The tongue is an important oral structure that affects speech, position of teeth, periodontal tissue, nutrition, swallowing, nursing/eating, speaking, and much more. Ankyloglossia (tongue tie) is a congenital anomaly that is generally characterized by an abnormally short, thick lingual frenulum which affects movement of tongue. ​

This cross-sectional multicenter cohort study examined Six-hundred and eleven (611) subjects ages three (3) and up from the general population. Subjects were surveyed in a standardized fashion by interdisciplinary professionals trained in the evaluation of oro-facial myofunctional disorders at ten (10) different sites including researchers in the United States, Hong Kong, Estonia and Ireland as part of the Functional Airway Evaluation Screening Tool (FAirEST) study.​

Dr. Soroush Zaghi, the principal investigator of this study said: “We can now fully appreciate the potential strength of the LPS measurements in identifying limitations in posterior tongue mobility that may be associated with functional deficits or submucosal restrictions that are not readily identified by other grading scales.”.    ​

After all the intensive exploration ​(which is now one of the largest case series on the subject in the literature), it was concluded that this study validates TRMR-LPS as a useful, functional metric for assessing posterior tongue mobility. ​

While many have crawled into their shells during the ongoing global situations surrounding all of us, some have used the time to delve even deeper into learning and expanding their knowledge and skills. We are excited to announce that one such passionate and forward thinking healthcare provider has just joined the ranks of TBI Affiliates; Dr. Tim Herre.

Dr. Herre is a third generation dentist who graduated from the UMKC School of Dentistry. As a holistic, biological dentist he aims to connect the dots between the mouth and whole body health for his patients. His passion is identifying growth and development concerns for young children, and collaborating with other practitioners to allow his patients to flourish into healthy adults. He also helps his older patients to thrive by harnessing the healing power of proper breathing, sleep and real food.

​His holistic practice in Leawood, Kansas focuses on TMJ, sleep/airway, tongue tie treatment, orthodontics and rejuvenation based dentistry.  

Beyond his work as a clinician, Dr. Herre also volunteers his time to action oriented collaborations such as the AAPMD Airway CoLab, and has furthermore joined with his fellow TBI affiliates to collectively provide over $250,000 of care free of charge to underserved communities.

We had such a fantastic time hosting Dr. Herre for his TBI Mini-Residency and could not be more thrilled to now have Dr. Herre and his outstanding team come into the fold as TBI Affiliates officially! 

Learn More abour Dr. Tim Herre at dentalhealthbyherre.com/

If everything is so “normal,” why do I feel so bad? Is this all in my head? Am I making it up? Am I just lazy? Am I crazy?

As long as I can remember, I suffered from insomnia. And I mean really bad insomnia. Before my dad died when I was five and a half years old, I clearly remember lying awake at night, unable to sleep, listening to my parents chatting in the living room. I dreaded going to bed at night, even at that young age, because I knew I wouldn’t sleep. I knew that that horrible internal vibrating would take over and sleep would not come.


As a child I suffered from constant headaches, with neck and upper back stiffness and pain. I had stomach aches, chronic constipation, and chronic sinusitis and bronchitis.  Swallowing was always difficult and was accompanied by TMD, the aforementioned insomnia, anxiety and panic attacks.

I complained constantly to my mom who told me I was just a hypochondriac and was making things worse than they really were. And when I ended up annually at the doctor’s office having a battery of tests run, all of which were always ‘normal,’ the doctor echoed my mother’s beliefs, making me feel more isolated and alien than ever.


I was twenty-two years old when I also began having one bladder infection after another which ultimately lead to the diagnosis of IC (interstitial cystitis) and I received my first diagnosis of IBS. The internist told me it was the worst case he’d seen in his twenty-five years of practice and referred me to a psychotherapist.

This began my conscious journey of trying to heal myself. I loved psychotherapy and I loved learning. I’ve always been interested in why we say and do the things we do and I believed that the more I knew, the more I could help myself and help others. Once I found myself repeating the same stories, I knew it was time to move on. Therapy had given me tools and a deeper understanding of human nature, but the insomnia and other symptoms continued.


I did Rolfing, myofascial release, and other forms of very painful body work. I tried Reiki and acupuncture, sound and color healing as well as transformational breathing and chiropractic adjustments. When none of this worked, I went on to theta brainwave healing, Native American healing, essential oils, NLP (Neuro-Linguistic Programming) and hypnotherapy, even studying and becoming a certified clinical hypnotherapist myself. I was determined I was going to find answers.


Sadly, while I had accrued invaluable information, tools, and resources, and had actually helped many other people, I was still suffering as the insomnia continued, evening worsening with many of the therapies I had undergone and I found myself withdrawing.


I was referred to a renowned neuropsychiatrist who told me within the first five minutes of our appointment that no one would ever guess the pain I lived with every day. He was so kind and understanding and he gave me such hope! He did a brain study and saw that my brain wouldn’t go into delta for more than two to four minutes at a time and he told me I was born with an abnormal brain. He thought I had ADD and began me on treatment but everything worsened and my weight dropped so significantly (I was not overweight to begin with) that he thought I had celiac disease. He became so alarmed he went back and reviewed my original brain study and told me he had missed something and had made me worse. He said I needed a calming antidepressant and started me on the lowest dose of Celexa then had me cut it in half with a pill cutter. Within twenty minutes I began shaking terribly and could feel my core was beginning to convulse so he had me take a Xanax. When that calmed me down, he switched me to Lexapro but I had the same reaction. This was over the course of two days and it took me two full weeks for my core to stabilize and for any kind of appetite to return. I stopped seeing him soon after.    


I was really tired of being judged by family, by friends, by the doctors and practitioners whose help I sought. There were several doctors who really thought they knew what was going on and that I would be an easy fix. When they turned out to be mistaken, they often had no idea what to do with me nor how to complete the relationship and did so badly. This only fed my incredibly negative beliefs about myself and I began to feel hopeless.       


I was in my forties, losing friends and losing faith, when I found craniosacral therapy.


The therapist seemed to understand my symptoms and explained that I had a high, narrow palate which could be treated by a dentist with a palate expander called an ALF. I was with an ALF dentist the next week.


He told me how people with high, narrow palates have restricted airways, and how the ALF would correct that and I would be breathing and sleeping well soon, but that was not my experience. After ten years with a lower device and a night guard then three years with the ALF, my teeth were so flared that I had excessive gum recession, exposed nerves and bone, and ended up losing a molar.


In the end the ALF had expanded my palate a mere 1.82mm but had flared my teeth 7.15mm and left me with periodontal damage and the need for restorative work.


On a brighter note, this experience led me to a myofunctional therapist, who immediately recognized my tongue-ties and referred me to Dr. Soroush Zaghi. During the frenuloplasty he made a cut that released my neck and skull.


As long as I can remember I have had very limited range of motion in my neck and head. This pain, tension, and significant tightness was actually something I felt internally from my skull all the way to my toes. I felt as if my internal body was constantly tense, girding itself against something that threatened my very existence. I now understand it actually was protecting me against the chronic waves of adrenaline that flooded my body every few minutes throughout the day, every day; leaving me shaking, my heart and pulse racing, and bewildered by what was happening in my body. Adrenaline is corrosive and it was battering my internal organs, slowly eroding my energy and my health.


Today we are hearing more and more about something called fascia. It is a flexible, fibrous sheath with multiple layers that holds our muscles on our bones and our internal organs together. Fascia was historically referred to by doctors and surgeons as connective tissue that holds everything together but that was all. This biological fabric is actually a sensory organ that literally communicates to our central nervous system about whatever it is covering. It permeates every muscle, nerve, bone, tendon, and vein, as well as holding emotions. And with emotional and/or physical trauma it loses its flexibility and hardens, like compression wear tightening, restricting movement and causing pain.


Along this interconnected highway is a fascial chain called the deep front line. One continuous link that begins at the floor of the mouth and tongue and travels down through the interior throat, the entire chest and diaphragm, lumbar, psoas, hips, thighs, calf muscles, all the way down to the feet and toes!
  
So, when Dr. Zaghi made that deep cut, I felt a release, along with a deep sense of relief as it traveled down through my chest and gut, the muscles letting go in a way I had never experienced, all the way into my legs and feet. I felt that inner holding and tension of a lifetime simply let go. My head was as weightless as a helium balloon and I had never felt that light or that free before and I began laughing and crying simultaneously.


While my tongue-tie release was a success, my sleep did not improve and I continued to have symptoms so Dr. Zaghi suggested we do a cone beam CT scan to rule out any maxillofacial structural issues. When analyzing CT of the head and neck, we expect the posterior airway space to be approximately 10-15mm wide to ensure low risk for symptoms of sleep disordered breathing. However, looking at my CT scan, Dr. Zaghi discovered that my posterior airway was only 1-2mm wide. In that moment, it all became clear. He told me there was no way I would ever have been able to sleep well and that I never would unless this was corrected surgically. No palate expansion device was going to work.


Dr. Zaghi suggested I do an at-home sleep study so that we could get a clear look at what was going on when I slept. We found that my RDI was 23.7 and much higher than my AHI of 15.6. RDI stands for Respiratory Disturbance Index which indicates how many times arousals and disturbances occur due to lack of oxygen. AHI stands for Apnea Hypopnea Index which indicates pauses in breathing (apnea) and periods of very shallow breathing (hypopnea.)    


What I have is UARS (Upper Airway Resistance Syndrome.) UARS is a sleep disorder characterized by the narrowing of the airway that causes arousals and disturbances to sleep, triggering the nervous system and releasing adrenaline into the body. Patients with Upper Airway Resistance Syndrome often complain of difficulty falling asleep and staying asleep. They describe chronic fatigue, excessive daytime sleepiness, and/or mood disturbances, anxiety, or mental stress characterized as “fight-or-flight.” For all those years when I laid down to sleep, this is exactly what was happening to me. My airway was collapsing and my body was overwhelmed with adrenaline. During the day I was hanging on, barely able to function, growing more and more desperate, and searching for answers that never came; until I found Dr. Zaghi.


To open my airway, I am going to need maxillomandibular advancement surgery also known as MMA.


But I have an HMO and the MMA surgery is not an option with them. The older I got the harder it was for my body to bear the burden of a lifetime of sleep disordered breathing and the chronic flow of adrenaline and cortisol that ensued. This physical pain coupled with the pain of not knowing what was wrong with me, and the fear that I was never going to get better sent me into a downward spiral of despair. I had gone into adrenal fatigue with Hashimoto’s Disease and hypothyroidism about nine years before and had been unable to work since, so paying out of pocket for the MMA surgery was cost prohibitive. To say I was frustrated would be an understatement and as result, and out of sheer desperation, I turned to yet another palate expander called the DNA. My teeth are no longer flared but there is no possibility of advancement based on my specific appliance’s design.


I am at a crossroads. Because of the amount of advancement I require to breathe, no holistic appliance is going to work. My husband and I have spent hundreds of thousands of dollars seeking help that either did nothing, or made me worse. And so, I have made a decision. I am going to move forward with the MMA surgery. The details have not been worked out yet, but the decision has been made and I am excited!


I have learned so much and I want to give help, hope, and knowledge to others out there experiencing what I have, suffering as I have.


When I found my first ALF dentist, I didn’t know anything about airway restrictions or high, narrow palates and crossbites. I didn’t know how devastating mouth breathing was, or what that even implied. I didn’t know which questions to ask but simply trusted him implicitly. He never told me just how narrow my airway was or that the ALF could have some negative side effects in regards to my oral health. I did ask my DNA dentist questions, but in retrospect I didn’t ask enough, and again, trusted that he was doing what was in my best interest. Both of these (and many other) holistic palate expansion devices are wonderful products and work really well with the right candidates. I am not a good candidate for any holistic palate expander and I fully accept that now. No amount of positive thinking is going to change that. In fact, I am a little narrow but really only require 4mm of palate expansion whereas I require 1 full cm of advancement. If I never expand my palate those 4mm it will not affect my quality of life whereas not gaining that 1cm advancement will. The thought of my life remaining the same fills me with a deep sense of hopelessness and I know I must find a way. I have so much life inside me and so much to contribute and now have a level of support, care, and expertise that I have never known before!


If you are having problems sleeping, experiencing chronic daytime fatigue, have anxiety, if you snore or have chronic sinus congestion and mouth breathe, please, know there is help out there! Dr. Soroush Zaghi and The Breathe Institute are quite literally saving my life and Dr. Zaghi is training doctors and dentists all over the world in this customized and holistic model of care.


Please reach out. Dr. Zaghi and his team of caring and compassionate experts are here to help get you on track and living your life to the fullest! I can personally attest to that!


Wishing you happiness and radiant health!
Trish

As a perpetual learner, Dr. Handa has continued her education with organizations such as the Pankey Institute, The Spear Institute, The Stewart Center, and of course now with us here at TBI. ​

​​Here are a few key points in the article by Bahr (2008) worth mentioning to further the study of oral sensory-motor therapy.

• By 2007, the field of speech-language pathology seemed focused on language development, assessment, and treatment instead of speech or feeding. Most studies in the field appeared related to language, not the motor aspects of speech or feeding.
• In fact, in 2007, there seemed to be far fewer studies on all motor-related disorders in the field (e.g., voice, fluency, motor speech, and the oral phase of swallowing).
• Additionally, the field did not appear to have enough PhD level instructors, and many university faculty members did not seem to be studying or teaching the motor aspects of speech and feeding.
• While ASHA had projects like NOMS (National Outcomes Measurement System), very few clinicians appeared to be participating in clinical research. 

Another article written by Pamela Marshalla (2007) was entitled Oral Motor Techniques Are Not New. This article compiled terms used historically to describe oral motor exercises in 84 speech textbooks from 1912 until 2007. Therefore, it seemed the topic of oral sensory-motor treatment had been studied for almost 100 years. Marshalla (2011) also described the evolution of oral sensory-motor therapy from 1928 until 2009 in a blog post.
​
It’s valuable to mention many early oral sensory-motor references were presentations, papers presented, and seminar handbooks. Here are some of them:

I see many patients with articulation disorders and associated orofacial myofunctional disorders. While they have knowledge of the field of speech therapy, exposure to myofunctional therapy is limited or nonexistent. This article is meant to serve as an introduction to the cultural and historical context of myofunctional therapy and its evolution as a fundamental aspect of articulation training Orofacial myofunctional disorders have been discussed in the literature for over 100 years. ​

In the late 1800’s, Edward Angle, D.D.S., also known as the “Father of Modern Orthodontics,” published Malocclusion of the Teeth. He recognized the influence of mouth breathing on the resting posture of the tongue and lips and viewed compromised resting posture as the primary hindrance to orthodontic treatment. In fact, he asserted that negative oral habits must be eliminated for successful orthodontic treatment to occur. ​

In 1961, Fletcher, Casteel, and Bradley found that subjects with tongue-thrust swallow were much more likely to have sibilant distortions than subjects without tongue thrust patterns. Their findings led them to contend that speech pathologists should consider basic oral muscle patterns when remediating articulation deficits “since the tongue-thrust swallow is intimately related to speech production.” Information from studies such as this led to some controversy regarding the expanding role of speech pathologists. However, it was becoming clear that the swallow pattern had to be considered in its effect on speech. Training desirable resting postures of the jaw, lips and tongue have evolved into fundamental features of articulation therapy. As Char Boshart stated in her book, The Key to Carryover, “The desirable resting posture provides a pivotal epicenter, right in the heart of all the action: speaking, chewing, swallowing.” The elevated tongue eliminates mouth breathing, improves muscle tone and facilitates efficient speech and swallowing. ​

...particularly in the afternoon.  Caffeine has a half-life of 5-7 hours for most people, meaning that it takes that long for half of the caffeine to work its way through the system.  Implement a caffeine curfew for yourself, so you have had your last cup of java by 11am or 12pm, giving yourself a chance to metabolize as much of the caffeine before bedtime as possible.  For more on caffeine, watch a video I posted recently on IGTV. ​

Guided meditation for sleep helps by giving your attention something to focus on, other than the worry list, such as the breath or sensation.  ​