Pediatric Tongues Ties: How They Impact Growth and Breathing with Elizabeth R. Dy, DMD

This week on The Less Stressed Life, I’m so excited to welcome Dr. Elizabeth Dy, DMD, a former restorative dentist turned airway wellness expert, who is now a leader in addressing oral ties, airway health, and sleep-disordered breathing for patients of all ages.

In this episode, we dive into the fascinating world of oral ties and their impact on everything from infant feeding to sleep and behavioral health. Dr. Dy shares her journey from general dentistry to finding her passion for functional and integrative care, as well as the importance of treating function, not just anatomy, in tongue-tie releases.

We also explore how oral ties can influence sleep quality, growth, and behavior in kids and adults, the role of nervous system preparation in successful treatment, and what to look for if you suspect oral ties might be affecting you or your child.

KEY TAKEAWAYS:

• “We don’t grow out of oral ties; we grow around them.”
• How oral ties can contribute to issues like poor sleep, mood changes, feeding difficulties, and even migraines.
• Why function-based treatments, including myofunctional therapy, are essential for long-term success.
• The importance of nervous system prep for surgery and how it helps with healing.
• Signs to look for if you or your child might have oral ties, including behavioral concerns, mouth breathing, and tension-related symptoms.

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ABOUT GUEST:
Dr. Elizabeth R. Dy ("Dee") is a Tufts University-trained dentist specializing in a functional and integrative approach to oral ties, orofacial pain, and sleep-disordered breathing. After 12 years in general dentistry, she transitioned to focus on airway wellness and now serves as CEO and Airway Wellness Director at the Sleep and Breathing Wellness Center in Tampa, FL.

A passionate educator, Dr. Dy teaches for The Breathe Institute and the Applied Integration Academy. Outside of work, she balances wellness pursuits with raising her three young sons and enjoys cooking, star-gazing, and connecting with loved ones. Known for her authenticity and bold leadership, she channels her passion into improving the lives of her patients.

WHERE TO FIND:
Website: https://www.sleepandbreathingtampa.com/
Instagram: https://www.instagram.com/tampatonguetie/ 

WHERE TO FIND CHRISTA:
Website: https://www.christabiegler.com/
Instagram: @anti.inflammatory.nutritionist
Podcast Instagram: @lessstressedlife
YouTube: https://www.youtube.com/@lessstressedlife
Leave a review, submit a questions for the podcast or take one of my quizzes here: ****https://www.christabiegler.com/links

NUTRITION PHILOSOPHY:

• Over restriction is dead
• Whole food is soul food and fed is best
• Sustainable, synergistic nutrition is in (the opposite of whack-a-mole supplementation & supplement graveyards)
• You don’t have to figure it out alone
• Do your best and leave the rest

SPONSOR:  
Thanks to Jigsaw Health for sponsoring this episode! Try their MagSoothe or MagSRT for better sleep and less stress. Use code LESSSTRESSED10 at JigsawHealth.com for 10% off—unlimited use!

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TRANSCRIPT:

[00:00:00] Elizabeth R. Dy, DMD: if you're somebody that is drawn to like the root cause we're understanding that the tongue is an important muscle that is meant to help expand the upper jaw and it's meant to help with feeding and speech.

[00:00:17] Christa Biegler, RD: I'm your host, Christa Biegler, and I'm going to guess we have at least one thing in common that we're both in pursuit of a less stressed life. On this show, I'll be interviewing experts and sharing clinical pearls from my years of practice to support high performing health savvy women in pursuit of abundance and a less stressed life.

[00:00:47] Christa Biegler, RD: One of my beliefs is that we always have options for getting the results we want. So let's see what's out there together.

[00:01:05] Christa Biegler, RD: All right, today on The Less Stressed Life, I have Dr. Elizabeth Dy, who graduated from Tufts University School of Medicine in 2011. She's a surgical affiliate at the Breathe Institute and graduate of both adult and pediatric dental sleep medicine, many residences at Tufts University School of Dental Medicine.

[00:01:20] Christa Biegler, RD: After 12 years of practicing primary care at General Dentistry, she sold her private practice and retired from restorative dentistry to focus on a functional and integrative approach to oral ties, oral facial pain, and breathing disordered sleep for patients of all ages. She also has an immense thirst for knowledge as well as personal development.

[00:01:38] Christa Biegler, RD: She's the CEO and Airway Wellness Director for Sleep and Breathing Wellness Center in Tampa, Florida, and she works with lots of other professionals. She's such an interesting blend of a person. I can't wait for you to meet her. I got to meet Dr. Elizabeth in person when we were in Tampa. the sticks in the woods recently on retreat together.

[00:01:58] Christa Biegler, RD: And so I got to enjoy all the fun that she is in real life. And I'm sure actually in her practice as well. And we talked so much about lip and tongue and whatever ties. And so I'm just delighted to have her here to share with us now. So welcome to the show. 

[00:02:13] Elizabeth R. Dy, DMD: Thanks so much. 

[00:02:14] Christa Biegler, RD: Yeah. Yeah. Yeah. And I think passion might even be an understatement.

[00:02:18] Christa Biegler, RD: So this is very exciting. I told her I didn't want just like the run of the mill generic. I don't want to give her the run of the mill generic episode on oral and facial ties because she actually brings such a newer level to it, but we'll start there and make this beautiful for everyone or make it attractive.

[00:02:35] Christa Biegler, RD: Like how do you know if you're in the right place? But first let's talk about how you got into this because it's not really. To be overlooked to go to school for eight or more whatever years to become a dentist and I think, on the outside, we may not all view that it's like giving up an identity of going to school for that and becoming something totally different.

[00:02:55] Christa Biegler, RD: I think to the outside world. We may look at this this is very similar. You're still working in the mouth. Dr. D. So tell us about why this happened a little bit of the origin story and how you fell in love with oral facial ties. 

[00:03:09] Elizabeth R. Dy, DMD: So I have three children ages nine, five and 15 months.

[00:03:16] Elizabeth R. Dy, DMD: And with my firstborn, I was really dedicated to. Breastfeeding for personal reasons. And I felt like I read the books and I went to the classes and I really struggled with pain. And I soldiered on like many women do. And I. Successfully nursed, I would say, and transitioned him to solids.

[00:03:41] Elizabeth R. Dy, DMD: And so when I had my second born son, I was like, Oh, the first one, he he fixed me anatomically that was no big deal. So I was expecting it to be like this easy peasy walk in the park. And we really struggled again. I had a lot of pain. I went to his pediatrician and I said, is this a lip tie?

[00:04:05] Elizabeth R. Dy, DMD: And he said to me, yes but we only ever refer out if mom is in pain because he's a boy and the first time he falls, it will fix itself. And so I thought to myself That's an odd thing to say but I am in pain so go ahead and give me that referral. He gave me a paper that he handed over and he said this guy is an ENT and this one is a dentist with a laser.

[00:04:36] Elizabeth R. Dy, DMD: And so I've been interested in laser dentistry since just a couple years out of school. And so I was like I know the difference between a laser dentist, because laser dentistry is very, it's a paradigm shift. Shocking that attracted me and a dentist with a laser. So I marched the poor kid across the parking lot to my office and treated his lip tie myself.

[00:05:02] Elizabeth R. Dy, DMD: Nursing got a lot more comfortable in those first couple months, and then that magical three, four month mark outside of that fourth trimester, the pain returned, he was yanking and tugging. And it was like this time where your milk supply goes from hormonally regulated to supply and demand regulated.

[00:05:25] Elizabeth R. Dy, DMD: And the little guy I found out later, couldn't lift up his tongue to demand the milk. So I was brought to awareness by some colleagues in my group called mommy dentist and business. And I found out about tongue ties and I went down this rabbit hole and I was pissed off and I. remember walking into my office and telling my then associate like I know I love general dentistry, but I have found my calling.

[00:05:58] Elizabeth R. Dy, DMD: Like I really want to help moms who struggle. I want to help them in their journeys to meet their goals and have their journeys end when they're ready and not because of miss education and missed opportunities. And so I became. Just all encompassed by this information. And I started pouring myself into a whole bunch of continuing education with the Breathe Institute.

[00:06:26] Elizabeth R. Dy, DMD: With Vivos, I learned a lot about just airway development, sleep medicine. And that's how that started. And I think because it's been such an organic process for me, it was attracting. patients and I started listening and saying because there's this unique subset of patients that really wants to dig down to the root cause, like I can't forget about my adult patients, my older kiddos, like it's never too late to treat.

[00:07:00] Elizabeth R. Dy, DMD: It just becomes a little bit different. And so I just decided that was like, 

[00:07:06] Christa Biegler, RD: Your thing. 

[00:07:06] Elizabeth R. Dy, DMD: My calling to be that person that helps them find the answers that they don't yet know they have the questions for. 

[00:07:15] Christa Biegler, RD: Yeah. So on that note, and let's not glaze over the fact that you went in to figure out why you were having pain and breastfeeding, and then you literally treated your son's tongue tie on your own.

[00:07:28] Christa Biegler, RD: You were like, thanks for these referrals. I got 

[00:07:30] Christa Biegler, RD: this. 

[00:07:31] Elizabeth R. Dy, DMD: Yeah, I did his lip tie. I did have a colleague initially release his tongue tie. It was a little bit like more fashionally functionally involved. So I was, I ended up being the one to revise his tongue tie when he was two and a half. 

[00:07:48] Christa Biegler, RD: Oh my gosh. 

[00:07:49] Christa Biegler, RD: But it was How painful is 

[00:07:52] Christa Biegler, RD: this for a baby?

[00:07:53] Christa Biegler, RD: To release the laser. 

[00:07:56] Elizabeth R. Dy, DMD: So the way that I describe it is that first, there are different types of lasers. And so we have different lasers in our practice for different types of treatment. So when we're doing a tissue release, especially with an infant, we're going to choose the laser the light scalpel CO2 laser that has a shallow depth of cut.

[00:08:17] Elizabeth R. Dy, DMD: And it cauterizes as it goes, and we secure babies so that we have a lot of control because we can cut fiber by fiber, so we want to make sure we get just enough of what they need and not more, so we want something that's going to allow for that precision with the least amount of thermal damage possible.

[00:08:40] Elizabeth R. Dy, DMD: So in my practice we attract a lot of holistically driven families. So we tend to lean a lot on nervous system preparation with body professionals and homeopathy. And so I can't say that it's not. Uncomfortable, but certainly at a very with a very vulnerable population, parents do also get concerned about like the chemicals and anesthetics.

[00:09:08] Elizabeth R. Dy, DMD: And so we try to meet families where they are. It's pretty amazing, though, the amount of tension in a tie and how it can present for a baby how they react when that tension is released because they're Transcribed upset when you're stretching that tight tissue and you're trying to mimic function and show how they're, they can be frustrated at the breast or the bottle.

[00:09:34] Elizabeth R. Dy, DMD: And so initially, you have that wound healing process. But sometimes with the babies you see how Relieved they are when that tension is now gone away and some babies have so much tension that they physically feel lighter to the parent when we hand baby back. 

[00:09:55] Christa Biegler, RD: Oh my 

[00:09:55] Christa Biegler, RD: gosh. 

[00:09:55] Elizabeth R. Dy, DMD: They have light in their eyes like, oh my, oh 

[00:09:58] Christa Biegler, RD: my gosh.

[00:09:59] Christa Biegler, RD: I remember. And I don't remember how old your second born was when you released that tie, but I feel like you were showing us pictures of the change in his face literally over a short amount of time, right? 

[00:10:11] Elizabeth R. Dy, DMD: Oh yeah. Oh, so that one was actually, that was my eldest when I learned about the ties and I started to look at him differently because each individual is going to Manifest these ties in a different way.

[00:10:25] Elizabeth R. Dy, DMD: And we are human beings that are designed to thrive. And so we will not grow out of ties rather grow around them. And so for my eldest one he was eating a lot of So we would never consider him a picky eater. He had a very healthy diet. But when he would sleep, his mouth would be open. His tongue would be down.

[00:10:48] Elizabeth R. Dy, DMD: He was more hyper reactive to like pollen. And so his eyes would swell up very easily. When he would wake up, he'd have these dark circles underneath his eyes, venous pooling. He'd have the occasional night terror. And as soon as we did that initial tongue tie release, no more night terrors, mouth closed, much easier breathing, no more venous pooling underneath the eyes.

[00:11:17] Elizabeth R. Dy, DMD: And now like very rarely gets like sneezy and reacting to pollen the way, versus getting a phone call from the school to pick him up because his eyes were so swollen that he couldn't see. 

[00:11:32] Christa Biegler, RD: Okay. I love it. I want to just underline that we will not grow out of ties, but we grow around them.

[00:11:36] Christa Biegler, RD: And so you offered a couple of reasons that someone might come in. Maybe the baby would be frustrated at the breast or bottle as a baby. And you've said this many times in different ways. And so this is a two sided question. It's like the exciting, cool stuff that you see, which you've just talked a little bit about.

[00:11:52] Christa Biegler, RD: But I want to know some additional reasons people might, or you might see a patient as a baby and what might be some of the reasons that. A kid comes in as an older child as well, just to create a bit of a list of maybe this actual structural issue is part of the problem. So what would be some other reasons baby would see you other than frustration with eating? 

[00:12:15] Elizabeth R. Dy, DMD: So in my practice, we're focusing on function. And so the way that I explain it is, if you're here because the pediatrician has identified the tongue tie or the lip tie, it's likely because it is medically necessary. The baby can't figure out how to organize the muscles to drink enough milk, whether it's formula or breast milk, in order to gain weight.

[00:12:41] Elizabeth R. Dy, DMD: So they're dropping in weight because they're expending more energy. then they're able to take in. Okay. So sometimes that looks like baby is falling asleep. It's taking forever for them to get those calories in or they get the milk down and then the majority of it comes up and spit up. Sometimes they're staying on their growth curve, but Families come in because there is excessive gas, they're they're colicky, and so there's not a airtight seal around the breast or the bottle, and gulps of air are going in with gulps of milk, and so if that air really settles in the intestines, it can be uncomfortable, they get very gassy.

[00:13:28] Elizabeth R. Dy, DMD: If it settles up, In the stomach, they can get really uncomfortable and that's more like colicky. If it settles up in the esophagus, then they may spit up more. Many babies have a combination, okay? So if they are having trouble with latching, oftentimes people are like, Oh, there's a lip tie or a tongue tie, go seek help.

[00:13:53] Elizabeth R. Dy, DMD: But that dysfunction can be happening at the bottle as well. But there are many bottles. That are made to accommodate oral ties. And so it masks that they stay on their growth curve. The parents are unaware, right? And so there is this concern of over diagnosis of oral ties and this mis education that oral ties are only if they're struggling with breastfeeding because there's this belief that they will grow out of it.

[00:14:23] Elizabeth R. Dy, DMD: But then when we fast forward, perhaps when they reach. three, four months old, they cannot have that range of motion to lift up the tongue and demand the milk. Or if they're having maybe they're now starting solids and they can't manage the solids around their airway safely. So they're jagging, they're becoming now protective of their airway.

[00:14:49] Elizabeth R. Dy, DMD: fearful of certain textures of foods that they don't have the coordination to manage. If they're holding a lot of body tension, perhaps we're seeing that as feeding is getting accomplished, but there's so much body tension that they are asymmetric in their rolling. They are skipping important milestones like crawling.

[00:15:12] Elizabeth R. Dy, DMD: They're very delayed in their walking, or perhaps they're more advanced. In milestones, and not because they have built up the muscle tone for things like standing up, but they're rather being pulled up for attention. So either delayed milestones, asymmetry in your body movement, or like seemingly advanced.

[00:15:35] Elizabeth R. Dy, DMD: Milestones can also be a red flag. 

[00:15:38] Christa Biegler, RD: I 

[00:15:38] Christa Biegler, RD: mean, almost anything and a lot of not some of those later ones, but some of the earlier ones are things that people come to me with. So it'll be interesting later. We can talk about nutrition versus structure, which is. Fascinating. Also carry on 

[00:15:52] Elizabeth R. Dy, DMD: versus because sometimes, we are evaluating a mom and baby diet.

[00:15:58] Elizabeth R. Dy, DMD: And it is that the symptoms are such that before we even do any type of procedure or concurrently with the procedure, we are working with an allergist or a nutritionist to evaluate like. Does mom need to cut out something from her diet or look at a specific type of formula because of some sort of intolerance or sensitivity for me with my youngest, we were having some problems with his bowel movements and we had already addressed, the function that would be contributing to what was going on with infrequency of bowel movements and I ended up Eliminating gluten and dairy, and we saw some improvement.

[00:16:44] Elizabeth R. Dy, DMD: I followed up. I changed pediatricians. We talked about potentially giving up soy. I went and we did some muscle testing, realized he had a sensitivity to stevia, and I was having a packet in my coffee every morning, drinking electrolyte drinks that have stevia in it, and he was just getting too much. So yeah.

[00:17:04] Elizabeth R. Dy, DMD: I cut out the stevia, he tested fine for dairy, so no stevia, no gluten, tested again, he just had too much stevia. So now his gut has been repaired, if he gets a little gluten accidentally, we will see softer stools, but we're no longer seeing days. Without a bowel movement. So it all goes together the way that, the body's designed.

[00:17:29] Elizabeth R. Dy, DMD: But another reason why families may return to me later on. For example, I'll get some older kiddos, anywhere between three and eight, and they'll say. I really don't understand because we nursed for a year or two years even and this was never brought to our attention that there could be oral tithes, but why are we here?

[00:17:54] Elizabeth R. Dy, DMD: And they may have been referred by The speech language pathologist, they may have been referred by the occupational therapist because of sensory concerns, autonomic nervous system dysregulation, they may have been referred by the orthodontist who is saying, I can't. move these teeth because we're fighting a tongue thrust, which a tongue thrust can be a compensation for an inability to lift up the back part of the tongue.

[00:18:27] Elizabeth R. Dy, DMD: And so these families will either say, I don't understand because we had this long nursing relationship, or we have the tongue tight clipped at two days old at two weeks old at the ENT. So then we get into a discussion of. Treating anatomy versus function. So again, that like medically necessary high, they give just a little more range of motion so that they can ingest those calories.

[00:18:56] Elizabeth R. Dy, DMD: Mom can be without severe pain. But it does not mean that there's enough range of motion for the oral facial muscles to be working in balance as they were designed to. Yeah. 

[00:19:08] Christa Biegler, RD: You just gave me a great opening to anatomy versus function. However, before I go there, I want to know, you just gave us lots of reasons people might be referred in for older kids.

[00:19:17] Christa Biegler, RD: What if the parents are figuring this out on their own? I'm guessing some of the same things that you saw in your son. This is a very attuned parent because I've had these, mouth open at night, maybe some congestion, maybe some circles under eyes, similar things to what I see.

[00:19:35] Christa Biegler, RD: What are some other reasons that parents might come in on their own without confusion, but they're just like I feel like something's not quite right. And I'd like assessment on that as well. Or you could flip that and say here are some of the crazy things that I've seen as we've addressed this with these kids.

[00:19:49] Christa Biegler, RD: Which is also very funny. 

[00:19:50] Elizabeth R. Dy, DMD: Is this related and I'm like, I'm never going to tell you, things aren't related, but let's explore this a little bit more. What does your intuition tell you? All I can do is tell you what I see and then rely on the functional therapists. Okay. Some of the things that.

[00:20:06] Elizabeth R. Dy, DMD: We've seen, yeah, like parents getting attuned to the fact that they're breathing, they're snoring at night and they're seeing the behavioral concerns. Social media has brought a lot of attention to these topics, so families will self refer or their, friends were dealing with something similar.

[00:20:29] Elizabeth R. Dy, DMD: A lot of it is going to be self referrals for mouth breathing behavioral concerns. 

[00:20:38] Christa Biegler, RD: Yeah, what specifically? 

[00:20:40] Christa Biegler, RD: You mentioned 

[00:20:40] Christa Biegler, RD: sensory before, but is there other big red flags? 

[00:20:44] Elizabeth R. Dy, DMD: Lots of aggression attention disorders. They're supposed to screen for Concerns with sleep if there are behavioral concerns in the school.

[00:20:57] Elizabeth R. Dy, DMD: However, there is this opportunity for providers to be better informed on the quality of sleep as opposed to the quantity of sleep. And so if there are different reasons why sleep is beneficial, and if a patient is this getting enough sleep to get enough growth hormone that they're staying on their growth curve.

[00:21:27] Elizabeth R. Dy, DMD: It's just not usually going to flag it, but we have different phases of sleep that help with immune system repair, cognitive repair, the activation of the glymphatic system for cleansing the brain of metabolic toxins and protein byproducts, like we have a lot of different opportunities , to put these things in our bodies.

[00:21:51] Elizabeth R. Dy, DMD: Whether it's medication food environmental things, contributing factors as well. And so sleep is an opportunity for us to help cleanse these out. And REM sleep as well, we want to spend a certain amount of time in different sleep stages. And if there is an arousal, we are going to shortchange ourself.

[00:22:19] Elizabeth R. Dy, DMD: Opportunity in these different stages and we'll stack up more light sleep. And so my analogy for that is, you've got the latest iPhone you are trying to use this app and you update it and you're like, it's not working. You're getting so frustrated. You're tapping on your phone really hard and you're like, why isn't this working?

[00:22:41] Elizabeth R. Dy, DMD: What's the next step? Way, power down your phone and fully power it back up. You do that and all of a sudden everything is working clearly and that's what we're meant to do. When we sleep, we're meant to fully power down and we're meant to have this beautiful chemo signaling through our breath work to allow our brain to know that we're in a safe place to shut down and reboot.

[00:23:06] Elizabeth R. Dy, DMD: And that's the difference between getting 12 hours of sleep and then needing, Red Bulls or a latte in the middle of the day, or really needing that nap to get through the day. Perhaps having brain fog or being more irritable. That's the difference between that and getting eight hours of sleep and waking up refreshed and ready to take on the day.

[00:23:32] Elizabeth R. Dy, DMD: So we want to make sure that if there are different types of arousal opportunities, perhaps you're a young family with kids that might wake you up in the middle of the night. That is not something that you can control. But any respiratory type of arousals that we can help you with to help optimize your sleep that can be really beneficial for getting that cognitive repair.

[00:23:59] Elizabeth R. Dy, DMD: And that way you have that reduced amount of irritability and that short fuse proper. 

[00:24:06] Christa Biegler, RD: So you see kids as mood change. 

[00:24:09] Elizabeth R. Dy, DMD: Absolutely. Absolutely. And it. Oftentimes with our approach, because we focus so much on function, they're working with functional therapists. throughout the process. So it's less of a like they get the release and aha, like that was the thing because we're working on function.

[00:24:29] Elizabeth R. Dy, DMD: We're seeing slow improvements throughout. And that's my whole point is to say, we want to learn you through function and that way everybody in the room knows what it is that's being treated and why it's important and you better know that you're on the right path and you're not searching for like a magic fix.

[00:24:50] Elizabeth R. Dy, DMD: We're all about empowering patients and families as opposed to looking at you and being like. This is a problem that we're going to fix for you. 

[00:24:59] Christa Biegler, RD: And you're magnetic when you talk about it because it's like, this should happen in your sleep. And so it's this beautiful orchestra of everything working beautifully.

[00:25:07] Christa Biegler, RD: And so it's very lovely. And I often tell my clients that. I have had most of the problems that they have. And in your story with your, I think it was your older son, you'd had a release and then you had essentially some regression. And so you've mentioned a couple of times function versus anatomy.

[00:25:24] Christa Biegler, RD: And the question is going to be for fun, just to flip it. It's what are these mistakes that people make with tongue ties? And I'm guessing that the answer is, Focusing on only looking and nothing doing anything. So talk to us about what the heck you're talking about when you say function over anatomy.

[00:25:40] Christa Biegler, RD: You mean it's not just that you clip it and you're done, right? What else has to happen? 

[00:25:45] Elizabeth R. Dy, DMD: Yeah, 

[00:25:45] Christa Biegler, RD: So a while back my college aged daughter shared with me that she was tossing and turning and waking up several times per night after a period of stress. We started her on magnesium and her sleep immediately improved. I personally think magnesium should be your first thing to try if you're having trouble sleeping or staying asleep, especially tossing and turning, and it's a no brainer if you have any restless leg issues.

[00:26:10] Christa Biegler, RD: The thing about magnesium is that there's a lot of types of magnesium that will give you symptomatic relief, but I like to steer my clients and loved ones to a more absorbable form of magnesium, because most big box magnesium is magcitrate, and that will push bowels, but it can be damaging to your teeth if it's used daily and it's not the most Rather, Jigsaw Health makes one of my favorite great tasting magnesium powders called MagSue that has magnesium glycinate, my favorite calming and absorbable type of magnesium. It's available in both a great tasting powder and to go packets, and they also make a product that's great for slow release, especially if you have restless legs, called MagSRT.

[00:26:51] Christa Biegler, RD: So, If you are not falling asleep easily or if you have disrupted sleep, you can try at least 200 milligrams of great magnesium like MagSoothe or MagSRT, especially if you have restless legs. It works better to take this at least 20 minutes before you go to bed to allow it to kick in and you can get a on All of Jigsaw's amazing products, including MagSooth at Jigsaw Health with the code LESSSTRESS10.

[00:27:16] Christa Biegler, RD: Now you can use LESSSTRESS10 as many times as you want with every order at Jigsaw Health, which is honestly pretty unheard of with coupon codes. So enjoy the magnesium from Jigsaw with my code LESSSTRESS10.

[00:27:31] Elizabeth R. Dy, DMD: if you're really looking, if you're somebody that is drawn to like the root cause we're understanding that the tongue is an important muscle that is meant to help expand the upper jaw and it's meant to help with feeding and speech.

[00:27:50] Elizabeth R. Dy, DMD: And so just to say oh, you've got a tongue. It's clear as day to me, because I've done all these courses. I'm the expert. Let's just I'm here. You're here. My laser is here. I've got the time and to release it. It doesn't mean that muscle is going to know what to do differently. And so you wouldn't say Oh, this is going on with my knee and I'm just going to jump into surgery.

[00:28:12] Elizabeth R. Dy, DMD: And then you're going to go right back to the activities that got you in that position. You're going to retrain, rehab those muscles. And so the biggest mistake would be to jump in with high hopes of it. Addressing what it is that's most meaningful to you and not understanding why that became such an impactful function that you were like, I have to fix this because it can be so much more, the doctor that is going in and clipping is helping with something that's medically necessary, but An integrative and a functional approach is about the quality of life.

[00:28:58] Elizabeth R. Dy, DMD: And that's not something that people can expect to have medical insurance cover, because that's not what medical insurance is for. And so we oftentimes will get families that will call in and just say I think my son has a tongue tie and I made this appointment, but I'm going to cancel it.

[00:29:15] Elizabeth R. Dy, DMD: I'm going to go with this other provider. That's in network. We wish you the best. We want someone to meet your needs but, we also just think perhaps that wasn't our target patient that searching for the answer is that is like that. patient, that parent that is saying, I noticed that, my son does this when we're expecting him to do it this way.

[00:29:39] Elizabeth R. Dy, DMD: And I want to know why, why is it that he makes this like grimace when he's swallowing? Why is it that a kiddo just barely brushes him on the playground and it's a full on meltdown or other kids might be like, Hey man, sorry I bumped into you. What's going on? If someone has that reaction and the parents like, Oh, it's cause I heard there was a tongue tie.

[00:30:06] Elizabeth R. Dy, DMD: And then you just jump in because you read on social media that. Behavioral concerns can be related to oral ties and you're just like, Oh, huzzah, big fix. And then nothing is different. Then we're contributing to these, the reason these New York times articles are coming out about overdiagnosis of tongue ties. 

[00:30:27] Christa Biegler, RD: Yeah. And on this note, do we have more ties than before? Is there something changing in utero that we are having more ties? Were they always there? Do we think that we're evolving with more ties? What's up with that? 

[00:30:42] Elizabeth R. Dy, DMD: I think that's a tough question to answer.

[00:30:45] Elizabeth R. Dy, DMD: And it's probably a little multifold, right? Like we are evolving because we had, we used to have room for our wisdom teeth and we don't need more. We're smaller in the way that we function. We also. are eating different foods. We have different sensitivities. So yes, there is a component of of evolution there, right?

[00:31:08] Elizabeth R. Dy, DMD: Also when there are parents that have dysfunction and oral ties and tension patterns that can get passed down because in utero, if a mom is not oxygenating properly. Who's teaching baby how to oxygenate and baby's growing in utero and everything is tight because the fascia goes from the tip of the tongue down to the tip of the toes and it's wrapping around all your internal organs.

[00:31:41] Elizabeth R. Dy, DMD: So there's a lot of tension there. What is baby fighting and trying to grow and what positions are they having to get into as they grow? So are they coming into the world already with tension patterns and then, expecting to function around that as well? So I would say that probably we are seeing more.

[00:32:07] Elizabeth R. Dy, DMD: One, because we are evolving, two, because there's more awareness to it but also, I feel like it's been a thing this whole time, and we haven't had that awareness because I treat all ages, and so I see just as many older kids and adults. And senior citizens, as I do newborns, 

[00:32:29] Christa Biegler, RD: and I think another day we can talk about adult symptoms, but I heard you just say something that I wanted to highlight that.

[00:32:35] Christa Biegler, RD: I remember 1 of my colleagues said that she could never there was a couple interesting things that happened after her tie was released as an adult in her. And she said she could touch her toes for the first time in her life, but also her HRV, or a measure of her nervous system, was never, she could never, with all kinds of inputs, she could never really get it to the right place.

[00:32:56] Christa Biegler, RD: And I would say, I definitely have people where that could be or I've had them where that could definitely be an issue too. If tension is one of the problems with a tie, then I think we have a tense society. In a way, right? And and I see the tension sometimes oozes through the screen because I do all telehealth.

[00:33:17] Christa Biegler, RD: And so I almost see that. And so on that note, when we're thinking about, and I want to go, we'll talk about nervous system and homeopathy and all that prep first. But of course, what people really want to understand that is not incredibly clear is how can someone maybe know if they have a tie without flying to Tampa to see you right away, right?

[00:33:39] Christa Biegler, RD: Like, how can you start that assessment at home? You gave us some symptomatic red flags, but are there some types of things that can help you know maybe this is an issue? 

[00:33:47] Elizabeth R. Dy, DMD: Yeah, so I'm frequently seeking someone to fix you. Whether it's like the stresses of your occupation.

[00:33:59] Elizabeth R. Dy, DMD: That's one thing, but if you just in general have always needed that chiropractic visit and it's no longer about a chiropractic adjustment to optimize and keep you well, it's more about like function is consistently subluxating you. What's going on with that function? Why can't you hold an adjustment for the rest of the week?

[00:34:25] Elizabeth R. Dy, DMD: Why do you feel like great in that moment? And then later that day you get in the car and you feel like you didn't hold it we want, we love, Chiropractic, we want it to be what it's intended for and to be optimizing your health. If you're constant, like you go get a deep tissue massage and you're like, just get in there.

[00:34:49] Elizabeth R. Dy, DMD: I need it go as hard as you need to, because I know that my body needs it. and you leave and you're still in pain or you feel like I have to have that regularly, you feel like it starts to get to the point where you have anxiety, where if my regular practitioner goes on vacation. What does that mean for me?

[00:35:15] Elizabeth R. Dy, DMD: That's quality of life, right? What if I go on vacation? Am I going to be miserable the whole time? What's going on with function here, right? What you can do is start to explore. Do you have a history of orthodontics? Again, if the tongue was meant to rest, like proper oral resting posture is your tongue up, your lips together, and easy breathing through the nose.

[00:35:42] Elizabeth R. Dy, DMD: If we have excessive forward head posture in order to open up the airway because having proper alignment will close off your airway, we didn't grow enough forward, then we're making postural adjustments in order to breathe through our nose. Or maybe it's so bad we're so clogged up and we're so narrow that we have to always have our mouth open and our tongue down in order to just breathe.

[00:36:10] Elizabeth R. Dy, DMD: Are we constantly taking like gasping for breath while we're eating? Are we talking very quickly? Because we have to take like little touch up breaths in between because we need to mouth breathe, but we also are talking, right? That's another thing. If we go in, we hold a lot of things in our soft tissue.

[00:36:34] Elizabeth R. Dy, DMD: And so if we go in and we just start stretching like our lips and our cheeks, if we touch the floor of the mouth underneath the tongue and it's like rock hard, it's so painful. Sensory input in the mouth is so painful. Perhaps we explore that. Do we start getting myofascial release? Do we start, doing self massage once we get that, or are we able to get that to relax?

[00:37:04] Elizabeth R. Dy, DMD: Or is it's constantly always tight and tense? It's very rare that somebody comes to me and there isn't room for improvement. But my goal is never to attach a surgical procedure to every person that comes into my practice. It is always to say, like, how can I help you? Can we get that tension to relax?

[00:37:28] Elizabeth R. Dy, DMD: Can we get function to improve? And if we hit a plateau in your progress, and you've now become more body aware, we've taught you how to look inward, we've empowered you is this It's now a crossroads where, to continue improving, we need to address these oral ties. 

[00:37:48] Christa Biegler, RD: Yeah, and I would imagine, you said almost everything about this when we talk about tension, but I'm sure headaches and migraines would definitely be a potential sign. 

[00:37:57] Elizabeth R. Dy, DMD: Yes, yeah, 

[00:37:57] Elizabeth R. Dy, DMD: so if we are overusing our lips and our cheeks to make up for limited range of motion with the tongue we're going to be pulling on all of these little cranial bones, right? And so if there's connective tissue that attaches these bones together and we're just like having all this tension and we're sliding like tectonic plates.

[00:38:24] Elizabeth R. Dy, DMD: We can imagine how that can be painful. And so absolutely a lot of patients that present with an unaddressed oral ties. If you're an adult, they're usually saying, I have clicking popping in my joints, I have a history of migraines I've been told that I grind my teeth. Do you go to the dentist and they can't take x rays because you can't tolerate the sensor in your mouth.

[00:38:53] Elizabeth R. Dy, DMD: You're getting your teeth cleaned and you just feel like you're drowning and you always have to reach for that suction. You have to be the one in control. of that, suction, or you might feel like I'm going to drown. It gives you anxiety. Do you go to the dentist and You have a high cavity rate.

[00:39:11] Elizabeth R. Dy, DMD: You get fillings or crowns and your teeth are always cracking. The fillings don't last. You get cavities come back around those fillings. The bites just never right. That's going to be high risk for at least improvement in the way that you're functioning. 

[00:39:27] Christa Biegler, RD: So when you're doing releases, there's a lot of other clinicians.

[00:39:31] Christa Biegler, RD: You're doing this, I would just call like this extreme holistic approach in your office. It's very common for people to use that word, but I mean it really seriously. With you, because I know a little bit about you. So there's lots of practitioners that kind of help. I almost think of it like, oh, to your PT for the mouth that is sometimes happening, right?

[00:39:48] Christa Biegler, RD: Usually, it's just to draw a connection that's like familiar for people. I'd love to know you mentioned. Before a little bit about you're doing nervous system prep and homeopathy to ease this talk to us about, and you mentioned that we store a lot in soft tissue, which speaks to me about nervous system prep, but tell me what happens when you prep your clients before, or you support them after surgery with nervous system prep and what does that kind of look like?

[00:40:11] Elizabeth R. Dy, DMD: Just to give a couple examples from this week I had a four year old in that I met a year ago, and I, identified that parents concern was mostly behavioral, and paired this four year old, then three, with an occupational therapist that I work closely with, and she specializes in retained primitive reflexes.

[00:40:39] Elizabeth R. Dy, DMD: And The whole point was to get the patient out of fight or flight so that the patient was not in fight or flight when we were like introducing an intentional trauma, right? That's a surgery is going to be an intentional trauma. Are we adding to the trauma that this little girl is holding in, or are we saying, function wise, there's room for improvement.

[00:41:05] Elizabeth R. Dy, DMD: I see oral tithes but that's not like it. The top priority for me, because if we just cut these ties and she's in fight or flight and we didn't address any of this, what's the likelihood that we're going to maintain that range of motion, or are we just going to sew it right shut because our soft tissue was like, I don't have time for this.

[00:41:30] Elizabeth R. Dy, DMD: Almost a year, they were very good about bringing her in and when that therapist said she is ready, they scheduled, we did a co treatment, which means that that occupational therapist was in the room with me and she was helping to prepare the patient beforehand. We talked about everything, what we were going to do.

[00:41:55] Elizabeth R. Dy, DMD: She came into the room. We did for that age use topical anesthetics. Okay. And she at moments did not love it. But she was really brave. She did amazing. We did a one week post op today. Did she hate me? Was she throwing a fit coming into the office because she was just terrified to see me?

[00:42:17] Elizabeth R. Dy, DMD: No. She came in, by the time I walked in the room, she was still smiling. She gave me a hug. She voluntarily got up on the table. She allowed me to stretch, take my post op photos. That is what like nervous system prep. can do for a child. And so some providers will be like, Oh, they're like non compliant.

[00:42:42] Elizabeth R. Dy, DMD: Like you, we can do the releases, but we're going to sedate your child and do the releases. And there can be a time and place for anything, right? But if the wiring from the connective tissue is such that a patient does not have that prep. And they go to sleep in one body and they wake up in another body.

[00:43:07] Elizabeth R. Dy, DMD: How confusing is that? So that's one way that we find that can be really beneficial just so that we feel like we're not in a room doing like being like a technician, just releasing the ties and the child's like screaming. And we're like, good luck with that. Afterwards, if our whole goal is to Increase the range of motion, maintain that range of motion so we can rehab the muscles to use that increased range of motion.

[00:43:39] Elizabeth R. Dy, DMD: There's such a reliance on the parents for the after care management. And if we're needing to sedate your child to get in the mouth, are you going to be able to get in the mouth four to six times a day to stretch? 

[00:43:52] Christa Biegler, RD: For the rehab. 

[00:43:54] Elizabeth R. Dy, DMD: How much benefit are we going to get there? Another reason it can be super important.

[00:43:59] Elizabeth R. Dy, DMD: And what do we do about that? I had a woman that had two surgical expansion procedures. So she, had surgeries by the time I went in there to look she was referred by a postural. Physical medicine specialist. So a PT that can relate how the bite and the eyes come together, give us a sense of our body in space and how are we adapting our posture to make sure that the horizon is steady. And so she had a life of pain, and she had tried to have expansion. She had two surgeries, and When I was just reflecting her tissue to take some pictures, when we were talking afterwards, she said, while you were doing that, I was experiencing PTSD from when I had my surgery, my jaw was wired shut it just brought me back to that place where I had to walk around with a pair of pliers on a chain around my neck because they said, don't look at your shoulder.

[00:45:06] Elizabeth R. Dy, DMD: Your incision sites, if you start crying, you're going to hyperventilate and you're going to have to cut. Like all of that came straight to top of mind after, I think, 45 years because I stretched her lip. So the body keeps score, the tissue tells the story. And so for me to go in and say this didn't heal optimally, it's holding you back.

[00:45:32] Elizabeth R. Dy, DMD: Let's go ahead and surgically release it the way that I think is how that going to bring up? And how quickly is that tissue going to want to scar shut because it knows this trauma. And so that's going to be something really important in her prep work. 

[00:45:51] Christa Biegler, RD: And how those are really valuable stories because these would be very underrated things.

[00:45:56] Christa Biegler, RD: And we're pretty aligned. I always talk about this kind of. triad of, in one corner of the triangle, there's like nutritional and chemical reasons for the symptoms. In another corner, there are structural reasons. And there are so many different types of structure, right? So alignment in whatever type of way I work with a lot of skin stuff.

[00:46:14] Christa Biegler, RD: So like skin integrity, that structure, what's going on in the environment structure. And for you, this is such a huge structural piece. And then the third part of the triangle is always this like emotional and nervous system regulation. piece, an energetic piece, and you would bring that just beautifully into the triangle so nicely.

[00:46:32] Christa Biegler, RD: And so it's just cool because you offer this entire other set of holistic tools to help people with these common but not normal symptoms from anything, from tension. Anything from tension pain. And it looks so different on so many profiles. So from any issues with feeding any in your story was so inspiring to, as adults, and thanks for describing my husband to a T when you described the dogs also.

[00:46:57] Christa Biegler, RD: So I got him that way though. Though and near me, I don't have someone who does this well. I actually sent him to the only holistic dentist within a couple of hours who gave him an oral appliance to broaden his palate. She let him know that he has a remarkably, I don't know what she said exactly, but, because it's been a year or two since I've read the report, but, so he wears this appliance every night.

[00:47:17] Christa Biegler, RD: And so the real question is, when people hear you talk about this and they're like, wow, I love Dr. Elizabeth How can I assess what I need? Does Dr. Elizabeth do assessments from a distance or how does someone find someone who is, that's the concern is that people are like, how do I find a holistically minded dentist?

[00:47:35] Christa Biegler, RD: But then you're like a different level as well. So how do people kind of land in the right place instead of kissing frogs? 

[00:47:42] Elizabeth R. Dy, DMD: So the reason that I'm here is because my mentor, Dr. Sarooj Zaghi with the Breathe Institute started taking a functional approach to oral ties, and there were just so many patients and families flying to California to see him that he really started this wave of education by creating a link.

[00:48:09] Elizabeth R. Dy, DMD: educational courses for other providers. He's an ENT and a sleep surgeon. So everything that he does, he's, we're talking about. Proper tongue position to help establish and support nasal breathing, because that's so important for wellness, right? And because so many people were flying to him, he started taking on, small groups of dentists to train us on this approach and why it's important and why it's important to evaluate.

[00:48:46] Elizabeth R. Dy, DMD: function, why it's important to get that body prepared for best outcomes. And so because people were replying to him, he's like, how can I one on one train? Providers that are really passionate about this so that patients can stop flying all the way out to California if they're closer to Florida.

[00:49:05] Elizabeth R. Dy, DMD: And so the breathe institutes website, breathe institute. com has a directory of providers that have trained in this. So we have the release providers and we can be ambassadors where we've just taken his course and we're familiar with his methods. And perhaps we've really integrated that into our own practices.

[00:49:28] Elizabeth R. Dy, DMD: And then there are these surgical affiliates like myself, where we have gone and for a couple days stood at his side shoulder to shoulder while he did and follow ups and procedures, and observed him and then went back to Our offices and put together patients because then he came to my office and said at my shoulder and watched me do consultations and follow ups and surgeries and absolutely was calling me out in front of patients like identify this nerve identify this vein because it's really important that if you're leading a patient through this journey, you're taking on that responsibility that you have the background education to keep them safe, to know when they're prepared to set realistic expectations.

[00:50:19] Elizabeth R. Dy, DMD: And so that's the difference between an ambassador and an affiliate, but for sure if you go on their website, you can see who has. even started to study this point of view. They also have a directory of myofunctional therapists. And so a lot of myofunctional therapists will work virtually.

[00:50:38] Elizabeth R. Dy, DMD: And so we will get referrals because they've been working with them, a myofunctional therapist, and then I'm the closest surgical provider. So even if it means that they're coming from Georgia, but they've chosen me, or they've come from another part of Florida at least then their number of visits with me.

[00:50:59] Elizabeth R. Dy, DMD: is much fewer than, the myofunctional therapy pre and post op visits. And in that case, I will offer the first visit to be done with telehealth where I do the intake. I'm trying to find a team that's closer for that patient. So if myofunctional therapist, based on their story, what I recommend a certain type of body professional?

[00:51:24] Elizabeth R. Dy, DMD: Is it going to be craniosacral therapy, upper cervical chiropractic, myofascial release a blend of all of them. So I try to help them find the resources there. If they feel like our approach, our office is a good fit. And they want to move forward. They've been diagnosed and they're ready. Then the next step would be to either, depending on how prepared they are with the community they have, their next visit would either be surgery, or it would be at least we've done that telehealth to know it's a good fit.

[00:51:55] Elizabeth R. Dy, DMD: Let's finish the other half of that consultation. Come in for, a cone beam CT scan and records. And so I can feel the tissue and give you a better idea of my recommendations. 

[00:52:08] Christa Biegler, RD: And I'm over here, Elizabeth has a lot of resources online. You're doing education online. And then I'm over here trying to encourage her to fill in some educational gaps for us that live far away.

[00:52:20] Christa Biegler, RD: So we can start to bridge this as well. So where can people find you online? 

[00:52:24] Elizabeth R. Dy, DMD: People can find me on Instagram at Tampa Tongue Tie, and I will put, I try to keep my social media pretty light, focused on office culture continuing education. That I do. I think that the Breathe Institute, following them online, they do a great job putting out quality educational content.

[00:52:47] Elizabeth R. Dy, DMD: Dr. Soroush Sagi is a Harvard grad, Stanford grad so research is like in his DNA. So he and his team do such a great job there of putting out the educational content. I just try to put up some case studies, what am I doing with my time away from the office when I go for continuing education?

[00:53:09] Elizabeth R. Dy, DMD: You'll see, I take classes that have nothing to do with dentistry. I'm going in a group of postural physical medicine specialists because I want to learn how more about how this relates. to the way that a patient's feet hit the ground and why their gait is a certain way. I want to learn more about the nervous system.

[00:53:31] Elizabeth R. Dy, DMD: I want to dive in with a retreat that, you put on where I'm loving on my nervous system because as the leader. Over here. If I am burnt out, what can I pour in to my patients? I very much pride myself on meeting with authenticity. I have been there in the middle of the night with that baby.

[00:53:50] Elizabeth R. Dy, DMD: I've been there with the pain and the toes curling. I've been there with, the breaking down toddler and the night terrors. So I've been putting in the work. Yeah. Myself, and I like to share that side on my social media. 

[00:54:06] Christa Biegler, RD: I think this is what makes you a relatable and an excellent clinician when you just have personal experience and a lot of people arrive at things because of personal experience, but when you can have such a depth of education and passion behind it and willingness, because I'll just emphasize again that I know that this was a you.

[00:54:26] Christa Biegler, RD: Kind of a big deal to leave general dentistry and then go into this somewhat foreign territory. 

[00:54:36] Elizabeth R. Dy, DMD: Laugh about 

[00:54:37] Elizabeth R. Dy, DMD: it. Like when patients will ask me Dr. D do you have any experience? I'm like, Oh, all of us, like all my kids, myself, you have to be, have that kind of passion to give up.

[00:54:48] Elizabeth R. Dy, DMD: Like I'm still paying my dental school loans. I don't do any of that anymore. And so obviously I'm super passionate about serving the community in this way. 

[00:54:58] Christa Biegler, RD: That's beautiful. Okay. Tampa tongue tie on Instagram, but your website is different now, isn't it? 

[00:55:03] Elizabeth R. Dy, DMD: Oh, 

[00:55:04] Elizabeth R. Dy, DMD: my website is sleep and breathing tampa.

[00:55:07] Elizabeth R. Dy, DMD: com. 

[00:55:08] Christa Biegler, RD: Perfect. 

[00:55:09] Christa Biegler, RD: Thank you so much for coming on today. And if you have questions for Dr. D, if you're like an adult listening to this and you have questions about adult stuff, drop us a line. I think there's a little thing on your podcast app. It even says like fan mail or something, or you can find how you can contact us from there.

[00:55:23] Christa Biegler, RD: There's a thing on the website. Send us some notes or send me a message on Instagram, @anti.inflammatory.nutritionist. Let me know what you thought of this episode and what questions you have for Dr. D to come back. So thanks so much for coming on today.