Breathe Sleep And Smile Podcast

Could ADHD, Bedwetting, and Behavioral Problems Actually Be Sleep Issues in Disguise?

• Dr. Mark A. Cruz

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What if symptoms like hyperactivity, poor concentration, bedwetting, and behavioral challenges are actually connected to how a child breathes and sleeps?

In this episode, Dr. Cruz sits down with veteran clinician Dr. Stephen Coates, who shares his personal journey into airway-focused dentistry after experiencing many of these issues himself as a child. Dr. Stephen Coates reflects on his struggles with hyperactivity, bedwetting, difficulty concentrating, and getting into trouble at school—and how orthodontic treatment and myofunctional therapy changed the trajectory of his life. 

Together, they discuss the relationship between airway health, facial growth and development, mouth breathing, sleep quality, and overall health outcomes. The conversation also explores real patient cases, including children with behavioral and developmental concerns who were later found to have significant sleep-disordered breathing. 


To learn more about Dr. Mark A. Cruz, DDS. visit:
https://www.MarkACruzdds.com
Dr. Mark A. Cruz, DDS. 
32241 Crown Valley Pkwy #200  
Dana Point, CA 92629  
949-661-1006 

When Breathing Care Changes Lives

SPEAKER_00

But now with you know the airway, it's like, no, you changed my life. I function better, I have more energy. Family's happy. Family's happy. I always say if you treat that kid in that family that's struggling, you're really healing the whole family because it's a stress on the entire

Meet The Airway Wellness Mission

SPEAKER_00

family. I'm Mark Cruz. I'm an airway-focused dentist that advocates for wellness. My mission is to help you transition from disease management towards true wellness, starting with your airway. When your airway is limited in any way, it affects your sleep, your health, even your smile. We treat root cause, not just the symptoms, so that you wake up refreshed, live fully, and smile freely. Visit our website, markacruz.com, breathe sleep, and be well.

A Clinician’s Path Into Airway

SPEAKER_00

So uh Steve, I know you're a seasoned um clinician. How long have you been practicing?

SPEAKER_01

Um this summer will be my 39th year in practice.

SPEAKER_00

So you've been doing that and you're in You've married 40 years this summer or so. So you were you got married in dental school. Um so you practiced for a long time, and then you um were introduced to this whole concept of airway dentistry. Tell us a little bit about how that came about, what you've learned from it.

SPEAKER_01

Um go how so starting for decades, I was referring patients to my local speech language pathologist, my functional therapist, you know, Fabi. Oh, you were Fabi Moyne, Rebecca Horse. Oh, you were doing that. I worked with them, I worked with them for 10 or 15 years at least.

SPEAKER_00

And well, tell me how how'd you how'd you know? Because that's that's kind of an exception. Most dentists don't don't appreciate that or know that.

SPEAKER_01

My path was when I was a kid, I had buck teeth, I had a tongue tie, forward swallow. Um the things I learned in the course, like bed wetting, hyperactivity, all these things that were going on. Um, I went to my orthodontist and he referred me to a myo uh speech languages pathologist, myofunctional therapist when I was eight or nine, so ear late 60s, early 70s. Okay. So I felt it was great for me, it really helped me. The orthodontics that were done, some was good, some was bad, right? I put was put in retractive headgear, but they didn't take any teeth out.

SPEAKER_00

Got it.

SPEAKER_01

So my buck teeth was probably that my maxilla was good, they just didn't bring my mandible forward, right? So he retracted me. That probably gave me, I had looking back, pediatric sleep apnea, but after the orthodontics, where I had some arch width improvement and the myofunctional, which really helped for the tongue strength, I went from always in the principal, I went to Catholic school, so I was always in there with the nun, getting a little spanking, um, and getting in trouble. Like then it's the mess. I wasn't, it wasn't bad, just more of a mischievous. All of a sudden, seventh grade, it was like boom, I got finished with ortho, the myofunctional, I was sleeping, I I graduated with honors high school, killed it. I mean, it was all good. So that's how I got it. I looked back and I went, myelfunctional, so I'd see kids with problems, like oh, I need to get you over here because I can't, I didn't like ortho, I don't didn't do ortho. It's like I refer you to a um speech therapist first.

SPEAKER_00

So, in retrospect, you you correlated the behavior change um to you know those changes and uh is that correct? Yeah, okay, and and knowing what you know now, what was it do you think that because you just talked about you know the structure and the function indirectly, but what was it that those changes did for you that allowed you to have those cognitive changes and function and all that?

SPEAKER_01

Just from not always being in trouble, getting good rest, yeah, and so that's how concentrate.

SPEAKER_00

Okay, so that's the thing, it's it it it it it was it better sleep, better concentration, you were able to test it.

SPEAKER_01

I was wetting my bed until I was, you know, I don't know, 10 years old, stuff like that. So so it was pretty significant. But back then they thought I, you know, they didn't know what ADD was. Right. So my parents sent me to a shrink, the child psychologist. We had one, I was in a dark room with wires, Rorschach, pink blood test. I mean, they were checking me for all sorts of stuff, and it was like, oh, he's a normal kid, but you know, whatever, we don't really know what's what's going on. So

Rethinking ADHD Through Sleep

SPEAKER_01

they didn't know.

SPEAKER_00

And now in your practice, you see when someone comes in with this quote-unquote diagnosis of ADD, ADHD. I I assume you see this very, very differently. Tell us a little bit about what what your understanding is, having gone through with this airway-focused approach and how you see the patient, how you see that specifically, ADD, ADHD.

SPEAKER_01

Well, I'm always thinking, is this really the diagnosis, or is this one of those, we don't know what it is, but we since he's hyperactive, or she's hyperactive, mostly the boys, we'll we'll give them some drugs for that. So I immediately start looking at growth and development. And they've all got you know narrow palates, and some of them are tongue-tied and they're all mouth breathing, you know, and vertical dimension growth and all the things that I see in there. I've had kids literally falling asleep in my chair just doing the exam because they're that exhausted. You know, you look at mom, is this normal? Oh yeah, it's like is this a problem?

SPEAKER_00

You know, it's oh they've got a lot of schedules, they've got soccer plaques, they've got baseball. It's because they're busy, right? Right? They always kind of so um yeah, you you've treated uh the the this population. Uh tell us a little bit about maybe with some specifics of outcomes that you had. Is it typical? Is it just every once in a while, or is it predictable?

SPEAKER_01

Um, so I'll give you one in particular that was really uh just it was a good relationship or a good response, I should say, by the medical community. So uh mom, Mama Bear, she ended up being uh get to know my wife and um through some interactions and things. And she was sharing with her what was going on with her kid. And my wife said, Well, my husband does airway and looks at kids and treats stuff. You should talk to him. Well, she went to the doctor, the physician, she came to me and she said, They say everything's fine, he's on the spectrum, he's got these you know issues and all this stuff. And I went, well, let's talk about it. So, you know, we went through it and did the subjective interview, and I said, Hey, let's do some more data accumulation. So we took the CBCT, we did the high-resolution pulse oximeter, um, we did all that, and I was like, Wow, he's really bad. I mean, the HRPO data was showing he was significantly high, I you know, we can't diagnose right, but high probability of having pediatric sleep apnea. So I said, here's the report, and it's you know, to take to his physician. She ended up, grace of God, somehow got into a guy literally the next day at down at UCI, and they did a test on him, and all of a sudden, well, this looked the report that I had done and said, I haven't seen this before. So they said, Okay, let's do a test. So they did actually, for his age, I was surprised they had a dice on him, which is a drug-induced surgical endoscopy. And they see a sleep endoscopy, and he goes, This is the worst kid I've seen. So the kid was literally put on a CPAP the next day. All of a sudden he's feeling better, great. I mean, real change. So now it's like, well, the physician called me and he said, Hey, I need to get his um mandible forward.

SPEAKER_00

I go, Pretty amazing.

SPEAKER_01

Great, but you know, but you know what we need to do. It's the maxilla that's the problem here. We gotta get his mid-face forward. Right. So he's like, Oh, so we had a little chat, and so that's what we started with. Then we went through forward pull face mask, we did expanders, we did all the things that we needed to do, and a couple years later he got retested, and he didn't need the surgeon said he doesn't have sleep apnea anymore, right? So, and now he's you know, I mean, playing a high level of of international travel sports for a young teenager. So, um yeah, it's it's crazy. Yeah, so so it's great to see, right? Yeah, the the data's there, right? Right,

Growth Guidance Over Tooth Straightening

SPEAKER_01

absolutely. One of the things that's added that it's added to my practice is I'm doing orthodontics, which I never wanted to do. I was restorative, fixed pros, cosmetics. Um, didn't want to really work on pediatrics, even though when I first got out of school, that's all I did. I worked at a children's clinic. Um as you say, once you see it, you can see it. So all these kids are sick and problems, and so it really added to my practice from the orthodontics. Again, great orthodonists in my in my neighborhood, in my area, they're fantastic, they're, I mean, so knowledgeable. I don't know if it's it just it's an area they were never taught to look at. And I think when you've been in practice for a number of years, how to change and to to look at something, go, whoa, maybe I didn't treat the way I could have treated. I think that can be a little scary to look in the mirror. But um, but they're great. I mean, they're great orthodontists, you know, it's just that it's just they don't understand the philosophy of of uh airway.

SPEAKER_00

Yeah, so I would argue um that uh you weren't practicing orthodontics. I I actually say I don't do orthodontics. Um orthodontics really is more the way it's defined mostly today, the way it's practiced, it's like tooth movement. Um it's more orthopedics. Doing the craniofacial all that stuff. So you were doing more growth guidance and and and and it's a much better way to put it than what I was, yeah. Right, that's just to make it, you know, uh to give it um for the audience uh a little bit of context. But the other thing is I'm gonna argue that the orthodontist is the most knowledgeable in this. In fact, when they go through their training, they go through and understand craniofacial growth and development. But what ends up happening in my experience has been is it becomes less relevant. Um and instead of early intervention, they wait till there's crowding, and then now it's pretty straightforward to go ahead and straighten the teeth out, and maybe they do some expansion. Now, increasingly, more and more they're doing expansion. But I think that the I don't blame the orthodontists per se as much as they hate me because they're doing what they were trained for, and it's very um efficient, it's a very efficient practice model to be able to monetize the movement of teeth, because that's what uh the public perceives that they want, not understanding that dental crowding shouldn't really happen if you look at an anthropologic standard. It never happened before. Now, worldwide, it's 90% of the world global population has um maloclusion of uh of some sort. So that's its own discussion.

SPEAKER_01

But if I had an orthodontist that was doing that, I never would have even put my toe in the water. Right. But right, exactly. I never put my toe in the water. And the the thing that they're missing is there is such an opportunity there because of their expertise in growth and development. Oh, 100%. And they should be, they would be killing it. I'd be sending them patients all day. Yeah, and stuff. I and I could deal with the myofunctional stuff with it, I can help with some other stuff, but yeah, they they could be doing this.

SPEAKER_00

No, I I I agree. And I I know I'd been years ago, I was flying up to Stanford, um, and it was a fly on the wall um during ground rounds in their sleep program, and Kristen Guimeneau was there, and one of the ground rounds, he pulled me aside and said, Hey, come into my office, let's talk. You know, what are you doing? And and we started talking about, you know, I'm a dentist, I do growth guidance. Um, I've been very interested in in this area beyond sleep, having to do more with with breathing and all that. And and um we had a number of exchanges. In fact, he asked me, said, Hey, will you come back and lecture to my faculty and fellows on uh you know these topics, which I uh was privileged to be able to do. But he said in that conversation that it is the orthodontist that is in the best position of all of healthcare to really deal with the sleep problem, not the sleep physician. He even admitted that in sleep medicine it's a rather primitive approach to managing uh uh they're managing it, whereas the orthodontist can cure it. Yes, exactly. Exactly. But I think the problem is it's a practice model because it's more of a medical model. Uh it's less procedurally driven. You're looking at structure, function, behavior, things that we talk about. And that's very different. You spend more time with the patient talking to the parents, birth history, uh, et cetera, et cetera, when you're talking about kids, right? Whereas if you're an orthodontist practice, you've got four or five chairs, you've got two, three assistants, and you're going in and saying, change this wire, change those ligature chunks, put a power chain. It's very easy in mass, and you're not spending that much time after the um the case presentation on uh on the progress because it's self-evident. And so this is part of the problem that I have, and I wanted to get your comments on, is that in dentistry, by and large, we can use orthodontics as just one example. You're not really measuring anything that's of meaning and tangible to the patient, whereas with airway, we are quantitatively and qualitatively measuring something that is tangible to the patient. Um, and can you comment a little bit about that in your cases when you're talking to the um the parents and the outcome or the patient? Um what is defining the outcome and success for you?

SPEAKER_01

So for kids or adults, right? Symptoms, is it fatigue, is it you know all the different things that are going on with it? Are the symptoms subjectively better? And then the objective data, whether it's the you know, let's say the myofunctional therapist, the lip strength, then the HRPO in the data is the heart rate better, the oxygen is much better, that you know they're sleeping. Um, those are the things that we look. Okay, we've treated to this, now we're stable, great. We don't need to go any further, we just need to maintain it, help with muscle, help with behavioral, you know, those type of things. So um I I don't know if I answered the question well. Yeah, outcomes measures. I mean we're measuring outcomes because you know, anybody can do the mechanical model. I think we talked about this before. I look at it from mechanical or biological or physiological um model. The mechanical is oh, they're straight, aren't they? Pretty. Yeah, mom's happy, dad's happy, they're great. Well, the kids or the parent, if they're an adult, they're still not healthy. They're great. I look better, but I'm still tired. Yeah. So it's changed my whole approach on stuff with that. I don't even look at, you know, the teeth. I could show you cases where we've widened our jaws and the smiles are fantastic, but that's not what the goal was. Right, right. Right. You know, they're happy.

SPEAKER_00

They're sitting breathing better.

SPEAKER_01

And they feel better and they look so much better. They just they love that broad smile instead of the narrow, you know, the narrow face. I mean, even if the teeth are not perfect, just having a broader smile, better facial balance, right? I can I'll have some photos I can send you. You can put in here with some of the adults and stuff, and you can take a look.

SPEAKER_00

Yeah, because I I would say that with uh one of the things that we didn't quite get right regarding smile design is that we have defined it and the public by and large has kind of accepted the mantra that what makes a beautiful smile is display proportion and arrangement. It's the straight teeth. Whereas you can have all that, but a narrow palate versus that same patient, if they got a nice broad smile, better facial balance, and the teeth may not be perfectly straight, it's just more aesthetic. Looks healthier. It looks and and what they report is they're sleeping better because they're breathing better. And so it's not a sleep problem, it's a breathing

Measuring Outcomes Beyond A Pretty Smile

SPEAKER_00

problem. It's day and night. So CPAP or an oral appliance will help you just when you're sleeping at night to some extent, but it's not helping you during the day. Moreover, you have to be committed for the rest of your life to doing that. It doesn't cure itself on its own, right?

SPEAKER_01

So well, think about patients we've treated, and you take the early picture and then you try to match up. Obviously, you're not doing filters, but you just try and match up. You go, and you just look at them and go, the eyes look better. There's more brightness, the skin color is better, right? They just have this better look. You know, it's not like summer, you take it the same time of year and all that. It's amazing. Yeah, I mean that oxygen means health.

SPEAKER_00

Yeah, yeah. And that's all qualitative and that's great, but I think at the end of the day, it's that quantitative data measurement with the high resolution pulse oximetry, the heart rate drops, and all those things. I'll show you.

SPEAKER_01

Um, I have a case that was one of my disappointments because I think those are always important too. Um patient came in, was having very, very narrow job, arched palate the whole bit, um, did the HRPO, data was not good. His C B C T data was not good, put him in a my tap, and he allowed me to take another C B C T with the MyTap in. The size of the airway on that was 90-day difference. But what was fascinating was the HRPO data. It looked literally perfect. I mean, his I was like, wow. And then I asked, and we did his paperwork on the subjective stuff, and they asked the patient, I go, How you feeling, guys? I don't feel a difference. Go, you can see your heart's really happy here, and your your your brain is happy, you're getting you know 98% oxygen, all this. But he didn't notice a difference. How old was he? In his was he 40s?

SPEAKER_00

40s, 40s.

SPEAKER_01

Just young to be that. Did he have a sleep study? Um, no, I didn't go to get wouldn't go get a go for him to get a sleep study. Yeah.

SPEAKER_00

But he's and you have to document that as a dentist for sure. I I don't advocate doing um the the oral appliances unless we call it a snorguard. Oh, it's a my tap, just to test it. Just to kind of test, unless they are committed to doing the uh, but be that as it may, yeah. So a lot of that's an area of a lot of confusion. People don't understand why that is. And of course, we talk about that in detail in the curriculum, and the effect of chronic intermittent hypoxia, literally decades oftentimes, that destroys uh uh a number of different structures in the brain, the the insula, the hippocampus, the mammillary bodies, all these things, the dorsal motor nucleus is that last relay for the autonomic nervous system, to where they're so sick that even if you fix it, they can't sense it. And and so that's what makes it confusing to not only the provider, but also to the patient. But you know, that's its own topic.

SPEAKER_01

Well, it's the pair the patient goes from sympathetic overdrive to paras uh sympathetic coherence, right? Right, parasympathetic coherence. And they're looking right, but they don't, their body is thrilled, but they don't know it.

SPEAKER_00

Yeah, so I think it when we measure it fully with our data sets, um, it's been rare that I've actually uh not seen a huge improvement so that when I talk to the patient and they may say, Oh, I didn't feel a difference, uh, I don't really feel a difference. It's interesting, those same patients are the ones that when the dog eats their uh appliance or they leave it in the hotel and they lose it, they're calling in a panic saying, I can't sleep, I can't, you know, I I need it. So I think there's a little bit of that as well. But let me like a disconnect from they don't want to admit there's something maybe. Well maybe for guys more than women. Yeah, for guys oftentimes how is it that big a difference? Oh, all the time. And it's not until they come in, they come clean, and and then they kind of kind of get it, but that's you know, its own discussion.

Training, Pushback, And Team-Based Care

SPEAKER_00

So tell me uh what are your thoughts on um commenting on the difference between let's say taking uh a weekend course on an appliance versus like going through the mini residency and and uh the difference in in how you see that information?

SPEAKER_01

The more you know, the more you don't know. That's the best way to put it. And so when you take the you take an appliance, and I've taken appliance courses, obviously, just so I have that skill set, they focus on the technical aspect of it, right? But it's not looking at the systemic aspect of it. Whereas the course, you're putting all the pieces together. Right. It's like what's going on with the breathing, with the brain, the the just reflux, um, you know, posture, tongue talk. I mean, you're really getting so much information, and it can be you know overwhelming on stuff, um, but that's part of to me, that's part of the fun of it, learning it. It's a challenge, right? We went through our guidactic stuff in school. That's why I used to go um back to the classes. I would audit them and take them again because I remember I I every chance I got, and I did this with oh, hang on, whoever, I would go back because one time to me is is nice, but it's it's an exposure. Yes, I you gotta if if you're committed to doing it, and I think that's what's great about these you know, these residency programs, right? I've done many residency programs throughout my career where it's taken a year or two years or whatever for something, and you just learn so much more because you take it, all right. Let's take it back to the office, let's implement. And you don't need to implement all of it, you just got to get your feet wet and get comfortable with it. And if you're Scared or hesitant, I should say, about doing it, the best thing to do is just to start doing it, right? Yeah, how to eat the elephant one bite at a time.

SPEAKER_00

Yeah, I I find and I always say the only way you really learn airway is by doing it. So you can get the theory and understand it, but it's not until you start measuring it with your own patience. And oftentimes what happens is you find it's your family or your neighbor, yourself, that you treat first, and then you go, oh my gosh, what a big difference. And then in good conscience, if you do that for your family or your you know your friends, how could you not do it for your patients? And then you start going down, and then you and then you come back, and now it's meaningful. I've had so many uh colleagues like yourself who've gone through multiple times, and they'll go through like the third time, they go, Oh my gosh, you your material has gotten so much better. And I'll say it's the same exact material.

SPEAKER_01

You're hearing it differently. No, that's it. Because like you're the here's the problem. When you get through, when you're going through data, you hear something, and while you're focusing on what that is, something goes by you, the train moves, and you don't pick it up. So that's why it takes some things. So I think in curriculum, um, I know you've developing a textbook, which I'm looking forward to. I mean, those are the type of things, resources-wise, that you get it, go, oh, yeah, let me go back and look at that. I think that's going to be vital in doing that, um, in making that happen. The text.

SPEAKER_00

I I I'm excited. I'm excited actually to have you uh help us um teach it because you've got the experience, you're a seasoned clinician, um, and you you've got the dental part down um you know before you started this, but now completely different way of how you look at that same information in a more global way. And I I would say I'm having more fun practicing dentistry, and it's more fulfilling because of the outcomes where you know you can do it full mouth.

SPEAKER_01

If someone comes in and smiling and goes, thank you so much.

SPEAKER_00

You changed our life, and and I mean you do those full mouth rehabs, and you're proud of them, and they're well they're technical, right? Right. I did that the smile design veneers. Casfassa, I got that down. Right. We're happy about it, but and the patients are okay, yeah, and I paid for it, and that's and that's fine, that's what I paid for. But now with you know the airway, it's like, no, you changed my life. I function better, I have more energy. Family's happy. Family's happy. I always say if you treat that kid in that family that's struggling, you're really healing the whole family because it's a stress on the entire family. Having a kid that is bouncing all over, and it's not their fault, right? And and now they don't need the tutor, now they're accelerating. We have a whole population like that. Our kids are sicker now than they've ever been. This is the first generation of children that will not outlive their parents for the first time.

SPEAKER_01

No, isn't that crazy? Yeah, and it just but there's so many metrics they're not going to match up. Yeah. Right? It's done the education, math skills, I mean, reading, comprehension. A lot of things. You know, it's our modern environment, as I say. But uh I I will throw one thing in. Um, when we when I started, right, and I got involved and I've taken all the data, I'm really doing all the stuff, but from a treatment standpoint, um, my confidence wasn't there yet, right? So I actually referred a number of people to you. And what was great about that is they were coming in and I could see what was going on. So I actually had a better experience of that. In fact, because I'm close enough, you know, I don't know how many miles were 20 miles or something. Um I came down and I remember I watched you came in one day, and like three or four of my patients were in your office that day. Yeah. It was like, hey, Dr. Coates. It was like it was great, but it really helped me to be able to follow and to see what was going on. So it was kind of hands-on for me, but boy, I I certainly learned a lot you know, seeing it done.

SPEAKER_00

And that's what I like about this program is we that we didn't have before, is we're training it so you could treat your own patient when we're there, because I don't want to I'm busy enough and I appreciate you know helping my colleagues with it, but I uh I I want to deal with this on a public health basis, not on my own community and and helping my community. This has got to be kind of a global approach. Well, no, that's I know that's your approach.

SPEAKER_01

You're trying to teach teachers, right? Exactly. And so it's everyone's got a different path, right? Yeah. So my confidence was at a certain level, you know. So other people's may have more confidence or less confidence, you know.

SPEAKER_00

It depends on uh a lot of factors. Uh maybe we'll end on this this one thing, it's because you brought this up earlier. That same community that you practice in. Um, I remember getting a call one evening from one of my good friends that was um in peer review, and he said, Oh, by the way, I'm not supposed to tell you this, but because we're really close friends and we've known you forever, I know who you are, um, you should be expecting a letter from the dental society. There's been a group of uh pediatric dentists and orthodontists and other dentists, in fact, uh an ENT ball, that um they want to bring you to peer review. They don't believe in what you're doing, they believe that you're scaring patients. And um and I said to them, well, you know, that's that's okay. I look forward to uh being at that meeting. And I remember that I was getting so many referrals from uh, as you say, the mama bears uh that were driving 20 minutes down the freeway to see me going away from that community, that they didn't want to be treated by those orthodontists and pediatric dentists. And I wasn't asking for the referrals, they were just saying, I'm not going to accept the standard of care that uh I've been told I went through it, I'm not gonna have my kid through it, didn't make sense. And what happened is I started treating them, I was measuring it, the medical metrics. They were changing it was changing the kids, and then of course they all talk amongst themselves. So I was getting more and more referrals, and then they finally wanted to put an end to it. And of course, I never got the call, and at that point, it's about that point, it was 2015, 2016, the uh American Dental Association came out with their resolution, largely because of the work that uh Barry and I had done the previous several years saying, hey, we need to start looking at this, and there's been a lot of resistance. So um I I think it it really the specialty of orthodontics, I have so much respect. They're usually some of the brightest people in dental school, right? They understand physics, right? But they're you know, they're they're missing this this this part of it again. I don't blame them, it's just um really could be so much more rewarding to really treat the patient attached to the teeth than just focusing on the teeth attached to the patient's buttons.

SPEAKER_01

Well, I think that's where we're the thing we're missing out on, which I used to love years ago, was the collaboration between the different specialists, right? So we have the orthodontist, we have the myofunctional therapist, the general dentist, even the pediatric dentist, or even the pediatrician. So we had a team that we worked with. Well, that kind of disappeared over time, you know. We don't have the same.

SPEAKER_00

It's not it's not integrated, and that's what airway is integrated. You cannot do it without having your full team. In fact, I I I could say that I would love nothing I'm looking for. I'll say publicly, I'd love to have an orthodontist, a pediatric dentist, or you know, a dentist that wants to be my partner, to be here to help me. Um, and um, you know, our goal is really to have this throughout the country centers, practices like yours that really are helping the community. Again, you know, it's not about us, it's not about our practice, it's about why we went into healthcare, why we went into dentistry is really to provide a service for our community to help them be better. And uh the physicians largely uh have gotten into just disease management, and the public at large is very frustrated. That's why wearables, everyone's using wearables, YouTube and social media is going crazy, a lot of misinformation, right? Mewing and bone crushing and uh looks maxing and all those things that we've talked about in other podcasts. But anyway, Steve, um thanks for um taking the time coming in and and I hope we can uh meet again and and talk more about this.