September 14, 2026 • 43 mins
Crooked teeth are easy to spot. The harder question is what they might be trying to tell us about a child’s growth, breathing, and sleep.
We sit down with Dr Vishal Sharma of Aura Orthodontics in British Columbia to unpack a broader view of orthodontics rooted in dentofacial orthopaedics. We talk about jaws as the foundation that teeth “ride on" and why crowding can be a sign of an undersized airway as much as a dental problem. Along the way we explore practical warning signs clinicians and parents can notice early: paediatric snoring, restless sleep, bedwetting, teeth grinding, fatigue, and the “bags under the eyes” look that often gets normalised.
We also tackle the uncomfortable middle ground between compelling clinical outcomes and research that has not fully caught up. Vishal shares how he thinks about evidence-based practice when the data is promising but incomplete, what he wants future university research to measure around palatal expansion and airway dimensions, and how to talk honestly about uncertainty without over-claiming. Finally, we zoom out to leadership: building a multi-site team while protecting culture, communication, and a clear clinical philosophy.
If you care about airway health, facial development, paediatric sleep apnoea, and earlier orthodontic assessment, this conversation will give you new questions to ask at the chairside. Subscribe, share with a colleague, and leave a review with your biggest takeaway.
Guest Biography
Dr Vishal Sharma is an orthodontist based in British Columbia, Canada, and a leader at Aura Orthodontics, a growing orthodontic organisation with three locations and a team of approximately 40.
After completing dental school and orthodontic training at New York University (NYU), Dr. Sharma returned to British Columbia, where he has now practised orthodontics for approximately 15 years.
His clinical interests extend beyond dental alignment into dentofacial development, airway health and the potential relationship between jaw development, breathing and sleep. His interest in this area became particularly personal through observing the growth and development of his twin sons.
Alongside his clinical work, Dr. Sharma is interested in strengthening the research base surrounding airway-focused orthodontics and discusses his work to develop further research in collaboration with a local university.
He also leads the continued growth of Aura Orthodontics while developing educational initiatives aimed at healthcare practitioners.
Links
- Dr. Sharma's website: www.meetdrvishalsharma.com
- Instagram: instagram.com/bigbrotherenergy
- Dr. Sharma's LinkedIn: https://www.linkedin.com/in/dr-vishal-sharma/
- Aura's website: www.auraortho.com
- Instagram: instagram.com/auraortho
- Aura's LinkedIn: https://www.linkedin.com/company/aura-orthodontics
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About the podcast
Voices in Health and Wellness features conversations at the intersection of medicine, lifestyle, and human potential, with clinicians, scientists, and thinkers shaping the future of care.
About Dr Andrew Greenland
UK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functional Medicine. Trained in both conventional and root-cause approaches, Andrew helps people optimise health, performance, and longevity, with a focus on cognitive resilience and healthy ageing.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Andrew Greenland (00:07):
So welcome to another episode of Voices in
Health and Wellness, where Ispeak with clinicians,
healthcare leaders, andinnovators about the ideas,
experiences, and challengeschallenges shaping the future of
healthcare.
Today's guest is Dr.
Vishal Sharma from AuraOrthodontics in British
Columbia, Canada.
Now, when most of us hear theword orthodontics, we probably
think immediately of braces andstraight teeth, but Vishal's
(00:30):
philosophy goes considerablyfurther than that.
His work explores therelationship between
orthodontics, facialdevelopment, breathing, airway
health, and sleep, particularlyduring childhood when growth and
development can potentiallyinfluence health for years to
come.
How clinicians how shouldclinicians respond when they s
uh when they're seeingcompelling outcomes in practice,
but large-scale research hasn'tnecessarily caught up yet?
(00:50):
And how do we distinguishgenuine innovation from getting
ahead of the evidence?
We're going to explore all ofthat today, as well as what
parents and fellow healthcarepractitioners should be looking
for when it comes to children'sfacial and airway development.
So with that, Richard, I'd loveto welcome you to the show and
thank you so much for joining metoday.
Dr Vishal Sharma (01:06):
Thank you so much, Dr.
Greenland.
It's an honor to be here.
I'm uh happy to discuss some ofthese topics in a little bit
more depth.
Dr Andrew Greenland (01:13):
Thank you.
So let's go back to thebeginning.
Can you give us a sense of yourjourney and how you got into
orthodontics in the first place?
And what eventually led you tothis more functional approach
that you've adopted?
Dr Vishal Sharma (01:24):
It's a great question and uh dates back a
bit, I guess.
So uh I was fortunate enough tohave the opportunity to study
at NYU, uh the dental schoolthere.
And actually, I was uh fullyinclined for a surgical track.
I was preparing myself forthat, and then just kind of like
a chance, uh a chanceconversation with a friend
(01:45):
completely shifted my focus uhtowards orthodontics.
So honestly, the journeytowards orthodontics, it was it
was not by any means uh acomplete uh childhood dream.
Though when I met my cousinabout uh 20 years later, uh this
is just recently now, she didrecite a story where when we
were children, I said I wantedto be an orthodontist.
(02:06):
I completely forgot that story,but she reminded me of it.
So maybe it was buried deepinside, and that's why the
switch over was quite easy.
Um, from there, I completed uhmy orthodontics also at NYU, and
then I returned back uh toBritish Columbia here to be in
Vancouver with my family.
Uh the journey, I'm now in my15th year of practicing
(02:28):
orthodontics.
Uh, and and within those 15years, it's been a unique uh uh
journey along the way from, youknow, as we all know, during
residency, we learn how to dowhat we need to do, but we're
not super proficient just yet.
So the first few years arealways kind of understanding
your flow, how you like to usecertain tools, what works good
(02:49):
in your hand.
And then the evolution till now,uh, I really especially kind of
the airway topic and what we'reon the forefront of doing today
is largely my children.
Uh, you know, seeing themobserving facial growth and
development.
And I'm fortunate enough tohave twin boys, and they both
have unique uh uh issues.
(03:10):
But to see that from birthonwards, to see how the current
medical system as it stands ispaying attention to certain
issues or not, where the blindspots are, just by nature of the
construct of our system, andseeing the impact of facial
growth and development or lackthereof, and how it begins to
(03:34):
form symptoms and what I seeclinically at what is considered
to be the age of orthodontics12 to 13.
Uh, some parents who aremindful might bring a child in
from seven to 10, but seeing mychildren, putting it together
with the base of myunderstanding and knowledge,
what I'm seeing in the clinic,what I'm seeing uh uh missing in
terms of the medical vertical,that's kind of helped formulate
(03:59):
this approach that we havetoday.
Dr Andrew Greenland (04:01):
Thank you.
Really helpful, really helpfulto get the back the back the
backstory and the journey.
Thank you.
Um so I know you've said thatorthodontics starts long before
braces.
What do you mean by thatexactly?
Dr Vishal Sharma (04:13):
So the most important thing to understand
here, because that's a loadedquestion, but the most simplest
way I can explain this is teethare like passengers on a ship.
So the size of that ship, theposition of that ship will
(04:33):
determine where the teeth areable to go, just like
passengers.
So what we current orthodonticslargely, but not exclusively,
focuses more on the finalposition of teeth.
And I think orthodontics isunder an evolutionary process to
understand this, but drivingthe message home down to parents
(04:55):
and patients is really the morethe bigger challenge.
We have to understand andrespect how much shaping the
jaw, like what are the pressuresthat shape the jaw into what
it's going to become?
And how can we influence thatfor the most optimal health,
which includes, in my view, atthe very tail end the alignment
(05:16):
of the teeth?
But prior to that is thestructure of the bones, how do
they fit together?
Are they distributing pressuresappropriately?
Are they allowing space forteeth to form?
Are they allowing for us as aspecies to breathe correctly?
And what I'm seeing in short isthat much of our modern-day
(05:37):
habits are not leading to that.
So we have issues, those issuesshow up in the teeth, but the
issue is really underlying.
We have to kind of peel backthe layers to understand okay,
what's happened here?
How do we correct it?
And what other impacts onhealth are happening as a result
of the crowded teeth.
So traditionally, we seechildren at seven to eight, as
(06:11):
recommended by our uhprofessional bodies.
I reckon that as healthcareproviders, dentists, physicians,
pediatric uh dentists, andpediatricians, both, should be
mindful of just a few thingsbefore the age of five.
And those are completelynon-dental.
Maybe one we could consider tobe dental.
(06:33):
If a child less than five hasdental crowding already, they
are already undersized in thejaws and likely to be displaying
other signs if we're payingattention.
Not always, but likely.
The other things are completelybehavioral and physical.
So, how well are they sleeping?
Do they sleep through the nightor are they waking up often?
(06:56):
Bed wetting is related to that.
The more you bedwet, the lesslikely you're in REM sleep, the
less likely you're breathingproperly, and the the greater
the chance that the jaws are notlarge enough.
Are children grinding theirteeth?
Grinding results in the sameissue.
When teeth don't fit togetherproperly, the muscles don't
(07:18):
really find a place to rest.
And when they don't rest, theyend up becoming hyperactive,
almost like a fidgety leg, youknow?
So that's what grinding reallyis.
It's just a fidgety muscle thathasn't found its peaceful home
and resting place.
Bags under the eyes.
Are they waking up unrested?
Do they fatigue generallyeasier?
Now, of course, some of thesethings have multiple possible
(07:42):
inputs, but these are just hintsthat we can detect and pay
attention to that, hmm, maybethere's an underlying issue that
we could resolve with a deeperanalysis.
Dr Andrew Greenland (07:53):
Amazing.
Um, I think you described umorthodontics to me essentially
as dental facial orthopedics.
What does that mean inpractical terms for those
listeners?
Dr Vishal Sharma (08:02):
Yeah, so for those of us who are medically
inclined, we can put the wordstogether and break it down to
like basic and medical uhterminology.
Dentopacial orthopedics meansyou know, face, uh growth of the
face, jaws, muscles, bones, andthe whole complex, and how to
manage that.
So when we think of anorthodontist, even in the
(08:23):
medical facility, our minds goto aligning teeth with braces or
uh invisible aligners.
Uh uh, there's severaldifferent companies that do
that.
So that's where our mind goes.
But in our actual credentialinglicensure, and the title of our
vocation is dentofacialorthopedics, and that is exactly
(08:43):
what I'm speaking to.
How can we assess, diagnose,treatment plan, and treat
misshaped jaws?
Again, so that at the end ofthe day, which won't by the time
the child is 12, 13, or 14, wecan have aligned teeth that fit
(09:05):
together well and function well,but in the meanwhile, that
allow us to breathe properly,distribute pressures properly
when we eat, and allow our bodyto get the most primary uh uh
nutrient we need, all of us,which is actually oxygen.
So rooting all of this backdown, and this is where I take
(09:25):
it a little bit further, I mightsay, is being cognizant of how
that link relates to how are webreathing, tongue position, and
other things that help formulategood growth and development.
Dr Andrew Greenland (09:39):
And with all of that, I mean, how much
influence do we actually haveover facial development whilst
the child is growing, in youropinion?
Dr Vishal Sharma (09:49):
If I understand the question
correctly, you're saying howmuch influence can we have while
they're growing?
Dr Andrew Greenland (09:54):
Yeah, facial facial development
specifically.
Dr Vishal Sharma (09:57):
Yeah.
Um quite a bit, rather, uh,because at this young tender
age, everything is still uhformable, uh malleable in a
sense.
We can uh manipulate and guidethe growth to be in the
direction that we want.
So, how much can we influence?
(10:17):
Quite a bit, more so than youmight say after, let's say, 14
or 15.
So, for example, uh my twinboys, who are now just five,
just started kindergarten.
I have them both in palatalexpander devices.
And one of the twins needed itmore than the other, but the
other one is gonna benefit fromsome expansion, nonetheless,
(10:38):
just not as much.
So, because the bones are soft,because the everything is kind
of choosing its direction ofgrowth, we know what the trend
is going to be.
We can't say with precision,oh, this is exactly how your
child will grow and develop if Isee them at five.
Can I predict what they'll looklike at 14 with 100% accuracy?
(10:58):
No, most certainly not.
But I can definitely give you atrajectory of which direction
is this child heading?
Is he heading north?
And if so, how much north?
I used I use the compass as anexample, as a metaphor here,
right?
So, what type of malocclusion,misfitting bite issues might
this child have are evident intheir growth up until five, to I
(11:25):
would say almost the 80 to 90percent accuracy in terms of
what range they would fit in.
And that is enough for us todecide whether we should
intervene or not intervene.
Dr Andrew Greenland (11:36):
Thank you.
Um so this um the audience forthis podcast is generally
practitioners.
So, are there any particularsigns that should prompt a
fellow practitioner or dentist,GP, or other healthcare
professional to consider anearlier orthodontic assessment?
Because you're certainlyadvocating for early
assessments.
What things shouldpractitioners be looking out for
that would warrant that?
Dr Vishal Sharma (11:58):
So I'll speak primarily to the dentist first,
uh, and then I'll move to themedical colleagues.
So uh dentist, pediatricdentist, anyone who's seeing
children from that two to fivewindow, if a child has dental
crowding, especially in thelower anterior section, that is
a definite sign of insufficientspacing, which will likely lead
(12:23):
to other issues.
Uh, and the reason for why thathappens needs to be explored a
little bit.
So dental crowding is one ofthose primary things that does
show up early.
Now, yes, a child is growing,so some of that crowding will
alleviate, but the most idealalignment for children who have
no permanent teeth is adequatespacing between each tooth, at
(12:47):
least a half a millimeter, ifnot greater.
So essentially it should looklike a white picket fence.
And if it doesn't look like awhite picket fence, with most
humans not having that, becauseof modern-day habits, which
we'll perhaps get to in amoment, but if they don't have
that, then there's likely a jawsize shape discrepancy.
(13:09):
So that's kind of like the redflag that anyone can kind of see
from afar.
You don't even need to be adentist to tell that there's
either crowding or there'sspacing, and that's pretty much
as black and white as it needsto be.
Beyond that, we can there aresome auxiliary signs.
Grinding at night, some levelof grinding is normal, but
constant and uh intense is adifferent style.
(13:34):
So if you either speak to aparent of a young child and be
like, oh my gosh, I could hearthem from the next room or are
you walking away, like that typeof grinding is not
pathological, but abnormal.
We would say that for now.
And then the last thing is ifthey're not feeling rested, if
the child is not getting sleep,that's likely to be a sign of an
(13:54):
undersized jaw.
There are absolutelyconfounding factors in the soft
tissue, such as enlargedadenoids, which also lead back
to jaw size and position interms of airflow.
But if they're not rested wellenough, they're waking up with
bags under the eyes, they'regenerally irritable.
Um, oftentimes, and this isresearch proven, that on the
(14:19):
lower end of the spectrum forADHD and even mild, mild autism
has been sometimes confused withpediatric sleep apnea.
And that's the one thing thatwe ultimately have to
acknowledge that, and now I'mgonna veer towards my medical
colleagues, is any suchsimilarities to adult sleep
apnea and children is theringer-dinger.
(14:41):
That's the one, that is thebell.
If your patient isdemonstrating um the type of
behavior that comes from beingunrested, easily irritable,
agitated, and oftentimes, andit's necessary to have these
diagnoses, but oftentimes we'retoo quick to shunt towards
things that may not be trueversus going up the ladder or
(15:05):
down the ladder, however youview it, of invasive diagnoses.
Is this potentially an airwayissue?
It should be uh assessed beforewe get into deeper uh uh
diagnoses that stay withchildren for for their life.
This is a modifiable component,and oftentimes, which I've seen
in my patients, simply openingup the airway via arch
(15:30):
expansion.
And this is not a hundredpercent uh linear uh
relationship, so I need toacknowledge that for our medical
colleagues, that this is anattempt to open up the airway,
that oftentimes helps alleviateseveral of these symptoms.
Um, one symptom that I haven'tmentioned that I think everyone
(15:50):
should be aware of parent,patient, dentist, or uh uh
physician is pediatric snoring.
If it's constant, if it's uh uhconsistent, and if it's fairly
frictioned, you know, you cantell the sound.
Is it a mild, like I'm justkind of breathing because I'm
changing positions, or is it anactual snore?
(16:12):
That is likely a sign of airwayblockage, and that relates to
jaw growth and development.
So I think amongst those uhfour to six uh signs I
mentioned, there's enough kindof like red flags we can just
burn in our memory to keep tohelp us as we see patients on a
day-to-day basis.
Dr Andrew Greenland (16:30):
Obviously, your parents your patients come
with parents attached.
Is there one thing that youwould um really like to change
the thinking about the parentshave regarding orthodontics?
Dr Vishal Sharma (16:42):
I think it's kind of already that, which we
kind of spoke to, but I'll speakto it a little bit more
clearly.
Is if you notice a dentalissue, which is the reason
actually most dentists referpatients to me, and even parents
themselves, when they comedirectly, uh, they come to me
for a crowding issue.
I notice that this tooth is wayin the wrong position.
What can I do about it?
(17:02):
That's a great sign to alsoburn in your memory, as I
mentioned earlier.
But the one thing that I wouldlike for us to start viewing
differently is that this all ofthese issues are pointing
towards actually an airwayissue.
So, not coincidentally, what Isee in the patients is when they
(17:24):
do present with a severecrowding issue, there is more
likely to be some level anddegree of airway blockage via
the adenoids and tonsils, orboth.
So when we and that's the onething I want us to take home is
(17:45):
that we need to look at this asan airway problem.
Is my child breathingcorrectly?
If you're 100% sure that theyare, fantastic, continue on.
But if you have any drop of adoubt, I would suggest seeking
an opinion from an airway-mindeduh dentist andor orthodontist,
(18:05):
because most often that issuecan go undiagnosed.
It's not airway management,it's not necessarily on the
pediatrician's radar becausethey see the child generally in
the first year, unless there areother complicating factors.
And we're not getting to see anENT with diagnoses until the
(18:26):
airways are far too blocked.
At that point, at least inCanada, the SOP for treatment is
monitor, moving towardssteroidal spray.
And then, if there's noresolution, surgery.
And oftentimes we do need ouradenoids for the duration of
life.
So I encourage you to seek anairway assessment, um, at least
(18:50):
from an orthodontist again ordentist who's airway-minded.
This will help us becausewithout oxygen or adequate
oxygenation, the analogy I liketo use in my uh lectures, is one
of a light bulb, which we canall resonate with.
And when it receives too littlepower, what happens?
(19:12):
Right.
If you said it flickers, you'reexactly right.
So the brain and the nervoussystem at the top of our
anatomical tree, you might say,but every system, when
significantly or sufficientlydeoxygenated, simply cannot grow
(19:32):
and develop the way it'ssupposed to grow and develop.
And that's as mat medicalpractitioners, that's what we
have to understand that okay,all of these systems are
developing early.
Central nervous system,respiratory, circulatory,
muscoskeletal, and endocrine,and every other system that goes
beyond that.
(19:52):
They're all developing at thisyoung, tender age, and without
adequate oxygenation, theysimply cannot grow effectively.
And that is likely to have amyriad of complications down the
line.
Um pediatric sleep apnea justbeing on the very early end and
detectable range.
Dr Andrew Greenland (20:16):
Thank you very much.
Um when we chatted before, Ithink you described a sort of
split mentality withinorthodontics.
Could you um speak a little bitto that?
And what what what are theissues and challenges in your
profession?
Dr Vishal Sharma (20:29):
Um currently there are a handful of us within
the profession viewing thingsthis way, and it's largely uh
tied to the lack of researcharound it.
And this is why I'm verypassionate about affiliating
with uh a local university here,so that we can start to get
(20:52):
this information intopublications more deeper
assessed, uh, you know, so thatwe can make these links um more
concretely.
And within the profession, it'shelping us all get to the same
page.
Now, orthodontics is veryunique in the sense that if you
get five opinions you'll pro uhfrom different doctors, you'll
(21:15):
probably get at the walk awaywith at least three different
treatment plans for the same endresult.
And that's just orthodontics,but I can understand how that
becomes super confusing for ourparents.
Um, and it also speaks to thechallenge within our direct
profession, that beingorthodontics, before I even
stretch out to dental at large,and then before I even include
(21:36):
the medical umbrella.
But getting to the same pageand understanding that the
likelihood of this connectionprior to it being completely
backed with full substantiatingresearch, uh, there is research
that does exist, Dr.
Greenland, but it's just not aslike crystal clear and like,
(21:57):
you know, it's not ringing thebell from the top of the
mountain.
Type of research yet, you know,where the whole profession
goes, Oh my gosh, we've missedsomething.
You know, this is very earlystage.
This is early understanding.
Um, you know, understanding uhuh how our biomedical
(22:18):
development intertwines with ourmetaphysical existence and how
we're able to actually functionas a fully developed, how we get
to be fully developed in thefirst place, um, and
acknowledging that this airwakeissue is a component simply
because of one fact that wecannot deny.
Nobody can deny this one fact.
(22:40):
And I suggest that this iswhere we start.
Adequate oxygenation is vitalfor proper development.
Just that I think we can allagree upon, doesn't matter which
field of study you come from.
So once we root there, we said,okay, is there something
perhaps blocking the airway?
And then just start to makethese connections because
getting these types of casereports, seeing these things in
(23:02):
your clinic, such as I am, aregoing to be the things that wake
up the light bulb within yourmind and say, okay, this is how
we can actually take a differentcourse of direction.
And if we resolve the airwayblockage issue early, we may be
on the benefiting factor ofseveral potential complications
(23:23):
that we don't even know about.
We don't even know where thattrade's gonna go, right?
Um, so that's the challenge,and I and I want to be part of a
uh healthy discussion.
Uh, you know, there arenaysayers and and disbelievers,
as with any you know, new way ofthinking, but the goal here is
unification.
Uh, for honestly, and thissounds like a reach, but is this
(23:46):
not for the betterment of allhuman species?
If we're all breathing better,and you and you'll notice me uh
defaulting back to breath, notto dental alignment, when the
jaws are proper size and shape,the teeth are more likely to
fall into the right place.
The likelihood you needorthodontics decreases, or maybe
mild orthodontics for aestheticand functional improvement.
(24:10):
But if we all focus on thatimproving the airway, let us all
breathe better.
Let us all breathe better.
Then we're on the right track.
Dr Andrew Greenland (24:20):
Thank you.
And with that, how do youpersonally decide when there's
enough evidence to change theway you practice personally?
Dr Vishal Sharma (24:28):
Um, so a lot of this was kind of like a
little bit of a rabbit hole, ifyou say, you know, a lot of us
have done this in our careers.
We get to a certain point.
Is this all there is?
Like it happened for me when Iwas gifted with uh my twin boys,
uh, and turning 40 was exactlythe same point of my life.
And this is kind of like anassessment, you know, like a
(24:49):
let's say like a rest stop whereyou take a checkpoint and those
kinds of things.
It was also coinciding withCOVID.
And I'm sure a lot of us did alot of deep thinking at that
time, and I had thatopportunity.
So this is where I began to uhsee things differently, see the
face differently.
Again, I just changed it thisway that okay, are we breathing
(25:11):
correctly enough?
Uh, and this is like on a sidequest that's happening for me in
my personal life was mydiscovery of meditation and
understanding that the more Islowed my breath, the deeper I
could connect to myself.
And every single answer I everwanted would just pop up on its
own.
And anyone who's meditateddeeply enough can tell you that,
(25:32):
yep, that is true.
So then I began to appreciatethe power of breath.
And all the while I'munderstanding with my own
children, observing my children,but my understanding of dental
facial growth and development,how what I do impacts how well
people can breathe.
And um, I went in a rabbit holeand discovered that these links
(25:56):
exist, but they're not fullyinterconnected.
Think of like a spider webthat's disjointed.
And if we just take a littlebit of time to kind of like put
all the pieces together, you'llbegin to see that this body of
work is actually pointing in acertain direction, right?
We don't need the you know toget full conviction from to your
(26:18):
previous question from thefield and the science.
We need to have that red flagresearch that makes us all go
have that moment.
But until then, we can see thatthe research is actually
already pointing in a certaindirection.
It does stop short, and thenthere's shades of gray, which is
where I recommend we start toconsider doing a little bit more
(26:39):
research.
And I know it's alreadyunderway with fantastic
fantastic scientists all overthe world uh to appreciate this
airway connection.
Dr Andrew Greenland (26:47):
Thank you.
And on the subject of theresearch, so I know you've been
talking about the uh work of theUniversity of British Columbia.
What data are you hoping tocollect and what questions would
you ultimately like thatresearch to answer for you?
Dr Vishal Sharma (27:00):
Um I I think the first is really trying to
see if expansion adequatelyopens the airway within um
statistically significant means.
So as a case report, I had thisone patient who had
(27:20):
approximately 1.5 to 1.25 to 1.5millimeters of airway opening
uh between the adenoid and theuh larynx.
After expansion, this opened upto 19.5 millimeters.
So we had a 2,000% increase inairway.
Now, unfortunately, and I'm notmaking any claims here, but
(27:41):
just to be transparent with thestory and give us all food for
thought, because this, what I'mabout to say, did help bridge
something for me.
That poor young girl wasdiagnosed with a tumor shortly
thereafter.
And I just asked myself, Iwonder if the oxidative stress
that she was under for all thoseyears had a contributing factor
to the development of hertumor.
(28:02):
And I just simply asked, I'mnot making a claim, but I say if
we all ask that question,whether you're an oncologist and
you're listening to this,you're a physician, you're a
radiologist, dentist,orthodontist, doesn't matter.
You might say that, yeah,oxidative stress is not good for
our bodies, and it could causea lot of problems.
Is that a problem with thetumor?
I don't know.
Now that's an extreme example.
(28:23):
No, not every patient isgetting a 2000% opening.
It was kind of like a freakoccurrence.
I floored me to see ithonestly.
But what we are seeing is theaverage patient will get 30 to
40% increase, and a handful ofpatients are seeing 200 to 600%
increases.
2,000% is an outlier.
(28:43):
But that is the first question.
That is the first thing I thinkwe start with, because then
we'll be able to understand thatokay, yes, jaw size and shape
is related to oxygenation.
We can improve it via a verysimple tool that we're already
using.
And this is kind of like thelowest barrier to entry to be
like, okay, let's focus on earlyexpansion when we see the signs
(29:06):
and symptoms for it.
And that would be uh ultimatelyopening the gateway for better
health for everyone.
And I think that's the firstquestion that I'd like to
answer.
Dr Andrew Greenland (29:15):
Brilliant, thank you.
So for sure, I'd like to switchgears a little bit now.
So maybe because um there'sanother part of your story which
I think is very interesting.
You're not only trying tochange how people think about
orthodontics, but you've alsohad to build an organization
that's capable of deliveringthat vision.
So, what's been the mostchallenging part of growing or
orthodontics while maintainingthe clinical philosophy you
(29:36):
believe in?
Dr Vishal Sharma (29:38):
Yeah, that's a great question.
I mean, I think the challengefor any leader is to get uh
buy-in from everyone who's onboard.
Um and I mean, look, we're allindependent thinkers and we all
have our uh autonomy, especiallyamongst the professions.
So when it comes to our uh uhmedical colleagues, dental
colleagues, we all have our wayof looking at things.
(30:00):
And that's more of a dialogue.
I think being a person whounderstands that unique
perspectives are the norm.
And rather than trying toforce-feed people into a way of
thinking, I like to address thedoubt in their mind and present
(30:21):
it and through dialogue bringthem into perhaps considering
that this is what I'm saying istrue.
And it's not because I'm sayingit, it's just because it's one
of those universal laws thatmight exist, you know,
constricted airway is gonna leadto deoxygenation,
hypooxygenation.
That's just true.
So, and then similarly, we weall need oxygen to survive.
(30:42):
These are facts, right?
Um, and I think that's thebiggest challenge, even in an
organization as a entrepreneurlike dental in in Canada, North
America, is very much like abusiness uh in order to survive
the test of time and have peoplebuy in.
It's it's really likecommunicating with them
adequately, giving them space todo it on their own.
(31:03):
You know, it's like when we forthose of who those of us who
have uh uh teenagers, I dealwith teenager patients all the
time, so I I know I don't havemy own yet, but we have
teenagers and they kind of like,you know, they're they're in
that strong opinionated phase,um, where you know, we kind of
have to let them see it on theirown and guide them into what is
the the the true mat the trueessence of the matter here.
(31:23):
And I think having that stanceis what's helped me immensely,
not force people into it, butcome into their own right.
And when they do, there's morebuy-in.
Of course, things likepresenting the data, presenting
the cases, like without actuallyhighlighting the case reports,
uh, we're not able to appreciatethe impact of uh this potential
uh way of thinking.
(31:43):
So we must do a combination.
Dr Andrew Greenland (31:47):
So I think you've got a team of 15 people,
if I've got my informationcorrect.
So, what does your role in thebusiness actually look like
today?
And how has that changed overtime?
Dr Vishal Sharma (31:56):
Yeah, actually, just a slight
correction there.
We're a team of 40 now, and wehave the three locations, three
doctors.
Um my uh day and time have beena bit of an evolution.
So when the children wereyounger, I was a little bit
stepping aside from the clinicjust to kind of give the support
necessary here and be present.
Um, and I'm super glad that Idid.
(32:18):
But about 60 to 80 percent ofmy time is clinical in a
week-to-week basis, and 15 to 20percent is management.
Uh, I do have a wonderfulmanagement team.
Um, we have a CFO who managesall things financial and legal.
Uh, and then there's an HRmanager and a marketing manager
just to help uh you know achievethe multi-prong goals that we
(32:40):
have simultaneously.
So it ends up being uh um notas heavily clinically uh uh as
it used to be in my earlieryears.
Dr Andrew Greenland (32:51):
Um and with that growth and the the change
in the way you apportion yourtime, has there been anything
you've found hard to let go ofpersonally?
Is it the clinical thing or isit other stuff that's um
involved in the in the role?
Dr Vishal Sharma (33:03):
I think uh anytime you want to have you
want to see growth, there is acertain level of, and this kind
of goes back to your earlierquestion, is like it's not a
lesser a reduced quality, but itit it this is what it feels
like, right?
So when we're practitioners, wethink, okay, no, we're all
alpha until we've gotten to thispoint.
We have an alpha type of way ofthinking, and we like to do
(33:24):
things our way, we know that wecan do it well, and so we have a
hard time letting go.
Um, I think doing that within asafe space.
Again, I'll I'll bring I'llbring the example oftentimes to
rearing children, but whenyou're trying to teach your
child that how to walk, you haveto let them walk a little bit,
right?
So you're kind of holding themjust lightly and loosely, you're
not actually moving the legsstep by step, although that's
(33:46):
may how it may start.
You have to allow yourself tolet it go and let them maybe
perhaps fall.
Um, and so running a team andallowing them to grow uh um
themselves, sharpen their ownskills and their own talent
while guiding it at the sametime is is is kind of like uh
(34:09):
how you know we're able to growand and and what my uh
philosophy generally is.
Dr Andrew Greenland (34:18):
And it's a it's a much bigger thing than I
mentioned just earlier on.
So 40 people, three locations,it's pretty pretty impressive.
What are the biggest challengesand bottlenecks that you
currently face in the day-to-daythat that may have been
completely different a few weeksago, a few months ago?
What are the things that keepyou up at night that you're
having to work through as afounder owner?
Dr Vishal Sharma (34:40):
That's a great question.
And it does seem to change fromthe you know week to week.
Currently, um right now, aswe're speaking, we're entering
into our education uh season.
So uh we do a lot of webinarsand a lot of like in-person
sessions.
And so it's my primary focus isuh trying to recruit audience
(35:00):
because when you do a webinar,as you may know, Dr.
Greenland, like you know,getting an audience to kind of
listen to your message is achallenge um that we all take on
at some point, especially youknow, venturing into uh this
type of field, you know, being abeing a physician, Dr.
Greenland.
Like like I was discussing withmy team.
Many props to you for you knowcarving out this niche,
(35:22):
designing the podcast, gettingit ready and everything.
Um but when we take on uh thesechallenges, yeah, it does
change over.
So currently we're in educationseason, but one of the constant
things is uh recruiting greatteam.
You know, there's uh it's kindof a qualified uh individual
shortage where I practice.
(35:43):
Uh, and I think a lot of thepractitioners would would agree.
So constantly finding you knowgood talent, people who uh want
to grow, want to contribute tosomething like this, see
themselves in this in thisfield, that that is one of the
constant underlying, it doesn'tmatter what year you ask me that
question.
It's one of those things that'salways there, Dr.
Greenland.
Uh, and it's no different now.
(36:04):
But those are kind of like thetwo primary things I would say.
Dr Andrew Greenland (36:08):
And how do you find great team players and
you know the ones that are goingto be aligned to your
philosophy?
Dr Vishal Sharma (36:15):
Oh, I think the most important thing is
really attitude.
Uh, you know, I'm a big energybeliever, as I spoke to
metaphysical and meditation alittle bit.
That's not a necessity by anymeans, but how you approach
life, how what your mindset is,is it resilient?
And these are things that arenot easily detectable through
traditional uh interviewingmeans.
So we do have a fairly rigorousonboarding process.
(36:37):
Uh, it's multi-tiered.
We do have, we do utilize apersonality test that gives the
candidate and us a little bit ofinsight into how this person
thinks.
Uh, and we're very protectiveof our energy in space.
There was a time that it wasn'tso harmonious, and we felt the
impact on multi on a multi-leveluh uh, you know, uh uh in a
(36:58):
multi-level way.
So being rigorous aboutonboarding, uh being quick to
let people go if they're simplynot a match is very, very
important.
Uh, because oftentimes wethink, oh, opportunity costs,
we've got to find someone else,train them again.
I'd rather just, you know, makedo with this individual.
I and I did that for severalyears, but I think that's not
(37:20):
the way to be developing like areally you know with it team.
And to the last part of yourquestion, buying into the
vision, that's something thatjust reveals itself over time.
But I think um sharing thepassion, and I am a generally
passionate person, um isintegral to that mission.
Dr Andrew Greenland (37:43):
So it has to give you a magic wand and you
could fix one thing in thebusiness tomorrow.
Um talent acquisition aside,would there be anything else
that you would love to be ableto solve?
Dr Vishal Sharma (37:54):
Um I think if people physicians, dentists, you
know, the qualification aside,if people could make that one
link, that how we breathe has amassive impact into how we grow
(38:16):
and develop and overall systemichealth in the long term, that
would be the magic wand.
Because I personally do believethat if we're able to oxygenate
properly, if we're able to taketime out to quietly breathe and
(38:38):
slowly breathe for a fewminutes in a day, we're all more
connected to a single thingthat unites us all.
And many, and this is gonna bea stretch to some people, many
of the issues that we currentlyface as a species, which are out
there, we all know them.
I think they begin to fallapart because we're in a
(38:59):
harmonious rhythm with ourself,and that is much uh more
synchronous and coherent atlarge, not just medically
speaking, but our entireexistence.
So, at first, we'll start withthe medical.
Dr Andrew Greenland (39:18):
And finally, what's the future hold?
What where do you see AuraOrthodontics being in the next
12 months or so?
And what about orthodonticsmore generally?
Where is orthodontics headingin your view?
Dr Vishal Sharma (39:30):
Um, so Aura specifically, I think we're just
gonna continue this mission.
It is a large mission that wehave undertaken, um, you know,
but I feel very passionate aboutit.
And we're just gonna continueon, Dr.
Greenland.
You know, doing things likethis, the podcast is a great,
fantastic way.
I cannot uh tell you howgrateful I am for the
opportunity uh and you findingus to help propagate the message
(39:51):
one individual at a time.
Uh, you know, especially withpractitioners, we can make a
large impact by hitting thatsingle point because we see each
practitioner sees so manypatients.
And if you're able to have thisconversation with your
patients, the messagepropagates.
So that's gonna be theimmediate 12-month.
Again, we are developingfurther our uh online
educational presence presence interms of webinar.
(40:14):
We're developing a website,we're gonna have a portal where
people can access these things.
We all need education for CEand credentialing.
So if we can fill a role there,um we're we're working on
developing that.
And then just again, even in myown, when I go to the office,
being present-minded and justassessing each case on an
individual basis and keepingthat question in the back of my
mind (40:37):
are there any possible potential complicating airway
issues here that I can helpresolve?
And then again, I am by nomeans making uh cause and effect
uh statements.
I am stating that we as a bodyof people can look at this a
little bit deeper so that we canget to a point where we can
make cause and effectstatements.
(40:57):
Um and at large fororthodontics, I truly believe
we're in a revolutionary phase,the early phase of it.
Um dental alignment isobviously immensely popular, but
much more accessible.
And I think if we're startingwith the orthodontist, focus
(41:19):
more on dental facialorthopedics, and I really do
reckon that we are going to beseeing patients and wanting to
be seeing patients.
It's not like we are, you know,self-serving in this in this
mission.
This is a need.
As I can see with my own child,he simply was not breathing
(41:39):
correctly.
If I recited his symptoms toany ENT, physician, sleep
doctor, you would say 100% yourson has sleep apnea.
And if at four years old he hassleep apnea and he's not
oxygenating properly, I have toask the question what other
possible impacts are there whilehis body's developing?
So that I think fororthodontics at large, dental
(42:05):
alignment will always be uh afacet of our profession.
Um, but I think in the longrun, um, we may need it less and
less if we're addressing thejaw size shape discrepancy
earlier on and focusing ourattention to the possible airway
(42:26):
complications that might exist.
Dr Andrew Greenland (42:28):
With that, Michelle, I was laughter.
Thank you so much for joiningme today.
Um and sharing your mission,because it really is a mission.
And I've enjoyed thisconversation so much because
we've covered something muchbigger than braces and straight
teeth.
We've talked about childhooddevelopment, we've talked about
breathing, we've talked aboutsleep, we've talked about
evidence-based practice, andperhaps more importantly, when
clinicians begin askingquestions that the research
(42:48):
hasn't completely answered yet.
So thank you very much forjoining me.
It's been an absolute pleasure,and obviously I wish you all
the best with your mission.
Dr Vishal Sharma (42:56):
Thank you, Dr.
Greeland.
I hope to cross paths uh againat some time in the future.
But until then, uh take careand thank you for the
opportunity.
So welcome to another episode of Voices in
Health and Wellness, where Ispeak with clinicians,
healthcare leaders, andinnovators about the ideas,
experiences, and challengeschallenges shaping the future of
healthcare.
Today's guest is Dr.
Vishal Sharma from AuraOrthodontics in British
Columbia, Canada.
Now, when most of us hear theword orthodontics, we probably
think immediately of braces andstraight teeth, but Vishal's
(00:30):
philosophy goes considerablyfurther than that.
His work explores therelationship between
orthodontics, facialdevelopment, breathing, airway
health, and sleep, particularlyduring childhood when growth and
development can potentiallyinfluence health for years to
come.
How clinicians how shouldclinicians respond when they s
uh when they're seeingcompelling outcomes in practice,
but large-scale research hasn'tnecessarily caught up yet?
(00:50):
And how do we distinguishgenuine innovation from getting
ahead of the evidence?
We're going to explore all ofthat today, as well as what
parents and fellow healthcarepractitioners should be looking
for when it comes to children'sfacial and airway development.
So with that, Richard, I'd loveto welcome you to the show and
thank you so much for joining metoday.
Dr Vishal Sharma (01:06):
Thank you so much, Dr.
Greenland.
It's an honor to be here.
I'm uh happy to discuss some ofthese topics in a little bit
more depth.
Dr Andrew Greenland (01:13):
Thank you.
So let's go back to thebeginning.
Can you give us a sense of yourjourney and how you got into
orthodontics in the first place?
And what eventually led you tothis more functional approach
that you've adopted?
Dr Vishal Sharma (01:24):
It's a great question and uh dates back a
bit, I guess.
So uh I was fortunate enough tohave the opportunity to study
at NYU, uh the dental schoolthere.
And actually, I was uh fullyinclined for a surgical track.
I was preparing myself forthat, and then just kind of like
a chance, uh a chanceconversation with a friend
(01:45):
completely shifted my focus uhtowards orthodontics.
So honestly, the journeytowards orthodontics, it was it
was not by any means uh acomplete uh childhood dream.
Though when I met my cousinabout uh 20 years later, uh this
is just recently now, she didrecite a story where when we
were children, I said I wantedto be an orthodontist.
(02:06):
I completely forgot that story,but she reminded me of it.
So maybe it was buried deepinside, and that's why the
switch over was quite easy.
Um, from there, I completed uhmy orthodontics also at NYU, and
then I returned back uh toBritish Columbia here to be in
Vancouver with my family.
Uh the journey, I'm now in my15th year of practicing
(02:28):
orthodontics.
Uh, and and within those 15years, it's been a unique uh uh
journey along the way from, youknow, as we all know, during
residency, we learn how to dowhat we need to do, but we're
not super proficient just yet.
So the first few years arealways kind of understanding
your flow, how you like to usecertain tools, what works good
(02:49):
in your hand.
And then the evolution till now,uh, I really especially kind of
the airway topic and what we'reon the forefront of doing today
is largely my children.
Uh, you know, seeing themobserving facial growth and
development.
And I'm fortunate enough tohave twin boys, and they both
have unique uh uh issues.
(03:10):
But to see that from birthonwards, to see how the current
medical system as it stands ispaying attention to certain
issues or not, where the blindspots are, just by nature of the
construct of our system, andseeing the impact of facial
growth and development or lackthereof, and how it begins to
(03:34):
form symptoms and what I seeclinically at what is considered
to be the age of orthodontics12 to 13.
Uh, some parents who aremindful might bring a child in
from seven to 10, but seeing mychildren, putting it together
with the base of myunderstanding and knowledge,
what I'm seeing in the clinic,what I'm seeing uh uh missing in
terms of the medical vertical,that's kind of helped formulate
(03:59):
this approach that we havetoday.
Dr Andrew Greenland (04:01):
Thank you.
Really helpful, really helpfulto get the back the back the
backstory and the journey.
Thank you.
Um so I know you've said thatorthodontics starts long before
braces.
What do you mean by thatexactly?
Dr Vishal Sharma (04:13):
So the most important thing to understand
here, because that's a loadedquestion, but the most simplest
way I can explain this is teethare like passengers on a ship.
So the size of that ship, theposition of that ship will
(04:33):
determine where the teeth areable to go, just like
passengers.
So what we current orthodonticslargely, but not exclusively,
focuses more on the finalposition of teeth.
And I think orthodontics isunder an evolutionary process to
understand this, but drivingthe message home down to parents
(04:55):
and patients is really the morethe bigger challenge.
We have to understand andrespect how much shaping the
jaw, like what are the pressuresthat shape the jaw into what
it's going to become?
And how can we influence thatfor the most optimal health,
which includes, in my view, atthe very tail end the alignment
(05:16):
of the teeth?
But prior to that is thestructure of the bones, how do
they fit together?
Are they distributing pressuresappropriately?
Are they allowing space forteeth to form?
Are they allowing for us as aspecies to breathe correctly?
And what I'm seeing in short isthat much of our modern-day
(05:37):
habits are not leading to that.
So we have issues, those issuesshow up in the teeth, but the
issue is really underlying.
We have to kind of peel backthe layers to understand okay,
what's happened here?
How do we correct it?
And what other impacts onhealth are happening as a result
of the crowded teeth.
So traditionally, we seechildren at seven to eight, as
(06:11):
recommended by our uhprofessional bodies.
I reckon that as healthcareproviders, dentists, physicians,
pediatric uh dentists, andpediatricians, both, should be
mindful of just a few thingsbefore the age of five.
And those are completelynon-dental.
Maybe one we could consider tobe dental.
(06:33):
If a child less than five hasdental crowding already, they
are already undersized in thejaws and likely to be displaying
other signs if we're payingattention.
Not always, but likely.
The other things are completelybehavioral and physical.
So, how well are they sleeping?
Do they sleep through the nightor are they waking up often?
(06:56):
Bed wetting is related to that.
The more you bedwet, the lesslikely you're in REM sleep, the
less likely you're breathingproperly, and the the greater
the chance that the jaws are notlarge enough.
Are children grinding theirteeth?
Grinding results in the sameissue.
When teeth don't fit togetherproperly, the muscles don't
(07:18):
really find a place to rest.
And when they don't rest, theyend up becoming hyperactive,
almost like a fidgety leg, youknow?
So that's what grinding reallyis.
It's just a fidgety muscle thathasn't found its peaceful home
and resting place.
Bags under the eyes.
Are they waking up unrested?
Do they fatigue generallyeasier?
Now, of course, some of thesethings have multiple possible
(07:42):
inputs, but these are just hintsthat we can detect and pay
attention to that, hmm, maybethere's an underlying issue that
we could resolve with a deeperanalysis.
Dr Andrew Greenland (07:53):
Amazing.
Um, I think you described umorthodontics to me essentially
as dental facial orthopedics.
What does that mean inpractical terms for those
listeners?
Dr Vishal Sharma (08:02):
Yeah, so for those of us who are medically
inclined, we can put the wordstogether and break it down to
like basic and medical uhterminology.
Dentopacial orthopedics meansyou know, face, uh growth of the
face, jaws, muscles, bones, andthe whole complex, and how to
manage that.
So when we think of anorthodontist, even in the
(08:23):
medical facility, our minds goto aligning teeth with braces or
uh invisible aligners.
Uh uh, there's severaldifferent companies that do
that.
So that's where our mind goes.
But in our actual credentialinglicensure, and the title of our
vocation is dentofacialorthopedics, and that is exactly
(08:43):
what I'm speaking to.
How can we assess, diagnose,treatment plan, and treat
misshaped jaws?
Again, so that at the end ofthe day, which won't by the time
the child is 12, 13, or 14, wecan have aligned teeth that fit
(09:05):
together well and function well,but in the meanwhile, that
allow us to breathe properly,distribute pressures properly
when we eat, and allow our bodyto get the most primary uh uh
nutrient we need, all of us,which is actually oxygen.
So rooting all of this backdown, and this is where I take
(09:25):
it a little bit further, I mightsay, is being cognizant of how
that link relates to how are webreathing, tongue position, and
other things that help formulategood growth and development.
Dr Andrew Greenland (09:39):
And with all of that, I mean, how much
influence do we actually haveover facial development whilst
the child is growing, in youropinion?
Dr Vishal Sharma (09:49):
If I understand the question
correctly, you're saying howmuch influence can we have while
they're growing?
Dr Andrew Greenland (09:54):
Yeah, facial facial development
specifically.
Dr Vishal Sharma (09:57):
Yeah.
Um quite a bit, rather, uh,because at this young tender
age, everything is still uhformable, uh malleable in a
sense.
We can uh manipulate and guidethe growth to be in the
direction that we want.
So, how much can we influence?
(10:17):
Quite a bit, more so than youmight say after, let's say, 14
or 15.
So, for example, uh my twinboys, who are now just five,
just started kindergarten.
I have them both in palatalexpander devices.
And one of the twins needed itmore than the other, but the
other one is gonna benefit fromsome expansion, nonetheless,
(10:38):
just not as much.
So, because the bones are soft,because the everything is kind
of choosing its direction ofgrowth, we know what the trend
is going to be.
We can't say with precision,oh, this is exactly how your
child will grow and develop if Isee them at five.
Can I predict what they'll looklike at 14 with 100% accuracy?
(10:58):
No, most certainly not.
But I can definitely give you atrajectory of which direction
is this child heading?
Is he heading north?
And if so, how much north?
I used I use the compass as anexample, as a metaphor here,
right?
So, what type of malocclusion,misfitting bite issues might
this child have are evident intheir growth up until five, to I
(11:25):
would say almost the 80 to 90percent accuracy in terms of
what range they would fit in.
And that is enough for us todecide whether we should
intervene or not intervene.
Dr Andrew Greenland (11:36):
Thank you.
Um so this um the audience forthis podcast is generally
practitioners.
So, are there any particularsigns that should prompt a
fellow practitioner or dentist,GP, or other healthcare
professional to consider anearlier orthodontic assessment?
Because you're certainlyadvocating for early
assessments.
What things shouldpractitioners be looking out for
that would warrant that?
Dr Vishal Sharma (11:58):
So I'll speak primarily to the dentist first,
uh, and then I'll move to themedical colleagues.
So uh dentist, pediatricdentist, anyone who's seeing
children from that two to fivewindow, if a child has dental
crowding, especially in thelower anterior section, that is
a definite sign of insufficientspacing, which will likely lead
(12:23):
to other issues.
Uh, and the reason for why thathappens needs to be explored a
little bit.
So dental crowding is one ofthose primary things that does
show up early.
Now, yes, a child is growing,so some of that crowding will
alleviate, but the most idealalignment for children who have
no permanent teeth is adequatespacing between each tooth, at
(12:47):
least a half a millimeter, ifnot greater.
So essentially it should looklike a white picket fence.
And if it doesn't look like awhite picket fence, with most
humans not having that, becauseof modern-day habits, which
we'll perhaps get to in amoment, but if they don't have
that, then there's likely a jawsize shape discrepancy.
(13:09):
So that's kind of like the redflag that anyone can kind of see
from afar.
You don't even need to be adentist to tell that there's
either crowding or there'sspacing, and that's pretty much
as black and white as it needsto be.
Beyond that, we can there aresome auxiliary signs.
Grinding at night, some levelof grinding is normal, but
constant and uh intense is adifferent style.
(13:34):
So if you either speak to aparent of a young child and be
like, oh my gosh, I could hearthem from the next room or are
you walking away, like that typeof grinding is not
pathological, but abnormal.
We would say that for now.
And then the last thing is ifthey're not feeling rested, if
the child is not getting sleep,that's likely to be a sign of an
(13:54):
undersized jaw.
There are absolutelyconfounding factors in the soft
tissue, such as enlargedadenoids, which also lead back
to jaw size and position interms of airflow.
But if they're not rested wellenough, they're waking up with
bags under the eyes, they'regenerally irritable.
Um, oftentimes, and this isresearch proven, that on the
(14:19):
lower end of the spectrum forADHD and even mild, mild autism
has been sometimes confused withpediatric sleep apnea.
And that's the one thing thatwe ultimately have to
acknowledge that, and now I'mgonna veer towards my medical
colleagues, is any suchsimilarities to adult sleep
apnea and children is theringer-dinger.
(14:41):
That's the one, that is thebell.
If your patient isdemonstrating um the type of
behavior that comes from beingunrested, easily irritable,
agitated, and oftentimes, andit's necessary to have these
diagnoses, but oftentimes we'retoo quick to shunt towards
things that may not be trueversus going up the ladder or
(15:05):
down the ladder, however youview it, of invasive diagnoses.
Is this potentially an airwayissue?
It should be uh assessed beforewe get into deeper uh uh
diagnoses that stay withchildren for for their life.
This is a modifiable component,and oftentimes, which I've seen
in my patients, simply openingup the airway via arch
(15:30):
expansion.
And this is not a hundredpercent uh linear uh
relationship, so I need toacknowledge that for our medical
colleagues, that this is anattempt to open up the airway,
that oftentimes helps alleviateseveral of these symptoms.
Um, one symptom that I haven'tmentioned that I think everyone
(15:50):
should be aware of parent,patient, dentist, or uh uh
physician is pediatric snoring.
If it's constant, if it's uh uhconsistent, and if it's fairly
frictioned, you know, you cantell the sound.
Is it a mild, like I'm justkind of breathing because I'm
changing positions, or is it anactual snore?
(16:12):
That is likely a sign of airwayblockage, and that relates to
jaw growth and development.
So I think amongst those uhfour to six uh signs I
mentioned, there's enough kindof like red flags we can just
burn in our memory to keep tohelp us as we see patients on a
day-to-day basis.
Dr Andrew Greenland (16:30):
Obviously, your parents your patients come
with parents attached.
Is there one thing that youwould um really like to change
the thinking about the parentshave regarding orthodontics?
Dr Vishal Sharma (16:42):
I think it's kind of already that, which we
kind of spoke to, but I'll speakto it a little bit more
clearly.
Is if you notice a dentalissue, which is the reason
actually most dentists referpatients to me, and even parents
themselves, when they comedirectly, uh, they come to me
for a crowding issue.
I notice that this tooth is wayin the wrong position.
What can I do about it?
(17:02):
That's a great sign to alsoburn in your memory, as I
mentioned earlier.
But the one thing that I wouldlike for us to start viewing
differently is that this all ofthese issues are pointing
towards actually an airwayissue.
So, not coincidentally, what Isee in the patients is when they
(17:24):
do present with a severecrowding issue, there is more
likely to be some level anddegree of airway blockage via
the adenoids and tonsils, orboth.
So when we and that's the onething I want us to take home is
(17:45):
that we need to look at this asan airway problem.
Is my child breathingcorrectly?
If you're 100% sure that theyare, fantastic, continue on.
But if you have any drop of adoubt, I would suggest seeking
an opinion from an airway-mindeduh dentist andor orthodontist,
(18:05):
because most often that issuecan go undiagnosed.
It's not airway management,it's not necessarily on the
pediatrician's radar becausethey see the child generally in
the first year, unless there areother complicating factors.
And we're not getting to see anENT with diagnoses until the
(18:26):
airways are far too blocked.
At that point, at least inCanada, the SOP for treatment is
monitor, moving towardssteroidal spray.
And then, if there's noresolution, surgery.
And oftentimes we do need ouradenoids for the duration of
life.
So I encourage you to seek anairway assessment, um, at least
(18:50):
from an orthodontist again ordentist who's airway-minded.
This will help us becausewithout oxygen or adequate
oxygenation, the analogy I liketo use in my uh lectures, is one
of a light bulb, which we canall resonate with.
And when it receives too littlepower, what happens?
(19:12):
Right.
If you said it flickers, you'reexactly right.
So the brain and the nervoussystem at the top of our
anatomical tree, you might say,but every system, when
significantly or sufficientlydeoxygenated, simply cannot grow
(19:32):
and develop the way it'ssupposed to grow and develop.
And that's as mat medicalpractitioners, that's what we
have to understand that okay,all of these systems are
developing early.
Central nervous system,respiratory, circulatory,
muscoskeletal, and endocrine,and every other system that goes
beyond that.
(19:52):
They're all developing at thisyoung, tender age, and without
adequate oxygenation, theysimply cannot grow effectively.
And that is likely to have amyriad of complications down the
line.
Um pediatric sleep apnea justbeing on the very early end and
detectable range.
Dr Andrew Greenland (20:16):
Thank you very much.
Um when we chatted before, Ithink you described a sort of
split mentality withinorthodontics.
Could you um speak a little bitto that?
And what what what are theissues and challenges in your
profession?
Dr Vishal Sharma (20:29):
Um currently there are a handful of us within
the profession viewing thingsthis way, and it's largely uh
tied to the lack of researcharound it.
And this is why I'm verypassionate about affiliating
with uh a local university here,so that we can start to get
(20:52):
this information intopublications more deeper
assessed, uh, you know, so thatwe can make these links um more
concretely.
And within the profession, it'shelping us all get to the same
page.
Now, orthodontics is veryunique in the sense that if you
get five opinions you'll pro uhfrom different doctors, you'll
(21:15):
probably get at the walk awaywith at least three different
treatment plans for the same endresult.
And that's just orthodontics,but I can understand how that
becomes super confusing for ourparents.
Um, and it also speaks to thechallenge within our direct
profession, that beingorthodontics, before I even
stretch out to dental at large,and then before I even include
(21:36):
the medical umbrella.
But getting to the same pageand understanding that the
likelihood of this connectionprior to it being completely
backed with full substantiatingresearch, uh, there is research
that does exist, Dr.
Greenland, but it's just not aslike crystal clear and like,
(21:57):
you know, it's not ringing thebell from the top of the
mountain.
Type of research yet, you know,where the whole profession
goes, Oh my gosh, we've missedsomething.
You know, this is very earlystage.
This is early understanding.
Um, you know, understanding uhuh how our biomedical
(22:18):
development intertwines with ourmetaphysical existence and how
we're able to actually functionas a fully developed, how we get
to be fully developed in thefirst place, um, and
acknowledging that this airwakeissue is a component simply
because of one fact that wecannot deny.
Nobody can deny this one fact.
(22:40):
And I suggest that this iswhere we start.
Adequate oxygenation is vitalfor proper development.
Just that I think we can allagree upon, doesn't matter which
field of study you come from.
So once we root there, we said,okay, is there something
perhaps blocking the airway?
And then just start to makethese connections because
getting these types of casereports, seeing these things in
(23:02):
your clinic, such as I am, aregoing to be the things that wake
up the light bulb within yourmind and say, okay, this is how
we can actually take a differentcourse of direction.
And if we resolve the airwayblockage issue early, we may be
on the benefiting factor ofseveral potential complications
(23:23):
that we don't even know about.
We don't even know where thattrade's gonna go, right?
Um, so that's the challenge,and I and I want to be part of a
uh healthy discussion.
Uh, you know, there arenaysayers and and disbelievers,
as with any you know, new way ofthinking, but the goal here is
unification.
Uh, for honestly, and thissounds like a reach, but is this
(23:46):
not for the betterment of allhuman species?
If we're all breathing better,and you and you'll notice me uh
defaulting back to breath, notto dental alignment, when the
jaws are proper size and shape,the teeth are more likely to
fall into the right place.
The likelihood you needorthodontics decreases, or maybe
mild orthodontics for aestheticand functional improvement.
(24:10):
But if we all focus on thatimproving the airway, let us all
breathe better.
Let us all breathe better.
Then we're on the right track.
Dr Andrew Greenland (24:20):
Thank you.
And with that, how do youpersonally decide when there's
enough evidence to change theway you practice personally?
Dr Vishal Sharma (24:28):
Um, so a lot of this was kind of like a
little bit of a rabbit hole, ifyou say, you know, a lot of us
have done this in our careers.
We get to a certain point.
Is this all there is?
Like it happened for me when Iwas gifted with uh my twin boys,
uh, and turning 40 was exactlythe same point of my life.
And this is kind of like anassessment, you know, like a
(24:49):
let's say like a rest stop whereyou take a checkpoint and those
kinds of things.
It was also coinciding withCOVID.
And I'm sure a lot of us did alot of deep thinking at that
time, and I had thatopportunity.
So this is where I began to uhsee things differently, see the
face differently.
Again, I just changed it thisway that okay, are we breathing
(25:11):
correctly enough?
Uh, and this is like on a sidequest that's happening for me in
my personal life was mydiscovery of meditation and
understanding that the more Islowed my breath, the deeper I
could connect to myself.
And every single answer I everwanted would just pop up on its
own.
And anyone who's meditateddeeply enough can tell you that,
(25:32):
yep, that is true.
So then I began to appreciatethe power of breath.
And all the while I'munderstanding with my own
children, observing my children,but my understanding of dental
facial growth and development,how what I do impacts how well
people can breathe.
And um, I went in a rabbit holeand discovered that these links
(25:56):
exist, but they're not fullyinterconnected.
Think of like a spider webthat's disjointed.
And if we just take a littlebit of time to kind of like put
all the pieces together, you'llbegin to see that this body of
work is actually pointing in acertain direction, right?
We don't need the you know toget full conviction from to your
(26:18):
previous question from thefield and the science.
We need to have that red flagresearch that makes us all go
have that moment.
But until then, we can see thatthe research is actually
already pointing in a certaindirection.
It does stop short, and thenthere's shades of gray, which is
where I recommend we start toconsider doing a little bit more
(26:39):
research.
And I know it's alreadyunderway with fantastic
fantastic scientists all overthe world uh to appreciate this
airway connection.
Dr Andrew Greenland (26:47):
Thank you.
And on the subject of theresearch, so I know you've been
talking about the uh work of theUniversity of British Columbia.
What data are you hoping tocollect and what questions would
you ultimately like thatresearch to answer for you?
Dr Vishal Sharma (27:00):
Um I I think the first is really trying to
see if expansion adequatelyopens the airway within um
statistically significant means.
So as a case report, I had thisone patient who had
(27:20):
approximately 1.5 to 1.25 to 1.5millimeters of airway opening
uh between the adenoid and theuh larynx.
After expansion, this opened upto 19.5 millimeters.
So we had a 2,000% increase inairway.
Now, unfortunately, and I'm notmaking any claims here, but
(27:41):
just to be transparent with thestory and give us all food for
thought, because this, what I'mabout to say, did help bridge
something for me.
That poor young girl wasdiagnosed with a tumor shortly
thereafter.
And I just asked myself, Iwonder if the oxidative stress
that she was under for all thoseyears had a contributing factor
to the development of hertumor.
(28:02):
And I just simply asked, I'mnot making a claim, but I say if
we all ask that question,whether you're an oncologist and
you're listening to this,you're a physician, you're a
radiologist, dentist,orthodontist, doesn't matter.
You might say that, yeah,oxidative stress is not good for
our bodies, and it could causea lot of problems.
Is that a problem with thetumor?
I don't know.
Now that's an extreme example.
(28:23):
No, not every patient isgetting a 2000% opening.
It was kind of like a freakoccurrence.
I floored me to see ithonestly.
But what we are seeing is theaverage patient will get 30 to
40% increase, and a handful ofpatients are seeing 200 to 600%
increases.
2,000% is an outlier.
(28:43):
But that is the first question.
That is the first thing I thinkwe start with, because then
we'll be able to understand thatokay, yes, jaw size and shape
is related to oxygenation.
We can improve it via a verysimple tool that we're already
using.
And this is kind of like thelowest barrier to entry to be
like, okay, let's focus on earlyexpansion when we see the signs
(29:06):
and symptoms for it.
And that would be uh ultimatelyopening the gateway for better
health for everyone.
And I think that's the firstquestion that I'd like to
answer.
Dr Andrew Greenland (29:15):
Brilliant, thank you.
So for sure, I'd like to switchgears a little bit now.
So maybe because um there'sanother part of your story which
I think is very interesting.
You're not only trying tochange how people think about
orthodontics, but you've alsohad to build an organization
that's capable of deliveringthat vision.
So, what's been the mostchallenging part of growing or
orthodontics while maintainingthe clinical philosophy you
(29:36):
believe in?
Dr Vishal Sharma (29:38):
Yeah, that's a great question.
I mean, I think the challengefor any leader is to get uh
buy-in from everyone who's onboard.
Um and I mean, look, we're allindependent thinkers and we all
have our uh autonomy, especiallyamongst the professions.
So when it comes to our uh uhmedical colleagues, dental
colleagues, we all have our wayof looking at things.
(30:00):
And that's more of a dialogue.
I think being a person whounderstands that unique
perspectives are the norm.
And rather than trying toforce-feed people into a way of
thinking, I like to address thedoubt in their mind and present
(30:21):
it and through dialogue bringthem into perhaps considering
that this is what I'm saying istrue.
And it's not because I'm sayingit, it's just because it's one
of those universal laws thatmight exist, you know,
constricted airway is gonna leadto deoxygenation,
hypooxygenation.
That's just true.
So, and then similarly, we weall need oxygen to survive.
(30:42):
These are facts, right?
Um, and I think that's thebiggest challenge, even in an
organization as a entrepreneurlike dental in in Canada, North
America, is very much like abusiness uh in order to survive
the test of time and have peoplebuy in.
It's it's really likecommunicating with them
adequately, giving them space todo it on their own.
(31:03):
You know, it's like when we forthose of who those of us who
have uh uh teenagers, I dealwith teenager patients all the
time, so I I know I don't havemy own yet, but we have
teenagers and they kind of like,you know, they're they're in
that strong opinionated phase,um, where you know, we kind of
have to let them see it on theirown and guide them into what is
the the the true mat the trueessence of the matter here.
(31:23):
And I think having that stanceis what's helped me immensely,
not force people into it, butcome into their own right.
And when they do, there's morebuy-in.
Of course, things likepresenting the data, presenting
the cases, like without actuallyhighlighting the case reports,
uh, we're not able to appreciatethe impact of uh this potential
uh way of thinking.
(31:43):
So we must do a combination.
Dr Andrew Greenland (31:47):
So I think you've got a team of 15 people,
if I've got my informationcorrect.
So, what does your role in thebusiness actually look like
today?
And how has that changed overtime?
Dr Vishal Sharma (31:56):
Yeah, actually, just a slight
correction there.
We're a team of 40 now, and wehave the three locations, three
doctors.
Um my uh day and time have beena bit of an evolution.
So when the children wereyounger, I was a little bit
stepping aside from the clinicjust to kind of give the support
necessary here and be present.
Um, and I'm super glad that Idid.
(32:18):
But about 60 to 80 percent ofmy time is clinical in a
week-to-week basis, and 15 to 20percent is management.
Uh, I do have a wonderfulmanagement team.
Um, we have a CFO who managesall things financial and legal.
Uh, and then there's an HRmanager and a marketing manager
just to help uh you know achievethe multi-prong goals that we
(32:40):
have simultaneously.
So it ends up being uh um notas heavily clinically uh uh as
it used to be in my earlieryears.
Dr Andrew Greenland (32:51):
Um and with that growth and the the change
in the way you apportion yourtime, has there been anything
you've found hard to let go ofpersonally?
Is it the clinical thing or isit other stuff that's um
involved in the in the role?
Dr Vishal Sharma (33:03):
I think uh anytime you want to have you
want to see growth, there is acertain level of, and this kind
of goes back to your earlierquestion, is like it's not a
lesser a reduced quality, but itit it this is what it feels
like, right?
So when we're practitioners, wethink, okay, no, we're all
alpha until we've gotten to thispoint.
We have an alpha type of way ofthinking, and we like to do
(33:24):
things our way, we know that wecan do it well, and so we have a
hard time letting go.
Um, I think doing that within asafe space.
Again, I'll I'll bring I'llbring the example oftentimes to
rearing children, but whenyou're trying to teach your
child that how to walk, you haveto let them walk a little bit,
right?
So you're kind of holding themjust lightly and loosely, you're
not actually moving the legsstep by step, although that's
(33:46):
may how it may start.
You have to allow yourself tolet it go and let them maybe
perhaps fall.
Um, and so running a team andallowing them to grow uh um
themselves, sharpen their ownskills and their own talent
while guiding it at the sametime is is is kind of like uh
(34:09):
how you know we're able to growand and and what my uh
philosophy generally is.
Dr Andrew Greenland (34:18):
And it's a it's a much bigger thing than I
mentioned just earlier on.
So 40 people, three locations,it's pretty pretty impressive.
What are the biggest challengesand bottlenecks that you
currently face in the day-to-daythat that may have been
completely different a few weeksago, a few months ago?
What are the things that keepyou up at night that you're
having to work through as afounder owner?
Dr Vishal Sharma (34:40):
That's a great question.
And it does seem to change fromthe you know week to week.
Currently, um right now, aswe're speaking, we're entering
into our education uh season.
So uh we do a lot of webinarsand a lot of like in-person
sessions.
And so it's my primary focus isuh trying to recruit audience
(35:00):
because when you do a webinar,as you may know, Dr.
Greenland, like you know,getting an audience to kind of
listen to your message is achallenge um that we all take on
at some point, especially youknow, venturing into uh this
type of field, you know, being abeing a physician, Dr.
Greenland.
Like like I was discussing withmy team.
Many props to you for you knowcarving out this niche,
(35:22):
designing the podcast, gettingit ready and everything.
Um but when we take on uh thesechallenges, yeah, it does
change over.
So currently we're in educationseason, but one of the constant
things is uh recruiting greatteam.
You know, there's uh it's kindof a qualified uh individual
shortage where I practice.
(35:43):
Uh, and I think a lot of thepractitioners would would agree.
So constantly finding you knowgood talent, people who uh want
to grow, want to contribute tosomething like this, see
themselves in this in thisfield, that that is one of the
constant underlying, it doesn'tmatter what year you ask me that
question.
It's one of those things that'salways there, Dr.
Greenland.
Uh, and it's no different now.
(36:04):
But those are kind of like thetwo primary things I would say.
Dr Andrew Greenland (36:08):
And how do you find great team players and
you know the ones that are goingto be aligned to your
philosophy?
Dr Vishal Sharma (36:15):
Oh, I think the most important thing is
really attitude.
Uh, you know, I'm a big energybeliever, as I spoke to
metaphysical and meditation alittle bit.
That's not a necessity by anymeans, but how you approach
life, how what your mindset is,is it resilient?
And these are things that arenot easily detectable through
traditional uh interviewingmeans.
So we do have a fairly rigorousonboarding process.
(36:37):
Uh, it's multi-tiered.
We do have, we do utilize apersonality test that gives the
candidate and us a little bit ofinsight into how this person
thinks.
Uh, and we're very protectiveof our energy in space.
There was a time that it wasn'tso harmonious, and we felt the
impact on multi on a multi-leveluh uh, you know, uh uh in a
(36:58):
multi-level way.
So being rigorous aboutonboarding, uh being quick to
let people go if they're simplynot a match is very, very
important.
Uh, because oftentimes wethink, oh, opportunity costs,
we've got to find someone else,train them again.
I'd rather just, you know, makedo with this individual.
I and I did that for severalyears, but I think that's not
(37:20):
the way to be developing like areally you know with it team.
And to the last part of yourquestion, buying into the
vision, that's something thatjust reveals itself over time.
But I think um sharing thepassion, and I am a generally
passionate person, um isintegral to that mission.
Dr Andrew Greenland (37:43):
So it has to give you a magic wand and you
could fix one thing in thebusiness tomorrow.
Um talent acquisition aside,would there be anything else
that you would love to be ableto solve?
Dr Vishal Sharma (37:54):
Um I think if people physicians, dentists, you
know, the qualification aside,if people could make that one
link, that how we breathe has amassive impact into how we grow
(38:16):
and develop and overall systemichealth in the long term, that
would be the magic wand.
Because I personally do believethat if we're able to oxygenate
properly, if we're able to taketime out to quietly breathe and
(38:38):
slowly breathe for a fewminutes in a day, we're all more
connected to a single thingthat unites us all.
And many, and this is gonna bea stretch to some people, many
of the issues that we currentlyface as a species, which are out
there, we all know them.
I think they begin to fallapart because we're in a
(38:59):
harmonious rhythm with ourself,and that is much uh more
synchronous and coherent atlarge, not just medically
speaking, but our entireexistence.
So, at first, we'll start withthe medical.
Dr Andrew Greenland (39:18):
And finally, what's the future hold?
What where do you see AuraOrthodontics being in the next
12 months or so?
And what about orthodonticsmore generally?
Where is orthodontics headingin your view?
Dr Vishal Sharma (39:30):
Um, so Aura specifically, I think we're just
gonna continue this mission.
It is a large mission that wehave undertaken, um, you know,
but I feel very passionate aboutit.
And we're just gonna continueon, Dr.
Greenland.
You know, doing things likethis, the podcast is a great,
fantastic way.
I cannot uh tell you howgrateful I am for the
opportunity uh and you findingus to help propagate the message
(39:51):
one individual at a time.
Uh, you know, especially withpractitioners, we can make a
large impact by hitting thatsingle point because we see each
practitioner sees so manypatients.
And if you're able to have thisconversation with your
patients, the messagepropagates.
So that's gonna be theimmediate 12-month.
Again, we are developingfurther our uh online
educational presence presence interms of webinar.
(40:14):
We're developing a website,we're gonna have a portal where
people can access these things.
We all need education for CEand credentialing.
So if we can fill a role there,um we're we're working on
developing that.
And then just again, even in myown, when I go to the office,
being present-minded and justassessing each case on an
individual basis and keepingthat question in the back of my
mind (40:37):
are there any possible potential complicating airway
issues here that I can helpresolve?
And then again, I am by nomeans making uh cause and effect
uh statements.
I am stating that we as a bodyof people can look at this a
little bit deeper so that we canget to a point where we can
make cause and effectstatements.
(40:57):
Um and at large fororthodontics, I truly believe
we're in a revolutionary phase,the early phase of it.
Um dental alignment isobviously immensely popular, but
much more accessible.
And I think if we're startingwith the orthodontist, focus
(41:19):
more on dental facialorthopedics, and I really do
reckon that we are going to beseeing patients and wanting to
be seeing patients.
It's not like we are, you know,self-serving in this in this
mission.
This is a need.
As I can see with my own child,he simply was not breathing
(41:39):
correctly.
If I recited his symptoms toany ENT, physician, sleep
doctor, you would say 100% yourson has sleep apnea.
And if at four years old he hassleep apnea and he's not
oxygenating properly, I have toask the question what other
possible impacts are there whilehis body's developing?
So that I think fororthodontics at large, dental
(42:05):
alignment will always be uh afacet of our profession.
Um, but I think in the longrun, um, we may need it less and
less if we're addressing thejaw size shape discrepancy
earlier on and focusing ourattention to the possible airway
(42:26):
complications that might exist.
Dr Andrew Greenland (42:28):
With that, Michelle, I was laughter.
Thank you so much for joiningme today.
Um and sharing your mission,because it really is a mission.
And I've enjoyed thisconversation so much because
we've covered something muchbigger than braces and straight
teeth.
We've talked about childhooddevelopment, we've talked about
breathing, we've talked aboutsleep, we've talked about
evidence-based practice, andperhaps more importantly, when
clinicians begin askingquestions that the research
(42:48):
hasn't completely answered yet.
So thank you very much forjoining me.
It's been an absolute pleasure,and obviously I wish you all
the best with your mission.
Dr Vishal Sharma (42:56):
Thank you, Dr.
Greeland.
I hope to cross paths uh againat some time in the future.
But until then, uh take careand thank you for the
opportunity.
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