Today’s guest, Dr. Sam Zink, is a dentist who focuses on airway dental medicine. Dr. Zink’s practice is rooted in the belief that all dentistry should support and enhance an optimal airway.
In today’s episode, Dr. Zink shares how having his three sons struggle with upper airway resistance syndrome drew him into this specialization.
We hear about why tongue and lip ties often go undiagnosed and the importance of finding a team that understands what it takes to diagnose and treat these issues.
For so long, these problems have been diagnosed on appearance alone, but as Dr. Zink highlights, there is a spectrum, and as such, you should be looking for functional signs rather than ones based on appearance.
We also discover how tongue-ties can manifest in adults and some tell-tale signs that you might have one.
Gain insights into tongue-tie release surgery and the vital role of aftercare, and why constricted airways can put you in a state of chronic stress.
Be sure to tune in today!
“I think it's important to remember, there's a big difference between normal and common. Or I would say, optimal. You want to have a vision for what optimal health looks like.” — Dr. Sam Zink[0:11:50]
“I tell people, in some cases, if you couldn't commit to the wound care, then you might be better off not getting it done.” — Dr. Sam Zink[0:29:45]
“I think that compensating for a small airway is one of the biggest causes of chronic stress.” — Dr. Sam Zink[0:39:17]
“It's really about symptoms, more than appearance. It's not about what the tongue tie looks like. It's about trusting your gut and knowing that there are functional issues, there's symptoms, then you should seek help from someone who knows how to evaluate based on symptoms and not just the appearance.” — Dr. Sam Zink[0:05:25]
Discount Code — SENSORY
[00:00:01] RH: Hey, there. I’m Rachel.
[00:00:02] JH: I’m Jessica. This is All Things Sensory by Harkla. Together, we’re on a mission to help children, families, therapists and educators live happy, healthy lives.
[00:00:11] RH: We dive into All Things Sensory special needs, occupational therapy, parenting, self-care and so much more. In each episode, we share raw, honest, fun ideas and strategies for everyone to implement into daily life.
[00:00:25] JH: Thank you so much for joining us.
[00:00:59] JH: Hello, hello. Welcome, everyone. You’re listening to All Things Sensory by Harkla, with your good friends, Rachel and Jessica. This is episode 152.
[00:01:11] RH: All right. We are having a great conversation with Dr. Sam Zink. I just really like his name.
[00:01:21] RH: Now, what's cool about Dr. Zink is he is actually the dentist who released Trip’s tongue tie. If you've been following my personal journey, I'm Rachel by the way, if you don't know my voice. If you’ve been following my journey –
[00:01:32] JH: By the way.
[00:01:33] RH: 152 episodes into it.
[00:01:34] JH: Come on, guys.
[00:01:35] RH: You should know. Unless you're new. If you're not a longtime lifer listener, then you might not know our voices. I'm Rachel and I have shared our journey on Instagram at The Sensory Project. 208. If you aren't familiar with that journey, Dr. Zink is the one who released Trip’s tongue tie, several, let's say, be several weeks ago.
[00:01:58] JH: Yeah. That's what we're going to talk about with him today. He's going to give us all the details on tongue ties and lip ties and fascia and –
[00:02:10] RH: Adult tongue ties and lip ties and how those are imperative to look into. Before you click out of this, if you're like, “Oh, my child doesn't have a tongue tie, or I don't have a tongue tie,” just listen.
[00:02:22] JH: Just listen.
[00:02:22] RH: With an open mind.
[00:02:24] JH: Just listen.
[00:02:26] RH: Good morning. Good morning. We have Dr. Zink here with us today. How are you?
[00:02:32] SZ: Doing good. How are you doing?
[00:02:34] JH: Oh, we're so good. Doing good. Yes.
[00:02:36] RH: We're excited to have you this morning to talk about all things tongue ties, lip ties. You are actually the dentist who released Trip’s tongue tie and lip tie. We have a special connection. We can share, there's no HIPAA or anything here. You have my permission to share.
[00:02:57] JH: Good call. Good call.
[00:02:59] RH: I’ve released my information.
[00:03:02] JH: Before we start talking about that, we do have five secret questions that we ask all of our guests on the podcast. We're going to start with that.
[00:03:11] SZ: Great.
[00:03:11] RH: All right. First question, would you rather ride a bike, or a scooter up a one-mile hill?
[00:03:18] SZ: Scooter.
[00:03:20] RH: Oh, okay.
[00:03:20] JH: Interesting. I would do a bike. I would ride my bike. I mean, I've done it before.
[00:03:25] SZ: Is it motorized?
[00:03:26] RH: No. It’s not motorized.
[00:03:28] JH: No. Like the one that you have one foot on and you use your other foot to go.
[00:03:33] SZ: Oh. I was thinking one of those electronic scooters you ride around [inaudible 00:03:36].
[00:03:37] RH:Yeah. Well, obviously, we’d choose that one if that was the case.
[00:03:43] JH: Next question. What do you eat for breakfast?
[00:03:47] SZ: I don't eat breakfast.
[00:03:49] RH: Do you do fasting? Is that what it is?
[00:03:52] SZ: Yeah. Intermittent fasting.
[00:03:53] JH: Okay.
[00:03:55] JH: What do you eat for breakfast at 2:00 in the afternoon?
[00:04:01] SZ: I've been doing the carnivore diet. I usually have steak for lunch. I've also been doing a four-hour feeding window. I eat between 2 and 6.
[00:04:10] RH: Oh, wow. That's hard. I don't think I could –
[00:04:15] SZ: It's not, once you get going with it. You start, you're providing and adopt to it.
[00:04:19] JH: It's true. That's true. I could ask so many more questions, but we'll move on. You have a couple of kids, correct?
[00:04:28] SZ: Yep, three boys.
[00:04:29] JH: Three boys. Which one is your favorite?
[00:04:36] SZ: Oh, boy. You know you're supposed to – They're all my favorite.
[00:04:39] JH: Yeah. That's not true, though.
[00:04:43] RH: Coming from an only child here, okay.
[00:04:44] JH: Who only has one child.
[00:04:46] RH: Exactly.
[00:04:48] SZ: They're five, eight and 11. It seems like the youngest is staying younger longer. We're cherishing, like oh, he’s still a little boy, snugly. I'm enjoying that right now.
[00:05:02] JH: That's fair.
[00:05:02] RH: I like that. All right. Now I can ask my question. What is your favorite book?
[00:05:09] SZ: I'd say, I likeA Pattern Language by Christopher Alexander. It's actually a book about architecture. It has all these different patterns about buildings and construction and homes. Yeah. I really like that.
[00:05:25] RH: Interesting.
[00:05:27] JH: Okay, last question. What is your sensory quirk?
[00:05:31] SZ: What's an example of a sensory quirk?
[00:05:34] RH: For me, I'm a little sensitive to sound. I don't like it when there's competing noises in the background. If a TV's on and I'm trying to have a conversation, that's my sensory core. One of my sensory quirks.
[00:05:50] SZ: It reminds me of the fact that my wife likes the stereo to be almost imperceptibly loud, like quiet. You can’t even hear it. I want it really loud, so I can hear the music. It's a battle sometimes.
[00:06:04] RH: Always a battle.
[00:06:07] SZ: Can that be a quirk? Is that I like music loud?
[00:06:09] RH: Yes. Definitely. Seeker. You seek that auditory input. We'll give it to you.
[00:06:16] SZ: I want the stereo to sound like a real apartment, say imaging and center stage. You have to turn it up, so that it confirm – It's just quiet. It's just other guys.
[00:06:26] JH: Sounds fair.
[00:06:27] RH: You like loud concerts then?
[00:06:30] SZ: To a point. Yeah. Getting down like rock concerts can damage your ears, but definitely live concerts with good acoustics is really cool. Actually, I went to dental school in Louisville, Kentucky. There's some really cool venues there. This is one called The Palace and it's an old 1920s movie palace with really crazy carvings in the ceiling and a theme of a Spanish villa inside, and has a blue ceiling with little chiroptical lights that look like stars.
[00:06:57] RH: That’s cool.
[00:06:58] SZ: They recorded a bunch of concerts there. I think one is Alison Krauss and Union Station. It's like, they were beginning. We went to concerts with this. I think, seats maybe 2,000. You feel really close to the stage. Then I went to this concert arena. I'm never going to [inaudible 00:07:14] concert again. I like the movie palace or Opera House size. Because the acoustics are really good and it's just that – you feel you're close to the stage.
[00:07:22] JH: Oh, yeah. I feel the same way. I hate going to concerts at Taco Bell arena. I hate it.
[00:07:27] SZ: Yeah. You're just like watching a video screen. I’m like, might as well just watch it on TV.
[00:07:31] JH: Exactly.
[00:07:32] RH: Exactly. Yes.
[00:07:34] JH: Excellent. Okay.
[00:07:35] RH: All right. Now that we all know your deepest, darkest secrets, tell us what you do, how you do it, why you do it, who you are, all those things.
[00:07:44] SZ: I’m a general dentist. Actually, I worked in IT before I became a dentist. I switched careers. [Inaudible 00:07:50] in Boise, Idaho when I worked in IT field. My wife as a dental hygienist, or was. She retired when our first son was born. I came home one night after almost being [inaudible 00:08:02] say, “Hey, I think I’m going to go to dental school.” It's a big life reboot for I look back. Your requisites, anatomy and physiology and biochemistry and all that good stuff for about a year and a half.
Then we went out to Louisville, Kentucky. We were gone for about 12 years before moving back to Treasure Valley, in Boise, Idaho area. My first son was born right when I finished my last semester in school. Then my second son was born in South Carolina. Then my third son was born in Oregon. Then we just came back to Boise about two years ago.
A big reason to move back to Boise was closer to family. Then I always wanted to have my own practice. Previously, I worked for a corporate dental type organization. I was able to start from scratch my practice here in Boise and limited to – our focus on tongue tie and airway.
[00:08:55] JH: Why did you decide to focus on that?
[00:08:58] SZ: Well, that does go back to my kids, actually. My oldest son when he was born, actually, every time I see a [inaudible 00:09:04] we have this intake. Well, my son had all these big symptoms, except for two. He was gaining weight. It was called [inaudible 00:09:16]. He had all these other symptoms and my wife had all the mother's symptoms, and we had no clue. She nursed him for over two years. I just think like, “Wow, it was really rough.”
Really poor sleep and reflux. My wife had severe pain. All the people they have interacted with, medical professionals, no one ever mentioned anything. I was a semester away from graduating dental school, and I had no clue. My second son had a lot of the same symptoms, not as many. I think, it's because my wife had learned to compensate, special pillows and positioning and she just was more skilled at it. It wasn't until my third son was born that it got our attention, because he was diagnosed with [inaudible 00:09:59]. At three-weeks-old, he was only 8-ounce birth weight.
Then had a procedure done and he bounced back so well. I got to go back and watch the laser that’s been sometime released. I thought, I can learn how to do this. I can help people not experience, but we've been through with our first two children not having any help, or awareness. It just seems like, there's a big gap in the community in general, especially within the medical community. Maybe you think, maybe your doctor, or your pediatrician, or your dentist might know about this, but it's not always the case.
Or I would say, it's more often than not, that I know for me, I didn't receive a specific tongue tie training. I mean, we knew how to tongue tie, or if anyone was with anatomy and physiology, but there wasn't really discussions about the symptoms, or the functional issues with breastfeeding, or with how a tongue tie would affect an adult.
[00:10:51] RH: It's so interesting. As we were preparing for our discussion with you, I actually thought in my head, I was like, “I wonder how many kids who are diagnosed with failure to thrive, it's because they have a tongue tie.”
[00:11:04] SZ: Yeah. Something that's coming up recently has been pretty interesting, is there's been some kiddos that were headed for feeding tubes that didn't have to go in a feeding tube, or a few that were on a feeding tube, were able to come up with the feeding tube, because of the tongue tie.
[00:11:17] JH: That's incredible.
[00:11:18] RH: Wow. It's frustrating to me, as a medical professional myself and I missed the signs too for my own little guy. I mean, it was on my radar, but I just – He was eating. He was nursing. I wasn't in pain. He didn't have a ton of symptoms. I thought that everything was going fine, but I had no idea.
[00:11:38] SZ: Yes. It can be sneaky.
[00:11:41] JH: Well, and I think there's this idea too out there, that if your child is colicky, or if they're not sleeping well, that those things are just normal.
[00:11:49] SZ: Yeah. Yeah, I think it's important to remember, there's a big difference between normal and common. Or I would say, optimal. They want to have a vision for what optimal health looks like. That's a big thing that's missing in the medical field, especially when you talk about people in different specialties, because we see – whatever your specialty is, we see extreme cases of not well. Even if you’re more focused on others, patients that have such terrible problems. They're extremely symptomatic. Then someone that's “normal” seems fine, but they're not fine. You have to know that whole spectrum from severe disease to optimal health. Often, our view is so skewed that we can't see the actual problem.
[00:12:31] JH: Yeah. I like that term, optimal health.
[00:12:34] RH: Yeah, yeah. It's a good a good quote that we'll have to pull out.
[00:12:36] JH: Yeah, I wrote it down.
[00:12:40] RH: For our listeners who maybe don't know exactly what a tongue tie is, can you just give us a brief overview of what a tongue tie is, a lip tie and what that looks like?
[00:12:49] SZ: Yeah. One of the terms that's a newer term that I think is really good to use is an umbrella restriction. There is, in my opinion, too much focus on the appearance of these structures of tongue tie and lip tie, vocal tie. They are fascia, or connective tissue that will gather into one spot. Lip tie, if you clip the lip of a baby, [inaudible 00:13:12]. Some people call it a string, which is not literally a string. It’s a metaphor. There's a tissue that looks like a strange shape. Sometimes you'll even see the tissue of [inaudible 00:13:23] turn white when you try to lift the lip.
The buckle ties are basically the same thing as under the upper lip, but on the sides. I tell people, it's like, if you see someone smile and they had a dimple in their cheeks, that's actually the buckle type causing that little dimple on the outside.
[00:13:40] JH: Wait. Hold on. Hold on. You're saying that dimples are crazy?
[00:13:47] RH: What?
[00:13:48] JH: Yes. Smile.
[00:13:50] SZ: Yeah. That doesn't mean that it's quoted a tie. I mean, that's why I don't go as much by the appearance, because you could have those and have a buckle tie. If it's not impacting function, it's not causing a limitation of the functional range of motion, it's not causing symptoms. That doesn't mean it's a problem that needs to be treated. This is the nuance, where it could be anatomic structures, but they may, or may not be causing a problem that weren't streaming.
[00:14:18] RH: Interesting.
[00:14:21] SZ: Then a tongue tie is a little trickier, I think, because it can be harder to see, because the tongue is a really dynamic structure. There's lots of muscles and cranial nerves, it's very mobile. Dependent on posture of the tongue. You may or may not see a visible [inaudible 00:14:35]. Most medical and dental professionals would agree that there's a certain type of tongue tie, which goes to the very tip of the tongue, that everybody goes, “Oh, yeah. That's a tongue tie.”
A lot of the most severely restricted, or type of ties that limit function can be virtually invisible. That's simply they call it a [inaudible 00:14:54]. Those, you really have to do a functional lift at a tongue to see that fascia is gathering up, then you can visualize on the midline. I do tell people like, even if you have a long sleeve shirt and you stick your finger under your shirt sleeve and you can't literally see your finger, unless you lift the finger, then you see the shape your finger makes within the shirt sleeve. That’s how most tie works is if you get behind, I was doing my examinations, looking at the baby's head and so then, upside down looking into the mouth. I'm looking at, turn up and back towards the back of the mouth.
As opposed to your ties, and you'll see that fascia connective tissue gather, you’re like, “Oh, yeah. There it is.” To the untrained person, it could be I said, really, totally invisible. Those are the ones, I said sometimes, cause more problems than some of the more obvious anatomic restrictions. [Inaudible 00:15:44]. If there's not an obvious strength at the tip of the tongue, then it gets dismissed in others, not a tongue tie. Because the baby can stick their tongue out, or they can move their tongue. That gets into where there's compensation. A lot of the other musculoskeletal system can compensate for the lack of mobility with oral restrictions. That's where also a lot of things get missed, because humans are very good at compensating.
[00:16:10] RH: That's how we're born to do, right? That's how we survive.
[00:16:13] JH: Yeah, that's true.
[00:16:15] RH: Okay. This is the order of our questions, but I had a gal reach out to me. She had her baby’s tongue tie released at four and a half months. She actually had her tongue tie released. She said, they took measurements of her leaning over and touching her toes before the tongue tie. She was 3 inches away from even touching the ground. Then immediately after getting her tongue tie released, she could put her knuckles on the ground. It's that real life?
[00:16:46] SZ: Yeah. Yeah, for sure. I just mentioned fascia. Fascia is connective tissue that just, like the entire body accumulates on nerve and blood supply. Basically, those with just have a much fast connective tissue again at this shape. The tongue is part of a functional unit of fascia, called the deep frontline. If you Google deep frontline fascia, there's just amazing video, where they've got a dissection of this fascia laid out on a table. It goes from the tips of the toes, to the ankles, the knees, the hips, the deep core and pelvic floor muscles, up through the diaphragm and the lungs, the heart and comes up through the neck, then ends in the tongue. The tongue is just massive, like which is the most power thrusting part of the visceral cell is the tongue.
That's a real deal. It's something that there's not a lot of research historically about fascia. It's newer on the scene. I took anatomy and physiology, a lab in dental school, where we dissected a cadaver. We didn't study fascia. We just cut it away to look at the muscles and the bones and the nerves and blood vessels, which were considered the things you were supposed to study. As more and more knowledge comes about fascia, we find that it's an extremely important, if not more important in some other structures we've traditionally studied. Yeah. I'd say, the tongue is one of the kings of the fascia system.
[00:18:14] JH: It’s so crazy.
[00:18:16] RH: Now I have to get my tongue tie released, just to see if it's real.
[00:18:19] JH: So, you can touch your toes.
[00:18:20] RH: I can't touch my toes, no matter how much I stretch, I cannot touch my toes.
[00:18:24] JH: See, I can touch my toes and I'm fine.
[00:18:26] RH: Do you have a tongue tie?
[00:18:27] JH: I don't know. Probably not, since I can touch my toes.
[00:18:33] SZ: Well, maybe you compensated touching toes. I do have a picture of a great case I did on a male in his 60s, where at the back of his neck, had a crease and a bulge and a poor head posture. Immediately after the procedure, I met, we took another photo, a profile picture and that crease and bulge was gone. A [inaudible 00:18:53] face and neck was visibly immediately transformed, much more relaxed.
[00:18:58] JH: That’s so interesting. I'm just picturing all the people I know who I'm like, “Oh, I wonder.”
[00:19:04] RH: I know. I know. Well, I had talked with someone yesterday, who's husband had swallowing deficits and sleep deficits. I was like, “It's probably a tongue tie.” She's like, “Yeah. It probably is.”
[00:19:22] JH: Okay. Okay. Here's my question. If you think either your child, or yourself has a tongue tie, what do you do?
[00:19:33] SZ: I mean, you talked about it. It can be, you have to find the right team. It has to be a good team. I don't even get the idea that the tongue ties in LBO, it's usually a sign that there's multiple overlapping issues with the body. Usually, the tongue tie can be just a tip of the iceberg. There's a lot of things usually involved with it, like malfunctional therapy, which is tongue and lip and cheek and swallowing exercises and activity. Both speech therapy can involve bodywork, psychotherapy, or chiropractic, or physical therapy, or specifically, people that come in and be fascia.
There's basically, a defined providers that are really aware and gung ho. I found, there's typically, there's like myself, people that have had personal experience with their own family. Themselves or their own family, those are the folks that are more tuned in to this. I mean, last thing you want to do is find somebody that says, “I don't really believe in all this stuff, but I'll do a tongue tie release for you.” If you're not really on the same page, then it's probably not the right type of person to seek out.
[00:20:39] RH: I think that's the biggest thing is getting the team and finding people who will tell you how it is and not just do the tongue tie release just to do it. Is it actually affecting function? Would it be beneficial to everyone to get it released? Or are we functioning okay? I'm a functioning adult. I have a tongue tie and I'm surviving, but could my function be improved? I think, that's what we need to think about with our kiddos as well. From an occupational therapy standpoint, it's our goal to make the child, or the adult we're working with live the most functional, happy, healthy life. We have to take that into consideration when we're looking into this stuff.
[00:21:21] SZ: Yeah. I mean, that's where the target, going back to optimal health. You have to decide – if that's what you're going for, if you're going to move towards optimal health, or if you're okay being normal and that's okay.
[00:21:30] JH: Being normal.
[00:21:31] SZ: Just, a lot of people aren't aware of what's possible, so they don't know what's at stake. They don't know how well they could be. Thinking more of adults right now too. One thing that's quite a bit different, we can show a contrast here is one reason it's great to treat purpose. I would say that the best age to treat is about five-days old. Really, should be earlier than that, but five-days-old, a few weeks old. I actually see a huge difference in the amount of the thickness and texture and restriction of the tissue between five days, five weeks, five months, it gets exponentially thicker and tougher and tighter at the anatomy that I'm actually releasing.
Plus, the baby's already learned lots of complications. The quicker you can get them on an optimal path for their development, the better. The good thing about infants is, they have so much growth potential. Let's say, you release a five-day-old and they're doing functional between, they're growing, they’re mid-face – the face is very important. That's going to support and enhance their airway, so they can breathe better and they can sleep better. Eventually, they'll be able to smile better, because they’ll have more room for a well-aligned teeth that function with their by – their [inaudible 00:22:37].
Now, if we think of an adult that goes their whole life without having a tongue tie release when they needed it, the process is much different to just releasing the time and having some of that support, but then more of a natural progression of optimal health. You have to do a CT scan look your way, look at the times the teeth. It becomes more of adult to figure out how to help the adult and make sure you're not leaving a weak link in the chain. Because if someone has a tongue tie release, but maybe have a tiny airway, and they don't have enough room for their tongue in their mouth, they might need other things first, before you release the tongue.
[00:23:13] RH: Interesting. That's why it's good to not just go to someone who will release it. You want to find someone who will look at the whole picture.
[00:23:21] JH: Why isn't there someone like you in the hospitals checking on all the newborn babies?
[00:23:29] SZ: I think that gets political. The bureaucracy thing. Yeah, I think it's just, there's a way of doing things. I know, just speaking from personal experience, when my third son was born, my wife and I had seen the lip tie and the tongue tie, anatomically in was really prominent. The first day [inaudible 00:23:54] in the hospital, it looks like there’s a lip tie and tongue tie. It wasn't a functional issue of symptoms at that point, because you saw you aren't really – its first day.
We asked the lactation consultant in the hospital. “Hey, what do you think? It looks like he has lip tie and a tongue tie.” She said, “I'm not allowed to say anything about that.” That's a real thing, that there are rules about what people can and can't say. I think there's the idea that in the hospital system, they don't want to the lactation consultant to worry the parents, because they want the pediatrician you're doing at 30. Then, the patient pediatrician refers to the entity, kind of in hospital, in network. I think that's what it boils down to, is there's organizational systems that at the end of the day, can learn to access the optimal care.
[00:24:43] JH: It sucks, because it's the same in the school systems. It's the same even in a clinic practice that you can't recommend certain things. You can say, “Oh, well. Maybe.” Even that gets tricky. I hate it.
[00:24:57] RH: I do too. Another common question we'll get is for a lip tie, my tie will just fall. They'll just bust their lip tie on their own. We don't need to get it cut, because that's just unnecessary trauma. They’ll just fall and split it on their own.
[00:25:18] SZ: Yeah. I don't get that one at all. I'm just like, “What? I don't see that it could be a valid recommendation.” Part of it, I mean, I guess, this doesn't need to do with – it just as a story that gets passed down. One thing I think of is whenever I have – a mom reaches out to me through my website, or calls and they said, “Oh, my baby has a lip tie.” I'm like, “Well, you know, where there's a lip tie, there's almost certainly a tongue tie.”
That's the reason why I don't would advocate just letting them split on its own. Because the lip is often the more visible sign, if there's an oral restriction. Those midline defects can go together. It's really a nice opportunity to say, “Hey, anatomically, you see a lip tie, then I would say 99% of the time, there's a tongue tie that is probably loading function, causing symptoms, if you know which symptoms to look for. Therefore, an opportunity to get both treated as early as possible and improve the life from the time of the treatment throughout the rest of their development.
As with people, when you have the opportunity to be missing it, they’re like, we’re just going to wait for it to rip. The less I would see, that'd be great if more people thought of that, that the lip tie is a more visible of the pair that will give you the – “Oh, I need to look into this [inaudible 00:26:33].”
[00:26:35] JH: We just want to take a minute and talk to you about our company, Harkla. Our mission at Harkla is to help those with special needs live happy, healthy lives. Not only do we accomplish this through the podcast, but we also have therapy products, easy-to-follow digital courses and the Harkla Sensory Club, to try to bring holistic care to you and your family.
[00:26:53] RH: Listeners of the All Things Sensory Podcast get 10% off their first purchase at Harkla, with the discount code Sensory. We'd recommend checking out some of our bestsellers, like the compression sensory swing, weighted blankets, or our course on sensory diets.
[00:27:09] JH: Here's the best part. 1% of each sale gets donated to the University of Washington Autism Center to support autism research and fund scholarships to families in need to receive in-clinic therapy for their child.
[00:27:20] RH: Learn more about Harkla, and all we have to offer at harkla.co. That's H-A-R-K-L-A.-C-O. Don't forget to use the discount code Sensory to get 10% off your first purchase. That's S-E-N-S-O-R-Y for 10% off.
[00:27:42] JH: The best part is all Harkla orders come with a lifetime guarantee and free shipping.
[00:27:49] RH: You really can't beat that.
[00:27:50] JH: No.
[00:27:51] RH: Yeah, you can't. Okay, let's get back to the show.
[00:27:55] JH: Okay, so say you take your child in and you get the tongue tie released, will that tissue grow back and will reverse itself at some point? Or is that potentially a problem?
[00:28:08] SZ: Yeah. I mean, there's always going to be healing. You want this wound to heal. In the end of the day, a tongue tie release is creating a surgical wound to provide a release, but it's also going to heal. The thing that can happen within the healing process is would it heal in such a way that it restores the original restriction? That is quite possible. That's a reason why we recommend a pretty extensive and not so fun regimen of wound care and stretches, which [inaudible 00:28:41] when I watch my wife do it and it looked really hard.
I guess, it's a good time to mention that there's a type of productivity that's more commonly done, especially if it's by seeing a pediatrician in the hospital, or maybe by a dentist who doesn't do a lot of frenectomy work, is a clip or snip the anterior portion of the tongue tie. It's a quick and easy and bloodless procedure. The problem is a lot of those is don't provide a functional release of the tongue. When you have a proper tongue tie release, there's going to be a diamond shaped room. You might even be able to see some muscle. We don't cut the muscle, but we release them closer to the skin and fascia beneath it. You'll see a pretty sizable diamond shaped wound.
I tell my patients, the goal is to do the wound care, where that is elongated and getting more vertical. It's going to want to collapse down horizontally and attach them and put them out. That's where that reattachment come in, is it if the healing is unguided, then it could be attached. Theoretically, there could be scar tissue that eve made the restriction worse than before the procedure. I tell people, in some cases, if you couldn't commit to the wound care, then you might be better off not getting it done.
I mean, because of what's at stake with the breathing and the sleep and the development and all those things that someone would go for it, but there's probably cases where maybe someone would actually have to step back and say, and maybe it's not for you.
[00:30:05] JH: Yeah.
[00:30:06] RH: That's a good point. Because those first couple of weeks, I mean, if you're not in their mouth every couple of hours, it's hard. I mean, it's so quick and you just get in, get out and you're on the way.
[00:30:17] JH: It's not forever.
[00:30:19] RH: No. I can see that if they can't commit to it, then you might be better off not doing it, depending on the case. It’s a good point.
[00:30:31] JH: Okay. We've jumped around everywhere.
[00:30:32] RH: Yeah. Let's just give our listeners an idea of how long the procedure takes. Then just a quick overview of the recovery. When should we expect that optimal function afterwards?
[00:30:47] SZ: Yeah. Well, in my office, I book patients in for an hour. I have a private client lounge room. It's a private room. Basically, the families are there for the pre-operative discussion and demonstrating the wound care. I have a lactation consultant here in the office that it helps with these cases. It's a team approach inside my office. Not all offices work that way, but I find that team approach is really, really beneficial.
The actual procedure, we do take the baby down to the operatory, where we have the laser and the laser safety goggles and everything. We swaddle the baby, and then that actual laser is just, I'd say, a few seconds, is under a minute for sure. The baby's an opportunity, five minutes to put it all in there, back to the mom. One of the goals of the procedure, the reason we have the lactation consultant present is that hopefully, get the baby to latch immediately after the procedure.
Sometimes, we'll see that the – especially if the mom has had a symptom of pain when they're seen. In some cases, that pain is gone immediately. Sometimes, the babies are not interested in their seeing. They might be a little numb from the topical anesthetic, or they may be in a little bit of shock from the procedure. Sometimes we even have a weight check done by the lactation consultant, or they'll show that the baby has been transferring two small amounts of milk. All of a sudden, immediately after the procedure, transfer more milk, or have the best feed they've ever had. That's pretty rewarding; something, I mostly, I don't guarantee it, but it's always something that happens and happens fairly regularly. What would then we see, is that the symptoms that have been present will sometimes quickly and then some gradually improve over the next few days and weeks following the procedure.
[00:32:29] RH: With the recovery, we see improvements over the next couple of weeks. What happens if we aren't consistently doing those post-operative stretches and things like that?
[00:32:43] SZ: Yeah. I mean, basically, symptoms can come back. Then you have to look at the wound and see, is there evidence of reattachment. Again, it feeds back and initially, we're looking at symptoms and not simply appearance and that's still our guide, is are symptoms resolving? Or did they resolve and come back? I would say, once you get past that first couple of weeks, it's not likely that were symptoms returning with these reattachment, because the oral cavity heals usually about two weeks pretty completely. That's also why it's important. Most of my patients are doing some bodywork, in addition to lactations, of course. We've seen a chiropractor and a psychotherapist that's helping to mobilize the tissues and provide the sensory integration.
[00:33:28] RH: Awesome.
[00:33:29] JH: Have you ever had a client come in and say, “Hey, I think my child has a tongue tie.” You look and you recommend not getting the release done?
[00:33:42] SZ: I haven't had that happen personally. I think that's partly just being known as a go-to for tongue tie, as I see people that have already been self-screened, or they are being referred by a lactation consultant. They've got the symptoms, that's why they're reaching out to me. Then typically, I don't do just exams on a baby to look at it and see if there's a problem. Even if people call me and they haven't reached out to someone else personally, typically, I'm referring, recommend to see a lactation consultant first. Because there can be issues with just the things are scaled and the positioning, all things lactation consultants do that can help.
Also, if they decide to proceed to a revision, or a tongue tie release, then that support is really helpful in preparing them. Also, the bodywork too. I mean, there's babies that have tried to call us. They have tied tissues. There's fascia that can be restricted that that can be mobilized and help. There may be some cases where they have bodywork and lactation support. From those interventions, the support, they don't end up getting a tongue tie release. I mean, that's great. I'd rather, if that's possible, then they don't even get me. Yeah, I'd say again, just by symptoms and I definitely want people to be prepared before they get to the stage of the release. It's really important to have that in place.
[00:35:03] JH: What about for an adult? An adult would go see a lactation consultant?
[00:35:08] SZ: Oh, no. Yeah. For an adult, I do a new patient exam. It basically involves a CT scan, or a radiology report. We take photographs and measurements, enteral skin. We're doing range of motion tests. It's mentioned earlier, it's a different ballgame. Then, we're looking to see, do they have low-tongue posture? On a CT scan, we can see where they're holding their tongue. some people have a low-tongue posture. That can be a good sign that actually, to release a tongue, there's room for it to move up and forward, and actually open up their airway.
I guess, a good point to mention that everything I do in my practice, I call it airway dental medicine. The goal is I want to support and enhance the airway. That's specifically the upper airway. Basically, anatomically, the tube you breathe through, that's from the voice box, up behind your tongue, behind your nose and your soft palate. Below the voice box, our trachea, we've got rings of cartilage that support the airway, so that when we breathe in, it doesn't collapse.
The upper airway is highly collapsible. A lot of that is because mouths are too small. Tongues are normal size, but basically, you say you have a tongue that's too big for your mouth, and just because of small jaws. Then, the airway is too small, and often not very resilient, and it's likely to collapse. That sort of people have reading issues. Then at night, the tongue mainly is the culprit that can block the airway, because when you go and try to get a deep sleep, your muscles get more relaxed. That's normal behavior. When your mouth is too crowded, then the tongue can block the airway.
Even when people are young, young females, younger men can have sleep problems, unrefreshing sleep, insomnia. It’s throughout life. It takes a long time before someone actually gets severe enough where they might be diagnosed with sleep apnea. Sometimes, a lot of people treat obstructive sleep apnea. I see this airway dysfunction as a whole spectrum of objectively identifiable anatomic issues, as well as some terms, they can identify from birth, all the way until someone's entitlement at 60, that gets diagnosed with sleep apnea.
I really enjoy working with people at any stage of their adult life, to support and enhance the airway and give a better quality of life, so they can breathe better and sleep better and smile better. I guess, I mentioned is that, when we have optimal development, we should develop dental arches that accommodate all 32 teeth, and they should be in good alignment.
Just if someone has crowded teeth, you know they don't have a big enough jaw to support their teeth and a healthy airway. If anybody's has had crowded teeth, braces, or had braces, and the teeth got crowded again, or they had extractions, wisdom tooth extractions, those are all signs that they don't have an optimal airway. Then the other thing I look at is the actual shape of the teeth. If you look at teeth, you can see, that's one of the most objective parts of the body, because you can measure. Those are your genetic tooth forms. You can say, “Oh your central incisor should be 12 millimeter is long. Now it's only eight, so we know exactly how much has been worn away.”
The thing that happens with adults is they clench and grind and have acid erosion that wears on your teeth. It's like, you're losing functional anatomy. That has consequences. A big part of what I do with adults is we actually restore the teeth to their original form. Then that allows their bite and their jaw then to work together to support and enhance their airway.
[00:38:31] JH: It literally is all connected.
[00:38:33] RH: So many things. Well, I was just thinking of myself when you were talking about that. I was like, “Oh yeah. I had braces. Then I had my wisdom teeth removed as an adult.” Now, my teeth are still a little bit, I guess, crowded, or crooked. I'm like, “Oh, crap.”
[00:38:50] SZ: Yeah. That's a great thing with the CT scan, we can visualize if you're breathing through a tube, it's more like a straw, or a snorkel. Of course, we want it to be more like snorkel, the straw. I see a lot of people breathing through tubes, or upper airways the size of a straw, and that stands to reason that might impact your quality of life.
[00:39:08] JH: Just a little bit.
[00:39:09] RH: Well, I was going to say, they're probably in fight or flight constantly, because their body can't get enough oxygen.
[00:39:14] SZ: Yeah, absolutely. I mean, I think that compensating for a small airway is one of the biggest causes of chronic stress. If someone's in a prolonged state of fight or flight, or sympathetic tongue, then that's going to lead into all kinds of other chronic health issues. I'm trying to find a slide here. Okay. This is a typical young female, who's not the[inaudible 00:39:37], big neck, but you might think of having sleep apnea, or they call upper airway resistance syndrome, which is I call it airway dysfunction. It's a small airway, we're trying to compensate.
There's a list of symptoms that especially as a young female, you might be experiencing is body fatigue, headaches, anxiety, depression, low blood pressure, cold hands and feet, hypothyroidism and digestive issues.
[00:40:00] JH: Okay, I'm fine.
[00:40:03] SZ: I would see this over and over. It's like, “Oh, yeah.” Then there's usually a tongue tie, small jaws, small airway, like that. Teeth is with that particular set of visual.
[00:40:13] JH: That's insane. That's amazing.
[00:40:14] RH: It's amazing how it affects your entire life, not just your mouth, your breathing, your talking.
[00:40:21] JH: Yeah, it’s everything.
[00:40:24] SZ: I’m going to give a quote. If someone says in the mouth, because your teeth are sensory organs and there's nerves that feedback and that's cranial nerves in your brain. It's one of the highest – the areas of highest neurological density. Of course, the whole head and neck is, but your jaws and your teeth do interact with your proprioception and your vision, and your head posture, staying level. Even, a lot of people are posture that forward to open up their airway. Because if you lean your head forward and take your chin up, it’s getting large and the tension in the airways is likely to collapse.
A lot of the postural issues are related to small airways. That's why a lot of people can't just tuck their chin, as they would collapse their airway. They're going to have good posture, because they have to survive. I’ll have to say, if you think about it, there's really nothing more important than your next breath.
[00:41:16] RH: Wow. For everyone listening, you could see Jessica and I just now – we're tucking our chins and moving –
[00:41:25] JH: Thrusting my head forward. Trying all the things.
[00:41:27] RH: We hope that everyone else is going through this too, right now.
[00:41:31] SZ: I can describe this too, is going to be a – I don't know. You're going to go either like it, or not like it. I figure not. You won't be able to unsee this, okay? Don't do it anyway. If you look around, especially you want to look at people's profile. Looking at someone from the front, they're going to move their head, so everybody looks normal. If you look from the side, you’re all doing like, you look at me from the side, my forehead is sloped. It has an angle to it. You see that?
[00:41:56] RH: Yeah.
[00:41:57] SZ: Theoretically, for edge to be vertical. Whenever I look at someone, an airport or have developed, if they have a sloped warhead, I think, wow, they have a huge cranial and facial compensation that keep their airway open to their whole life. This is, it changes throughout life. When I look at someone, I say, if their forehead was vertical and how far back in their face would their jaws be, that's a more clear picture and non-compensated picture of their cranial facial development. You'll see that when I put my forehead vertical, my jaws are actually a lot farther back here when I have a visual head posture. It gives you a more true picture of the problem.
[00:42:36] RH: Wow.
[00:42:36] JH: Geez. That's pretty crazy. Okay, I said earlier, I had one more question. I really do have one more question. Then unfortunately, we have to let you go. Is it genetic? Are tongue ties genetic? You said, your three boys went through this. Then you're talking about your forehead. What's going on?
[00:42:55] SZ: Yeah. There's definitely a genetic component. I see more boys than girls that have tongue ties and lip ties. I think there's a male predominance. There's a big, if you get in the weeds too much, but I've learned a lot more about epigenetics. I guess, there's some validity to say that is, I used to think 80%, I see nature versus nurture, or environment versus genetics. I'd say, is it 80% genetics and 20% environment. I think it's opposite. 20% genetics and 80% environment. The little twist in that is, our human genome doesn't change very quickly. It takes many thousands or millions of years.
What we're seeing with inherited issues, I think, is epigenetics or gene expression, where a baby can inherit a tongue tie from a parent base, more based on DNA expression, not around any evolutionary change. We are seeing kids inherit the smaller jaws in tongue ties from their parents, or from their ancestors. If that makes sense, so it's both.
I would say, the good news is, if you then believe that it's 80% environment, then there's a lot we can do to intervene, but then have proper gene expression, which is the again, I want to intervene in infancy ideally, because theoretically, an infant who has a functional tongue tie release, has functional breastfeeding, optimal breastfeeding, their muscle activities may stimulate their [inaudible 00:44:14] to pull genetic potential.
When we talk about weaning, you have to lean onto harder foods, which is hard to do in our modern world, that if you have good lip posture, tongue up, lips closed, breathing through the nose, chewing hard foods, having good posture, all these things can help the child develop optimum airway, where they wouldn’t – braces and tongue tie release and surgery and all these things. That is the potential to if we can catch it early, to help them grow more optimally and not have to suffer needlessly.
[00:44:49] JH: Then also, not pass down this continuous cycle. We can just keep talking forever.
[00:44:56] RH: I know. I know.
[00:44:58] JH: So many questions.
[00:45:00] RH: It's interesting. I love that we can connect adults and infants and we can realize that it's not just related to babies and this isn't just an episode for parents. It's an episode for everyone to be aware of and to just have it, have that knowledge in the backseat and keep it in mind.
[00:45:18] JH: Yeah. Geez. Yeah. Before we let you go, your last, like one piece of advice that you could leave our listeners with today.
[00:45:28] SZ: I would say, maybe especially for moms, or have these babies with issues, I would say trust your gut, trust your intuition. [Inaudible 00:45:35] going to listen. It's really about symptoms, more than appearance. It's not about what the tongue tie looks like. It's about trusting your gut and knowing that there are functional issues, there's symptoms, then you should seek help from someone who knows how to evaluate based on symptoms and not just the appearance.
[00:45:58] RH: Got you.
[00:45:59] JH: Awesome. Okay.
[00:46:01] RH: Thank you so much, Dr. Sam. Dr. Sam, Dr. Zink.
[00:46:04] SZ: Yeah, my pleasure.
[00:46:07] JH: Do you have any questions for us before we let you go?
[00:46:11] SZ: I don't think so. I think that's really good. That’s really enjoyable.
[00:46:16] JH: Perfect. All right. Well, we appreciate you sharing your time with us.
[00:46:19] RH: Yeah. Thank you so much.
[00:46:21] SZ: Yeah.
[00:46:21] RH: Did everybody learn as much as we did?
[00:46:24] JH: Did you try all the things as he's talking about them? We looked at each other's foreheads during –
[00:46:30] RH: Yeah. We changed our posture.
[00:46:32] JH: Yup. Then later on after this interview was done, we took a break to eat lunch. Rachel's husband, Daniel was down there. I was like, “Daniel, turn to the side. Let me see your forehead.” Can I share? His forehead’s a little bit slanted.
[00:46:46] RH: It is. Yes. He's also a terrible sleeper as well. We're going to connect the dots.
[00:46:51] JH: He probably has a tongue tie. Well, and there's a genetic component potentially.
[00:46:56] RH: I have a tongue tie, we found out.
[00:47:00] JH: I think I'm fine.
[00:47:01] RH: Are you? You don’t have any issues.
[00:47:04] JH: No. See, and this is the thing, you have vestibular challenges. You have a tongue tie.
[00:47:09] RH: I can’t touch my toes.
[00:47:10] JH: You can’t touch your toes. I am fully integrated vestibularly. The only reflex I don't have integrated is my bobinsky. Pretty sure, I keep putting my tongue to the roof of my mouth. I'm pretty sure I'm fine there. My teeth are a little crooked. Whatever.
[00:47:26] RH: You sleep good?
[00:47:27] JH: I sleep so good. I love sleep. It’s my favorite thing to do.
[00:47:31] RH: What's your favorite occupation?
[00:47:32] JH: It’s sleep. I love my bed. Okay. Oh, my gosh. We're rambling.
[00:47:35] RH: Yes. That's the point is function, right? Look at the function. Listen to this episode. We actually have a bonus episode with an IBCLC coming out to Friday, to explore this topic a little bit more in detail. If you don't know what an IBCLC is, maybe you should listen to that episode.
[00:47:54] JH: Yeah. In the meantime, leave us a review on iTunes. Shout us out on Instagram, All Things Sensory Podcast. Let us know you're listening. I think that's it.
[00:48:05] RH: All right. We’ll talk to you on Friday.
[END OF EPISODE]
[00:48:09] JH: Thank you so much for listening to All Things Sensory by Harkla. If you want more information on anything we mentioned in the show, head over to harkla.co/podcast to get all of the show notes.
[00:48:20] RH: We always have the show notes and links, plus full transcripts to make following along as easy as possible for everyone.
If you have follow-up questions, the best place to ask those is in the comments on the show notes, or message us on our Instagram account, which is @harkla_family. If you just search Harkla, you'll find us.
[00:48:40] JH: Like we mentioned before, our podcast listeners get 10% off their first order at Harkla. Whether it's for one of our digital courses, one of our sensory swings, the discount code Sensory, will save you 10%. That code is S-E-N-S-O-R-Y. Head over to harkla.co/sensory to use that code right now, so you don't forget.
[00:49:03] RH: We're so excited to work together to help create confident kids all over the world and work towards a happier, healthier life.
[00:49:10] JH: All right. We'll talk to you guys next week.
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