack of tongue tone. The palette’s narrow because genetically we’re going that way. We need to work on infantile suction from the first day.

And we do a disservice to babies and moms because the swallow pattern is what drives growth of the upper and the lower jaw, especially the lower in the first two years of life. We get more jaw growth in the first two years of the mandible than we will at any other time. And anybody that says they can grow a mandible consistently, I don’t know if you got a person, we’re missing a huge growth window if we don’t optimize function.

So baby number one comes to us. We treat them through, they’ve already had a lactation and chiropractor. They’re in a good space to be moving forward with tongue tie treatment, laser phrenectomy. They return a week later. We make sure symptoms and healing is appropriate. So there’s patient one.

Patient two, four and a half years old has seen ENT. The adenoids and the tonsils aren’t big enough to be removed, but hyperactive snoring, lack of sleep that is disrupting the family as they’ve had to lock the child in the room because they’ll come into the parents’ room so much. So they wait for him to start screaming on the camera before they help him because the ENT said there’s nothing they can do.

And they’ve been asking questions about this kid for four and a half years. So what do we do? We’re super narrow. The lower teeth are tipped in. There’s not a visible crossbite because it’s compensatory, but if you look at the maxilla, it’s smaller than the mandible, and we need that hat to be bigger than the mandible.

So we expand them and we can get statistically significant shrinkage of the tonsils in the adenoids with expansion. The question is, is it enough to reduce the need for tonsil and adenoid surgery? They were already told no tonsilil and adenoid surgery. What choice do we have? Let ’em suffer or expand him. Upper palatal expander, improve the nasal breathing.

[Jaz]
What age are we talking here, Liz? For patients? What age are we talking? 

[Liz]
That’s a four and a half year old. In a perfect world, I’d wait closer to six. Typical orthodontics, but I still like the concept of fix before six when I can. But if I’ve got a kid who’s sick, I’m not gonna let them suffer because no one else said they could help them.

I’m gonna inform the family. There’s gonna be some relapse. You’re probably gonna need a second incremental palatal expander at some point, but I want your child breathing and growing and releasing human growth hormone and healing that brain as quickly as humanly possible. So there’s patient number two. Patient number three-

[Jaz]
I’m loving this by the way. I’m actually loving this. You’re making it tangible. I’m loving these two patients so far. But then, so this, yeah, the expansion. Okay, so, so this gonna be brilliant. So the first one was actually diagnosis and managing parents and helping a child to feed better and a tongue tie release, right? Did I get that right? 

[Liz]
Yeah. 

[Jaz]
Second one was, again, diagnosis and education. And this was, sorry, expansion at the age of four and a half. Brilliant. 

[Liz]
3D printed expanders go in like a dream. So my boy, tonsil and adenoids weren’t quite big enough. His a HI was a 10. That’s not good. We expanded him. We took his AHI (apnea-hypopnea index) to a 1, so sleep numbers, but then he relapsed ’cause we couldn’t correct the breathing.

So we did some adenoids, tonsils on top of that because I got him breathing better for a little while. But it didn’t solve the whole problem. And that’s kind of where this interdisciplinary care comes in is one thing is not always enough. Sometimes it is, but each little step here is incremental. So that tongue tie release in the baby could have prevented the expansion at four and a half. Maybe we could have started expansion. It’s seven on that second kid.

Okay, so patient number three. You got a 3-year-old female. She complains of migraines. That’s not her chief complaint. Her chief complaint is TMD pain. She’s narrow. 

[Jaz]
How old, sorry? Did you say how old she was? 

[Liz]
32. 

[Jaz]
32, okay, fine. 

[Liz]
So she’s narrow. She has abfraction recession on her maxillary dentition. She has a thin biotype. She has been clicking since she was in orthodontics and now it’s coming to a head and it’s causing discomfort. Her mandible is locked up. And why is it locked up? Because it never grew to the correct spot and the orthodontist lined everything up and now we’ve got this beautiful smile, but it’s dysfunctional and uncomfortable because she’s got a restricted envelope of function.

[Jaz]
Can you explain for our younger colleagues, what does a locked up bite look like?

[Liz]
So how many class ones do you see that have TMD issues? Like class one bite. So a normal bite on paper, which should be functional. Yet we’ve got people that are class one that are chipping their anteriors. And you’ll go and you’ll repair an edge.

And then three months later, oh, your bonding failed like right after I left. Like your bonding sucks, is basically what they’re trying to tell you. Like what’s really happening is that path of function is compromised. The path of function does not have enough rotational space because the mandible is likely tucked back, the condyle is posterior displaced and maybe they weren’t dysfunctional and uncomfortable until that mandible, that kind of like tiger in the cage concept that mandible wants out. It’s got nowhere to go. So it’s either breaking teeth or it’s causing myofascial and or internal derangement of the TMJ complex. 

[Meggie]
Can I throw something in there? 

[Liz]
Yeah. 

[Meggie]
Like that’s the patient Jaz that like if you put them in a mandibular advancement device or you put them in an anterior deprogrammer, or those are the patients that are the most at risk for developing a bilateral posterior open bite because finally they’re uncaged. And their jaws like, nah, I’m not going back. Thank you. Like, I don’t wanna go back to that dysfunctional jammed back position. My CR is actually forward. 

[Jaz]
Yeah. So some schools of some occlusion camps would call this a constricted chewing pattern. 

[Meggie]
Correct. 

[Jaz]
A CCP. And so I love these analogies as well. And yeah, uncaged is a great way to put it being re locked. A lack of wiggle room, a trapped mandible by the maxilla. So this is the kind of theme we’re exploring. Please continue with patient three 33-year-old. 

[Liz]
So you’ll see that in kids too. They’ll posture forward ’cause they’re trying to get outta their tonsils. So tonsils are in the way. 

[Jaz]
So this my second born and we’ll talk about him a little bit more later ’cause I’m actually genuinely more curious about him and he can be patient five, we’ll come to him. 

[Liz]
Yeah, sure. Perfect. So I’ll give you my decision tree. So 32, she had ortho, she was in ever since then it’s the jaw’s been clicking. She played soccer, so she got hit in the head a little bit. So the ramus length is a little bit off because she grew not on the disc is what many of us would say. And so what do we do? She’s not breathing well through her nose. So we start some lip taping because she’s able to, she can breathe well through her nose when she’s at rest, but when she goes into sleep, her lips part open.

She realizes her migraines decrease. The symptoms of them with just lip taping and better nasal breathing, but now she wants more, and so I tell her, if the lip taping doesn’t work, come back and see me in two months and let me know how you’re doing. She wants more. She’s asking for more. She’s asking for more treatment.

So what do we do? We go ahead and we refer her to myofunctional therapy to work on that tongue posture and placement. We start considering tongue tie released, release some of the tension in her tongue to better able live where it’s supposed to. And we start thinking about some type of expansion in adult, which is possible.

There is orthognatic surgery, which is patient four, but patient three is a candidate for enlarging the entire craniofacial respiratory complex through maxillary expansion. So we put her in a MARPE, mini implant assisted rapid palatal expander. Really, the current protocols are to go very slow. So there are some people that are calling it a mini implant assisted slow palatal expander, which makes way more sense.

And we expand her and make the hat that sits on top of the mandible larger. We give her that improvement in her ability to function well. And then restoratively, we fix some abfraction lesions that were popping out on her over and over and over again ’cause now they’re not. 

[Meggie]
The cool thing about that patient too is we get so many oral cavity volume improvement. It’s unlocking that lower jaw. It is increasing the floor of the nose, so it’s decreasing nasal resistance. So by just making that one change, we’re checking multiple boxes of improvement. And yeah, the facial aesthetics is really cool. I was like, I like my cheekbones better now. 

[Jaz]
It’s amazing to know. Oh wow. You have one on right now. 

[Liz]
Sure do. 

[Meggie]
I used to have one. All the cool kids end up getting on. 

[Liz]
I got a cute little gap here I masked, I can show you. 

[Jaz]
I mean, very good and I like it that you talk the talk where you walk the walk, like when I’m making occlusal appliances, every single one I’ve done, whether it’s a mandibular advancement or for the bruxism and whatever, for the TMD, I’ve had it on myself as well.

So it’s great that you guys practice what you preach on yourself as well. Now, patient three, like I love that you are talking about lifestyle. I love that you’re talking about oral posture, anatomy function. These are the very basis of of our healthcare. Right? Can I just probe you further on the mechanism?

‘Cause it’s not the first time I’ve heard it. The mechanism behind mouth taping, then allowing you to breathe better nasally, which can then help with migraines. What’s the connection there? What’s the hypothesis on how that works? 

[Liz]
Have you ever been on an airplane and you hit turbulence and the whole plane goes like, nobody can say no to that. It’s the same thing with breathing. We need our breathing to be passive and not turbulent. And what happens when we nasal breathe is we release nitric oxide from our perinasal sinuses, which is actually a vasodilator. So it gets more oxygen to our tissues. It’s actually a treatment for erectile dysfunction.

‘Cause like breathing, that’s a problem for that too. So this is again, a full body concept. So nitric oxide release is essential to health. The nasal breathing, it filters, it humidifies, it warms the air that we breathe. When we nasal breathe and we get that nitric oxide release, we kind of get that double whammy. If we’re mouth breathing, what also happens is that turbulence of the airflow causes that collapsibility that me was talking about. So it’s twofold. You’re missing the health benefits of the nitric oxide and the filtration and the cleaning of the air, but you’re also getting the turbulence of the airflow that’s sleep disruptive and not supportive.

So many of our patients, especially those upper airway resistance patients are gonna wake up at 2:00 AM 3:00 AM they’re gonna have to go to the bathroom. That’s why they’re getting up. And then they just, the weight of the world is on their shoulders. They got stuff to do, and it’s because their body is in fight or flight mode.

And it has been for years. These are anxious patients. Our depressed patients, our patients who feel like they can never get enough done because there’s so much brain fog. So like the trickle down of the symptoms from not nasal breathing is substantial. It’s not just TA tonsilil and adenoid enlargement in childhood.

When we don’t grow out of it and we grow into it narrow and open mouth posture or class three, we’re not going to be breathing well in adulthood, and that will have a systemic effect. And so mouth breathing will help with getting the oxygenation to an unoxygenated area, the TMJ complex, and it will help the brain heal from- 

[Jaz]
You said mouth, you meant nasal breathing will help. 

[Liz]
Nasal breathing. Yeah. And so a lot of people will support and get proof of concept from mouth taping. And it’s kind of fun because it’s become really mainstream now that it’s been on- 

[Jaz]
Thank you, tikTok. 

[Liz]
Some of the reality shows. Yeah, TikTok. 

[Meggie]
Well, I’ll say that the other thing to consider with that too is like I can breathe through my nose. I can sit here and I know I’ve trained myself through myofunctional therapy to feel wrong. If I’m mouth breathing during the day at night, your body’s gonna find the path of least resistance to breathe. And for me with a narrow nasal passageway and nasal valve collapse. I default to mouth breathing without the tape.

And for some of us that have already grown into a suboptimal foundational structure, we need a little bit more support. So in addition to mouth tape for adults, I will also recommend some sort of nice nasal dilator. Like I- 

[Jaz]
I think she wrote that on here as my next thing, because I saw the ads for it and I was like, this seems pretty cool. And like I tried it myself and obviously your nose goes like really, really wide. And it felt great. I was like, wow, this is what breathing feels right. Is it normal? Should it be feeling like that? 

[Meggie]
In combination with mouth taping, because you can keep your mouth closed, but if your nasal passageway is still restricted, you’re not gonna get that full effect. So those two things together are really impactful. 

[Liz]
It’s just one more way to decrease the resistance that’s occurring internally. And like Meggie said, when we go to sleep habitually, we can become mouth breathers ’cause we haven’t for lifespan, but our muscles also go into paralysis. Say for example, that tongue is down and back because it’s always lived there or it’s substantially tied in adulthood.

It doesn’t a have the strength to live up there or the mobility, but it’s also going into this phase of sleep. That’s where a lot of our upper airway patients are REM sleep disrupted. And so the manifestations of that long-term health-wise is, it can be Alzheimer’s, it can be cardiac because we’re working hard to combat a disease that’s been underlying for a lifetime, like- 

[Meggie]
And we’re not getting a restorative sleep cycles. Yeah. 

[Liz]
That health stability, I use the phrase I want to bring harmony to your system. I want your system to function in harmony because right now something is working harder. Your neck, shoulders, your nasal passages are working harder than they need to be. They’re not working the way they were designed. So does that answer your question? 

[Jaz]
Emphatically. And I just wanna say just a theme. Something I learned from one of my mentors is at dental school we get taught that, oh yeah, if you find an oral cancer that’s a one time, you can save your patient’s life. And then you say, oh, actually if you find a Barrett’s esophagus, you might be able to help save your patient’s life.

Well, actually what you are talking about, not only are we helping save lives, actually helping to extend quality years to someone’s lives, right? So, 10 years, why often here, you are adding 10 quality years and if you are intervening with children at the right time, then yes. I mean, the reach of that could be much greater.

[Meggie]
And to circle back to dentistry, right? Like we’re talking now about erectile dysfunction, quality of life, sleep, quality, rest, and systemic health, which is obviously so important. But as dentists, we’re also helping get, give our patients the opportunity to be on a trajectory that requires less intervention.

So much restorative dentistry is avoidable if we get them on a more optimal health journey. So even as dentists, we’re changing their quality of life. Yes. And we get all the warm fuzzies of increasing their life quality and maybe longevity, but we’re also helping them not have to put out fires and suffer through unnecessary dental work as well.

[Liz]
So let me give you patient four. 

[Meggie]
Oh yeah. 

[Liz]
Patient four is Bob. Bob’s your patient in your practice. He’s been there for years. He was there when you bought your practice and you don’t know if he’s ever really liked you. ’cause he’s kind of cranky, can’t really get a read on him. He’s just like, he’s a bit older, he’s bigger, he’s kind of crotchety. And you’re like, I like this. This guy like me. Is he gonna leave my practice? 

[Jaz]
What does crotchety mean? I just wanna just, what does crotchety, that’s the first time in my life I, I’ve heard that. 

[Liz]
Oh man. I mean he is cranky. Like cranky. Cranky. Yeah. So you like think he’s gonna leave your practice and you kind of don’t mind if he does because you’ve been saying, Bob, you need a full mouth rehab.

You got acid reflux. And he is like, I’m on my reflux medication. I don’t want my teeth fixed. ’cause he doesn’t feel good and he doesn’t feel good in himself. So what do you do? You start saying, well Bob, I know you’re on the reflux medication but it’s still there. Like clearly ’cause you just choked up a bunch of phlegm sitting here and you just complained about your heart pain.

I think you should get a sleep test and you say it every six months. Like, I don’t wanna give you a solu- this is what John Coy says, and I love it. I don’t wanna give you a solution to a problem you don’t have. But I am seeing some signs that could be related to sleep disorder breathing. So like, talk to your primary care, like he doesn’t wanna hear it from you and he doesn’t need to.

He finally goes to his primary care and then all of a sudden you have this book “Breath” in your lobby from James Nestor, which is great because it’s written by a journalist who’s amazing and funny and he swears in his book and people like reading it. And so you have it in your lobby. And one day Bob comes in and he points to the book and he goes, I have sleep apnea.

And you go, well, Bob, oh shit, I’ve been telling you that for a long time. But he goes, have you read this book? I go, well, Bob, it’s in my lobby. Like of course I’ve read it. But so Bob is finally ready to talk about it because you know what? He had that sleep test and he goes, I didn’t ask the question until I knew you’d been talking about this.

But my physician said, Bob, I’m worried you’re gonna have a heart attack. And sometimes that has to do with sleep apnea. And he goes, my dentist thinks I have sleep apnea. And now you got two people coming together for the common good of Bob to help him where he’s never really felt helped. And now Bob, he has a sleep test and I say, great.

He goes, how can you help me? I say, I think you need your sleep test. And I think there’s a chance you’re gonna need CPAP and that’s okay. And because he gets his CPAP, the next time he comes in, he’s happy as a clam. He’s lost 25 pounds, he’s got a new girlfriend and he wants his teeth fixed. So now you have a full mouth rehab and you saved somebody’s life.

And in turn, not to do, only prolong their life, you made a really cranky man really happy. So you improve the quality of their life as well. So the first three patients either self-referred or referred over, but these patients are in your chair every single day and they’re asking for help, like they’re coming to you for a reason.

Bob didn’t leave because he knew there was something else, even though I don’t think he liked me very much. But I mean, I think there’s just a lot of opportunity for us to do better for our patients. We see our patients more than they see their doctors. And you can take a blood pressure and you can see that it’s high and then you can ask why, especially if they’re on medication. But sometimes it’s sleep related breathing disorders. So, I dunno. That’s my little soap box, my 2 cents. You wanna talk about patient five?

[Jaz]
I’d love to, I mean, firstly, I just wanna emphasize again how much I’m enjoying this chat with both of you and how we’re making it tangible. One of the taglines of this podcast is making dentistry tangible and this space within dentistry is putting the mouth back in the body.

And it’s so exciting to talk about, but there’s much more I need you on the podcast to talk about it. So, formally these are some themes that we’ve never touched on a podcast for. So I’m very grateful for that. And so, yeah, patient five, right? His name is Sihaan. He’s now two and he was exclusively breastfed up till age one.

Okay. So that’s fantastic. I think. So well done to my wife, but I’m always very careful when I talk about this because I’m very mindful of the fact that there are some women who are unable to because of life circumstances or whatever, but those, if you’re able to, and you can breastfeed your child, I mean, what a great start to life you give a child, and I’m sure there’s something that you talk about and helping to work as a team with their lactation consultant, what they’re called. And so I was really proud. Did you know, you probably know the stat, only 1% of women are breastfeeding at month six in the UK? Only 1%. 

[Liz]
And you know what’s wild? The world guidelines, not to put even more stress on families, they want us exclusively breastfeeding until age two, I believe is the- 

[Jaz]
I think it was age two as well.

[Liz]
Yeah, because the US just changed their guidelines as well. And like we have a epidemic of maternal stress and postpartum anxiety and postpartum depression. And a lot of it is on feeding and the stress associated with it and the metrics and what does my app say? Did my baby get enough to eat? It’s maddening. You’re right. This can be a very sensitive topic, but women should be able to be given the choice and the assistance to breastfeed if they’re able- 

[Meggie]
And can I add one thing to that too? Like, and so yes, we always go into breastfeeding kind of like you just did Jaz. Like if you’re able to, if you can, ’cause we don’t wanna add more pressure to one of the hardest chapters of life, which is postpartum, especially when you don’t get enough maternity leave or you have a baby that has other issues. So maybe that is the path of least resistance to choose to bottle feed or you’re unable to breastfeed. But knowing the importance of breastfeeding, even for families that don’t breastfeed, can still be a superpower because now you know your child is at risk for not having optimal development. So great. Roll up your sleeves and add in other things that can help counteract that, rather than be like, oh, well now that my baby’s on that growth. 

[Jaz]
Yeah, you haven’t missed a boat. There are still things like we were discussing, so. 

[Meggie]
Exactly. So great. If you can, and if you can’t, okay, well, you at least are aware of why you should or would optimally be able to, so let’s see what else we can add in so that there isn’t such a huge deficit.

[Jaz]
He had one year of breastfeeding, but then now like why has he got crowding? He’s got deciduous teeth, right? And you should not have crowding deciduous teeth. Am I right? Would you agree with that? 

[Meggie]
You should have positive spacing. 

[Jaz]
Spacing. 

[Meggie]
If there’s just teeth are touching in the deciduous dentition that is crowding. 

[Jaz]
And so not only he’s got teeth touching, but his centrals are slightly imbricated, like his As. And so he’s had that since they’ve come through. I’m like, how does this work? But then of course he had moderate sleep apnea. Now at the time when he was diagnosed, I think they said it because in a publicly funded system we have in the UK, they probably don’t test very many one year olds.

I was a very adamant parent ’cause I’ve been through my first child and now I saw the benefits of an airway intervention had on him. And I was like, I knew something wasn’t right with Sihaan because of how much he was waking up his snorting, his stopping, breathing, all these factors, right? And so I pushed for it and yes, his sleep score was even worse than my firstborns.

So breastfeeding, great big tick. But he still has crowding. And I love what you said, Liz, you said earlier, right? Posturing your mandible forward. And he smiles like that sometimes. He loves to go in that position. I always joke, that’s his purple minion position. You know, purple minions, right? So that’s his purple minion position.

So, you probably see children like this all the time. As a parent who has real concern. That’s how I’ve always been pushing and real interest in helping him thrive. What should I do? 

[Meggie]
How stressful to know that there’s a problem and then not know what to do. 

[Liz]
So breastfeeding was good for a year. There’s a chance that even on the first day of life, there was some compromise to the latch that didn’t lead to the terminate clearing, because that’s what happens with first latch is as first latch is appropriate, there will be a distraction breath that occurs because babies are born with congested turbinates.

There’ll be a distraction that occurs as they take that first breath while latched, that clears the nasal cavity. ‘Cause there’s like the whole thing with the birth crawl and there’s a whole timing that’s supposed to be physiologically appropriate and that’s often interrupted with modern day intervention to make sure a kid’s healthy.

Maybe there was medication on board, maybe there was C-section. So everybody’s birth journey is different. At the end of the day, at least we got a healthy kid. But there’s a chance that many of our children, that latch was disrupted. The nose was blocked from the get go, increase the resistance, and led to even in the presence of breastfeeding some type of acid reflux that was continuing to block the nasal cavity.

[Meggie]
One thing it took me a while to learn was that the acid reflux causes more inflammation, causes more congestion. So it’s not just detrimental to the teeth in an infant that doesn’t have teeth, it’s causing more swelling, more stuff, and decreasing that negative airspace. 

[Liz]
And depending on who you talk to, everybody’s gonna have varying opinions on why adenoids and tonsils get enlarged. There’s going to be many reasons adenoids and tonsils get enlarged, but in part, that acid and that presence of inflammation can have a huge impact on that tissue that’s trying to fight a battle of harmony for the system. So for a child of that age, there’s a pretty good chance that the adenoids and potentially the tonsils are quite enlarged.

The other thing, and this probably isn’t you guys, but when we talk about environmental stuff, there can be nutritional impacts. Especially I hear a lot of gluten and dairy sensitivities, especially here in the US. We have mold in our homes. We have different viruses- 

[Jaz]
Just to add on the diet, Liz, if you don’t mind, I recently bought this like home blood test, which tells you all your sensitivities and whatnot. I bought it for myself, but actually I have a very good system and I knew my wife needed it more than me. I kind of said, Sim, you need to do this. Okay. And lo and behold, severe dairy allergy, severe allergy to case in the protein in dairy, mushrooms, cashews. So many things that she enjoys and so they’re everywhere, right? And so it is our duty to get tested and that could be part of it as well. I mean, maybe my son has it. 

[Liz]
And so that’s the thing is like you can’t go back in time and say, well, if we’d eliminated dairy, we wouldn’t be having these issues. All we can do is look at what’s sitting in front of us. And work for better.

And so for a kid like that, there’s a pretty good chance that adenoids and tonsils are significantly enlarged. Maybe it’s as simple as putting them through a nutritional panel to see where we can make changes to reduce that inflammation, putting them on some type of naturopathic path. And again, I don’t do that.

I guide that through other naturopaths. Many of the families we look at are minimal intervention. They don’t want surgery. And nor do I want that for your child. But I also tell people that noise that you were hearing earlier, in my background, that’s my dryer vent. If a dryer vent is closed and clogged up with gunk, it needs to be cleaned out.

And that’s kind of the way I describe this. Adenoids are clogging the two. They either need to be reduced in size naturally, or they need to be surgically intervened on so that a child can breathe, but at that age it’s gonna be difficult to say, well, let’s expand ’em. There are a couple of dentists who’ve expanded or increased the oral volume of the oral cavity with aligners at that age.

Is it something that you would always recommend to a patient? No. Is it something that you could do on your kid? Potentially, but I would always talk to the ENT first with that age group. Yeah, because at the end of the day, depending on the age of the child, the lack of breathing that’s occurring can have a different implication.

It can have an IQ impact, it can have a behavioral impact, and that can be really like systematically broken up by age. So that’s where I want that kid breathing as quick as I can for patients. 

[Meggie]
And Jaz, like you’re seeing, it’s already causing a growth change, right? He’s got crowding who’s posture his lower jaw forward. So you know, Liz is spot on working with an ear, nose, and throat doctor. I would add in there, if you have access to a, in our country it’s SLP, Speech Language Pathologist that has functional feeding therapy to start to optimize the muscles so that he can start to grow that really reactive bone by having his tongue posture in the correct position whenever he can.

Using a growth guidance appliance of that age to help chew and develop muscles is really important. And then other things outside of the things that we’ve already mentioned, have a HEPA air filter in the bedroom introduce in a really non-threatening way, saline rinses or nasal rinses. In my family and growing up, we would use nasal sprays or neti pots when we were sick.

And so it was this thing that we dreaded because we were sick. We didn’t feel that we didn’t want anything up our nose. But in an ideal world, that’s part of normal hygiene. You brush your floss and you rinse your nose. And so while he might have inflammation that’s causing congestion because of diet, because of environment, because he missed that first latch, who knows?

What can we do? What do we have access to to make positive change where we are right now? Maybe we don’t have an ear, nose and throat doctor that’s on board because of his age. Maybe we can’t do expansion because of his age. Well, what can you do? And I would just say, throw spaghetti at the wall and see what sticks.

But I will say from my own personal journey, don’t hold your kid down and put saline up their nose, because then it’s a really long battle back to making that fun. So give him like a misting aerosol bottle in the bathtub, something that he can control. And I think the kids are smart, even if they don’t understand everything that we’re talking about right now. I think that there is this intuition that, hey, I breathe better, I feel better, I sleep better. 

[Jaz]
Well, just to celebrate with you ladies, that since he turned two, like 15 days ago, for some reason, miraculously he’s actually sleeping through the night for the first time in two years. So this is huge for our family. So for two years we’ve struggled a lot. I’m just like, wow. Liz, sorry, did you wanna add something? 

[Liz]
No, because I’m talking about like the extremes, right? Surgery and expansion. Meggie’s talking about all the day-to-day stuff that we do, and kids are smart, they’re intuitive. When mine are in trouble, they’ll come up and they’ll stand next to me and they’ll go. Because they’re trying to show off at their nasal breathing so they’re not in trouble anymore like you guys are. Oh man. Little manipulators. 

[Jaz]
Wow. I just wanna say this was absolutely amazing. I’m so glad we connected and we shall meet at AES. But I really want you to just talk about your education that you guys provide, because whether you have docs from the US or docs from the UK who’s gonna make that trip over, which I would love for them to do, and I myself am thinking I need to learn more about this as well. How can we learn more? What are the channels that you provide? Where are the websites which, where we can follow you to learn more about this wonderful thing that you’re talking about? 

[Meggie]
Well, you talked early on about our journey, right? Like our evangelism, our educational like resources is a journey and we are constantly adding and changing things. So right now, I would suggest going to our website because we have a resource page that has one of the questions we get all the time is, where’s the research? We’ve compiled a lot of research and we have access to that on our website. 

[Liz]
Hundreds of articles. It’s amazing. 

[Jaz]
Yeah. Good ’cause one question actually I wasn’t gonna ask is the evidence based? You know, there’s a lot of controversy, especially around orthodontics and airway, right? There’s a lot of controversy, let’s face it. And so is it like in the world of occlusion, a lot of what we follow and what we teach is not evidence-based because you can’t get the study, you can’t get a randomized control tile when everyone’s got different height of ramuses, different tooth time contact, different facial structures, different dietary habits.

How can you disprove anything? And so where are we at with with airway? I mean, it’s great when we’re talking about that on the wheel website, it’ll be a great place. I’ll put that in big letters for everyone to click onto because everyone needs to do their own research and homework and make sure that there is a good scientific basis and foundation.

[Meggie]
We said this at the beginning, we didn’t have a really clear path forward. There are unbelievable resources out there for education, and because we’re at a time where science is catching up and there is more research to support what we’ve been seeing and have seen clinically for decades, it’s easier now to jump in than it was maybe 10 years ago when we jumped in.

So we’re trying to make the journey easier. So while there’s so many different platforms out there for education, we wanna create what’s worked for us. So we have compiled our research. We have an email that goes out daily to drip information, like, how nice is it to be spoon fed, easily accessible information without having to commit to hours at an end.

And we’re also super excited because we have recorded our first course, which is gonna be on demand, and it’s gonna be a really big overview of kind of this podcast, but a little bit more in depth on each section within a course library that has how we do things in our office. And then we’re gonna offer monthly one-on-one office hours with us so that we can talk real time about individual cases. Case number six through a hundred, right? 

[Liz]
Because a lot of it’s the decision tree and just knowing where to go next. And it’s not hard when you wrap your head around it, but that’s what I’m really platform the untethered way. It’s just gonna be such a great space for people who are really trying to dive into this.

And Meggie’s always talked about the concept of babes, littles, and bigs. So babies, children, and adults. And we kind of have it segmented out into that to make things a little bit like in this, it’s like a mind dump, right, in this podcast, but we can really start to compartmentalize all the age groups based on what we’re seeing, and then know how to control the controllables from there.

And that’s what I think our course will do a good job of. So definitely check it out, sign up for the email list. It’s gonna be amazing. And then AES like, we have two, it’s AES American Collaboration Society. It’s in February and Chicago, Jaz and Mahmoud are gonna be there. It’s gonna be awesome, but it’s very occlusion and joint heavy and the conversation of airway hasn’t always been at the forefront of it.

But I’m super excited. We have Tracy Nguyen and Jeff Rouse on our stage this year. I’ll be there ’cause I’m helping organize it. But we would just love to have everybody join us in person because in the first time I was there, someone was fighting about how the maxilla causes the problem and someone else was fighting about how the mandible causes the problem. And when you have two incredible world class speakers like going toe to toe on a stage, it’s fun dialogue that you can have. 

[Jaz]
The panel discussions a great highlight when I attended two years ago now and I’m excited to listen again and share a little bit. But honestly the lineup you guys have brought me and Mahmoud aside, I mean if you look at the actual names you got, you got Rocabado, you’ve got Lassmann.

You’ve got Jeff Rouse, you got some amazing names. So I’ll put the links to all that but also to Untethered for the email list. Also resources and the on-demand course. So ladies, you have your day to start now. After this, it can only get easier from here. You guys did a wonderful job on this podcast and I really enjoyed, I was learning. Thanks for patient number five. It was like a free consultation for me. So thank you so much. 

[Meggie]
So much fun. Thank you for having us and letting us spout our excitement. 

[Liz]
Yes. We really appreciate you. 

[Jaz]
For those who listening on Spotify didn’t actually get to see it. For those who watch it on YouTube and stuff and gotta see it, you could see that at a point Liz was jumping to like, I loved it very much. Thank you so much.

Jaz’s Outro:
Well, there we have it guys. Thank you so much for listening all the way to the end. Didn’t I tell you? That’d be interesting. Listen, Protrusive Education is a paste approved provider. You can get your CE credits or CPD, this episode’s, one hour CE credit, or one hour CPD, depending on where you are in the world.

If you want to collect your CE, you have to answer a quiz and get 80% at least. Go to protrusive.app, or for those of you who are already on the Protrusive Guidance app, scroll down, answer the questions, and get your certificate. You’ve done the hard work, you’ve listened to the episode. Now’s your chance to consolidate your learning, and don’t forget to download your premium notes.

Every episode we do, we create these premium notes. We also have a transcript of every episode, and our premium members can download all of this. Don’t forget to check out Liz and Meggie’s website, and I’ll put that on there as well, so you can check out their resources and education they have. More power to these fantastic women for sharing everything they know, for sharing their journey so selflessly and so compassionately.

I had a lot of fun on this episode. I hope you guys did as well. And if you did like it, please do hit that subscribe button. It helps us a lot. And with that, I just want to say, one last thank you to my team. Without Team Protrusive, there will be no podcast. I would be totally burnt to toast, completely burnt out, and it’s only through the team looking after the video editing and helping with the premium notes and quality controlling that I can continue to hopefully sound as infused as I was on day one.

So thank you Erika, Gian, Krissel, Mari, Julia, Nav, Hannah, Xyra. As you can see, the team is growing every few months and of course the podcast is growing. Thanks to you and all the supporters of Protrusive, appreciate you very much so again, catch you same time, same place next week.

Bye for now.