Episode 33: Airway-Focused Breastfeeding with Dr. Sam Zink

Jacqueline Kincer  0:01

Welcome back to Breastfeeding Talk: Milk, Motherhood, Mindset. I’m your host, Jacqueline Kincer IBCLC. And I’m so excited to bring this episode to you. We’re kicking off some incredible interviews here for 2021. And we’ve got Dr. Sam Zink, from Boise, Idaho, on the show today, and he is a dentist. And I know I’ve already had Dennis on the show. And we’ve already talked about tongue tie and frenectomy. But he is bringing an awesome, eloquent fresh perspective to some of the deeper implications of dysfunctional breastfeeding of ties of untreated ties. He’s filling in some gaps, and really just explaining things in a way that is so incredibly easy to understand that he blew me away. So it’s actually really funny because I think other than, you know, maybe the first episode of this podcast, I haven’t really listened to the episodes on my own, I record them. But this is an episode that I actually think I’m going to listen to. So without further ado, let’s go to the interview with me and Sam.

 

Jacqueline Kincer  1:44

Welcome to the podcast Dr. Sam Zink. I am so excited to have him on this episode. He is a general dentist and the owner of zinc Dental in Boise, Idaho, and he practices airway dental medicine, where he provides integrative treatment to infants and adults to support and enhance their airway. And that’s what we’re gonna be talking about on today’s episode. So welcome, Sam.

 

Dr. Sam Zink  2:09

Thanks for having me.

 

Jacqueline Kincer  2:10

Yeah, thank you so much for being here. It’s actually really great to have you on this episode, because we’ve had another dentist, but there’s always more to learn about ties the airway, oral facial development, and to take this conversation deeper in another direction is going to be so informative for everyone listening. But before we get into all the cool, nerdy stuff, I’d love to hear about how you even got into this work. Because, you know, most dentists out there don’t do what you do. And it’s very unique and very specialized.

 

Dr. Sam Zink  2:45

Yeah, so um, I always wanted to be a medical doctor growing up, but I ended up going into the IT field because I don’t want to be in school for too long for 12 years. But um, my wife became a dental hygienist and I was like, actually actually get my MBA. And I decided I want to go to dental school. So I actually went back to dental school, when I was a little bit older than most dental students. I was 28. And so I really enjoyed it. And I just wanted to, you know, have a career where I could make a difference and have a family and still have time with my own family. And so, I just went through the standard dental school experience, I went to the University of Louisville, Kentucky, and think I got a great education, but there was really nothing discussed other than really cursory person anatomy discussion about a friendly lumber, not really talked about a tongue tie. So it wasn’t until well, my first son was born. I had a semester left of dental school. And and looking back now you know, I have an intake form for infants that come in with symptoms and there’s a list of baby symptoms, a list of mother’s symptoms. And I just think my first son, he would have had every single baby symptom, like poor latch, fallen asleep while attempting to nurse Billy, he didn’t have problems with weight gain, which is probably why through this process, we saw lactation consultants and and pediatricians and different number of medical professionals that no one mentioned, they might have a tongue tie despite having almost all the baby symptoms in my wife, she had 10s of symptoms, lots of pain. She said she remembers having pain breaking through the Percocet she was taking because she had a C section. And she had that much pain from the from the breastfeeding and just powered through, chained up nursing him for two and a half years. And she even had you know, mastitis and then a lump in her breast where she had to get a biopsy. And it was just extra milk and plug ducts. And and again, no one ever said hey, maybe you might want to check out sometimes as the cause of all this. So I mean, I was really happy to be a first time father but I also remember thinking like, man, should it be this hard? Should he be waking up every hour and nursing and then crying and not sleeping? And so it’s kind of one of those could have would have should have things that I wonder would have been like if he had been treated At an early age say, I don’t know, you know, five days old. Yeah, that’s

 

Jacqueline Kincer  5:06

it’s so interesting that you share that because I think for even just, you know, parents who maybe have like a six month old right now, they’re they’re kind of doing that hindsight 2020 thing as well, you know, and just saying, Gosh, you know, how do we know? Right? We could have avoided so many issues. And I, you know, thank you for sharing your wife’s experience there. Because, yeah, things can get really severe when these things go missed. And it doesn’t mean, you can’t breastfeed for two and a half years doesn’t mean your baby won’t gain weight. Those aren’t always the signs that something’s really wrong.

 

Dr. Sam Zink  5:35

Yeah, yeah. And so, you know, as I said, I was finishing up dental school and went into practice. And my second son was born a couple years later, and he had less symptoms. But a lot of this, I think he had some of the same problems with tongue tie and lip tie, actually, a really prominent lip died his case, anatomically. But there were less symptoms. And I think a lot of that was because of compensations. Similar, I’ve had had a lot of lactation help where they gave her a special pillow, and she positioned really expertly and she kind of had gained a lot of skill, where I think that, you know, is good in a way, but I am concerned that people don’t realize that the compensations have consequences. And I’ve talked to a pediatric dentist about this, where they think maybe even if the baby with tethered oral tissues is trying to latch, that their job could be getting pushed in a direction that could cause adverse growth.

 

Jacqueline Kincer  6:25

That’s such an important point that I think really gets overlooked. And I think about even my training as a lactation consultant, a lot of it is really just training us to, you know, teach our clients those compensations that you’re talking about. So, you know, a lot of times people get really hung up on, you know, what brands, nursing pillows should I buy, or, you know, this nipple shield or whatever, and I’m, like, well, truthfully, shouldn’t eat any of those things. I mean, if you want those things, you can use them, but if you need them, that’s definitely a problem. And, you know, all these sort of latch techniques that people are selling, and, you know, selling these video ideas about and you know, like, you shouldn’t have to work that hard at it. And I think that’s what people need to realize is that, you know, if something is that hard, and if you have to do all these extra things to make it work it there might be, might be something we need to treat going on there.

 

Dr. Sam Zink  7:18

Yeah, I can remember back with my second son, my wife, she must have heard from a friend or read a blog post about tongue tie. So that started into the picture. But then she asked me, Hey, you’re the dentist, can you look around, do some research. So I asked a pediatric dentist that I knew. And they said, Oh, you know, it’s just kind of a fad, or it’s not a real thing. Like, as long as they can stick their tongue out. It’s not a big deal. So I took that information back to my wife and kind of watched her, you know, research process.

 

Jacqueline Kincer  7:46

Oh, that’s Yeah, that wasn’t the right answer was it? You know, what, I’ve had a lot of clients actually who are married to dentists, husbands, and they have told me that, you know, they’ve researched it. And they asked her husband and they’re like, I, you know, I don’t know, this wasn’t in my training. So it’s, it’s great that you’re actually bringing that up.

 

Dr. Sam Zink  8:07

Yeah, I I’m wasn’t, maybe there’s an idea that the doctor wants to have the answers, and they want to give something definitive. And I probably wasn’t humble enough to say, Get webmaster don’t really know me as somebody else. But I guess I wish I wish I could have gone deeper rather than just taking someone’s answer at face value, you know, but I’m with my third son. So my boys now they’re five, eight and 11. We had, we had moved to Oregon. And when he was born, actually, in my sins, my wife’s a hygienist and I’m a dentist are pretty savvy with oral cavity. And we noticed in his case, the day he was born, that looks like his he’s got a little lip tie, and he’s got it for any of them under the tongue. And, and maybe those are going to cause an issue. So the first day he was born, we called a lactation consultant who was in the hospital over and said, Hey, what do you think it looks like? He has a lip tie and a tongue tie. And she said, I’m not allowed to say anything. But you might want to check out Dr. Harry’s blog. So Dr. Gary is an EMT in Portland, Oregon, and has a wealth of information on this blog. And so I started reading the whole thing, and really interested in all the all the blog posts there and thinking, yeah, for sure, let’s get my son checked out. And so again, in his case, there really weren’t a lot of symptoms. And again, I think it’s because my wife had now on the third child had good compensation skills. But we actually saw the pediatrician when he was one week old, and I think is fairly typical for pediatricians. She didn’t really look she didn’t really have a way to to do an assessment. She just said, Oh, well, sure she was accommodating. She said, Well, if you you know, you guys are the professionals. If you want to his tongue tie checked out, I’ll refer you to an ENT t. So she referred us to an EMT there in town where we lived. And we went to the CMT, who wasn’t necessarily like us, you know, savvy with 10 ties in for breastfeeding, and he looked at my son said, Well, you know, there’s definitely a lip tie there. But we really don’t like to do those because there’s too much bleeding if we really see what the scissors and it’s not worth the mess, and then it’s kind of mild tongue tie. But you know, if it was my son, it’s not enough, I wouldn’t do it, I wouldn’t put him through the trouble. And so we just thought, you know, he’s the expert. And, and really at that point, at two weeks old, we didn’t really have a lot of symptoms to make us concerned. But it snuck up on us really fast. When he was three weeks old, my mother in law actually saw a picture and said, hey, it looks kind of shriveled up and and like, is he getting weight? And so my wife went to the hospital did like a drop in lactation clinic. And they weighed him. And they said, you know, did you know he’s only eight ounces of a birth weight? She’s like, No, I didn’t know. So they said, hey, you need to just try triple feed in pumping, start giving him a formula. And she came home crying, and said, you know, what are we going to do? And I said, Well, we should have just gone to see Dr. Kerry in the first place. And so that’s going to go to show that like not every doctor dentist or EMT is necessarily going to be breastfeeding and tongue tie savvy. Yeah, I’m,

 

Jacqueline Kincer  11:10

I’m so glad you mentioned that as well, because I think many parents go through a very similar journey that you’re describing, which is, you know, maybe they saw something online, like Dr. Harry site, and they thought maybe that’s an issue. And then, you know, may have an open minded pediatrician, some, some are not, they’ll say, Well, you know, that’s not a real thing. Or, you know, I think that’s more rare these days. But hopefully, at least in my area, but and then even if they do refer to usually to an end, like you said, who again, might see the ties, recognize them, diagnose them, but says, well, it’s not worth treating, because they don’t understand the the consequences of the treatment and not treating. So it’s, I’m glad you brought that up. And unfortunately, most families are still in a place that they really do have to seek out, you know, the care provider to treat on their own. They’re not often getting referred to the right people. So you know, I, I just saw an article that came out, and you may have seen it as well, I believe it was with the American Academy of Pediatrics, and they had a an EMT actually write this and essentially say how there’s two camps of basically professionals out there, one that says, We should release every frenulum. And the other says that, you know, this is kind of a fad, and we shouldn’t do anything. And I don’t think that that’s true, I don’t think that there’s only those two extremes. And that’s where we can put most, you know, health care providers in those categories. But it was recommended in that article to basically never treat what we call a posterior tongue tie and only ever treat an anterior one. And it just goes to show that there’s, there’s still just a lot of opinion based practice going on in healthcare and less of, you know, the evidence based practice going on. So it’s important that we talk about

 

Dr. Sam Zink  13:07

that. Yeah, yeah. So, you know, we were at a kind of a moment of truth or crisis, almost where we actually caught up to Dr. Harry’s office, and he was out of town for several weeks, on vacation or something. So I was at a point I go, maybe I should just bring home scissors from the dental office and do it myself. Because you’re kind of feeling desperate, you know, we now we feel like we had really identified the problem and knew the solution and, and didn’t really have the help. But fortunately, I decided not to do that. And the next day, their office called and said, Hey, we have a pediatric dentist up in Portland area that has chatter Dr. Harry has the same laser, you know, we’re comfortable referring patients in his absence. So they got us in the next day. And then I asked to go back and see the procedure. And, you know, it seemed like really, it’s a, it’s a fairly straightforward, safe, minimally invasive procedure very quick. And I was like, Heck, I can do this, you know, I’ve seen it done, I need to get some more training. But if this you know, this helps babies that much, you know, this is something I definitely want to learn in. And then over the next days and weeks, I mean, it was tough to do the stretches and there was some pain involved and in for my wife and and for the baby, but I have these pictures now we have a picture when he was one month old, and he’s just looking shriveled and gone and breaking out with X amount of space. And then one month later, you know, two months old, he’s plump and happy and just looks like an amazing thriving baby. And we never did do the pumping in the formula feeding it was just functional breastfeeding got him really back on track.

 

Jacqueline Kincer  14:43

So yeah, that’s so awesome. I think, you know, that unfortunately, is the advice that’s handed out at some of these you know, hospital support groups, you know, or wait clinics right and, and I get it too because they’re, they’re very busy and really they’re not. You’re not like a A patient just because you show up there unnecessarily, you know, you don’t have to birth at that hospital to go and, and they’re just trying to triage quickly and get the biggest result fastest the baby’s losing weight, let’s feed the baby more, right? So I do understand, but you know, we don’t ever want, that’s a temporary solution that needs to be followed up, right, you can’t tell a mom to triple feed and supplement and all these things forever. You know, that’s how breastfeeding ends up, you know, ending, really. So I’m glad that it worked out for you. And I’m also so glad that you got a chance to see the procedure and see the value in it and see the result in your own family. And know that this was something that you wanted to do to make an impact.

 

Dr. Sam Zink  15:39

But feel like that is a huge factor in you talks about there’s this maybe divide between those two camps. And I feel like the people that are in the kind of pro frenectomy camp are people that have times I’ve had a child that had the issue, and I saw the benefit. I mean, that’s, that’s I’ve seen that consistently. And it’s unfortunate that it would have to take that but you know, sometimes it is like, you’re you’re sort of ambivalent unaware unless you really are faced with with your own struggle. And so I guess that’s the benefit of going through something like that is to be able to help other people once you’ve been through it.

 

Jacqueline Kincer  16:13

Absolutely. And I think that Dr. Garry actually has a similar story about how he got started in treating this too, because most EMTs you know, really, it’s not their thing. So, yeah, well, you mentioned, you know, all three of your sons, you know, have these issues. You got the third son treated. What ended up happening with your two older ones. Yeah, and

 

Dr. Sam Zink  16:34

I’m glad you asked. So I’ll try to place this timeline correctly. But when my third son was born, I had just started as in 2015, I was five years out of dental school, I knew I wanted to do some advanced dental training in occlusion and TMJ. So I ended up taking started to continue on through bio Aesthetic Dentistry, or they call it OPI. So right around the time he was born, I was had been taking courses in splint therapy and diagnosis and TMJ. And sort of this optimal model. One thing that’s cool about bio Aesthetic Dentistry is we have these kind of like, it’s like a living fossil records, people, we’ve taken models of their teeth, and they have like these ideal arch forms, and unworn tooth morphology. So give us really an optimal health model to shoot for to compare someone that has problems against this. So I bring this up, because I think it’s important, whether its tongue ties, or airway or TMJ, to not just treat disease and symptoms, but to actually have a vision or a picture of what optimal health looks like. Because a lot of times people just say, Oh, you’re fine. But just because you’re fine. Not having severe symptoms that like most specialists see doesn’t mean you’re anywhere close to optimal health.

 

Jacqueline Kincer  17:42

Yeah, and I think what I’m hearing you say is that most people think of dentistry as a place to go to get your cavities treated, or, you know, maybe a root canal kind of thing, or to have their teeth straightened, or whitened. But there’s so much more to it than that. And most people really aren’t getting anything beyond that when they go to the dentist. Yeah.

 

Dr. Sam Zink  18:03

Yeah. And so that, that that happened in around the time that my third son was born and had to set success for neck. Can you really plan to see that in all my practice, and just observing people saying, what is what is optimal health look like? And what are those characteristics? So yeah, then fast forward a couple of years, I think it was around. Yeah, 20 2017, my, my middle son was having terrible sleep issues. He was in our bed every night, and I would take him back to his bed, and he would come back to our bed snuggle in between us. And I didn’t just let him sleep there. And he was four years old at this point. And he would have night terrors, and he would just have dark circles and bags under his eyes. And he was just really struggling to get quality sleep. So because we thought, Oh, well, first, you don’t have they have time wasn’t treated. We took them both out to get hairy and had them evaluated. He said, The forensics at this point, he said, they definitely have tongue tied, but it’s a really bad age to try to treat this. Just because it’s hard to do myofunctional therapy at this age, you have to most likely do sedation or go to the operating room. He said so specifically my middle son, you want to get a lateral step X ray, which I could do in my dental office and look at his adenoids. And then you need to check out this dentist here in town that does ortho tropics. And so I didn’t really know much about that at the time. But we did go head right away get the lateral step X ray, which showed the his adenoids. It’s sort of like tonsils up behind the nose. So it blocks the nasal passage. He had about 70% blockage of the nasal airway. So they had to split a pediatric sleep questionnaire and he scored like an 80 or 90% out of 100. So we had a lot of sleep symptoms. And then we have consulting with a pediatric EMT. And the other associate, we went to a sleep study and we said no, if he’s, you know if we can go go and get this done. Why would he do the sleep study? He’s already scored 100 pediatric sleep questionnaire. And so we had an adenoidectomy done. He had sort of smaller to normal tonsils. So they decided not to take out the tonsils. In hindsight, it might have pushed for that more to clear that whole airway. But he hadn’t I don’t think, to me, it went pretty well. But he did better for about, I would say six weeks, we thought there was a big improvement in his sleep. And then he reverted, he regressed back to the same old tossing and turning and being in our bed. And then I captured this video of him a few months later, where he’s sleeping with his head just hyper extended, like his chin, so high in the air. And what that is, is it’s a child trying to survive by opening their airway through head posture. And you can see his mouth is open. And we start realizing is that even some kids, I think tonsils out our neck to me does help open the airway, and they start to grow and develop more normally. But I think in my son’s case, he already had this adverse job development and a malocclusion that was the limiting factor. Hmm.

 

Jacqueline Kincer  21:00

Yeah, I think that gets overlooked. And I’ve I’ve seen studies about adenoidectomy saying that it’s very likely to get a relapse of symptoms as soon as four weeks after it’s done. And so you put your child’s you know, you know, under anesthesia to get this done, it’s not so fun. And, you know, like you said, things were better for a little bit, and then they’re, they’re not, it might be like, you’re saying to, it’s not that we don’t ever do that may be part of the treatment plan, you’ve got to address these other things. So, you know, you mentioned really the the jaw developments and things like that, I’d love for you to chat more about that. So, you know, we can recognize it sometimes more easily when we have an older child or an adult who’s able to speak and articulate and all of that sometimes it gets missed in babies, and, you know, we’re not productive. Thankfully, we don’t need to, you know, do adenoidectomy babies or whatnot. But, you know, these are the things that we look at later on down the road, if if we don’t address things early on. So yeah, I’d love to learn more about you know, basically, if I was going to sum it up in a question, just because you even said this. So well, as you know, you ask the question, what is optimal health look like? And this kind of started the journey for you. So how does dentistry? Or how can dentistry help people or what you do as a dentist help people create optimal health?

 

Dr. Sam Zink  22:28

Oh, that’s a great question. I, I look at pictures of my son from the time before he was even had an adenoidectomy. And and you know, when you learn something, and you learn to see signs, and you can’t unsee it, right. So now I’m like, how could I have missed all the signs are here in this, we had family photos, I’m looking at his face in this picture. And he’s got a gummy smile. So if you see a lot of gum in a chat, smile, more than likely their maxilla has rotated clockwise, and it’s down in their face, and there’s mouth breathing. So that’s part of what causes that vertical growth

 

Jacqueline Kincer  22:59

in the maxilla is the upper jaw for those who don’t know,

 

Dr. Sam Zink  23:02

2018. And then, you know, there’s the teeth and the upper jaw, there’s no space, and adult teeth, or at least 50% larger than baby teeth. And so if you don’t have wide gaps between baby teeth, you’re going to have crowding in the adult dentition. And he had dark circles under the eyes. And, you know, just see, these are big red flags, besides his symptoms, that just by looking at a photograph, you can almost go, I’m pretty sure this child has an airway issue, and they most likely have a sleep issue and, you know, could really benefit from basically moving their jaws and teeth into a place that supports and enhances airway. So that’s why I told you that Dr. Gallagher had mentioned reaching out to the dentists that did ortho tropics, and I just didn’t do that. We were taking it one step at a time. But then I did contact him and I was really trying to decide, you know, should I just have this other dentist, treat my son or or should I, you know, should I learn this? So I did decide to take the ortho Tropics mini residency in 2017 and 2018. And I still had that dentists in Portland helped me but we started treating my son when he was five with ortho tropics, which is like a pediatric job development techniques. So we actually used an expander in his upper jaw to create big spaces between the teeth and expand his palate. And part of what got me really interested in orthopaedics was there’s a lot of discussion about the problems that adults have and that Dr. Hang he’s the instructor there in Los Angeles, actually reopens extraction spaces for people that have had their premolars extracted, and I go, I’ve had my premolars extracted, and oh, like if someone wants to reopen those spaces, there might be maybe it might have been wrong to take them out in the first place. And part of why I was thinking that was my son’s having sleep issues from basically a small oral cavity thick. And just as a little side arts pretty big thing though, but you can see CT scans in pictures online where the size of the upper jaw directly He sort of dictates the size of the airway. So the airway sort of soft tissue hanging off of the upper jaw. And think of it like a tent, like your, your bones like a tent frame, and then the, the soft tissues like the tent fabric. So if you make the mouth bigger, you have a larger airway, and the larger airway is much less likely to collapse under the inspiratory pressure breathing in. So So here, I’m kind of looking at my Senate five, I’m looking at myself at about almost 40 thinking like, wow, by the time you know, I don’t feel like I had problems earlier in life from having extractions and orthodontics. But, but now that I’m getting closer to 40, I’m feeling like I’ve gained some way I’m sleepy and fatigued, I wake myself up, kind of choking on my tongue, like there’s not enough room for my tongue in my mouth, and started connecting those dots.

 

Jacqueline Kincer  25:47

That you’ve said so many things so eloquently, I don’t even know where to where to begin, just I if I was listening to this episode, right now, I probably rewind the last few minutes and just replay it because it was so good. I love the way you explained the correlation between the upper you know, the upper part of the mouth, the palate, upper jaw, and you know, everything that follows from that. And I know I’ve worked with our airway dentists here, and he said, how much easier it is to expand the upper jaw anyhow, like the lower jaw kind of follows whatever you do up top, now, you might have to do things with that directly. But that makes sense to me. And I think there’s a lot of parents out there who are recognizing, you know, these high palates and their babies and or they’ll say the baby has a very small mouth, or the jaws recessed, right. And these are some of the things that they really struggle. It’s like a catch 22, you know, they struggle to get the good deep latch that they know they should be getting their baby to have because of these things. But then on the other flip side of that is getting the good deep latch is what ultimately grows that John airway. So we have to, you know, we have to do what we can to enable that. And I’d love for you just because you I think you’ve said like 50% of your practice is doing the infant from next to me. What are what are the things you’re seeing in babies in terms of airway issues? You know, what are what are parents seeing? What are you seeing, and how do we fix those?

 

Dr. Sam Zink  27:17

Yeah, and I’m going to circle back to that. Because I’ve, I’ve seen some information about, if you have an ultrasound of a baby, and you get a nice sagittal view, which is like the side view, you can actually do a measurement called the inferior facial angle. And it’s like taking a line to the cranial base in the nose, and then back towards the chin. And basically is that angle gets smaller, there’s a threshold at which you can say this baby in utero has retro nappy, I mean, their jaws are cheaper back in the face, and usually the lower jaw is too far back. So we’re we have an epidemic of collapsed facial form and collapsed airways. And we can actually see this now in utero. So you can have babies born where, you know, some people say it’s normal for babies to have a retreated chin, but I wouldn’t say that’s normal. Again, it’s not optimal. But one thing we have seen is where baby with retreated chin, they do seem to already as a newborn struggle with their airway, we’ll see sleep postures where they’re sticking their neck, you know, the crane, their neck back, they’re really extending their chin way up to open the airway. And, and that’s not good to start life that way. And the breathing might be more raspy or labored. But we have seen as it some of these babies, we released the tongue and they’re able to do functional breastfeeding, and that’s growing and developing their midface. And we’re seeing faces and jaws come forward even in infants with this, huh?

 

Jacqueline Kincer  28:32

Yeah, yeah, I’ve I’ve definitely seen that as well. And interesting. You mentioned that on the ultrasound because I had a good friend who posted you know, one of these 40 ultrasound pictures on her Facebook page. And I saw that chin so far back already, and I was like, do I tell her or? And then after the baby’s born, you know, you don’t want to sensitive time, right? You don’t want to how do you how do you bring that up? Sometimes, right. But it’s like, like you said, once you see something you can’t unsee it. And I think she posted a video, like towards the end of the pregnancy of her tummy moving because the baby has so many hiccups. And I was like, oh, man, lots of hiccups are not a good sign either. It’s not that they it’s not bad if they do it ever, but when it’s all the time I usually go that’s that’s probably a baby with a tongue tied just because they’re there. You’re struggling to swallow properly that amniotic fluid and then and then the baby came out and you know, was gaining weight great. She had a ton of milk but you know, the reflux was there and the snoring was there. And I think she posted a cute video of the baby snoring and I was like, Okay, now I got a message her just she doesn’t know and I know she thinks her baby’s perfect and her baby is perfect, but we can just make things so much better. You know, and actually, she didn’t end up going to get treatment which is really cool. But yeah, it’s it’s there’s amazing things that we’ve seen and I don’t know if you’ve seen this but you mentioned you know this idea that the baby’s born with a recessed jaw Normal are that’s kind of what we’re taught. I actually have, you know, I forget the exact title of the textbook, but it’s like one that every lactation consultant has like human lactation and something in breastfeeding or something like that. And it actually says babies are born with a recession to help facilitate breastfeeding. And I’m like, that doesn’t help facilitate breastfeeding at all. And I think it’s maybe Dr. Kevin Boyd, who’s done some research on this, but looking at fossil records, and there used to be infants born with the upper and lower job, not recessed, and they clearly were doing okay. So, you know, what can we do? Like you said, it is an epidemic, you know, it isn’t?

 

Dr. Sam Zink  30:42

Oh, I think that’s where that proper that perspective comes from. I’m glad you brought that up that Kevin White’s published a number of articles about evolutionary medicine and dentistry, it’s basically idea that you need to look at the fossil record. And they, there’s even some articles, I think, when even went down the Atlantic magazine about Kevin Boyd at the pin Museum, and they’ve got this collection of pre industrial schools, and they haven’t been schools, and yeah, they’re their jobs are way forward in the face, you know, they can measure that angle, they call it the SNA. So it’s like from the cranial base to the nose to the chin, or to the upper jaw. And it’s like 90 degrees, which means it’s really far forward. There. Even now, in the orthodontic literature, they use these norms that are based on like people from the 1940s. So they say maybe, like 82 degrees is normal. So you’re already starting from a norm that maybe is compromised by a problem with basically, you know, what the anthropology literature literature shows is that there was a collapse of facial form and reduction in the size of the jaws and increasing cardio in the teeth that happened, right around the Industrial Revolution, when the food supply became soft, I think we went from chewing four or five hours a day of hard chewing to only chewing 5% of our pre industrial norm. So basically, if you’re, if your muscles don’t work hard enough, then your bone is not going to grow to its full genetic potential. So that’s at the root of it, basically, infants having smaller dies, breastfeeding can’t help but also there can be sort of a drop off when they go to solid foods, it’s kind of hard to, to chew for five hours a day, hard chewing, or most people wouldn’t want to because we have access to soft food. But that’s a big part of the problem is this soft diet that basically makes it so people don’t have room for teeth, and they have impacted teeth and, and and not enough room for wisdom teeth. And so that going back to the evolutionary medicine dentistry idea, it’s really a blind spot in the dental and medical education and think Doctor boy, in his article says, it would be like an engineer not studying physics be the same as a dentist or a doctor not studying evolutionary medicine and dentistry. So

 

Jacqueline Kincer  32:43

I like I like what you pointed out there that we’re basing things on, you know, this, really, it’s funny that it’s outdated, but it’s more recent than what we should be studying. Right. So there’s been this movement towards, you know, Paleo Diet. Now, you know, we’re recording this on January 7. So, you know, most people I know, are starting, like, the whole 30 diet, you know, and, and there’s all these things going on. I’m like, Yeah, but you can’t just first of all, that’s not a paleo diet, because they didn’t eat mashed sweet potatoes. You know, like, that just wasn’t how they ate and paleo was, it’s not just a diet, it’s, it’s truly a lifestyle. And that doesn’t mean, you know, a lot of people that go to extremes, like they, they sit on the floor, and they sleep on the floor, and they things but I mean, it’s not that we want to go back to making life really hard, right? Like, obviously, with our lifestyle these days, it’s impractical for us to spend five hours a day chewing, we’ve got to be, you know, in terms of just societal expectations more productive than that we can’t spend that much time eating, we have other things to take care of. We have work, we have children, we have, you know, we have to sleep like all the things right, but there is, there’s definitely way too much convenience, like with pouches for kids, or, you know, smoothies and protein shakes and all that kind of stuff. So, you know, where, where’s the balance, because I feel like sometimes people get this information, they go, okay, great. And they either become kind of purist about things, and a little bit obsessive, or they almost go like very defeatist and say, Well, I’m never going to have that 90 degree angle with my draw, you know, why should I do anything at all? So how do we how do we help? You know, parents, especially, you know, just like, what, what are the main things that we want them to focus on? Because I think, for most people, it’s unrealistic to expect perfection, right? Get, we’re not gonna, I’m not saying you can’t have it, but I think most people probably aren’t going to invest fully in a treatment plan to bring their job back to like how we used to have them, you know, hundreds of years ago.

 

Dr. Sam Zink  34:46

Yeah, I think just awareness of optimal is really important for for doctors, for providers, and for the patient to know here’s what optimal looks like and then we don’t expect to have the job a caveman, but we can move towards it. So Have some sort of objective measurement. And there’s some really cool ones like, within the ortho Tropics literature, we have this idea that about 40 to 42 millimeters of the inner molar width of the upper six molars, we can measure that objective you can measure on a school or in someone’s mouth. Like we kind of think we need at least 40 millimeters or more, how’s this human tongue. So if you’re talking about see a child, or an adult getting palatal, expansion, jaw expansion, if you have a target to shoot for, then you can actually move towards optimal where traditionally, maybe with poudel expansion, they would say, well, we can, we are only going to move it two millimeters, well, that’s just sort of like a guess, and not really looking at, where do you want to go. And so a lot of cases, you actually need to expand the upper jaw, and the lower jaw to match. Because if you expand the upper dot too much, they would not match the lower jaw, and they would compromise the equation or how the teeth meet. But in any of these cases, you know, whether it’s breathing, or airway, or tongue tie, or palatal size, we want to just we can move towards optimal. And we might not say we’re gonna get there, but we can make significant improvements in vital function and health and quality of life and longevity by moving towards the optimal.

 

Jacqueline Kincer  36:08

I love it. I think you answered that question. So well, because I think some people don’t always have a great answer, you know, as to why why we should even go for that. And that was really good. And myself having done myofunctional therapy and measuring that interval or width, it’s so important, because I would work with families who would, you know, we would recognize the ties in their baby, and they’d get them treated in great. And they would say, Oh, my six year olds, you know, I spent in speech therapy for two years, and you know, definitely has a tie to, and you know, I’m gonna go get that released at the same time, or I’m gonna, you know, I’m gonna get it done. And I’m like, Well, hang on, we got to take some measurements. Because if you don’t have room for the tongue, then there’s no point really in releasing the tongue first, because it’s got it can’t go to the right position. And so people are putting the cart before the horse and thinking, Oh, tongue tie release will fix everything, or lip tie release. And that’s really not the case. And, and thankfully, I would say, you know, at least there’s not really any practical way to do it anyway, but for not needing to expand babies before they get their tongue ties released. So there’s that. But when we look at anyone beyond infancy, that’s a huge, huge consideration to make. Yeah, so

 

Dr. Sam Zink  37:25

Kevin Boyd has shared some nice articles, they’re actually written by a dentist in like the early 1900s, his name’s Vogue. And he has this book index, which they look at the interval width and and say, by age four, we know from those studies that they should have 28 millimeters between the primary molars, and you should grow like a millimeter or two a year till you get to that 40 millimeters I mentioned. So we had this sort of growth curve of the palate from at least h4. So by three or four, you can really start to notice, if that palate seems small, and if it would need expanded, now, like the younger the child is, maybe they would benefit from frenectomy. And by the soft tissue growth influencing the jogger to be better, but I would say probably by the time they’re four or five, it’s it’s probably going to be somewhat limited in how much just the tongue tied to the salon would help influence the jogger itself. But like with adults, you know, that’s a big part when I see adults that come to me because often they know I do tongue tie, but the donor don’t. And that’s a big part of why I do a comprehensive examination, we get a CT scan, and an intraoral scan. And I’m able to use digital tools to measure their inner molar width, and their airway size, because there’s actually an tongue posture, those are all factors that speak to their prognosis. What I have found, though, and also talking about getting towards optimal, is that kind of break it down into for adults, is 30 millimeters in similar width is small, 35 is medium and 40 is large. And really I don’t see any largest because if they have a tongue tie, they probably don’t have if people that have functional Tang, that they’re the ones that develop those 40 millimeter intermodal widths. So I often see people kind of between 30 and 35. So I think the people who have a 30 millimeter in or more width, and there’s their icon small as they don’t have as good of a prognosis with a tongue tie release, because they don’t have room for that tongue. Now, depending on the patient, you know, I have quite a few speech therapist says patients and they’re really gung ho and so I tell him, you might get some what I called downstream benefits, which is the myofascial release and attention in the neck in the back and all the way down the body. And some of those can be nice, but we say you might have to do the frenectomy. Again, if you do get expanded, so might be too but I have seen a lot of patients where they’re at that 35 So they’re medium and they’re not this optimal caveman 40 or 50 millimeters, but yet they do have really nice benefit from a frenectomy or functional for neoplastic. It’s really more an involved procedure for an adult for to get a full release but but they do quite well at 3435 36 millimeter intermodal width. So it really is a case by case basis. It’s a sort of precision medicine and dentistry. And really every every situation is unique. So that’s that’s why, like said babies it’s I think they have more of that growth potential. But the adults, you want to take all those factors, basically the three dimensional Josh shape and size into consideration.

 

Jacqueline Kincer  40:09

Yeah. And I mean, gosh, how long does it take to take that measurement? Not long at all, it would be so great if if at minimum, every pediatric dentist was screening, you know, if we start there, then by the time they get to an adult census was taken care of. Right. So, like, you were saying, By age four, it’s supposed to be a certain measurement. Yeah, like, wow, that would be it takes two seconds, right to just well, hopefully, if the kid sitting still right to measure and we could at least screen so maybe they’re not the dentist to treat it. But at least there there could be screening. And so now I know, all the parents listening are going to go and get a poetry tape. And they’re gonna measure their own mouth and their kids and, and all of that, which, you know, great, go and do it. But I want to keep kind of dancing around it a little bit about breathing specifically. And, you know, you’ve talked about babies or even like your older son, right sleeping with the head tilted back and maybe the mouth open, or I’ve seen babies where the tongue protrudes between the lips, even. They just kind of have this posture where they look like Bulldog a little bit. And Bulldogs weaned off severely compromised airway. So we know it’s impacting breathing negatively, but but why is breathing so important? Like what? How should we be breathing? I guess is my question.

 

Dr. Sam Zink  41:23

I guess it’s there’s two sides of that coin. One is that there’s, there’s a lot of this is involved with posture. So if someone’s going to breathe, they’re going to survive, and they’re going to compensate with their body that may cause adverse growth, or pain or tension, or all those things. Because, you know, the breathing is going to be the most important thing in terms of, you know, this next day, like, there’s nothing more important than your next breath. You know, you don’t, you don’t breathe air, you’re dead. But, you know, the posture for compensating for breeding will cause the malocclusion or cause adverse growth, or maybe a convex space or a forward head posture. So we really see that this soft tissue dysfunction is driving crooked teeth. And even you can look at like tongue posture, and correlate tongue posture to mouth vision and say, like, if the tongue is fully rested in the palate section to get through the mouth, there’s a proper swallow, then you’re going to have that nice 40 millimeter inner motor with. But if the tongue rest lower in the mouth, and there’s an airspace above the tongue, you’re going to see progressive crowding. And there’s some interesting variations to like, my son was actually one of these, where if there’s less room for the tongue, the tongue will sort of squish or split between the back teeth, and then the front teeth will erupt, they’ll come together. And so they end up with this deep bite, it’s where you look at someone and maybe their upper teeth cover the lower teeth completely. But what you learn about that is that’s not their normal, that’s not how they rest. Even if their lips are together, they’re probably sitting there with the, again, the tongue behind the back teeth, there’s not enough room, and then the front teeth are kind of apart. But then every time they try to bite down or swallow, they’re pushing their TMJ back backward. So often, I see people if they have a deep bite, or they have teeth that sort of pointed backwards in their face, I can almost guarantee they’re going to be have TMJ issues at some point. So really, that posture influences the function which influences the structure. But then as far as breathing itself, there really is an optimal way to breathe. And most people find that weird, but we can actually quantify and I have an instant my office where I measure every new patient, and we check their entitle co2, so how much carbon dioxide they’re breathing out. This device has a nasal cannula, it’s called a capnograph. It measures a co2 They’re exhaling, as well as their respiration rate. So I often find patients where they should be breathing, maybe six to 10 breaths a minute for very calm, parasympathetic activity. And they’re breathing like 20 breaths a minute, and they don’t look like they’re hyperventilating, they’re just sitting there normal, but they’re breathing very quickly. And then co2 is really interesting. It’s really, it’s produced in the cells as they do work. And it’s what unlocks the oxygen from the red blood cell to go into the tissue. So, so people are hyperventilating, and they’re breathing too fast and too deep. They’re, they’re blowing off, they’re losing too much carbon dioxide, and therefore, they actually have blood flow constrict, and the oxygen is not able to get into the cells. And that’s why the blood flow constricts. So we actually can see brain scans where this brain is getting less blood because the person’s hyperventilating, they have low co2, and the blood flow is shutting down or slowing down to prevent cell death. Because if your cells did work, but couldn’t get the oxygen, they would, they would die individually, and you have all kinds of problems. So I can help people go from this learned unconscious, dysfunctional breathing behavior, because it really is a behavior. It’s more like posture or gait, like something you kind of learn from your parents from observation. People have these poor breathing behaviors. Then they also develop a certain set point of co2 where if they try to breathe slower, they try to read less, they really can’t because they’re sort of tolerant to this low level of co2. But we have a tool where we can train them over a one month period to breathe less, less quickly and lighter, so they retain more that co2, they get to this optimal level of 40 millimeters of mercury or co2. And that allows their blood flow to increase to their, their brain and to all their there’s tissues in the body that’s allowing the oxygen two maximally into the cell. And so I would say there’s nothing really more important than your next breath that properly distributes in oxygen to the cells.

 

Jacqueline Kincer  45:28

Oh, my gosh, okay, everybody go back and re listen to that. That was beautiful. Like, wow. Yeah, and it just and some of the things that I’ll just share to piggyback on that, like, how does this translate in the real world is obviously a number of health problems, right. I mean, there’s so much research coming out, even regarding mental health, specifically, you know, behavioral disorders, and even ADHD, you know, which we recognize in kids, but also adults, but those are all rooted in sleep issues. And as a colleague that you and I both know, rock Roger price has taught, it’s not, you know, it’s not sleep disordered breathing, it’s breathing disordered sleep. So our sleep becomes disrupted because our breathing is disrupted, and it’s fully unconscious. And in most times, it is anyway, but you could sit here and start focusing on your breath, you’re not going to do that in your sleep, you might do it in yoga class. But there’s a reason why yoga has so many benefits, right? Because you have that breath consciousness or, but I’ve seen when I’ve done the myofunctional therapy work with people, and helps them with that breathing behavior. repatterning that you’re just describing, I had a 36 year old male, who I mean, he fathered children, like I worked with their baby too. And he had erectile dysfunction. And he said once he did the myofunctional therapy, and he was totally gung ho about it, and he got his frenectomy that problem resolved, because like what you’re saying about the blood flow restriction, you know, it impacts so many things. And then I’ve had many mothers who have gone on to get their tongue ties released and have other babies, and where they may have experienced vaso spasms with breastfeeding the first time, those went away, you know, with subsequent children, because now that blood flow to oxygenation cells, it’s so you know, vastly improved. So those are just a couple things I’ve seen in my practice, but obviously, there’s so many implications. And I think for parents out there who I see babies that are breathing very quickly at times, and parents notice that you know, but the pediatrician, I don’t even think there’s anything that they’re ever concerned about unless the baby’s blue, really, and it’s not because they don’t care, it’s just because they’re not really aware. So I you know, we do see that, and I think there’s a lot of parents who, you know, take sleep crosses work with sleep consultants and things, and this baby just will not sleep and they are exhausted, and they’re at their wit’s end. And so when we make the connection, you know, maybe you can do a really good job of describing what’s the connection between breathing and sleep, because sleep is where our body restores itself. So if we’re missing, that we’re not getting good quality of that, you know, it’s just, it’s just this whole vicious cycle.

 

Dr. Sam Zink  48:13

Yeah, well, I mean, that’s why I have a, I have a methodology I use in my practice, where it’s sort of like a pyramid where one one level supports and enhances the next level. And that’s why breathing is at the bottom, it’s the foundation. Also, I feel that’s just simply because like someone could have airway issues and TMJ and sleep apnea, let’s say they get double jaw surgery, which are surgically the jaws are brought forward 10 millimeters in the face, it makes a dramatic change in the airway in the face, and they can usually breathe better and sleep better. But let’s say that person has this radical surgery, and yet, their breathing behavior is still dysfunctional, their their, their benefits are going to be severely limited by that breathing dysfunction. So why not start someone with optimal breathing? And that’s the cool thing about using biofeedback with an objective measurement of co2 is there’s a lot of techniques out there actually, real quick. I mean, there’s a great book came out called Breath by James nester, did you read that, and it talks about the ancient wisdom, all these techniques and the yoga and the meditation and the prayer. And it’s really interesting, but I think one thing that wasn’t talked about other than as diagnostic is you can use a capnograph and co2 biofeedback to actually customize a breathing retraining program to an individual. And then you can transform that learn unconscious, dysfunctional breathing behavior into learning, conscious, optimal breathing behavior. And sort of like learning to ride a bike, you spend a month with this device as a rental. And then after you’re done, you can then you can do to some like some most simple breathing techniques where you try to read like six breaths a minute, he’s an app, but you’ve learned that tidal volume and you’ve gone through that process to where you’ve overcome the discomfort of the carbon dioxide hypersensitivity, and so you’re able to tolerate the optimal level. And one interesting thing about that treatment is it’s actually FDA cleared for panic and PTSD. So that’s goes to this reduction in blood flow, it really causes a reduction in function of the brain. So when you restore the breathing, you restore the blood flow, you restart the oxygenation, you’re basically supporting enhancing the function of every cell. And that translates into improvement or elimination of panic attacks, and PTSD.

 

Jacqueline Kincer  50:18

Hmm, Mm hmm. Yeah. So, so much to unpack there. And I, just because of my work, I think about, you know, even women who are birthing, and we know that if you learn certain breathing techniques for you do Hypno babies, which is going to help, you know, slow the rate of respiration and things like that, but you’re going to have a much easier birth. Yeah, you know, when you have that, that tension created, that creates anxiety, your body doesn’t want to put a baby out into the world, because it’s an panic state. So that’s not a safe environment, right. And so then the labor slows, or it’s more painful, or it’s almost like you’re working against your body. And then I think about how many women experienced postpartum anxiety, which, you know, can be very often rooted in things like trauma and what have you, and just lack of support and you know, other diet, other things. But if you have dysfunctional breathing behaviors, on top of that, you know, you can you can take the medication, you can do all the things, but doesn’t, it doesn’t change that at the end of the day. And then I think about breastfeeding posture, and how many moms sit there hunched over sort of collapsing their diaphragms? And what have you? And, you know, not really, you know, there’s just, there’s just so much right, that we could really tie all of this into and, yeah, I love that there’s a tool to measure it. And you mentioned it’s a rental. So that’s really a great option for people who are looking for, you know, for something to help with issues are

 

Jacqueline Kincer  51:49

experiencing. Yeah.

 

Jacqueline Kincer  51:52

Yeah. And just to circle it back to babies who are breastfeeding? I would I’m curious if you would agree with this, you know, like you said it this pyramid readings at the bottom of that hierarchy, that’s the base. And when I am trying to explain to parents the consequences of the ties that I’m seeing in their baby, I often bring it back to that base of breathing. But if the baby can’t breathe, well, they certainly can’t breastfeed, well, because maybe it’s that, you know, their nasal passages are compromised because of the high palate and position of the jaw. So now their mouth breathing, which they shouldn’t be doing. And then if the breast is in their mouth, well, they can’t stay latched. And so it’s like, all these things. Right. So what are what are some of the things that you see, you know, we see these impacts in adults and older children, but what are the things that you’re seeing? It’s causing problems within breastfeeding babies specifically?

 

Dr. Sam Zink  52:47

Yeah, I mean, with, that’s the reason that’s a big reason other than my own family experiencing these issues with tongue tie from infancy, and then kind of getting to see the consequences of untreated tongue tie and my older sons. I feel like it’s really the first and best airway intervention. And it’s hopefully a thing that we can do to do it early enough, and with proper support and wound care, and, and, and this optimal breastfeeding, I’m hopeful that they would avoid these other dysfunctions, the breathing dysfunction, the job development issues, so it doesn’t mean that they won’t need intervention. I mean, my son who’s five now who had different ectomy, he is by far the best breeder, sleeper, his lips are together. So I see the huge benefit of that compared to my other sense, but also, he’s still I think he’s gonna need some expansion, his teeth are kind of a little more gummy smile, and the teeth are narrowed together. So it doesn’t mean that the tongue tie release, and the breastfeeding got him completely optimal. But again, I think I am well towards optimal, but then you can also still have an objective measurement of what’s optimal, like the interval or width and, and sort of get him even better off so that he can avoid consequences in the future. But I don’t know about you know, breathing retraining, there’s a lot of techniques you can introduce to a child and also posture training, there’s a program called kopecks, some between myofunctional therapy Kopec something like we take our breathing, which they have some cool videos for kids. I really have parents can really educate themselves, and get the right interventions and be minimally invasive, and help their whole family get more towards optimal health. But yeah, definitely the younger you start, the farther you are along in the journey, so you’re requiring less intervention and less kind of pain and suffering later.

 

Jacqueline Kincer  54:28

Such a good point, you know, one of the things I do that, that a lot of IBCLC O’s are trained in is, you know, this oral habilitation for the infants and, you know, I know you work with one of my colleagues and you know, we all try to partner to do this team holistic approach. And it’s very easy for me to retrain a baby to solely basal grief, it takes a few days. Now you were talking about this device and you know, a month and you know, for an adult right so, and and then it’s Just your brain is very habit based. Everything’s habit based. So the way your baby latches the way they breathe all the things, but it is it is a quicker process when it’s a baby. So the sooner we can do these things, I feel like not only are you just saving a ton of time and frustration, but certainly money down the road. And like you said, it’s not a it’s not like, just because you released your your baby’s ties now means that you’ll never be orthodontics or any of this stuff. But, you know, you’re certainly giving you and your child a really good head start and a really healthy starts, you know, as optimal as we can get it, you know, as early on as we can get it. Yeah, that’s true. Yeah. Oh, gosh, well, this has been so incredibly informative. And I think that you’ve answered a big question that I get a lot of the time, which is, you know, what happens if, if I don’t treat these ties, and I you know, I really appreciate you sharing the story of, of your son’s with us, because your personal experience tied with your, you know, actual medical and dental training is so important to take both of those, and you can really describe it so well. And I’ve shared my story with my children, too. So for the listeners who want to go back and listen to those episodes, you certainly can, but it’s been such a treat having here. And I’d love to hear you know, if there’s one thing that you could leave our listeners with, just to some some of what you’ve had to say or if there was anything else you wanted to add, I’d love to hear it.

 

Dr. Sam Zink  56:30

Yeah, I think just getting awareness about what’s optimal, and, and observing. And I think breathing is a good place to start and specifically mouth breathing, that’s something that’s pretty obvious to see, you know, if someone’s breathing, we say, you know, or the tropics, like, there’s an optimal posture, that helps the growth to go in the right direction. And that’s, you know, breathing through the nose, tongue and fully in there, if the mouth lips slightly together, and teeth lightly together, also for between 48 hours during the day and all night long. So if you have that happening, then then theoretically, someone’s going to develop properly. So if someone kind of knows what’s optimal, then they can compare that to what they’re seeing in their children and themselves. And then just be aware to find the right help and providers that can help them on that journey towards optimal health.

 

Jacqueline Kincer  57:22

That’s so great. And if someone is out there thinking about, you know, maybe not their baby, but an older child, you know, with some of these issues or themselves, is there a great resource for them to find you or someone like you to work with? Not everyone is going to be local to you. So yeah, it’s wondering if you had anything to point them to?

 

Dr. Sam Zink  57:44

Yeah, I mean, there’s a I think it’s the foundation for airway health. They have a pretty cool resource about a lot of this stuff. And like a provider locator. Also worth the tropics, North America, it’s a good resource. And, yeah, there’s a couple months.

 

Jacqueline Kincer  58:00

Awesome. Yeah, I’ve definitely sent people to the foundation of airway Health website to go use their directory to seek someone out. So thank you so much, Sam, for everything you’ve shared with us. It’s been absolutely mind blowing in some ways. And I really appreciate you being here today.

 

Dr. Sam Zink  58:17

Yeah, it’s my pleasure.

 

Jacqueline Kincer  58:19

Thank you. You’re welcome.

 

Jacqueline Kincer  58:22

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