Treating Oral Ties with Dr. Liz Turner

In this episode, Jacqueline is joined by Dr. Liz Turner as they deep dive into the world of ties, treatment, and beyond. Dr. Liz Turner is back for another episode to go even further into ties, diagnosis, and if/when to treat. Jacqueline and Dr. Turner both share their personal experiences with ties and how they navigated their journeys. 

As a new mom or an experienced mom, it may be challenging to notice if and when your baby has a tie. There may be many decisions to make and you may be faced with pediatric care that doesn’t always agree. Dr. Liz Turner gives some great information on how to tell if your baby has a tie, how to get your dentist on board, and how to go about treatment. This episode gives some great in-depth information on the entire tie process.

In this episode, you’ll hear:

• How to diagnose ties and decide if/when to treat
• The ins and outs of the frenectomy procedure
• What’s changed in the last couple of years in the field
• Common misconceptions and misinformation parents encounter along the way

A glance at this episode:

• [4:18] How Dr. Liz deals with skepticism from patients
• [5:20] What changes Dr. Liz Turner has been seeing in the last 5 years in preventative medicine
• [8:43] How new mothers struggle to reach out for help 
• [11:33] How Dr. Liz decides whether or not to treat a condition and how she helps families make educated decisions
• [15:23] Suck-swallow-breathe pattern
• [20:09] How to choose your provider
• [25:54] The tools and tolerability of a frenectomy surgery
• [31:58] Common ways to release ties
• [38:40] Homeopathic remedies and breastfeeding
• [46:17] Common misconceptions and misinformation parents are encountering
• [53:00] Growth and development
• [58:05] The importance of proper feeding habits
• [1:03:55] Mild ties vs. severe ties and how to tell the difference
• [1:07:33] How to get your dentist on board
• [1:12:37] The dangers of what you read on the internet

Related Links:

• Episode 8: How Tounge Tie Impacts Breastfeeding and Beyond wit

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Transcript

Jacqueline Kincer  0:03  

Welcome back to the Breastfeeding Talk Podcast. I'm your host, Jacqueline Kincer. And today I have got a veteran guest Dr. Liz Turner. And if you don't know her, she was with us back on episode number eight. So really early on in the podcast three years ago, almost to the day. Did you know that was I can't believe it. 

Dr. Liz Turner  0:59  

I can't believe it's been that long.

Jacqueline Kincer  1:01  

It was March 4 2020. And today is March 3 2023.

Dr. Liz Turner  1:05  

Oh my goodness. And that was like right before everything hit the wall. I was pregnant. Yep. We were all like still out and about doing stuff and then the world shut down. Like a week later. 

Jacqueline Kincer  1:16  

It was so nuts. So here we are. We've kept in touch Liz is doing great things. If you don't know her. She's been a general dentist for seven years before discovering the link between oral restrictions growth and development, and basically everything else in dentistry. She grew up in a small town on the coast of Maine and completed her dental education in downtown Boston at Tufts University. She spent countless hours running the Charles River studying anatomy, and never did anyone talk about the tongue and the profound impact it has on the body. She is proud of her two babies ages five and three, who have been her why and her journey of discovering oral restrictions, sleep growth and the impact that these things have on the quality of life a human being can have. As a general restorative dentist with an airway focus, Dr. Turner has the opportunity to treat all ages and doing so is able to see the impact of untreated oral restrictions from womb to tomb. She specializes in cosmetic restorative dentistry. I just had some of that done last year with an airway focus always as well as focusing on treatment of other oral tissues interceptive orthodontic expansion and preventive functional dentistry. So I'm so excited to have this conversation today. Last time, we talked about how tongue tie impacts breastfeeding and beyond. So if you haven't listened to Episode Eight, I would definitely encourage you to pause this episode, go back and listen to that one first and then jump in because we're going to do a deeper dive today. So it's been a few years, Liz has done so much to just, you know, keep herself educated. She's really grown her practice, she's treated tons of patients, since I last talked to her. And so we're gonna dive deeper into ties and all of the ins and outs of everything involved in treating those. So thanks for being here.

Dr. Liz Turner  3:04  

Oh my goodness, I'm just so excited. And I just can't believe that three years have gone by so much has happened in that time. I was at another practice in Colorado, I had originally been in Minnesota practicing and my philosophies started to shift in Yeah, I had been a dentist restorative dentist for seven years, but wasn't really paying attention to the joint occlusion, which is like the bite and the impact of what the musculature of the mouth does. And my boy was born, everything's changed. And that's like when I say that, they're my why like I am so just lucky to be their mother. And they've impacted my life so much, not just in how much I've evolved as a person, but also as a dentist and looking at the big picture, I think is so important. And this is so under recognized under appreciated in our medical community. And it's it's oral dysfunction impacts the life. So whether it's tongue ties, or whether it's low tone, there's so many things that can change the growth profile of the child who eventually turns into an adult. So it's just incredible to see how our medical community is starting to recognize but also how far we have to go.

Jacqueline Kincer  4:18  

Hmm, yes, I think that's a really good way to put it. And you know, it, all of this awareness is great. Sometimes what we encounter as professionals is, you know, some skepticism from the families that we're working with, because just because they haven't heard it somewhere else, and we're the ones that are saying it, right. You know, they're kind of like, well, why hasn't anyone else caught this? On the flip side, people can be, you know, sort of angry at their previous providers like, well, they should have caught this what you know, and there's a lot of different emotions, I guess that people go through when they start to learn about this stuff, depending on how deep they want to go into learning. So you know, it's It's really, I think we're at a really good point, though, you know, I feel hopeful about things, right? Because it's been a frustration, we're on this side of healthcare and saying, Hey, these are all these problems. And you know, we really can't do this alone. We need, you know, other professions within healthcare to start to recognize these things. So I'm curious, you know, kind of the last five years have been really pivotable. What What have you been word is that I don't even know, really dynamic, I guess. You know, it's really been, I guess, 10 years since I've embarked on my journey into becoming a lactation consultant, and doing this work. And I was sort of hearing about ties a little bit here and there. And it wasn't, it wasn't really part of the professional education until a few years later. So for you in the field of dentistry and working collaboratively, collaboratively with other health care providers, what have you seen even in the last five years in terms of those changes?

Dr. Liz Turner  5:58  

I too, am just so hopeful. I mean, there's been a huge, huge push towards preventative medicine and, and overall health. And I hate to say, but I think COVID helped to spur that because we recognized how our society wasn't able to fix us with the medications that had always been promised. I think the generations before us were so focused on, okay, here's your medicine. Now you get better, whether it be cardiac medicine, diabetes, medication, pain medication, there's so many avenues where we are just treating medicinally and not looking at preventing what caused the problem. And so as my practice has grown, I purchased a practice from a retiring doctor who was just wonderful back in November of 2020. So we spoke in March, my baby was born May 10. And lo and behold, she had ties, which we were talking about hiccups in utero. I think in that episode, I was like, oh, yeah, she's got him, but I don't know. And, and it's just so common to see something like that, because they start swallowing in utero. And if that swallow pattern is disrupted, it's super common to see those hiccups. So, you know, she was my baby. And I was like, let's just wait and see a little bit longer. And I started to see all the compensations snowball, as they often do, and we treated her around a three and a half months, probably should have done it, you know, two months before, but again, she was my baby. And I was like, let's see what we can do functionally everything else. But I purchased this practice in 2020. And from there, there's just been such a influx of patients who have read certain books, they've read breath, they've read the dental diet, they've read, sleep bright kids, and they're starting to try to take matters into their own hands. And I think it's exciting to see our generation and the generation that's coming after that wanting to look more at it, reducing their risk of problems versus waiting for them to happen. And as my knowledge on tethered oral tissues, and oral posture has developed, I recognize how much our skeletons are impacted. And then how much that affects jaw joint health, teeth health, it affects spinal health, it affects your entire body and our alignment. And it's just, it's so impactful when we can recognize these problems early and get proper treatment for them.

Jacqueline Kincer  8:20  

Oh, yes, absolutely. And you and I had some similar experiences with our second children because I too, was like, yeah, there's probably it's, she's, it's not tight. There's other things we can do. And I did not get her ties treated right away either. So

Dr. Liz Turner  8:41  

and that's the hard part is because there's so much going on with maternal health when you have a baby. And as somebody who's always just felt like I could fix my own problems like to reach out for help to somebody, whether it be a therapist, a lactation consultant, a body worker, even a friend, you just as a new parent, you're on a lone Island, and then throw in a lot of the kiddos that were born in the last two years, with COVID and fear and RSV and everything. I mean, parents are alone right now and finding I was at an event last night, it was a really incredible experience because it was a just a whole bunch of providers who are in the birth space and they were holding an event for existing parents, new parents, it was postpartum doulas. It was fitness instructors, pelvic floor therapists, chiropractors, lactation consultants, feeding specialists, carseat gurus it was just really neat to see everybody coming together to support parents and I think if if families aren't used to asking for help, then they're they're gonna miss out on on the help that's available. But we're always so used to trying to fix things on our own. And yeah, as a as a new mother. You just don't know what you don't know and everything. It's happening so fast, but so slowly. So, you know, it's looking back, I wish I'd done things just a little differently with both of my children. But that's I think what I strive to do in our practice is help guide parents in the direction that's appropriate for their family, by giving them the knowledge that they need. And I think that's the other thing is everybody feels like if a tongue ties diagnose it, there's pressure to get treatment. And at the end of the day, what I tell families is, I want you to feel like you have all of the information that you need to make the best choice for your family. And that's something that I think is, is really hard because these parents are consenting providers for somebody who doesn't have a voice. So to be able to give them the empowerment and the knowledge to make decisions, I think is so important versus like, yep, you have a tongue tie, we have to fix it, you have a tongue tie, we have to fix it. So it's hard because, you know, I still think it should be fixed, but get letting them make their own decision is the most important part to me.

Jacqueline Kincer  11:05  

Yes. Oh, gosh, no, I hear you. And you know, that it is what's important, though, right? How could anybody, you know, some people, you know, like to make good decisions. But I think, you know, most parents these days, you know, they're researching everything, they're researching every little thing they put on their baby registry. And there's this overwhelming amount of choice when it comes to, you know, products and knowledge, and you know, all of these different things, right? So, in your practice, it's so wonderful that you have this personal experience, and you understand, you know, what these families are going through and where they where they're coming from. So how do you go about doing that assessment and diagnosis for ties? How do you walk those families through that decision of whether or not to treat? Because I think this is so important, and I think a lot of people just, you know, they they often even have fear, right? I'll try to kind of, you know, talk to patients about this and go, you know, you're going to do a consultation first. You know, some providers will offer to treat the same day, because a lot of times families will go, okay, yeah, no, I understand the problems and my nipples are falling off. And let's just do it. Right? You What do you mean, I have to wait another few days, I can't do this. And then other times, you were like, No, I need time to make a decision. So what's your process like in your practice, because I think that would help parents understand, you know, sort of what to expect and, you know, even questions to ask their potential providers,

Dr. Liz Turner  12:29  

for sure. So for those of you that haven't listened to Episode Eight, I'll just give you the really quick breakdown on what restrictions in the mouth are, and what's the difference between a friend and a tie. So what we're looking at is this stuff, it's not a fad, we've known there a lot around for a long time, we know the biology of the body, the frenulum, these little, I hate to use the word strings, but that's a way that you can kind of note them in your mouth, you'll feel that there are seven little spots in your mouth where there's a little line of tissue, and these frenulum are actually their folds in the mucous membrane in the fascia, and the one underneath the tongue that goes from the underside of the tongue all the way to the floor of the mouth, and then down to the rest of the body. It's also called Anglo glossy, that's the medical term when it's too short or too thick, and it's restricting the movement will cause symptoms. And then some of these can be hard to catch. So this type of tissue, it's made of type one collagen, which does not stretch. So the idea that these stretches, it's inappropriate information, I do see that the tissue around it can be pliable. And that's where I've really started to look closely at hyper mobile individuals or those that I suspect have some degree of hypermobility, because I think those compensations make the actual restrictions harder to know. And so that's what we've gotten really good at in our practice is really assessing for hypermobility, as well as looking at the symptoms, the anatomy, the placement of the jaw, because that's one of the biggest things diagnostically that's getting missed and pediatricians offices, things like that, or hospitals where they say, oh, yeah, there's something it but it's mild. And I mean, mild with symptoms, to me is that's a symptomatic problem. It doesn't matter what it looks like it's causing an issue. So when we look at what happens in our office, I really am a big believer in the birth process and growth is it's a lot. It's a lot on a little system. There can be cranial nerve compression, there can be body tension, and really working out some of those kinks as a blanket term would be a great idea prior to treatment. So we use this term bodywork, it's osteopathic, it's cranial sacral it's chiropractic it's it's Some will call it like baby massage. But I just feel that we get better outcomes when we reduce the tension in the body before and after treatment of tethered oral tissue. Choose. I also feel strongly that working on improving the functional mechanics through working with an ibclc or an older baby, sometimes an OT or an SLP is super duper important. Because if we just go and we released the tongue that time doesn't know what it's doing, the system is already functioning the way that it is. And it has been functioning that way since it was in utero. It starts the coordinated correct me if I'm wrong, but suck swallow breathe pattern really starts at 32 weeks. Right? Right.

Jacqueline Kincer  15:30  

Yeah, and embryologically those ties are present as early as six weeks. But they're definitely all said and done by 12 or 13 weeks.

Dr. Liz Turner  15:39  

Yeah, so we already have a baby babies are so smart, you guys, they're so smart. And they'll figure out ways to grow and to eat. And they don't know the difference between right and wrong way. They just know what they need. And that's the nutrients and they want to feed, they want to grow. If they can't get what they're looking for, they'll figure out ways to change what they're doing to get it. And sometimes that's gulping milk from a body bottle because they're unable to withdraw milk from the breast, sometimes that's falling asleep at the breast because they get so exhausted, they can't expend any more energy, and then they'll feed again. So it's these like long, frequent feeds. So when we come into our office, we try to screen patients for if they're ready for release, if they're educated in release, and if they've done what I feel is really important to get best results. And so those individuals are scheduled for same day treatment, if they elect we obviously, we don't want any pressure to be felt. But we do allow time for the procedure and for trying to feed afterwards. For people that haven't had bodywork or haven't heard of it or haven't had lactation support or functional support and haven't heard of it. I just feel really strongly that to provide the best informed consent for that family possible, I should be able to have a conversation with them before doing treatment, about why I feel that these things are important. And that could be done virtually it could be done in our office with a true in person assessment. But I just feel ethically, I should be able to have a conversation with that family about why I feel bodywork and functional support are important prior to the procedure and what the risks are if we don't do it with higher risk of reattachment tight healing. We won't get as positive outcomes or less predictable outcomes, I would say because there are babies that respond really well to release alone. But how do we know that this baby is going to be that way. So just in my in my heart, I feel strongly that it's important for me to talk to them about that. And we try to we know these things are time sensitive. So individuals who've had consultations and they're ready to move forward, we work to get them in really fast. I'll move my schedule around, I'll come in at different times. But we know that these things are time sensitive. And I there's there's a lot that goes into it. So we do in person assessments, where will I assess for buccal restrictions now very, very heavily, I think they're very important and underrecognized. And I'll talk a little bit about that we assess for the lingual or the upper lip restriction. And we assess for the tongue restriction. I'd say it's very rare that I find myself needing to treat the other three Frana in the mouth, which are the lower buckles on either side as well as the lower lip. There are some providers that do treat those and I don't think that's wrong, I just don't see the difference in results in my practice. So I do find a big impact with the upper buckles on the right and left side. And I think that that goes along with growth and development as well, as well as ability to get a deep latch for more improved feeding mechanics right away. So those are what we assessed for in our practice are those four sites most often. And then we always have conversations with the families about what the procedure looks like why we use the instrument we do, which is a co2 noncontact ablative laser, the particular kind that I like is called a light scalpel. I like it because there's no aiming beam. So I have really good visualization of the tissues that I'm working on. And I offer I don't offer immediately for families to come in the room because I've heard time after time that when it's offered to families, they feel pressure to be there like they should. So I do wait for families to ask to be in the room with me. And then I'll admit I do try to talk them out of it just because I know that as a parent who's done this on their children and watched it on their children. When it's your kid it's hard all you want to do is hug them and make them feel better. And they're numb they try really don't feel much during the procedure. But it's just hard to watch your little one go through a surgery, even if it's only 30 seconds long.

Jacqueline Kincer  20:09  

Yes. And I can I speak to that too. Basically, when I've, you know, worked with the dentist collaborative collaboratively for those appointments, you know, she takes the same approach as you. And I think this is very common for, you know, providers such as yourself who are really skilled with this. Really, there would be those occasional parents who were very upfront that they needed to be in the room. And that was even how they would like choose the provider, because many would just not allow it. And they were like, No, I'm not comfortable with that. And so that was always fine and respected. But I cannot tell you, because my job would be to assist them immediately after the frenectomy. So getting that latch reminding them, hey, yes, of course, your baby's crying, or, yes, they're obviously tired, they were just, you know, swaddled with their mouth held open. And it's not pleasant, right. So just kind of walking them through that getting, really, my job was to calm the mom down, because the baby will calm down, you know what I mean? And then she like, she's like, Oh, my gosh, she's like, that was so hard on me, I definitely shouldn't have been there. Like, I cannot tell you how many times those parents were so sure they needed to be in the room. And then they were like, I should not have done that. It was traumatized.

Dr. Liz Turner  21:22  

I've had dad's crying, it's hard. Yes, you just love these little so hard. And for those of you listening, that are going to be going through this process or have, I hope you'll relate. But I think one of the important things about choosing your provider is we, I those of us that are in this space are all well intentioned, and I think everybody involved has some form of personal experience. And I can just speak to the fact that and this is the verbiage I use for families is, I am okay with being the the bad guy today, I want you to be in the most comfortable position for me to bring your baby back to you. So you can calm them, you love them more than anyone and they love you more than anyone, and I want you to be in the least stressful position to try to sue them afterwards. If that's back in the procedure room, that's okay. If that's here, which I would encourage it to be, then that's okay, too. But I think one of the biggest things is finding a provider that you feel like you can, you can let leave the room with them for you can let the baby leave the room with that person for two and a half minutes and feel full confidence that everything's gonna be okay. And and that's, you know, pick your provider based on their skill based on who they are. Again, all of us are well intentioned, but like, do your research. I just disagree with some of the practices that are out there. I don't think that a quick snip is is the answer. I think, again, sometimes we get lucky. And it can be. And I think those medical providers that are doing those in their offices, again, they're well intentioned, but you know how complex babies are. I mean, way more than I do the reflex integration, all the things that go into these little systems and how they're changing so quick, we got to make sure we do everything possible to get best outcomes we can't miss a step is is kind of my thought process. So it's

Jacqueline Kincer  23:13  

it's so true. And to your point to relating back to our first podcast episode we did yeah. Because when the pandemic started, I remember probably a couple of weeks in I got a call from a pediatrician. And his practice was not one that I referred to because two of the doctors there actively denied ties and told patients not to see me. So you know, that's a little harsh. Yep. And they just, they were like stuck in 30 years ago. I mean, the handouts that they gave developmentally, would be encouraging rice cereal in the bottle at throwbacks. And I'm like, you know, that's a dangerous recommendation, right? Like, I can't believe you're handing this out, like the AP doesn't recommend this. Do you even get their newsletter? So anyway, but stuff like that, right. But this one doctor there was very good when he was so well intentioned, and not that the others weren't. They just I don't know, they were stuck in their ways, right? They're like, gonna retire soon. And they did. So the pandemic came, we got a lot of doctors retiring. But this guy called me and he goes, Hey, he goes, I know, we haven't always been on the best terms with, you know, my partners. And he's like, but Are you still seeing patients? And I said, Yes, I am. And I'm taking precautions. You know, I don't really know what's what, right. A couple of weeks into this. We're like, I don't know. And I said, Are you and he goes, Yes. And he goes, I just wanted to let you know that. If somebody really needs it, I will do it. He's like, I only have scissors, but I will release ties. And so he's like, if you need anybody to do it, and I did. Because temporarily, like people were like, I don't know, I'm not going to do this. You know, so what have you and so I was sending, you know, those babies where I was like they're really not going to do well. They're not going to be okay in terms of getting enough food and all of that unless these ties are treated. You And you know, for those situations like, you know, some of those babies, like you said, if it is a quick snip, hey, that's great, right? Even if it wasn't a complete release, it was still an IPS and enough of an improvement for them to get by. And I was so so grateful for that, right that nuanced of like, yes, we know, it's maybe not the best tool and maybe, you know, this guy only does the tongue but not the lip or whatever, right. But it was enough. And so I think those little things are important, right now that things are a little more normal, or what have you, I will say, the laser that you just mentioned, that you use the light scalpel is really a wonderful tool, I have seen hundreds of frenectomy is done with different types of tools, different lasers, scissors, you name it, and I have seen so much ease of visibility, so much cleanliness with it, sometimes no bleeding at all. So I would love for you to talk about the laser a little bit. I know parents are like very, you know, sometimes it has to be a certain tool. And it's like, well, you know, really the skill of the provider. Right? And that you trust them is, you know, Paramount. But second to that. Let's talk about the tools because I think it does matter, do you think so

Dr. Liz Turner  26:11  

that in that moment, using that scissor and releasing that baby could have saved breastfeeding for that child. And for that. And, again, I would agree it's not the tool, it's the skill of the provider. But I do feel that there are some tools that are superior. So the reason I prefer this particular type of laser is in a ablation basically means disappearing. And the way that this laser works is it works on a wavelength where it's looking for the water molecule in the cell, our cells are made up of water. And so when it looks for the water molecule, it basically makes it explode. So we're not cutting tissue that shouldn't be cut, we're helping to move the frenulum back to where it's supposed to be, whether that be the lip, the cheeks, or the tongue. So when I'm doing releases, what I'm looking for is for flexibility in the lip and the cheeks, less restrictive motion, the ability to get a wide open gape. And the way that I explain these things to parents is I use the analogy of the doors to the car and the motor of the car, I look at the cheeks and the lip is the door to the car, if they're so tight that you cannot open the door, you're never going to be able to turn the car on and use the motor, which is the tang and vice versa. If that motor works, but the door is or if that the doors worked, but the motor doesn't work, then we're never going to be able to get the car driving. So when we look at the request of just the lip, just a tongue, if I'm seeing restriction in any of those areas, I know that the system is never going to correct itself, if we can't get the the flexibility in those areas that we need. So when we look at the the cheeks, what were they're almost not visual, sometimes I can show them to parents, but it's rare that I get a picture of them. But you won't even be able to see the release sites afterwards in the cheek unless you're up there with a headlamp and your head sideways and you're really stretching that cheek out with the lip, when we go to release it, that tissue just kind of disappears. And we have the ability to elevate that lip with less restriction towards the nostrils. And not that I need the lip to flip up to the nostrils. But I do need that lip to be able to sit neutral at the breast of the bottle. Because one thing and we were talking about this before is bone is going to follow tissue. And I'll talk about that in a moment. So same thing with the tongue. When we're lifting up the tongue, we're looking for that tight restrictive type one collagen and many times it's called a posterior tie or an anterior tie. Every anterior tie has a posterior component. So it starts at the front and it goes to the back and where it's separated in utero, to me makes not much difference besides it the closer it is to the tip, the larger the site is going to be and potentially more discomfort, higher risk of tighter healing just because every wound is going to heal in contrast, so the bigger the wound the marking contract, but that's why we have some aftercare protocols in place. So it doesn't to me where where it starts and doesn't matter. It's where it finishes. And when we're using this laser because we're able to get a clear and dry field. With no bleeding, we're able to get a complete release back to the genioglossus muscle, which is the muscle underneath the tongue one of them. It's kind of our roadmap for did we get a complete release or not. So we remove the fascia which looks like a little spider web on top of the genioglossus muscle and there's really no vessels there anything like that there to the side. So by using the really precise laser that can operate a half millimeter from the tissue and can really go cell by cell in terms of dissection. We're able to get a very be very safe and positive outcome. I don't see blood vessels. When I do these releases, they float to the side. And I will say those babies that have done functional work that's even more apparent. I see that also in older kids and adults who do myofunctional therapy, the releases are safer, the vessels are to the side, the functionalities better right away. But yeah, we get to the bellies of the genioglossus. There's too little bellies of muscle there pink. And so sometimes the baby comes back and it looks like bleeding, but it's not, it's actually just you can see the muscle now and you couldn't before. Over the next couple of days, it starts to heal in and heal over with a wider yellow scab. Sometimes it can look highlighter yellow if there's been any jaundice. But in those first six days, there's so much healing happening. And we're just really trying to guide that into the most flexible position. So I prefer this laser because I feel I can get a precise and safe outcome for these littles. And because it's a non contact laser, we really have no major risk of rate of infection, and there's minimal thermal introduction to the cells. So we get less wound contraction, it's just a it's a cleaner process overall. So to your point, I do think that there can be benefit to phase one treatment or like an initial clip and a pediatricians office, if we've got a woman and a baby who are really struggling. And we they need a little bit of a release of that front fan of tissue in the first couple of days of life. Go ahead and snip that don't go so far back, though, that you're creating a gigantic wound that's going to reattach you have risk of hitting the salivary glands or a nerve, get the baby functional. Let them see a functional provider to improve on those mechanics and then get them to somebody who has the skill set in the tools to do it. Right. Those are my thoughts.

Jacqueline Kincer  31:58  

Oh, I love how you explained the laser and kind of the start to finish process. Because I'm sure you've seen it, you know, from from people going to other providers and maybe not having great outcomes. But for me as a lactation consultant over the years, I've seen people who, you know, sort of, you know, get to me after the fact and go, Oh, my gosh, what's going on. And I just want to give a couple of examples to the audience so that you guys know the difference. So like, for instance, I've seen releases done with electrocautery, which is thankfully not a common tool anymore. But basically, it's just a heated, you know, metal tip device that touches the tissue, and it burns it away. So it's not the same process. Yeah, and let's

Dr. Liz Turner  32:42  

talk about that. Just for that. Let me tell you about the timing for that actual release. When we take our babies to the laser suite, they're out of the room for two and a half minutes. And most of that time is spent swaddling, putting protective eyewear on and taking preoperative and post operative photos, the release sites take anywhere from two to 10 seconds. So if I'm releasing a cheek it, it basically will take two seconds, a lip will take three to five. And a tongue because we're repositioning a couple of times the laser is probably on for five seconds. But that site because we're elevating and repositioning, elevating and repositioning probably takes 10 total seconds. But the actual laser is only about five to seven, the electrocautery I mean, those sites, that's one and a half minutes of plucking and burning and plucking and burning of this tissue. And that's a horrible graphic. But that's like if you Google it, that's what you're gonna come up as a video. So yeah, and then the healing on those is just pretty icky.

Jacqueline Kincer  33:44  

It's truly, truly gnarly. I mean, you know, the babies that I've seen that have had that done have so much swelling, there is just so much sort of, you know, inflammation and this white tissue and all these inflammatory cells trying to heal and repair what's going on. I usually see a lot of scar tissue with those. I've seen, you know, when babies make sudden movements, which, you know, you're doing your best, like you said, with a swaddle, there's an assistant, you know, to secure that baby, a lot of times I've seen these providers doing it without any sort of assistant. And so when you're when the when the device is touching that tissue, and if the baby moves, like you're going to touch that tissue with it and right, it's not a laser that just snaps on and off and isn't even like physically touching the tissue. I had a case once where I did this home visit and I think it was seven days after this baby had the tie released. It was electrocautery The wound was massive. There was so much swelling they were giving the baby Tylenol around the clock was screaming its head off when I went to look in there. Because I guess there was even though it was cauterized there were still a lot of bleeding and they had applied a substance that you know less you'll be able to explain that more but it basically looks black once it's applied to the tissue. matrei Yep to, to stop that bleeding. And so I mean, this baby was just in screaming pain. The EMT who did it also did a couple of sutures, which was very painful and limited that baby's tongue range of motion and kind of did the opposite of what we wanted to do. At 10 days post op, that baby got those two features out and was like a happy baby again. But these parents literally weren't sleeping, they were like taking the baby and shifts, the dad had to take off work for a week. I mean, it was nuts. And that's an extreme case. But I will tell you with electrocautery not rare that those babies are in so much pain, and they're so swollen and so sore, that any kind of feeding, whether it's bottle or breast becomes so difficult and uncomfortable for them. So anyway, I do think the tool matters a great deal. Because even in the best of hands, it doesn't matter if you're burning the tissue, it's still going to be incredibly painful, and just not create the outcome that we're wanting. Uh

Dr. Liz Turner  35:55  

huh. And that's I, this sounds kind of masochistic. But I test we do use a topical numbing this, it hurts, it's still a surgery, if we didn't numb the areas, it really would not feel comfortable. So I test every batch of anesthetic on myself. And then I laser like certain areas of my gums. And so it's just not that big a deal. And I know how to use the instrument so and I'm informed consent on myself, I recognize the risk of which there really isn't any because I'm not operating on a spot on myself that has any vessels or anything like that. But I do test it to make sure everything feels good with the anesthetic that we use, we use a anesthetic that is stronger than what you would get for most commonly for a dental feeling like you know when they poke you with a pokey thing, but they've been topical gel on that's generally a topical benzyl cane which isn't safe for babies. There's something that can happen within the the blood and oxygenation. So we use something different, but it's also stronger. So when we do bring our babies back, it's not uncommon for them to not latch and I tell people that don't to be discouraged your baby, they just went through a little something and they're numb and it can feel really funny. Like you don't go and eat a giant sandwich after you had some dental fillings your mouth just feels not the same. And now they have different mechanics. We do have many babies, though that do latch and a lot of individuals who are having discomfort will have less discomfort immediately after but when they are healing the first day can be the hardest, I think the four hours after the procedure, I tend to find there's a bit of a witching hour where that baby's just uncomfortable. They come down from this adrenaline rush, the parents are stressed because they're crying so it's hard to stay calm. I tell people getting in the bath, going for a walk and letting baby be on you are some of the best things that you can do. So get outside getting water. And then when we talk about pain management for these, many times, families will choose to under six months use tylenol. And that is in completely appropriate when used in prescribed doses and for a short period of time. I also have many families that choose to not use tylenol and will use a homeopathic regimen. And I think it can be entirely case dependent. I don't think there's any way to predict what baby is going to respond the best to one or the other. But it's just one of those things, trying to keep them comfortable so they can heal. And if that is using a little bit of Tylenol in the family needs to I don't want them to feel like they've done something wrong, or anything like that. So it's also one of those I tell people if you have it on hand, then maybe you won't need it. But if you don't have it, you're going to need it type of thing.

Jacqueline Kincer  38:40  

So yes, so true. And I'm sure you've seen so many families that just will say all I had to do was give one dose and they got through that witching hour and then it was fine. You know, and just also just to reassure people, whether it's breastfeeding, a pacifier bottle, feeding, suckling relieves pain, it releases endorphins for your baby. Obviously, it breastfeeding nursing directly at the breast is more beneficial in the sense that there's that skin to skin, there's that warmth, there's that CO regulation of temperature, heartbeat, respiratory rate, all of that so that there's additional calming that happens. But those things naturally relieve pain and the sweetness of breast milk, the sweetness of formula that also does have some analgesic effects and so for people that you know there's no science behind homeopathic remedies, there's nothing in those that would actually have a medicinal effect, but they are combined with a form of sugar and so if you are giving that to your baby that sweetness can help relieve the pain as well so they're not going to do harm in any way so yeah, please choose to give that it's totally fine but usually infant Tylenol is sweetened as well. So anyway, it's not you know, Tylenol actually does have effects on pain, but just to reassure families like your baby being in pain is not good for them. So we're not encouraging that you avoid those types of solutions because they are there for a reason.

Dr. Liz Turner  40:06  

Yeah. And that's to that point, there is a substance, they call it sweeties. It's basically sugar water, but they'll use it in the hospital a lot. And some providers will use it in their practices when they're doing these releases, but it's basically sugar, water, water. Personally, I don't feel comfortable using that on someone else's child without them, really understanding that we're introducing sugar into their system. Like, there's so much with gut health and gut regulation in these first couple weeks, couple months of life that I just don't feel comfortable being the one responsible for introducing the sugar into the system. I think getting baby back to their parent and then letting the parent make that decision as to what they want to administer what's best for their family is the way that that it should be. That's how I would, I would feel most comfortable. If it was my child and looking back, like my son, you know, had a circumcision, which I watched, because that's who I am. But yeah, I mean, sweeties work, that sugar water that suckling it, it did help him get through, like the hardest part, which is the injection of the lidocaine. And would I do it again, maybe, but I also look at his gut dysbiosis now, and I think, well, was that something that I could have avoided? I don't know. There's everything combined. Don't feel

Jacqueline Kincer  41:26  

that way. I would encourage you not to feel that way. We don't want to introduce that ideally, to babies who have been exclusively breast milk fed. Because yeah, it's like for all of those reasons. But we do know this. This is this is a simplification. There's been more research done on this since then, but there, this has been studied that one bottle of formula, let's say, you know, in the first couple of weeks, you know, first month that newborn period, right? That if you from then on exclusively breastfeed, it takes two weeks for your baby's gut to heal, which sounds like something we should bring all these alarm bells about, like, oh, my gosh, one bottle of formula can do so much damage. No, that's not the message that I'm trying to impart the message is that, if you then are able to provide exclusively breast milk, or you know, mostly breast milk that does so much healing to your baby's gut. So those effects are not necessarily permanent. So I just wanted to throw that out there that I'm pretty sure the tiny amount of Sweeties, that's okay. Yeah, totally. beat yourself up.

Dr. Liz Turner  42:28  

Yeah. And but that's, I mean, how often do you hear oh, my pediatrician said that I should just start supplementing with formula. That's where I feel like we're, we're really getting out of our scope of practice. And a pediatrician is not a feeding therapist. They're not an ibclc. They're not. They're not specialized in exactly what to recommend. So I just feel that pediatricians as a whole should be looking at what they're telling families, because what they're telling families is recognized as gold standard. And you and I, no offense to us, but they always go back, oh, my pediatrician said, Oh, my pediatrician said, It's not until we really establish how important looking at the specifics of feeding and what we're feeding our that we can get them to recognize how important this stuff is just because if the the pediatrician is kind of negating it or telling them I'll just do this, and it'll get better. I had a young one who, the, they're grinding their teeth, and I did a release on them about a year ago. And they're grinding their teeth. And so they're over a year and the pediatrician said, Oh, just put a pacifier in their mouth and they'll stop grinding. I'm like, Who? Who? What are we telling families, like we're supposed to be discontinuing pacifier use, at least trying to buy six months. So when you're telling a family to introduce a pacifier to year old to correct grinding, which is an airway problem, it just baffles me. So to that point, I think it's time for pediatricians to really start referring a bit more to ibclcs and feeding specialists. You know, don't send them directly to me, I want to I want them to you. So I'm sure you see that stuff a lot. Oh,

Jacqueline Kincer  44:11  

very often still, sadly. And it's very frustrating. You know, we are very connected as a team at holistic lactation and then we have our you know, professional network of colleagues, whether it's, you know, an online forums or just ones that you know, we work with in other settings or just know from, you know, conferences, whatever other connections, right. And I cannot tell you like the heartbreak that happens behind the scenes for so many of us, where like, I got a friend from a friend of mine, she sent me a message the other day, she had just seen this family, the mom is like four months postpartum, she's never really pumped more than twice a day and you know, maybe puts the bras the baby to the breast like six times a day, and it's just, you know, she does not have enough milk and all of these things right. And you know, It's this just this whole, like, why it Foreman so she finally coming to the ibclc because she finally learned that they exist. She's relied on the pediatrician for all of this time

Dr. Liz Turner  45:11  

in the hospital system. It's hard because I think it's families feel like they've seen I have so many consultations where you say, oh, have you seen lactation? They said, Oh, yeah, and the hospital, and lactation support in the hospital. I mean, they're just trying to make sure your baby is getting enough to survive. They're not looking at the specifics of your latch in in, if I hear, Oh, they said, my latch looks good one more time. And then I see the latch. And I'm not even trained to assess that. Like, oh, that's, that's probably the worst lunch I've ever seen. It's hard because they think that they've seen maternal guidance, postpartum is is really lacking in our country. I mean, it's, um, I think about all the time, like, the minute the baby comes, it's all about the baby, and the mom gets neglected. And this is a diet. It's not just about the baby, it's about it. How many moms do you see that that push through discomfort? And they say, oh, it's not that bad. And they're like, oh, yeah, I mean, I do I missing half of my nipple on the left side, but I just don't use that one. And until three days from now, and then I switch sides. And it's just hard. I mean, moms are so strong, and we really need to be giving them a little bit better guidance. So I don't know, do you want me to talk about what I also look for long term? Because I think that's a common question I get I do what happens if I don't do anything?

Jacqueline Kincer  46:27  

Yeah, so I do. And before you jump into that, sure, I, oh, my gosh, I might even link to this in the show notes. I shared this with my team yesterday, I was just scrolling Instagram and this comedian came up, I'll have to look up his name, but he has this bit about, like, you know, this, these freezes about men. And it was funny, because I was like, this is one of those, like, Not Safe For Work conversations, but in this work environment. So but it was like how we have these, you know, balls to the wall. And you know, all it takes balls to do something like that. And the guy was like, balls are like the most vulnerable part of a man's body. Like, there is nothing tough or strong about them, you could raise them, and we will win son pain. And he was like, women, on the other hand, like their nipples are getting chewed off and they're fine. And like, he goes on, you know about it. And I was like, Oh my gosh, right. Like that is so true. Like these moms are willing to put up that you just grew a baby that's uncomfortable. You got it out of your body, somehow you're healing from that insanely painful, no matter how you decided to give birth, right? And the healing that's happening. And then your nipples are getting chewed off. And you're like, Yeah, that's fine. I'll just, like, you know, pomp for a little while. And then you know, that'll put the feedback like, Oh, my goodness, like, the thing was that they go through, right. And we're just you and I are looking at this going? No, it doesn't need to feel like this. It doesn't need to be so hard. We want to help you there is a solution. So I just had to mention that because my

Dr. Liz Turner  47:57  

gosh, you got to look up the there's an Instagram account called Boston BIA man, and my husband loves it. And it's this guy from the East Coast. And he puts up all these things about being a man. And it's like, just, it's just making fun of men and how tough they are. And like, it's like, oh, I, I was walking down the street and there was a car. So I jumped in front of it be a man. And it's just funny. And I give my husband a hard time all the time, because they just kind of like do stuff. And like that, that just wasn't really good reasoning, like, you have a stomach ache and you're complaining about it. But you just ate an entire pizza. Like if you didn't eat that whole pizza and you only ate maybe half the pizza, you wouldn't have a stomachache. So it like this. Let's talk about preventative care here. So let's look at the root cause of what your problem is. And that's don't eat the entire pizza in one sitting.

Jacqueline Kincer  48:51  

So that's good advice. But yes. Yeah, I would love to hear I would love to hear about like, what happens when these aren't treated? And then also, if you could just touch on, like some of those common misconceptions and misinformation that parents are encountering along the way too? Sure.

Dr. Liz Turner  49:07  

So what I see a lot of is is families that have had, they've known something's up. They don't know what they can't pinpoint it. And sometimes they've even gone as far as specifically to ask a provider, does my child have a tongue tie? Is there a tongue tie? And these babies are coming in, you know, three, four months supply has started to change from hormonally driven to supply and demand. And that's not everybody. But commonly we'll see jumps or dips in supply and or babies just falling down on the growth curve. And it it they had been for a while a lot of them but it was never so dramatic that until they go from you know, the 60th percentile to the sixth that the pediatrician or someone brings it up. But I think one of the misconceptions is that this is just a breastfeeding issue. This is not just a breastfeeding issue. This is a full blown feeding speech, sleep and growth and development issue. These kiddos are having

Jacqueline Kincer  50:09  

I don't know if you said breathing.

Dr. Liz Turner  50:10  

Yeah, I mean sleep, I mean I all of it, we need breathing more than we need anything we need airway health more than anything we can live without food, we can live without water. I mean, not for very long, but we can't live without oxygen. And and one thing that I see a lot of is, is just the misinformation that this is strictly about breastfeeding, because moms will come in and they'll just say, if this is just about breastfeeding, I'm okay with not being able to do it. And, and I think we in our practice, get a reputation of being not as like laser happy as, as some areas we don't just like recommend we leave for everyone. But I will say my bias is towards the individuals coming in our practice are most often tied. It's very rare that I have a baby coming in with oral dysfunction and anatomy that we don't end up doing treatment on because once I can break it down for the family, what is going to be impacted. And I always say I don't have a crystal ball, I can't tell you exactly what is going to happen. But in my experience with this anatomy, I will normally see X, Y and Z in no particular order. Oftentimes, these kiddos are going to have difficulty forming a bolus of food. They'll have difficulty starting solids. And if they don't have difficulty starting solids, they'll likely gravitate towards certain textures. So they'll get pegged as picky eaters. So I have this wonderful friend, oh my goodness, I just am so grateful for her. She's the product designer for easy peasy, her name's Her name is Don Winckelmann. And when we sit down, we can talk about growth and development, but also feeding because she knows so much about feeding the guy could never even begin to tap into and I've learned so much from her in just a short time. But when we look at the social implications of picky eating, when we look at kids getting made fun of because they can't chew with their mouths closed, we look at the social stuff that comes along with feeding it's so impactful. So then that goes into speech as well. I treat so many kiddos older kiddos for posterior tongue sounds is just the blanket term I use it my speech therapist will probably laugh at me because there's way more advanced terms like resonance and backing and fronting of letters. But a lot of times what I find is they have difficulties with certain posterior tongue sounds they've difficult with r and k and g, they have difficulty elevating the tongue to the roof of the mouth, which is something they haven't been able to do since they were trying to breastfeed. So that's where again, it's not just a breastfeeding issue, it's a floor of mouth oral tension issue. So they can't elevate well, to form that sound, they can't elevate well, to get a negative seal at the breast, they have too much tension on the floor of the mouth or in the lips or the cheeks, to form the bolus to swallow. So then we get into growth and development, we know that a short lingual frenulum or a tongue tie will lead to a narrow upper jaw, a narrower upper jaw will lead to a longer soft palate. A longer soft palate will lead to a higher risk of sleep disordered breathing. So do tongue ties cause sleep apnea, I don't have literature that says the baby that was born three years ago will have sleep apnea in 10 years, but I do have literature that church that journey as they grow. So we know that that narrow arch form will have an impact on a nasal breathing. An impact on nasal breathing will lead to a longer facial profile, an open mouth posture, higher incidence of enlarged tonsils and adenoids, higher incidence of sleep apnea, higher incidence of clenching and grinding at night, higher incidence of damage to your teeth and to your jaw joint. So do tongue ties just cause breastfeeding issues. I could go on and on about the impact of these long term. And it breaks my heart to look at some of these older adults I treat I'm not a pediatric dentist, I get pegged as one a lot. Because I love love love treating kids because I can help change their growth profile. But I see so many adults who have they're sick and they don't know it because they've lived with it for so long. And I've had people die in our practice when they shouldn't have died. Because not that they had a tongue tie but they had something in their oral development, something with their systemic health. And what came first was it was it the chicken or the egg? I don't know its nature, its nurture. It's the environment we live in. But if we can help somebody's job, be bigger to breathe better. We can help them oxygenate better, we can help them sleep better and heal better. There's so much literature on how sleep quality and oxygenation impact almost every chronic health issue that we have, whether it be diabetes, cardiovascular disease, PCOS, infertility, anxiety, depression, PTSD, like we need to sleep, we need to breathe. And we can't do that if our jaws are too small. So my my verbiage to parents is, I want whatever you want for your feeding journey, if that's to breastfeed exclusively for three years, great. If that's to switch to a bottle, because breastfeeding isn't for you. That's okay, too. I want you to feel supported and what you choose for your feeding. But I do know that the oral mechanics are disrupted. And I do know that I have concerns over the growth profile of this child, if we don't work to improve on those mechanics. So 85% of cranial facial growth is completed by the age of six years old. That is a tremendous amount of growth in a very short period of time. What happens when we turn 18 months, it's toddler Ville, I have zero control. I'm not doing an expander an 18 month old, I'll do one on a three year olds. But I want that kiddo sleeping and growing better before we hit that time period. So when we treat babies, we're treating them not just for breastfeeding, not just for bottle feeding, but we're treating them for everything through the lifespan. And the other thing that's that's really scary, is most mandibular growth or lower jaw growth is completed in the first year of life, or not completed, but the biggest peak is in the first year of life. So that mandibular rotation, that lower jaw rotating down and out. If you think of a baby with a good latch, they're coming up and towards you. They have their neck extended, they have their lower jaw wide and forward, they're getting a rotation of that lower jaw. In doing so they're getting growth of the mandible. This is a fifth, sixth U shaped bone, it fits into our skull. If there's an asymmetry or an under development there, they're going to have joint problems, they're going to have jaw joint problems, maybe it's not pain, but maybe it's damaged to the teeth because they're supporting themselves on back teeth that they shouldn't be. And so I can control upper jaw growth all day I can put in expanders my orthodontist can put in expanders, there's a lot of controversy over who's doing the expanders, what type of expanders whatever, we can expand Jaws, we can expand upper Jaws, we can't really expand lower jaws, we can't encourage that growth any more than putting forces on it. If we can get the job to grow naturally, as much as possible, we can reduce how much forceful movement we have to do. So I don't know about you, but I if it was my kid, and I could get them to grow as much naturally as possible. That's what I would want to choose. I mean orthodontics, but they're still probably going to hit Onyx. But if we can to reduce the severity of it, I mean, it could be the difference between jaw surgery, like we have so many patients that need jaw surgery, and so many of them are doing it because they want to feel better, they want to be healthier. So shout out to my husband who's gonna have jaw surgery is really excited.

Jacqueline Kincer  58:05  

Oh, boy, well, he's obviously got the best person to support him through it. He loves and yeah, to your point, like when you know, the baby was, you know, they are nursing, but they have that shallow latch. You know, for some mom's it's painful. For others. It's not those mechanics, it's not encouraging that forward jaw growth that you're talking about. They're not moving that tongue, and then therefore moving that jaw in the right direction. So they're not getting that forward growth, they're not getting that opening of the jaw joint that they should be. So there's where that's happening that's modeling that bone and directing its growth in a way that it's not supposed to be directed in. And so yeah, like, why when people say, Oh, well, will they just grow out of it? And there's so many people, you know, first of all, you already mentioned the type one collagen and that no, it doesn't stretch, so you're not gonna grow out of it, you tend to grow into those problems. And so you can remove breastfeeding, and then you can bottle feed, right, and then you can, you know, get off of the bottle and you're doing solid foods, and then you can put your kid in speech therapy, and then you can, you know, it's like, but they just, it changes, right. So you can eliminate breastfeeding, but it doesn't eliminate the oral dysfunction. And I think that's such an important point for people to realize, which is, you know, if you want to treat it now, great. There's absolutely a case to do that. If you're if your baby has these ties, if you don't want to treat it now, there's not a lot we can do through toddlerhood, so you do have to wait. Treatment often ends up being you know, more expensive, more time consuming. Now you're having to gain the child's compliance, which is not always easy to do. So there's all these other factors and coming from somebody who in this last year has had a lot of airway dentistry work done. It is way more expensive. Then, you know, I would have liked like more than $10,000 And I would say that I spent on The low end of things to be honest with you like for what I needed and what I know other people often get. And it's not because I'm like, all into the airway stuff, and I wanted to do all the things, I didn't do all of the things. So I'm just sharing that with people, because perspective is everything. And, you know, while you might be able to sacrifice something regarding feeding, now, we have to ask ourselves this question of like, what are we wanting the rest of our child's growth and development to look like?

Dr. Liz Turner  1:00:28  

Yeah, and that's, I mean, I think the biggest thing is, is when we start to look at growth of a skeleton, we, we can only change so much when that skeleton is completed. And there's still continued growth, it's just not as significant. So we're only able to change an adult skeleton so much non surgically. And there are surgical options, there are implant assisted expansion options, there are ways to get the bones in a different position as adults. But if we can reduce the need for that in the next generation, that's awesome. Because we know our diets have changed too. I mean, we're not masticating food the same way we used to be. There's, in New York State, I believe this is coming from my colleague at dawn Winckelmann. They're planning on doing away with food pouches with in the next year, because food pouches are a type of feeding, that's just helping the jaws grow inward instead of outward. So there's so many things when it comes to growth that we're doing with not just our breastfeeding mechanics, but our overall feeding mechanics that are impacting it negatively. And then the we mentioned just briefly how bone follows tissue. And I just want to bring that point up one more time, because when I talk about growth and development, like it's not about just the tongue tie, it's about the lip and the cheeks as well, because when we have a lip that's restrictive, and it's been continually pulled on that frenulum. So sometimes all all assess a baby at four or five months. And that frenulum underneath the lip doesn't look as severe as it probably was three months earlier, because the change in the jaw shape has already happened. So as that jaw is developing forward in narrow, it's going to be higher vaulted palette, the palette, the roof of the mouth is also the floor or the nose, so that nasal breathing in that baby's already obstructed, and babies are obligate nasal breathers they need to nasal breathing that happens like first latch. So we've got to try to improve on that as much as possible. So we'll have a lip tie that's pulling the jaw forward, then we'll have a tongue that's resting low, because it's restricted. And then it has further to go because the palette is high. And then we throw in the buckle ties. And a colleague of mine who I'm so grateful to know, his name is Jay Levy, he's, he's a doctor out in the Pacific Northwest. And he has a theory, which I completely agree with. It's called the bolus bucks inator theory of growth. And it's not just the tongue pushing against the palate, it's the actual ability of the bolus of food and the cheeks to move side to side that pull on the jawbone as well. So if we have a restriction and overuse of the bucks, inator squeezing inward, we're also going to have a narrower jaw. Whereas if we were able to elevate those cheeks away, push food back and forth, relax the cheeks, we're going to be able to get more outward growth as well. So that's where I think the whole thing is a system. We can't like cherry pick ties, if it's causing a symptom, and there's anatomy there, I think the conversation needs to be had about the benefit of of treatment. So whether or not families choose to do it, that's okay. But that the informed consent is lacking here, we can't just tell someone, it's a mild tie, and then tell them what it doesn't cause or what it does or doesn't cause so my little,

Jacqueline Kincer  1:03:55  

whole mild tie thing is just so nuts to me, it's like, okay, well, I mean, it's a tie, or it's not. Yeah, I mean, the whole definition of it of being a tie is that it's causing some sort of functional impairment. Yeah, like, otherwise, it's just a normal frenulum that allows full range of motion, and you're fine. And there's nothing that it's like, I don't know, it just it really is black or white there, you know, it's not does the anatomy exist on a spectrum? Sure. But depending on, you know, where that frenum is located, or how much restriction it has, that doesn't create mildness or severity, you know, like, everybody, I mean, we've got so many people, right, that they, they have the same structure, they can have the same exact looking formula, but they can have a different set of symptoms. And because there's so much more to it, you know, than just that anatomy, so I love that you have that perspective. I love that you take this approach. I feel like what you you know, you're so well educated. You got so much experience, you've personally gone through this, you walked alongside so many families in this treatment, you work with so many other professionals and providers. You know, this is really the future of, you know, not just breastfeeding and ties, but all of healthcare. And you're not like you said, you're not just a pediatric dentist, you don't just do ties, there's all of these other things that you see. And you treat. So you're looking at this whole spectrum. And it's so important that families and other professionals do the same. So I love your perspective, Liz, gosh, it's so refreshing.

Dr. Liz Turner  1:05:33  

Yeah, it's so fun, I have one more thing that I just want to bring up in misdiagnosis, I know we have to wrap up. But what I see often is, babies are going to have a small lower jaw when they come through the birth canal. And then that mandibular rotation is going to start around three months. So we're gonna have a pull back, lower jaw profile. But what I oftentimes will see is that there's a restriction there, that's going to inhibit the growth forward. And what I tell families is, if that lower jaw is pulled back, everything in the mouth is pulled back to. So though, it doesn't look as visual when I'm getting in there and lifting up. And if a provider didn't take both fingers and lift up on the tongue on either side, if they were only looking if that tongue could stick out, that is not any way to get a diagnosis, that is not a true evaluation. So but sometimes I'll lift that tongue up, and it doesn't look as visual as maybe the lip or the cheeks do. But if everything in the mouth is pulled back, if that jaw was sitting in a more neutral position, that would be much more clear in terms of anatomy. So again, like you said, the, the what they look like is on a spectrum. And just because it looks like something doesn't mean it's not causing a problem. It's really, it's hard. You really need somebody and I, I rely on my functional therapists a lot. Like what what are you seeing functionally, that's being impacted? Here? I rely on symptoms a lot like we have so many babies that haven't pooped in two weeks, how abnormal is that? It's crazy. So yeah,

Jacqueline Kincer  1:07:05  

absolutely. It's not because they're not getting enough milk, you're like, No, they're I mean, they're just so they're so tight, they're so restricted. You know, this really affects, you know, digestion begins in the mouth. So they've got this whole restriction going on. And, you know, I think what I appreciate so much is, is like you said, that functional assessment is so important. So for anyone who's listening, that's wondering, you know, does my baby have ties, or I suspect they have ties, or I know, they have ties? You know, how do I get somebody good on board to help me through this? You know, you really do need somebody, I think that, you know, you've done such a good job of explaining this was just that function, right? Like, it is disrupted? Yes, there is a procedure that can enable that to be corrected, but it doesn't self correct. Like there's no magic bullet by virtue of finding a co2, laser, airway dentist, you have got to understand all of those things that have inhibited your child's oral function and their growth and development, and then be working with someone who can help remove those dysfunctional patterns. Yeah, right. It can be oral exercises, those of us who are really skilled ibclcs. With this, we very often teach those things, you know, some of these are stretches or massages to try to relieve that tension and all of that, it's teaching you and your baby a better way to latch so that that jaw growth and tongue movement does happen that those cheeks are working, how they're supposed to. The lips are in the right position. And then it's that bodywork, it's you know, that if there is that tension that's gone down through other parts of the body, if there's something in the neck, if there's something, you know, in the torso, and what have you getting that body work to correct that as well. Because, you know, we've released, you know, this one little piece, which has, you know, other effects, but maybe there's, you know, residual tension somewhere else in the bodies. Yeah.

Dr. Liz Turner  1:08:57  

And that's a way that I explained that to parents cuz they're like, doesn't do anything. Like think about it, if you slept wrong and your neck was pinched, you had a pinched nerve in your neck, you can't turn your head the same way that you would if you weren't experiencing that kind of like sharp shooting pain, and not that that's what babies feel. But if there's some type of a nerve compression, or an area of tension, mechanics are going to be compromised, so and then to your point of like finding providers I know not everybody, I'm so lucky to live in Denver. I have so many wonderful providers I work with all over. And I have other release providers in town who I just trust so much. I've trusted them with my families, I trust them with my patients. And I think we all really share responsibility with these cases. But for those of you that don't have access, I mean, so many like like you, Jacqueline, you do virtual consultations, because I really feel that when you're working with somebody who has an advanced skill set, whether it be virtually or in person, you can still maximize what you're getting out of those visits. And and if you're looking for some When you say you find a dentist, but you can't find a lactation consultant, you find a dentist you like their website, they're offering some things that I'm talking about. You're getting a good feeling, call their office, ask them. Do you guys have a list of people that you work with, I need some lactation help, they will 100% be able to give you a list of names. Well, maybe it's one person because maybe that's all that they have available to them. But work with that person. Like there's a beauty and collaboration here. And that's where the magic happens. I really think it's not just a surgery, like I can I can laser talks all day, I can laser lots of stuff. But as my husband I live lasered hairs often on the wrong side, like lit them on fire, it was great. But it's that's not where the magic happens, the magic happens in the function and getting the system working. And I mean, these babies, they just work so hard.

Jacqueline Kincer  1:10:49  

Oh, they do and to like, you know, so so many of the telehealth consultations that we've done, you know, certainly not all, I mean, people come to us because of our high level of skill set because of our, you know, release sort of teamwork approach. And that we're, you know, we're really, really, you know, very certain that there's no one right way to breastfeed. It's always honoring, you know, whatever the choices are, if that particular family and, you know, if you're saying you want to exclusively pump awesome, like, let's help you through that and make sure that's going to work for you. Because otherwise you're like shooting in the dark, right? yet. So many of these telehealth consultations we've done I mean, we've done I mean, so many different countries, I don't even know anymore, I stopped sort of keeping track. But you know, we start there, right? And we try to optimize breastfeeding as much as we can we do that, you know, visual assessment of ties we, the episode that we have before yours with Katie Hearn, on our team, we discuss the ways that we're able to do those assessments over telehealth with people in you know, your hands on involvement as the parent, which is usually very enlightening for you, when it's your fingers and your baby's mouth. And we're walking you through what to feel for and what you see. And you're having this aha moment of oh, my goodness, that explains everything, right? Yeah. And so if we start there, and we go, well, let's do we can get, you know, the nearest providers, three hours, five hours and other country, more common in Europe, obviously, not a big country like the US, right? And then we connect you with those providers, we have a list that we maintain, and relationships we maintain, you know, either we've just connected, you know, through emails and zoom calls, or maybe we've met people at conferences, or we get a referral, like, I can be like, hey, Liz, do you know anybody in, you know, Saskatchewan? And you're like, Oh, yes, I do. And here's the name. Like, they're wonderful. We have Facebook groups to do that. Yeah, like, so like you're saying A good practice is going to have some names and some places to send you.

Dr. Liz Turner  1:12:47  

Yeah, and that's the other thing with the Internet. Just be careful and take what you read from other families. And, and don't fixate on it, because you're gonna hear positive stories, and you're going to hear negative ones. And not every story is the same. Not every starting point, not every preparation, not every finish line is the same. And just remember that you know, your babies, your kiddos the best. And if you're not getting the answers, or the outcomes that are preferable for you, it's okay to ask for a second opinion, it's okay. To, you know, ask more questions of the providers. But also, when you're reading some of these Facebook, blog groups and things like that, I I think that there can be a lot of judgment and shame and how people parent and how they do things and it's your family, it's your choice. Don't like your mother in law discourage you in one way or the other. Or, or you know, somebody you've never met on the internet, be a troll. There's so you need to do what works for your family. And don't let anybody like shame you or talk you into or out of something. Because they don't know your story.

Jacqueline Kincer  1:14:03  

Oh, absolutely. It's honestly that is that is truly truly good advice. And for anybody that is in the Denver area, or you know, Colorado in general. If you're looking for someone great, obviously Liz Turner is wonderful. And she knows lots of other people who are as well. So we've got her information linked up in the show notes. Liz, it's been such a pleasure to have you on the show. I feel like we're going to do another episode again.

Dr. Liz Turner  1:14:32  

Yeah, so I we were talking before guys, if anybody has anything they want to know more about, like I'm an open book. I've I've learned a lot. I've made mistakes. We are constantly changing our protocols. We have some things in place for hypermobility, we really are trying to look at how we can optimize the outcomes of these procedures. And when we start to talk about older kids, there's some protocols that we have in place in our office and there's products we love products. We don't love it. So if anybody is interested in learning more about certain things, like let Jacqueline know, and we can do another maybe we could do even like a q&a or something like that. Oh gosh, through questions and rapid fire, but I'm on Instagram to Dr. Liz TLS zt I am terrible at responding to messages, because I actually had to turn off my notifications, because I I like internalize this stuff. And I'll lay in bed at night. And and wonder, okay, what, what's the best way to answer that? Who should they see? So I'm happy to do virtual consultations or anything like that. But don't be discouraged if I don't respond to you for even like 30 days, because I try to recognize I have a family too. Yeah, absolutely.

Jacqueline Kincer  1:15:43  

No, I appreciate you being so open to that. And yes, if anybody has questions, we can absolutely bring Dr. Shara back for a future episode. And if anybody who's listening has not joined our wonderful online community, the nurture collective, which is not just a support group, it is not a Facebook group full of moms ready to judge you and offer you advice that you don't need. It is actually full of very succinct modules that are specific to every stage of breastfeeding from pregnancy through weaning. All the common problems that come up as well as like me and Kate and Mackenzie our whole team and they're supporting you, but guest experts that we bring in once a month. So let's turn her is going to be our guest expert for April next month. So April, yeah,

Dr. Liz Turner  1:16:31  

yeah, we'll do q&a, then we'll do all sorts of stuff.

Jacqueline Kincer  1:16:34  

Yes, absolutely. You can actually like hop on Live with her and chat to her. So thank you so much for being here, Liz. It's been wonderful to share this knowledge with our audience, and I'll see you all in the next episode. 

Dr. Liz Turner  1:16:45  

Can't wait to talk to you soon.