SPEAKER_02 0:44

Hello, hello everyone, and welcome to another Beauty of Breathing podcast episode. Today I have Miss Margaret Stoch presenting. Margaret to you guys, she's a speech language pathologist and founder of Advanced Therapy and Wellness Center in Illinois. She specializes in feeding and swallowing, or facial myofunctional disorders, and airway-centered care linking oral function with breathing, sleep, and overall health. Using a whole body root cause approach, she addresses patterns such as mouth breathing, low-tank posture, and oral motor dysfunction. She is also a myofunctional

Welcome And Tongue Tie Conference

SPEAKER_02 1:26

therapist and certified nutrition coach who collaborates with multidisciplinary teams to support lessing functional outcomes. Welcome, Margaret.

SPEAKER_01 1:35

Well, thank you so much, Ronato, for having me. It's such an honor to be here with you today and share my story. Thank you.

SPEAKER_02 1:42

I am so excited. So we met each other at tongue time in Switzerland this year. How amazing wasn't that true?

SPEAKER_01 1:50

Oh my gosh, that was uh a great conference. I am really looking forward to the next one. Um, and uh yeah, we really had a had a good, good time. So it was fun, very inspiring to be surrounded with you know just a lot of people that come together to learn all these things, right? And not only help our patients, but help each other out to get better, be more educated, be more knowledgeable, right? To bring this information out to the world. So it was uh super fun and inspiring at the same time.

SPEAKER_02 2:24

Yes, and kudos to the organizers, guys. I mean, it's absolutely insane to be able to put a conference that big, that fast. And it makes me so excited that so many people in Europe and around, because there were people from all over the world there, um, were excited about talking about Tang Tai. So the next one's gonna be, I think, July, don't quote me, but 7th through 9th, maybe something like that. Uh 2027. 2027, next year, yes. And I'm super excited to go see St. Gallen in the summer now.

SPEAKER_01 2:55

Right? Yes, for sure. Winter was fun, but uh definitely looking forward to seeing some flowers and green grass uh in the south mountains.

SPEAKER_02 3:03

So and it's such a cute little city, and the food was incredible, anyways. I cannot wait for you guys to come hang out with us uh in Switzerland. So the topic today is my airway wake-up call. What adult uh expansion? So she had the Murphy done just like me, taught me about breath, sleep, and resilience. Ta-da! How would you like to start this? Tell us a little bit about uh yourself and how did your airway journey start?

SPEAKER_01 3:34

So I went back to school to become a speech pathologist after I had my first son and was working in the hospital setting. That's where I started my career, and my passion was working with feeding and swallowing. I uh specialized in working with

Her Son Sparks The Airway Journey

SPEAKER_01 3:52

um adults that had had a neck cancer, and um, that grew into my passion for working with pediatric swallowing uh disorders. And you know, I could go on and on about my story, but ultimately what happened, I had my second son was working um in another hospital and wanted to get into more um working with infants in our um post-NICU clinic, and went to a breastfeeding course. And I am a true believer of you know, everything happens for a reason. And a guest lecture and not um conference was Dr. Milton Gavillis, which a lot of people know, I'm sure of. And he presented about tantis, and everything that he talked about was my son, who at that time was four and a half years old, and we've been on this journey from the time he was one month old to try to figure out what was wrong, wrong with him, right? What was going on with him, and so long story short, went to Dr. Dr. Gavelis, started working on my son, started providing treatment for him with palato expansion, tongue tie release, and all that. And then at the same time, I got myself into this rabbit hole of my functional straightway sleep, all of those things, all of those things, travel around the world, educated myself as much as possible to know how to help my son first and foremost, and then at the same time help my patients. And um, you know, as I started taking myofunctional courses, I knew that I was also a patient at some point, right? But at that time, it was my middle son was my number one priority, so I had to take care of him, and then I also had a two-year-old son at that time, right? So then he was next, and I had to go back and do my 10-year-old and then my husband, and now finally it was my turn. So ultimately got the Marpee September of 20. I can't keep track of time, September of 24. Uh, got it placed, then it was taken out right before we went to Switzerland, uh, first week of January. And as you can see, I'm still an ortho. Who's your Marpee? Do you mind sharing? Who did my MARP? Yeah. Uh Dr. Huang out of uh Gold Coast Orthodontics in Chicago.

SPEAKER_02 6:24

There you go. A lot of people are looking for providing Chicago. So there you go. Give him a shout out.

SPEAKER_01 6:29

Yes, and he's amazing. And I am not as a straightforward case.

Choosing MARPE And Going All In

SPEAKER_01 6:35

There's a lot wrong with my face, my oral structures, and how things develop. So it wasn't just like, oh, I need you know a few millimeters of expansion. We're talking about me starting with 26 millimeters of um palater width, which is an average of a two-year-old, right? Oh my gosh, I was a four-year-old, I was a 30. So that's where I started, and um I expended 13.36 um that is insane. And on top of that, my whole face, because growing up I had all these issues with my you know, dental health and and whatnot, I had teeth extracted and a lot of dental work done, and so my whole face shifted to the left, so my midline was off. So we had to structurally bring my face more center so things look more symmetrical. My lower jaw is still a little off. You know, if you know, you know, you could probably notice some things, right? So um, but when I was a teenager, I had an underbite. I knew I wanted to do something with my teeth. My parents didn't really have money for my you know braces and things like that. And so when I started working, I'm like, I'm gonna get braces, I'm gonna get my teeth fixed and all that. And they told me I my only option was double jaw surgery. And at that time, when I was 18, 19 years old, they they told me that that was it. And we didn't know about these things, right? So when I found out about like I can get this fixed, right, and would not have a jaw surgery, not have screws and plates and different things in my face for the rest of my life. I was like, sign me up. It's just it was just a matter of time, and time had to be kind of you know, things had to figure out. I'm a business owner, I'm I'm am I a functional therapist, right? So there's a lot of things that I had to organize and put in place in order for me to execute this. Like I I had to find the right time, and so things just kind of like this is it, I'm doing it right now. And I went all in.

SPEAKER_02 8:44

Ah, I love it. And this is a shout out right here to moms and business owners and wives and just women in general out there. We always put ourselves last. And you cannot fill anybody else's cup with you if yours is empty. So remember, put the oxygen mask on yourself first. If you're able to, please go ahead and go with this. Uh, I have patients all the time who say, Well, it's not the right time. I have something going on. It's not the right time. I have this presentation to do, or I have this job. I cannot have spaces in between my teeth. Well, it's you're never gonna have the right time. It's never gonna feel like the right time. Like you said, you just have to, you know, trust your provider, first of all, jump with both feet and just go for it. It is such a small part of your life compared to the amount of years that you're going to benefit from getting this done. Um, I'm I'm a huge, of course, proponent of Maxillary expansion for adults, uh, which we're gonna get to talking a little bit more about the different acronyms and different types of expansion, uh, because we have a lot of people confused out there. And also for you guys that don't know, we um go live on Instagram for Beauty of Breathing. So if you're not following us at uh Maya Moves on Instagram, uh some Tuesdays at noon, uh I do these live so you guys can listen to us live and ask questions. So it's a little bit more of an interactive podcast. I miss Clubhouse for those who remember Clubhouse, so that's why we decided to do this. Um, so please send your questions if you guys are with us live right now. Um how was the process? A lot of people are afraid of the pain, of the procedure. The name surgical is in the middle of MARPE, and um, you know, well, it's not in the middle of MARPE, so it's mini MARP stands for mini-assisted assisted implant rapid positive expansion. Surgical is not even in there. However, people think that this is surgery. Can you please explain a little bit of what your experience was getting the MARP installed?

SPEAKER_01 10:57

Yeah, and I I think it's also important to mention that the MARP is custom made, so it's not one size fits all. And um, it is a custom-made appliance for you and what you need. And it and like I said, in my case, I had other

Placement Day Pain And Practical Tips

SPEAKER_01 11:13

also objectives of getting the MARP, which one of them was shifting my face to the right so to be more um symmetrical, right? So with that being said, the Marpey being a custom-made appliance is it also depends on how many screws you're gonna get. In my case, I had eight screws. So I've heard of I don't know how many do you have, I but I've heard that between four and six. Um I still had my Marpe here. I have it in my drawer. I definitely kept it as a souvenir for sure. And so so I show up to the appointment, and um, there was a lot of anesthetic for sure, a lot of shots in in the palette. And at first, I I also have a tongue tie, a posterior, right? And so my gag is pretty sensitive. And at some point, I think just the overload with the anesthetic and everything that I had, all the gear that I had in my mouth, it was a little hard for me to like swallow and coordinate my breeding with the swallow and stuff like that. But overall, it was really great. The the office and Dr. Wang, like his assistance, everybody was so great. So I don't know, I was probably there for an hour altogether.

SPEAKER_02 12:35

And what was the hardest part about it? And what was the part that surprised you that you were like, huh?

SPEAKER_01 12:42

That wasn't a hardest part about it was trying to figure out how to keep my tongue in my mouth so it's not constantly rubbing against it. And I I really had to kind of overcome these challenges of you know, like, how do I cover the screws and how do I clean it? And how do I eat? What do I eat, and all those things initially? Also, there was a little bit of pain. I think a lot of kind of the discomfort didn't come from the actual like the appliance, it was more of the structural stuff, like when things started shifting. So the pain from the appliance and like getting the age screws in my palate probably lasted maybe for like two days, three days max. But then I was cranking also, like starting day two. You know, the next day I was already cranking, and my nose, the tip of my nose, my cheekbones, that was the like the pain or the discomfort. That's where it came from. And that probably lasted for good, I don't know, 10 to 14 days, where I felt like I had to occasionally take some pain medication just to kind of deal with it. I also did um an eye mask, uh a red light massager on my face to like help to kind of calm things down. I also did craniosacral therapy almost every day. I am blessed to have an occupational therapist in my practice that uh does craniosacral. Right? I I got lucky there. And so we were doing all those things to to help with um with the discomfort. But after that, it really was just figuring out kind of like how to change my patterns of my day. Like, what do I eat? When do I clean my teeth? How you know, how do I do it, and things like that. And it really wasn't that crazy. Like right now, from my experience, the patients that we have in our practice, when they go for the MRP, I have a list of all the things for them. Like these are all the essentials that you need, right? Um, because I really didn't have that going in for the MRP, like you you need to make sure you have wax, you need to make sure that you have the water pig, right? Or the little um brushes, uh, you know, uh-huh and things like that. So I have lists for my patients, like these are all your essentials, and you're gonna be good. You just make sure you have all these things.

SPEAKER_02 15:09

So that's amazing. You didn't know that I had wax and I didn't know. Oh, I didn't open, I didn't open the package that Dr. Lipkin gave me. So he put a bunch of wax in there, and that to me, that was one of the most difficult things. It was actually my tongue getting hurt on the appliance, even though he covers them with um composite, whatever that is. Um, my tongue was still so sore. I had, you know, like ulcers almost on my tongue, and then it's difficult to eat. To me, that was the most painful thing. I had zero pain other than that. Besides, whenever they were installing it, you have the you know, the shots. Girl, I am such a chicken when it comes to needles. I actually had to give blood today to just do blood work for health purposes. They took 16 vials, I almost fainted. But just because I'm so scared of needles, like I don't like them. I am, you know, so I'm the worst dental patient when it comes to that stuff because I know they have to do the anesthesia. However, it was super comfortable. He put something very, very strong, um, topical-wise, on the roof of my mouth that I already couldn't feel. So towards like the end of the first shot, I felt a little tiny bit. And then whenever he was putting the screws, uh, the last screw, I felt a little bit of the last bit of the screw, almost felt like it was going into my tooth. And I was like, oh my gosh. You know, uh to me, the worst part about it was knowing what he was doing because we're so knowledgeable in this area. And right before he started, I looked on the computer screen and you showed the size of the screws. And whenever I saw that, here I'll show you to you guys for those who are watching this on YouTube or Instagram. Those are pretty long screws, you know. And one of them said 17 millimeters. When I saw that, I was like, oh my gosh, that is so much. So I kind of got freaked out and it got into my head. So I really feel like that's the worst. If you know, the least you know, the better. Uh, close your eyes and just trust the process and just go for it. Um, but then afterwards, yeah, it's my tongue getting sore. Jennifer Sullivan, who used to work for my own moves, great friend of mine, um sent me a link for uh a wax from Amazon, because that's what she had done. And so I purchased that. And then whenever I was like putting my stuff away one day, I found the wax they had given me. I could not believe I missed it. So that was helpful having something cover over there so my tongue would get used to it. And then food. You can't, I couldn't eat salad. If you eat like rice, chia seeds, stuff like that, everything goes underneath it. So that's a little tough to clean.

SPEAKER_01 17:56

Yeah, and also like I I do quite a bit of like different supplements and things like that, swallowing pills was because they always would get caught. So that was the one thing I was really looking forward to, not getting choked up on doing my supplements uh when the Marpee came out because now my airway is so big, my throat's so big, so I can swallow multiple pills at the same time. And so um that's just a side effect of having a larger airway. So it's great.

SPEAKER_02 18:22

So explain the feeling of that first swallow as soon as the Marpie was out.

SPEAKER_01 18:32

So when the Marpey came out, I it's just kind of weird because the like you said, the more we know, the harder it is. I'm like, what is my tongue doing? Why can't I get my tongue up in there to get my tongue tie? Because I still have the tongue tie. And so now because my palate's so wide, my tongue has to go up there to reach it, right? And my tongue tie is more obvious. So it took actually like a few weeks to figure out the swallow now

The Weird Part After Removal

SPEAKER_01 19:03

because I had nothing to get my tongue pushed against because the Barbie wasn't there. So that was the weirdest thing I I thought. Um, but uh other than that, you it's the breathing, it's the sleep, it's the energy. Is I I can't even describe like all those changes and all those symptoms that I had. I had nasal uh bleeds like twice a week for as long as I remember, probably starting like teenagers, TMJ issues, headaches, fatigue, like all those things, right? And all of that is pretty much gone. It's just my teeth I have to figure out right now with the um restorative part. But other than that, I I sleep so well. And like I said, I you know, I'm I I multiple businesses, I have three kids, they've a lot going on, so sleep in quantity isn't always there, right? But the quality is there, and I I'm still able to function and have a lot of energy. Yeah, I don't feel like I'm gonna fall asleep behind the wheel when I'm driving. I, you know, like all those things are are great. So I'm super grateful. My husband comments, like, Oh, I can't hear you. Breathe with you know, where we go to sleep, and I'm like, I can't hear you, you need a Murphy. So all those things are are really great.

SPEAKER_02 20:24

Um is asking, how long did you have the extender for? Do you mind mentioning that again?

SPEAKER_01 20:29

16 months, and it's not that everybody has to have it that long. Like I said, mine was a little bit more complex. That's why we were using the MARP as an anchor to shift my to the right. That's why it had to stay in uh as long as it did. I think every is anywhere between nine to twelve months, right?

SPEAKER_02 20:50

Yeah, uh, I had mine about 12 months, but it's and things are changing. So, because things are changing, let's talk a little bit about that. MARPY, MASPY, MAPI, SARPY, DOM, DOM Zero. What are all these acronyms? Patients are more and more confused as this world of adult palatal expansion uh expands, literally, uh, into the world. So if anybody over here is listening, let us know in the comments what is the most common um acronym that you have heard. Uh, recently a patient wanted to get adult palatal expansion, and we're recommending, you know, this person, this person, well, but they do they

MARPE MSE And Other Acronyms

SPEAKER_02 21:39

do this specific one? Oh, they're all the same, you know. There may be different protocols of turns, there may be different protocols of what the appliance looks like. However, adult palatal expansion needs to be bone born or maybe a hybrid. Let me explain what that means. So you oh, and we had the MSC also, right? So the MSC, uh, you mentioned earlier that the MARP is custom. The MSC is the one that is not custom. So the MSC was an appliance done by Dr. Moon Moon, and it had the places for the screws already. So the places where the screws go, it was the same for everybody. That is why so many of them failed back in the day, because the roof of the mouth has different thickness and quality of bone. You don't know where that is unless you take a CBCT x ray, which is that 3D X ray. X-ray to find out exactly where is the best place to get that installed. So before they were a little bit blind, just putting it anywhere hoping that it would work. And four screws was not enough for everybody. So then we have the Marpees that are attached to the bone and attach the teeth. So those are called hybrid. Whenever you have anchorage on the bone and on the teeth, they're hybrid. Whenever you have anchorage only on the bone, that is a bone-borne expander. Whenever you have anchorage only on the teeth, that's a toothborne expander. So if it's MARP, MASP, dome, pretty much they all do the same. They're all going to anchor on the bone at some point, and you're going to have the little wrench. Then you do the turns and it's going to open up the suture. So the most important thing for children and adults is to open the suture of the maxilla. So your upper jawbone, the maxilla bone, there are two bones with the suture in the middle. And you have to have the little key, the little wrench, and the little screw in the middle to get those two bones to split apart. That's when you're going to notice changes on your face. So cheekbones are higher, your upper lip kind of comes out a little bit more. You may have nasal changes, eye changes, hopefully all to the positive. Now, what is the rate of turns? Is it going to be slow expansion? Is it going to be rapid expansion? It depends on what the provider is used to. We noticed that with these types of appliances that are bone-born, when you have the appliance into the roof of the mouth, you don't have to move fast anymore. The only reason why we had to move fast before, it's because the applying was attached to the teeth. And in order for us not to get too much teeth tipping, we had to move a little bit faster. And of course, it depends on the age of the person. So there's so many buts and variables whenever we're talking about palatal extension. So don't necessarily get stuck on a name. Talk to your provider. Ask questions. You know, what exactly does that mean? What is your turn protocol whenever you're searching for somebody to do something? There's one of those groups online of maxillary extension for adults. And recently I heard of an orthodontist, I think he might have been in Ohio, who applied an MSE or a Marp device on a patient, an adult patient without the screws. And he did the expansion without the screws. It makes zero sense. I'm not sure why he would do something like that. And obviously, this patient got a lot of tooth dipping and not true palatal expansion when the suture opens up. But talk to your providers, ask somebody, ask my functional therapist. We are really in this. You know what I mean? We're always seeing patients and checking with other providers who does the things that we are we believe in. Now we have some questions coming from the audience. Let me go through that real quickly. Awesome. It could be braces, it could be invisalign, it really depends on what that person needs. Can you talk a little bit about uh she mentioned orthotic, so um TMJ patients and this adult pal to extension? What do you think?

SPEAKER_01 26:17

Yeah, so I had developed TMJ issues probably in my early 20s and started just by you know clicks here and there when I opened my mouth or when I yawn, things like that, and then started kind of getting worse as I got older, and it, you know, turned into clenching, facial tension, uh facial pain when I uh wake up in the morning. But what I find um the problem is the um, you know, potentially tongue type, but it's lack of tongue space and then oral uh dysfunction, right? Whatever it is as far as oral rest posture, chewing and swallowing and things like that. So you're going to be compensating if your tongue's not doing what it's supposed to be doing for whatever reason, you're going to be compensating a lot of times it is with the jaw. And so that's what happens. And when you go into a dentist who doesn't understand myofunctional disorders and they put you in a splint or you know, they they're give you something, it it doesn't really address the root cause of why you have that problem in the first place. I come from like what is the problem? Like, where where do we start and let's tackle that and then go from there and not let's just put band-aid on these on these symptoms. And so, like you were saying with with the Marp and and Paladar Expander, too, it's super, super important that you develop a team, don't just go to one provider. I know there are a lot of orthodontists that will do polydor extension for adults and they don't um collaborate with myofunctional therapists. That's a red flag right there. It's a red flag. If you're looking to potentially get this done, invest your time, money, energy into this, you want to make sure that you are working with somebody who has a team that has a team of a myofunctional therapist, craniosacral therapist, a chiropractor, whoever, physical therapist, right? We're we're all gonna need a team. One person's not gonna fix all your problems, not especially for adults. Even for kids, we need a multidisciplinary team to address all the things because it's a it's it's a it's a system, right? And we have to address each part of the system individually to provide the actual like the true healing, right? And improvement in health and quality of life. We can't just be going after one thing and ignore the rest.

SPEAKER_02 28:47

Amazing, Miss Toch. Can we see before and after pictures of your treatment? You're welcome to share to your stories today and tag me.

SPEAKER_01 29:00

If you guys go through my Instagram and Facebook, I have a lot of different things. I just posted something the other day. I actually also have a um before and after x-ray of my face. So you can see my nose, how paper thin my nasal cavity was, and to what it looks like right now. The floor of my nose, I believe, expanded by 10 millimeters just in my nose. So you could you could definitely see a difference from what my face looked like before, as far as like the width of my nose here.

TMJ Clenching And The Team Approach

SPEAKER_01 29:31

And the biggest thing when I started cranking too, what I noticed first was like when I was washing my face, how my hands felt on my face was so different. I'm like, oh, what is this? Oh, it just felt so like it was in my face. Because you're so used to tectile, right? Like you have this sensation that you're used to your whole life to like how you wash your face and what it feels like. And all of a sudden I'm like, Oh, what are all these things, right? So that was kind of fun experience to to also go through. But one thing I can show you guys is the yeah, that's your model. Yeah, that's the model of my two screws that um I actually lost before my barpee came out, so I I had them in here. But this is the roof of my mouth this way, sorry, 26 millimeters.

SPEAKER_02 30:23

Wow, girl, that is insane. It looks beautiful. You know what I was gonna share the other day. I don't know if I shared it on my stories, but I recorded myself. Uh, I was at church singing with my uh little son, and Benny was sleeping on my shoulder, so I couldn't lift my arm up. So I was kind of recording from down here. And when I watched the recording back, all you can see is my palette, and it's huge. And I was like, oh my gosh, I have to share this on my uh stories for my moves, just for you guys to see. Like, uh, it makes me so happy to see that huge U-shaped palette, dome-shaped palette. Um uh we have more questions here. So let's see. Can you do a tongue tie before expansion or should you should it be done after? What about lip ties? Great question. What do you think, Margaret?

SPEAKER_01 31:12

So for me, I um had my upper lip, lower lip, and the left buckle done last January, which was while I was in treatment. And the reason why I wanted to get it done before my tongue tie is when my upper uh brackets came on, I could not close my lips. And I would be drooling on this side, and I knew I had all these things, right? But the plan was that I'm gonna go and get it all done at the same time, but it bothered me, and knowing what I know,

Tongue Tie Timing And Mirror Test

SPEAKER_01 31:46

right? I'm like, a cold doctor gave us, I'm like, we gotta take care of this now. I can't take it anymore. Okay, so you had your tongue tie released while you still had the appliances? Oh, my upper lip, lower lip, and the buckle. Oh, okay. My tongue tie is not released yet because I had to wait until the MARP was out. To answer the question, is it depends? It depends. Every patient's going to be different. However, if you have um a MARP and when with Dr. Gavel is what we do is we do a um phrenoplasty, and I also work with Dr. Kaylee Wells, who is a chiropractor and um she specializes in uh craniopathy. So I am getting a tongue tie release with the guidance of her working it on my cranium on my neck, right? To do that. So, because of my MARP and how it was anchored to the bones, we didn't want to do the tongue tie release because everything is um then kind of stuck, right? So she wouldn't be able to move the bones or and do her adjustments while I was in the procedure. So that was the kind of rationale why decided to wait after. But also for a lot of people, is you can't get the tongue tie released unless you have enough room in your mouth to be able to rest your tongue on the palate. Because if your tongue doesn't fit the roof of your mouth, where is it going to go once it has that range of motion? Exactly. Make your breathing and your sleep worse if your tongue doesn't sit comfortably on the roof of your mouth. So for a lot of our patients, we really have to coordinate what we do. Sometimes we do the lips first, sometimes we wait till the expander is completely out, sometimes we're able to get it while they're still in expansion or the tongue type release. We can still do that while they're in expansion, but there needs to be enough room on the roof of the mouth, and they have to be functionally ready and be able to sustain palatal suction, right? And and or rest posture with the tongue resting on the roof of the mouth for them to also be safe when sleeping.

SPEAKER_02 33:59

How can a patient at home right now go look in a mirror and check if they have enough room for their tongue in their mouth to get the release done?

SPEAKER_01 34:05

Yeah, so you have to get your tongue suctioned. It's not just a matter of getting your there. You go, you can you can demonstrate what I'm talking. You have to get your tongue suctioned to the roof of your mouth. A lot of times when we have patients coming in, I say, Can you get your tongue to the roof of your mouth? And this is all I get. Yeah, that's not enough, right? We have to get that suction against the palate. And in order for you to determine whether your tongue is able to sit there comfortably, number one is do you feel any pulling? Is it pulling down your neck? Is it uncomfortable for you to do that? And then we're looking at the spillage. We call it the spillage. So, how much of your tongue is pulling over your teeth? That's huge. If your tongue's coming over and covering your molars, you do not have enough room for your tongue in there, right? So your tongue should be able to fit in between your teeth. Maybe have a little bit of a spillage, but definitely not covering your molars on both sides. And a lot of times, also when you suction, if you have a tongue tie, if you have tight um fossa connections under your tongue, your tongue might be like tipping in there or like squished in there, and it'll kind of bunch in there, right? So a lot of different variations, but the tongue should be relatively flat on the palate with without having that sensation of it being pulled down or having that kind of tension going down your neck and down your chest. So um, if you feel that there's definitely some sort of restriction, whether you know it or you know, somebody mentioned it to you if you can see it, but it's you know that posterior that mid-tongue restriction. Yeah, uh Zaghi talks about, right?

SPEAKER_02 35:44

So I am more of a risk taker. Everybody talks about the width, being so worried about the width. I'm not worried about the width as much as I'm worried about the AP distance. What's the difference of transverse and AP? So whenever somebody suctions and you see the overflow of the tongue onto the chewing surfaces, yeah, that is not great. We don't want that. Um, however, whenever somebody suctions and the tongue is actually more forward, you have a hard time bringing your tongue further back. You feel like you're choking. If you're that person who suctions your tongue, um, and if you try to hide your tongue a little bit because you don't want your tongue peeking through your teeth, if you try to hide your tongue on the roof of the mouth where it's supposed to be, and you feel like you're choking, to me, that's more of a red flag when it comes to a release. I did have my release done before uh palto expansion, about a month or two before. However, I did that. I was a 30 millimeter molochamolar, I did not have sleep apnea. Um, I knew I was already gonna start expansion, it was already scheduled. Uh, and I wanted to see what was gonna happen. So when I did have my tenta release by the incredible Dr. Samira Jafari um in Atlanta, she's literally one of the best release providers in the world, guys. Um, I did notice a change to my sleep right away. My sleep got deeper. Like it's almost like whenever you go to sleep and you don't remember and you wake up and you're like, oh my gosh, I actually slept throughout the night. Like that's crazy. Um, that's exactly what I felt. And then I got the MRP installed and my sleep went downhill from there a little bit. I started snoring again because of course your ORS posture, which is a function of your tongue, no longer can work properly because now you have this device up there. So I did start snoring a little bit, according to my daughter. I was left in the same room I did at some point. Um, but I did have that insane experience when the MARP came out. And I was recording. I need to go find a video so I can post for you guys. But I was holding the camera and he removed the Marp. I was like, I don't want to swallow yet, I don't want to swallow. And I got up and then I did it. And I was like, oh my gosh, you can see it on my face. The insane feeling of having the tongue actually touch the roof of your mouth the whole time, and the roof of your mouth will come down a little bit. Uh, you can see on my scans that I had really, really high voltage palette and it did come down a little bit. So now the distance that I have to reach my tongue to the roof of the mouth is slightly shorter. But if it filled up the whole roof of the mouth, I had, you know, it was insane, but it was such a cool experience. We have more questions. Uh, can expansions or this orthotic, this is Tela again that asked before. Can expansions or this orthotic help with military neck? She has a bunch of C1, C2 issues. I feel mine is rotated to the right. Sorry for too much questions. No, please send your questions, guys. We love the live interaction. It goes back to the collaboration that you were talking about, right?

SPEAKER_01 38:48

Yeah. So there are um studies and there are providers that work with TMJ and aligning TMJ, and that goes directly to the posture, right? So we know that whatever happens in the jaw is gonna affect the rest of the body posturally. So if you have a proper appliance that puts your jaws in the proper alignment, it will probably do something, right? But you also have to work with a functional provider, a physical therapist, chiropractor, kidnocy, whoever is going to work on the patterns that you already have there. You know, if you're an adult, you probably have, you know, 30, 40 years of compensations and patterns that are dysfunctional. And it's not going to go away just because you put something in your mouth and your jaw is finally aligned. Muscles have memory, right? And everything's gonna kind of stick unless you um address it. And a lot of times that uh you know, addressing has to be uh specific, right? It can't be one thing and then ignoring the the next. Like you have to do all those things. Sometimes you have to do them simultaneously, and sometimes you have to do one thing and then take care of the next thing, right? So the collaboration is the key.

SPEAKER_02 40:06

Yes, body professionals, we need them in our team. Um, an upper cervical chiropractor would be good for to take look at your C1, C2. There's different different types of them. Um we'll look for an upper cervical chiropractor. Um, can this expansion be done correctly after implants? Great question. I have three work canals cavitations and all amalgams, I guess, replaced. The question cut off.

SPEAKER_01 40:32

Yes, so you you can do the MARP because MARP does not move the teeth, it expands your bone, right? So you can still do the MARP. The question is going to be then aligning the rest of your teeth with whatever expansion you have. And there's all kinds of ways to fix it with today's technology, with bridges and all kinds of stuff, right, for restorative purposes, for veneers, right? So um, all those things are available to then restore the

Implants Ortho Limits And Options

SPEAKER_01 41:06

teeth to what you want them to be, but you can still get an expansion with MRP or something similar, um, you know, when it comes to the palate.

SPEAKER_02 41:16

My question is: where are the implants placed? So if the implants are on the lower, it's going to be, in my opinion, a little bit harder because the lower is very limited. You cannot necessarily expand a mandible, even though my old friend, Dr. Sivalen, did send me a message uh last year at some point going, Renata, yes, you can extend a mandible. Uh, but you can do an appliance on the bottom to upright those seeds. So if the implant is already placed in a spot where it cannot be moved, uh, which I have also heard the implants move. Now, with ortho. Um, maybe you can get just the crown replaced to get it to be more upright. You know, there's options there, but it's a little bit harder to make the the mandible wider. There are also surgeries that you can get done where they actually open, uh cut the mandible in the front and expand that way. So nowadays there's options. However, if you want a more less invasive, it's a little bit more challenging if the implants on the bottom. I actually have an implant on the top. I have an implant in a premolar area that I lost the tooth before I was even a hygienist out of the blue. Um, but I was able to get palatal expansion and my implant did move after they did um Invisalign. I did Invisalign and it did move some. Um it's of course it's difficult. There's issues with implants, with more bacteria around, with harder to keep it clean. Uh I had the space there that I didn't have before, so I know things have shifted. Um, but anyways, there is a possibility. I think that the most important thing is finding somebody who's highly skilled, highly trained in this, have done several palato, adult palato expansion um cases. Ask for photos, ask for before and after photos, ask uh if they do custom appliances. Um, ask, ask if they work with a myofunctional therapist. That's that's already gonna tell you there if they're a good provider or not. Oh, somebody said just wanted to say hi to you, beautiful ladies. Hey Andy. Um, upper middle and every quarter. Okay, he's talking about where the implants are placed. Dr. Ilya Lipkin was my provider. He's in New Jersey. Absolutely love him. He's one of the best, best in the world. Uh, if anybody's around him, but he does have people travel from all over the world to go see him. Do you want to mention your provider again? Uh, Dr.

SPEAKER_01 43:49

Juan out of Gold Coast Orthodontics in Chicago.

SPEAKER_02 43:52

And uh, somebody asks, where is that in Chicago? Uh Gold Coast. So, like Michigan, Michigan Avenue on Lakeshore Drive.

unknown 44:02

Perfect.

SPEAKER_02 44:02

Uh, somebody said, just joined. Where is the best place to start if looking for extension as an adult? Orthodontist, myofunctional therapist, both best questions to ask when looking for a provider. So I just mentioned the questions. Where would you recommend they start, Margaret?

SPEAKER_01 44:17

My recommendation would be starting with the myofunctional therapist who has a team because they can guide you to where you need to go. Um, and I I like to joke that we're like the party planner. And uh love that. Right. So we have a patient coming in and then we're guiding them. Okay. And then we are going to be collaborating with the providers that they choose because we have several ownership. We have several providers that we work with. So whoever our patients wants to want to go to, then we're gonna meet together and

Finding Trusted Providers And Resources

SPEAKER_01 44:49

figure out okay, what needs to happen first, second, and third, and we're gonna go from there. But we're always talking, always communicating. And it's important that you are part of that team too. So educate yourself too. Do your research, ask the questions. Like if you're not sure about something that was recommended to you, ask questions. Make sure that you understand why you're being told that you need to do this or that, right? And then decide what do you think is best for you. I have patients that don't want to get pallato extension, they only want to get the tongue tie. And we work with as much as we can with my, you know, my functional tongue function, and then they know that they're gonna have to do something for their sleep for the rest of their life. But that's the choose, right? So you need to be part of that team and decide what do you want, what are you willing to put in, you know, financially, time-wise, like it all takes energy, effort, sacrifice, and it you have to understand why you're doing it. At the end of the day, you can't be doing it just because you're you're told that this is what you need.

SPEAKER_02 46:00

I 100% agree to do this. Myofunctional therapy first. Why? Because they know where the good providers are. You know, look at this patient that just posted on Facebook um this week that went to an orthodontist and they did a Marpe without screws. That makes zero sense. Uh, I had another patient this week that two months ago, I think it was, they extracted four premolars and a 12-year-old. Like, why? Why? After they did an expansion, and he still needs expansion. So if you start with a myofunctional therapist, they are going to know where the good providers are, where the people that think like we do are. Uh, and I really like to do first phase therapy before you guys start ortho or do tongue tie release. Uh, it's so important for you to have awareness, for you to have good mobility, for you to have good nasal breathing. So there's so much that we can do before expansion, throughout expansion, and of course after. Um, but this has been such an amazing time. We went a little bit over time for our podcast, but it was all worth it. Anna was saying thanks for the informative live. You you guys were fun to watch. Thank you. If you guys have any more questions, please um don't hesitate to reach out to us. Do you mind uh Margaret sharing with everybody what's your Instagram handle?

SPEAKER_01 47:20

Um, advanced underscore therapy underscore ATWC. So my my practice is Advanced Therapy and Wellness Center, and we're located in Crest Hill, which is the um southwest suburb of Chicago.

SPEAKER_02 47:34

Um, somebody's asking for patients or uh providers in Seattle area. I saw somebody asking for somebody in Texas. Um if you guys go to www.airwaysircle.com slash directory, it is a free resource that we offer to the airway community. Um these are most of the providers that are referred to, that have been recommended to us, people that are usually doing um uh continue education hours in airway, people who uh have myofunctional therapists have heard of it. Um, if you guys go to airwaycircle.com, search the directory. So you click on search and make the the mileage, increase the mileage to like 50 miles around you, 100 miles around you, so you can kind of have an idea what providers you can find. If there's nobody directly close to you, call the closest myofunctional therapist around you and ask if they know anybody in your area. That's usually the best way. We also have a Facebook group for patients. So if you're uh a patient or a parent of a patient, go to Facebook. Um, Facebook and search Airway Circle Patients. Um, and you can post there. We have patients and professionals in that group that can kind of support you and help you with uh your treatment, whatever you're going through. Um, but anyways, love you guys. Thank you so much. This has been wonderful. I had so many more questions. Maybe we need to schedule more of these. Um, I'm going to post this also on um Instagram. And I would love, if you guys are watching this recorded version, either Instagram or in your podcast um provider, let us know what other topics you'd like us to bring to you. But thank you so much, Margaret.

SPEAKER_01 49:20

Thank you. Thank you so much. It was uh really a pleasure to be here and share my story. Thank you for having me.

SPEAKER_02 49:26

All right, thank you guys, have a wonderful day. Bye bye.