The Tongue! How it Can Alter the Health of Your Patient

You're listening to The Dr. Phil Klein Dental Podcast Welcome to the show. I'm Dr. Phil Klein. Did you know that from infancy to geriatrics, the tongue can alter the health of your patient? And it does so in ways that may not be visible in early stages. Today, we'll be discussing orofacial myofunctional therapy, OMT, and your dental practice. Our guest is Shirley Gutkowski, a dental hygienist who focuses on developing the muscles in the snoring complex. She is a popular author and speaker, having practiced clinical dental hygiene for over two decades. She often speaks on minimally invasive dental procedures to arrest decay and periodontal disease. Before we get started, I'd like to mention that Shirley's webinar, titled The Five Dimensions of Tongue Tie, is now available as an on-demand webinar on VivaLearning.com. Simply type in the search field, G-U-T-K-O-W-S-K-I, and you'll see it. It's an excellent webinar for the entire dental team. Shirley, it's a pleasure to have you on Dental Talk. Thanks for having me, Phil. I'm excited about this topic because we've done, as we mentioned offline, over 450 episodes on Viva Learning so far on Dental Talk, and I don't think we've had a single episode on oral facial myofunctional therapy. uh it's more information for our viewers it's more information for our podcast program and having you talk about it as an expert as you are so to begin let me ask the simple question what is omt oral facial myofunctional therapy and what is breathing retraining uh it is working with the functions of the muscles in what i'm calling the snoring complex because nobody's ever heard of this before it's very very uncommon to talk about and so we harmonize those muscles we make sure that they're working appropriately and we help get the tongue out of the airway So those are the structural things that we do. We work with dentists who do tongue tie releases. We work with orthodontists. We work with ENTs. We work with psychologists and chiropractors. There's quite a variety of practitioners that we work with. And that's the orofacial myofunctional therapist part. And breathing retraining is to settle down people's breathing every day, all day. Most breathing practices are, okay, sit down for four minutes or 10 minutes, think about nothing, and try to just focus on your breathing. in out and maybe some counting maybe you're blocking a nostril but the breathing retraining is really a neuro activity where we're resetting the breathing center in the brain to have a higher tolerance for co2 people who mouth breathe blow off too much co2 and then they have um they don't have enough co2 for their physiological functions in their body So the CO2 is responsible for relaxing all smooth muscle. And for the 98% of you who don't remember what smooth muscle is, it's the muscle that encases the entire GI system from about the esophagus all the way down to the other end. And smooth muscle also covers all of the larger veins and arteries. So when you don't have enough CO2, you have a higher chance for high blood pressure, for instance. So let me ask you this. You talked about OMT and breathing retraining. Tell us how that relates to the dentist, the routine dentist who goes to work every day, sees patients, spends most of his time doing restorative work and hygiene and periol work. How does the OMT affect his or her practice from the standpoint of clinical dentistry? Well, let's start with your basic patient that has six crowns and the last two crowns had decay almost right after. So when you're mouth breathing and you're a grownup, your mouth is drier, you have a lower pH and your restorations, the doctor's restorations are going to not last as long. I hate to say fail because that's not really adequate, but so recurrent decay. um recalcitrant periodontal infections also are motivated by mouth breathing so getting the mouth closed is really really important people need to breathe through their nose now let's start talking about a little bit of a younger crowd all these young women especially with tm joint problems if they're mouth breathing their entire life guess what their TM joint is going to be out of whack somehow. If their tongue is not in the proper position, which is two-thirds of the tongue up against the roof of the mouth, then the scaffolding is not being held up right, and then that will also impact the TM joint. And then if we go to even younger kids, what about these kids that keep coming in with cavities and they brush their teeth all the time? They are also very likely mouth breathing. They may be mouth breathing because of allergies or they may be mouth breathing because their tongue is not fitting in their mouth. If the tongue is not in the right place during. The whole time that they're growing, the jaw is not going to grow and they're going to have jumbled up teeth. They're going to be crooked. And then you're going to straighten them out. You may even take some teeth out, but you're never going to be trimming the tongue back. So then the tongue is going to lean back into the airway and impact the size of the airway. The tongue is the kind of etiology for all these sequelae. And we talked about offline some of these sequelae. Can you talk to us about all the things that could happen if this is not addressed? Sure. If the tongue is resting too low, so low tongue posture, you have a higher chance of having jaw joint problems, dental decay, periodontal disease, malocclusions of all designs. All of the different malocclusions, you know, class three, class two, just jumbled up messes. They can all be traced back to poor tongue posture. With the poor tongue posture comes over breathing. When you're over breathing, you have a higher chance of getting rid of too much of that CO2. And then you have GI problems. You have reflux. You have just. poor digestion when your tongue is not involved in moving the food around your mouth you're not very often what i see in people that have a tongue tie which ipso facto turns into low tongue posture they're either chewing their food forever or they're taking two big chunks and they're swallowing down these big giant pieces of food and when that Those big pieces are in there. It takes longer to digest. And then that turns into a problem when you get into your 30s and 40s. So we also see the TM joint going here. when the tongue is in the wrong place. We also see headaches. We see the forward head posture, which is a huge problem in our elderly population because it's a big fall risk for having your head forward. But that forward head posture is an attempt to open the airway. So we have the airway tube that goes up through the nose, through the sinuses, and twirls around in there, and then goes through the oropharynx, and then down and down and down. And if you push your head forward to get the tongue out of the way of that airway, you see these pictures all the time in this mandibular advancement device ads to get the mandible forward, to get the tongue forward. moving the head forward opens that part of the tube a little bit so that it's easier to breathe. Let me ask you this question here. So as a general dentist, what do you recommend the general dentist does when they do their initial exam, when they go through their treatment, when they do their re-care appointments to help identify and possibly expedite treatment for this so we avoid a lot of these sequelae? and that includes working with an omt an oral facial myofunctional therapist so All your gagging patients have a tongue problem. So let's start out with the most hated patient. So their tongue looks really big and it's slumping back and they're gagging and they're fighting the mirror and all of that. Those people should be referred to a myofunctional therapist. And then coordinate with the myofunctional therapist and work together to find the... appropriate treatment. For some of those people, it may be advanced arch development. It may be tongue tie release. It may be just facial exercises or tongue exercises. And get that tongue out of the airway so that they can be better dental patients for you. Then all your kid patients that you see are mouth breathing or that have a cavity, those patients should always also be assessed by a myofunctional therapist to see what is happening with their musculature and get that harmonized so that they can breathe easier and then have a more appropriate oral pH. We know that when you sleep with your mouth open, the pH goes down. When you have a lower pH in the oral cavity, regardless of age, you're going to promote karyogenic bacteria to proliferate, and you're not going to know why. You're not going to understand. You're going to reach that critical pH. The enamel is going to dissolve, and there you sit with cavities with no cause, no etiology. this kind of therapy is it a child a pediatric patient or is it across the board it's really across the board we would like to get a pediatric patient obviously because we can put off a lot of problems um as the child grows but if these i've had a 70 year old no she was 63 years old in braces for 11 years 11 total years. She had them in her 40s and her 50s and now again in her 60s. That's not cheap. And nobody looked at her tongue. She had one of the more severe tongue ties. We got rid of that tongue tie. She comes back, I don't know, a couple of months later and she goes, you know, since I had that tongue tie released, my constipation went away. And I was, you know. Who would think that that would be tied in there? But it was, and it really resolved that one problem for her that she didn't know that was going to be solved. And what's the general treatment for that one? What did that woman have done to her to resolve that tongue tie? She had a two-stage laser. tongue tie release she had the first centimeter or so released in one session and then a few months later she went back for the rest of the release her tie her restriction was in the back it was in the it was the last part of the middle third of the tongue So you have to go in there and you have to wiggle around in there to find all of those restrictions and then break those restrictions at that level. That's what people are talking about as a posterior tie. Okay. So that is a treatment for this woman that had the tongue tie condition that led her to have braces for God knows how long. As far as the oral facial myofunctional therapy, what does that entail? generally for her it was getting her tongue ready to have the tongue tie released so we have to do build strength and endurance because these are functional frenuloplasties these are not just your basic baby foot flick with a laser it's pretty I don't want to say involved because it's not like you're laid up or anything afterwards. But it is more invasive because you're going back further. And then we had to rehabilitate her tongue so that it would live on the roof of her mouth, so that she could breathe with her lips together, so that she could swallow. She'd been swallowing incorrectly, which is probably part of her constipation problem. Aerophasia. not chewing her food appropriately and then swallowing incorrectly. Oral facial myofunctional therapy is kind of like physical therapy of the muscles of the face. Correct. Okay. And that supports the proper movement and behavior of the tongue. Correct. Okay. All right. This is really interesting stuff, Shirley. It's stuff that we've never heard about on Viva Learning as far as podcasts go, because this is the first interview I've ever done. with someone who's so knowledgeable on this topic. And when you mentioned the gagging patient, we all have that. I was an endodontist, so I didn't have too much of that. We put a rubber dam on and we were pretty much in our own world. But with general dentistry, when you're taking impressions and doing things in the back of the mouth and even just plain suctioning, you can have gaggers that constantly interrupt the procedure. And that's a red flag, right? That's a red flag for someone that might need to be looked at for a tongue problem. Exactly, exactly. You can't even scale. You can't polish back there. And they want to talk because they don't want to gag. So those are going to be your talker's problems. But on the other hand, you could have a patient with this very strong gag reflex and very sensitive to anything in their mouth, and their tongue may be totally normal. we're not saying that absolutely related to the tongue but it's a good it's a red flag to keep an eye out for exactly exactly and if you just do your basic oral cancer screening and you just don't say huh that's weird and move to the next step you know because you're looking for tissue changes normally but now you're going to go oh functional changes so It's really not a big deal to find these things. It may take a minute to explain them, but it's not that big a deal to refer them out to a tongue specialist. Shirley, thank you very much for doing this podcast. Tremendous insight into a condition that probably many general dentists don't really look for, or even a condition that's not top of mind. for most of us. And now we have something to at least alert us to a possibility of a problem that could lead into many more problems and maybe intervene with some OMT, some therapy that could help that patient regardless of their age. Very, very important. Exactly. Yeah. Thank you so much, Shirley. We really appreciate your time and have a great evening. Thank you so much for having me on. I'm very excited to be spreading this word around.