Jen & Board Certified Airway Orthodontist & Owner of Foundations Orthodontics: Dr. Renee Moran

On today’s episode of The Ripple Effect, host Jen McNerney sits down with board-certified orthodontist and airway-focused provider Dr. Renee Moran, founder of Foundations Orthodontics. Together, they explore the powerful connection between jaw development, nasal breathing, sleep quality, and whole-body health—and why early airway screening can change everything for kids and adults.

In This Episode, We Cover

    •    Why orthodontics should be whole-health care (not just straight teeth)
    •    Dr. Moran’s personal jaw surgery story + the moment she realized she could finally breathe
    •    Signs of airway restriction in kids vs adults (and why “tired” can look like hyperactive)
    •    Common red flags: allergic shiners, bedwetting, scalloped tongue, gummy smile, long/narrow facial growth
    •    How early to screen kids (and why the growth window matters by around age 8)
    •    How CBCT/3D imaging helps assess airway + skeletal structure (“teeth can lie”)
    •    Why a team approach matters: myofunctional therapy + bodywork during expansion
    •    MARPE/SARPE + the shift toward slower, more comfortable expansion protocols
    •    The benefits of custom 3D-planned braces (precision, predictability, fewer visits)
    •    Tooth extractions: when they’re helpful vs when they’re a red flag
    •    Tonsils/adenoids: why Dr. Moran often recommends expansion first, ENT second
    •    Genetics vs environment: what actually shapes airway and jaw development
    •    Adults + airway treatment: how options have evolved and may be less invasive than you expect

Guest Bio

Dr. Renee Moran is a board-certified orthodontist and airway-focused provider, and the founder of Foundations Orthodontics. She trained at the University of Colorado on an Air Force scholarship, served as a military dentist, completed her orthodontic residency with a master’s degree, and was named Resident of the Year. Dr. Moran’s approach prioritizes airway, function, and long-term stability—helping patients breathe, sleep, and thrive.

Connect with Dr. Renee Moran / Foundations Orthodontics

Website: foundations-orthodontics.com
(There is also a “Foundations Orthodontics” in Georgia—be sure you’re on the Colorado site with the dash!)

Find your host, Jen McNerney:

https://jenmcnerney.com/
https://linktr.ee/heartrootedhealing
https://www.facebook.com/jenslpNET
https://www.instagram.com/heartrootedhealing/
https://www.tiktok.com/@heart.rooted.jen

Transcript

PJ McNerney 0:00

Warning, listen to this podcast at your own risk. Side effects may include joy, feeling, content, illumination, newfound senses of purpose and wellbeing. Courage, realizing you are not alone.

Jennifer McNerney 0:18

Welcome to the Ripple Effect. I am your host Jen McNerney, sharing the unfolding stories that made us and healed us.

0:30

today on the Ripple Effect podcast, I have a very special guest and I'm gonna introduce you to Dr. Renee Moran and I have taken notes. You're a board certified orthodontist and you're definitely airway focus provider. You have a holistic approach to bite correction. You have a hole. List on your resume of like you, you trained at University of Colorado on an Air Force scholarship, served as a military dentist. You completed your orthodontic residency with a master's degree and were was named Resident of the Year. And now I met you in the season of you having Foundations Orthodontics, and Yeah, you, I have people on my podcast that have made a really instrumental difference in our li like my life and like, and also my kids and my husband family. It's all family affair, right? Yeah. I think the only person you haven't yet, um, had the pleasure of working on is our youngest, but she's soon'cause she just turned six. And we'll talk about all the like Yeah. Jaw development and all the. All the things for and and ages and when to get, you know, and have an assessment. Thank you for being here.'cause I know you just worked your long day. Happy to be here. Yeah. So I wanna just really thank you because I feel like my health and everything, I had gone through healing from Lyme and I didn't realize how much breath was. The kind of key to my healing journey and how much better I feel after expanding with you and having braces with you and meeting you. So I just wanna say thank you. It's amazing what airway can do, isn't it? Yes, yes, yes. So since like I, I have people, obviously I'm trained as an SLP, speech language pathologist, so. There's like a niche group of us that work with airway, tongue ties, myofunctional therapy. So there are definitely people that want you to like address things because it's gonna also make their lives easier too. Yeah, yeah. Um, where do you wanna start? I mean, I would say. Let's, so let me just, Can we start with a little back history of you? Because I really was, when I was going through my assessment with you, mm-hmm. I was really like drawn to the fact that you have a very personal experience with jaw surgery. So you were able to give me really accurate. Advice. Yeah. Um, so yeah, I'll start there because my background to even, even before I started really focusing on airway was always, I always looked at orthodontics as. It should be a whole health service. It's, you know, cosmetics, as I say, is the icing on the cake. When things fit and function together, they tend to also look good'cause they're where they need to be. So, lining up teeth is the easy part. Getting it in harmony with the entire system. Like not just airway, but you know, muscles, joints, the teeth, the bones, the gum tissue. And airway, they all have to work together, to be able to get a good result that's gonna last the rest of your life and be healthy. So, that's kinda what piqued my interest in orthodontics to begin with., As you mentioned, I was in the Air Force, as a general dentist first, and I actually worked really closely with a prosthodontist and. What they do prosthodontists is their specialty is like full mouth rehabilitation. So they're going in and putting crowns and bridges and implants, like restoring every tooth in the mouth to this kind of perfect bite. And that got my interest in, you know, figuring out how things should fit and function together. But I was like, well, why don't we just fix the teeth into that position before you grind them all down and need all these. Full mouth rehabilitation. Why aren't we treating orthodontics like a full mouth rehabilitation? Because it is, we're moving every tooth in the mouth. Why aren't we moving them in the proper position so they don't have these problems? So she wanted me to go to pro residency and I was like, no, I'd rather fix, like fix this before it becomes a problem. Let's do preventive work. Like that was my goal, is let's do preventive stuff so that we don't have to solve these later. So. Kind of looking at the bite and function. I decided to go back and do my orthodontic residency. And it was in that residency where I started paying attention to my own bite. And I was like, mine. I mean, I, I was super narrow. I knew I was narrow. I had an open bite in the back. My back teeth actually didn't touch at all. I could only hit on my front teeth. And I started looking at that more of like a functional problem, right? My teeth don't function great. I'm banging on my front teeth, I'm gonna. Crack them. At some point they're going to break. So let's do this. Let's go ahead and move forward with jaw surgery. My top jaw, the whole maxilla was too small. It was narrow. It was short. I had kind of an underbite, kinda edge to edge bite in the front. And then, like I said, the back teeth didn't even touch. So in my residency, put on my braces, set me up for jaw surgery. And luckily, I had one of my co-residents who was treating me at the time, she went into the surgery, so she was there with the surgeon and during that surgery they were going in and, you know, they were expanding me and they almost expanded 10 millimeters. It was a pretty big incident. Whoa. He was in there. He also saw that my turbinate and my nose were really swollen. He just looked at her and he is like, is she, is she a mouth breather? Oh wow. She was like, oh yeah, she's a mouth breather. So he went in and did like a little work on my, you know, he took out my turbinates. Um, I didn't have a deviated septum, but I think he actually took away, you know, well he took out the turbinate and ended straighten it a little bit. And with that and the 10 millimeters of expansion, I woke up and I had no idea this even happened. Right. Like I, but I woke up in the recovery room and was just like. Wait a minute, like this is what it feels like to be able to breathe. Like I had no idea that I had an airway problem. And then just looking back and being like, I was in the field. I was a dentist that was somewhat paying attention to this. I wouldn't say it was, I was that focused in it at that point, but. I was screening, I was looking at the x-rays. I knew kind of that I was a mouth breather, but I felt like I wasn't snoring. I thought I was getting a good night's sleep. Turns out I wasn't. But until that, I fixed it and I was like, wow, this is what it really feels like to be able to breathe through your nose. And I now remember my dreams and I actually feel well rested. I like to share that story because I was in the field and I didn't even know I had a problem. So a lot of people don't realize that they're struggling because that's all they ever know. Right? Right. So unless you have a team looking for stuff like that, to see those symptoms and be like, you know what, actually I'm seeing signs and symptoms of sleep disordered breathing, or, upper airway resistance, whatever that might be, these people don't know. Because that's their norm. Mm-hmm. And I know that because I was in that situation. Yeah. So me, if you asked me if I had an area problem, I would've said, no, I'm fine. Like, that doesn't, it doesn't bother me at all. But now on the other side of that, and knowing what I was missing. I would've done it just for the airway problem. You know, I don't even care about, airway was almost a better benefit than the bite was for me. Um, you know? Right. And that was my story. That my story was airway, well first it was tongue tie release, but then not having enough space. In my mouth. That actually created more issues for me than it, it created more like aspiration, more, more snoring, more sleep, because my tongue was just flapping over the airway. Now that it had all the range of motion. But I will say, yeah, I feel the same way about tongue ties or tethered oral tissues, because we were not taught this. I was, I'm in speech pathology, my graduate program, we were not taught about this or airway or any of that. How was I even in, you know. Orthodontic residency. This is not something that's just normally taught. This is something that you have to kind of seek and do your own research on and stay up to date with it.'cause it's changing so quickly. Mm-hmm. As far as the advancements on what we can do that you, you've gotta be on top of it and it's not mainstream, I would say. Yeah. So, so I know that one of, um, people may wonder since a lot of people aren't gonna know any different, what are some. Telltale signs and symptoms of airway, reduced airway or, because I know I had bags under my eyes and I looked tired all the time and I just was like kind of that failure to fry Thrive student, like not paying attention and like having some attention issues and focus. So I don't, I can go through like what I notice, but. What do you notice in your practice from kids to adults too? Um, some of the symptoms are the same, but in kids, typically if you're not getting a good night's rest, they become. Hyperactive. Um, you know, a lot of, and there's plenty of studies out there that show that a lot of kids are misdiagnosed with ADHD when really it's an airway problem, because when they're tired, as you know, like kids get rambunctious, they get crazy when they're tired and kid, you know, adults, it's the opposite right now. We ask adults, you know, when they're not sleeping well, are you falling asleep at the wheel? Are you tired of your day? So different symptoms there, but some of, like you're saying. Under the eyes we call, we call'em allergic Shiners is the, is the name of it that dark. Dark bags is usually a telltale sign that you're not getting good drainage of the sinuses. There's a lot We do actually a screening tool for every kid that comes in. But things you wouldn't necessarily think of, like one of the longest studied, um, symptoms is actually bed wet. Oh, and I was a bed wetter. Yeah. And I was. And I was so, I was even related, but no. And I was so embarrassed. I remember be bedwetting up until like first, second grade and like how embarrassing if you have a friend over and I know, and it's one of those things that you're like, how is that even possible? But it's when you're not in that deep sleep, these micro arousals and you're a kid, like that's when you're gonna wet your bed. If you're in a deep sleep, you're not wetting your bed. So, um, huge strong association there. Um, there's, obviously crossbites where the bottom teeth are wider than the top. There's scalloping of the tongue is another interesting one. I think I also have that too. One that I find interesting, and this took me a while to figure out, excuse me. And you actually have a little bit of it, is, um, the gummy smile. Mm-hmm. So once it's a problem, it's very hard to correct, but if you catch it early, um, you can fix it in a kid. But the reason being is if you're showing excess gum tissue. It's because usually if you're a mouth breather and your lower jaw is, it has to stay open to breathe, right? So your lower jaw goes down the top jaw keeps growing down to matches. So this is happening during growth Uhhuh. So another one of those reasons we gotta catch these kids early is because, like I said, once that's down, it is really hard to get back up without jaw surgery. Ah, so that many smiles is another one of those things that most people are just like, oh, that's just your genetics. And I think that's, I think I knew I had a gummy smile, but you're naming what that is. It's similar to if you have a posterior tie, then the jaw just doesn't have a void. It just like grows. It just shapes into that void that, there's no framework for it to grow around. It's just kinda, um, same reason why, these same kids end up with a kind of a very long, narrow face. It's because when you're growing, like I said, teeth like to touch teeth. So if you have to hold your jaw open to breathe, the top jaw is just gonna keep growing down. And because of the angle of the lower jaw, the way you know it grows down. Mm-hmm. And then the next one, it comes, the back of those teeth are gonna hit first, and you end up with this open bite in the front and like a very long, steep, very long face height, which then you're introducing, like you can't close your lips over your teeth. And it's, and this is because of the jaw structure, so this is. Deeper than just soft tissue. This is I can't tell these people, like we were talking about, you can't tape your mouth closed if you can't, like if, if you're, no, I know like this and your top jaw's like this, and that distance is so long, it's impossible for those people to close their lips. They can't do it. Yeah. So again, going back like this, all, if you're gonna change jaw structure and actual face skeletal changes, we have to catch this early. Early like we're talking. So how early, like what is like the youngest client that, or youngest patient that you, in terms of the jaw development? Because I know that when I. Spoke with you, Dr. Moran's. Amazing.'cause I mean I have two in braces right now. At one point I think we had like three or four of us in braces. But you always explain things so beautifully and it makes sense to like the layman person, right? Like us that are coming in to see you. But what. My daughter's six, and I know she has a bit of a gummy smile. So now I'm like, oh gosh, I'm gonna make an appointment like tomorrow. Like it's with you guys again. Like if you, if you have to open your mouth open to breathe, that's the way your jaw's gonna grow. So if there's airway concerns, four is usually the earliest that I've treated somebody. Um, I mean they just, for me, I say it's not an age thing. It's like when they're confident enough to sit in the chair by themselves and I can actually, mm. That's kind of my limit on age. It's not a number. It's when are you able to sit in the chair and let me work on you? But if there's airway concerns, the earlier the better. Especially with that small upper jaw and especially also if it's short width wise, that windows open a lot longer that we can expand. But what is that window for the upper palette, the upper jaw coming forward? Like think. People with an underbite, right? Like the, their side, edge to edge, or even in a full underbite. Mm-hmm. Really at age eight, that suture's completely fused. So, wow. I, it drives me crazy that the American Association of Orthodontics says, don't even see a orthodontist until the age of seven. And I'm like, well, if they come in at seven, which means they're usually not making that appointment until they're like seven and a half. Right. And at eight, eight. That window of opportunity is closed. What am I gonna do? You're so limited on being able to bring that top jaw forward versus in a five-year-old, if I put, we call it a reverse face mask.'cause um, you basically have to wear this device that sits out here and you pull the top jaw forward to it. Oh. That movement is, it's very difficult. So the earlier you catch the kids, the better. So I, I love to treat them at like age five. Ideally. Okay. Okay. Yeah. So I know, what do you think about, so I know when I came to you and maybe you can explain like how you assess. Obviously you do a very thorough case history, like are you a bed wetter? Like all those signs we just covered, but I had a CB CT scan. Is that like kind of something you do on everyone or We do., And there's a couple different things we're measuring in the CBCT Yes. So. One of the easiest things people look at, but honestly I feel like is the least predictable, is actually the airway volume that we can get from there. I use that as a screening tool, but really nothing more than that. So it's. And I call it just that this is a screening tool. If it is extremely small, and we're talking just like looking at the airway size, and I look at the most constricted part, and if it's less than a hundred square millimeters, when you're sitting up in this x-ray machine, you're awake, you're alert, all your muscles are, have some tenacity to them. What does that look like when you're laying down asleep at rest? Like all of those muscles are falling back into your airway. Probably smaller, so Right. Again, if it's already small at that stage. It's a screening tool for me to start asking more questions. Okay. Okay. They might not answer them accurately until you start really probing, on some of those deeper kind of sleep quality questions. So airways one thing we look at the CBCT, but for me, I'm always looking at actually the skeletal measurements of the maxilla to the mandible. Mm. Because I say all day long, teeth lie teeth. You cannot look at the teeth and see if somebody's. Jawbones are the right size. The teeth will tip and tilt and go where they need to go to get you to the best fit possible for your mouth. Mm-hmm. But that does not mean that just because the teeth put together that the bones are actually the right size. So I don't like to take the measurements off the teeth at all.'cause they're malleable. They can move and they can shape and in both ways. Like they might be totally flared out and it looks like you've got all this room in the world'cause they're, the top teeth are actually wider than the bottom, but. If you look at the bone, the bone's like way in here. So I do all my measurements on that 3D x-ray from the skeletal level, uhhuh, and then determine kind of where, where can we go? You know, is this a good skeletal relationship and the teeth are just off. The limit is always the lower jaw. That's what people I, I think this is a good thing for people to realize because some people come in and they wanna be expanded. And I say like, there's not a lot I can do, right? Like the bottom teeth have to be upright centered in bone. So if they are already like this and the maxilla is at that limit, I can't go any further. You're not gonna be able to chew, right? So I would love to expand the maxilla, like 20 millimeters in everybody and just open up that airway. Huge. But you still have to function. So the limit is always where those bottom teeth. Now if they're tipped in like this, I can take those teeth and, and move the teeth on the bottom and widen the lower jaw this way. Yeah. With just tooth movement. But I'm not changing the size of that lower jaw. That is the limit. And that's, and you say that lower jaw is totally, the suture line is in, it's all eight year, eight years old? Yep. Yeah, pretty much. Okay. Um. That width, what is already kind of predetermined at that point. So that is always the limit. So there are some people that come in wanting maxillary expansion that we can't expand and mm-hmm. Unfortunately that is what it is. I mean, if you wanna get your teeth together, that's our limit. But the maxilla should be about five millimeters wider than the mandible. At its most ideal position to get the teeth fitting together, with them upright fitting in kind of cusp to groove relationship. That's the ideal. So those are the measurements we take. Okay, cool. And like I know somebody was saying, she's an, she's a myofunctional therapist. The importance of a team approach, because I had, when I went through expansion, I had a cranial sacral therapy, I had body workers. I went to chiropractic. I did like, I did myofascial release. Like yeah, I know. I mean, I know that not, maybe not. All of your patients are in the know about how important body work is, but have you seen a difference in people, your, your patients that do access body workers while they're expanding? Or braces? I mean, especially like in adults that we're doing, these skeletal expanders and there is, as, so much pressure in there that just going in and. Getting those massages to loosen up those sutures. And it just, I feel like everything moves smoother, more predictable, more, equals It's not asymmetric that's huge. In kids we don't need as much of that, but it helps like sure, you know, everything helps go in there and loosen everything up. Obviously myofunctional therapist we work with all the time, um, for timing on that. I'd love to kind of get their feedback too.'cause I hear it. Both sides is right. I have found best that like they can start with the myofunctional therapist kind of while we're in, you know, even before sometimes they've already met with'em before they even see me. Then obviously it gets to be a challenge if I need to expand'em. And there's an expander in there, right? Because the expander sits on the roof of the mouth. So now all these exercises they're trying to do to get their tongue up there. Yeah, perfect. There's not as much room, but the idea is if you kind of build up that mind muscle connection to begin with. And be working on just strengthening that, but then wait to get the release until after, like you said, there's room. Because otherwise if you do the release before the jaw's big enough, one, I feel like they just heal poorly. Like they're gonna heal back to where they were before.'cause you can't get the tongue up. But then two, now you've got this FLA tissue with no more. I do, I tend to learn, I tend to learn by making mistakes. So they do. They do. Right. And they're always learning. And like I said, this is such. A fast-paced field right now with all of the advancements we have that, like I said, I would've treated you differently now than we did, you know, three years ago. Yeah.'cause that was in, because I was gonna say like, I remember having like SARPE vs. MARPE. Is that even a thing anymore? Like, like the acronyms? Is it like search? It's funny'cause we're actually just changing the name of it again now. What is it now? Massp is kind of the latest term. Oh, okay. So MARPE is just a mini screw assisted, rapid palatal expansion. So that's when in adults we go in and we have to expand that top jaw with screws because now that suture's mostly fused, so we have to use a little bit more force. If you just put it on the teeth, the teeth can't handle it. It's too much pressure to open up that suture. But if you put the screws in the bone and nice, good, dense bone, you can put a lot more pressure and open up that suture. But now the latest studies outta Stanford are showing that we really should be slowing down those turns pretty drastically. Really it stemmed from, because all these adults don't want to come in with these, this big gap between their two friends, which I'm like, I mean, if, if I hadn't had a husband that loves me very dear, like I probably would've not done it, but I'm like, I'm, I'm happy. I'm happy to have the gap. Yeah. I mean, and it's short lived, but it's a big gap, right? It's like a whole tooth. It looks like a Oh, yeah. Oh yeah. It was, I got some, I got some looks. I mean, and then I would be eating and there would be food that would like literally come out of the, the gap, and I'm like. No, it's, so anyway, now the new protocol is turn those slows way, way down so that you're actually kind of expanding at the same rate that those teeth are coming back together. So like, we're kind of pulling the teeth together at the same rate that we're expanding at. So there's still a tiny little gap there, but it's much, much slower. So now, okay. MSASPE is mini screw assisted Slow palate. Slow, not so like we are, we're replacing the R Rapid to slow slowing this down. Okay. I mean names, but yes, that's kind of what's been thrown around is like, we need to change this name. So now it's massy. Yep. Yeah. And I would say that your. Your, um, practice because even when I had my braces, now you guys are 3D printing or you're having, not you, but you're, you have a company that you work with that 3D prints the brackets and what are the benefits of that? So the benefits there are we, like I said, we take that 3D x-ray of everybody too, so we can incorporate kinda that tooth scan that we take with the 3D x-ray. So now when I'm. Setting up your plan. I basically, I, I tell people, I'm like, I go home and I do, I play my own video games. My video games are setting up teeth. I do. I just love you. I just love you. I love how meticulous you are, your brain. Oh my God, you're a genius. It's fun. It's fun. So, you know, in cases like years of where we're, you know, I know I'm gonna expand and because we've taken those measurements, I know exactly how far we need to go. So I'm like, okay, I'm gonna expand this maxilla. Six millimeters. Okay? So I'm gonna plan that in my digital plan. I'm gonna expand at six millimeters, but now I gotta get the roots at the right torque and position and, parallel to each other. So I'm looking, I'm able to look at everything now and say, okay, this is exactly where I want it to finish. With this right. Torque and control over those teeth, um, build me braces to get me there. So it's, it's amazing. It's like retrofitting it back so that each bracket is individualized for that specific tooth movement for the root movement. Already based on the plan that I'm expanding six millimeters. Wow. So like that sort of precision has never been there before. So one, obviously you get a better result'cause we've already planned for all of those movements. It usually goes two, it goes faster. Faster.'cause you're, it's more individualized. Yeah. And there's less back and forth. Right. You put a stock bracket in there and we call it round tripping like teeth. Just start moving kind of willy-nilly and then you have to go back and like. Fine tune it and then fine tune with like a ton of bends in the wire and really get it to where you want it. But I mean, my eye from bending a wire, I, I can't tell the difference between five degrees and seven degrees of torque that I'm building in there. But I can now, when I'm building the bracket, say I want seven degrees of torque instead of five degrees of torque. Wow. And it, we'll get there. So. Faster, more predictive, more precise. Mm-hmm. And then I also, I don't have to see you as often, so less time outta work in school and all that too, because it's so precise and there's less of this back and forth when I put the wire and I know exactly where it's gonna go. We could just let the wire do its thing. Like I'm not trying to like. Make sure it's not going haywire or anything. I know it's not.'cause it's all in a controlled system. So usually the appointments, they used to be like every six to eight weeks are now like 10 to 12 weeks. I did notice that.'cause my, my Abby just got her braces on and you're not even gonna see her for two months. So like eight weeks to Yeah. I was like, wow. I'm like, this is great because we drive two hours to see you there and back. So, so yeah,, that's been a huge advancement and really it's only been around for about two and a half years. Really? Mm-hmm. Yeah. So it's, I always say it's kind of like we almost had that with aligners like Invisalign. But it's more predictable. So with plastic, you just don't have as much control, especially of a root position. So when I set up those cases, it's still a little bit of guesswork, I'm gonna overcorrect this to get the movements I want, knowing that the plastic just isn't quite gonna get there. So I almost don't even like to show people my setups on those,'cause they look ridiculous Sometimes everything's overdone, so like you look at it and it doesn't look good. Right? But you know, like you're only gonna get a third of what you put in there versus the braces, which it's. Pretty accurate. Like I don't very rarely overcorrect anything. And you put a stainless steel wire in there and it's, boom. You know, it just, it goes,'cause the wire's a little bit stiffer. Now. I still love aligners for some things, but, mm-hmm. Um, it typically, you, the braces are in there 24 hours a day. They're always gonna be a little bit more efficient and a little bit more predictable just because of the strength of'em. So, pros and cons to both, but. I do find that the braces are just a little more predictable and usually more efficient because of that. So, yeah. And can you address, because I see, and I don't know if I, oftentimes I'm like discerning, do I say something or not? Just the like, mm-hmm. I've seen orthodontists like remove teeth. Before putting on braces. And I, I feel like that's a big red flag, but maybe I'm wrong about that. Like what, like can you address like, the idea of gathering space by removing teeth? Like, uh, yeah, so obviously again, this goes back to timing because if you catch this early enough, there's no reason we can't make those jaw bones big enough to fit all the teeth. I will say there are some times when you catch them too late and they have so much crowding that it is like one tooth is completely on the outside of another tooth to open up that much space predictably without causing any sort of periodontal effect, like recession on those teeth like you would need. You could do it, but you'd probably need some bone grafting. You would need a ton of screws to like back the teeth, back up backwards because the only thing to push teeth kind of. Backwards is something to pull backwards to. So we either need screws back there, you need to wear like some sort of headgear, which I don't love. We don't, I typically don't wanna push things backwards, but when there's that much crowding it's usually'cause everything's drifted too far forward. Oh. So there's rare cases. I really like. I think I called one tooth in the past year. Because like I said, I tried to get kids in early enough, it was too late. Okay. But there are some certain, certain s that you're like, there's, we can get the teeth in, but the amount of work and effort and extra surgeries you need to do it. It just doesn't make sense. And I'm okay sometimes because everything's already drifted forward versus like taking teeth out and then pulling everything back to close the space. The only time I'm taking teeth out is because there's no space at all. Like you take the teeth out, you don't even know you took the teeth out'cause that was closed and everything's drifted forward. Um, where people get in trouble is there's not that much crowding. You take teeth out, now you have space to close. If you close it by pulling everything back, that's a whole different story than you lost space.'cause everything drifted forward. Okay. Does that make sense? That does make sense. So it's not extractions in itself that's bad, it's how that's It's the root, it's the why you're doing it. And also, yeah, or like how it's closed. Because there are certain, certain circumstances where I'd even say sometimes, and again, rare now that we have these tads and screws and stuff, but. It used to be before we had that, that sometimes if you had like a really big open bite again like this and your back teeth are hitting and you can't close your lips, right? Because the. The front dimension is too big. Um, we used to treat that with like taking out a premolar in the back and moving the molars forward, which then takes this tooth that's hitting heavy and brings that contact part further forward. So there are ways to do extractions that can actually help with their way.'cause that actually allows the jaw hinge close further forward and close the down to get the lips closer together without impacting the airway at all. In fact, it's making it better. So I always tell people, and again, I'm, I still don't extract. Rarely ever, but there it's not, there are, it's, it's case by case and it doesn't mean that extractions are necessarily bad. I used to do it. That actually can help with things. So don't just say like, all extractions are bad. It's extractions done for the wrong reasons, and then like fixed the wrong way that they all background. Then my next question is, yeah, since airway orthodontics is pretty niche mm-hmm. How, how do orthodontists become trained in something like this? Do they just have to have like your personal like experience and you're like, wow, this is it. This is root cause Or like, because I do see a lot of my daughter, you know, she's a teenager now, so like a lot of'em are getting braces on and they're just kind of lapping braces on, and I'm like, I don't feel like there's any awareness of airway, or they're not really looking at that. Is that just because they don't have the information? A lot of it is you don't know what you don't know. Right. Like I, like I said, I, even without my personal experience, I would say I was still even looking at it more than most, but especially if you come outta residency and you go straight into like a corporate position where you're seeing 110 patients a day, you have zero time to do anything else then just to be like, okay, your diagnosis is crooked teeth and we're gonna do whatever we can to straighten'em like that. That's the whole time they give you, and that's, I'm not saying. That they don't get, they can't do any better. Like they literally have no time to treat those patients. So that's the benefit I have of being in a private practice where I don't have to see 110 pa, nobody's telling me you've gotta see 110 patients a day, or you don't have a job. Right? But it gives me time to actually study the case and take these measurements and they're like, let's dive deeper in why you have these problems, why are you snoring at night? That's not normal for a kid, let's look at this airway. Let's measure the skeletal width and not just look at the teeth. Because I'll tell you, in our residency, it was like if you didn't have a crossbite, meaning, like the top teeth still fit over the bottom teeth, then there were, you didn't need to expand. Why would you expand the teeth fit in the right spot? I'm like, well, yeah, the bottom teeth are like this touching. They're almost touching the other at the tongue. Um, we weren't trained. Mm. You have to take continued education. You have to go to these extra courses, you've gotta be looking at studies, and there's plenty of studies out there now, but you have to take the time to read'em. So again, if you're, if you are so strained all day long, like go, go, go, go, go. And you have zero time to look into this stuff,, it's, again, like I said, you don't know what you don't know. And then if you're not. Going outta your way to learn more, then you're just living your day, day to day and you're not looking at these extra things that are really, like you said, looking at the root cause of these problems. They're just solving the problems. Yeah. Kinda like I said with me and the prosthodontist, like they're solving the problem after it's already happened. That's what most orthodontists are doing. They're saying, oh, you've got crowding. Let's pull some teeth and fix'em. Like, yeah. They're not saying like, why do you have this crowding? Is, why is your maxilla so small? What are the, what is the why behind all of this? And that's. That's where I have fun, like mm-hmm. Let's change the shape of their bones so that they're set up for success, so that's the difference there. And somebody asked about tonsils because that's more of the ENTs realm, but, but like, like what is your experience? So, I mean, we have ENTs that we work with, like you said, working as a team. But my philosophy there is a lot of the soft tissue everywhere. Tonsils, adenoids, turbinates, like all of that upper airway is use it or lose it. There's a reason that my adenoid or my, turbinates were so swollen is because I wasn't breathing through my nose. So if you don't get the oxygen through to cleanse that tissue, they swell up, they get irritated, they get inflamed. They're not getting cleansed daily. So my recommendation is, and we screen for those all the time. I can see the adenoids on the x-ray. I can see the tonsils in your mouth. But I never start with the ENT I say, okay, why are they swollen? They're probably swollen'cause you're not getting enough airway through there. Right? So if you need expansion, let's start there. Let's get more airflow through there. And nine times outta 10 they shrink on their own. Mm-hmm. There are still a certain amount of kids that will always need to have them out. Like they're so swollen matter what we do. Or they're getting infections every other week. They still would benefit from getting them out. But I never start there. Mm-hmm. Right. Like stay conservative. If you already need expansion, let's do it. Let your body heal itself first, and then if it's still struggling and they're still getting swollen all of the time, or you have allergies or whatever it is that they're just like, no matter what we do, they're always gonna be swollen, then yes, we still use our ENTs Okay, so I, the other question Dr. Moran, I wanted to ask you, because we're talking about the soft tissue, is just somebody said, is this genetic like. Is our airway in our jaw development. And I mean, I know tongue ties, not that it's causation, but I have a gene mutation that's more like mm-hmm. Um, that seems to have a correlation with tongue ties, but do you think it's genetic? Is it epigenetics? Is it what we're eating? I don't know. Like what do you think? Why you're, you think it's all of those things? I, there's definitely some genetic component to it, but people with the same genes like. If your diet's different, right? If you're eating a harder chewing diet or whatever it is, environmental factors, like if you're in a home with smoke, like, you know, there's so many different factors that are involved in that, that it's, it's really hard to pinpoint one thing. So I do think it's a little bit of everything. Environmental is huge too though. So yes, even if you have a genetic component, but your environments are different, you're gonna have a different result, um, from that. Okay, cool. I figured that, I mean, I wish we all had a magic answer, but we don't. So my fault, it's just my genes like yes. Some of that. Um, but it, it's, I don't think it's all of that. Okay. And also you practice out of Centen, well, I guess it's technically Centennial. I say Denver, I'm going to Denver. But you also have a practice up in, Granby and Winter Park, or just Granby. We, we work at a two dentist office there, so outta Winter Park Dental and, and Granby Dental. Okay. And do you also address airway at those locations as well? I, I don't treat them differently just'cause they live in the mountains. Yeah, that was a silly question. So you have like this CBCT scan up there in both of those offices. Wow. Okay. So real, I should say the CBCT machine is only in Granby. So if we see you in Winter Park, we just send you, I mean it's Granby is like what down the road. Okay. So like literally you have. You're pretty accessible, like to the Colorado Springs folks, to the people that live in the mountains over off of 70. And so, yeah. Um, and your, the best way to, if somebody wants to schedule a consult, it looks like your website is pretty accessible for that. Or is it better to call on the website or call? Um, usually if you do it on the website, we still have to call you anyway to get a little bit more information, so, totally. Whatever you decide is easiest for you at the time. But we try to make it easy to get in schedule. Um, I'm actually, we just redid our website, so I'm hoping it's working, but we did just put on there to be able to schedule your own appointment online too, so that you, you know, you can get all that scheduled even without calling us, which is nice. Which is foundations-orthodontics.com. Yes, there's one Foundations Orthodontics in Rome, Georgia. Oh, so that's why you have the dash. Okay. The Georgia one, but yes, foundations orthodontics.com and Wow. Well. I mean, is there, I think we covered a lot. That's a lot to digest If somebody's listening to this right, I'd say bottom line, get in early for a screening.'cause the window of opportunity to fix all of these things is always gonna be easier if we have more time to do it. Your rule of thumb is like, if a child can sit in the chair, then you know, my four year olds are way better behave than my 12-year-old. So it's not, it's, it's really, yeah. Like, are they mentally, can they sit in a chair and, and nothing And the nice thing is, is at that age, nothing we do hurts. Right? So it's not like you're going to terrify them for the rest of their lives. If you get'em treated at age four, it actually is way more comfortable at age four than even 12, like so. Mm-hmm. You know, and I always tell people like, I'm not gonna lie. I'll tell you if something's gonna be uncomfortable. Like expansion in a 4-year-old is really pain-free, it's annoying'cause there's stuff on the of your mouth, but it does not hurt at all. So it's good to let kids know that like, yes, this is gonna be a little uncomfortable. It doesn't. Anything we do really, honestly, again, earlier, the better. Yes. And I was gonna ask you, because I am getting a lot of people that have asked me questions that are in their forties, maybe almost fifties, and I think that they're freaked out because I went through surgery and I don't, I, I tell them I'm, I, technology is different. So please go see Dr. Moran. This could, this might not be your. Situation at all, like Yeah, exactly. And again, just updates and advancement of everything. So like when we did your expander, we, I didn't have a lab that had the capability of looking at your 3D x-ray and actually planning exactly where the screws needed to go. We just put screws kind of like willy-nilly. We're like, okay, we know we need screws. Let's just put them in parallel to each other. Now I work with a lab that we completely custom make all of those markies, um, which is just that skull expander for an adult, really? Mm-hmm. With the screws. Um, but I can put, I can put six, I can put eight screws if I need to in some cases. So our window of being able to open up the suture without any surgical intervention has gone. Way bigger. Bigger. Mm-hmm. Um, with the advancement of these custom appliances now for adults, because I had interviewed a myofunctional, SLP, who also went through expansion and he didn't have to have a La Forte jaw surgery to open up the suture line. He just used the device, did it, and I was like. That had to be weird. And he's like, I remember when I felt it. It's like a pop almost. Yes. He was like, it was the weirdest thing. But then he said he was able to go, he's a runner, and he was able to run because like when you expand here, you might be correcting a deviated septum, which I did have, and I remember Dr. Elizabeth Turner who, who referred me to you, she was like, have you had a lot of concussions? I'm like, how do you know that? Because she looked at my scan. Yep, that'll do it. Yeah. But yeah, no, it's, I mean, like I said, the advancements are only getting better and better and our capabilities just keep improving. Um, so I mean, so there's some cases where we still recommend some surgical intervention, but like I said, that window of being able to do it now with without any surgical intervention has gotten much bigger and more predictable with these custom appliances. And I think that's what I want. A lot of my listeners to hear because I think they're avoiding going to you because they think it's gonna be like super invasive or they're gonna have that crazy gap that I had. More gaps? No. More gaps. That's the best news. Uh, everything's much slower now. And actually we do a lot now with aligners and adults with those expanders. So actually the problem is, is when the expander is done, it's hard. You can't really move the teeth that are attached to this. The, um. Expander, but now we can kind of be working on moving the teeth with the aligners everywhere else while that expander is still in. And then we can kind of cut it out and keep going, after the time has healed. Um, so again, just. So many benefits. Sorry you didn't get to go. That's okay. I feel like it's all good. It, I mean, I was, I liter. IL. Same results. And I will say that I can't believe how much my health has improved. Like, it's like, it's not only that, it's your metabolism, it's, you know, when you start, we don't really know. What we are all, what's happening in the brain with REM sleep. We don't know, like what happens, people haven't really studied it as much, but you need to reboot and sleep and get into that deep REM sleep to like literally have longevity or just even that type three diabetes, which is really Alzheimer's like I was looking at, like I was gonna be that person if I didn't get that airway open. It's amazing what good quality oxygen can do for your body. Yeah. Yeah. Well, I thank you Dr. Moran, for being here with me. I mean, thank you personally for helping to heal like my entire family Yes. Are such a pleasure to work with. So, yeah. Yeah. Thank you. Um, I, as you can tell, I, I get passionate about this'cause it, it means a lot to me and I've been through it myself, so I know what it can do for people and, and that's what I'm here for is to kind of, like I said, treat that underlying cause and set up for success. Well, thank you. Thanks for being here. Of course. Have a good evening. All content by Jennifer McNerney and guests are for educational and informational purposes only. Listeners acknowledge said content does not constitute medical or professional advice or services. This podcast is for private, non-commercial use Only guests on this podcast do not necessarily reflect any agency, organization, company, or potentially even themselves.