#390 | Tongue Ties, Airway Health & the Long-Term Effects of Poor Oral Development with Hilary Fritch, DMD

I'm Cynthia Overgard, birth educator, advocate for informed consent, and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Show. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Hi, I'm Hilary Fritch. I'm a biological and airway dentist. I practice in Bozeman, Montana. I pretty much am doing airway all day these days with pediatric cases and adult cases, trying to help people sleep better and breathe better. Primarily, like, focusing on improving airway volume with orthodontics, talking about nasal breathing habits, myofunctional therapy, and biological dentistry from a more, like, root-cause approach. Just taking a look at everybody's mouth and what it has to tell us about their overall health. Super excited to be here with you guys. I've been obsessed with all the things that Trisha and I haven't known each other for a long time that she has to offer the world, and so this is really, really fun for me to be here today.

Well, it's super exciting for me too, Hilary, because you kind of popped up out of nowhere. I had no idea that you were doing this kind of thing, and as an IBCLC who sees lots of tongue-tied babies and understands a lot of what that means for their infancy and their feeding, but doesn't understand, I'm learning, trying to learn as much as I can about what the long-term consequences are of that. I was so excited when I learned that this is, like, what you specialize in because we all need to understand more how airway and oral function and mouth anatomy affects people's long-term health because it seems like it's a pretty serious issue.

Yeah, big time. Really serious. It's interesting to see, like, the gamut of age ranges when the little kids who are compensating in every way possible to try and function, but are seeing all kinds of ADHD symptoms and, like, bad behavior, trouble in school, headaches, you know, that kind of chronic fatigue manifests in different ways in children. But as they turn into, like, 70-year-olds, we're seeing high blood pressure, heart disease, Parkinson's, dementia, diabetes. Like, nasal breathing is so essential to good sleep and good overall health, so we don't stress our hearts out all night. And so the downstream effects of a tongue tie are wild because, you know, the tongue is the architect of the face. So if the tongue can't do its job growing the jaws forward and wide, then our airways get small, and then we can't breathe well at night. Then we don't get enough oxygen, and our sleep is fragmented. Every cell in the body is affected by that.

So, can we really just say that, like, tongue tie or restricted airway can be the root cause of so much of the chronic illness that we see in children and adults today? Like, if these things would have been corrected in their young life, that many of these people would not suffer, especially with things like ADHD. I mean, can you explain how that works? The link there, and how much do you think airway health can prevent something like that or fix something like that?

Yeah, 1,000%. A tongue tie can lead to these downstream health issues, and there was research in Brazil that proved it. So people with severe tongue ties had severe health issues in their 70s. Moderate tongue ties had moderate health issues, and mild tongue ties had mild health issues. And so, like, a big cohort of people were studied, and that was what they were able to show. What happens is the tongue being tethered down then can't have the mobility that it needs to grow the face forward and wide, and it's the tongue pushing on the palate that helps us grow forward and wide. So if we don't have enough room for our tongue, and we don't have a big airway, and we can't breathe through our nose very well, that's because the roof of the mouth is the floor of the nose. So if the tongue doesn't grow the palate properly, then the nose will be affected. Then we're going to be mouth breathing, and then the tongue can fall back in the airway and cause the oxygen to drop and the sleep to fragment, and so it's just all interrelated.

And then sleep fragmentation leads to less recovery in the brain overnight. More—

Yeah, like, you'll see the patient will be, like, in deep sleep, and then drop into light, and then drop into REM, wake up, then drop into light again, then try and get deep, wake up, and just, like, all over the place in, like, five minutes of REM, five minutes of deep sleep, and it's just all fragmented instead of, like, a nice big chunk of REM where they could have had a dream. And you talk to these patients. A lot of them don't even have dreams, or if they have a dream, it's a nightmare. And so back to your question about ADHD, what happens? You know when you feel jet-lagged and you're just, like, kind of, like, wired? That is overtired. And those kids that are chronically getting poor sleep are overtired and kind of wired, and then they just can't focus. They didn't get good REM sleep to consolidate memories. They can't focus because they're constantly in this parasympathetic state. They're not dropping into the sympathetic at night, and they're just, like, living kind of in a hyperarousal. So at night, we're supposed to drop into rest and digest, right? Parasympathetic. Really get that restorative brain health and body health. And if you don't get that, and you're just always overstimulated, then your behavior during the day is going to look like hyperactivity. So I'm a huge believer. Before we put kids on meds for ADHD, we need to be testing their sleep because I barely ever see a kid that doesn't have their sleep affected by airway. Like, the reason everybody needs their wisdom teeth out and braces is because they don't have proper jaw development. So if you don't have proper jaw development, then you don't have proper airway development.

So the fact that the vast majority of us need or needed our wisdom teeth out, is that sort of an evolutionary problem? Like, does that necessarily mean that if the wisdom teeth came out or had to come out, the mouth didn't fully develop? Or is it like, oh no, at this point in history, almost everyone has a mouth like that, even those who breathe well? You know?

Yeah, I mean, a properly developed jaw should have room for the wisdom teeth. So the caveat I would give to that is, at this point, we just pull everyone's wisdom teeth without checking if they even have room. Because sometimes parents will be like, "Hey, we were told to get these out. Can you take a look?" And I'm like, "There's a chance they're gonna have room. I would wait and see." But we don't really have a wait-and-see culture. We have a, like, get-it-out-before-it-causes-a-problem culture because they're easier to get out when they're little and the roots haven't formed and you can just roll them out. So I get that. But, yeah, if you look at ancient human skulls, they had room for their wisdom teeth and they had properly developed jaws and airway. So, I mean, in reality, if you don't have room for them, you didn't grow the jaw that you were meant to have.

What happened to our jaws?

It's modern life. It's tongue ties. It's lack of breastfeeding.

Lack of breastfeeding is a big one.

Yeah, it's like, you know, you guys probably know Weston Price studied this. It's a diet that's not nutrient-dense, and then once you're born and, if you're not breastfeeding or you're not chewing foods that require some effort, those forces, like, everything is, like, puréed and, like, those stupid puffs, like, melt in your mouth. It requires no jaw development or muscles, which leads to jaw development, in order to eat these processed foods that we eat. So if you look back, the royal families were the first ones to start having jaw development issues, and that, I think, was because everything was, like, soft and cooked and roasted and puréed, and maybe they didn't breastfeed as long either. They would, like, hire a wet nurse or whatever was happening, and so that was the beginning of it. But the biggest change really happened when baby formula came out. We saw epigenetic changes then that compounded with each generation.

Because of, not because of the formula necessarily, but because of the bottle feeding?

I think it's the bottle, but also the nutrition, the lack—

Yeah, the nutrient density is important, and then actually, when you nurse, you have to bring your lower jaw forward to latch, breathing through the nose the whole time, and the tongue's working, and the muscles are working, and they're learning a proper swallow pattern, and all of that myofunctional therapy that's built into breastfeeding that teaches the muscle function is what grows the face. So that is really essential with breastfeeding.

Yeah, let's just say that again. Breastfeeding is myofunctional therapy for the face. Breastfeeding is the most important exercise when a baby has a tongue tie. It's the most important exercise you can do to help resolve the tongue tie before and after correcting the tongue tie surgically. Would you agree with that? Like, breastfeeding is the best possible exercise. Everybody's worried about all the exercises they have to do after a tongue tie release, the swiping and the lifting and the pulling and the finger sucking, all this stuff. I'm like, just breastfeed more. That's the best.

Yeah, breastfeeding is like God's myofunctional therapy.

Right. Yes.

Yeah, that's essential. We're huge on breastfeeding in the airway world. Like, we just see a big difference. I had a little peanut in today who's nine. She was born in the NICU, wasn't able to breastfeed. Her mouth is so crowded. Her palate was, like, super vaulted and narrow. I mean, those kids are always at a disadvantage with palatal development and facial growth. So it's super obvious.

Well, how much of these high palates and abnormally shaped palates are related to genetics, or is it the embryonic development of the tongue in utero? Or I guess probably a little bit of both? And is a high palate ever normal, or is it always a problem?

It's not normal. It should be flat and wide, and it's both epigenetic changes. Because I'll see some moms who do everything right, but somebody in their bloodline didn't breastfeed, and now they have, like, they still have to intervene. So it's both things.

And a high palate is never, like, functional? It's always a problem, and there's always some sort of correction?

Nice and flat and wide. If it's high and vaulted, it's going to pinch the nose this way and this way, because the floor of the nose is the roof of the mouth. So that skeleton right there determines the nasal volume, and so if it's high and vaulted, it's also hard to get a good tongue seal because you got to kind of, like, fold your tongue to fit it in there. And so it's really hard to get a nice seal, and then your tongue can't, like, stay in the mouth like it's meant to, and it's gonna fall back in the airway more. So you really want to get it sort of suctioned to the palate, which is meant to be flat and wide and, like, suction-cup shaped.

Right. And so I see so many feeding difficulties in babies with high palates. Even if I feel like their tongue has, like, decent function, but I guess it kind of can't really have optimal function if they have a high palate because the tongue isn't doing the job of shaping the palate. But they have so many feeding issues as far as, like, gas and reflux, digestive discomfort, and that's because they swallow in a way that's discoordinated because of that higher palate. Is that correct?

I think so. I mean, you probably know more about that than I do because I'm not looking at feeding habits as much. But it's really hard to get good muscle function, so a lot of times we wait to do myofunctional therapy until after we've done expansion because you really need that width and those flatter palates to get ideal myofunctional therapy treatment. So it would make sense to me that you're seeing that in babies with feeding habits.

What's a way that a person could self-assess on herself or on her child?

So babies should have two to three millimeters of spacing in between all the baby teeth, so they shouldn't really be touching at all. So if they don't have that spacing, that's an immediate, like, jaw development issue. If you're seeing any mouth breathing, that's an issue. If they are getting, like, chronic ear infections or tonsillitis, or, you know, if they're having trouble breathing through their nose, or if they're a kid that gets colds all the time, usually those kids are mouth breathers, and the lymph tissue is swollen from managing a system that isn't set up properly. We're supposed to have air going through the nose all day and all night, and when we don't, it'll get the lymph tissue inflamed because they're not operating ideally. It's having to do extra work to manage a system that isn't working according to plan. So we also see teeth grinding is really common, delayed bedwetting. There's, like, dark circles under the eyes, and—

TMJ, that would be from the teeth grinding. The TMJ migraine.

Yeah, TMJ. I don't see as much in kids, although once in a while I'll even have a kid that's, like, clicking and has pain. But women are really, like, that turns into TMJ, chronic head and neck pain for adults. Yeah. So kids, it's like picky eating can be one, and a tongue tie is also. If you see that they have a tongue tie, then it's going to be hard to have good jaw development.

Yeah, I mean, it is kind of unbelievable if you start noticing, especially in men. I see it in women too, but I cannot not see it now when I see men walking around with recessed jaws and the unbelievable difference. And I actually will tell, when I'm counseling parents about whether or not to have a release, I will actually have this conversation with them, even though it sounds like it's aesthetic. It's not just aesthetic. It really is about the lifelong health of their son, but the aesthetic component is huge. I mean, a man with a recessed chin and a recessed jaw and not a strong jaw, their face is completely different than it would be if they had that release and the ability for the jaw to come forward and grow in the way it was meant to be.

Yeah. That part breaks my heart because people think, "Well, I just don't have, you know, whatever. I don't get that nice face." But really, like, you didn't get a nice face not because your genetics were bad, but because your jaw development and your breathing and your sleep and your airway was all, you know, improperly grown. So when we start to restore the jaw development, we can help bring the jaw forward and help widen the face and improve the cheekbones, like that whole mid-face development, cheekbones, and having enough forward growth to fill out these nasolabial folds and have lip support. That's all jaw development.

What can be done about it? Is there anything that parents can do? I mean, and what about the adults, like, for whom it seems it's like—

When is it too late, or is it ever too late?

It's not too late. I do expansion on 70-year-olds.

How do you do that? Is it physical? Do you manually do it with, like—

I use a removable expander. It's made by a company called Vivos. It has, like, it's like an old-fashioned retainer with the acrylic in the palate and little clasps on the teeth, and it has a little key that you turn to widen, and then another key that pushes forward. So we're remodeling the palate by cyclical loading and unloading on the bone, and so as you do that, you can help it start to blossom. But people do, like, MARPE and DOME and other things that, like, open the suture. So there's multiple ways to do it. I just, I like this non-surgical technique because it's really low-risk and we get results.

What about releasing tongue ties in adults? How do you feel about that?

I'm a fan. We have to do myofunctional therapy first to get the tongue strong because if you just release it, it can fall back into the airway even more. So I'll, and myo is shown to cut apnea in half. That alone, just getting the tongue strong. Once in a while, I see somebody with a beautiful airway and beautiful jaw development, and they still have apnea because their tongue at some point in their life just got weak and it's falling back into their airway, so the myo piece is really important. And then I let the myo make the call about when to get the tongue tie release. Like, I want her to say, you know, "I'm plateauing. It's nice and strong, but I can't really get it all the way up." And that's when we do the release.

Please explain myofunctional therapy.

I say it's like physical therapy for the tongue and the lips. So we're doing exercises to get the tongue and the lips stronger, and this whole region, it can stabilize the jaw. It's really nice. A lot of people just, like, don't know where to bite, and they're just kind of, everything's loosey-goosey. So to help stabilize everything, rewire the brain to keep the tongue in the roof of the mouth so that it automatically knows where to go, and you don't have to think, "Oh yeah, let me close my lips and get my tongue up." You want to teach the tongue to be sealed to the palate and all fitting within the teeth and kind of, like, pressed up against. It's mewing, basically. But there's exercises that you do, like, three times a day. It's involved because we really want to rewire the brain to get that nasal breathing habit. So it's all done in an effort to get a good nasal breathing habit and get a good tongue seal to keep the tongue in the mouth so it's not falling back in the airway.

So tongues can get weak over a lifetime, and then how do they get strong again? Why do they get weak?

I think, like, for those handful, a couple of patients that I've seen good jaw development, they were all, like, ranchers. They grew up homesteading, their families, and they, like, you know, I'm sure they were breastfed and fed a, like, traditional diet, and they have this beautiful jaw development. But I think maybe, let's say they get a cold one winter and they're mouth breathing a ton, and they just kind of get in a habit of mouth breathing, and then at night, all of a sudden, they're mouth breathing all the time. Happens a lot with elderly patients. And then their tongues, I think they just lose that suction. I know they weren't mouth breathing as a kid because they have a really square jawline, which you cannot really get if you're mouth breathing. Your face is going to grow long and narrow. I have a classic mouth-breather face, like just not enough bone under here and a higher angle right here. Like, a more square angle on the jaw means the face grew forward. So I'll see these, like, I have a 75-year-old with a really square jawline and just a really weak tongue, and somewhere along the line he just stopped having that seal. And maybe we don't value it. Like, I think back in the day, people were like, "Close your mouth. Breathe through your nose." Like, we knew that was important, and we've sort of gotten away from that. And I think, you know, when you're 30 and you start to mouth breathe at night and snoring, and everyone's like, "Whatever, it's normal, that's fine," and eventually it manifests into, like, you know, other issues. Then you start to realize, hey, maybe I got to get my lips closed. But if you have years of not doing that, then the tongue just loses its, you know, programming.

Is the main reason for an adult snoring that they are mouth breathing or that they have some type of airway issue?

Usually, it's mouth breathing. Some people can snore through their nose. I think it's, like, 15%. It's not a lot. But as the airway narrows, it's kind of like if you imagine a garden hose and you stick your thumb on the end, and it starts to pitter-patter. The noise of the water is different because you're narrowing that volume. And so if the soft palate or the uvula falls back, or the tongue, and it closes that airway volume down, or if you just have a small, some people have, like, their airways are like a coffee straw. Like, I've had patients who have, like, 0.3 millimeters of airway, and that's when they're wide awake and upright. So it's not going to take much for that to fall back, and then the tissue vibrates and creates a snoring noise.

And what can be done about that for adults?

So for adults, a lot of times just breathing through the nose, keeping the mouth closed can help. That's one, like—

Mouth tape.

Yeah, mouth tape. If you keep your lips closed and breathe through your nose, then it's more likely that your tongue is going to stay up in the airway, and then this tube that goes behind the, you know, through the nose, behind the soft palate, behind the tongue, and down into the lungs will stay open. Sometimes we make a mandibular advancement device, which is like a night guard that holds the jaw forward so it can't fall back. That's like a Band-Aid that doesn't improve the airway, but it maintains the airway that you have. We can do a laser therapy on the soft palate that just, like, tightens it up. It turns those collagen fibers from type one to type three, and just, like, tightens. It's kind of like the laser you'd use to tighten your skin on your face, so we can lift the soft palate and the uvula up. And then we can do orthodontics to try and grow everything forward and wide so that the airway volume improves and the nasal breathing improves. But, like, some people, I see sometimes, I'll see, like, 22-year-old guys who are really healthy, going to the gym all the time, and they test positive for sleep apnea, and we just put them on a nasal dilator and mouth tape, and it's a cure. You know, usually that's not a cure for everyone, but those type of people, it can be. So it depends. You really need to get a CT scan to look at where are the blockages, because sometimes we'll look in there and I'm like, "I know you can't breathe through your nose. It's all congested and inflamed. You've got polyps all over in your sinuses, so we got to get the nose open, or we're screwed." Basically, I tell patients there's four elements to a good airway, and each of them are a pillar that stands alone. So if one of them is a problem, you're going to suffer. So one is, does the nose work? Two, do you have enough room for your tongue? Is the garage for your tongue big enough, or is it hanging out the back of the garage? Three, is the tongue strong enough to stay up and out of the airway? And then four is, how big is the airway itself? So depending on each patient, we, like, attack each of those four pillars as needed to treat their breathing and their sleep.

And again, do you think most of this comes from not recognizing this in children and infants and correcting it early on? Because if you correct it early on, it can completely change the trajectory of how the tongue grows and develops. I have shared, I think, on the podcast, or at least I share with my patients all the time, the story of my two children, my first and my third, who were both born with exactly the same tongue. And when my first was born, I had no idea about tongue tie. Nobody was talking about it. She's 21 years old. Nobody was talking about it 21 years ago. By the time my third was born, who's 15, I knew about tongue tie. I recognized that his tongue looked exactly like my daughter's tongue, who is tongue-tied and was not corrected, and I cut his tongue myself when he was—

How did you do it?

He wasn't 24 hours old. I had sterile scissors because I actually, at the time, as an IBCLC, was doing in-office frenotomies with sterile scissors, so I had a little sterile scissor pack just at home, and he was sound asleep. And he did actually have his tongue up on the roof of his mouth, which was great, and I recognized that as that, okay, that's good. It's not severe. But I saw that little frenulum, and it was paper-thin. I mean, I could have, like, cut it with my fingernail. Yeah, so, so thin. And I just took the scissors and I snipped that thing, and he didn't even notice. He didn't even flinch. He didn't even wake up. He had no idea it had happened. And I put these, my kids, side by side now. I've made them do this because I actually want my daughter to address this now in her life, and I have shown them, stick out your tongue, like both of you open your mouth and stick out your tongue. They had the exact same tongues at birth. They recognized them exactly as identical, and his tongue is, like, a mile long. He can touch his nose. He can lift it. And my daughter can hardly get her mouth all the way open and can't get that tongue up to the roof of her mouth very easily, like that. So that's the difference. I mean, I'm sure there are a few other things at play, but I genuinely believe that if I had not released his tongue, then he would have a very similar jaw and tongue development as she did.

I've heard this story so many times from moms because they have the same thing where they didn't know, and then by the second one they were like, "We're having trouble nursing," and they address it, and then the jaw development happens naturally like it's meant to.

Yeah, so, and it's so easy when they're young. But it's, you know, tongue tie has become such, like, a fad that a lot of parents are just kind of resistant to it because they think they're being overdone. And I'm always trying to explain to parents that they are being both overdiagnosed and undertreated. Both things are happening. You don't need to cut every single frenulum. Like, a frenulum exists for a reason. It's there, and it's normal to have one. But you really need a good functional assessment of how that tongue is working to determine if it actually is impeding their, not just their feeding, but their sleeping, and is it going to have long-term effects? So most people are just looking at, like, is it causing a breastfeeding problem? But that's not the only thing to look at. It's also like, okay, feeding is going well, but I can look at that tongue and I can say this is, especially if you tell me that the baby is sleeping with their mouth open a lot of the time, I can tell you that that problem is going to just get worse and worse and worse, and you're going to have these downstream effects. And it's so much easier to deal with it now.

I heard a story that back in the day, midwives would, like, keep one fingernail long and cut it. I don't know. Is that true?

I've heard that too.

I can see why they would do that because they're so thin when they're first born. Not all of them. Now, the more complicated ones are the thicker ones where it's more in the back of the tongue.

Yeah.

Those are the really, those are actually the cases that I find the most difficult with feeding and have the most complications with feeding. The thin ones, kind of like, yeah, I guess, yes, you just snip them all because they're so thin and easy, and they're really holding the front of the tongue back.

Yeah, but—

I had friends, like, accidentally tear theirs when they were doing some fascia release on the skinny ones. But there's some that they call Eiffel Tower, and they're just, like, a fat—

Yes, yeah, the two legs, they come down and they attach on either side of the bottom, but—

It's all interconnected. You know, that fascia from the tongue goes down to the feet, and so sometimes when people get a release, you'll see, like, major mobility changes. Like, they can touch their toes, and these headaches go away or this back pain goes away. It's wild how our understanding of fascia, I think, is growing, you know, like crazy. But that being tethered right there is going to translate to the whole body.

Yes, that is something that I also find really difficult to explain to parents because it's just, it's a hard concept to understand. But sometimes I can see in these babies this constant splaying of the toes like this. Their feet are always tense like this, and I'm like, that's because they actually have this tension throughout the entire body, starting in their tongue, and their entire body is stiff. So many of these babies are just like rocks, you know. They're just, they don't have that relaxed rag-doll kind. Even after they've been well-fed, they can still be really stiff, and I don't see that so much in the babies who are not tongue-tied.

Do you see that correlating with colicky babies?

Absolutely, yes. I mean, I think tongue tie is probably one of the biggest reasons for colic. Like, that's just, to me, just a catch-all term. But if a baby has, if a parent thinks that their baby has colic, the first thing I'm doing is looking at their oral function.

Interesting. One of the biggest reasons that we talk about tongue tie in airway dentistry is from folic acid over-closing the midline, right? Especially, like, with MTHFR kiddos or some people that don't detox well. What do you think about that?

I mean, yeah, we've had, we have had this conversation with some other people on the podcast, and what my understanding of it is that the folic acid, the excess folic acid in our fortified foods today, is actually interfering with folate, the natural folate function. So maybe it's a folic acid overload, but more likely it's a folate deficiency because the folic acid is interfering with the folate doing its job, which actually makes perfect sense. And of course, we know that we started folic acid in pregnancy because it was meant to prevent neural tube defects, and tongue tie is of the midline. It is a midline defect or overgrowth or interference, and it's got to have something to do with the folate-folic acid imbalance. It just makes sense.

Yeah, and it's funny. I was in, like, a small town in Montana and looking in their prenatal section, and every single prenatal had folic acid instead of folate. I was like, "This is tragedy."

Yes. Yeah, this is still the norm. I mean, you have to spend extra money to get a prenatal, a lot of extra money, to get a prenatal that is made with folate instead of folic acid.

Nobody knows that. I'll tell moms that, and they're like, "What?"

Right, and their doctors, their OBs, aren't telling them that.

And their OBs won't talk about tongue tie. Moms all the time will be like, "I know they had a tongue tie. I told the OB, and she said, 'I'm not talking about tongue ties. I'm not looking at tongue ties,'" and so they just get, you know, shooed out of the hospital with no, "There's no problem."

OBs don't learn anything about that. They don't learn anything about breastfeeding. They don't really, really learn about pelvic floor health. They don't learn about perinatal mood disorders. The healthcare system in this country is very segmented and siloed, and that's the really difficult thing. If we had a little bit more of a holistic approach, it would be helpful. Or at minimum, conveying to women and young parents that you really need to hire a team of people in this stage of your life. We've got to stop having all roads lead to obstetricians. And if an obstetrician were really good and knowledgeable, as Trisha and I are in this respect, we would know who to point them to when people ask us questions and we don't want to presume to answer them. We say, "Look, go see a pelvic floor specialist. Go see an IBCLC for this." Everyone is going to their pediatrician or their obstetrician for literally everything from postpartum depression concerns to breastfeeding issues, and that's why they dismiss it. Even postpartum depression, they dismiss, or they just write a prescription. But that's really something that would make a really big change if everyone even knew that there are myofunctional therapists out there doing this. So many people would avail themselves of that resource, but they don't even hear about it.

Well, that's in dentistry. You know, most dentists are not talking about this. So the vast majority of dentists would be like, "Tongue tie?" You know, they might identify the most severe tongue tie that anybody could recognize and identify. It's the less severe ones, or the more posterior ones, or the ones that really require you to do a full history and evaluation and ask the right questions. Those are the hard ones to identify. And it sounds like airway dentists like yourself or holistic dentists, which are few and far between, are the only people who are really addressing this.

Yeah, we weren't taught anything about nasal breathing, nutrition, the tongue, toxins.

How could you not be taught about the tongue? It is like your heart—

And brain.

I don't know. I remember a doctor in dental school saying, "Your tongue will expand to fit the space that it's offered." Like, that was literally the only thing I remember about the tongue, and that isn't even true.

It's the opposite, right?

No, it's totally the opposite. It'll, like, overflow and create an open bite and create gaps in the teeth because it's, like, fighting for room.

Can you explain for everyone specifically how the tongue goes all the way down to the feet? Because if someone asked me that, I would say, yes, that's what I've heard. That's what I've learned. I know it somehow connects to fascia somewhere in the body, and all fascia is connected. And what the heck is fascia? Well, fascia is like that, that, I don't know if it's muscle or tissue, but that wraps the whole body, that holds us all together. But can you get very specific? Tell us about the back of the tongue and exactly where it goes because I want to visualize it correctly.

Yeah, I mean, so we have a lot of people who hunt in Montana, so I'll tell them, you know, when you're, like, separating the tissue, you can see that silver fascia in there. And so, like, even if you're, like, cutting chicken and you take the skin off and you can see that fascia, like, it's like a little webbing that attaches the skin to the meat. That is the fascia, and it's sort of like if you picture your body as, like, a Jell-O pudding, the fascia is, like, what's holding all the different elements together. So we traditionally think of, like, the bones being the things that hold it together, but the fascia is what's holding all of this Jell-O pudding together. And so the tongue is, like, a muscle and fascia and some nerves and blood supply, right? And so that fascia is, like, this tight little webbing that goes, like, you know, the whole volume of the tongue, but also underneath the tongue into this floor of the mouth, and then basically on the anterior part of the airway, the tongue kind of attaches low down in there. So if you look at a CT scan, it's, like, way down into here, and that fascia translates across the whole belly, legs, all the way down to the toes, which is why sometimes that tight tongue can cause pain on the top of the toe. So it's, it's like that pretty silvery webbing that holds everything together. And I think there's, like, an energetic element to it that we don't understand yet, how it carries energy and flows through the body, because I know when they do anesthesia, that fascia, some part of that fascia kind of dies during anesthesia when they put the body to sleep, and then it, like, lights up again when the body's awake. So I think it has something to do with consciousness, which might sound really woo, but there's, I think there's a lot more to fascia than we can even understand. But it's a, it's like a, it's like a webbing. You can picture it like that.

So it can lead to pain in the toe, and what do you mean a tight tongue?

So a tongue that's tethered down, like, if the tongue doesn't have the mobility that it's meant to have because that frenum is too tight, or sometimes it's tight in the posterior part of the tongue and it's, like, locked in place, so it can't move around like it's meant to. That fascia will translate all the way down to causing sometimes pain on the top of the foot.

Can you give exercises adults can do to test or see if they have, like, a healthy, strong tongue?

Yeah. Basically, if you can't have good mobility, sometimes I'll tell patients, like, "Can you do this? Point your tongue to the spot," which is that little bump behind your two front teeth, "and then open," because some people are like, they just can't even figure out how to do that. Or can you get your tongue pressed to the roof of the mouth? It's called the cave, where you, like, get it sealed up. If you can't do that, then we need to work on your tongue's function. You know, it's like when you were a kid and your parents were like, "Can you do this?" These tongue exercises are important for understanding: is the musculature weak or is it programmed badly? Do we need to, like, work on the function? So one thing that is a really obvious one is if kids get ear infections a lot. So a proper swallow will teach the tongue, when the tongue swallows and moves properly, the fluid in the ear moves, so it prevents stagnation and infections. So if that is happening a lot, we should probably look right away at tongue function. So there's some, you know, more obvious things, and patients are, most people don't have great tongue function, but once in a while I get someone in and I'm like, "Do this, do this," and they're just boom, boom, boom, boom, and they got it all, and their jaw's really stable, and they just know. Like, it's kind of like this part of their body's an athlete.

And is the same true for a weak tongue?

Yeah, like a weak—

Tongue can't do those things anymore, or what?

Yeah, it's like it doesn't know where to go. Like, a lot of times, kids that have a weaker tongue don't like to chew hard foods, and they're really picky about what they eat, and they sort of have this unconscious understanding that this is going to be a problem for me. I want something soft and easy. And they could have speech issues, so those, they kind of, like, go hand in hand.

Another really important thing is if the tongue isn't functioning the way it's supposed to with chewing hard foods, they also don't produce the enzymes necessary to break down foods well. Therefore, they're not absorbing the nutrition from the foods as well as they could, which is also a potential contributor to the correlation between tongue tie and ADHD. Poor mastification, mastification—

Mastication.

Mastication. Thank you.

It's a weird word.

See, that's that. Remember we were talking about the beginning? Those words.

Why are they not producing the enzymes? What, like, what?

Because if their tongue isn't functioning with the strength, the proper strength and rhythm to break down food, digestion starts in the mouth, right? That's where you first start getting your absorption of nutrients. So if you're not masticating your food properly, you're not absorbing the nutrition properly. It's not that you're not absorbing nutrition. Of course, they still grow and develop into healthy, functioning people, but you may be missing a lot of absorption of certain vitamins and minerals and nutrients that you would otherwise absorb if your tongue were working better. And then you add, compound that with the poor sleep, and you have a recipe for poor mental function.

Yeah, a lot of the kids are, like, skinny and underdeveloped and late bloomers. They don't have an appetite. Remember when they said, like, it helps to cook your food first, so it gives your body time, like, we're gonna eat. It starts to cue the proper digestive signals, so there is a lot of breakdown that happens in the mouth. If you're not chewing long enough, or you haven't taken the time to prepare your body for that meal, then you won't have the right enzymes in the mouth. You won't have enough acid in the gut, and then the digestion gets slowed down, and we get putrefaction. Digestion also massively affected by toxins, like one mercury filling can cause your stomach to not have enough stomach acid in order to digest your food. So there's, like, a whole lot of stuff in dentistry that can cause digestion issues.

Being a late bloomer, I always associate with being a positive thing. So what were you talking about when you said could be associated with a late bloomer?

I was, like, a really late bloomer. Like, my parents put me on birth control when I was 16 to help me get my period. You know, like, I don't know, remember when that was a thing in the '80s? I guess it was the '90s. But these kids are, like, underdeveloped, way too skinny, way too small. They haven't grown enough for where they should be. I'm not saying I want them to get their period at age 12 or at age nine. I think 16 is probably fine, but I was, like, I probably weighed 85 pounds and was really short. I hadn't, I was still kind of, had, like, a 10-year-old's body when I was 16, and I think because my sleep was so affected, I wasn't getting growth hormone release. So if you don't get good, the first, if you don't get to bed on time, you can miss your growth hormone. But if you also get really fragmented sleep, you can miss growth hormone. So your body just won't release that hormone as it's meant to.

Right. Growth hormone is only released in a certain time frame in the night, and you have to be asleep by that time to really get the full benefit of it. And that's, like, before 11 p.m. or something. And think how many kids are staying up till one o'clock, two o'clock in the morning, and then if they're sleeping with poor sleep quality, it's amazing actually how resilient the body is. They still grow up, you know, to be, I don't want to say healthy because we're a really unhealthy society. I mean, it's hard to say that people are healthy. Most people are not healthy. They are struggling with all kinds of issues. I mean, later in life, the heart stuff, but cancer and the mental issues, the amount of anxiety that kids today live with. I mean, I know there's so many confounding factors, screens and lifestyle and all that, but a lot of this has got to do with this and how they're sleeping and how they're absorbing nutrition and the lack of breastfeeding that started in the 1950s. We're seeing this massive downstream effect now. So, I mean, I'm really grateful that I'm seeing so many of these babies and can hopefully help them by getting them on the right track with breastfeeding and educating their parents about the risks of having oral tension. But I'm still evolving in my practice and trying to figure out how many babies actually need the release or don't. And it sort of sounds like from this conversation that if there's any question that there's oral tension or a high palate or a narrow palate or not optimal function of their tongue, a release is just going to only benefit them, and there's not a lot of risk to it. So—

Yeah, I mean, I'm really conservative now, especially with fillings and crowns, and my take on dentistry has changed a lot. I'm conservative everywhere I can be, but I am bullish on tongue tie releases because you'll see it, like your story. And then my mentor's kids, he had one of them released and one not, and one developed like they should, and one needed intervention. Even though they had some spacing in between their teeth and some gaps, and he saw, he thought they looked really good. He was just like, "I'm just gonna, I'm just gonna do it anyway," and it makes a big difference. So, and it's super obvious at this point in my career. Like, all these kids with really poorly developed jaws have tongue ties. And in childhood, they still, of course, because they're still young and their jaws are not fully developed, if you get them corrected at between two and eight years old, it's still going to make a big difference.

I mean, I'm seeing them between zero and three months. I'm trying to get these tongue ties corrected by three months of age because it's such a simple procedure then, and that is going to have these massive benefits. But it's still very worthwhile to do if they did miss that window, to do it as a toddler or a young child.

I like to see every kid at three. That's about as early as I'm able to intervene, and we usually use a tooth pillow-type appliance that helps them get the tongue to the roof of the mouth, positions the lower jaw forward, and makes them breathe through their nose, gets the tongue and the lips stronger. It's kind of like a four-for-one. And then we can do expanders as early as age four for a really symptomatic kid. So, yeah, I mean, I think everybody should have their kids' airway looked at by an airway dentist because really there's no other doctor that can help them with this jaw development except a dentist at age three.

So, can you just give us a list of, like, the top three to five things that a parent can look at in a young child to determine whether or not they need to see an airway dentist or if they are having airway issues?

Yeah, I would say any parting of the lips, constant mouth breathing. You want silent nasal breathing, lips sealed in the night. If they're a restless sleeper, they're rolling around a lot, that's a huge one. If they're grinding their teeth and they don't have spaces in between their baby teeth, then you need to have them looked at. Big spaces, like you could fit a quarter in between each tooth. Almost nobody has that, so that's pretty much every kid needs to get looked at. Also, like, I would just get looked at because if they say, "Amazing, you look beautiful," then yay, you know. But, like, almost every kid needs help. Even some that have spacing have a deep bite where the bottom teeth totally are hidden, and we want to help that because that deep bite will trap the lower jaw and prevent it from growing. So I'm a huge fan of just checking everyone. Like, I think every baby should be checked for a tongue tie, and I think every toddler should be, their airway should be checked.

And go to an airway dentist, not just your regular dentist, because you're not going to get the proper evaluation.

Yeah. The most important thing to think about in jaw development is the tongue is the architect of the face, and nasal breathing is essential to overall health. So we got to be breathing through our nose to get that nitric oxide and get that proper jaw development. So you want to be looking for good nasal breathing and good tongue function. Those two things are going to help guide the growth as they were intended to be. So nature's plan is breastfeeding, a good mobile tongue, and a really nice open nose.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.