The Root of The Matter

Transforming Dentistry: Innovation in Sleep Health, Teledentistry, and Airway Wellness with Dr. Blaine Leeds

January 28, 2024 Dr. Rachaele Carver, D.M.D. Board-Certified, Biologic, Naturopathic Dentist Season 2 Episode 2
The Root of The Matter
Transforming Dentistry: Innovation in Sleep Health, Teledentistry, and Airway Wellness with Dr. Blaine Leeds
Show Notes Transcript Chapter Markers

Embark on a journey through the ever-evolving landscape of dentistry with Dr. Rachaele Carver, as she sits down with the forward-thinking Dr. Blaine Leeds. With a career spanning nearly three decades, Dr. Leeds shares his transformation from a traditional general dentist to an innovator in sleep health and teledentistry. Peek behind the curtain of a small community dental practice that's unafraid to push the boundaries of technology and patient care, heralding a new era where aesthetics meets functionality through pioneering clear aligner therapy.

The conversation pivots to a fascinating look at teledentistry and its revolutionary role in redefining patient experiences. Imagine the convenience and education patients receive before even stepping foot into the clinic, thanks to virtual treatment coordination. We’ll uncover the untapped potential of early pediatric assessments, challenging age-old orthodontic practices, and shedding light on how proactive interventions can set the groundwork for a lifetime of healthy smiles.

Finally, we draw attention to the critical but often overlooked connection between oral health and airway wellness. Dr. Leeds illuminates how misconceptions about jaw development and early oral habits can have profound implications for long-term health. Through compelling patient stories and expert insights, we emphasize the importance of a comprehensive, patient-first approach in dentistry – one that not only treats but anticipates the broader impacts on overall well-being. Tune in and be inspired to advocate for a healthcare future that's as much about prevention as it is about cure.

To reach out to Dr. Leed's office go to: drblaineleeds.com

To buy Dr. Leed's book go to: askdrleeds.com

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To learn more about holistic dentistry, check out Dr. Carver's website:

http://carverfamilydentistry.com

To contact Dr. Carver directly, email her at drcarver@carverfamilydentistry.com

Want to talk with someone at Dr. Carver's office?  Call her practice: 413-663-7372



Disclaimer: This podcast is for educational purposes only. Information discussed is not intended for diagnosis, curing, or prevention of any disease and is not intended to replace advice given by a licensed healthcare practitioner. Before using any products mentioned or attempting methods discussed, please speak with a licensed healthcare provider. This podcast disclaims responsibility from any possible adverse reactions associated with products or methods discussed. Opinions from guests are their own, and this podcast does not condone or endorse opinions made by guests. We do not provide guarantees about the guests' qualifications or credibility. This podcast and its guests may have direct or indirect financial interests associated with products mentioned.

Speaker 1:

Hello everybody and welcome to another episode of the Root of the Matter. I'm your host, dr Rachel Carver. Today we're very fortunate to have Dr Blaine Leeds with us. Dr Leeds is a general dentist who's been practicing for over 28 years. He is an expert in sleep health and author of a book what Happens when your Child Doesn't Sleep Unlock the Secret to Happy, healthy Children. We've talked about that topic a few times before, but it never hurts to keep hearing that information. We'll talk about a few things. Dr Leeds is also a fellow Dawson Academy Scholar, so talk about all about lovely inclusion, how that led us into really understanding aesthetics a little bit more. Dr Leeds does a lot of clear-liner therapy, so we'll talk a little bit about that. The good, the bad, the ugly. So why don't we just start with? After dental school 28 years ago? How has your career evolved? Well?

Speaker 2:

I'd say, in vastly different ways. My career has evolved. It was pretty standard for a while I had a facility sharing partner that I actually got to have a lovely lunch with him the other day. He and I I sold my practice to he and an associate a few years back, in 2011, actually, and he and I, independently of one another, followed almost the same sleep and airway path where we were working with children's appliances, but he and I got to have lunch together this week, first time we had sat down together in the same place in 12 years, which was really cool. But he's got a nice facility where he's got a really cool setup with a CVCT and a kind of TENS unit. He treats complex TMD, tmj and pain problems pain patients that's specialized not specialized, but offered that service to his general dental patients for a long time. He graduated from the same dental school that I did in 1981. And so, which is kind of a trait of our profession, if you do it the right way here, you can do it well into your 70s and 80s, and so he's a very young 72 now I think it is, and 72 going on. 52 runs a couple six miles twice a week. Paddles, paddles of the river all the time but.

Speaker 2:

But our practice was very traditional. We were in a small college town in Arkansas but one of the things that my colleague had a commitment to early on was technology and I think we were the first dentrix office in Arkansas, which is very strange. I ended up the last couple of years living just a few miles from their headquarters in Utah helping us start up out there. But my partner, dr Steve Fisher, back in the day, steve always had a commitment to technology and, for example, we had maybe one of the first dental x-ray systems that did not require a cord dangling from the patient's mouth. We just thought that was silly, no offense, and all of your similar equipment companies out there that make that kind of device. But we actually had a Swedish, a Sordex Fendant processor that would process films that were size one and size two way back in 1996, before dentrix had any imaging capability within their software. So we had to have a company in Dallas drive up to us in Western Arkansas and build a software bridge to let us keep our x-rays within dentrix. And so we had digital charting, except for our paper medical histories, way back then in 1996. We had digital everything pretty much, which was really ahead of its time. But our patients were thrilled when they would come in and see their bite wings for the first time ever on a 19 inch monitor back then, which seems tiny to me now because everything's 50 inches or larger it seems.

Speaker 2:

But pretty standard general dentistry though for us in a small town where we had technological advances, really compared to a lot of our colleagues in the state and the deep south where we were. But patients did not want to drive an hour and a half to the orthodontist or an hour and a half to the endodontist and so we did everything except place implants at that time. And then Dr Fisher started doing that later and his colleague Dr Cook still does that, and I did all the training to do that. But somehow my career got chopped up into increments where I did never start placing.

Speaker 2:

I did all the training with Don Callan back in the day. He was a gifted periodontist and taught implant concepts with a company called Perio Seal, because their motto was let's keep that line in the implant, there where we let's do something seamless, where we can't have bacteria build up at the junction of the implant and the analog. So Don was doing things with that and but so pretty much standard general dentistry, thriving hygiene. In a little college town 10,000 people we were doing 13 days a week of hygiene, with seven hygienists splitting up different schedules to help us do that. Just on my side of the office and Dr Fisher was doing two or three more days every day of hygiene on his side, and so he had a really robust general dental practice where we tried to do everything under one roof as much as we could.

Speaker 2:

So I did that for 22 years and then to me, everything changed in our profession and in healthcare really, when we were able to hold an Android or an iPhone in our hand and have FaceTime, and I knew that when you and I could do what we're doing now and do it on a phone. I can remember standing in line to get the first iPhone in Arkansas back in 2007 with the metal back on there, and I thought you're telling me, for 780 bucks I can have a laptop in my pocket that runs Safari. This is, this is outstanding, so I want to do this and my son, who's still a big Apple he's a filmmaker, but he's an Apple guy and he had brought an iMac into our home a few years prior, and my wife is a professional photographer, so everybody was fighting over the iMac, so we became Mac people. But when I saw that technology, I knew and that's you mentioned off air about the app, and I did build an app with PhD labs in California called SmileFinder.

Speaker 2:

That sadly never launched, and we had it ready to launch, but I didn't know anything about fundraising, so I didn't know anything about angel investing, or so, frankly, I didn't ask for enough money.

Speaker 2:

If I'd asked for $30 million, you and I wouldn't be talking now.

Speaker 2:

I'd already be on the island with Richard Branson somewhere if I just asked for the right amount of money playing tennis with him and Beyonce or so, but anyway, and so about that same time, though, some people in the orthodontic world were using that technology and reached out to me and they said, hey, we're thinking the same way here, and so they reached out to me when I have an interest in helping them, and so that kind of took my practice for the last seven or eight years over into the telehealth world and the AI world, which is now just advancing in a huge way, just fractionating, as we call it, like the glass breaking and fracturing in different directions.

Speaker 2:

There's AI technology that came out last week. It didn't exist 10 days ago that now can help us, and so that's one of the things that I'm dipping my pinky toe into the water with right now, because I know some about technology, but I don't ask me to code anything. I'm mostly just a hardware user, a software thinker and software user, but in some way my career took that turn and that kind of got us up to today.

Speaker 1:

Fantastic. I definitely want to come back and talk a little bit more about that teledentistry, because that is becoming more and more popular. I know one of the things I enjoy the most. I'm not in my office on Fridays, but that's when I'm doing my consults on Zoom and I'm recording webinars and I'm doing my podcasts and that's such a wonderful way that we can reach people without having to necessarily travel. Obviously, if we can't perform the dentistry, but creating awareness, helping people under stand how decay and all that is how it happens is great for prevention. It also helps if you do the exam ahead of time.

Speaker 1:

I think one of the problems sometimes in general dentistry, a new patient comes in. You need three hours with somebody and financially that doesn't make sense. So I've been really enjoying having this consultation really getting to, because one of the things I have a very similar practice, a small college town, a town right next to a small college town having to do a lot because there are not a lot of options where we are and we're really busy. There aren't enough dentists in our area and when a new patient comes in, I sometimes have three, four, five hygienists in a day and just me and trying to figure out how do you dedicate that time to that new patient. You don't want to be distracted, you don't want to keep getting pulled out of the room and it's a really hard balance that I find. So I'm loving the teledentistry part. I can really create a nice relationship with the patient because I think dentistry really trust is so important in dentistry.

Speaker 1:

You may be not the greatest dentist, maybe you have an excellent bedside man and you listen. I think more than ever patients want to be heard. I know I do. When I go somewhere, I want to tell my story and I think, unfortunately, in a lot of medicine today you have eight minute appointments. That's it.

Speaker 1:

I'm so business-like and I think unfortunately dentistry is going the same way because it's becoming so expensive to run dental practices or so much bureaucracy and it's just it's really challenging. Seems like a lot of younger people coming out of school too. They don't want to be a business person, they just want to go to work and then come home at five o'clock and play video games or go golfing or whatever it may be. So I worry that dentistry isn't far behind with all these other DSOs coming up and buying and I think unfortunately we lose some of that personalization. So again, having that tell a dentistry, you can create that nice relationship and so when they come to the office they've already established some of that trust and then you can get in and do the work. So I think that's a valuable far. Obviously, we haven't figured out the AI yet to reach through the computer screen and fill the cavity, but who knows what could happen in the future?

Speaker 2:

We have figured out how to do a much more than rudimentary exam on a patient and with dental monitoring. Now, some of those photographs that the dental monitoring units can take, those photographs are much better than intra-oral photographs that I would take or my team would take in our office. The photographs that I've been using to evaluate telehealth patients are really diagnostic. There have been patients that I've said hey, there's a little bit of pathology on your lip, you need to get that checked out. We probably saved a few people's lives because we spotted an oral cancer lesion that was early and they were able to have it removed and have it treated. You can see a lot of traits and signs and symptoms and patients and all kinds of different things. But in kiddos all we really need is some photographs and an assessment filled out by the parents and we can guide them to an appliance. That's that two appliances will fit every child from age two to nine pretty much, and so that is real treatment that can really happen across a telehealth medium that can really help someone and they don't have to.

Speaker 2:

Maybe the dentist is not, maybe they're in New Haven and you're where you are and they can't get there in traffic, or maybe they use public transit, maybe they don't have a way to get to you, but the telehealth will connect you and currently in our situation we're using a super duper treatment coordinator and partner, ashley Newton, in our office. We're going to have all virtual treatment coordinating. So when we wrap with the patient, they'll just say you'll get an email and Ashley will go over everything financially with you and you'll do it by Zoom and that really has been a help to our office, making things smoother and it saves time because they're not log jamming your team there in the office and, of course, a hardened salesperson might say oh no, don't let them leave the practice without getting some sort of financial commitment.

Speaker 2:

But hopefully you're doing what you need to do while they're there to understand that you're ready to take care of them as a guest and as a client and patient, and that you don't worry about letting somebody walk out of the office because you're going to be connecting with them in a virtual way. And I like to do the same thing you're doing. We want to bring all of our practice our patients into the practice. Now for the virtual meeting of some kind.

Speaker 2:

And you look at a guy like my colleague, dr Brian Harris, who's in Scottsdale, arizona. Every single one of his Vanir clients is educated through a virtual medium and with some actually evergreen video from him, so that he's not even live on that video, but it explains everything to the patient in a brief and very succinct way so that they understand exactly what he does and they understand that they're not going to get a tooth removed when they go in there that day, because what he does is something wholly different. He shares with them and they understand pricing and they understand everything about it before they come in. So these clients come into the office ready to be a patient, many of them pay upfront to hold the appointment, and so it makes it very efficient for the team and it gives them the patient it feels like you're dedicating time to them specifically.

Speaker 1:

That you're not because I know I feel scattered when I'm running about the patient feels like it doesn't. It doesn't create that good feeling that you want your patient to have to in order to create that trust. To me that's so important and even I've had my own practice now almost 15 years and that's still that's given us still something we struggle with trying to really again maximize the patient's visit so they really feel like we are committed to them, because obviously we don't become dentists or doctors because we just want to make a buck. We really care about that patient. These are stressful careers and our goal is and part of the reason I'm doing this podcast is because I just care so much about people and I know I can treat my two 3000 patients in my little town in Northwest Massachusetts.

Speaker 1:

But by doing things like these podcasts, doing the webinars and articles that writing can reach a bigger audience and try to create that awareness so patients know there is an alternative. I really want patients to be able to take their health in their own hands right. And speaking about that, let's go over a little bit about your book. Let's reiterate for all our listeners here how important it is to look in a child's mouth right, prefer, believe in before like age six and try to intervene. Why do we want to do this at this early age, versus some traditional orthodontist still say no, we got to wait till all the baby teeth are out, then we'll take a look at you. Why might that be detrimental or why is there a better way? Shall I say?

Speaker 2:

Because we're really in our fourth generation in from patients who've had anatomic changes in their jaws. And if I did, I looked at the thousand telehealth patients last week and almost every one of them, their lower jaw look like someone took their thumb and index finger and pinch their molars together. And when kids leave the incubator, what do they have in their mouth? Pacifier, and some of the pacifier companies are making better products now that don't do this quite as bad. But when that child begins suckling on the pacifier, we're taking the cheek muscles in and we're moving baby molars together. And when we see a two year old child because I was educated just like you mentioned these orthodontists and general dentists hey, let's wait till the baby teeth come out about age 10 we'll send the orthodontists see what they say. I've even helped an orthodontist by taking out some teeth on a child or two over the years, because that's what we were taught to do back then and that's why they call it practicing dentistry, because we get better at it right, we figure out, we learn from our mistakes and I didn't. I'm so embarrassed that I did not know until 2017 that airway was important. I knew before. Then. I knew in 2012 because I became a CPAP patient myself so I knew how much better I felt because I could sleep. Now I know that I couldn't sleep well because I have a unilateral posterior crossbody, have a midline pallet of torus because my molars were moving together and the bone in my pallet had nowhere to go, so it created a nice little baboon's bottom on my pallet right. And so because I was taught in dental school that tori were idiopathic, we're not sure why they were, why that happened, that it was just an overgrowth of bone. After the growth plate fuse, a bone has to go somewhere. The osteoblast make the bone and so you know we have little Tylenols under our gums, underneath our tongue, that are our tori. But the tori are there because the mandible is deficient in size and the mandible is deficient in size because the maxillus deficient in size most of the time.

Speaker 2:

And to go back to your Pete Dawson comment, that occlusion meaning the way the teeth hit one another when the peaks hit the valleys on the teeth or they hit the marginal ridges on opposing teeth, those bumps lock into the valleys on the teeth and the jaw growth is locked into that position. And so when we see a child that's age two and they have beautiful primary teeth that have zero space between them. That patient is crowded. They are not normal. They have a baby set of baby teeth on a two and a half year old child. It shows no space. I've had patients tell me oh, look at Tommy's teeth, they're perfect and they don't have any space and he has no crowding. And I said actually now we know that's crowded because we want to see what we want to see space between every baby tooth. And why is that? Because the adult teeth that are replacing them are larger. So we call the memory or pediatric final exam the freeway space. Right, the freeway space where the baby molars are is actually larger than the primary teeth or the permanent teeth that replace them, and so we need to maintain that space. That's why, when my parents would say it's a baby tooth, so what do you mean If we take it out when they're six, who cares? We're trying to maintain that space for the adult teeth to come in. We also, as practitioners, need to make sure that we're helping these kids grow their jaws properly and that they have someday they'll have some hope of having 41 millimeters between their cusps of carobelli on their upper six year molars, because that's what we want. We want a flat, broad palate where the tongue can fit up in the palate, rest behind the upper anterior teeth so that we can do what Breathe through our nose. Because human beings are obligate nasal breathers, we should be breathing through our nose invisibly, effortlessly, peacefully, quietly, all the time, and when we're not, something's up, and it's not usually good. And so when you have these little kids I have a three year old patient His mom finally relented and had his tonsils and adenoids removed at age three.

Speaker 2:

Our only complaint was he drools. To me he drools all the time, like his t-shirts are wet and the poor child couldn't breathe through his nose. So therefore he had to go head forward and breathe through his mouth and he couldn't swallow all of the magical saliva that he was producing, which we know he needs to keep his teeth clean and keep plaque from building up on his teeth. And kids as you've got several patients, they can salivate to beat the band right, and so when their head is forward and their mandible is deficient, they're walking around like a little rubber bowl full of saliva, and so he's just he's going to be drooling all the time, and so we.

Speaker 2:

Finally she went to see five ear, nose and throat specialists in a really nice metropolitan area in the middle part of the country. That I won't give away so we don't offend anybody, but no one knew what to do with this guy. And the final, the fifth person, said let's just create more space, so let's take out tonsils and adenoids, and certainly that is indicated on some patients. But if he was my grandson or my three year old child, we would be trying as hard as we could to see if we couldn't make room by expanding the arches first. And so that's why it's important, because we don't, even though we know full banded, bracketed orthodontics may not need to start till age 10 or 12. Let's make that as easy as we can on the orthodontist and their teams and the patients and the parents by not letting the child choke to death from age two to 10.

Speaker 2:

While we wait, because it really happens, and when we don't sleep and we don't get oxygen to our brain, that's when things start to happen like bad behavior and acting out at school and poor academic performance and falling asleep at school and and wetting the bed and breathing through our mouth and snoring so loud you can hear it in the front of the house when they go to bed. So all those things are related to underdeveloped jaws and so, as we started the top of the show talking about, you're here to have this virtual conversation with me, to share this information, and that's all I'm doing. That's the only reason I wrote a book. Everybody knows in our world you can't who's going to buy a book about dentistry? Nobody, nobody. First of all, nobody wants to go to the dentist. One in five patients don't go at all because of fear, right, and which is a horrible indictment on our profession and the way we market it. Right, everybody should know, in 2015, 2016, 2020, 2000 and beyond, although it's not that way, that dentistry is safe and dentistry is fun and dentistry should be easy.

Speaker 2:

And if dentistry is painful and you're having a God awful root canal or a God awful surgical experience, then you got the wrong meds on board. You got the wrong provider. I mean, there is a way to do it where it's, where either you don't remember or it happens in a way that's very comfortable, and so that's the story that we've got to get out there. Let's tell the real story of dentistry and how it happens in your practice and in my practice, which is we treat the patient like a guest. It's like they're going to Disney World right, be our guest. Walt Disney called people guests. They're coming to the park, they're going to be guests, and that's what these patients are to us.

Speaker 2:

And my dad used to say you know, the customer is always right, son. And I would say, yes, they are, but these are not customers, these are patients. So there'll be times when these folks are in our hands and we're the only ones that can help them. It's in that particular moment of that procedure and so. But that doesn't mean we don't treat them like family or like a guest when they're under roof, and that can happen. So if you're listening out there and you're a patient and you're looking for a dentist or a dental team or a hygienist to work with, or a surgeon or a specialist, don't give up. There is an office that you can go to that's not far from you, where somebody will really take care of you.

Speaker 1:

Absolutely so. Just circling back to the tonsils and adenoids, that's something I see all the time and so, as you said, there are certain indications. But that's some good, healthy immune system, right? It's immune tissue. So if we are removing an immune organ, does that put you at more risk of immune dysfunction later on? That's the controversy, and what criticism of removing them will say, and I think there's definitely some legitimacy there. So we were born with tonsils and adenoids and I think our great universe, energy, whatever you want to call the greater power put them there for a reason, right? So what is your belief about? Why did these become swollen and out of control in the first place?

Speaker 2:

We know the answer to this and it's not my answer, it's probably my buddy Ben Morales' answer. Ben's not far from you. Ben's been doing this for 20 years. I've been doing it for seven. So what we do know is back to what we said earlier.

Speaker 2:

Humans are supposed to breathe through their nose because in our nose we have hair and the hair filters the bacteria and the crud out of the air and leaves it in our nose where we can blow it out or wipe it out. And that air, when it goes through our nose, it hits a little sensor near the parasyneses in the back of the oropharynx. That causes us to secrete a very important chemical called nitric oxide. Nitric oxide is a vasodilator and it's the only time this is secreted in our body's physiology or our body's systems is during nasal breathing. So that's number one. That's why we need to breathe. Number two if we breathe through our mouth because there's some sort of obstruction in the nose or in the airway behind the nose, the air doesn't get filtered. It's stark, cold air. It goes right to the tonsillar area and we know that people have they may have patients that have little fissures in their tonsils. If you're a mom and dad, if you look in there and take a tongue depressor, you take a lollipop and stick on your kid's tongue and have them say ah, you'll see that the tonsils have little slots, little fissures in there, and so when crud gets breathed in through the mouth it can register in the tonsils and it can inflame the tonsils and that's where we get tonsillitis. And so when the germs are breathed right in the mouth, then we get this inflammation of the tonsils and adenoids, because we're supposed to be breathing from the nose. So that's why it's important. We've even seen children that had their tonsils and adenoids removed. That began to regenerate the tissue and had to have them removed again. Or someone thought they had to have them removed again. But we used to.

Speaker 2:

When we would take out teeth for orthodontics thankfully in my career, even in the late 90s, we were already really slowing down on that, trying to figure out another way to do that. Because would you lop off the pinky toe so you could get that? Get your foot in that pair of pumps? Absolutely, you wouldn't do that. So why would we take out teeth? We should have room for all 32 teeth and when we look back, this is the case. We have Robert Coruscini's book about anthropology. We have others who've studied human beings, and we used to. We had room for all 32 teeth, we had big, wide smiles with big, wide incisors and we've gotten away from breastfeeding.

Speaker 2:

Moms are busy here in the US and North America, the Western Hemisphere and we are. Moms are going back to work and so they need to bottle feed and they need to pump and have somebody else breastfeed their child. But the breastfeeding motion, as we found out, is more of a biting motion than a suckling motion. So it expands the arches, it toughens the gums, it spreads the palate apart and the mandible makes it wider just the act of doing that. And when we look at the science over in sub-Saharan Africa, where there's food insecurity and other reasons, moms have to breastfeed until age four or five years of age, we don't see a sleep-obstructed breathing and sleep apnea on that continent because the jaws develop properly, they develop wide, large smiles and they all have their wisdom teeth. So that's the reason for it.

Speaker 1:

I like to reiterate that a lot. When we talk about breastfeeding, it's not just because the breast milk is nutritionally superior to formula. There's so much more to the structure of the face, because you cannot mouth-breathe when you're breastfeeding. Right, you train that baby how to nose-breathe. And not only that, you're having proper tongue suction, proper swallowing, and all of these go into the proper development not just of the jaws but the brain. Right, You're giving the right brain signals to grow the brain to the full dimension there.

Speaker 1:

And we also know in today's day and age. I've got two teenage kids. The amount of anxiety and depression in kids today is enormous, absolutely enormous. When you're mouth-breathing you're also stimulating that sympathetic nervous system which immediately puts you into that anxious, overactive nervous system. If we can teach our kids at a very early age to always breathe through our nose, could we possibly stem some of that anxiety. Hopefully there's a lot more to it, obviously, than that. But just teaching that nape-breathing that when we have a nervous patient in the chair dental chair right, we say take a deep breath, breathe through your nose, right, we have to have them close their mouth.

Speaker 1:

So many people are just breathe, do the box-breathing or the 478 breath. That's how we get those people to instantly switch that nervous system to the parasympathetic. So again that breastfeeding is so much more important than just the constitution of the breast milk. It really is so valuable for growing. All of this and we know, I've been taught that from age four to seven is when we have a huge growth spurt. So if we wait till age 10 to send them to the orthodontist, we've missed a really good portion. Now can we grow people's jaws into their 50? Absolutely. I have done it.

Speaker 1:

So we used to be taught oh nope, after 12, that's it. They're never going to grow anymore Blowning. We know that's not true. However, when they're young it's so much easier. When they still have a lot more growth to do, it's much easier, it's less expensive. Some parents, when we talk about these appliance therapy, like, oh, and I was like you could do braces, you could wait and do braces for I don't know, five, six, seven, $10,000. If you don't correct the reason why the teeth got crooked in the first place, that child is going to be spending 10, 11, 12, $15,000 in adulthood to re-correct the crooked teeth. Because, unfortunately, I believe that one of the reasons we have relapse after having five years of braces is because we never corrected the real problem, right. As you said, if you look back at our ancestors, you look at these African populations who are eating their native diets, too right, which are really high in minerals, really high in the fat soluble vitamins.

Speaker 2:

Those patients. They have wider jaws and a wider smile. Therefore, yeah, the mineral, the diet that they eat, is more rigid. So, like they'll hand the child a carrot when they're two years old and the lawn that they can't get down their windpipe basically. And in prehistoric times, human beings handed them a bone of some kind that had meat on it and they chewed on it.

Speaker 1:

So that's the other problem today with most kids' foods. Right, the finger foods are all soft. We've got the squeeze patch. So you were talking about the pacifier, right, when you're squeezing it in, you're pushing the cheeks.

Speaker 2:

You have yogurt, right, joel, we have yogurt, yes.

Speaker 1:

I know it's terrible. I was like, oh, I know I was one of those parents, it was convenient, I get it. I was a busy mom too. And now I'm like, oh, I wonder my kids and? But I put my kids in the appliances early. I would have liked to do it earlier, but I didn't know. When they were really young, my older daughter sucked her thumb, so she was seven years old. I didn't. And I was like, oh, if I had only known that these devices existed, it would have been good. Now she wouldn't have.

Speaker 1:

But we've done all the expansion and all the devices and everything and the myofunctional therapy we had a podcast about that. So teaching the muscles and the tongue where they're supposed to be positioned is huge, because that's another problem, I think, with relapses of braces too. Right, if you have a tongue thrust, maybe you do the braces, they try to maybe correct that open bite, but if you don't correct the habit, the tongue is just going to push it back right back out. So so again, we have to really look at the whole picture and I think sometimes we're trained as dentists to just focus on teeth, like focus on the teeth, and we forget everything else that that goes in. I know one of the issues sometimes with Invisalign one of my critiques has been just looking at the teeth. So how did the impact? So I know you do some of the clear liners. Tell me a little bit about how you treat with clear liners and how you overcome some. How do you make sure that everything is going to be balanced once you've shipped around the teeth?

Speaker 2:

Thankfully, most of the clear liner cases that I've done have not been full arch enough to do retractive orthodontics on somebody. We've done that in some cases, which is what Invisalign is still doing. But then you're mentioning a tongue thrust. Well, the patient is tongue thrusting by definition. They're trying to get their tongue up in their palate where it belongs right, and the patient has been. They keep trying to retract with orthodontics to close space between the teeth and then the tongue. The tongue is thrusting because, guess what? The tongue is supposed to be antroposteroly, far further forward than it is. In other words, so is the palate. If you go back in and expand and you talk about easier retention, once we get the jaws expanded, there's plenty of room for the teeth. Then even the lateral incisors, which are the most often common relapse point on an orthodontic case. They've got room and the bone becomes more stable around those as well. But yeah, so, but currently, since 2017 and beyond, when I look at or even if I'm looking at a fixed prosthodontic case on a patient, I was talking to a guy who does a lot of all-on fours and other versions of that and we were discussing with a group of people and his team and all of his staff that were in the room and I could just see it. I could see his face flush when I went, when he was realizing how many patients he had done full mouth implants on and put them in a retracted position, having no idea how much pressure he had put on the airway space. And so Invisalign and the other 73 companies that make clear aligners have been doing that for a long time too, because, like you say, they're only focused on the teeth. And are the teeth straight and do we not have space there? There's lots of patients that I've counseled with. I know it's more aesthetic if your teeth are slammed tightly together, but you as a human being can't breathe when that happens.

Speaker 2:

So what we need to do myself included, I have a unilateral post to your cross bite. I'm currently working with an orthodontic company because I was going to do my own expansion right, because I know that's what I need, so I was going to, and so I stopped and started orthodontic therapy two or three times, because I know that I'm going to need space between almost all of my front 10 maxillary teeth, and so I'm going to need, if I'm going to, if I don't want to have space between my teeth. I'm going to need to have some cosmetic dentistry done at the end, and so my current treatment plan from my orthodontic provider is one that expands without attachments, without IPR, all right and expands me to the point where it should flatten my palate, it should eliminate a lot of my snoring, it should open my airway to the size of my index finger instead of the Wendy's soft drinks straw that it is now. So that's the goal. Can we get people expanded?

Speaker 2:

And so now, and many of the companies out there Candid does a really good job with this, orthofx does a really good job, these two aligner companies that take airway into consideration. Spark does a really good job with this. In fact, they're even working on some treatments with children. From what I understand, I've never done one Spark case, but I understand they're trying to do more mixed dentition expansion on kids, and that's where we're headed with. Clear aligners is some sort of hybrid appliance clear aligner therapy that looks good and expands well.

Speaker 1:

And that's how I approach these cases where we're expanding and then you finish once you get to the dimension, then you can finish with the aligners. Then the aligners, it's easy, and you only have maybe a handful versus 50 or whatever in some cases.

Speaker 1:

But I think the other thing where we went wrong for so many years is we tended to think of the maxillaz as this fixed bone right, and so we were always focused on the mandible and that's why we had to take teeth out in order to fit right, because the maxilla, the upper jaw, is supposed to fit over the lower jaw, whereas most people, evolutionarily, it's because the maxilla has not grown forward enough. If that tongue cannot sit on the palate and rest, the tip should rest on those little rugue, we call them, the rough little bits of tissue on the back of your front teeth. That tongue's supposed to be up there to push the maxilla forward, and when the upper jaw, the maxilla, can move forward, then your lower jaw can come forward. It's, ah, that feels so good, that's where it wants to be. So, as you said, artificial, all these, every single patient I've seen I've yet to find the exception, anybody who had what you called four on the floor. It was very common. We took out four premolars to create to push everything back. All of those patients have sleep apnea In my practice, without an exception, every single person, because now we have shoved everything back into the airway.

Speaker 1:

So, and for those of you who are maybe dentists out there. How many cases have you had of fractured porcelain, something like that? And Terabridge, those patients are airway. I remember Dawson you remember them telling that story. They had this one patient and all four of the main guys. They all tried to restore him and he used to fracture, you know, and he fractured. Everybody thought they were going to do a better job right and then they all failed. And I think I don't know it's been almost 10 years since I finished Dawson, so I don't know if they incorporate more airway, but at the time I think that's what they were missing. They were missing the airway component of this patient. So no matter how beautiful and perfectly they put crowns on all its teeth, he was an airway case and until you move the jaws into the right position he's going to fracture porcelain all day long. So a lot of my patients same way.

Speaker 1:

I think the other big thing we see in adults is the deep bite, so your upper jaw covering those front teeth almost fully, covering the bottom teeth, where ideally should only be one to two millimeters, and that deep bite is another way that lower jaw gets forced back into the airway. And when that bite is very tight on those front teeth, top and bottom, as you get older, as the collagen starts collapsing a little bit, and that jaw is constantly moving forward, like you'll notice. Do you notice? On your front teeth they're starting to wear. That's not normal, right? The normal wear rate is one millimeter every 100 years. So you know there's a dysfunctional issue there. If you're starting to get wear, it's not just because you're old or that's just the way life should be. No, you're grinding forward a little bit, trying to open the airway.

Speaker 1:

So and I think most and even though back in 2017, the ADA came out and saying we all have to be looking for this, how many dentists actually you know are doing this? I think more and more. It's great. The awareness is really coming up, but, as a restorative dentist, we have to be aware of this or our stuff is going to fail Over. Not only is that frustrating the patient, we lose time and money. So having that awareness airway is so much more than breathing. You know it's all so related. So having a more holistic view is going to make your patients healthier and they're going to be happier. Your dental work is going to last longer. I think it's really really important to consider all of that. All of those things so really important. When I learned about Dawson, I learned about occlusion, but I was like that airway is missing there.

Speaker 2:

But, again.

Speaker 1:

I took my courses way back in 2015.

Speaker 2:

Yeah, I did too. I mean, I did all of that. I was fortunate to be a part of an organization where Glenn Dupont who's still teaching, I think, with them Glenn was able to come where we were. We had enough dentists that it was cheaper to fly Glenn in. There was a fly all of us there.

Speaker 2:

So got to know Glenn, and that was Pete's son-in-law by the way, and Pete's no longer with us, but I got to meet Pete and have dinner with him a couple of times and it's really nice to be around him. But yeah, we have to. As dentists, we have to think about the whole patient, and one of the things we started doing in our practice and I'm sure you do it we started having our hygienists and our assistants take blood pressure on patients, because our adult patients, their blood pressure is elevated sometimes because they're not sleeping, they're not breathing well, and so, and they'll go to a medical practitioner and they'll write them a script for a beta blocker and say, hey, we got a little hypertension. It probably runs in your family kind of thing, your cholesterol is up, whatever. Oh, but let's that's the name of the podcast right, let's treat the root cause, right, and so that's what we're trying to do.

Speaker 1:

I think, and as you mentioned, a dentist, we can be the front line and in overall health and blood pressure is one way. It's easy thing, same thing every one of our patients. They come in the assistants taking their blood pressure Because and then now we have such great sleep studies before used to have to go to a sleep place. So it's such an artificial environment with a thousand things taped here. Now Companies like sleep image and watch Pat, watch that has a disposable one, so you just take that home, you do it boom, because I still silly that as dentist, we can't technically diagnose sleep apnea. But most of these companies have sleep physicians with their company, so you send it there. So it's such a wonderful, easy, relatively inexpensive screening tool. But, as you said, sleep apnea, that is a major risk factor for all chronic diseases, right oh?

Speaker 1:

yeah, absolutely is yeah and I also we do. We use the silha saliva test with all our patients because what I found, which was really fascinating, in my own case I had done. I always been fascinated with my own health. I'm always trying to deal with my my gut and trying to get that as healthy as possible so I make sure my exa mother doesn't flare again and cause other problems.

Speaker 1:

But I did a test with biome. It was like a stool test but it included a saliva test and it said oof, your gum health is not optimal. I thought what I'm like that's crazy. And so it really made me think I don't have bleeding gums, I don't have any of the overt signs of gum disease, but what I do have is inflammation in my gut. I think we have to remember that the same tissue in our mouth is the same tissue that lines the entire digestive tract. So that to me was like oof, if I've got some inflammation happening in my gut, that's affecting the whole terrain of that mucosal tissue throughout my body. So that can create deficiencies, that can create then the overgrowth of the so-called pathogenic bacteria.

Speaker 1:

So with the silha test, I love it because it measures seven different markers. So it looks for white blood cells, protein blood. Obviously it's obvious when somebody has clinical gum disease, their gums are bleeding, they have maybe bad breath, they have recession there. But what about the patient like myself? So when I did that biome test and it came home, did silha showed oh yeah, you got a little bit of protein stuff happening here. So I know I'm like, okay, great, I see this stuff is starting. What can I do to prevent it before I start having bone loss and bleeding gums? It's so much easier to prevent things than it is to treat. So we have all these little tools in the silha. It's 25 dollars for the patient. These aren't expensive things, but amazing ways to screen.

Speaker 1:

What about the person who has reflux right? Do they have a sleep problem, right? Because when we're having reflux there's a change in abdominal pressure here. So does that mean we're gasping for air and that's causing the? Maybe we have also obviously a weakness in the sphincter there.

Speaker 1:

But again, thinking about this holistically, what's going on? What can we do as dentists To really get that patient to the next one? I think you need to get this investigate. Or they come back with a sleep Say, yeah, this was showing apnea, let's get your internist, let's get a sleep physician involved. Let's take these next steps because this is a major risk factor. So I think it's exciting to be a dentist right now, because I think we do have a little bit more time to spend with our patients and not everybody's going to have the depth. Like you, I'm in a small town, so I've had to learn as much as I have Because there's not a lot of resources. So, but in other areas in cities there are plenty of health coaches galore, right Everywhere. So reaching out and creating a community of people like, okay, do you have a good gi specialist? Do you have maybe a naturopath, somebody who is going to look at the whole body together because then we can really Make the greatest impact to prevent, prevent, I can't say it enough.

Speaker 2:

It's so much easier to prevent, and that's why we're talking today is it's about communication. It's about communicating with the family, doctors and the people and the physicians and internists who treat diabetes and treat these and and GERD and all these things that are so closely related to what we do. You mentioned Sleep image. I'm a big fan of the sleep image ring, sleep studies, and this is good news for you. In new york, a dentist cannot administer a sleep study. Did you know this? It's against dental statutes. So you're so these patients that are from new york, that are just an hour from you, they can come to you and be a patient in your office and have a sleep study. And so if we have listeners in new york that need a sleep study done they don't want to wait six months to get into the hospital polysomnography program they can come see you. And then is it northwest mass? Is that where you said?

Speaker 1:

Which is great too, with with the telehealth right because and now with the watch pat, that's disposable, they don't have to return the ring to me. Yeah, that's right, you can send it to the patient, they can do it. So that's that's another fabulous avenue for teledentistry. Let's rule out sleep apnea, or, if there is, how do we get you to to the right person? So I think that's an amazing service that dentists do Absolutely 100.

Speaker 2:

Yeah, great.

Speaker 1:

As we're, as we're winding up, is there anything else you really want to have our listeners understand? Take away.

Speaker 2:

The number one thing is nobody's going to advocate for your health but you and we just talked about all these miscommunications between our professions. We talked about how people get diagnosed with hypertension when they really have apnea. We talked about kids having tons tonsils removed when they really had underdeveloped jaws. Nothing was wrong with the tonsils, the jaws were underdeveloped. So, as a parent, as a patient, yourself research. There's no excuse anymore. We have the internet, right. We have chat gpt. You could type into chat gpt Do I have sleep apnea here on my and? And read it carefully, because chat gpt is still making mistakes. But you, there's no excuse for you not to research your own health. I'm battling it every day. I have some. I'm 54 years old. I'm Way too overweight for my height, so I'm I'm looking at ways to control my blood sugar, ways to levelize my blood sugar. I'm trying to treat with my issues as food, with food as a medicine. But the number one thing I want people to take home from this is there's a new. We're telling the new story of dentistry. Okay, dentistry doesn't have to be scary. If you're, if your dentist is scary, find another dentist and be an advocate for yourself when the doctor tells you. I want you to take this medicine to prevent diarrhea and you're also taking one that causes the cause.

Speaker 2:

I've seen patients that are on a modium ad and a stool softener and they never thought that was odd, let's you know. Or I just talked to a patient the other day who said I got a call from my pharmacy and my pharmacy said it's time for you to go to the doctor because you have to have a physical in person visit to get your medicine. We can't give you more refills until you do that. So this patient went to the doctor and the doctor said oh Shoot, we had any blood work in a while, so let's do some blood work. It wasn't fasting blood work, so the patient had pumpkin pie with lunch they did. So they did a blood sugar. Analysis of blood sugar is 202. So, oh shoot, you need farcega. So and the doctor didn't even say to the patient I'm going to call you in some medicine for your blood sugar. They just said okay, we'll see you next time.

Speaker 2:

The pharmacy called the patient two hours later and said you have a prescription and the patients said for what? And so so if the patient is not I mean you I can tell you when I got and I was going to applying to medical school, you should meet some of the people that Applied when I did and got in. These are human beings just like you. They put your pants, their pants on, just like we do every morning, and they're more busy than they've ever been, and so they're running. So guess what they're? They can't help it. It's not their fault. They're making errors or they don't have time to learn the new information that's out there.

Speaker 2:

So, as a patient, that's what I would wrap with and say be your own advocate, research, read, don't. And this patient that was just describing, when the pharmacist called them, they started reading the side effects Thank god of the medication and realized, wait a minute, I wasn't fasting when I went and I don't think my blood sugar was all that high. I'm going to take my fasting blood sugar tomorrow. And so turns out they really didn't need the medication. But there was just a whole series of Of communication errors there that happened not not because of anybody was at fault, because Things just everybody was busy. And then you got in the system and so that's the number one thing be your own patient advocate. Read research, treat, take care of your town. You're. Nobody's going to care more about your health than you Moms are the same way.

Speaker 1:

Nobody knows your kid the way you do, and we talk about it all the time Trust your intuition. Anybody who's heard my story to knows that when I was given the Final drug that was an immune system altering drug for my eczema I was like, wait a minute. I'm like, I'm 33 years old, I'm not going to shut down my immune system because I have a rash, you know so. So we all have to tap back into that intuition.

Speaker 1:

Oftentimes somebody will come into the office and you know there's complaining of pain and I can't find anything. So I say what do you think is wrong? Because I'm not in your body, just because I've been doing this for 20 years and I have all this experience and not I'm not in your body, right? I don't know what it feels like on a normal day. So it's so, so important. So I love that. You said that we have to, and I always say I also want to shout out to the pharmacist because because, as medical physicians and dentists, we are so busy, we are so lucky to have these professionals who get all the input from these different places, and they I can't, they can't imagine how many people's lives they save on a daily basis because they have their thumb on on it. So shout out Yay, pharmacist.

Speaker 1:

I love that and so, yes, please trust your intuition. If anybody wants to get in touch with you, dr Leeds, and maybe have some teledentistry and learn more, how can they get a hold of you? Yeah, they can go to my website, drblaneleedscom.

Speaker 2:

They can reach me at my phone number, 47997 smile, if they want to call me. I'm licensed in 12 states, so maybe I'm licensed in their state. Or they can send me an email to ask drleeds at gmailcom or Pre-order my book at askdrleedscom.

Speaker 1:

Great and we'll put all that into the show notes. And it's Blaine, b-l-a-i-n-e, leeds is L-E-E-D-S. And again, thank you for taking the time on this Friday afternoon to come and share all of your great knowledge, and for all those of you listening. I hope you enjoyed the episode and we'll see you next time.

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