Speaker 1: 0:43

Hello everybody and welcome to the Beauty of Breathing podcast. I have one of my good friends with us here today, dr Dar Radfar. How are you today?

Speaker 2: 0:52

Hi, bernarda, I'm doing great. Thank you for having me on Excited to talk about TMJ and sleep today.

Speaker 1: 1:00

Awesome. Do you mind introducing yourself to the crowd?

Speaker 2: 1:04

Sure. So I'm a dentist for the last 22 years. I'm known as Dr Rad. I coach and consult on having practices incorporate sleep apnea into their practice from start to finish. I also have a bunch of products for sleep and total oral health under my Rad Health Incorporated brand and I go on stages all the time and try to speak about sleep and awareness of sleep and how we can help our patients to be able to get assessed and ultimately treated, either through CPAP oral appliance or surgery.

Speaker 1: 1:42

So how did you fall into the world of sleep?

Speaker 2: 1:47

Say that again.

Speaker 1: 1:48

How did you fall into?

Speaker 2: 1:49

the world of sleep. So in 2009, I actually fell asleep at the wheel. I crashed my car driving up 30, 40 miles an hour into a tree, not knowing that I had sleep apnea. I was feeling more tired throughout the day and you know, when you have a personal experience or you have a significant other or a child that you see struggling with sleep and sleep disorder, breathing issues, you definitely dive in a little bit more to fix yourself Right. So I selfishly got a home sleep study back in 2009. They gave me a CPAP machine. I gave it back three weeks later. It just kept falling off my face. It was uncomfortable. And then I was patient zero.

Speaker 2: 2:31

I made myself an oral appliance. It helped me reduce snoring and sleep better and be able to have more energy throughout the day for my kids my kids were super young back then and that just propelled me to start talking to my patients about it. And since then I've treated over 2000 patients. I've helped over 3000 dental practices incorporate sleep. It all starts with either yourself or someone near dear to you, or even maybe someone within your office if you're a dental practitioner, when you see the benefit that they have, let alone if you have, with wearing oral appliance and going see the benefit that they have, let alone if you have with wearing oral appliance and going through the process. It definitely propels you to be able to do more.

Speaker 1: 3:13

Wow. Thank you for sharing that with us. We have several people listening in live these Beauty of Breathing podcast recordings. We do live on Instagram on my MyoMoobs account, so if you're not a follower yet, just look us up on Instagram, at MyoMoves, and we also have at Airway Circle. Airway Circle is a community of healthcare professionals that are there to learn more about airway and help their patients finding the root cause of their sleep issues and breathing and myofunctional issues. So if you are a parent or a patient, you can go over to our Facebook Airway Circle Patients and you can ask questions. There are several professionals there ready to help you. If you are a professional and you want to learn more, join our membership at airwaycirclecom. We do Thursday night lives, so every Thursday night we do webinars with incredible professionals. You actually have spoken for us before, so thank you, and that all goes into a membership. So join us. Before we keep going, would you tell everybody a little bit about your red products and how can they find it?

Speaker 2: 4:22

so in during covid, uh, people would come in and have me check their sleep appliances and I'm like so, john, how's it going? Oh, great, my wife loves you. Doc, you still allowed us to come to the bedroom together. Thank you for that. I'm like great he's like, but I can't shut this guy up. What do you mean? You have a lot of anxiety. You know stress, I mean who doesn't nowadays? Right, and even during COVID it was a lot worse because we were worried about everything about the elderly ourselves, our kids being on Zoom and all these kinds of things.

Speaker 2: 4:56

And so people were taking Advil, PM, tylenol, pm, xanax, marijuana I'm in California A bottle of wine, benadryl, right, all these things to be able to fall asleep and they were doing it consistently and I kind of you know I was, I also was having some sleep issues, a little bit of insomnia, you know my mind was racing getting back into the office about after seven weeks of being closed and all this other stuff. So I kind of my biochemistry degree got into, I kicked that into gear and put together some things like tryptophan, valerian root, l-theanine, did a bunch of research, melatonin, and so I kind of put together a concoction and I made my first sleep supplement called Rad-ZZZ, rad-z's, and that was my first product. It was really to help not only myself selfishly but also my patients, because they were all taking all these medications and over the counter or prescription.

Speaker 2: 5:54

That was really liver and kidney toxic and so it wasn't good for them to be taking this consistently, and I've noticed about four out of five patients who take rad Z's really truly benefit from getting a solid six to seven hours of sleep. So it helps you stay asleep, fall asleep, stay asleep and actually breathe better. I put an ingredient in there called N-acetylcysteine or NAC. Nac is a natural expectorant of your airway, so it helps. If you Google NAC and sleep apnea, you'll see nationalinstituteofhealthgov studies that show a reduction of apnea hypopnea index, or sleep apnea, by about 30% just by that supplement alone, and that's one of the ingredients that I put in rad Zs.

Speaker 2: 6:40

And then, as you know, a lot of people develop jaw problems clenching, grinding stress, which we'll dive into. Uh, some of it's related to sleep, some of it's related to anxiety, so I develop rad jaw. Uh, rad jaw is a jaw supplement that helps with muscle tightness so you don't clench as hard. Certain some ingredients that help with that and also with the popping and clicking to be able to regenerate some of the cartilage and and bone there. So that was my second and now I have 11 total products.

Speaker 2: 7:09

My newest one is a pet product. It's for cats and dogs. It's a dental hygiene kit to be able to have a variety of ways to be able to keep your dogs and cats' teeth clean, because they're also our babies and part of our unconditional loving family.

Speaker 1: 7:27

for some of us who have pets, I can tell how much thought you have put into every one of these products and I like how you you're made things a little bit more holistic and preventive and healthier for the individual. So that is fantastic Awesome. Well, everybody, what is your Instagram so people can go follow you? My Instagram is fantastic Awesome. Well, everybody, what is your Instagram so people can go follow you?

Speaker 2: 7:48

My Instagram is Dr Rad health, so D R R a D health, and my website is rad health INC, so rad health inccom, for the products and, if any, any dentists or hygienists want to take any courses in sleep, it's radseminarcom, so, as you can tell, everything's rad. We try to keep it fun within the Rad Health family.

Speaker 1: 8:16

I love it. That's fantastic. So let's talk a little bit about our topic. Today. We're going to focus on the connection between TMD and sleep apnea. So what is even TMD? Because everybody calls it TMJ.

Speaker 2: 8:29

Yeah, so TMJ is actually the body part, temporomandibular joint. Tmd is temporomandibular disorder, right? So it's really the diagnosis, or any sort of problems you have with your jaw is TMD. Now let's call it TMJ because that's what the general public calls it. So TMJ can get affected if you're not breathing well.

Speaker 2: 8:52

More than 50% of patients who have jaw popping and clicking, muscle tightness, neck and shoulder pain, headaches, grinding of their teeth, of course, are associated with sleep disordered breathing. We notice this in kids especially who grind their teeth. You know Johnny's grinding his teeth at seven years old. First question is is how well does he sleep at night? Does he wake up energized? Does he snore? Tonsils adenoids need to be evaluated, possible phase one orthodontics to expand the jaw to be able to get more room for the tongue, myofunctional therapy, tongue tie, all the fun things you talk about on a regular basis. So there's a big correlation with TMJ problems and sleep, but there's also TMJ issues when it comes to anxiety and stress. It's a fight-or-flight response that we have when we take with us to bed about. I got to worry about my kids in the morning, one of them's sick. Is no one going to wake me up at night?

Speaker 2: 9:48

And then my partner this or my job that or you know stuff I still have to do for work, and we take that to bed with us and technically we tend to clench and kind of have that fight or flight response and that can cause the massetereter, the muscle of the jaw and the temporalis to clench and get stronger.

Speaker 2: 10:09

And so I've been using, actually, botox a lot more frequently than ever before, not for making people pretty sometimes, you know you can, you can put a little bit yourself if you have some leftover in the bottle, right, uh, but but it's really for therapeutic purposes. It's some 15 units in the masseter on each side. You can have a patient bite down. Or even you can bite down on some cotton if you have some cotton rolls, but on something a little squishy. And if your masseter, your cheek muscles feel like it's flexing really hard and you can feel almost like a little golf ball coming out, your muscles are way too strong. That's one muscle, renata, you and I don't need to work out the gym. We work out right. We try to get our muscles all firm and toned and people ask me all the time about these.

Speaker 1: 11:02

I'm not going to say the name of it, but these devices that you chew on or exercises that you do to grow, you know, make you have a better, more beautiful jawline. You don't want this muscle to get bigger. The type of muscle fibers that the masseters have are similar to the type of muscle fibers we have in our legs, so they have the potential of becoming very muscular compared to the rest of the muscles in our face. So, yeah, if you clench or if you exercise this muscle like crazy, it is going to become more bulkier, but it's not necessarily a good thing.

Speaker 2: 11:41

Correct. Yeah, and it's the one muscle we don't need to want to make bigger. Even the New York times last week released an article that I was in. They interviewed me regarding mewing, which is what you're talking about. There's some Instagram ads that you see, or Facebook, or TikTok really brought it out that you know, a 17, 16 year old can sit there and use either a wad of gum and chew on gum for about 30 minutes to exercise that muscle.

Speaker 2: 12:09

Well, guess what? Eventually, you're going to come see me because you're going to have jaw pain. You're going to have the popping and clicking because the jaw joint is the number one joint that we're using electively to be able to talk, chew, yell, eat, yawn. So you know if you overuse it. And then you also are on a carnivore diet and you eat a lot of steaks, right, which is chewy, or you eat a lot of. You're vegetarian or vegan and you eat a lot of raw whole almonds. By the way, no more almonds. For all you listeners, I get slapped virtually when I say that Sliced almonds Don't do raw whole almonds. It's amazing Some of the dentists, if you're listening out there, or even hygienists, when you guys get the yeah, I was biting on an almond and look my molar cracked and I'm like, yeah, it's not just that, it's also because when you clench and you grind, those masseters get strong.

Speaker 2: 13:06

So someone who has a strong masseter, renata, if we give them a banana to bite right, which is really the softest thing, their amount of pressure that they're slamming their teeth against each other is much, much higher than someone who doesn't clench and grind their teeth or doing the mewing techniques of getting their jawline more chiseled, so to speak. So just biting into regular food, any food, a sandwich, let alone raw whole almonds causes a bigger force of enamel to enamel, increasing the chances of fracturing lines and eventually cracking your teeth. So it's not just wear a night guard or a sleep appliance and we're going to protect our teeth and then throughout the day you can chew gum or eat nuts and exercise these muscles, because you're also eating throughout the day and every time you're not wearing a night guard most of us throughout the day. So every time you choose something, that food can really impact and cause the teeth to crack. So the more we soften up the masseter and temporalis, the more we can live comfortably and not break our teeth.

Speaker 1: 14:11

So what are some reasons why people clench and grind their teeth?

Speaker 2: 14:16

So anxiety and stress, which I think like 99.9% of the population has now. I love it when my medical doctor asks me when I go in for a checkup so are you going through any sort of stress or extra? Yeah, my pulse is still beating and I'm still alive. Right, who doesn't go through periods of stress? Chewing lots of gum can cause problems If you're a daily gum chewer.

Speaker 2: 14:44

Some of us are trying to quit cigarettes or whatnot and doing Nicorette gum and you're doing 30 minutes to an hour of chewing gum. It's a way of, like curbing your hunger. It's a way of a stress reliever. That's a big no-no. I always say chew gum for a few minutes to get your garlic breath under control, or your onion breath and spit that sucker out. Or use some sort of a you know, a breath mint, but don't crack on the end of the breath. We need, don't crunch on it. That's another thing, right, eating lots of chewing ice, raw whole almonds or hard nuts. I remember in high school we used to have corn nuts, spicy corn nuts from the vending machines here, the United States, I think, love to have those in the school cafeterias. And when you're 16, 17, and you wanted a snack for a dollar, you would just get those corn nuts and so harder crunchy and also chewy foods like steak.

Speaker 2: 15:39

A lot of my patients now in Los Angeles area my offices are in Thousand Oaks, in Oxnard, california the carnivore diet right. So they're having steaks for lunch and steaks for dinner. They're intermittent fasting in the morning and it's really chewy. And if you've already had the stress, the anxiety and the clenching and grinding, you're going to have more jaw problems. Make sure you cut your meat into little pieces.

Speaker 2: 16:04

And then, finally, one of the most prevalent reasons is not being able to breathe well. When you're not, if someone suffocates you or your oxygen intake is less, you tend to punch down. It's a fight or flight response. So we're noticing if you had a night cam on somebody who has sleep issues and breathing issues meaning they have sleep apnea you'll notice that they grind their teeth forward and wear their lower front teeth down. The classic person is well, I sleep with my mouth open. How am I grinding my teeth? That's a sleep apnea patient. Because they keep their mouth open, they get an obstruction of breathing, they slam their teeth together and they bring their lower jaw forward. And that's another reason why people have TMJ issues.

Speaker 1: 16:49

Very good. Somebody asked I thought encouraging chewing was good for jaw development. It is. We love chewing, chewing, chewing.

Speaker 1: 16:56

However, if somebody has TMJ issues that's what we're focusing on today that's when you have to be a little bit more careful and you can't chew anything to chew your hard foods, because it can exacerbate your TMJ problems clicking, popping pain. However, most of these TMJ patients either have a tongue tie, so every time you move your tongue, your tongue is supposed to move by itself to do all tongue functions chewing, swallowing, breathing or rest posture. When your tongue cannot move because it's tethered to the floor of the mouth, your jaw is going to move every single time your tongue moves. So, like that, you start damaging your joint. It's almost like if you were stepping the wrong way with your knee all day long. Eventually you're going to need knee replacement surgery, right? So it's the same thing with the jaw joints. You have to be very careful. Also, if you're up in your lower jaw, do not grow forward enough during development. A lot of times we see TMJ issues in these patients. So in a myofunctional therapy perspective, a hundred percent we want patients chewing, but that's why you shouldn't follow everything that you see online, because it's going to depend on the patient. So you know it's not great for everybody to tape their mouth.

Speaker 1: 18:11

Somebody asked this a little bit earlier. I'm going to go through some of these questions In jaw development issues. Let's see my orthodontist extracted eight of my teeth. Is extraction of teeth correlated to TMD issues?

Speaker 2: 18:27

So extractions of teeth are correlated to sleep apnea. Yours truly has sleep apnea. One of the reasons is because of that. I had four bicuspid extractions done in dental school, so now my arches are more narrow. When you extract teeth you have a higher percentage. The estimates are about 83% 84% higher chance of having sleep apnea, which then means you have more TMJ issues. If the oral surgeon or the dentist extracting wisdom teeth which could be the other four teeth so four bicuspids and four wisdom teeth if it was a very traumatic, lots of pressure, very aggressive, that can cause TMJ problems. It's almost like getting into an accident, having the airbags deploy and hit your face. That's another way people can get TMJ issues. Or a ball hit in the face or a fall with the chin hitting against a table or a chair, which we hope never happens with our kids, let alone ourselves. These are ways that TMJ's problems can start. But yeah, the bicuspid extractions.

Speaker 2: 19:34

I'm a big, I do orthodontics myself. I do traditional braces and Invisalign. I learned it through Progressive Ortho Solutions in Orange County, a two-year program, so I've done a lot of braces. My ortho consults, especially for five-year-old to like 14-year-olds, are we need to expand the jaw and create more room for the teeth so that we can prevent teeth extraction, so that your child has a less likelihood to developing sleep apnea and snoring issues. I love it. Drop the mic right there. It's the expansion. The class two jaw correction when our beautiful babies are young is not just to create more room for teeth to come in and make things look pretty and not have to have them go through the extractions. And I'm sorry that you went through that. I went through that as well because I didn't do phase one ortho as a kid. So hygienists and dentists push phase one ortho treatment when you see not enough room, crowding posterior cross, bite class two correction early so we can have the benefit of breathing better because the tongue has a place to sit.

Speaker 1: 20:50

Perfect. I do want to go back a little bit to clenching and grinding. We always say that it's because of stress. But, like Dr Dara was saying, if somebody goes to sleep and for some reason, there is blockage in the airflow. So if you have enlarged tonsils, enlarged adenoids, deviated septum, if you have allergies, if you're sick, for whatever reason, there is blockage in the airflow. Whenever you're trying to breathe, then there's less oxygen that goes into the brain. If there is hypoxia that is stress your body is under stress. What happens when your body is under stress? The blood pressure goes up, heart rate goes up and all of these things change. Of course, then the lower jaw can come forward. What comes forward with the lower jaw? The tongue. If the tongue is obstructing the airway, all of a sudden everything moves forward. It frees your airway. You can breathe again.

Speaker 1: 21:43

I want everybody to try this. Look in the mirror and I want you to bring your lower jaw forward to touch your upper teeth. I remember that I used to have so many patients with signs of clenching and grinding and they would look at me like are you crazy? I did not grind my teeth. Well, your teeth naturally have something called the mammalons, so they have this little beautiful round shape at the end of the teeth. Sometimes orthodontists will shave that down after ortho. However, you're supposed to have a little bit of that throughout life, chewing, of course. Slowly it goes away. However, if you bring your lower jaw forward right now and you touch your teeth together, and then I want you to move slightly your lower jaw to the side, one side, one way, and slowly move your jaw to the other way, if in any of those moments those teeth fit perfectly like a puzzle, guess what? That's what you do at night. That's exactly that spot.

Speaker 1: 22:40

You like to keep your lower jaw because one, it's easier to breathe. Like I said, it brings your tongue forward. Also, and I do believe the number two is because that's where your TMJ likes to be, that's where your condyle and everything over there feels better. A lot of times we see these patients who have had so many teeth extractions and upper and lower jaw are too far back, have also TMJ issues. Just because the condyle is not ideally where he wants to be. He keeps wanting to move forward. Somebody else said my son has a deviated septum, therefore narrow jaw and unable to breathe through the nose. He's 11. Any suggestions, for example, nac supplements for him. I am in the UK.

Speaker 2: 23:31

So, first of all, when you bring your jaw forward like that and you're trying to get more air, if you feel your masseters, your cheek muscles, you'll feel them contract, you'll feel them get strong. That's not a workout session we will be doing in any gym or home gym. So any forward lower front teeth worn down, scalloping on the side of the tongue, those are the key landmarks when it comes to sleep. When it comes to children, again, I've shared this with you before you, before renata, and the few weeks after my accident, when I fell asleep with the wheel, not knowing I had sleep apnea. My two and a half year old son, uh, I noticed that he was snoring more. He had issues with respect to just being more happy in the morning, getting up. His growth percentile was at 30% while his older sister was at 90th, and so we had a pediatric ENT evaluate. His issues was tonsils and adenoids.

Speaker 2: 24:34

And so at two and a half years old, making that decision as a parent to voluntarily surgically put him through that type of treatment. It was a very hard decision. I myself have also had a DVA septum. At nine years old I thought I was Michael Jordan and I got elbowed in the nose playing basketball more than once, and so I became a mouth breather.

Speaker 2: 24:57

Mouth breathing is notorious for getting at that age, 11 years old a high arch palate, because the more you breathe air through the mouth and the suture or that little line in the middle of the roof of your mouth hasn't closed yet it's more likely to come up because of the air pressure. While your kid is doing PE physical education, while he's studying, while he's running or she's running while he or she is sleeping, that constant breathing through the mouth causes the palate to become more arched, the teeth become more narrow and then the soft palate becomes more forward towards your lip as opposed to further back and therefore, as he or she gets older they're more likely to have sleep apnea and snoring. So deviated septum correction, adenoids and tonsil evaluation surgical intervention looks like a possible thing to do right now for your child.

Speaker 1: 26:00

All right, yeah, so get a consultation. You know a lot of us my functional therapists work online and we are looking at all of that. I always tell my patients that we have three pillars. Ok, the first pillar is the airway. We got to make sure that this tube is free and clear. Pillar number two, upper and lower jaw we got to make sure they are grown full enough, so we work with an orthodontist. Full enough, so we work with an orthodontist. And then number three is the muscle. We've got to make sure the muscle has enough tone, has enough strength and it's functioning properly.

Speaker 1: 26:30

If you only address one of them, the patient is very likely to relax. For example, if you just do myofunctional therapy and this patient has enlarged tonsils and adenoids they're going to relax because you can't breathe. There's no way to keep your tongue up if you cannot breathe through your nose. I had a patient recently that had expansion done twice. She came to me, she was 13. So she had expansion in a seven and a little bit, I think a four or seven, four and seven and she relapsed both times. Why? Why they gave me an x-ray. After the orthodontist looked at the x-ray and said, yeah, her airway is a little small. But I looked at the x-ray guys. She didn't have enlarged adenoids, she didn't have enlarged tonsils. She had enlarged lingual tonsils. Those get missed all of the time and I said nothing ever is going to work until we get that taken care of. Number one thing you have to do in order to survive is to breathe. So if you can't breathe, your body is always going to reverse too.

Speaker 2: 27:31

So, renata, you mentioned something very important, right the parents who are listening or soon to be parents in the future. When you have a child and you see signs of a problem, what is that? A child and you see signs of a problem. What is that? The problem is snoring, the problem is grinding of their teeth. The problem is you look and you see that their eyes are sunken in, they're more tired, they're more grumpy, they're more moody.

Speaker 2: 27:55

There's really three people that you need to visit. Number one is a pediatric ENT, number two is an orthodontist and number three is a myofunctional therapist. I think those three let's call it treatment modalities all have to be looked at to talk, to see if there's tongue tie, to see if there's adenoids, tonsils, deviated septum and to see if there's any sort of expansion or class two correction that's needed. It's a lot. It's a lot. I understand as parents, you're dealing with a lot. You got to really go through all that. I mean, we're talking such a big difference in growth when it comes to growth, hormone production, adhd issues. So physical and mental development.

Speaker 2: 28:43

And all we can do as parents is give the best possible outcome for our children, and it takes work to be able to make those kinds of appointments, to be able to go in have the treatments done. It's a lot, but that's the responsibility that we take at least part of the responsibility that we take as parents.

Speaker 1: 29:02

We have another question, at least part of the responsibility that we take as parents. We have another question how can I change my 17-year-old mouth breathing son into a nose breather and he's always tired in the day Would he benefit from maxillary arch expansion? Teeth are already well aligned without ortho. That's a great question. If your teeth are perfectly aligned, how can you get ortho?

Speaker 2: 29:22

So, first of all, the inner molar space has to be around 42 to 43 millimeters, so, like between the inside of the upper molars, you can have perfectly straight teeth. And if you worked on that, renata right, you went through it through a lot to get there. It's too narrow, even though the teeth can be perfectly straight. If it's too narrow, even though the teeth can be perfectly straight. If it's too narrow, you're still not done with expansion. And we talked about the pediatric ENT or an ENT looking at the adenoids in the tonsils. There's a reason why we're mouth beaters is because the nose is obstructed. The turbinates could be inflamed. I had my turbinates cleaned out and it helped for a year or two and then you got to go back in again.

Speaker 2: 30:04

De-receptive issues, mouth taping If a patient or a person can mouth tape and breathe through their nose comfortably, then it's just becomes a habit. It literally it's a habit that they're breathing through their mouth. They just got to retrain themselves and remind themselves. But it's very unlikely it's habit induced. There's some blockages sinus issues, turbinates, adenoids involved. Something's going on that's making the person a mouth breather. If you don't open up the nasal passages, you can't ask your kid or any adult to become a nose breather.

Speaker 2: 30:38

And remember, nasal breathing increases the chances of nitric oxide production, gives you more of a less of an anxiety kind of life. In meditation and yoga we're taught most of the breathing techniques is to breathe in through your nose right. And there's a reason for that, and that's to vibrate the back of the nose fibers, the cilia, to cause the pituitary to increase nitric oxide production, which vasodilates the blood vessels and causes more blood flow and relaxes the body. So very important to have a pediatric ENT. And then, even though he's been through ortho, I would still make sure there's enough room for the molar to molar distance. You can maybe even do the measurement yourself. You want at least 42 to 46 millimeters in width between the inside of the second to last tooth If you don't have wisdom teeth to all the way to the other side.

Speaker 1: 31:37

Yes, 100%. Again, start with a myofunctional therapist. We have a group of referrals that we know. That we know depending on where you are. That's when we have a directory on Aries Circle. So if you go to ariescirclecom slash directory you're going to find professionals all over the world that are looking at these Interview professionals in there. Give some of them a call and see who you're going to align a little bit better with.

Speaker 1: 32:04

But a 17 year olds, your old mouth breather? Yeah, like Dr Dar said, there could be many, many reasons. Palo expansion usually does help because if you do expansion in a way where you open the suture, you're going to see a space in between the two front teeth. You're also expanding the nose, the upper palate, so the roof of the mouth is the same bone as the nasal cavity, the maxilla. So whenever you widen the mouth you also widen the nose.

Speaker 1: 32:34

But now does this patient have allergies? As a myofunctional therapist, I'm telling all my patients reduce allergens, reduce fragrances, reduce allergens, reduce fragrances, reduce, you know, plug-ins and laundry detergent. And clean the air conditioning more often, get hypothermic sheets. I have a list of things that I usually recommend to make sure that this patient can breathe better. Nasal sprays just saline, cleaning the nose more often, reminding the nose that it needs to be used. So tons of nasal exercises we do and breathing exercises, so the nose does work better. We interviewed dr rosaba courtney yesterday from australia on aries circle and she is just a genius when it comes to breathing and she was talking about nasal disuse if you don't use your nose, it won't work. Um, so we do tons of that to help our patients breathe better. But, yes, expansion could definitely help. Does mouth taping work? In which shape? Somebody asked you just mentioned that Mouth. So I have a controversial answer to this which tape works Well?

Speaker 2: 33:47

answer to this uh, which tape works well? Uh, any tape will close your mouth shut.

Speaker 1: 33:49

That tape didn't even work. No, exactly, but it's not about that. We have to find out why. Why is a station breathing through their mouth because it's a rescue breathing if you can't breathe through your nose automatically going to open your mouth? So I don don't recommend first of all closing the lip shut and then, second, I don't recommend anybody taping just because you need an evaluation. We got to make sure there's no blockage anywhere. We got to make sure it's comfortable, like Dr Dar said, comfortable for you through your nose. So working with a professional that can kind of guide you and teach you how to do it the right way, the proper way, and using the right tape for yourself, is the best thing that you can do. Let's see what else. We have questions here in the meantime. Do TMJ problems affect mandibular growth in children?

Speaker 2: 34:48

problems affect mandibular growth in children. Mandibular growth in children is definitely affected by TMJ. If they're clenching and grinding their teeth, they're going to destroy their condyles, so it can definitely have an impact. That's why if you again, if you notice grinding of your teeth or the teeth of your child, there has to be an airway evaluation done with the pediatric EMT. I always go there first because I like to know if there's anything surgically that needs to be done so I can prepare myself. It's not all. As you said, you could do the ortho and it still relapses. There needs to be an airway evaluation first when it comes to the adenoids, the tonsils and even the turbinates.

Speaker 2: 35:27

Now you mentioned something I wanted to talk back about the mouth taping. I've had patients who their sleep appliances have broke and we're fixing it. So it takes a couple of weeks to get it back from the lab. They freak out and they're like Renato, what do I do, right? Well, what am I going to do the next couple of weeks to get it back from the lab? They freak out and they're like Renato, what do I do, right? Well, what am I going to do the next couple of weeks? I know it's bad. You convinced me two years ago and I'm a patient for life and I've had these patients mouth tape and they told me, oh my God, it was so much more beneficial than not. Now can they breathe through their nose? Yes, meaning when they put their finger on one nostril and close it and try to take breath in through their nose, camnic right and do it on the other Cause.

Speaker 2: 36:17

If you're obstructed in your nasal, you're almost going to suffocate yourself by mouth taping. Now, one of the major things with mouth tape is if your jaw opens up, as it's opening, and kind of like getting lazy, so to speak, it also goes back right. It's not just a up and down straight motion, it's a hinge. So as the jaw opens, even ever so slightly, it gets retreated the opposite of what a sleep appliance does right. So mouth taping can help position and keep the jaw in its original position so that it doesn't fall back. But, as you said brilliantly, if you have obstruction, this is not the sleep apnea treatment protocol. No board of certified sleep physician will write mouth taping as the only or way of treating sleep. It's an adjunct to be able to push you to start nasally breathing. But if you're congested or you have allergies or you have turbinates that are or deviate septum. The mouth taping is going to make you feel like you're suffocating, or deviate septum.

Speaker 1: 37:23

the mouth taping is going to make you feel like you're suffocating. There you go. Last question Somebody said, wow, my wisdom teeth extraction was aggressive. It makes sense. No wonder I'm having these issues now. So can dental procedures where you keep your jaw open for a long time, or like wisdom teeth extraction, anything like that? Could that start a patient to have symptoms of TMD?

Speaker 2: 37:51

Unfortunately, wisdom teeth extractions are most of the time, a must. You have to have them done. They are impacted. They're affecting the tooth next to it. You have pericoronitis or prevention of pericoronitis, which is an infection of a wisdom tooth when food gets stuck right in the back of that gum tissue where the hides. So the risk is there. There is also a risk of temporary numbness in your you know, tongue and cheek and face and whatnot. It can lead to tm. Yes, is it the only thing that can cause the jaw problem? Not necessarily Typically patients who clench and grind their teeth and then they go in and the surgeon puts them under and is aggressively grinding and moving that and the jaw keeps getting pushed back.

Speaker 2: 38:38

It's almost like you're getting into some sort of traumatic accident or a fall that impacts the jaw.

Speaker 2: 38:44

So really kind of it's beneficial to make sure your oral surgeon is not, sorry to say, a butcher.

Speaker 2: 38:55

It makes a big difference and the biggest advice I can give you all if you have kids that are going to be teenagers or you yourself have to get wisdom teeth out, be a little bold with the oral surgeon or the dentist and say you know, you may even want to fib, even though I'm not a big believer, but say you know, I'm a little concerned that sometimes I have some jaw pain or jaw tightness. Will this affect me after I have my wisdom teeth done? Will this affect me after I have my wisdom teeth done? In the back of their mind, they're going to be like, let me not be so aggressive, taking this wisdom tooth out on the bottom, and so maybe they'll go a little bit more on the gentle approach and cut the tooth into more pieces, as opposed to be super aggressive and cause jaw problems. So address that you're concerned about it. Let them know that you sometimes feel like your jaw is tight and you may have a concern about that, so they can be a little bit more gentle.

Speaker 1: 39:52

Perfect. Well, I took some photos of some of the questions that we have here that we don't have time to go over. I'll be answering those in my story. So guys run over to my move stories. I'll be addressing some of the extra questions we did not have time to cover. Well, dr Dar, thank you so much for spending some time with us today. I really appreciate it, educating our followers, our listeners. What are your last words?

Speaker 2: 40:20

Thank you for listening. You know, one of the biggest things I've been always talking about is the more we open our mouth and we discuss what we know with our patients, with people at you know, family gatherings or friends and whatnot. So how's your day going? Great, I was on this podcast and I listened to Dr Ad and Renata talk about how kids grinding their teeth is a no-no. What do you mean? My kid grinds his teeth. What is that? The more awareness we put out there, the more we can help humans and our kids and whatnot in this world of sleep apnea and TMJ and they are very much correlated. Treat the sleep, you lower the chances of TMJ or TMD issues.

Speaker 1: 41:07

Perfect, you dropped the mic, all right. Well, thank you everybody for listening. This podcast episode should be out in about a week. Thank you, dr Dara. Have a wonderful weekend.

Speaker 2: 41:18

We'll see everybody later. Bye everyone.