Dr. Piya Gandhi On Why You're Breathing Wrong - How It's Affecting Your Jawline, Sleep & Overall Health

They are the Bostics.

- Hello everybody, welcome back to another episode of the Bostics.

Today we have Dr. Pia Gandhi, who is a board-certified pediatric dentist with a focus on functional pediatric dentistry. Her practice is primarily dedicated to thorough screenings for various disorders, including airway issues, sleep, speech, feeding, and growth and development issues. Dr. Gandhi also specializes in the diagnosis and treatment of tongue and lip ties, particularly

in infants and children with airway disorders. This episode is not only for parents of children or for children, it is also for the adults out there. We talk heavily about the airway breathing, jaw position, sleeping disorders, what we can do as adults, what we can do for our children.

In this episode, it's really for people to understand something that's very basic that many of us look over. We spend so much time focusing on sleep and jaw structure and anxiety and stress management. But many of us are unaware that it could be a root cause of the way our jaws position or where there are tongue position, the way that our jaw is structured from birth and things

that we can do as adults to change it. So this episode, again, is not just for the parents out there looking to help their children, which this episode definitely does, it's also for the adults that are thinking they may have an airway issue that they may have tongue posture issues, that they want to breathe better and get their jaw more in alignment so that they can live better.

We could have kept talking to Dr. Gandhi on and on with that, Dr. Pia Gandhi, welcome to the Boston. I'm so excited for this episode personally because of what I have gone through in my own experience. Let's we'll get to.

But I want everyone to know this information. So you are our child's dentist, doctor.

“I think we'll start with getting a lay of the land, which is if there is a parent who's”

listening, how do they identify a potential airway issue in their child? The golden rule for pediatric sleep is that children should be silent and still with their mouse closed while they're sleeping. So if there is anything else going on, more than 50% of the time, then you want to pay attention to it.

I would say the most common things that we see are teeth grinding, which parents pick up on all the time because you can hear it and it sounds awful. The child's open posture or helicoptering in the bed, just lots of movement.

Those are really some of the first signs that we see for kids that are already starting

to struggle with sleep. What are you seeing the mistakes that are being made when they see that? Because I'm sure there's people go to their dentist right away. What are the mistakes? Yes.

Some of it, I should say a lot of it, has been a lack of education in the dental and medical field in general about what's normal and what's common and the detriment of mouse breathing has not been talked about enough.

“So so many parents will go, myself included, that's how I ended up here and bring up a”

concern to their pediatrician or their dentist. My child is snoring or, you know, I can hear them grinding and so many times the answer is, oh, don't worry, they'll grow out of it or that's normal, don't worry about it. And to me that's the killer is the don't worry about it. As a parent, you know whether there's something going on with your child or not and too often

it's just dismissed. Oh, you're, you're worrying too much, you know, when really most of these parents have the right pulse on what's going on, unfortunately the conversation is just brushed off. And I know I didn't learn this in dental school, I didn't learn it in pediatric residency, I learned it because I needed it for my own child.

And so like the expander that we use now, I came up with that through iterations of what I needed for my own three-year-old and we got, I had the same story, she didn't breastfeed. Oh, don't worry about it, just give her a bottle. She started snoring at three. Oh, don't worry about it, she'll grow out of it.

And then it was like, okay, then take out her adnoids and tonsils. We did that. And guess what? It still didn't work, you know, and it was just like, don't worry about it, she's fine, she's fine.

I knew she wasn't fine. So I had to start looking for answers.

“So what happened to, so say our age group, our generation, you know, I think it was very”

common when we were kids to see many children in braces still is.

And basically if you went in and you had a tight airway or crooked teeth, that was like,

I didn't hear anything about expanding back then. And I wonder for those of us that became adults that had these issues, maybe they had to get braces and we had an airway, she looked, what does that look like later in adult life if you don't address it? There are many adults, our age and our generation that have poor sleep and sleep at

me. We've somewhat normalized that for adults as well, you know, you're just getting older,

has become is now as an adult restructuring your jaw is jaw surgery, which is much more

extensive.

“And then just talking about the mouth breathing component of it, mouth breathing is habitual.”

So if you've been doing it for 40 years, yes, you can get your jaw restructured, but then you also have to retrain those muscles that have been doing the wrong thing. But really what's happening is our overall health is declining because poor sleep is going to impact your entire body function as an adult cardiovascular, you know, weight loss, anxiety, like mental health is huge.

And so we're seeing our generation on a lot of anxiety meds, on a lot of, you know, blood pressure meds. And what we're doing is we're just like slapping band aids on all of these symptoms and the root cause is poor sleep and a poor airway. Let's give the audience a visual perspective of exactly what we're talking about here.

We've all seen the meme of someone who is a mouth breather and a nose breather and it's

a drastic difference in the way they look.

Yes, if you could describe to the audience what that each looks like, how would you describe it? So a mouth breather because they're posture, they're resting posture is like this. Everything starts to go really long, like their mouth is hanging open. Their mouth is hanging open, but mouth breathing doesn't even have to be fully hanging

open. Even if there's just a little space, you are now removing the pressure of your tongue on the root for your mouth. So we're not getting growth this way, we're getting growth this way. We call it like your face is melting essentially.

You start to lose your chin because now we have this open posture. The nose becomes very pronounced. You don't have great cheek bone structure. And then even if you look at the eyes, they're kind of downward slanted. So literally everything is melting this way.

When really there should be great structure growing this way. So when we start to put pressure this way, it starts to support our cheekbones. And even out our facial proportions, we have nice defined like jaw structure. It's harmonious. Yes.

Yes. Exactly. A lot of people are starting to talk about this a lot more now, but you are way ahead of the curve. But you know, Lawrence got her mouth deep because we've dressed as sleep issues.

We've had people come on and talk about nasal breathing. There's that book, Breath, James Nestor, right? So like this is now starting to become more discussed.

“But I think again, our generation was of the generation where when you looked like that”

or had these issues like, oh, I need the chin implant or I need the nose job or I need whatever it like cause medics surgery to fix some of the things you're talking about. But to your point, none of that addresses the root health cause or the root issue around health because you may look different aesthetically, but you still have the sleep issue and the blood pressure issue and the anxiety issue because you haven't actually fixed

the structure. And those other structural surgeries, you know, chin implants, septal surgery, those things are limited by the underlying job bone structure. So there's only so much even aesthetically that you can get away with with that. But to your point, you're not actually fixing the function.

So adults that have had good jaw surgery, they look like they've had a chin implant and a nose job because we fixed.

Can you say this to the first generation, please?

Can you excite us to the internet? I went for new listeners and viewers. For new listeners and viewers, Lauren documented, what even called the job mass of jaw surgery in 2015 where they literally broke because I was there, they broke her whole jaw, moved it forward.

It's a brutal surgery for a top and bottom. It's a brutal surgery, I couldn't believe it, and then they basically wired her back up.

“But after that everyone's like, oh, did you get a nose job, do you get a chin?”

It's like, no, but literally they moved her face in her jaw into a different place in her skull. Yeah. But is that? And so if you're an adult and you don't address this as a kid, is that the only option

or the things you can do to start moving the jaw back in place? Really to make significant difference, the surgery is the way to go. So if you're way off, that's kind of-- Yeah. Maybe some adults and many of them are my patients' parents and they're seeing--that is

what brings them in with their child is experiencing some of this as an adult. And so when I assess their airway, some of them do ask, like, is there something else I can do? Can I put an expander in? Can I wear a sleep appliance?

The sleep appliance will help temporarily because they posture your jaw forward during sleep. That's not the airway a little bit. But it's not going to be a long-term fix.

even if it's just with-wise, so not a double jaw surgery, it's still surgical because everything

is fixed at this point. So there are different levels of surgical intervention. But if you are deficient in what we call the posterior airway space, which is when everything

“is set too far back, the only way to advance forward permanently is with jaw surgery.”

So you mentioned chin implant, and the reason that I was against actually doing plastic surgery to my face and I chose the jaw surgery was because I have seen people get a chin implant instead of do the surgery and what happens if anyone's listening and decides to get a chin implant that I've seen is it gives you this chin but then you're upper part of your mouth is back.

So now you've created almost this synthetic face, literally, where the chin is forward, but the upper is back. I don't know if there's a word for that. Is there a word?

I mean, it's really with the upper jaw being back, it's called maxillary retrusion.

Yes. But it becomes much more pronounced when you start messing with the other things. You had just talked about is creating balance. When we expand, we create a balance-looking face. And if you look at celebrities or models or anyone that is just aesthetically pleasing to

almost everybody or the naked eye, they all have very balanced faces. So those are the people that are more likely to also have the healthy airways. I noticed in other countries that there is a different diet where they're working out their jaw on a daily basis based on what they're eating. In America, I noticed a difference, and this is maybe because I've become a practitioner

of the jaw. Have you seen this? Yes.

And this is why the majority of children that are in my office have underdeveloped just,

are diet is a huge part of this. And baby food is where it all starts. So we have this huge culture of pures and pouches and dissolvable crackers and even convenient vessels to drink out of that are all working against a natural swallow pattern, good chewing skills.

And that is how our face develops is by chewing. So when we have young patients and let's say I do a tongue-tie release on an infant, at their last check-up visit, the big thing we're talking about is how do we continue good job development moving forward. And a big part of that is baby-led weaning.

And baby-led weaning is the technique of introducing baby food and skipping over the pures. So we go straight to table food, squishable solids that you can squeeze between fingers because jaws are really tough, like you can chew through a lot with no teeth. And so what that does is it starts stimulating the growth right away.

When we chew, we also exercise our tongue. So we move our tongue side to side. And that is a great way to get tongue strength is by chewing.

“So when our little ones go to therapy, that's how they get the tongue moving, is through”

food. And then there's this product that you guys are familiar with, the Myomanchi. Essentially what the creation of the Myomanchi has fit a place in our society because we're not chewing our food. Normally we would just get normal growth from chewing, but our food is so processed that

we have lost a lot of that. When I ask parents about their child's eating habits, the generic question is, is your child a picky eater? Let's too. That's too generic.

And we've normalized picky toddler eating. The other thing we've done is we've made a lot of pre-chued food. So when I ask parents as your child eat meat, I ask them meat that's not in a hotdog, nugget, shredded, or ground form because essentially all of those things we've pre-chued. So they're not using those skills.

And so it's a poor assessment of actual oral motor skills. And it's also we're not getting any growth out of those things. With that also as adults age, too, it's a lot of adults with smoothies and soft foods and potatoes, like, so grab a meat stick. Yeah.

Yeah, well, no meat stick either, though, because they're now saying that those have-- No, no, no, not like, not more ordinary thing. I mean, the more whole raw food that you can get, the better eat the apple, not the apple sauce. You know, it's small substitutions.

But they're not as convenient, that's the thing, is we're a culture of convenience. And so even these, like, 360 miracle cups to rid of, you know, that kids drink out of,

“that if you turn them upside down, nothing comes out because you have to bite on them to actually”

drink. That is teaching a totally abnormal swallow pattern. Well, how does our upper jaw expand by swallowing thousands of times a day? So if we're doing it incorrectly, we're not getting the appropriate pressure and we're not

What's the brand of the water bottle that kids should be drinking in? So it doesn't have to be a specific brand. It is a flexible straw cup or an open cup. That's it. Okay.

Millions of brands out there. There's just like a normal, normal straw.

I want to pick on us for a second, and hopefully you can help with this.

Obviously, our baby just started eating solids. We're trying to strengthen his tongue posture because he got a tongue tire release, which we'll talk about.

“What are the foods that you would introduce to him?”

He's so little, we obviously want to be careful with choking. What are the foods? So like sweet potato and avocado, the rule generally is anything, even if it's a carrot, you're going to take it to a consistency where you can squish it between your thumb and your index finger.

What kind of the rule? What about meat? How do I give a meat? Yeah. So meat's a tricky one.

You're going to make it small, and you're going to cut it small, and I would start with softer meats. You know, I'm not a feeding therapist. So like a lot of this, I defer to our in-house feeding therapist when I identify that we're not chewing correctly, but generally with baby-led weaning, the rule is, if you can squish

up between your fingers, and me, it's not the first thing I would go to on a kid, like

a little kid that age. But avocado. But avocado. Yes. And then once we get some more, like, he's got two bottom teeth, but once we get our molars,

then we can move on to things like meat where we can actually chew a little bit better. But initially, I would start with the veggies that you can squish between your fingers. Carrots. Sweet potato. Broccoli.

Really cooked, carrot. Yeah. All of this cooked. Anything you can't squish? Don't give them.

I am getting red. I'm going to go on a fucking rampage after this, and I am getting red. We were peering liver. I was like, "Oh, I'm being healthy with the liver." So it's...

And you can probably give him liver, it's, you know, if it's soft enough, just give it too. Don't pure it. You know, if you wanted to give them some of the, like, so right now, if we want to give them some pure aid, is it okay to do that if in combination, you're first giving him the

other stuff. You just want the exercise of the tongue in the chewing. Yes. The other thing with... Because what you don't want to do is like, underfeed them apart.

Right. And the other thing is with baby-led weaning, is it's about the chewing, but it's also about teaching them, like, self-feeding and self-regulation. So like, when they are done eating, you know, we're not just shoving food in their face constantly.

So it just teaches them to listen to their bodies also, just healthy habits for eating from the beginning. You know?

“How do you know and how did you know with our baby that they need a tongue tire release?”

Because when we were in the hospital, they say, "Oh, you don't need one," but I said, "I'm calling Dr. Gandhi." Yeah. So... I think that's a common thing for a lot of parents.

It's a huge thing. A lot of parents are told, and we... I could say that we've had three. So I can... I'm gonna confidently say a lot of times you're told that they don't have a tongue tire

when in fact they do. So it's a complicated situation. Some of it being hospital politics, lactation providers are, you know, a lot of hospitals not allowed to say. If there's a tongue tire or not, I have parents that come in that say, "Yeah, I got your

name, like, on the slide in the hospital." Because there's a lot of medical practitioners that still... I hate to say, "Don't believe in this," because it's not a thing to believe in. It's an actual thing. But they didn't learn it in medical school.

They don't know enough about it. They say there's no research except now there's tons of research that they just haven't read. So it's sort of a taboo thing that in the hospital, you can't really talk about it.

“And how we know in our office, well, you have to do a thorough diagnosis.”

And again, even sometimes when parents are sent to a practitioner to look at a tongue tire, they're sent to ENT is commonly that just take a quick look and say, "Oh, no, they're fine." Well, what it looks like is one piece of it. It's really what it's doing in terms of movement and function.

So when you guys came in, we have you fill out like a symptom form. What are you seeing? How are we feeding? Is there already mouth-breathing? Are we having trouble on the breast or the bottle?

Are we gassy? Tension in the body is also very much related to ties. So babies that are colloquy, they tend to have more tension and some of it is because of the tongue-tie. So when we do our assessment, yes, we look at what that tie looks like or the fremulan.

We also have you fill out what's going on at home.

And then lastly, I do a comprehensive movement assessment, which is the most important part.

We're going to see how they're sucking. We're going to see how the tongue is elevating, how it's moving side to side. That is our biggest tell of what's going on. And you have to put all those pieces together because some babies will have no symptoms feeding.

Especially if their breastfeeding and mom has this amazing milk supply, well, guess what your tongue does it need to work very well. Very much. If I think we're hypersensitive to it because Lauren, again, going back to her, had to have later in life, massive jaw surgery.

My fall question to that is if you're a parent that has an area way as she may be your

or not there?

Jeans play a role in this for sure.

tongue-tie is definitely genetic. I mean, I see parents with it and then all the siblings. The exact inheritance pattern we don't really know, but it's a very high likelihood that

“if you've had one child with it or you have a tongue-tie that you should really just get”

all your kids checked for it. I got your name on the slide from Allison of Branch Basins. She told me to go to you so that's so interesting that you say that. And the person that told me that bond had a tongue-tie was my cranial sacral doctor, Dr. Maria, who I love.

Why is cranial sacral so important to this equation? Yeah.

So again, it's going back to full body function.

So when we look at things like a tongue-tie, it's going to impact the tension in the body, the swallow pattern. cranial sacral therapy is really working on the connection between the head and the pelvis. And so if we have a tongue-tie, we are more likely to have underdevelopment of the cranial bones, which is attached to the rest of the head.

And then if there's tension here, it actually is pinching on our cranial nerves. And then our cranial nerves are not firing correctly. Well, guess what's controlled by those cranial nerves, suck swallow, digestion, movement, breathing, diaphragmatic movement. All of it is connected.

So when we do cranial work with or without a tongue-tie release, we're going to get better alignment of those bones, better pumping of the CSF fluid in the spine, which is the way we nourish our nerves and have them fire correctly. So all of this comes back to the fact that when we're dealing especially with airway breathing sleep, tongue movement, we have to look at a whole body.

We can't just like look right here. Someone told me off air that colic is actually not even a real thing that it was created because people wanted to sell medicine for it. And that what colic actually is, and I want your opinion on this, is when the babies coming through the birth canal are being pulled out through CSF that the body is out of whack.

And that is a traumatic experience for the baby. And cranial sacral helps make the energy flow and fixes that, which then takes the way of the colic. Yes. So I don't know that I'll go all the way to say it's not a thing at all.

But what I will say is I have many babies that have colic. And when we address cranial strains and tongue movement that the colic goes away. Now we've touched on something about the birthing process. So it's called birth tension. And birth tension is exactly what you said is when we have a baby delivered via C section,

there is so much pressure put on their head when they're coming out that it causes what's called subluxations. And that is when your vertebrae goes slightly out of line. When your vertebrae are slightly out of line, that affects the nerve firing. Well, again, those nerves control digestion, which is going to impact gasiness.

So it's all connected. So you know, chiropractic care cranial sacral therapy.

“I mean, I wish I knew about these things when my daughters were born because I think every”

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payroll, that's three months of free payroll at gusto.com/skini, one more time, gusto.com/skini. Do you think that Michael, who has delivered a C-section, could have headaches and migraines from his birth? I would say that the impacts of it probably created a domino effect that we're still seeing.

“Well, I mean, in my mom, talking about this, I think I was the first one in my family,”

and they tried, naturally, and then, or, I vaguely, or whatever, and then could not in the NC section. And I heard it was like a bit traumatic, but what I think to your point is, it sounds like

And so, to clarify, I don't think we're saying callic symptoms are not real, but people

may not be aware of why they are originated and what to do about them. Well, and the way we're told to treat it is with gripe water, or whatever, that, I mean, it doesn't really work. You know? And if you're talking about what all the things you just described, the gripe water

is a little burps, not going to solve all of that. Right.

“So, I think we're going to have some gripe water for my hands, that would be wonderful.”

But this is the gripe water also has natural flavors. This is not everyone knows. But this is also what we're doing with everything that's a, that's a effect of a poor airway, and poor oral motor function.

We're just, we're just throwing a medicine at it, or, you know, like, we're treating

the symptom. We're not looking at the why. So I want to focus, again, we'll go back, I will keep going back to the kids, but for adults in their 20s, 30s, 40s older, and they're dealing with this, and they know they have an airway issue, and they're sleeping poorly, and they're having anxiety, and they're mouth-breathing

many of them, maybe, using Lawrence's mouth tape. What are some things that they should be thinking about, and who are the people they should start to go and see? Yeah. If Josh surgeries, one of those options, what are the things in between in the information

they need to collect?

“So the good thing is, in the dental field, there are a lot more practitioners that are”

becoming more airway aware and focused, so trying to find for an adult, it would be more of a general dentist that is airway focused, and there are lots of great online resources to locators to find these dentists, airway health solutions, as one, the airway circle is another, the Breathe Institute, so starting there, and they may not find a dental practitioner, what they might find is a myofunctional therapist, or a chiropractor, but just

someone that is airway aware that can start their journey for them, because what happens is, yes, there's more people trained in the dental field, but we're still not everywhere. I mean, you guys drive to me, right? We do the Houston problem, but the buck is journey. So I don't want people to get paralyzed by the fact of, well, I don't have a dentist

right near me. Okay, well, let's start somewhere, and myofunctional therapy is a type of therapy that the goal of myofunctional therapy is lips closed, tongue up, breathing fear, nose, proper swallow pattern, all the things that are going to help support out the airway, and even if you need jaw surgery, that type of therapy is going to support all that structural

change that you do, and so that is a great place to start, and generally, more accessible than finding an airway dentist. If you can find an airway dentist in your area, awesome, or if they do virtual consults, then like for me, if people contact me and I know they need jaw surgery, then I'm going to send them to the Houston team of surgeons if they're in Houston.

But you don't need to go from nothing to going all the way to the jaw surgeon first.

So if she would have done some of these therapies before, she did her surgery back then, which I was little, no? No, but I'm saying it before the surgery. And now, if she have had an easier recovery, yes. So myofunctional therapy is again, not something that oral surgeons are taught about.

So they're taught about the surgical techniques of, you know, moving the jaw, but it's

“almost equivalent to like when you get knee replacement, you do PT, right?”

Then it'll just replace your knee and say, go, so it's the same concept. We have to do some physical therapy for our oral facial region in order to support that structural change that we're going to do, especially on an adult that has been having this structure for years and years and years. These bodies are a little more forgiving, but even then, we can't just isolatedly start

shifting things around and thinking that the rest of the body is just going to magically adjust to that. Okay. One more question from an oral health perspective, say you have two patients that start in the same place.

One with a poor airway issue, one with a jaw, a good jaw out there, right? What happens from an oral health perspective to each of those people's teeth if they start in the same place? So it's funny, I was talking about this the other day about how a big thing is cavities, right?

And what we're taught in school is, you just have to brush twice a day and floss and you won't get cavities. Well, that's really not true. Really it's more related to our oral function, so the way we breathe, mouth breathing, dries out your mouth and our saliva is what protects us from cavities.

And so huge increase risk of cavities with mouth breathing. The other thing mouth breathing is going to do is it's going to change your oral microbiome. And so we all know like gut and oral microbiome is huge in terms of disease and inflammation. And lastly, tongue function. If we do not chew well, then we're eating a lot more softer food, a lot more higher

carbon food. Again, increase risk of cavities.

If the tongue has poor tone or it's not, you know, moving correctly or tied, then we're

going to have residual things on our teeth longer, teeth grinding.

“All the adults that are fracturing their veneers and crowns, why is that?”

It's because they're bruxing really hard at night. And that's not a stress issue. That's a poor airway, poor sleep issue. So when we try to teach like general dentists about airway and why they should care about it, one of the big things that we say is it's going to make your dentistry last longer.

Your results are going to be better because you're going to be putting these in mounts that are functioning correctly. Otherwise, you're just setting these patients up for failure. So if somebody has, or they're getting, you know, a ton of cavities, it's also potentially a good indicator that they have an airway issue.

Yeah. Because it's not normal to get cavities that frequently. If you have a good airway posture with proper posture. Also, if you're, if you come in and tell me that you're like doing all the things, the brushing, flossing, the, you know, for kids, not a lot of juice and all that other stuff.

And we're still seeing like all these cavities, something else is going on here, you know. I want to say, and this is the perfect episode to say, "Mouth taping has changed my life." Because yes, I had draw surgery and that was great, but I was still, I didn't do the Maya work. So I'm starting to do that now and the, "Mouth taping has truly changed so many things."

And I haven't been able to articulate it until you came on the show. But you're right, like having the tongue posture and teaching the tongue and my eyes are brighter. I noticed my jaw has gotten stronger and sharper. I noticed even my posture has gotten better from "Mouth taping."

There's things you don't notice as well when we first started dating, we, sleeping together.

She used to snore so loud. Like somebody was running a cheese on next to my head. Wow. Like insane. The dress surgery made it better, but still now when she does, the mouth tap like that goes away.

But I mean, it was, if you, if you would walk in like, "I didn't, we don't need a guard dog." So when you hear that, they're just like, "Don't run away." Do you believe in "Mouth taping?" And if so, what are the benefits? Do I believe in it?

Absolutely.

“You should come to my house at night and everyone has mouth tap on, including my children.”

And in fact, they feel such a difference in their own sleep that if they run out of mouth tap, it's like, I mean, the world is ending in our house. And so, I 100% believe in "Mouth taping." With that said, I don't recommend that people just start putting mouth tap on, flip it ly, okay?

Because some people do not have a healthy enough airway to support mouth taping. So parents asked me, "Well, you know, should I do it?"

And the first thing I would say, even for an adult, is try it while you're awake, like

watching TV, or doing something silent, reading a book. Because if your airway can't handle it, you will start to feel a little panicky in your body. And then you definitely don't want to do that at night. That means, okay, your structure is not where it needs to be.

But to your point, mouth taping can really help with the habitual side of mouth breathing that even after your jaw surgery, you needed to do some retraining of your lips and where your tongue should go. And the same thing with kids that have like adenoid and tonsile surgery, the snoring sound will go away.

But their sleep quality still may not be where it needs to be, because they're still that mouth open habitual breathing that's happening. I know I feel a difference the nights if I forget to tape. Oh, yeah. I know there's a huge difference in the way I feel in the morning.

Huge. And obviously, like, I'm not walking around all day with my mouth open. I wouldn't say I'm a mouth breather, but at some point of the night, obviously, I'm still opening my mouth.

“And I think most people are, if they are.”

I don't want to let's, she's so noise, I take video. She's got this, she's a, she's a, she's a, she's a, you've got a millimeter gone. Oh, she's got the mouth. She's got the mouth. That's still thing.

Can you tell him to tape his mouth? I should, I keep telling him. You know, I also wanted it. No, no, I love it. I had a reverse question.

I noticed sometimes one of my big problems is clenching. Mm-hmm. No, but your lips are still open. Sure. But what I'm saying for people that clench and I wear the mouth at the guard, obviously, for

to guard my teeth, but that's an error issue. So, is that where does that come from and is it? And what's the effect of that over time? Yes, so I get tension. Yeah.

So, broxing, grinding, clenching, it is low level stimulation for your body, so that you don't fall into an apnea state. So, it is your body's way of keeping you breathing. The problem with that is that you're now active during sleep. So, your quality of sleep is not great.

Also, anyone that has smaller structure or suboptimal function, they're going to have, what's called pair of functions. So, things as a result that are not normal for kids, sometimes we'll see like, they have like oral fixations, nail biting. It's just because the harmony is not there.

The systems are not working the way they're supposed to, and together.

So, similarly, what have we done?

“We've given every adult a night guard to wear.”

But that's not really fixing the problem that the airway is not functioning well. And then what happens on term? We have TM joint issues. Again, those joints start degenerating very quickly if you're broxing and clenching. So, like the oral surgeon I work with a lot, he's like, "No one needs TM joint surgery."

Like, "No, we don't need TM joint specialists. We need airway specialists." So, what is someone like myself to do for that? Is it trying to expand? Is it a tongue tie issue?

I mean, I'd have to look at, it might be all of the above. Yeah.

It's very rare that it's one thing.

Even for children. So, as an adult, if someone thinks they can fix everything with one thing, I would be

“wary of that because it's multi-factorial.”

This is where working as a team, like having a team of people that you work with is really important. Because, as I just said, I mean, you asked me questions about baby-led weeding. I'm not a feeding specialist, but I have great feeding specialists that I work with. With adults, it's the same thing.

I'm not the jaw surgeon, but I release the adult tongue ties and can provide the myofunctional therapy in the office. So, usually we're looking at an adult, we're taking a scan of your airway, so we're looking at the anatomy. And that's the anatomy of your upper airway, but your nose, your sinus is, all of that,

your TM joints, and then we're looking at the size of your pellet, and whether you have a tongue tie or not. So, it's all of these things combined, we have to take an overview and then kind of dial in, what are the things, and in what order do we need to address them? Our friend, Dr. Jericho or Toledo, do you know him?

So he did a colonel beam scan of me, and he did, he said I have a tongue tie issue, and my big thing is when I was younger, I was probably not, this kind is myself that I should have been. And I have broken my nose multiple times, and I have sinus issues, and so he's saying I got to fix that, and potentially do the tongue tie, and that would be like where I need

to start mixed with my official. Yeah. Yeah.

And I would have never thought that I had that issue because it was clenched, but then

as I've gotten older, I realized everything you're talking, oh my God, yeah, that's exactly what I'm doing. Well, the other thing that happens when we age just naturally is our bodies don't compensate

“as well, as when we were children, and that's why looking for the early signs on children”

of deviation of growth, they may not have the laundry list of symptoms that we know is coming in adulthood, but the point is, is those early symptoms, they don't just disappear on their own. You know, people when commonly pediatricians will say, oh, they'll grow out of it. Like us and the airway field, we joke, no, they're going to grow further into this problem.

We're just going to start compounding shit on top of this when their bodies are not resilient like they are right now. And so if, and the way to change their path of growth when their children, it's not, you know, magic, but it's so much easier than trying to do whatever we're doing as adults. Oh, our kids get sick and you have the flu and they're down for 14 hours, we're down

for like a week. Yeah. Can't recover. If someone wants to expand their palate as an adult, what does that look like is the only way to do that through, is it called Sharpie, Marpie, Marpie, there's Marpie, there's Sharpie.

And I don't, I don't have a robust knowledge on the adult expansion, but yes, there's, there are some providers that will do things like, I don't know if you've heard of like the Vivo's appliances, so they are removable sort of mouth guard type appliances. Historically, those are not going to give you significant expansion. So the difference is, when you look at a palate and you expand, you want to make sure that

the expansion is actually bone movement, not teeth tipping. So sometimes people will say, oh, yeah, I got like three more millimeters from whatever they're using and really all they did was they tipped their teeth out. Okay. A couple of things with that is that's not very stable for the teeth.

And that type of movement may visually look like you expanded, but what didn't happen is you didn't get any actual bone separation. When you're actually expanding, you want the bone, the palate bones to actually separate. That is how you get airway improvement, not just a better looking arch. How do you do that on adults, it's surgical.

So the palate bones as an adult, they're already fused, kind of. And so they will surgically separate them and then they will put it in an expander similar to what the kids get, but they'll be screws into the bone. And then when you turn the expander, so it doesn't really, it attaches to your teeth and

So it's not like surgery like you're put under, it's more of like a procedure that you wear.

“And but most of that development is going to be lateral expansion.”

So if you need forward movement, you're not going to get a lot of it just with that. That's where the surgery, the root, like what you went through really comes in. Tell us about the process of a mother and father who bring their child and that needs a palate expansion, what that looks like very specifically for the audience. Yes.

So we're going to do what's called an airway consultation. And we do like both parents to be there if possible so we can show them everything.

The first thing we're going to do is take a CBCT scan of their upper airway.

So that's the cone beam. That's the cone beam. Yep. And it just, it's a 12 to 15 second scan where they stand and the thing goes around their head, pretty easy.

We're going to take pictures of their entire body because as you were saying, like posture is affected, symmetries are affected, then we're going to take into oral pictures as well to see what their bite looks like, what their palate looks like and they're trying to scream. So get over it.

Sometimes yes. But you have even though it's very gentle, they're moving on the TV. There's toys. There's everything. So we do this starting, you know, to and up.

So obviously, age range is going to matter as to what how they're going to handle

some of these things. If you like forget how they behave, but in your perfect world, what's your ideal age to get your hands on a kid that has the issue? Definitely under five. If I can catch them two, three, four, that's awesome.

Four to me. Well, not just to me, but four is our peak growth of our upper jaw. So the kid is narrow at four, they're not catching themselves up. So I don't know why we would wait till 7, 8, 9, 10 to fix it. So we got our daughter in right away.

Yes. So we've taken the pictures, we've taken that CBCT scan, then we take an intro oral scan. So if you were, if you're an adult and you had braces or a palatal expander, you probably got those like molds taken with the gooey stuff. We don't do that anymore because that's really hard to handle.

We have a little intro oral scanner. It looks like we call it a magic wand. It takes digital images of the arch. That is what we use to send to our lab to make our custom-made expenders. So I put all those pieces together.

What the photos look like, I look at the airway during that consultation. I will pull up the airway scan in the consultation room and I will show the parents. These are the adenoids. These are the tonsils. This is what the scientists look like.

Is there already a deviation on the septum?

“What does the airway space look like because images are a thousand words, right?”

So when I can show them that their child's adenoids are huge and really constricting the airway tube, it's like a traffic jam or a bottleneck on a highway. So if that's sitting right behind the nose, when we're trying to get air through the nose, it's going to get stuck right there. So what is the child going to do?

Open their mouth and then we look at mouth breathing. So I show them that image. I walk them through what I'm looking at.

I also send that to a radiologist to get a second set of eyes on it.

And then I do my clinical exam. During that clinical exam, I'm looking at tonsils. I'm measuring the palate. I'm also looking at their face, you know, what is, what is their profile look like? Do we, do we already have a, you know, a retreated backsilla or mandible or upper lower jaw?

I'm screening them for a tongue tie. Mouse breathing is so easy to pick up on if you just look at them in the chair. A lot of them will also have chap lips chronically because of the mouse breathing. And then we're putting all those pieces together. So I'm breaking everything down for the parent.

If they need expansion, we're showing them examples of what those expanders look like. Each of them are custom made. So we'll show them a sample, but they're all custom designed, depending on what kind of movement the child needs. The fun part for the kids is, you know, there's colors and glitter that they can choose,

like glow in the dark. The great part about this and the question that I get most is, especially on the young ones, are you going to have to put them under to put this in? It is the easiest insertion because these are custom made. They sit on top of teeth, they're 3D printed.

Is there an adjustment? Absolutely. There's something new in the mouth and we are trying to swallow and speak with it in. But nothing about this is painful. Even at home when you're activating it, it's such a slow schedule because we're trying

to mimic natural body growth so that we're not putting the body into shock because this is impacting our nervous system. So we try to be really gentle and that leads to, you know, generally a smooth process. We're dealing with children. So, you know, there's no guarantees.

“You have to, you have to kind of always be ready to pivot.”

But generally, this is a much easier process and a simpler process than I think a lot of parents anticipate. And that's really what we're trying to do is do something that's not traumatic but highly

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many parents with young children that this could reach, like we hope that happens. But what we're also trying to avoid is the situation that Lauren had to face, which is you become an adult.

You never address this issue.

You go through poor airway habits, your entire adult life.

“And then you have to have a massive surgery that's, that was a traumatic surgery that”

she had to go through. People have no idea. I had a full identity crisis, because I got the surgery. And when the surgery is over, it's like, okay, go on your way. I happened to have a couple infections after so I had to keep going back to get the

things out. Finally, when I was out, you lose a dramatic amount of weight immediately because you can't really eat, but then you look at your face in the mirror and it looks different. So swollen and you look different and you, I literally had an identity crisis. I couldn't even look people in the eye for about a year and a half.

I was insecure of self-conscious. I will say looking back though, it humbled me. I really realized, like, I don't want to use my looks to lead.

I need to use my personality and my knowledge and my intellect, so they did do some great

things. But that surgery takes a year or two of your life and makes it very chaotic. When you know how most surgeons are, and I guess they have to do this because we're also nobody will get surgery. If it's a guy, you'll be fine.

It'll be easy. And then like you get up there. It's a huge surgery. Huge. And one that I'm still dealing with, I just had my screws out.

It was, it was a six hour, she was under for like six hours. Yeah. Do you regret it though? No. Okay.

Yeah. I don't, and I want to say that to everybody.

I don't regret it for one second.

It changed my life, it changed my posture, that with mouth taping, and the myel fascia that I'm going to do in the cranial sacral, all of those things have set me up. I think to be comfortable aligned in harmonious in my body. But I guess what I think about is she may, maybe she still would have needed a surgery. If she would have done this as a little girl, as you were described in the preventative

stuff. Or even just the retainer would the surgery have had, even if she had it, would it have been as intense with the woman? Well, less, yeah, she, I mean, the development would have been better. So even if they're needed to be some movement, it may not have to have been as much.

“And the more movement you have to make, the more dramatic the surgery.”

Yeah. And when we talk about early treatment, yes, expansion at four. But if we can catch babies that have ties, that's the place to start. I mean, because 50 to 55% of that drug growth is done by age two. And what's doing it?

Our tongue, our mouth closed, and the way we're eating. So if we can screen somehow every baby for a tongue tie, that is the best point of entry right there. Because even to that point, some of the babies that I've released as, you know, their tongue tie is an infant, they, some of them have still needed expansion.

But to your point, that expansion would have had to be much more drastic if we didn't have a working tongue. Yeah. And, you know, as we've learned more about this conversation and as we've known you and you had more children, you know, we brought our son bond right away.

The second one. He was born out. I was like, Dr. Gandhi, we're coming home. I mean, you saw him when it three months, maybe maybe maybe. Maybe two months earlier.

And it is traumatic after the tongue tie, it's not fun, but it's worth it.

“You have to do the stretches, the stretches.”

Yeah. There it's, it's not fun. No, it's not fun. It's, but I also don't tell parents, oh, this is easy, you know, you've got to prepare yourself to have help, but it's worth it, you know, it's worth it to get that tongue working.

And unfortunately, that's another place where parents just get so brushed off about it. But what I'll tell you with him, what I've noticed is before that we could know, you're just because we've paid attention to this stuff, know how you're sensitive to it. You could see there was a little bit of mouth breathing going on. And, you know, every infant in baby has a little bit of a recession, obviously, but we saw,

but now as he sleeps, his mouth is closed, he's breathing through the nose, more energy, immediately after that, like right away, sort of lifting his head up and looking around more and looking at that tension that's related to ties. Yeah, before his head was kind of down, then he's like up more and like more mobile. So you could see it changes things right away.

It's information to me, I'm so passionate about getting out to every single parent on the planet. This is a really important episode for me just because of what I've been through and I know how much it can help and what I've noticed with you, too, is like the best thing that you do is you make space between the teeth when you expand the palate, which is so helpful

to the growth of the child. I do want to say, because my dad's probably listening, this is not my dad and mom's fault. They took me to the orthodontist and the orthodontist prescribed a retainer and braces and a head gear. We were so prescribed.

It's not like I didn't go somewhere to get all the things that you're going to get.

Yeah, it didn't have to do that.

Unfortunately, so many children are still getting prescribed that by our orthodontic community and you brought up your parents and validating that it was not their fault. It's really heartbreaking when I have parents come into my office and cry about how guilty they feel because they will say, I have taken my child to the dentist every six months like I'm supposed to.

I have brought up the concern to my pediatrician, like I was supposed to and no one, no one was listening and they feel like it's their fault and to me like, I don't know if I've ever told you my story, but that was my story over and over and that is how I got into this. When I opened my practice, I didn't anticipate doing this kind of work.

My older daughter, Syra, who will be 13 on Friday at three was snoring, showing terrible behavior signs and her dad is a physician and he was like, it's fine, she's fine. I was like this is not normal and she would keep it together at preschool and come home and just like melt every day. Tantrum, I had no idea what was going on and I did the things that all these parents

do. I went to my pediatrician. I went to even as an infant when she couldn't breastfeed. I went to the lactation consultant and you're just told like, you're fine or you're crazy. It was me listening to myself and trying to figure out how I could allow my child to live

her best life. So how did you figure that out?

“So I believe in, you know, there's a higher being universe, whatever you want to, whatever”

you want to call it, I had decided to buy a laser for my start at practice. And so I took a course by Dr. Syruzagi, the Breed Institute in California. And I was sitting, this was 2017, I was sitting in his course and he started talking about children with tongue ties and underdeveloped airways and literally everything he said was Syruzagi.

I started crying during the course and I'm thinking in my head, I'm a dental practitioner and I didn't even know these things. He's an ENT, but he's a special ENT because ENT is don't even look at this. And I went home, I assessed her for a tongue and lip tie and sure enough, she had a tongue and lip tie.

And in 2017, we weren't talking about my dysfunctional therapy and chiropractic care. We were doing it in a very medical way, like linear process, see the tie, release the tie, and now it should work, like your tongue should work. Well, I did a tongue tie release on her and we got a little bit of improvement, but I didn't do any of the other things.

And so at that time, she was about three. And again, I was like, something still off here, I missed something, you know.

“And so I went back to the drawing board, I started honestly shadowing the lactation consultants”

and Houston, the chiropractors, some of the therapists, and really trying to get a better understanding of how all these things work together. And then, you know, the whole discussion of pallet and how the tongue impacts palletal development. And so that's when I decided, like, when I looked at her and I said, wow, she has no space

for her teeth. She is mouth breathing. So my, my poor children have been through every iteration. So we started with kind of more myofunctional appliances and then I moved on to an expander, not the version that I have now.

And it took me from three to about seven and a half for me to get it right with her. And it's right now.

Oh my God, she is incredible.

She is a point ballerina at the Houston ballet. Wow, she's just full of life. And it's crazy. I still get emotional and it's like, she hears.

“And I, like, I truly believe she would not be the person that she is without this intervention.”

And I, I feel like I met the true her at seven and a half years old. But no parent should have to wait seven years to see their child thrive. And the killer is, it's an relatively easy fix. It's all about screening and identifying. And we're just brushing it off and it kills me.

Well, it's, as you're talking, what's crazy is, you know, when you say 2017, that was not very long ago. And sometimes we will get pushed back, especially when it comes to topics around medicine or health on this show. Because we talk to people and sometimes we talk to people maybe earlier than, I guess,

maybe the majority of people are ready to have the conversation, right? And anytime people start to rock, the boat and start talking about alternatives are doing different things in a different way, especially when it comes to medicine.

People always get crazy in up and arms.

But what I point out, if like these last few years haven't shown that like we're still

Absolutely. Right.

“Like, we, I think as it, as it relates to this field, specifically medicine and”

health, we have to as a population be willing to understand that we just don't know so

many things, but there's likely going to be more information that continues to present to do things in a more efficient and better way. And that is really the hurdle that we're facing with physicians because there's this complex of, we know everything. And as a practitioner that does this, I mean, I'm still learning every day.

I mean, I'm saying, even on my own daughter, there were so many iterations of things that I tried and if you're not open to saying, I need to learn this better or this may change, then you're really stunting the growth of yourself as a practitioner, but also the, what you can provide for your patients. And when I started this and this still goes on, I get a lot of pushback.

Oh, yeah. Oh, my gosh. I have had to grow some pretty thick skin, but to me, the fact that I've lived this as a parent and I've seen the difference in my child, I will go up against anyone to defend this work.

Well, you know, and I think the medical community in particular is very critical of other

people in the community going outside the box, even just by a little. And again, doing this show for a long time, we've had people come on that are very credentialed to have all the, you know, of all the right degrees, all the right, you know, credentials, and all that stuff, and they come on and say, hey, I was taught this way and used to think this way, but now I've learned this thing and maybe questioning some of that and they get a

ton of pushback, sometimes even the medical community just threatens them. Yeah.

“And funny enough, like there's one example I think of, and I won't hire the listeners and viewers”

will know where a woman come on and start talking about the way screenings are done for women. And in some kind of saying, hey, there's other ways that are maybe to look at for some of these screenings. She got so much shed. It's a much pushback.

I think she was threatened to have her license stripped and maybe ended up moving to it a little. But then a few, like a year later to the date, we had a doctor come on the show. We haven't released episode yet, who is a cancer researcher and screener who built his entire career in that line of work, saying, hey, some of the things that I've seen, we've seen

better alternatives, and there's like direct correlation to some of the things she was talking about. And so I think it's really disheartening because you have somebody who's kind of sounding the alarm bells saying, hey, maybe we should look at this in a different way, gets a ton of pressure and pushback.

And then you have someone that is literally in that field saying, no, she was right and we should pay attention. But I think a lot of doctors and people are scared because their livelihoods in jeopardy if they say the wrong thing in the wrong way or what's perceived to be the wrong way. I mean, I've experienced some of this myself.

It's a scary, it's a scary place to be because a couple of things is, one, it's your livelihood. You've spent your whole life building this training for it.

“But the other part is, I think about if this is taken away, who's going to help these children?”

No. Who's going to do this, you know? And the problem of positions not changing, dentists not changing, it's ego related. They would have to admit that they were missing something, but they had been doing something wrong.

But we're all learning in human, like you have to get off that pathway and think about what you're missing and the detriment that you're doing to your patient. A sign of intelligence is being able to change your mind. I think we need to get back to that. Yes.

No, it's a me the doctor or the medical personnel that I trust or the people that are saying, like, right now, this is the best information we have in base on that, I think we're this. But if new information presents and finds a better way, I need that person to like, hey, we found this new thing that we didn't know about before and this is maybe better.

Like that would be insane. Imagine like if you started a business, you're like, we used to do it this way 30 years ago. So we're only going to keep doing it this way, you wouldn't have a business. But this is, you know, I train other dentists to do this work.

And one of the biggest worries that they have is, well, I've had my practice 10 years and I've been seeing these patients for 10 years. How am I now going to go tell them, oh, you have a tongue tie that needs to be treated or you need palatal expansion. Are they going to turn around and say, well, why didn't you tell me this 10 years ago when

I've been sitting in your chair? And you just have to be honest, this is, you know, we are learning more. I'm learning more. And so I'm trying to bring the best benefit to you and just be honest about it, people appreciate honesty.

Yeah, I mean, especially if you're coming from a place where all you're doing is trying to help them. Yeah, we used to take a horse and buggy when we went across the country, but now we take a plane.

Like we can't, we imagine those who have been like, listen, we've always done the horse

and buggy. What you believe in muwing, I'm you all day long. I don't mean to brag, like I am the, I am literally, it should be called boss sticking.

I am a huge believer in it. Maybe just call it more. I mean, it is, it's a form of myofunctional therapy exercise for your face. You're Tony. I mean, I'm right.

You're Tony Muscles, right? Thank you. Right. So it's like any other muscle that you would tone, the more you do it, the more tone it is get, the more defined it's going to look like, you know, it works.

I'm a prophet. Tell us the real truth about why people are getting their tonsils and adnoids removed

so often is that essential and necessary.

A lot of tonsil and adnoid inflammation is because of mouth breathing. So when we breathe our mouth, we take in unfiltered air and the first thing it's hitting is your tonsils and adnoids. So we know there's research actually that if we can get the mouth closed, breathing through our nose, they can shrink.

If we expand, they can shrink. But if we remove tonsils, adnoids and continue to mouth breathe, they will regrow. I have seen kids that have come in that have gotten them removed and they're back. That's because again, we're not looking at the root cause. The reason kids are getting them removed is because we're not looking at the big picture

and historically, that was the first line for pediatric what's called sleep disordered breathing, which is the precursor to sleep at me.

“So that's what, you know, if you go the traditional medical route, that's the first thing”

they're going to recommend.

Let's take up the tonsils and adnoids. And then what happens is the snoring sound goes away. The mouth breathing doesn't go away. The structure doesn't change. The sleep architecture really doesn't change either.

And so then we haven't solved the issue that we came in to solve. We've just gone through a surgery that is now not going to work. So again, it's got to be a comprehensive look at the airway. Yes, the tonsils and adnoids are a part of it. But so is the size of the palate, what the tongue is doing, are we mouth breathing, even

like vitamin deficiencies? I mean, it is comprehensive the stuff that impacts sleep.

Unfortunately, our medical system is so isolated, that one person's just like, let's

just take these things out. So it's really not the end all be all. And I, most of my clients are ones that don't want to remove tonsils and adnoids. They want to look at the root cause. And so they're coming to me a lot of them because someone has recommended that they get

tonsils and adnoids removed and they want to know what are the alternatives. I want to make sure that we can secure our appointments after this episode.

“Yes, I get, can we, like, be out of, like, secret ones?”

I'm, I think a lot of parents are going to have an aha moment just from all the knowledge that you've shared, but I just want to make sure that we're, like, on your own. Absolutely. We have feelings. And last thing, for if someone is not in the Houston or Texas area and they're

looking for someone who's specialized like you, what should, what resources should that make sure. Yeah. So a couple of things is, and if you go to my site, Dr. Pia, got me.com, all of those resource pages are there.

And also what's on there are a list of red flags symptoms to look for in your child. So if you're wondering, or if you're not sure, that's a great place to start. But airway health solutions has a directory of practitioners that have trained with them, which is, I teach for them. So expansion for, and that's for Pediatrics and Adults.

The airway circle is more of a malfunctional resource, but on that site is also dental practitioners and surgeons. And then the Breathe Institute, which is where I've done most of my training, they also have a nationwide, actually it's international directory. So those are great places to start.

And you have a show. I do. It's called the Pediatric Breathing Project.

“If you want to take a deeper dive and hear more about it, you know, we do bring in, like”

the chiroes and the myos. So you can hear more about those specialties and how they play a role in all of this. And then also just our practice website has a lot of educational videos. I loved interviewing you. Thank you so much for everything that you've done with my kids.

I'm just so appreciative to you to come and spread this message. It's so important.