5 Clues Your Child’s Behavior Is Breath-Related

Child behavior issues? It might be breathing. Discover how airway problems mimic ADHD, anxiety, and more.

In this powerful episode, Dr. Michael DeLuke uncovers a hidden root cause affecting millions of kids: undiagnosed airway obstruction. From snoring and mouth breathing to bedwetting and school struggles, these signs often get mislabeled as “bad behavior” or ADHD—when in reality, your child might just be struggling to breathe.

Dr. DeLuke shares how traditional orthodontics and medicine often miss the mark—and introduces Orthodontics 3.0, a game-changing approach that supports proper facial development starting as early as age 3.

You’ll learn what questions to ask your pediatrician or orthodontist, what symptoms to watch for, and how early intervention can completely change your child’s life.

If you're a parent, teacher, or caregiver—this is a must-listen. Tune in, take notes, and share it with someone who needs answers. It could be the best gift you give a child this year.

Episode Transcript

Speaker 1 (00:00):
Are your kids acting out or silently struggling to
breathe?
I brought in Dr Michael DeLukebecause he's going to address
these issues that are goingunseen.
For example, is your childsnoring, bedwetting, way past,
beyond the years that theyshould be?
Are they having behavioralissues?

(00:20):
Are they struggling payingattention at school?
Now, this was my son and I'vegone through that road and I
knew how hard it was to diagnose, to get to the root cause of
the issues, and a lot of it washis sleep and also the airway
obstruction.
So it's not talked a lot enough.

(00:41):
Dr DeLuke is an orthodontist.
He will give you guidelines andquestions to ask orthodontists,
who to see, and questions toask and notice about your own
kids.
This hour can change yourchild's life.
Well, welcome, dr DeLuke.

(01:14):
I'm such a pleasure and anhonor to have you on here.
Thank you very much.

Speaker 2 (01:19):
Thanks so much for having me.
Melissa, Really excited to behere with you.

Speaker 1 (01:21):
Yes, and I have so many questions, so I'm just
going to dive right in and let'sstart with airway obstruction.
Can you just explain what isairway obstruction, and
especially related with kids aswell?

Speaker 2 (01:34):
Yeah, it's a tough question to answer succinctly,
because airway obstruction canbe due to different things and
I'm guessing you're asking it inthe context of, say, let's
sleep, disordered breathing orpotentially obstructive sleep
apnea, is that?

Speaker 1 (01:48):
the general gist of it.

Speaker 2 (01:50):
So when, when you have a child, that we'll talk
about children out.
It is different for children andadults.
So, specifically now we'llreference this with this
discussion, we referencingchildren right now.
Um there, they should be nosebreathers.
We should be breathing throughour noses and there are many
reasons for that.
The nose people have describedit as the gatekeeper to the body

(02:11):
.
It purifies and moisturizes air.
The nose actually hasantimicrobial properties through
nitric oxide.
So when we breathe through theparanasal sinuses, as they
enhance the oxygen uptake by upto 20% because they incorporate
nitric oxide, which is aprofound vasodilator, so our
lungs get more oxygen to them,which then allows our bodies to

(02:34):
get more oxygen to ourperipheral tissues.
It also there's these littlethings in the nose called
turbinates, and they're like aconch shell Some call them conch
or concha and they have thatswirled shape to them and they
have a really important functionto humidify the air.
They clean the air, they slowthe air, they pressurize the air
.
So when we breathe through ournoses, it really not only

(02:57):
purifies and moisturizes the air, it also allows us to uptake
more oxygen in our lungs.
So you say, well, okay, whywould that be a big deal?
Well, so many things canobstruct the ability to breathe
through the nose.
And again, speaking withchildren, when children are born
they're obligate nasalbreathers.

(03:18):
They have to be able to breathewhile they're feeding, right as
an infant.
They then are able to breathethrough their mouths.
That is not.
Yes, we can get oxygen in.
We can survive that way.
It is not the ideal way tothrive.
So what can obstruct theairflow?
Well, we could have enlargementof those turbinates.

(03:40):
I talked about those swirlythings that are bones covered by
soft tissue in our nose.
If those get enlarged, as whathappens with allergic rhinitis
and there are estimates, someestimates from the American
Institute of Allergy that theysay that up to 40% of kids
American Institute for Allergyand Asthma say up to 40% of kids

(04:01):
are suffering from allergicrhinitis.
And when suffering from allergicrhinitis and when you have
allergic rhinitis, which wethink of as kind of like a
stuffy, runny nose related toallergies, those patients are
more likely to have and it'skind of a fancy phrase of it,
but it's called turbinatehypertrophy.
Hypertrophy just means thatenlargement of the tissue, so
those turbinates that arecovered in tissue get large and

(04:24):
swollen.
They swell up, and there was a2019 article in the Journal of
Oral Science, which stated thatthey looked at 544 children, the
ages three to 10 years old, andthey found that there was
evidence of turbinatehypertrophy in 81% of the
patients who had allergicrhinitis.
So just think of it like fourout of five patients who have

(04:46):
allergic rhinitis have thisswelling in their nose.
So if almost half kids havesome sort of allergic rhinitis,
some reaction in their nasalpassageways, and then four out
of five of them have swellingthat is going to restrict their
ability to breathe through theirnose and I see this all the
time in young patients and thenlet's just take it back from

(05:06):
there.
Let's say the turbinates arefine and the nasal passageways
are fine.
Well, if you go back in throughthe nose and get back up toward
the back of the nose before itturns down toward the throat, we
start into what's called thepharynx.
People probably heard of thepharynx, but there's the main,
two main areas where we can getobstruction.
It's called the nasopharynx,which is at the back of the nose

(05:27):
before we get to the back ofthe throat, and then what's
called the oropharynx, which islike at the back of the mouth
and the throat when someoneopens and says, ah, you're
looking at their oropharynx.
You can't really see withoutimaging or using an endoscope at
the ENT, the nasopharynx.
So when we go up into that areaof the nasopharynx there's

(05:47):
something called the adenoidsand a lot of people have
probably heard of the adenoids.
It's a common thing to heard of.
It's a type of tonsil, it's alymphoid tissue and it's a
reactive tissue.
So when we breathe through ourmouths we are taking all that
unfiltered air in and there aretheories that that unfiltered
air in and there are theoriesthat that unfiltered air hits
that reactive tissue and causesit to enlarge.

(06:09):
That's just one of the reasonsthere are many why that tissue
can be enlarged so that canobstruct airflow.
Then we go down a littlefurther into the oropharynx and
that's where we have our tonsils, or technically called our
palatine tonsils, but whatpeople just call tonsils.
Again, lymphoid tissue can getswollen and inflamed and further
restrict the airflow.
Then that patient, if they arenot breathing well through their

(06:31):
nose, that changes the way theshape of the face grows.
So if we are nose breathers ourfaces will grow differently
than if we are mouth breathersand that's been shown.
We've known that for many, manydecades.
It was a really famous group ofset of studies done, published
by a gentleman named Harvold, inthe seventies into the early

(06:53):
eighties, where he looked atrhesus monkeys and he plugged
their noses with silicone and hestudied how they grew.
And they all grew with theselonger faces, narrower dental
arches, lack of tongue space andcrowded teeth and bad bites or
malocclusion resulted.
So it's this negative cascade ofevents because then, when

(07:14):
you're growing more narrow, soto speak, because you can't
breathe through your nose, youhave obstructed breathing you
open your mouth more, becausethat's your lifeline, you have
to get air in to survive.
So you habitually open yourmouth more, because that's your
lifeline, you have to get air into survive.
So you habitually open yourmouth more.
Well, what happens when youopen your mouth more?
Your cheeks stretch and thatinward pressure of the

(07:34):
musculature further constrictsthe arch and it makes the palate
narrow and high and vaulted.
And what's on the opposite sideof the palate, above the palate
, is the floor of the nose.
So that's all getting squishedin.
So you can see you start to havethis really negative cascade of
events can be caused by amyriad of factors, and now your
tongue doesn't have room.
So now when you lie supine atnight.

(07:56):
Your tongue doesn't have room.
Your tongue is supposed to restat the roof of your mouth very
easily and not fall back to yourthroat and block your ability
to breathe.
But when a lot of these kiddosare narrow and their faces and
jaws are so narrow, they lieback, the tongue falls back, so
that's another way thatobstructs, so they have to open
their mouth further.

(08:17):
And a gentleman who is aphysician, who's a world famous
he's passed since passed, but hereally is kind of known as the
founding father of sleepmedicine, modern day sleep
medicine Christian Gimeno.
He talked about this as thisevolving cycle of what's called
facial dysmorphism.
So the more you have obstructednasal breathing, the more it

(08:37):
changes the shape of the faceand the way your face grows, and
the more that negative cyclecontinues, face grows and the
more that negative cyclecontinues, and so that's really
where the overall obstruction ofbreathing through our nose
becomes an issue.
And we can, if you want, let meknow we can talk about the
negative sequelae and thenegative things that happen
beyond just pure, beyond, I'dlove to dive into because I got

(08:59):
into that, because my son Mateus, we went through that when he.

Speaker 1 (09:03):
I noticed it.
You know I'm a dental hygienist.
I noticed it when he was aboutthree years old.
You know that.
I'd love to dive into thebehavioral.
You know, things that I sawlike for him, the sluggishness,
uh, the anger temperament therewas, uh, you know, the
bedwetting way past the yearsthat you know that was
appropriate there was.
Also, I did a few times hewould, you know we'd share a bed

(09:27):
and whatnot.
I would document the times hehad sleep apnea.
So that makes sense when yousay the tongue, you know, and he
was.
And then he had the allergies.
I remember he, the first yearhe was born, I remember in the
spring, he had those allergiesand the red eyes and the stuffy
nose.
He went through everything youjust mentioned.

(09:48):
So I've, that's why, you know,at our dental office we dove
into, you know, healthy startand trying the expander for him.
So I'd love for you to sharethat because I went down that
road with Mateus and otherpatients that we had at our
office as well.

Speaker 2 (10:04):
Yeah, absolutely.
And for parents out there, ifyou see this in your child, like
Melissa did with Mateus,videotape it Videotape.
Take your phone out andvideotape record.
Show my age right.

Speaker 1 (10:17):
Record it video.
Take a video of it.

Speaker 2 (10:21):
And that's what happens when it gets to be my
age.
That's something my children,my teenage girls, would laugh if
I said that.
But record it, take your phoneout, record it right and just
take that recording.
It's invaluable because whenyou take that to a physician or
if you need to see a sleepphysician or the orthodontist or
the dentist and say this is howmy child is breathing, I'll

(10:41):
answer your question in a second.
The importance of that is it'shard for them to deny that
that's a problem and if you justgive a verbal recount, they can
be like well, you know, youknow kids, and I will state this
, and I've had on my podcast agentleman named Jerry Simmons
who's an amazing, brilliantsleep physician, and he said
unequivocally children shouldnot snore.

(11:04):
He said unequivocally childrenshould not snore.
And absent, obviously, if theyhave a cold and their noses are
plugged up, right, I mean thoseisolated instances, but on the
daily or on the nightly, so tospeak, children should not snore
.

Speaker 1 (11:16):
Say that all the time to parents.
I say your kids shouldn't besnoring, yeah.

Speaker 2 (11:21):
And if they are, there's a problem and that needs
to be addressed.
And we can talk more about thislater, about how to address
that and what to do and howparents need to sometimes
advocate for themselves.
But yes, there are significantbehavioral and neurocognitive
deficits that can result frompatients who aren't breathing
properly or who are mouthbreathing and or snoring.

(11:42):
So before I dive into that, Iwant to just state for the
audience the problem.
A lot of times and this isorthodontists, unfortunately
have done a really poor job ofeducating ourselves or our
residents and the public on this.
But we talk about this a lot oftimes as OSA or obstructive
sleep apnea, and there'ssomething called a sleep study,

(12:06):
called them with polysomnographythat measures that If you ask
sleep physicians or pediatricENTs, they will be the first
ones to tell you that pediatricpolysomnography.
When you look at a, when youtake a child for a sleep study,
that child could have a zero onthe apnea hypopnea index, which
was, incidentally, developedmany decades ago by Dr Gimeno

(12:27):
and is not based off of any data, any randomized clinical trials
, any studies.
They literally took the adultdata which was made in the 70s
looking at asymptomatic 40 to 60year olds.
They took that subset of dataand they literally took a third
of it and made that for the kids.
So the scale in and of itselfis very flawed and Dr Gimeno
recognized that later in hislife.
I did not know him but I havegotten to be very friendly with

(12:50):
people who did and they've beenon my show and they've said on
my podcast like that was one ofDr Gimeno's biggest regrets was
making that scale, especiallyfor children, because now that
is what everything is judged bywhat insurance companies judge
reimbursement by.
It's become a big problem andthe orthodontists unfortunately
look at it and say, well, ifthey don't have obstructive
sleep apnea, then they're fine.

(13:10):
That is not the case.
Obstructive sleep apnea.
What's important for theaudience to do is think about
sleep disordered breathing orsleep-related breathing
disorders as this spectrum ofdisease.
Okay, so it's a spectrum ofdisease that goes from snoring
to something called upper airwayresistance syndrome, to

(13:32):
something called obstructivehypoventilation, to end-stage
disease essentially, which isobstructive sleep apnea.
So a child can have all thesebreathing problems and not have
obstructive sleep apnea.
They can have, as you said withMatthias, apneas, meaning they
can have periods where they arenot breathing right.

(13:52):
No breath apnea.
They can have hypopneas, whichare insufficient breathing or
less breathing, going on,breathing going on.
But you are not necessarilyhaving them for the duration
that you need to have or thefrequency to qualify as having

(14:13):
obstructive sleep apnea.
So you have to.
To qualify as having OSA, achild would have to have an
incidence of apnea or hypopneaor adult for that matter of 10
or greater seconds.
Well, children have fasterrespiratory rates.
They have more activesympathetic nervous systems.
They are less likely to sufferfrom apneas or hypopneas of that

(14:34):
duration.
They tend to become hyperaroused prior to that.
So in 2007, american americanacademy of sleep Medicine added
to it well, it can be an apneaor a hypopnea of two successive
breaths duration.
It doesn't have to be 10 ormore seconds.
But here's the catch Not everysleep lab uses that criteria.
It's just a recommendation, so alot of sleep labs don't use

(14:57):
that.
Some sleep labs use that up tothe age of six.
Some use it up to the age of 18.
It's very, very randomized onhow these sleep labs operate
these studies.
My point of telling you that isyou could have a child like
Mateus and you take him for asleep study and it comes back
with a zero on the apneahypopnea index and you take that
to the dentist, orthodontist,physician, ent and they look at

(15:19):
it and say he's fine, he doesn'thave a problem.
That is not true.
If you talk to the sleepphysicians they will be the
first to tell you just becausethey don't score on an apnea
hypopnea index doesn't mean yourchild is healthy from an airway
perspective.
So, getting to theneurocognitive and behavioral

(15:42):
deficits, as well as thecraniofacial growth that I was
talking about a moment ago, youdon't have to be diagnosed with
obstructive sleep apnea for thatto be the case.
You can just have some level ofsleep disordered, breathing on
that spectrum which starts withsnoring, and still have
behavioral and neurocognitivedeficits much like you just

(16:04):
spoke of.
There are tons of themHyperactivity and ADHD is a very
common one.

Speaker 1 (16:08):
Yeah, do you find like a lot of kids are being
misdiagnosed when it's actuallya sleep disorder?

Speaker 2 (16:14):
Yeah, well, yes, so ADHD, the diagnosis is a
symptom-based diagnosis as well,and that's the tough part is
sleep-disordered breathing is asymptom-based diagnosis.
It's based off of patienthistory and clinical symptoms.
It's not like a scale.
That's why we like the apneahypopnea index for diagnosing
obstructive sleep apnea, becauseit's a number, it's much easier
to quantify and certainly aswell for reimbursement purposes

(16:37):
for insurance companies.
It's a number, and so, with therandomness of the subjective,
the subjectivity of thediagnosis I should say random
the subjectivity of thediagnosis for sleep disordered
breathing also is the case forADHD, meaning it is, I believe
it's two.
You need two professionalsinvolved in the child's life to

(16:59):
fill out a form and documentthat this child is presenting
with these certain symptoms andthen that will give them a
diagnosis of ADHD.
They could behave in a mannerthat would qualify them as
having ADHD just based on beingsleep deprived and not getting
deep, restful sleep because ofthe way they are breathing.

(17:21):
There are some estimates thatup to 50% or greater of children
that have been diagnosed withADHD have a sleep-related
breathing disorder Asthma right,asthma.
There's some estimates that upto 30% of children diagnosed
with asthma havesleep-disordered breathing.
Well, why?

(17:42):
Well, because they're breathingall that unfiltered air through
their lungs.
They're not doing the things wetalked about before that the
nose is meant to do purify andmoisturize and humidify the air
and it gets into the lungs andit irritates the lungs.
So they havebronchoconstriction as a result
and asthma.
So it's not that sleepdisordered breathing causes

(18:03):
those things necessarilydirectly, but indirectly.
The fact that you're notbreathing the way we are
designed to breathe is eitherexacerbating or causing those
issues to present.
And you mentioned bedwettingright, called nocturnal enuresis
.
That is extremely common, to gowell beyond the normal age.
In patients who have sleepdisordered breathing.

(18:23):
There are all sorts of othermood disturbances depression,
failure to thrive.
If your child is tossing andturning like crazy at night,
that is not normal.
They shouldn't wake up upsidedown in the bed with the covers
kicked off.
If they're tough, if they aregrouchy in the morning, tough to
wake up, dragging to get toschool in the morning, that is a
sign that something is going onwith the way they sleep.

(18:45):
They have morning headaches.
Sometimes it shows up asdaytime sleepiness.
Right, they could behyperactive for a while and then
they crash.
It can be their relationshipswith their peers and the
students that they'reinteracting with on a daily
basis in school.
They could have trouble mixingin with other kids because of

(19:07):
this and so this, all thesethings that were then
unfortunately in our medicalsystem.
Throwing medications at and justtrying to medicate a lot of
these kids with essentiallyspeed is what we're really
giving them when they have ADHD.
You're getting them on theseheavy duty medications without
looking at at and I'm not sayingthat it's always airway and

(19:28):
sleep right, it can certainlyhave, you can certainly have
asthma.
You can certainly have ADHD andnot at all be related to sleep.
The problem is is it sometimesis related and when we're
medicating them the same way, nomatter what, and not looking at
the etiology or the cause andjust looking at the symptoms.
We have to get away from justtreating those symptoms and look

(19:48):
at why they are that way andmake sure that we're not just
sending for a sleep study,coming back at zero and saying,
oh, the child is fine, and Iface that all the time.
Parents I'll send to ENTs andif it happens to be an ENT that
I don't work with as often andthey see that ENT and they take
a sleep study.
There's times I've had kids thatare just suffocating themselves
and they come back with anormal sleep study.

(20:09):
I had one parent, melissa, thattold me that I had prepped her
that the sleep study may comeback normal, even though she'd
showed me the video of her childsuffocating at night.
And he's got the dark circlesunder his eyes and he's on
multiple meds from theneurologist for his ADHD.
And I was starting to diagnosethis and figure out what was
going on with him and refer himto other colleagues.

(20:29):
And mom said when she went forthe sleep study they woke him up
at 4am and ended the study.
Yet he came back with a zero.
And I'm like well, we know thatin children the time that they
show the most incidents oflonger duration apnea and
hypopnea is when they get in thedeep REM cycles of sleep later
in sleep.

(20:50):
So who knows what time heactually fell asleep by the time
he was tossing and turning andthen they wake him up at 4 am.
It's possible he hadn't gotinto the point of sleep yet that
he would have had these apneas.
And the last thing I'll sayabout that on the neurocognitive
side, there are numerousstudies in the medical
literature.
One which was kind of really alandmark study was by Karen

(21:11):
Bonick, published in Pediatricsin 2012.
She looked at almost 10,000kids between the ages of 4 and 7
years old and determined thatearly life sleep disorder
breathing had strong, persistentand statistically significant
detrimental effects on childhoodbehavior.
Think about that On childhoodbehavior.
And David Gozal, anotherphysician.

(21:32):
He published an article in 2016where he found that snoring
alone just snoring again not adiagnosis of OSA just snoring
alone in children.
He looked at 1,010 childrenages five to seven years old.
Found that snoring alone has asignificant impact negative
impact on neurocognitivedevelopment.
So we know that there's thisproblem out there.

(22:01):
Isaiah and colleagues in 2021in nature communications studied
the MRIs.
So they're studying the MRIs ofthe brains of over 10,000
children that were enrolled inthis adolescent brain and
cognitive development study.
Found that children who snoredor even gasped during sleep back
to your son right and smallervolumes of gray matter in their
frontal lobes.

Speaker 1 (22:21):
Wow, that's so fascinating because, yeah, I did
a brain scan on Mateus too, andthey had found Did you.
Yeah, and they had found theinflammation was in the amygdala
.
So I'm kind of trying to get tothe root cause as to why.
But they also wanted to give acouple of medication.
I'm like, no, no, I'm going tokeep diving and seeing.
Where is that inflammation allcoming from?

(22:43):
And so I've been diving in andactually we got it.
He got diagnosed he's had aparasite actually Giardia and
mold and heavy metal, so that'scausing all the inflammation.
But I know with him we're stilldealing, probably with the jaw
structure from him earlier on,even though we had him on a

(23:05):
Healthy Start appliance you knowat three years old and
hopefully that you know thathelped a lot, but I'm wondering
if that's still an issue.
So I'd love I know you talkabout when you're a podcast,
that you even do surgery onthree, four, five years old for
the jaw right To open up thatairway.

Speaker 2 (23:24):
Is that correct, not surgery just jaw growth
appliances, so expansion, yep,appliances to just help develop
it, and people will.
One big misconception is that,and sadly, just like in anything
, there are people who takethings and run with it.
And so, yes, there areproviders out there in the
dental field who are saying,okay, every you know any patient

(23:47):
with an airway problem, expand,expand, expand, which means
widen everything out and they'llbe fine.
And that is not true in thesense that not every patient's
obstruction or airway problem isdue to narrow, deficient width
in their arches.
A lot are, but not all of them.
It takes more diagnostic timeto figure out where it's coming
from, and that's a lot of what Iteach, and I'm giving a lecture

(24:07):
at the end of this week,actually at Florida Dental
Association's convention on theteam approach to this and how we
have to work together and how,really, in my mind, the
orthodontist can be thequarterback of all of this.
Even though we're not doingthat quite yet, I really believe
we need to be.
So when you talk about treatingyounger patients, traditionally
in orthodontics we think aboutthe earliest a patient would

(24:29):
ever be treated is six, sevenyears old, and for most people
that's still earlier than theywould treat most weight right.
So when I would tell parents inmy practice that we were going
to start at five, six, sevenyears old, they're like well, I
didn't get braces till I was 12.
What's going on?
So we have to change themindset on how we think about
this because and I'm going tocome back to more directly

(24:50):
answering that question but theindirect answer is, if we wait
and don't do anything, young, itis a very reactive, symptom
driven approach.
So the concept there is wecan't change the way these
patients grow.
We can't really do much aboutit.
All we can really do isstraighten their teeth once
they're crooked.
So let's just kind of wait andwatch.

(25:12):
Maybe we have to pull someteeth because maybe their jaws
are so narrow that the teethdon't have room, because rarely
is crowding of teeth due to bigteeth.
It's not never, but it's almostnever.
It's almost always due tonarrow jaws.
So one of the reasons thosejaws are narrow is again the way
they're breathing.
But if we're not looking atthat as orthodontists and we see

(25:32):
the patient at seven, eightyears old and they're really
crowded with narrow arches etcetera, we just say, well,
there's not gonna be room fortheir teeth, mom or dad, we're
gonna have to pull some teethand we'll straighten them out
when Johnny's 11 or 12 or 13.
And that's the traditionalapproach to orthodontics.
I actually call it.
If anybody out there has readPeter Attia's book Outlive I
call he talks about medicine 2.0versus 3.0.
I call that orthodontics 2.0,which is very siloed, it's very

(25:56):
reactive, it's very tooth based.
It's not looking at the overallpatient and their health.
We're just there to be thesetwo straighteners that have
learned how to use biomechanicsin the mouth in a way that
others don't know how.
So we're the best at movingteeth around.
I like to do to practice what Icall orthodontics 3.0, which is
and I this is a lot of what Iteach as well is we need to

(26:18):
start thinking about treatingpatients earlier, much earlier.
Patients earlier, much earlier,and being more proactive in
helping guide the growth anddevelopment of the jaws, the
craniofacial complex or thecraniofacial respiratory complex
, and helping them not need asmuch treatment later on.
So when you talk about thesethings we can do young.

(26:42):
The hard part of this isbecause most parents will hear
this and say why the heck aren'tthe orthodontist doing this
right?
I mean, it makes total sense.
Again, not to be overlyskeptical, but insurance doesn't
reimburse it.
The same way, our officepractice systems aren't set up
to do this we.
When you're an orthodontist andyou're seeing 75 to a hundred

(27:02):
patients a day straighteningteeth, it is a major overhaul to
start thinking and you'retreating mostly teenagers and
adults right.
It is a major overhaul to startthinking about treating even
six and seven year olds in mass,let alone three, four, five
year olds.
It's a whole different level ofbehavior, behavior management,
patient management, parentmanagement, team training.

(27:25):
I mean it's another world.
And so and we're not taught todo this in our residencies.
Honestly, melissa and I'vetaught in multiple residencies
throughout the US orthodonticresidencies.
Most of them are three yearslong, some are two and a half.
There's a couple out there thatare two, but for the most part
they're three years.
So you go to four years ofcollege, four years of dental

(27:45):
school, and then you have to bewell towards the top of your
class to get into an orthodonticresidency and then you go to
another about three years.
In that time you may very welltreat no patients
orthodontically under the age of10 years old.
You may.
If you're lucky and you're in areally good program you may get

(28:06):
a few.
If you're in a good orthodonticresidency you may get a few
patients that are younger.
There's a couple spectacularprograms that they're treating a
bunch of patients in that 6-7window.
I don't know any right now.
I'm sure there's maybe one ortwo out there that are treating
patients younger than that,because it's just not what we
historically have done, it's notwhat we're taught to do, it's
not what we know how to do.

(28:26):
So we not only, unfortunately,don't know how to do it, we say,
well, for all those reasons Igave, it would change everything
in your practice.
Right, and you're not trainedto do it.
And you're not trained to do itand you're busy, you're
successful, you're doing whatyou're doing in your practice.
You're making patients stilllook better.
I mean they still look betterafter your treatment, even if

(28:47):
you haven't necessarily had awhole health approach.
So it's really hard to convincemy orthodontic colleagues like
you should think this way,because there's no real
incentive to.
It's not like the other way isdirectly harming the patient.
Now, indirectly, you could makethe case that by ignoring the
narrowness and the airway andall that, you are setting that
patient up to have very severehealth problems down the road.

Speaker 1 (29:09):
Yeah, like core mortalities, right?
I mean that could lead tocountless of things as they grow
older.
Yes, so yeah, it's veryimportant to address those
earlier on.
So you're starting thatmovement, which I love, because
I know, actually, my husbandwent to their dental office.

(29:30):
He was starting as well.
He made sure he told all thehygienists to start talking
about this with parents and askthem questions.
You know I would ask them arethey snoring, are they?
You know, and I do feel thereneeds to be a questions.
You know I would ask them arethey snoring, are they?
You know, and I do feel thereneeds to be a questionnaire.
You know, a questionnaire forfamily, maybe even at school?
You know, you know they do theear and eyes test at schools.

(29:52):
Well, why not?
You know a sleep one as well,you know.

Speaker 2 (29:56):
Yeah, I can't believe you said that because that
Jerry Simmons, with whom I wasspeaking on my podcast that I
referenced before, who's thesleep physician in Texas he is
working with actually he was onan episode together with Steve
Karstensen, who's a dentist outin Seattle.
They're working on somethingcalled C gasp, which is the

(30:18):
children's general airwayscreening protocol.
I believe is what the acronymstands for, and it's to try to
get it to the point where thiscould literally be like the
nurse, just like you just saidit was so insightful for you to
say that would like they testeyes and ears, they would test,
they would run.
It's like a five question testthat they would essentially put
these kids through to try tofigure out at some entry level

(30:40):
of screening and get this intothe hands of the pediatricians
and the nurse practitioners.
And they're trying to have tomake it a validated
questionnaire.
They can't just create it andput it out there.
There's a lot of data.
There are a lot of data thathave to be analyzed to make a
questionnaire validated or tovalidate it.
So they're working on that nowand gathering the data set.
That is very exciting and theother part of it there is a

(31:05):
questionnaire right now andpeople can Google it and find it
.
And if you want, I can.

Speaker 1 (31:09):
Yeah, we could put it in the show notes because I'm
sure a lot of parents arelistening and they're like, okay
, what are those five questionsthat I can kind of ask myself or
the kids, and then and then,and then, how do they find
someone like you, orthodontist,that could help treat them and
guide them along the way?

Speaker 2 (31:27):
That's the hard part.
And one other thing on thequestionnaire there's something
called the Shervin SleepQuestionnaire Shervin's
Pediatric Sleep Questionnaire.
Shervin was out of Michigan.
It was published in the year2000.
It's a validated questionnaire.
It was.
Shervin was out of Michigan.
It was published in the year2000.
It's a validated questionnaire22 questions which ask about
sleep behavioral issues.
They really gives is a greateasy tool for practices to

(31:51):
implement into their intakeprocess.
Sadly, in the orthodontic arenato address what you were just
asking about, finding anorthodontist Many people
listening probably have been tothe orthodontist with their
child or themselves and theorthodontist walks in, does a
little cursory exam, grabs amirror, looks in the mouth,
minute or two in the room right,the biggest thing is yes, are

(32:12):
you ready for treatment?
No, are you not?
Are we going to pull any teethor not pull any teeth?
And you want braces oralignersers?
I mean, it's a pretty quickthing.
They kick it off to theirtreatment coordinator to go over
everything and the orthodontistgoes back to the clinic to keep
working and straightening teeth.
And that's unfortunately how alot of orthodontic practices are
set up.

(32:33):
And that's sad because you'renot asking those other questions
.
We do a basic medical history,but unless something is like
jumping off the page, somecongenital heart defect that
they might need prophylacticantibiotics for, or the history
of childhood leukemia, orsomething that really stands out
, we're just looking downthrough the systems like, yep,

(32:53):
no, no, no, no, no, everything'sgood, healthy kid.
It's not the case.
We don't ask the rightquestions.
So the first way to answer thatis find out, when you call an
orthodontic office, if they doan airway screening.
Now I will tell you the AmericanDental Association, the
American Academy of PediatricDentistry and the American

(33:16):
Association of Orthodontics allhave publicly stated that every
dentist should screen for airwaycompromise in children.
So if you have a dentist ororthodontist who is not
screening for it, you need tosay to them why aren't you
following those recommendations?
They're not laws.
It's just guidelines that ourassociations put out there, much

(33:40):
like I referenced before theone from the American Academy of
Sleep Medicine in 07.
Not everybody follows it, butit is still a guideline that is
based in science that they areputting out there to say this is
something you should be lookingat.
There is no standardization orprotocol for what that looks
like and that's tough.
There is no education a lot oftimes.

(34:02):
So these organizations I'vebeen critical of the American
Association of Orthodontistsbecause they've made that
comment, but they don't provideany education on how to do it
and they don't help ourorthodontic residents implement
that into their trainingprograms.
There's a lot of trainingprograms I know of firsthand
that I've tried to helpimplement these and they're like
we don't want to do it, wedon't want to do it.

(34:24):
There's no need for that.
So that would be.
The first question is to ask ifthey ask airway screening
questions, if they screen forairway obstruction or compromise
in children, you probably aregoing to get a lot of no's or um
wells, you know, maybe we couldum.
So if they say yes, ask themwhat their protocol is.

(34:45):
Ask what their protocol is, askwhat they do.
Do they use 3d imaging?
Can I talk for a minute aboutthe 3d imaging side?
yeah, absolutely, yeah,absolutely so that's a big thing
.
There's all these articles.
One just came out againrecently, I don't think this
one's in New York Times and ittalks about that medical.
It conflates medical CT scanswith dental CBCT scans.

(35:09):
So it's the CB stands for conebeam, so it's a CT type scan,
but it's done with a cone beam,so it is a fraction of the
radiation.
So, for example, like a CT scanof your head for valuation of
your sinuses, right, medical CTscan, that's going to be like

(35:31):
2000,.
What we call micro sievertsit's a way we measure effective
dose of radiation.
Just to give some context, likedaily background radiation that
you just get from just walkingthe face of the earth is like.
The estimates are anywhere fromlike six to eight ish.
You see five, ten, but aboutmicrosieverts.
So you know you're talkingmagnitudes.
More than what you get in a day.

(35:51):
A flight across the us, I think, is like 75 microsieverts of
radiation.

Speaker 1 (35:57):
Yeah, I always say it's like five chest x-rays, One
flight like a three-hour flightis the same amount of radiation
than one chest x-ray.

Speaker 2 (36:09):
Yeah, so you get exposed to this background
radiation just living.
But obviously if you get aradiograph taken with ionizing
radiation, which a CT scan is,you have an influx of it at that
point, a cbct image, so a conebeam image which is a three full
3d of the skull.
It lets you see everything inthe skull, not in the detail

(36:33):
necessarily that you can seewith an actual ct.
You can't manipulate it quiteas easily in terms of slicing it
and everything.
So that's why surgeons and theywant the precise an ENT surgeon
say, would want a precise CTscan.
But for what we do from thedental standpoint, especially
the orthodontic standpoint, a CTscan at the lowest level of
radiation that machine can go,which there's two types of

(36:55):
machines.
There's a low dose machine,which is what I've always used,
and then there's a regular dosemachine.
So let's just take the regulardose machine.
If you do the regular dosemachine at the lowest level it's
about 50-ish micro sievertsright, about 50-ish.
So it's at 140th of a head CT,a fraction right, less than a

(37:15):
flight across the country.
If you get a low dose machineyou can take that same image for
like 13 to 17 microsieverts ofradiation, so like twice a two
days worth.
Now I'm not being dismissive ofradiation and like what's the
big deal?
Two days worth.
But think of the diagnosticinformation we get.

Speaker 1 (37:36):
We get out of that right, it's so worth it.

Speaker 2 (37:39):
Whereas the traditional 2D x-rays just to
put it in context, the 2D likethe Panarex you know, the one
that looks like kind of thejack-o'-lantern and the side
Ceph, head view, thecephalometric view, called the
lateral Ceph those combined withdigital technology typically
are about 25 to 35 microsieverts.
So, yes, you're splitting hairs, but the low-dose 3D image that

(38:04):
my machine could take is lessradiation than a 2D, panarex and
CEF.
Yet you'll hear a lot oforthodontists say well, we don't
do 3D because the radiation istoo high.
It's not true.
It's simply not true.
When they first came out 20years ago, yes, these CBCT

(38:26):
images were in a couple hundred,you know, a couple hundred
microsieverts.
They were magnitudes more thanroutine 2D imaging.
But that's not the case anymore.
So with that 3D image, if thatis a good sign, if the
orthodontist you're going touses a CBCT image, that is a
good sign.
That means they're looking atmore than just 2D of the teeth.
Right, they're looking atthings great, in a greater view.

(38:48):
Now, not everybody who has onedoesn't mean that they
understand airway.
There's just a good chance ifyou call and they do an airway
screening and they're looking atthese things and they have a 3D
image, a CBCT machine.
That orthodontist is probablylooking more from the airway
side of things.
And then the last questionwould be is what do they do with

(39:09):
patients when they detect anairway problem?
And I would ask those questionswhen you call an orthodontic
office.
This movement, melissa, has tocome from the parents, because I
have.

Speaker 1 (39:19):
Yes, well, that's why I'm having this show, because I
have so many, a circle ofparents and I'm you know I'll be
at a sporting event, you know,watch my son play soccer and I'm
educating you know other momsand they're like, oh, I want to
know more.
Send me some links.
Who should I go see?
I'm like, okay, I'm going tohave a couple of podcasts, I'm
going to have specialists, sothen just listen to that.

(39:39):
So I, you know, I do have toget to all the parents.
You know they want to helptheir son.
They see, you talk about, like,the allergies.
I see so many kids dealing withallergies and the dark circles
on their eyes and I see it.
I'm like, oh my gosh, this isthe sleep, the airway, and so

(40:06):
now I just love that I'll have apodcast.

Speaker 2 (40:06):
I'll be like okay, you need to listen to this, you
know, and, yes, you do have tostart with the parents educating
this.
That's where we start themovement.
Absolutely yeah, without adoubt.
I am a ton of parents thatlisten to my podcast as well.
I've been shocked at how manydo, and it gets pretty technical
.
But there's podcasts likeHuberman out there today and you
know people that are listeningto medical-based podcasts, and
so I have a lot of laypersonswho listen and follow my content
and they'll message me or emailme on a show or comment on a

(40:27):
show and say this is my child,how do I find someone to help
them and what can we do aboutthis?
Because it is frustrating forparents, because a lot of
parents will hear this type ofthing.
They will go to an orthodontistand I say this not as a
criticism, just as the reality,because I don't want people to
hear this and think that they'rejust going to be able to call
an orthodontist and get in withone right away who thinks this

(40:49):
way.
You may not find one in yourentire area, truthfully, and you
know.
That's why the parents need topush the orthodontists to do
better To make that shift.

Speaker 1 (41:00):
Yeah, we create that movement From the top down,
exactly.

Speaker 2 (41:03):
Our organizations.
Ada is great.
I should say the ADA is amazingon this.
They're really with guys likeSteve Carstensen that I
referenced before.
They're really leading thecharge.
The AAO American Association ofOrthodontists, american Academy
of Pediatric Dentistry.
They are not taking charge onthis the way that they should.
They are hiding behindobstructive sleep apnea.
They're like well, unless achild has OSA, you know, it's

(41:24):
nothing really and that's aphysician's job.
We're just there to kind ofscreen.
It's really a cop out and Icould you know beyond the scope
of today to talk about why Ithink that is, but it is the
reality that they are not doingtheir part.
I've had conversations with thepresident of the AAO in the past
multiple of the presidents andpast presidents about this, and
I have challenged them to dobetter and nothing really

(41:46):
changes.
They don't.
There's not a lot of talk aboutthis at their meetings.
If it is, they make sure theyprovide counter arguments to try
to say why this isn't a thing.
So I love my profession, I lovemy orthodontic colleagues and I
mean that it's why I'm sopassionate about trying to get
them to change.
I just am frustrated by howmany of them refuse to, and I

(42:08):
provide the literature and thedata, and I can literally just
have conversations on all theliterature from the medical
literature and dental literature, supporting everything I say,
and they just say it's quackery,it's you know, it's, it's, it's
no, no logic to it, there'snothing to it.
So it's a challenge.

Speaker 1 (42:25):
So if we get more, parents asking for the, then
that's how the they won't have achoice.
Oh, it's a supply and demandright, so they'll have to change
, Do you?

Speaker 2 (42:33):
know.
That's what orthodontists usedto say about Invisalign and
clear plastic aligners.
I say Invisalign because theywere the first one.
We didn't embrace that concept.
We shunned that concept thatyou could ever move teeth with
plastic.
And once the parents and thegeneral dentist started doing it
and the patients started thepatients and the general dentist
and the patient starteddemanding it.
It was amazing how manyorthodontists because I was just

(42:55):
starting my career in the early2000s when it came out and how
many that and I was taught.
Like you know, there's no waythis can work.
This is crazy.
Well, once there was a marketdemand for it from the public,
orthodontists all of a suddenstarted really figuring out that
you could maybe you couldstraighten teeth with plastic
and we became much more open toit.
So I think the same thing willbe the case with this is once

(43:16):
more, parents tell theirorthodontists you need to to be
looking at my child younger andyou need to be screening for
airway obstruction and you needto know what to do in the event
that you find one.
And some of that, melissa,isn't anything I do.
It's working with my colleagues, my medical colleagues, my
myofunctional therapy colleaguesto get these patients the help

(43:39):
that they need and deserve.
And that's another big challengeis we are trained
orthodontically like we don't doanything till the teeth are
really crooked and then our jobis to straighten teeth.
I like to think of us as theconductor of this operation,
where we have to tell theparents or teach our team, teach
the parents, teach the patient,communicate with the ENT,

(44:02):
communicate with the allergist,communicate with the
pediatrician, communicate withthe speech and myofunctional
therapist.
It's challenging, it's it's.
And I again, I grant a lot ofgrace to my ortho colleagues,
because if you're busystraightening teeth all day and
you're doing really well at it,why are you going to change the
way you do everything?
It has to become that purpose.

Speaker 1 (44:22):
You know purpose driven because you're seeing a
significant change in kidsbehavior and health and so it
has to become more.
Yeah, that purpose driven, yeah, to help others and what have
been yours.

Speaker 2 (44:34):
Have you noticed people being more open to it?

Speaker 1 (44:37):
yes, yes, because I talk about it and I talk about
it just, you know, in related toeven just my son and patients
that we've had at our dentaloffice.
They are, they are seeking, andactually I've been, you know, I
still temp and I now I onlywant to temp where they have
their.
They do airway, the biologicaldentistry.
I'm really really leaningtowards that, because you're

(45:01):
talking about the scans and eventaking drops of iodine before
you take the x-rays, like usingozone, like just really getting
to the root cause, not justsaying, okay, I see some
grinding, here's a night guard,let's what's causing the
grinding?
Like okay, let's, let's do somestress management, like let's
start incorporating some stressmanagement tools, breath work,

(45:22):
meditations, let's get to thatroot cause.
You know, and for me too, I see,for mouth breathing, sometimes
I'll see them oh, you were justin, like just three months ago,
but you have all that buildupbecause you know your mouth
breathing is that dry airconstantly on their mouth.
So it's causing all thatcalculus to build up so quickly

(45:44):
and and so I'm, I'm just seeingit and uh, yes, people are
driving, you know, longer.
They're like, okay, becauseI'll say, well, only know two.
Actually I recommend a lot ofpeople to Dr Trevor Nichols
because you introduced me to him, and actually I'm having him
next ina couple of weeks here.
And um, I recommend you knowpeople to go to him, and then I

(46:08):
I tell people to go to theoffices that I've been temping
at, because it is really reallyhard to find and I'm really
particular and picky now wherewhere I work too, because I want
patients to be well treated.
But I do feel patients that areopen to that are open to paying
for it Because, like you said,insurance won't cover a lot of

(46:28):
these things and but they'reseeing the value.
You know the long term value,because this will save them from
the core mortalities andchronic health issues.
As and and I'm also, you know,been diving into a lot of
correlating, you know your guthealth to the oral biome as well
.
You know getting what, whatbacteria is in there.

(46:49):
You know or and uh, so they are.
They are very open, everyonethat I've talked to.
They just don't know where tostart, they don't know which
question to ask and they don'thear much about it.
So that's why I really wantedto have this and to hear you
know your expertise on it, askthe questions and then guide
them along.
Now, for adults that aredealing with sleep apnea, what

(47:13):
do you have for you know?
What do you recommend for them.
You know, treatment wise.
Now, that's new, that's outthere, you know.

Speaker 2 (47:23):
Yeah, it gets to be pretty involved with adults.
I actually just had Dr DaveMcCarty on my show.
He's amazing.
He's a sleep physician out andinternist in Denver and he's
starting a new much, veryprogressive, much needed
platform where it's kind ofagain that Peter Atiyah 3.0

(47:44):
concept where he's putting a lotof specialists under one roof
and really trying to get at thecause of why these patients are
suffering with airway problemsand how to deal with it.
So it is he actually I can giveyou a link to that episode for
the show notes too, if you want,because he just taught he's so
smart and he really breaks downa lot of what this whole
challenge of sleep apnea is inadults.

(48:04):
I would say from the dentalorthodontic perspective.
Again, our job is to recognizeit, detect it.
I'm ashamed of the number oftimes over my career before I
understood this, how manypatients I can look back at and
I can remember them andsometimes I show them in my
lectures that I didn't detectthis in and they were.

(48:26):
You know, say, a female in hermid-40s comes in and she's on
SSRIs and having depressionissues and maybe going through a
divorce and having issues withchildren or children and all
sorts of other issues and theysent.
She sent to me because herteeth are broken down, as you
said, right, a bruxer.
She's clenching, she's grindingand her teeth are so broken

(48:47):
down.
The dentist sends her to me totry to rebuild the bite.
So, because the dentist can'tput even bonding or veneers or
anything on the teeth becausethat she's just going to break
it.
Well, bruxing and clenching,grinding, but especially bruxing
, is directly related to anairway problem.
So, instead of just makingthese patients a night guard, as
you accurately said, which istotally treating the symptom and

(49:09):
not saying that's not valid, Imean you got to protect the
teeth.
So, until you get this undercontrol, like you got to protect
those teeth, so there'scertainly a place for a night
guard.
It shouldn't stop there.
We need to figure out why isthis patient grinding?
I had someone on my show awhile back.
She's a general dentist inTexas and she said that she has
every patient who is a severeBrux or she has sent for a sleep

(49:30):
study.
Again, sleep studies in adultsare different.
There is more accuracy In anadult patient.
There's still issues, but it'sbetter.
Has come back with some levelof sleep apnea.

Speaker 1 (49:40):
Okay, have you ever heard?
I've heard, I'm starting tohear this a little bit, but I
don't have all the facts buthave you ever heard?
Bruxism due to parasites?

Speaker 2 (49:50):
Due to parasites.
Not heard of it, but I wouldn'tdeny it.

Speaker 1 (49:54):
I've had it come up a few times saying uh, you know,
I've worked at different dentaloffices and they're like oh, did
you know that that could be acorrelation?
But I I just starting to diveinto it and I'd love to see if
there is some truth to it well,yeah, the concept is that you're
in again sympathetic overdrive.

Speaker 2 (50:12):
You know, when you're sleeping you're supposed to be
in a parasympathetic state.
Your nervous system is supposedto be calmed down and relaxed.
Well, the bruxing is a very.
You're using your skeletalmuscle pretty aggressively to
generate force and so that isthat sympathetic overdrive and
that hyperactivity that you'redoing when you're sleeping,

(50:32):
which, if you're in a deep,restful sleep you're not doing.
So if you have a parasite, say,that puts you into this
sympathetic overdrive.
That could, I mean.
I'm not saying that as ascientific reason, but just
logistically thinking.
That could certainly make sense.
And we see the bruxing in thesepatients that come in all the
time in the orthodontic officeand we just think, well, geez, I
got to rebuild the bite andit's going to be a tough one
because they've got strong jawsand they're grinding their teeth

(50:54):
and clenching, and so we treatthe teeth.
And I think back to some ofthese cases and I'm like, oh my
gosh, I look back at this isbefore.
I had 3D, look back even attheir 2D images and I can just
see in the lateral view.
I'm like, oh my gosh, theiroropharyngeal airway was so
small and their tongue space wasso restricted and a lot of
these patients did have teethpulled as kids.
And it's not that pulling teethcauses the airway problem.

(51:17):
It's that the air, the teethwere crowded because a lot of
times the way the patient wasbreathing was causing them to
have narrow jaws and thosenarrow jaws don't have room to
accommodate the teeth.
So orthodontically you removethe teeth to be able to give
them straight teeth.
So people say, oh, extractingteeth causes the airway problem.
Really the way to look at it isthe airway problem is there.

(51:39):
Extracting the teeth is treatingthe symptom of the crooked
teeth.
It's not getting at the cause.
So a lot of orthodontists, Ithink, don't want to admit that
we weren't doing it right withextracting so many teeth all
these years because they'reworried about liability.
A lot of times make the patient.
Sometimes you can make themnarrower, but if they're really
severely crowded you're not evenmaking them more narrow.

(52:01):
You're just basically takingfour teeth out to make enough
room for the teeth that you havethere and straightening them
out.
So I'm not doing this to indictthe orthodontist and be like,
oh, you should never pull theseteeth on these patients, you
didn't know better and youtreated the symptom right.
You waited until the teeth camein crooked.
You pulled teeth along the wayand then you straighten them out

(52:21):
.
A lot of these patients and I'msure you've seen this, melissa,
in your practices that you'vebeen involved in, a lot of these
patients who are bruxing, whohave airway problems as adults
did, have teeth pulled when theywere, when they were kids.
Again, not that the teethpulling caused it.
It's that these patients wereairway patients way back then
and no one recognized it.
No one detected it becausetheir teeth, they just treated

(52:44):
their teeth and then again takeit beyond the dental arena.
Then they go to the physicianand they're having psychological
issues, right, depressionissues, anxiety disorders.
Throw medication at them yeah,not getting at the cause of it.
Then the general dentist Nowthey're in their 20s or 30s.
They notice they're clenchingand grinding their teeth all the
time.
Make them a night guard, rightand the jaw joints start to hurt

(53:05):
.
Make them a night, a bruxingappliance or a night guard, and
then they start to havehypertension and maybe elevated
blood glucose or type 2 diabetes.

Speaker 1 (53:20):
Put them on the physician put them on a
medication.

Speaker 2 (53:21):
That's that 2.0 concept that peter atia talks
about treating the symptomsinstead of saying what is going
on with this patient.
So that is, to me, again, theprimary role of the dental
professional in adults.
Then, once you have that, thatis where you need to onboard a
sleep physician much morequickly in an adult patient and
get them evaluated, becausethere's something.
There's obstructive sleep apnea, which is typically what it is

(53:43):
in kids.
It's very rarely central sleepapnea in children.
It can be, but it's very rare.
The converse is true in adults,or I shouldn't say that,
actually the the adults it canbe either, and so you can have
central sleep apnea and orobstructive sleep apnea, and if
it's central and it's moreneurologic, there's relieving.
The obstruction isn'tnecessarily going to help that

(54:05):
patient, so it can get very,very complicated, and that's
what, uh, dave mccarty istalking about in that episode as
well, as does Jerry Simmons andSteve Carson said in the other
one I've been referencing.
So then, what the dentist ororthodontist can do is there are
things that can help.
So there's something called themandibular advancement device
and that is something thatpatient wears to bed and it
helps posture the lower jawforward to bring the tongue away

(54:28):
from the airway to help it stopit from falling back and
obstructing the airway at night,and that can help CPAP
obviously, uh, for patients, butsome patients are CPAP
intolerant or they don't want towear it.
Um, but that's trying to forcepositive pressure down the nose
into the lungs to get by, topush that obstruction aside.

(54:49):
Um, and then there's somethingcalled MMA surgery or
maxillomandibular advancement,which is jaw surgery, where you
take the upper and lower jaw andyou surgically bring them
forward to again try to open upthat respiratory complex and get
the patient more ability tobreathe air in through their

(55:09):
nose.
There's also something done now,often called Marpie, which is
essentially you use these littleanchors, these mini anchors,
like little screws that go up,and you use what people think of
as a traditional expander, likethe thing you turn and crank,
and it's screwed into the palateinstead of anchored on the
teeth.
And we're finding now that youcan use these and actually split

(55:30):
your upper jawbone.
It sounds horrific, but theupper jawbone.
It sounds horrific, but theupper jawbone is like a zipper
in the middle of it and thatzipper, when you're a kid, is
like totally separate.
There's space in between andthat's where they grow from.
It's like the soft spots kindof in a child's head.
Right the bones are separate sothat they can grow.
As you stop growing those bonescome together and they don't

(55:52):
technically really fuse, theyinterdigitate.
So it's like a zipper that'slocked and you can, if you apply
the force properly.
We now know you can split that,and so that can sometimes be
done with an addition of alittle cut in the middle of the
palate, in the middle of theroof of the mouth, to like cut
the suture up a little bit, freeit up, and then you put that

(56:12):
anchor in and turn it and try toget that expansion again, not
just to expand the mouth but toexpand the nasal cavity as well
and help facilitate nasalbreathing.
So there's a lot going on nowthat the dentist and
orthodontist can be involved infrom the sleep and airway
perspective.
But again, in both cases, butespecially, especially with
adults, you're not treating yourdental provider, isn't treating

(56:35):
the airway.
In that sense they are tryingto help you manage the problem
in the adult or providetreatment to what I like to call
normalize the anatomy, meaningthe more normal we can get your
anatomy, the better the chanceyou are going to be a nasal
breather Right, and so in achild, people are like well, the

(56:57):
orthodontist job isn't to treatairway, that's the physician's
job.
Great, I agree.
My job is to normalize thecraniofacial growth and
development, though, and we knowthat patients who have more
normal craniofacial growth anddevelopment breathe through
their noses more easily.
So, especially if you've gottenthem to the allergist and ENT,
et cetera, to free up anyobstructions.
So that's my objective Inadults.
That's the concept of whatyou're doing with that MARPI,

(57:20):
what you're doing with themaxillum endibular advancement,
what you're doing just when theywear that appliance at night to
bring the jaw forward.
You're trying to normalize theanatomy so that they can become
a nasal breather.

Speaker 1 (57:33):
Nasal breather.
I love that you explained thatand this will be so good for
people listening.
I have this question all thetime.
You know a lot of people noware, you know, talk about the
mouth taping and utilizing thatand they're always oh, which one
should I use?
You know, but I don't like tohave the taping.
Some of them say, oh, I've gotmy lotion on, is there anything

(57:59):
else?
So what?
What do you recommend?
Like?
What's your thoughts about themouth taping?
Or, if somebody didn't like themouth taping, what's another
option if they want to getstarted with practicing nose
breathing?

Speaker 2 (58:05):
I feel that to do that, people should really get a
workup first from their dentalprofessional physician, both to
know why they are not breathingproperly.
Because if you have and I'vehad people, multiple people on
my show, talk about this as wellIf you have obstruction of your
nasal passageways from likechronic, you know, allergic

(58:27):
rhinitis or turbulent, turbulentinflammation, turbulent
hypertrophy or obstructiveadenoids, and you tape your
mouth your mouth's how yousurvive.
So you're going to puttremendous strain on your system
when you do that, because youphysically can't get air in
through your nose, right?

(58:48):
So if you block the mouth,you're creating another problem.
So if you don't know what yourobstruction is due to or what's
being caused by, you have to becareful with that.
Now, can it work in somepatients?
I'll admit I use mouth tape.
I started a few months back,maybe six months ago and because
I've had two sinus surgeries.
I have terrible allergies and Ihad my first one in 06.

(59:11):
I had another one in 2009.
And I have to irrigate dailyand I have all these other
issues with my sinuses.
So for me, I have been clearedout.
My nasal passageways are clear,but I have narrow nasal
passageways and something calledmy nasal valve, which is on the
side when you breathe in likemine, go in.

(59:31):
They shouldn't go in.
They shouldn't go in andcollapse.
So I'll use a breathe rightstrip to help keep the nasal, my
nasal valves out and mouth tapeto then force myself because I
have the patency in my nose tobreathe through my nose.
I don't have obstructive sleepapnea.
My tongue isn't falling backand blocking my airway.
That works great for me.
But I know my anatomy.
I've been, I'm still, under thecare of an ENT and an allergist

(59:54):
, and I know from reading my ownscans and having surgeries what
my situation is.
So for me it was just kind ofopening my mouth when I slept,
because it was easier to get airthrough my mouth, because my
nose is narrower and I've hadmultiple and I have chronic
allergies, but I'm you know thatwasn.

(01:00:14):
But by doing this it helps mebe an obligate nasal breather.
That's different, though.
If you did this to me before Ihad my surgeries 20 years ago,
how would I breathe?
So people need to be carefuljust throwing mouth tape on or a
breathe right strip on, becauseyou could be covering up the
problem or making it worse ifyou don't really know what
you're treating yeah, does thatmake sense?

(01:00:35):
That's a good point.

Speaker 1 (01:00:35):
No, I like that.
That's kind of like thepatient's asking oh, teeth
whitening, let's do that.
I'm like well, let's take careof the decay or periodontal
disease.
That's more important, right,right, let's figure out what's
going on.
Yeah, what's going on first.
Yeah, yeah.

Speaker 2 (01:00:51):
It can be great.
It's just it might not be for,it's not for everybody, and you
need to know if it's for you,which is really where your
physician, your dentist anddentist coordinating with the
physician in the case of adultsshould be should be involved in
that decision-making process.
It means that a lot of thosethings are over the counter
remedies that we all hear aboutand people try, but if you don't

(01:01:12):
know why you're snoring, justtaping your mouth shut isn't
necessarily going to solve theproblem.

Speaker 1 (01:01:19):
Yeah, keep asking questions, getting to the root
cause and, yeah, then bypassingit.
Yeah, I'm definitely very bigat being my own advocate for my
health and that's why I see somany specialists, even when it
comes to my children, andsometimes it's overwhelming, you
know.

(01:01:39):
It's overwhelming for forparents and for people.
So this is great to have thesepodcasts to talk about it and
share the information for theroot cause.
So I really appreciate youtaking the time to be on here
today and, um, I know there'sgoing to be a lot of parents
listening and they're going tobe well guided now and ask the
right questions and what to lookfor.
So it's, it's always a relief,you know, when you're like, oh,
this is why and there's, there's, you know I can help my child,

(01:02:02):
you know, cause they see themstruggling, you know, throughout
the day, behaviorally or so.

Speaker 2 (01:02:12):
Parents know best.
That's where I've had peoplesay to me oh well, you know you
need a sleep study on this childand I'll talk to them about the
inaccuracies of sleep studieson children and say I will take
a parent's recount of theirchild's issues, description of
the child's issues in a videothat that parent takes of that
child any day over.
What happens in a one nightrandom sleep lab study that I
don't even know the accuracy of,who did it, the reliability of

(01:02:34):
the type of scoring they wereusing.
You know not that they'reinvalid, and there definitely
are things you can, insights youcan, there's, there are data
there you can take from thosestudies.
But as the end all be all, I'lltake a mom and a mom's
intuition that something iswrong with you, right, like I
mean you were talking about itbefore.
You knew that there wassomething not right.

(01:02:59):
You knew he wasn't breathingproperly.
So if you're a mom out there ora dad but I feel like moms have
a little more of that instinctand you see that happening fight
for your child.
Do not let your child continueto suffer being a snore or a
mouth breather and let providerstell you that's okay, and that
goes for medical providers,dental providers.
It's not okay and ourpediatricians need to do a
better job on this, and I'mgoing to call out the
pediatricians on this.
So often it's like, unless theyget strep five times a year,

(01:03:22):
unless they, pediatricians needto be more proactive as well.
They need to start to askairway questions and breathing
questions and sleep questions oftheir patients.
So that's another mission.

Speaker 1 (01:03:33):
Yes, because then the kids get these sinus infections
or they'll get infected, sothey're given all the
antibiotics and that's goes downthe whole rabbit hole I'm going
into with the gut health, youknow, and that creates a whole
other mental health issues forkids to get issues.
So so, yeah, no, I appreciateit so much.
So how can people find you?
Because you've got a fantasticpodcast.

(01:03:55):
I listen to it all the time andI learn so much, and then I can
carry that on when I'm at workand educate people and tell them
to listen to you and give themgreat advice.
So, yeah, tell our audience howto find you.

Speaker 2 (01:04:09):
Yeah, so people can email me if they would like.
It's drmikeattheorthocoachcom.
Um on um YouTube.
That's at Duluc orthodonticcoaching.
That's where we post a lot.
I don't do a ton, I just kindof post the podcasts on there.
Uh, where the podcast typicallygets listened to by most is on
Apple or Spotify and if you justsearch for the doc podcast, so
it's the, the T-H-E and thenseparate word D-O-C, doc stands

(01:04:32):
for Duluth Orthodontic Coaching,and then podcast.
That will come up on there.
And yeah, it's been reallyexciting.
I mean, the show has grown somuch in the past six to nine
months.
I started it two years ago andit just kind of just an idea
that really my wife had.
She was like she just podcastabout this.
How do you get cause?

(01:04:56):
I didn't know how to get thecontent out, much like yourself.
So how do I get the message out?
And and it just led to that.
And now the show has gottenreally big.
I just uh, this week I'm up inthe pushing episode one 10.

Speaker 1 (01:05:01):
I'm up towards that range.
Yeah, you're really good.
You're really good at it, and Iremember how I got introduced
to you.
I don't even remember how youhad found me, but you had me as
a guest on your podcast inSeptember or October.
Yeah, yeah, it was great havingyou on.

Speaker 2 (01:05:15):
I really that's been a really, really listened to
episode by a lot of people.
I've got a lot of amazingfeedback for your, your story on
that and Instagram.
At the ortho coach, I'm workingon my Instagram game.
I need some help.
My daughters, my teenagedaughters I'm always like, yeah,
I got to get some help from youguys.

Speaker 1 (01:05:31):
Yeah, they're really good.

Speaker 2 (01:05:35):
My daughter is even better than I am sometimes, but
I'm building that and try to putmore and more content there.
Okay, fantastic.
Well, thank you for what you'redoing.
I really it's awesome thatyou're trying to get the message
out and reaching the parents.
It's so big and I reallyappreciate you having me on to
try to spread that message.

Speaker 1 (01:05:49):
Absolutely Well.
Thank you, it was my pleasure.

Speaker 2 (01:05:51):
Thanks, Melissa.

Speaker 1 (01:05:52):
I created this podcast because I know as a
parent how hard it is to seeyour child struggle and you
can't pinpoint what's the rootcause.
So I'm sharing my own journeywith my son and airway
obstruction and sleepdisturbances, and that's why I
wanted to have Dr DeLuke on.
So I hope this was helpful tonudge you in the right direction

(01:06:15):
as well for your own children,and because, at the bottom of my
heart, this is something thatwe need to create a movement,
educate.
So once you learn this as aparent, pass it on to other
parents.
I hope you enjoyed this and Ido it just out of my passion for
you to guide you the rightdirection for the health of your
children.

(01:06:35):
Just like Dr Mike said, don'tbe afraid to fight for your
kids' health.
Follow, like and subscribe.
I can't wait to see you again.