Katie The Traveling Lactation Consultant
Katie The Traveling Lactation Consultant
Ep 15 Dr Maggie Davis
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Dr Maggie Davis is a Pediatric dentist and also owns Florida Tongue Tie in Palm Harbor. Her training and expertise are guided by her personal experience with her own son's tongue ties being missed. Due to that, Dr Maggie has created the Florida Tongue Tie center in order for multi-discipline specialities to be able to collaborate for best possible outcomes for all TOTs kids.
Podcast host: Katie Oshita, RN, BSN, IBCLC has over 22 years of experience working in Maternal-Infant Medicine. Katie is a telehealth lactation consultant believing that clients anywhere in the world deserve the best care possible for their needs. Being an expert on TOTs, Katie helps families everywhere navigate breastfeeding struggles, especially tongue tie and gut/allergy related issues. Email katie@cuddlesandmilk.com or www.cuddlesandmilk.com
Disclaimer, this content is meant for information only and not as a diagnosis or medical treatment for any condition. If you or a loved one needs help, please seek out a qualified medical professional for assistance. Welcome to the podcast. I'm your host, Katie Oshta, BSN, RN, IVCLC, and infant feeding specialist. Quench your thirst for knowledge and travel with me across the nation to discover, learn, collaborate, and better serve clients from all over the globe. Let's ride and thrive together. Join me in welcoming Dr. Maggie Davis on the podcast. She is a graduate of the University of Florida College of Dentistry, where she graduated fourth in her class and was inducted into the Omicron Kappa Epsilon Honor Society. She completed her residency in pediatric dentistry, also at the University of Florida, serving as chief resident. As a former athlete, Dr. Maggie often volunteer coached children throughout college, and after going on three dental mission trips, she realized that pediatric dentistry was her true calling in life. She has now been in private practice at Pediatric Dentist in Palm Harbor, Florida, in the Tampa Bay for over a decade. She practices at Dr. Maggie Davison Associates and has opened a sub-specialty practice, the Florida Tongue Tie Institute, within her practice. Here she evaluates patients for signs and symptoms of tethered oral tissues and sleep disorder breathing and provides a laser, lip and tongue tie revisions from birth through adulthood using a light scalpel CO2 laser. At the Florida Tongue Tie Institute, Dr. Maggie works closely with orthodontist, who is formerly trained in myofunctional therapy and a board certified in sleep medicine. Dr. Maggie herself is a board certified pediatric dentist and holds her certification in pediatric tongue ties and lip ties given by the American Board of Laser Surgery. She is a graduate of Dr. Richard Baxter's Tongue Tie Academy and Taughts Tethered Oral Tissue Program, as well as Autumn Henning's Plot the Talk course. Dr. Maggie is an active member of the Academy of Laser Dentistry, American Board of Laser Surgery, International Association of Tongue Tie Professionals, the AIATP, Tampa Bay Birth Network, and a member of the Tampa Bay Cleft and Cranial Facial Center, and a council member of the local YMCA. In Dr. Maggie's spare time, she enjoys the outdoors and time with her family, including her three young sons. When her first son was born and had difficulty nursing, her passion for learning more about tongue and lip ties began. And down the rabbit hole of never-ending learning, she has fallen to continue in multidisciplinary ways to help her pediatric patients. Dr. Maggie established the Florida Tongue Tight Institute as a way to collaborate with providers from multidisciplines to receive the most optimal outcomes for children with TOTS. Please welcome Dr. Maggie today.
SPEAKER_01Okay. I mean, I think it's always a good introduction to kind of know like your background. And one thing we didn't talk about much was even just as a provider, all dentists should be screening and looking at airways. And that's one big thing about our practice as well. Because with my son who was tongue-tied, there was it's there's also other factors. And we struggled with sleep apnea, all these things, several sleep studies, you know, just giving a short version. But now too, I don't know how much you've talked with providers about like myobrace and just the myofunctional therapy, things like that. So just knowing just you know, more providers should be able to help recognize and screen for things because this is, you know, he's my tongue diabetes, he's my baby that didn't sleep, my baby that had sleep apnea, and he's gotten better each step of the journey. But I imagine what kind of kid he'd be if he didn't have a medical mom and dad, you know, to help recognize things and get him the treatment. And now, you know, we're working on things with my obrays. He's my jeweler, he's my stutter. It's interesting, all these things kind of come together, but with the right therapies, there's huge strides and you know, tough of his class with things, but you know, just every day working on things. But I'm grateful to have met different providers along the way. But the tongue tie kind of started it all with him. And even my first baby, too. You know, we had some, we had issues with it too. And that's what set me on the journey of like learning more. But with my second son, I was able to recognize it, you know, right away and get him that help and then get you know additional help.
SPEAKER_00But you're right, it shouldn't be, it shouldn't even be really about the tongue as much as just airway. Like we just need to focus on airway. And if we if we are evaluating good airway, then we're evaluating the tongue and the palate and the nasopheronics and everything, right? We're looking at their sleep and but it just feels like airway is not addressed.
SPEAKER_01Exactly. That I mean, it's something we don't get as much of in our pediatric dental training residencies, and we should. Um, but as part of doing a dental exam, we're looking at mouse every day. And so that's something where we are the you know, a great person to be able to look in there and screen and look at Malin Potty scores and brodsky scores and make these um, you know, um note these things so that we can then ask a parent, does your child have this, this, this? Oh yeah, actually, it looks like we've been wrestling an alligator in bed all night. Um, you know, yes, there is snoring. Yes, there is mouth breathing, so that we can better recognize and then let them know I'm not the ear nose and throat doctor, but this is what I think you need to, you know, be your child's advocate. These are the questions you should raise to your pediatrician. And we do the pediatric, um, you know, dental sleep questionnaire, giving that that advice. And so often parents are like, I've never heard this from my pediatrician. And I thought we were just coming to check for cavities today. And I was like, well, no, this is important and you know, to go over these things. And um, oftentimes we'll get them on the right track, and then we'll see them two six months later and say, you know, how do we do it? And I'll say, Wow, Dr. May, we actually did this, and we went for a sleep study, and we found out we were having apnea. We've since gotten tonsils and adenoids out, and what a difference it's made that some of the ADHD symptoms, you know, have gone away, bed weddings gone away. So I really push for that. And, you know, all these things stem from passion that starts a lot of times with your own kids.
SPEAKER_00Right. It very much does. I think pretty much all of us in this world have pretty personal stories with it. I mean, there's the occasional exception, but for the most part, we all fell into this out of necessity and then dove in and went, oh my God, what a light bulb. Like, okay, it all makes sense. And then after you get into it more and more, then you start to wonder, and I try not to assign blame or anything else, but I do have to look back and go, where were the providers for my child or myself or you know, a client or something else? Like, why are we not getting this knowledge out there? Why is airway and the start of our GI system at our mouth? Why are those not number one? Like, we've had all this stuff in the last five years about our gut brain, right? I mean, gut, gut, gut is gut health is becoming this huge thing. You can go to Barnes Noble and see all these books on it. Everyone's talking about it, right? And everyone's talking about now the new phrase of your, you know, it's your gut brain and it creates your hormones and does all this. And I'm like, yes, yes, yes. Your gut starts in your mouth, right? Like your mouth starts, your tongue actually starts the parasoltic wave. Like, why are we not starting up here? It's like we just opened up our eyes to the gut, but we only started halfway through. Like how about starting at the beginning?
SPEAKER_01Yeah, exactly. And that's another fascinating thing that the more as providers, like I think what you're doing here is wonderful because it's opening our eyes to the different specialties and learning things outside of our formal training. And just exactly what you just alluded to learning more about even how it first starts and learning what feeding therapists know. If we could see through their eyes, we could better help these kids learning to recognize things. And we don't all have to be masters, you know, of these different specialties, but learning enough to recognize that and seeing problems and saying, you know what? I'm seeing X, Y, and Z. Just you know, do you notice that at home? Does your child, oh yeah, he's always done that? I didn't know that was normal.
SPEAKER_00Kids toss and turn and get up 15 times a night.
SPEAKER_01Yep, all those different things. And so when you can learn about other specialties and see it, you say, wow, my education is lacking. And that's where so many of us keep doing more courses because once you start seeing it, you realize how much you don't know about the overlap with the feeding therapy, you know, with lactation, with the airway, you know, or meeting orthodontists who are airway aware. It's amazing that so many aren't aware. You know, how do we think the mouth got this way to begin with? That we need to figure out, you know, why functionally, you know, this this got this way.
SPEAKER_00Oh, yeah. I mean, recently I have, and I'm I'm gonna do a whole podcast on this. Um, I'll record it next week, I think. But recently I've looked back in my own childhood and I've looked at it because I was looking at Richard Baxter's questionnaire on the adults and kids, and I was like, oh my God, like my whole childhood was on this form. I'm like, okay, had difficult breastfeeding, my mom got through it, but had horrible colic, right? She just talks about how I screamed and screamed and screamed, and I was never happy. I was a horrible sleeper. I went to bed, I grind my tea. I had enlarged tonsils and adenoids, and this one is really interesting to me because I'm like, I don't know if this one's too far out, but to me, it's like it makes the connections. I had such large tonsils and adenoids that they caused grandma seizures. Wow. Yes, I had seizures from the time I was about four to about seven until I had my tonsils and adenoids removed. And I had a neurologist and a pediatrician, and my neurologist felt that they were something else. My pediatrician felt they were definitely caused by the tonsils and adenoids. And this was, you know, I'm 43, so at a time when we really didn't address 10 time. I mean, I know Cotlow in New York was doing it, but nobody else really was. And so I had my tonsils and adenoids removed at seven, but stayed on medication until I was like 11, which was terrible. Um, which is a whole nother story. But yeah, lots of side effects. But they went away afterwards. But my tonsils and adenoids were compressing my airway. And I hadn't learned tonsils and adenoids from mouth breathing from the sun dye. So I literally had seizures and yet nobody was getting in there looking at my mouth, you know, and just all of these things and the headaches and the neck tension and all of this. And it's like, oh my gosh. And so now I'm in this journey for myself of okay, how do I do this this year? Do I, you know, how much therapy do I need first? And how do I get that because I'm traveling? And when is the right time for the release for me? And, you know, people they've been listening on the podcast know that both my girls have time we're doing the same thing with them, trying to figure out when is the right time for their release. But it's it's not an easy decision. That's one thing that's easier with babies. I mean, we talk about optimal timing of release with babies, but we're only talking about a difference of maybe a week. It's rarely, it's a rare situation where I say we need to wait a few weeks. Occasionally, if I've got a baby with like real severe, severe tortocolis, right?
SPEAKER_01Work through some things first.
SPEAKER_00Yes, then we'll do that. The most part, if I see a, you know, a two-week old, a one-week old, a four-week old, we're not gonna hold off. We're gonna get body work, you know, we're gonna schedule the appointment, it's probably gonna be a week out. We're gonna get body work before that, then we're gonna have the appointment and have the phonectomy.
SPEAKER_01Yeah, I mean, we want the appropriate timing so that all the therapists can be on board. Parents are well educated. But as we both, you know, are alluded to, the earlier they can have treatment in their life, the better, so that we don't have these compensatory mechanisms and all these other unwanted side effects that we're seeing with sleep, you know, with your story. It's a perfect example. And so I often have adults come to me and same thing, checking every box, you know, and we are optimistic, you know, about our outcomes, but we have to let that patient know there's some work that needs to be done here outside that our expectation has to be real, that we need to work with the orthodontists, you know, and talk about maxillary expansion, that you're not as pliable as you were when you're when you were a child. And so, and finding the right people that understand those things, we'll do sleep studies and can get them the help they need, you know. But ultimately, if we can screen and get them seen when they're a child, much better outcomes.
SPEAKER_00Oh, yeah. I mean, I spent six years in speech therapy and still, I don't know if you heard it a second ago, I can hear it when I do it, but I have trouble with R's and L's, like girl, world, those types of words are really still challenging for me. And I don't think other people pick up on it as much, unless there's someone like I have a friend whose kid went to a lot of speech therapy. Yep. She she hears it. Um, and I always hear it in my own head, but it's not terrible. But yeah, it's six years of speech therapy. Like, what would it be like if we had known?
SPEAKER_01Exactly. The results you could have gotten faster, and you just think about the time, the resources. And we were talking earlier today, as you know, you were shadowing around the clinic with me, that yes, we want all of our patients to see the right therapist, but we also have to put ourselves in their shoes. And sometimes they've already gone down roads like that where they've been in speech for two years, and that's a lot of financial strain on that family.
SPEAKER_00Time, driving, commitment, turning down other things they might not have been able to do, whether it was work, family, fun time, like it was a major commitment. And sometimes they feel like they got nothing out of it, right? It didn't change anything.
SPEAKER_01Yeah, exactly. And getting pulled from school. So, you know, this morning we had a family, it was four-year-olds and just under one-year-olds, and that now seeing the you know what's happening with their four-year-olds, they were much more, you know, um excited to have treatment because they said, although we're we've made it through feeding mama, good supply throughout, and you know, oversupply made through. We talked about the repercussions, and she said, You don't have to tell me, I'm seeing it with my four-year-old. And I only wish we would have done treatment when he was younger because we've been in therapy for three years, not really seeing the progress. And then it finally took a speech therapist to potentially recognize a tongue tie and to get them here to see us. Um, you know, and now we're talking about how we're gonna successfully do treatment on a four-year-old and starting Mayo and kind of retraining that tongue and preparing them to have the tongue release. Whereas the little guy, we were able to do treatment right away and he's, you know, we're optimistic for outcomes for both of them, but he's gonna have much faster results and not have to have gone through all those years of speech and all the financial and time restraints that the family has been frustrated with with their four-year-old.
SPEAKER_00Exactly. I mean, you think about too, just how different body work is on a four-week old versus a 40-year-old. Like, you know, I've been holding my body a certain way my whole life, and and there's compensations that I do. I mean, I've had shoulder surgery, so I move differently than I used to, and all this type of stuff versus a baby that's been alive four weeks. I mean, they have some stuff from being in utero, but their body is so much more pliable. Yeah. And I'll tell parents it's like they're they're like play-doh, like they just accept suggestions and movement suggestions so much easier from chiropractic care than adults can. And not that chiropractic isn't beneficial for us, it is, but it's just not as fast. I feel like the results aren't there. And that's something I tell parents too. It's like the results should be there fairly quickly for a baby.
SPEAKER_01Yeah, and we were having that conversation today that just the fascia is so much more responsive. Yes. I mean, that's that's why babies, you know, yield so well and so quickly. And the fascia response. And families have said too, you know, is this something, you know, will I have to go to body work for months and months, or the results we see, will they just come back? And it's no, we see it much quicker in kiddos because that tissue responds well and it remembers. Um, and we do that along with a tongue tie release, and things can function properly, and things are, you know, in harmony and in balance, as opposed to carrying these poles and these asymmetries for years. Right. Yeah, they're hard to unravel.
SPEAKER_00And there's a lot that the parents can do too. I mean, I'm always teaching parents that I work with, sucking exercises, rhythmic movements, things that they can take ownership for and do because you know, they're in this and they don't want to just have the baby have the phonectomy and then go to body work once a week and they're like, well, what do I do the rest of the time? There's like 60 feedings a week, you know, and I'm there for one.
SPEAKER_02Exactly.
SPEAKER_00So I'm like, there's a lot of work that they can do because they're the ones there.
SPEAKER_01Yeah. I feel like good providers in all specialties are ones that can empower their patients and educate them so that they, you know, yes, they're the ones that are with them so often. And I was explaining that this morning too, that with my son with speech therapy, we didn't see results as quickly until the whole family got more involved. And all, you know, you can't just expect, you know, you pay for something for an hour and you think that's going to solve everything once a week. You have to practice these things at home, make it a part of daily life. And the same thing goes for feeding, um, for lactation. So, whether we're talking about a one-month-old or a 12-month-old, is making sure these are habits that we are enforcing at every meal and all family members are on board, grandparents and and everyone.
SPEAKER_00Yeah, it's it's a commitment, you know, and and at my end, it's different than it is when you're working with a child or a teen or an adult. You know, I'll tell the parents it's usually, you know, I'll say four to six weeks. It depends. Some babies do really well, and by three weeks, they're at their new normal, and we can, you know, really wean down on things. Other babies, you know, that six-week mark is is still a little bit iffy. The older babies when they're really having trouble and stuff like that, but it's a good guide. But it's it's different as an adult, right? I feel like I wish I wish someone would tell me, okay, if you do four myo treatments, you get your tongue done, you'll be great. And I'm like, oh, find me up, right? Like I wish. Yeah. It's not going to be that easy.
SPEAKER_01Yeah, it's going to take a little bit more time, you know, for all this thing to happen. But you're the perfect person with the perfect resources. And I know you'll be committed to doing it. But again, going back to if we can screen and calibrate so that we can be catching these kiddos right away. I've heard many people talk about it, but in the hospital system here in the US, I wish we could do a better job of screening.
SPEAKER_00But again, we don't have pediatricians, not like Brazil has their screening tool, but I don't know that we're there yet. We don't have, first of all, we don't have universal acceptance of tongue tie being a problem, of being of occurring, of it even existing. There's still so many, especially pediatricians, but ENTs and other medical providers out there who really won't accept that tongue is a condition and that it can have full body ramifications and lifelong consequences, and they're just not going to see it. And so I feel like that's number one is we have to have buy-in, right? You have to have everyone accept that this is something. And we don't all have to agree on treatment. I mean, for example, if you think about hearing loss, right? We screen babies for hearing loss in the hospital. We don't all agree on treatment. Sometimes they get cochlears, sometimes they go to sign language, which depends upon what the family thinks. It depends upon that, you know, if the family has any experience with deaf culture, it's, you know, it my husband taught sign language for 15 years. So, you know, I know some of that stuff, but it depends, and that's okay. It doesn't have to be a universal, okay, you have this, we'll give you this. I'm not looking for a pill or a fix, but everyone universally accepts that if there's, you know, this test comes back, there's hearing loss, and that we should address this in some way because we know that early intervention, no matter which path we take, leads to better results. Right. Well, here we have something that is very similar. If we have early intervention, we will have better results, no matter which which path we take. If we choose not to release and we choose to watch and wait, and and you know, maybe they're feeling like it's it's not impacting that much. There's an obvious anatomical tie, but we don't have a lot of functional issues yet. Okay, we wait, we watch, we assess through time, it's noted, and we just see that's fine, that's appropriate medical care, right? Like if there's no functional loss, what are you fixing it for? But it would be nice to have that, you know, that early intervention for those who are having functional loss right away.
SPEAKER_01And I think one of the best ways to get there with the medical field. I mean, I'm a scientist, you know, first. Um, I'm in a house and my husband's a physician, and we always talk about anything that we incorporate change in our life. We buy a new vacuum, we, you know, we we get a new car. What are we gonna do? We're gonna do our research. We want to see the facts, we want to see evidence. And so I think anyone who is involved in tongue tie procedures and specifically dentists or ENTs that are delivering care, we need to develop better ways to track our results. I'm not saying everyone needs to have an IRB-approved study. It's hard to do when you're balancing your private practice and your family life. But our practice here at Florida Tongue Tie Institute has evolved is just even our intake forms, our follow-up assessments, having pain scales, having weights, having some measurable tangibles so that we can look and see are we doing things the right way? Do we need to do our post-op stretches differently? Do we need to, for example, I I've learned over the years too, some babies who I maybe was maybe thinking more conservative, the symptoms, maybe I wasn't looking at all the right things 10 years ago. That now when we screen, we're looking at things, and that babies who I said, well, let's go follow up a lactation, let's see how we can do. And the lactation consultant, you know, having good communication with them, gets back to me and says, You know, Maggie, we're we've done this, this. I'm just hitting a wall. We we just can't. And yet doesn't look the most severe, like the ones the pediatrician will see, but that class two posterior tongue tie, and we say, you know, we've tried this, this, it's time for treatment, and then seeing amazing results. And so you're trying to do right, you know, by your patients and Be conservative, but just like the same tongue tie in one child to the next can you know show different symptoms. And so if you're not looking at that quantitatively and seeing which symptoms are there, then it's hard to learn from your mistakes or recognize. So if we can have more data to look back and see, then we know, okay, just because this baby isn't showing this, this is still an indicator for it. And we saw weight go from this to this, we saw pain go from this to this. This is better evidence that we can then use, you know, for pediatricians and the like, um, you know, and even amongst our own field in dentistry to help show that there is true data that shows this, that it's not just anecdotal. So I think if there's any opportunities for any of us to do research, that I'm also part of a craniofacial team, and you know, we're trying to build a study so that you know it's hard working with babies. And it's hard to do a sham, not to, you know, say, oh, we did a tongue tie, and then the mom goes, Well, I don't see anything. So it's hard, you know, to develop these studies, but so that we can have that information, you know, at our side so that we can go up to that to an anti herpediatrician and let them know, no, this is proven benefits, um, and this is the appropriate time for it. And we get better results, those who do follow-up, those who are doing their stretches, those who are also involving other therapists like lactation or infant feeding specialist. So I think that's the biggest area where we as a whole need to improve.
SPEAKER_00Yeah, it's it's a very hard thing to get the research, though. I feel like, how would you possibly withhold a phrenectomy knowing that it's you have a mom who has bleeding nipples and you're gonna be like, okay, well, you got put in this one, so you're not gonna have the phrenactomy today. And it's like, wait, what? Yeah, but I know that it could help, and you said it could help. And yeah, because I'm part of the study, it's not, you know, it's ethically as hard to withhold. So I do think that working with, you know, infants really does challenge the the ethical, you know, issues of the study. So you have to kind of look at that, and you're right, we have to, you know, sometimes we just have to keep rate and all this type of stuff because that's what we can do right now. And I know that there's research happening. I mean, Dr. Geharry's doing some. Dr.
SPEAKER_01Baxter.
SPEAKER_00Dr. Baxter's doing some. I know Melissa Cole is a lactation consultant in Portland. She's doing some with Dr. Geharry. They're trying to work on their post-exercises because I see huge variations there. I mean, I've seen providers who want you in there every two hours around the clock for a few days and then every two hours during the day. And then I see providers who are like, no, we're overdoing it and we're creating scar tissue. And it's and I understand the you know, the the negatives of overdoing too, because you especially with the breastfeeding baby creating an aversion and creating scar tissue. Scar tissue is very unforgiving. But I think it's most confusing to parents because they're just not getting clear answers. And this is this is muddy waters, tongue-time world. I feel like for parents, so overwhelming. You know, it's like I will meet with them and say, okay, hey, this is what I'm assessing, this is what we're doing, this is why. And we'll talk about, you know, what are the functional losses and what is, you know, baby can't lateralize. We're not moving the tongue side to side. It's not elevating, we're not getting it up at all, we're not extending, we're not cupping, and we'll talk through these things. And then they go to the pediatrician the next day and they come back to me and I'm like, so how are things going? And they're like, Well, the pediatrician said there's no tentiness. Okay, but the pediatrician suggests, well, they said we should start supplementing because my milk doesn't have enough calories, and that's my baby's not gaining, or something like that. I'm like, hmm, interesting. Okay, did they assess the baby? No, okay, so it's very muddy water. These poor parents are so overwhelmed, sleep deprived, and all they want is the best for their baby, you know, and it's not very clear. And to some degree, you can find that in medicine, right? You could there's always some differing opinions.
SPEAKER_01Yeah, exactly.
SPEAKER_00And I understand that, but this this does feel like a very muddy area.
SPEAKER_01Yeah, I think I we try to spend an adequate amount of time with patients so we can kind of help explain those differences and learn that child and see them for follow-up and explain to them, yes, we don't get the exact same result for each baby that three times a day or four times a day with the post-op stretching, but explaining to them the rationale of why we're doing it and what we're trying to achieve and tell them it's more about the quality of what we're doing. Like this is what we're trying to achieve for you guys. That might be four times a day. For you, that might be six times a day. But for me in our practice, I try to listen, you know, I see these children back for follow-up, but I also communicate with the providers that either they've come to me already with or that I've set them up with, so that we can say, you know, how's you know, baby Z doing? And say, no, I I think eight times a day, too much for this child. You know, we're having a harder time with latch, and there's still seven days. And then when we back things off, aha, there's our magic number. Or some babies, we talk about unique bodies heal differently with the scar tissue. And so I think just continue to be a part of the process to see them for follow-up, to make sure they're with the correct providers for follow-up will help. And then, at least amongst the dental or pediatric dental worlds, I think whenever we can collaborate and via meetings like the Academy of Laser Dentistry, Laser Study Club, all these things are great resources for us to talk openly about, you know, what works for you, what doesn't work, and sort of hone those things. But ultimately we're all going to have little differences, you know, at the end of the day. But if we can explain our rationale to parents, I think it makes it less confusing, yeah, you know, for them. Just like this is the end result we're trying to get. It might be a little bit different for you to get there versus someone else.
SPEAKER_00I think one of the things I've seen in my practice that's been very beneficial is incorporating sucking exercises and movements. And thinking, you know, I will tell parents those post-care, after care stretches, wound care, whatever you want to call it, the part that the release provider told you to do, that is like a band-aid. We're gonna rip it off, we're gonna do it fast and easy, we're like getting it out, you know, just get it done however many times, as you know, because I generally try not to contradict release providers. I wasn't the one doing the release, if that's what they're gonna tell them, because I have clients in different areas throughout this country, and I'm not gonna generally go against that unless they were given no post-care. And then I will step in and say, okay, this is what we should do, and we should do something. But I think what balances it a lot is having the training to do the rhythmic movements and the sec training. Because if I'm getting in there, even if I am getting in there six times a day, but it's only for five seconds, but I'm also getting in there five times a day, four times a day for two or three minutes, and we're playing and we're doing fun things with our mouth, and mommy's making funny faces at us, and we're singing a song and we're turning it into a game, right? Then we get less aversion. That's what I see. And I see when we turn it, when we make sure that we have fun connection too, that it's not just, hey, I'm gonna come over and stick my hand in your mouth right now. Like now we're gonna, and like I have, and I'm sure there's lots of different ways, but with my clients, I will have them start their sucking exercises, usually, especially the first week outside, right? We'll start outside, we'll start touching the cheeks, we'll connect with baby, we'll make eye contact, you know, we'll start maybe singing or talking to them, then we'll move inside, you know. And I explain to them it would be kind of rude if someone walked over and stuck my hand right in your mouth and didn't even say hello.
SPEAKER_01Your first response is protective, you know, and tightening up.
SPEAKER_00You know, I say that, you know, babies can't give consent, but if we come over and we massage their cheeks and we start talking to them and then we move into their mouth, it gives them a warm-up, it gives them a chance to know, hey, this is coming and this is gonna be safe and pleasant. I'm not gonna hurt you. We're just gonna hang out and play. And so I think that makes a big difference. Like in lactation world, you having the training to do the oral habilitation and do all of that, like you have to rehab the mouth. You can't just, I'm not working on latch that much with my clients. Like, we'll work on it a little, but really what we're doing post-tenta release is is much more oral.
SPEAKER_01We have and we talked about this earlier, but I'd love for you, for those listening, what are your recommendations uh for lactation consultants to have that best training? And where did you find you learned the most?
SPEAKER_00So I started my journey with a structure and function class, which is from More Lactation M O H R. And they're based out of California. It was just a small two-day course, and it got me understanding oh, reflexes and oh, look at this tension. What is tension? It has that, and that was kind of one of my little, oh, I'm gonna jump into this, but it wasn't until I took the IBCLC masterclass that really gave me a huge wealth of knowledge. And it's done so much more than that because it's also given me a network of other providers who have taken the class. There's a Facebook group. So constantly we're on there and we're saying to other, you know, master class trained IBCLCs, hey, have you seen this? I'm seeing this with these clients. What do you, you know, what's your favorite exercise for this, or what do you like to do with this? So it's that networking too, and the the constant learning where somebody, you know, yesterday posted, hey, I saw this new study. What do you guys think about this? Right. So it's that, but that class was it was 30 units, it was a big one, but it was huge because it was also taught from other modalities. There was Sandra Colson was teaching the Mayo, Sharon Vallone was teaching the body work section. She's a great chiropractor that works with Jennifer Toe back in Connecticut. Then Brina Sampey from Portland area was teaching all about the reflex integration. And then Jennifer Toe was doing the breastfeeding. So there was a lot of collaboration with the four of them, and that was that was practice changing, I would say. And I've taken, you know, the untying Anchoraglacia from Dr. Harry. I'm halfway through the Tentai Light from Dr. Baxter. You know, I read all the books that can get my hands on everything from Jaws to, you know, shut up. What's the close your mouth, save your life? Yes. Ten tie book and sucking skills and all of it. Like I just want to know. And like if I could only just like put the books under my pillow and like absorb it now, but there's not enough time. There's not enough time, but it's it's what I do. It's it's all my time. But I would say that was the number one most changing for my practice. Absolutely. Because it gave me not only the understanding of what was happening and why I was seeing these things, why was I seeing Torticalis more often with Hentai? Why was I seeing, you know, reflex more often? Why was I seeing these babies that maybe their reflexes weren't integrating or they were integrating too early? But not only did it give me the understanding, it gave me practical. Like I have a huge stack of exercise cards. And so people will say to me, you know, what exercise would you do for this? And I'm like, I've got like 10 exercises that can work on elevation. I would want to put my hands in there or watch you do something and be like, okay, let's let's see what you need today, right? And what will baby do today? Because like I had a baby last week that wouldn't lateralize. And, you know, mom was trying. We were going back and forth during the lateral. And I said, let's try this. And so I said, What happens when you put your hand in there? Because he's four months. And she's like, Well, he just wants to chew. I said, Perfect, we're gonna go the chew stuff instead. So we put our finger in and he's chewing and he's reaching and trying to get right. So he's still lateralizing, yeah, but to him it's a game and he's chewing on our finger. So it's more about figuring out what exercise works for this baby today, and then I change them up every week. It's it's like asking a physical therapist after surgery. They're not gonna hand you a list of all their exercises because you don't need them all. Yeah, right. You need focused ones that work for your body right now.
SPEAKER_01And I see the exact same thing in my patients with their postdoc, but you know, we have outlines, you know, for my older patients that can do Mayo. These are examples of exercises, but you may do great at one, and your child may not have any idea how it is. This is where you need a unique provider to know your child and see your child. And that's why we advocate for them to be established and have a relationship ahead of time so that way we can see what we're good at, just knowing the terminology of how to place our tongue. And so that way afterwards, okay, we know that exercise, so we can do this even during procedure on older kiddos who you know can know what you know, holding cave means, all that is extremely helpful to do a good release and also for their post-op care, knowing the terminology so they can do these things, but it might not mean anything for someone just to read down a list that to know what they're struggling with and to have someone say, Okay, we've you've mastered this, you keep working on this with mom at home. But I want you to help me do this, you know, and and make it fun. And if their child's having a hard time with it, okay, we need to practice when I need a more fun way to do this. And so that's why it's so important to have that relationship established ahead of time so that we can do the fun pediatric things that we do and tailor it to their specific needs.
SPEAKER_00Right. I mean, I think the having that relationship with providers is huge and they should be fun. Like one of your clients said earlier today, that they were going to a speech therapist, but it wasn't working well, and her son didn't seem to want to go. And then when they switched, he was having a lot of fun. And I'm like, right there, that's it. Like kids are really good at judging character and you know, judging just like being honest about where they're at, are they comfortable or not? You know, I tell clients all the time if they're going to a body worker that I don't know, I say, you know, we can research their credentials, we can see if they're, you know, pediatric and everything else. I said, but then go with your gut. Like, how does the baby do in there? Did they try to put the baby on a drop table like an adult? Yeah, or do they have like a little kid table with like an infant pillow to rest the baby on? Do they have breakables all over the office? Or do they have toys in the corner? Like that'll tell you what their comfort level is, right? You walk into an office and you can tell they've never had kids in there because they're like, oh my God, don't touch that, don't touch that, don't touch that.
SPEAKER_01Yeah, right. Kids are amazing at feeling that energy. And we feel that in our dental practice all the time. And you know, parents will say, Oh, I didn't think they could do this. I don't know why they're acting like that. They're being so good. So, well, they can feel the energy from your staff and the, you know, the training, the toys, like you said. And so finding that right fit and comfortable, they're much more likely to succeed and follow your recommendations. If they trust, believe you feel comfortable, feel that energy. And it's apparent right away, usually with kiddos when they're just running off to go play, like, oh, they're happy here. They're not clutching to their mama. Oh, yeah. And so that's that's amazing. And building that network is really important. We're talking about the difference in chiropractors and looking at their training, that thankfully it takes time. I I was, you know, in my first courses, you know, raising my hand and go, Oh my gosh, what y'all are describing is amazing. How do I get you in my community? And so it takes time to find those providers, but then also collaborate, motivate each other, um, you know, take similar courses and come back and share. I've been to courses and then said, Oh, I need to go to lunch, you know, with my lack teaching assembly that I work so closely with and say, you know, look at this cool new stuff that I learned, so that we can kind of be on the same page, excite each other to learn more and carry it back, you know, to each other. So it takes time, but it's worth it. And in most places, unless you're really far out, you know, you'll have something like that. You just might have to kind of dig a little bit and build those bonds and maybe help show them a course. I've had SLPs show me about, you know, podcasts or courses. And then here I am a year later taking those courses that they said, you know, that I they planted that seed with me. And so, same, same thing, you know, for us as dentists, you know, giving them that information as well.
SPEAKER_00So and it is hard. It's you know, it's it's challenging to stay up on everything and to find the hours. But, you know, like I told you, my kids are homeschooled, and there'd be days like we went to the library on Tuesday and everybody sat for three hours and did my kids did homeschool stuff and they were working on their projects and everything else. And then I was working on my classwork for three hours, and they're just used to that. Like, you know, if I'm not seeing clients, then I'm probably doing classwork, and it's you know, there's always something for me to be learning. Yeah, exactly. I finish one, and I'm like, oh, I've got like two more in the wings that I want to do.
SPEAKER_01The same way, you know, you pop those earbuds in when you're kind of between things or on your commute listening to things, and you know, those little 20 minutes add up.
SPEAKER_00And um, yeah, I know I love to listen to podcasts when I'm cooking.
SPEAKER_01Oh, that's perfect, right? But I feel like, like you said, every door that opens just opens three more, and it's exciting. But those are the people you surround yourself with, those passionate people, you know, and so you keep challenging yourself to learn more. Um, you know, and I feel that same way with the lactation consultants that I work with close to here and the in the speech therapist that I work with here.
SPEAKER_00Yeah. So we were talking earlier about how you will you see clients of all ages for release at the floor of Tunkai. So, how does that, you know, how is the practice different with different ages? Like what does the procedure look like? How does that change? And how do you kind of design that?
SPEAKER_01Well, we have different intake forms too. So we're looking at different things. The traditional, we talked about like with infants, we're using the CO2 laser. Most parents will, you know, have them get gloves on and show them like this is how we'll do stretches afterwards. So that's probably what most people are more familiar with doing. You know, you're using the laser and leaving that wound open. What really gets gray is once we start getting a little bit bigger, we start getting molars, it starts getting hard for parents to get in there and get under the tongue. And just based on experience, I've changed the way I practiced and you know, did tongue ties on two-year-olds 10 years ago. That seeing reattachment, you want the best for these kids. Um, you want them to have good results. You don't want them to think, okay, I did a tongue tie that it didn't work, it must not have been that. Well, now it reattached. It is the tongue tie. And so I talk it through with families on kiddos that are in that gray, like two to four, where you know, pretty much anyone, we could use a laser and and get in there and procedurally release the frenum, but can parent realistically manage that wound? Are we going to see reattachment? And so we'll talk about, you know, are you able to brush? Have you ever looked under the tongue? What have you seen? Oh no, we can't get in there. He doesn't let me brush. The speech therapist couldn't really see anything. There's a lower likelihood that they're going to be able to get in there for the amount of time we want them to, which is generally three to four times for up to three weeks. And then even beyond that, you know, we'll we shorten how many times you have to get in there, but still even up to the six-week mark. It's not as realistic for them to be able to get in there and do that, at least what I've seen in my practice. And I've changed how often I see kids for follow-up that I used to see them at, you know, one week or you know, seven, eight days. And now I've been a little more cautious in seeing them sooner, that you can still kind of open that area, but I'd rather catch it at day four.
unknownRight.
SPEAKER_01And if I see them and they weren't listening to the message and then the pre-op and instructions and all the videos and things that we've given to them, if they get home and or they come back four days and say, Yeah, we really can't do it. We haven't been able to get in there. It's like, ugh, okay, let me help you. And come get get the gloves on again, get over my shoulder. Do you see this? And then I'll say, you know what, I want you to come back again. And these are complimentary visits, they don't take a long time, but having them come back again because I want the best outcome for this child, and I want this family to share their success with others and it not be, you know, that doesn't work. You know, it's it was it's not time, guys. No, it works if we're doing the right post-care pre- and post-care.
SPEAKER_02Right.
SPEAKER_01And so we'll show them again and say, okay, I want you to come back and we're gonna do this again because I want to see this be successful. And so just being realistic with parents and asking them honestly how things go at home, trying it here in our office, seeing what they think, we get a good idea. And then and parents kind of even come to the conclusion themselves, yeah, that that's not gonna happen, Dr. Raggy. I don't think we're gonna be able to do that. I say, okay, well, then our other modality is considering a sedation, a conscious sedation, and we work with a great team of pediatric anesthesiologists, um, do them first thing in the morning and then come in, and so we're MPO for a little bit, but we will do the similar release of the CO2 laser, but what we're doing is we're using sutures and they're resorbable, but using sutures to get that wound to reapproximate. And yes, there is a little sacrifice in pulling those edges together. But when we talk about having, you know, some 5% sort of reattachment versus 50% uncontrolled, you know, reattachment, it's worth that trade-off to me and the experience that I've seen. Um, that the beauty of being a pediatric dentist is we get to see these kids. And we take photographs as they continue to get older. And so I've changed my technique, even with lip ties, you know, doing just a little bit more, not just up down with the CO2, but a little left, right, you know, and seeing reattachment. Um, and there's multiple factors, patients' healing, parents' ability to do the stretching, their follow-up care. Um, but I've changed things slightly, but over time to help prevent reattachment. But um, with the tongue ties, I've seen, you know, the better results when we get that primary closure done right after release using the sutures in that age range that stretching, doing the post wound care is not very realistic.
SPEAKER_00Or for older, right. But yeah. Today, like you know, older teens of adults, a lot of times you prefer a functional cranioplasty.
SPEAKER_01Yeah, and in that case, it's different because I there's a little bit more tissue. Sometimes we have some genealoglossus muscles involved that we, you know, need to kind of go after. And in those cases, um, you know, if if someone's cooperative to sit for sutures, you know, we we're not doing sedation on them, but I need them to be cooperative to get some good sutures in there again, so we have the best outcome. Um, but I would prefer them to not be sedated. Um, I'd prefer them to have had some speech or myofunctional therapy ahead of time so that they know the terminology of holding cave, um, different exercises for lateralizing, putting tongue to spot, because I'm going to ask them to do that multiple times throughout the procedure. So I can really see that anatomy come out at me and see where is it pulling. And we'll see more tension on the right side, on the left side. But that is a little bit more of an open wound that we do want to have closed. So, yes, for majority of our adults, I mean, it's one thing to have just an anterior, thin piece of fascia. But as most of us know, if there's an anterior, there's a posterior component. Yep. And the adults, many of the symptoms are the tension, the pain. And we think about all those floor mouth muscles that are connecting to everything else. And so to release those adequately, you know, I want them to hold cave and and, you know, release those some of those muscle fibers and not just do, you know, a superficial sip with the CO2 laser, but really get some of those deeper fibers, see how they're functioning throughout the procedure, and then we'll we'll suture, we'll suture that and let them know what you know for for about five days. I don't want them using their tongue too much, um, kind of, you know, resting that. So we keep those sutures there. But then after that, we're ready to take on those myofunctional exercises that we've been practicing ahead of time. And so that's when that takes over day five, and just kind of going at their pace, not pushing it too hard, but working to get to where they were. And then some that um initially, you know, we do sometimes feel that oh, my range of motion is lost. I could do this better before. But then we say, nope, give it time. We're sore, we're protective. This procedure that we had done, we have to give it time, get started on this mind function exercise, and we're gonna see. Okay, a couple of days later, we're back. Now here we go, we're beyond. But we do measurements as well. So that again, we want to have measurable data and see where we are to start immediately after the procedure. And then when they come back for their follow-up visits, so we can see you know what we're getting.
SPEAKER_00Yeah, it's nice to have those follow-ups and to be able to see what's happening later. Because without it, how would you know? That's what there's one release provider I've worked with that for a while, COVID wasn't doing a whole lot of follow-ups. And I was like, I'm seeing your clients more than you are afterwards. So it's like you have to listen, like this isn't working, and we've got to change this. And you know, I mean it it matters how much you see them afterwards because day of sure they can say, Oh, it feels so much better, or sometimes it's more, but oh baby's sleepy. They didn't really nurse after, you know, yeah, they got overstimulated and they shut down and they didn't nurse. That's okay. But you know, are you seeing, are you seeing them later? Are you getting are you getting feedback on whether or not it works?
SPEAKER_01Yeah, and I think we are as far as the release provider, we are just one piece of the puzzle. I'm not saying we do everything at those post-op visits. I am managing the wounds, but intervening, and and there is a certain level of trust, as with the DMD behind my name, that they trusted me to use the laser on their baby, they trust me for their follow-up. That if I see they're not following up with octation, they're not going to feed their not doing their myo, then I can give them again the push of this will not give you the results. We see over time, we get the best results when we follow our wound carefully. We see the providers pre-impose that we need to. And so when we still see, oh yeah, mom, you're still seeing that you're feeding better on the right breast and not the left. Remember, we talked about that body work. Okay, we're gonna call um, you know, our chiropractor here and see when they can get you in this week. You know, how can we help you with that? So they're, I feel like more likely to follow that recommendation rather than just leaving them out in the abyss. Um, thinking, well, I didn't need it for my first child. You know, I've done this before. Like, what can a lactation consultant teach me? It's like, no, no, no, they're huge. And I'm not trying to do that role, but I'm trying to recognize they're still struggling. Let me give you those names again. We had a mother this morning, a great example, bottle feeding, and said, Oh no, I'm I'm going back to work soon. So I don't want to make that hard transition. We're just gonna stick with a bottle. There's no reason you shouldn't see a lactation consultant that they are going to help you choose the right bottle, pace feeding, nipple sizes, all those different things.
SPEAKER_00Just to work on the oral function and exercises. I was like, that's a bigger concern for me right now than the actual, you know, like we if you want to bottle feed, fine. Like, and I can tell you in like five minutes how to go pick out a good bottle and we can talk about it. That's not that long of a thing. But oral exercises, that's what your baby needs right now. So yeah, even a non-breastfeeding parent still needs to see lactation because we're basically infant feeding specialists. So, you know, we should be the ones seeing for any infant feeding needs.
SPEAKER_01Yeah, and we can't all be masters of every you know profession, but learning enough to recognize and just having you here today was excellent. So fun to have it. And I think you know, the parents really, when they can see it and get in and give things the chance, it's like, wow, I didn't realize there was all that too. That I just learned 10 things. And so it's educating our patients, opening their eyes to that, being receptive to that.
SPEAKER_00It's been great being here today. Thank you so much for letting me shadow and watch you do releases and seeing your clients. I mean, I am learning so much by traveling and meeting with providers all over. It's really been so much fun.
SPEAKER_01Yeah, well, there's many people out there in different stages of their tongue tie journey, and so to hear you is very motivating, I'm sure, for them. And hearing different specialties, you you just learn how much more there is out there to learn and how we can collaborate together, you know, and make things better for our patients. So thank you for being on this journey and sharing it with everybody. Yeah, and I think it's it's awesome.
SPEAKER_00Thank you. It's been great. When you change the way you look at things, the things you look at change you. I hope that you enjoyed the podcast today and learned something new. If you know someone who would benefit from this podcast, please share.