Very Dental: Embracing the Airway with Dr. Marianna Evans

[00:00:01] This is a production of The Very Dental Podcast Network.

[00:00:05] This is The Very Dental Podcast.

[00:00:13] Welcome to The Very Dental Podcast, where you'll find entertaining and relevant conversations with visionaries, clinicians, and your friends in the dental space.

[00:00:27] Now here's your host, Dr. Alan Mead.

[00:00:30] Very dental people, welcome back to another episode of The Very Dental Podcast.

[00:00:34] It's Saturday at the Spear Summit 2022 in the morning.

[00:00:39] The exhibit hall is a little quiet right now, which is okay.

[00:00:42] It's pretty cool. They have me sort of set over on the side of the exhibit hall so I can kind of see the action, but it's pretty great.

[00:00:48] Joining me is someone that I just met here at Spear Summit this weekend, Dr. Mariana Evans. Mariana, how are you doing?

[00:00:55] I'm great.

[00:00:56] So Mariana, you practice in Philadelphia, is that correct?

[00:01:00] I'm practicing right outside of Philadelphia.

[00:01:03] And she is dual specialty, she's an orthodontist at a periodontist. Is that right?

[00:01:08] Yes.

[00:01:09] Okay, so there's a lot to dig into there, but I do just want to say Mariana presented on the main stage at Spear Summit.

[00:01:17] Was it yesterday or two days ago?

[00:01:19] Yesterday.

[00:01:20] Okay, so that's a big stage. That's a big wide stage. How was it? How did it go? How did you feel?

[00:01:25] It was really nicely organized. It was a beautiful stage, but I felt very comfortable. I did not feel like I was on the backstage.

[00:01:37] Excellent, excellent.

[00:01:38] And in general I was greeted. This is my first time at Spear. I was greeted very warmly.

[00:01:44] It's very special for me to meet all these passionate dentists about interdisciplinary.

[00:01:55] And you're in a very friendly group towards Airway. Very airway centered group.

[00:02:02] Because anyone who's spent any time in the Spear sort of orbit, it's very airway. I know that's kind of your shtick.

[00:02:11] So I want to get into that, but I will say this. Something you probably didn't know.

[00:02:15] So the way they organize this meeting, I found this out by talking to Greg Kinzer and Jeff Rouse yesterday.

[00:02:21] This meeting is basically whoever Greg wants to hear because Greg doesn't go out to do a lot of his own CE very often.

[00:02:28] So he's like, oh, we'll just invite people here because Greg obviously has great contacts and stuff.

[00:02:32] So if you are a guest here, you are someone that Greg wanted to hear, which is I think that's a pretty cool way to do a meeting anyhow.

[00:02:38] Wow.

[00:02:39] Yeah, there you go. It's very exciting. So that's really cool.

[00:02:42] So give us a very short version of what your presentation was like, what it was about.

[00:02:46] So my presentation, as I said, this is my first time presenting at Spear.

[00:02:53] So I wasn't sure what... how to connect with the audience and what exactly they wanted to hear.

[00:03:03] So I chose a topic of how to diagnose and what can be done about hypoplastic mxela.

[00:03:14] Basically, my topic was about connecting the dots in terms of what a restorative dentist can identify and have it affect their practice

[00:03:27] and what can be done by an orthodontist, by a periodontist, by orthognatic surgeon and an ENT in correcting hypoplastic mxela

[00:03:39] and how it relates to airway, to occlusion, to periodontal health.

[00:03:45] So people are trying to connect the dots.

[00:03:47] Yeah, and it sounds like interdisciplinary stuff was kind of the focus, which of course is a very...

[00:03:51] Yes.

[00:03:52] Spear is very, very interested in that.

[00:03:56] What's interesting to me... I actually had a conversation with Becca Bacow this morning just as she was walking past

[00:04:02] and saying that so many people are really interested...

[00:04:05] I'm a restorative dentist, so I'm...

[00:04:07] So many restorative dentists are really focused on and interested in treating airway

[00:04:14] and their struggle is, okay, there's often maybe most of the time some kind of an orthodontic component,

[00:04:21] whether it's a little kid or an adult, and their orthodontists are kind of not in that paradigm.

[00:04:28] Does that sound like something you've heard before?

[00:04:31] Yes.

[00:04:32] As an orthodontist...

[00:04:33] I was gonna say this is kind of a softball for you, but what advice do you give to someone who's like a restorative dentist

[00:04:40] and has kind of been open to the whole airway thing that maybe doesn't have the tools or an orthodontist that's keyed into that?

[00:04:47] Clearly there are some orthodontists who really have taken this, but it's taken a little while

[00:04:52] because it's still... Even though it's been something a lot of people talk about for a while,

[00:04:56] it's still pretty new and ortho, I think.

[00:04:58] So speak to that for me.

[00:05:00] So I think with respect to both restorative dentists or general dentists

[00:05:06] and to an orthodontist, I think this is definitely a paradigm shift in dentistry

[00:05:12] where we are looking beyond the mouse.

[00:05:15] And the connection between oral and airway health is very strong

[00:05:21] and of course we may not have enough research,

[00:05:25] but the research that we have is very clear about the link.

[00:05:31] So if you take, in defense of an orthodontist,

[00:05:35] if you take an orthodontist that went through the school that is treating a patient,

[00:05:41] everyone wants to do a good job for that patient.

[00:05:44] But in the orthodontist of today and the past

[00:05:50] is a specialist that was very interested in improving the smile, straightening the teeth,

[00:05:59] is focusing on the teeth, on fixing the malocclusion.

[00:06:04] And they don't... We didn't... Even myself,

[00:06:10] we didn't have training on the link between the airway health

[00:06:14] and malocclusion in an orthodontic program.

[00:06:19] So now this concept that is not taught

[00:06:24] maybe is just being started to be taught in the average orthodontic program

[00:06:32] is something that they have to integrate into their practice

[00:06:38] as a new concept, as a new protocol.

[00:06:43] And I think it's not easy because every orthodontist today has an average practice

[00:06:48] where they see between 50 to 100 patients a day.

[00:06:52] They have the system... They have their own workflow.

[00:06:56] They have their workflow and this is something that's been working for them.

[00:07:00] This integrating this concept into their practice is challenging

[00:07:06] and it may require some restructuring of the practice,

[00:07:11] restructuring of the vision, restructuring of the way they treat the patient.

[00:07:17] So I think it's not easy for an orthodontist that has been practicing

[00:07:23] for 20 years to change.

[00:07:27] It's the same as for a restorative dentist that has been taking impression

[00:07:33] for 25 years to go into the digital...

[00:07:37] It's a perfect analogy. It really is.

[00:07:39] It's doable but you really have to want to do it.

[00:07:42] But the problem of airway and what orthodontists as a specialist can do

[00:07:50] for a child or can do for adult is something that no other specialist can do.

[00:07:57] The impact that the orthodontist can make on the systemic health of the patient

[00:08:03] in terms of correcting the structure, correcting the jaw deficiency

[00:08:07] is something that the medical provider doesn't have in their toolbox.

[00:08:13] So I think it's a matter of time and of course we need more research

[00:08:17] that every orthodontist is going to do it.

[00:08:20] But going back to your question,

[00:08:24] what will you advise to a restorative dentist

[00:08:27] that sees the importance and is trying to collaborate with an orthodontist

[00:08:31] don't give up?

[00:08:33] I think you have to start with one patient at a time

[00:08:37] just like when you build something you start with one break.

[00:08:41] So take one patient that in your practice

[00:08:44] that you see the link between the malocclusion, the jaw deficiency

[00:08:49] between the failing restorations and start working it up

[00:08:54] or if you can somehow connect with other practitioners

[00:09:01] or orthodontists that or oral surgeons or other teams

[00:09:05] that have been implementing this concept into their practice

[00:09:10] and maybe ask them to share one of the cases that they have treated.

[00:09:16] I think we all have to learn and we all are in this together.

[00:09:21] And I think this is all about interdisciplinary care

[00:09:26] this is all about getting our patients, our children healthier

[00:09:30] and I think we have to elevate each other.

[00:09:36] So I would not give up on an orthodontist

[00:09:39] I would try to share the knowledge

[00:09:45] try to educate them, share the article

[00:09:49] if you come across a paper that is discussing the link

[00:09:53] and there is a very nice paper that actually came out in January

[00:09:58] from the University of Pennsylvania Sleep Surgery Department

[00:10:02] that I recently joined and this paper was written about

[00:10:06] the link between the jaw maldevelopment and sleep apnea

[00:10:11] and it has a beautiful literature review

[00:10:14] because in the end of the day it is about the science

[00:10:17] we want to practice evidence-based medicine, evidence-based dentistry

[00:10:21] so that paper has a very nice review on that link

[00:10:26] that we are discussing right now between oral and airway health

[00:10:30] and I think there are many other papers like that

[00:10:33] so share with your orthodontist a paper once a week

[00:10:37] maybe you can share a case, maybe you can work together on a case

[00:10:41] but I think it's just one patient one airway at a time

[00:10:46] that they have to work on.

[00:10:47] Yeah absolutely

[00:10:48] So I mean you obviously are, you've taken this paradigm shift pretty seriously

[00:10:53] I'm curious when did you train in ortho?

[00:10:55] So I graduated from University of Pennsylvania in 2010

[00:10:59] Okay so you've been doing this for a little while

[00:11:01] and so my question is, if you kind of indicated that

[00:11:04] when you were training there wasn't a big airway focus

[00:11:07] so I'm curious for someone who graduated or got out of ortho school in 2010

[00:11:12] how did you kind of come to the airway

[00:11:15] in the stuff that you're really passionate about

[00:11:18] how did you get to that?

[00:11:20] So I was very lucky being a graduate from Penn orthodontic

[00:11:26] and periodontal program because that program was always focusing

[00:11:30] on interdisciplinary care but mainly on the peri-ortho connection

[00:11:35] and the airway, I mean we were just starting to integrate

[00:11:42] cbc imaging into the education

[00:11:45] so we were just kind of hungry about this new technology

[00:11:49] that it offers orthodontists in terms of diagnosis and treatment

[00:11:54] so being able to look at the airway and the nasal cavity

[00:12:00] and the anatomy with the cbct was an eye-opening experience

[00:12:05] So for me I was always interested in interdisciplinary treatment

[00:12:10] and my program in particular was all about expansion

[00:12:15] So yesterday I talked about expansion

[00:12:18] I know Rebecca is talking about expansion

[00:12:20] you heard a lot about Jeff about skeletal expansion

[00:12:25] and all the new developments that we have for adults

[00:12:30] and also for children

[00:12:32] so the program itself set me up to correct the structure

[00:12:39] to correct Maxela

[00:12:41] You actually got a lot of it

[00:12:43] So I got the education have to intervene properly

[00:12:48] not to do dental valve expansion, put the teeth in the bone

[00:12:53] don't create periodontal defects so for me

[00:12:56] I had the foundation in terms of intervention

[00:12:59] but the eye-opening moment for me was

[00:13:07] when I started to treat my patients

[00:13:11] and I looked at those kids that have in the medical history

[00:13:15] ADHD and they are on the medication

[00:13:17] and I can see that they have very difficult time

[00:13:20] delivering oral appliances

[00:13:22] because they are breathing through their mouth

[00:13:24] then I look a little bit more back

[00:13:26] and I see those huge tonsils

[00:13:28] and they have difficult time wearing appliances

[00:13:33] they have decalcification

[00:13:36] because they are mouth breathers

[00:13:38] they don't brush their teeth very well

[00:13:40] and then I started to see that

[00:13:43] I started to look at images

[00:13:46] because at that time in 2011

[00:13:48] I had CBCT unit in the practice that I was practicing at

[00:13:53] and I started to look at the CBCTs

[00:13:56] and you cannot unsee like narrow airway

[00:13:59] you cannot unsee large tonsils, large adenoids

[00:14:02] and I started to look up some papers

[00:14:06] on mouth breathing, on tonsil actomies

[00:14:11] I was very also fortunate to be in Philadelphia

[00:14:14] one of the biggest centers

[00:14:19] on research and education on pediatric sleep

[00:14:23] he said Philadelphia Children's Hospital

[00:14:26] so I was able to connect with the team

[00:14:30] and the sleep department there

[00:14:33] they have some very well known papers

[00:14:38] and projects that they did on tonsil actomy

[00:14:42] adenoid actomy in children

[00:14:45] that is not as successful

[00:14:48] I mean successful to treat sleep apnea

[00:14:52] but it doesn't give like a full resolution of the problem

[00:14:56] Exactly, it's like they come up with a solution

[00:14:59] it doesn't do what they would hope it would do

[00:15:02] Exactly, so if you are curious

[00:15:04] if you are starting to ask a question about the link

[00:15:07] it's just like you find a paper here

[00:15:09] and then paper takes you to another paper

[00:15:11] and then tomorrow you see another patient

[00:15:13] with the problem that you read about yesterday

[00:15:16] and then somehow you then do like a full literature review on your own

[00:15:23] because once you finish your residency

[00:15:26] you still have that mode

[00:15:29] that's in your body that you're still a resident

[00:15:31] and you still want to learn

[00:15:33] it kind of doesn't leave you after you graduate

[00:15:36] so I realized how much I didn't learn

[00:15:39] in my residency and how much there was actually

[00:15:43] in the literature that I never even knew existed

[00:15:46] Interesting, interesting

[00:15:47] and the problem is the problem of airway

[00:15:50] that there is a little bit of literature in the ENT papers

[00:15:55] in the sleep medicine, in orthodontics

[00:15:59] in allergy literature

[00:16:02] so you have to kind of ask the right question

[00:16:06] do the search and start connecting the dots

[00:16:08] it is an interdisciplinary problem

[00:16:11] truly, yeah

[00:16:12] and then what happened to me

[00:16:15] I was able to connect with other orthodontists

[00:16:19] or general dentists

[00:16:21] and medical doctors that are also interested in the same

[00:16:24] just like...

[00:16:27] it just started rolling, yeah

[00:16:29] I think, you know, it's interesting too

[00:16:31] because I have to say that it sounds like you have a network

[00:16:34] within the Philadelphia or within where you are

[00:16:37] of enough people that are kind of looking at this

[00:16:40] that you can work together

[00:16:42] so my practice, for example

[00:16:44] we have two locations

[00:16:46] and both of our practices are in the medical facilities

[00:16:50] so in my first location

[00:16:54] I was on the same floor with the pediatric ENTs

[00:16:58] and the sleep center

[00:17:00] so the interesting story about that

[00:17:03] when I started my practice in 2011

[00:17:08] there was a new sleep physician

[00:17:10] that started his practice, my age

[00:17:12] both of us are exactly the same age

[00:17:15] even now we have kids the same age

[00:17:17] but anyway, he started the same year

[00:17:19] and I stopped by his office

[00:17:21] introduced myself

[00:17:23] and he is a pan graduate

[00:17:25] Yale graduate

[00:17:27] and then he went to this very famous sleep program

[00:17:31] fellowship at the University of Michigan

[00:17:34] he has all this education behind his back

[00:17:37] and I introduced myself

[00:17:39] and said I would like to work with you

[00:17:41] because this is what we do with expansion

[00:17:43] and he was very nice

[00:17:45] very polite but had zero interest

[00:17:48] interesting

[00:17:49] and he came back to me

[00:17:53] three months later

[00:17:55] he comes back to me with a pile of papers

[00:17:59] and he said I want to learn everything

[00:18:01] I can learn about skeletal development

[00:18:04] and expansion and what you are doing

[00:18:06] we have to work together

[00:18:07] so he went back

[00:18:09] he did his own lit review on his own

[00:18:12] because he is very scientific

[00:18:14] and he saw the link

[00:18:16] and he basically discovered the same way

[00:18:19] the connection that I discovered after school

[00:18:21] after graduating from all of this program

[00:18:23] interesting because you guys sort of went through the same process

[00:18:26] on some level

[00:18:27] independently he just came to me

[00:18:30] and said like I want to work with you

[00:18:32] I know that you can help my patients

[00:18:34] and we had so many

[00:18:37] and we did patient by patient

[00:18:39] like one patient, like I send him

[00:18:41] and then we do sleep study before and after

[00:18:43] and then he sends me another patient

[00:18:45] and we do

[00:18:46] he had like the whole Excel spreadsheet

[00:18:49] was very organized

[00:18:51] just tracking the outcome

[00:18:53] it was tracking

[00:18:54] and that's how we started patient by patient

[00:18:58] and to the surprise

[00:19:01] to him and me

[00:19:02] every single patient

[00:19:04] that we have treated

[00:19:06] skeletal

[00:19:07] had resolution of sleep apnea

[00:19:09] on the follow-up sleep study

[00:19:11] every single one

[00:19:13] there was not one patient that didn't

[00:19:15] pretty hard to argue with that kind of outcome

[00:19:17] yes, yes maybe it's not good enough for a paper

[00:19:20] because you need a lot

[00:19:22] a larger sample

[00:19:24] but every single one of them

[00:19:26] he did not have to prescribe a sleep up

[00:19:28] okay, okay

[00:19:30] so just so I know and the listeners kind of know

[00:19:32] what kind of patients are you typically treating

[00:19:35] in this situation

[00:19:36] you said it was a pediatric sleep

[00:19:38] no, it was he was actually adult

[00:19:40] that was seeing both adolescent patients

[00:19:43] and the adults

[00:19:45] okay, so in your day-to-day practice

[00:19:47] you're seeing all ages basically

[00:19:49] so I see, I even see infants

[00:19:52] for counseling of the

[00:19:55] facial development and also for anectomies

[00:19:59] so we see like

[00:20:02] my patients are from zero to

[00:20:05] from day one to maybe like 75

[00:20:08] okay, okay

[00:20:10] I don't really see much older patients

[00:20:12] okay

[00:20:13] but we have all age groups in our practice

[00:20:18] so what's a typical day

[00:20:20] at your practice

[00:20:22] I'm wondering how much of it is

[00:20:23] how much of it is like consultations

[00:20:25] how much of it is like

[00:20:27] literally like fitting appliances

[00:20:29] or whatever

[00:20:30] I'm just curious how that works

[00:20:31] and it is

[00:20:32] I mean it sounds like

[00:20:35] is most of your work with airway stuff

[00:20:38] or is it just kind of a part of the practice

[00:20:40] I would say

[00:20:42] when it comes to evaluation

[00:20:44] it's 100% airway

[00:20:46] every patient is going to have airway evaluation

[00:20:50] nasal score

[00:20:51] screening for

[00:20:53] do people show up in your office

[00:20:54] because of airway issues typically

[00:20:56] in terms of new patients

[00:20:58] I would say 80% of the patients come

[00:21:02] because of the airway

[00:21:05] okay, okay

[00:21:06] a lot of referrals from physicians

[00:21:07] or whatever with

[00:21:08] referrals from physicians

[00:21:09] I'm part of the PEN sleep surgery team

[00:21:11] so we have collaborated

[00:21:13] and we have a lot of patients

[00:21:15] that cannot tolerate CPAP

[00:21:18] or want definitive treatment

[00:21:21] not just a solution for the night

[00:21:25] but they want to have a structural correction

[00:21:27] so we do a lot of teamwork

[00:21:29] and see these patients together

[00:21:32] and I have a lot of

[00:21:34] now in our community

[00:21:36] I would say

[00:21:37] that a lot of dentists are starting to screen

[00:21:40] for airway issues

[00:21:41] and they refer patients just

[00:21:45] because they understand the connection

[00:21:47] and I will say that like

[00:21:48] if you talk to Jeff or anything like that

[00:21:50] a lot of dentists that

[00:21:51] once you see it

[00:21:52] you can't not see it

[00:21:53] you cannot unsee it

[00:21:54] it's hard sometimes

[00:21:56] if you don't have someone to send a person to

[00:22:00] or if you don't have a team to send to

[00:22:02] it's a little

[00:22:03] I won't lie to you

[00:22:04] it's depressing a little bit

[00:22:06] it's kind of hard

[00:22:07] because you really do see it everywhere

[00:22:09] it's very much part of

[00:22:12] particularly on kids

[00:22:14] you don't have to look very hard to see it

[00:22:17] yes, and the biggest one

[00:22:19] every time I give a lecture

[00:22:22] I think maybe one or two dentists

[00:22:26] come to me after the lecture

[00:22:27] and talk about their children

[00:22:29] yeah, exactly

[00:22:30] or their family member that needs

[00:22:33] I mean it's around us

[00:22:37] I would say every patient

[00:22:39] that you see in your dental practice

[00:22:42] will have some kind of airway issue

[00:22:45] that is connected to the

[00:22:46] it's funny because airway

[00:22:47] or development

[00:22:48] airway and orthodontics

[00:22:49] like go hand in hand

[00:22:50] it is funny when you see

[00:22:51] you can't not see it

[00:22:53] how many adult patients

[00:22:54] do I do recalls on

[00:22:55] that would be hugely benefited

[00:22:57] with some kind of orthodontic intervention

[00:23:00] that's an airway

[00:23:01] goes kind of hand in hand with that

[00:23:03] I feel like

[00:23:04] I am curious

[00:23:05] this is like a sort of big picture question

[00:23:07] but why do you suppose

[00:23:10] as a species

[00:23:13] why do we have so much of this

[00:23:15] why is it that

[00:23:16] we're not developing our airways Greg

[00:23:18] was there a golden age

[00:23:20] in humanity where we had better airways

[00:23:22] I mean are there things that have happened

[00:23:24] with diet or activity or whatever

[00:23:26] or do we think that this is just

[00:23:27] we just understand things better now

[00:23:29] so I think the

[00:23:33] from the evolutionary standpoint

[00:23:35] our faces started to shrink

[00:23:38] a very long time ago

[00:23:40] little by little

[00:23:42] when we introduced

[00:23:46] agriculture and started to cook

[00:23:48] foods but I think

[00:23:50] so we didn't have to chew as much

[00:23:52] it's just that that's exactly right

[00:23:54] we didn't have to chew as much

[00:23:55] that's exactly right

[00:23:56] but if you take a skull

[00:23:58] from

[00:24:00] three, four hundred years ago

[00:24:02] to compare to like a three-differented

[00:24:04] skull of one of our average patients

[00:24:07] three, four hundred

[00:24:09] only three to four hundred years ago

[00:24:12] it seems like we still were developing more

[00:24:15] when it comes to the oral jaw structure

[00:24:18] we had room for the wisdom teeth

[00:24:20] so the main

[00:24:22] decline in facial development

[00:24:25] is happening very recently

[00:24:28] and it's happening within the last

[00:24:30] three hundred years after

[00:24:32] industrial revolution

[00:24:34] so that's when we developed the factories

[00:24:36] when the pollution

[00:24:38] problem of pollution started

[00:24:40] this is when women went to work

[00:24:42] this is when we started to develop

[00:24:44] introduced daycare

[00:24:46] and I think

[00:24:48] it's definitely the change

[00:24:50] in the diet like

[00:24:52] transitioning to very soft diet

[00:24:54] bottle feeding

[00:24:56] like when we developed plastics

[00:24:58] and now we have all these bottles

[00:25:00] pacifiers I think

[00:25:02] we really disconnected

[00:25:04] from the nature

[00:25:06] and the face is just not growing

[00:25:08] okay so you also mentioned

[00:25:10] I'm just gonna key into this

[00:25:12] you mentioned your mom too

[00:25:14] you have children so knowing what you know

[00:25:17] what were some of the challenges and the things

[00:25:19] that you looked at with your own kids

[00:25:21] because I know you can't disengage from that

[00:25:23] as a mom

[00:25:25] like how has what you known

[00:25:27] what you've learned and what you do

[00:25:29] influenced what you do with your kids

[00:25:31] well I am very

[00:25:33] fortunate that I

[00:25:35] learned about this before I had my kids

[00:25:37] so I think with my kids

[00:25:39] we

[00:25:41] I didn't introduce the pacifier

[00:25:44] I was working very hard

[00:25:47] to be able to breastfeed

[00:25:49] both of them

[00:25:51] and in terms of the diet

[00:25:53] I for example didn't introduce

[00:25:55] sugar to the diet until

[00:25:58] age 3 for example

[00:26:01] with my older one and my little one

[00:26:03] is one right now and I think I will do the same

[00:26:06] so they don't have like

[00:26:08] my 6 year old doesn't have a sweet tooth

[00:26:11] he's not craving dessert

[00:26:13] that's huge by the way

[00:26:15] when you think about and then also

[00:26:17] I mean the soft diet unfortunately

[00:26:19] I try to give them

[00:26:22] like all of the foods that we give them

[00:26:24] is homemade

[00:26:26] he takes his lunch

[00:26:28] to school

[00:26:30] my older one and the little one

[00:26:32] is eating everything that we as adults

[00:26:34] I wonder your older one just going to school

[00:26:36] but in seeing everyone else's lunch

[00:26:38] I wonder what that's like for him

[00:26:40] I think right now he

[00:26:42] just normal

[00:26:44] that's pretty cool

[00:26:46] he's not craving, he doesn't have cravings

[00:26:48] for junk food

[00:26:50] he doesn't have cravings like for cookies

[00:26:52] even sometimes you want to bring him

[00:26:54] a cookie as a treat

[00:26:56] and he

[00:26:58] he doesn't ever

[00:27:00] wow that says a lot

[00:27:02] that's very cool

[00:27:04] I wish I could say the same about my children

[00:27:06] let's just say that they will take the cookie

[00:27:08] thank you very much

[00:27:10] but

[00:27:12] I think there is definitely

[00:27:14] a lot more

[00:27:16] that we can do as parents

[00:27:18] today having that education

[00:27:20] so that knowledge about the diet

[00:27:22] and sugar

[00:27:24] and inflammation related to sugar addiction

[00:27:26] sugar is

[00:27:28] humans are more

[00:27:30] sugar is more addictive

[00:27:32] than cocaine

[00:27:34] like by six or seven times

[00:27:36] so if you introduce it

[00:27:38] also more socially acceptable

[00:27:40] early to like

[00:27:42] one year old they get really addicted

[00:27:44] to it

[00:27:46] they crave it so I think

[00:27:48] there is a lot right now that is available

[00:27:50] about healthy diet

[00:27:52] and I have been

[00:27:54] living in this country since

[00:27:56] 2004

[00:27:58] and I see

[00:28:00] a positive trend

[00:28:02] in terms of

[00:28:04] awareness

[00:28:06] and

[00:28:08] interest of

[00:28:10] public in healthy diet

[00:28:12] so I think the trend is positive

[00:28:14] but I think if you

[00:28:16] think about

[00:28:18] facial development and young child

[00:28:20] I think you have to think about hard foods

[00:28:22] like

[00:28:24] it's not a chicken on the boat

[00:28:26] it has to be like

[00:28:28] a little more veal chop

[00:28:30] if you are giving a child meat

[00:28:32] it has to be like

[00:28:34] giving your one year old

[00:28:36] whole apple

[00:28:38] you can peel the skin off but give them the whole apple

[00:28:40] let them like kind of chew on the apple

[00:28:42] give them a challenge

[00:28:44] I get it

[00:28:46] so I think we need to be creative

[00:28:48] as parents

[00:28:50] we are all used to cutting everything up

[00:28:52] in little tiny pieces and I agree

[00:28:54] that is interesting that you say that

[00:28:56] and I think

[00:29:00] there are factors

[00:29:02] that you can control

[00:29:04] and there are factors that you can control

[00:29:06] so I think when it comes to

[00:29:10] diet of a very young child

[00:29:12] you can definitely control

[00:29:14] what you give them

[00:29:16] and how you raise them

[00:29:18] it's in the tough thing as a parent

[00:29:20] to stay

[00:29:22] strong on knowing what they should have

[00:29:24] because it's so easy

[00:29:26] the one thing you can say about

[00:29:28] the world in 2022

[00:29:30] it is really easy to cave in and give them garbage

[00:29:32] and

[00:29:34] that's tough

[00:29:36] when you are saying you give them whole foods

[00:29:38] that they have to chew on

[00:29:40] that's not the typical

[00:29:42] when you look at baby diet

[00:29:44] that's interesting that you say that

[00:29:46] I look at the children's menu

[00:29:48] in the restaurant

[00:29:50] it's all about convenience

[00:29:52] it is

[00:29:54] burger and chicken fingers

[00:29:56] I mean it's not healthy

[00:29:58] it's like you are describing what my children want to eat

[00:30:00] I mean you are not wrong about any of that

[00:30:04] but to try and connect

[00:30:06] that to actually how their facial development

[00:30:08] is

[00:30:10] as a doctor

[00:30:14] as a dentist

[00:30:16] you are looking at things in a clinical way

[00:30:18] but the story is that

[00:30:20] they are only seeing you two times a year

[00:30:22] what they do in the rest of the year

[00:30:24] and I don't generally

[00:30:26] weigh in a lot on that

[00:30:28] it's interesting that we are talking about this

[00:30:30] because if there is an influence we could do

[00:30:32] we could give them

[00:30:34] there is a lot of value there

[00:30:36] absolutely

[00:30:38] I think

[00:30:40] there is a very

[00:30:42] like

[00:30:44] I see a difference now in young moms

[00:30:48] there is a generation of young moms

[00:30:50] who are very interested

[00:30:52] in raising their children

[00:30:54] in the healthiest way

[00:30:56] maybe not as much about convenience

[00:30:58] and I think it's a movement starting

[00:31:00] and I think

[00:31:02] like we are talking about this today

[00:31:04] there are some authors

[00:31:06] like Nestor

[00:31:08] James Nestor writing book

[00:31:10] about connection between breathing

[00:31:12] and facial development

[00:31:14] and then there are also some authors

[00:31:16] writing about the diet

[00:31:18] I think all of this

[00:31:20] is a very positive trend

[00:31:22] we are going in the right direction

[00:31:24] and I think

[00:31:26] they are going to be a revolution

[00:31:28] against

[00:31:30] fast food

[00:31:32] against all the processed foods

[00:31:34] that

[00:31:36] have been

[00:31:40] so popular

[00:31:42] and controlling

[00:31:44] controlling us

[00:31:46] for the last 50 years

[00:31:48] just like fast food came out

[00:31:50] after World War II

[00:31:52] and it was very popular

[00:31:54] everyone got excited that they don't have to cook

[00:31:56] then

[00:31:58] but also it's not a challenge to eat

[00:32:00] everything you get is soft

[00:32:02] easy to chew and high calorie

[00:32:04] high sugar it's delicious

[00:32:06] but it's like there is zero challenge

[00:32:08] in preservatives

[00:32:10] so just like it became

[00:32:12] so popular in 50s

[00:32:14] I don't know I think 50s

[00:32:16] I think this new

[00:32:18] trend is going to

[00:32:20] the revolution of new foods

[00:32:22] that are not only healthy for our body

[00:32:24] but also important for our face

[00:32:26] is going to be

[00:32:28] the future

[00:32:30] because humans are very creative

[00:32:32] and we are hungry

[00:32:34] for that change in our society

[00:32:36] focusing on our

[00:32:38] health

[00:32:40] I have an interesting thought before we go

[00:32:42] dentists like me

[00:32:46] we talk a good game about

[00:32:48] prevention

[00:32:50] you talk about

[00:32:52] sugary food

[00:32:54] how well you take care of your teeth

[00:32:56] I tend to think of those things for patients

[00:32:58] that's typically not a knowledge problem

[00:33:00] any patient that walks in my office

[00:33:02] knows they don't floss enough

[00:33:04] and they probably should

[00:33:06] eat so much sugary food and brush better

[00:33:08] but airway

[00:33:10] that is a knowledge problem

[00:33:12] there's a ton of people that don't

[00:33:14] how many patients

[00:33:16] walk in my door and think

[00:33:18] when I ask them if they breathe through their nose

[00:33:20] and if they breathe through their nose

[00:33:22] that doesn't even need consideration for them

[00:33:24] about health

[00:33:26] and I have to say that a knowledge problem

[00:33:28] is actually a little easier

[00:33:30] to present

[00:33:32] to a patient

[00:33:34] when you can bring them information that's new to them

[00:33:36] that they're like hey I could

[00:33:38] eat my nose is important

[00:33:40] they all know that they shouldn't be eating sugary foods

[00:33:42] and they're not brushing well enough

[00:33:44] so that's more of a discipline

[00:33:46] problem

[00:33:48] or an execution problem

[00:33:50] but this is kind of a knowledge problem

[00:33:52] because I don't think a lot of people realize

[00:33:54] how important airway is to development

[00:33:56] and honestly just general health

[00:33:58] what do you think about that

[00:34:00] it's not only a problem at the level of the patient

[00:34:02] I think it's a problem at the level of

[00:34:04] a physician

[00:34:06] I'm not sure if from last week

[00:34:08] I'm seeing a patient from Boston

[00:34:10] that has major airway issues

[00:34:12] can breathe through his nose

[00:34:14] needs a jaw surgery

[00:34:16] has very deficient maxillin mandible

[00:34:18] and they went to

[00:34:20] an ENT

[00:34:22] in I think Massachusetts General Hospital

[00:34:24] like a very famous

[00:34:26] hospital in Boston

[00:34:28] to the ENT department

[00:34:30] and they were concerned that

[00:34:32] the child

[00:34:34] is adult now

[00:34:36] that patient couldn't breathe through his nose

[00:34:38] so what

[00:34:40] was the recommendation of an ENT

[00:34:42] then breathe through your mouth

[00:34:44] oh my god

[00:34:46] yeah

[00:34:48] so I think

[00:34:50] it's a

[00:34:52] as a physician if you go to the medical school

[00:34:54] the focus is on how to treat

[00:34:56] yeah

[00:34:58] I think the same in dental school

[00:35:00] we are so over focusing

[00:35:02] how to fix the problem

[00:35:04] that we don't even have time

[00:35:06] to ask a question why the patient

[00:35:08] has the problem to be treated

[00:35:10] it's 100% right

[00:35:12] and I think that question why

[00:35:14] it just doesn't have a place because

[00:35:16] the program is overwhelmed with

[00:35:18] how to fix it

[00:35:20] so I think when you go

[00:35:22] to an ENT

[00:35:24] they don't even

[00:35:26] probably think much about

[00:35:28] the mouth breathing

[00:35:30] but

[00:35:32] they don't

[00:35:34] it's not the

[00:35:36] core in their evaluation

[00:35:38] and thinking

[00:35:40] about the difference that it makes

[00:35:42] for your body

[00:35:44] in terms of if you breathe through your nose

[00:35:46] and the mouth so I think

[00:35:48] it's not only education of the public

[00:35:50] it has to be

[00:35:52] at the level

[00:35:54] of the medical provider

[00:35:56] I agree but I do think since it's more of a knowledge problem

[00:35:58] not a

[00:36:00] I know but I'm not going to do it

[00:36:02] there's a lot that you don't know

[00:36:04] I think you have now that we know

[00:36:06] like you know I know

[00:36:08] I think you have to

[00:36:10] get the word out

[00:36:12] thinking has to start with

[00:36:14] teaching from diapers

[00:36:16] for my son for example

[00:36:18] I tell him you eat through your mouth

[00:36:20] you breathe through your nose

[00:36:22] and just a very simple thing

[00:36:24] that has to I plant a seed in his brain

[00:36:26] so I know

[00:36:28] that when he like if he's sick

[00:36:30] it's a big deal for him because he can breathe through his nose

[00:36:32] so I think

[00:36:34] you have to educate

[00:36:36] from little ones

[00:36:38] that you have to be able to breathe through your nose

[00:36:40] I love that

[00:36:42] and like when they watch TV

[00:36:44] you close your mouth

[00:36:46] you are breathing through your nose

[00:36:48] when you are running

[00:36:50] teach them to breathe through their nose as a habit

[00:36:52] not

[00:36:54] it's so good because

[00:36:56] it's like so simple but it's also like

[00:36:58] it's not natural

[00:37:00] when you're running you breathe through

[00:37:02] it's not natural but you're exactly right

[00:37:04] it's all very true this is really interesting

[00:37:06] to think about that

[00:37:08] there's

[00:37:10] you can't start too early

[00:37:12] is what you're basically saying

[00:37:14] I kind of love that

[00:37:16] but in general

[00:37:18] I think there are a lot of papers

[00:37:20] talking about how bad

[00:37:22] everything is for your body

[00:37:24] you can tolerate CPAP

[00:37:26] if you can breathe through your nose

[00:37:28] so there are a lot of comorbidities

[00:37:30] just from breathing through your mouth

[00:37:32] so I think we just need to kind of

[00:37:34] pull that literature together

[00:37:36] we have to have more interdisciplinary

[00:37:38] meetings between

[00:37:40] between ENT sleep physicians

[00:37:42] so we can learn from each other

[00:37:44] I agree

[00:37:46] and I think

[00:37:48] they're all kind of in their own camps

[00:37:50] until they work together

[00:37:52] we're not

[00:37:54] making the dent that we should be

[00:37:56] I really like that

[00:37:58] Marianna this was fantastic

[00:38:00] this was really good

[00:38:02] I'm really glad you got a chance to

[00:38:04] present here at the Spear Summit

[00:38:06] but this was really nice to talk to you

[00:38:08] I'd like to stay in touch this was fantastic

[00:38:10] thank you so much for having me

[00:38:12] thanks for being on

[00:38:16] do you want to support the very dental podcast network?

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[00:40:14] you guys have heard lots about my experience

[00:40:16] taking a course at Cosmine in back in May

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