Oral Wellness to Overall Wellness

Episode #644 with Karese Laguerre

Just by looking in your patient’s mouth, you can help prevent and treat a myriad of health concerns. Many common issues can even be eliminated, and Kirk Behrendt brings in Karese Laguerre, founder of SPUR Dental Wellness, to explain how myofunctional therapy is the path to overall health and wellness. Help patients breathe, eat, speak, and sleep like never before! To learn how, listen to Episode 644 of The Best Practices Show!

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Links Mentioned in This Episode:

Learn more at The Myo Spot

Learn more about SPUR Dental Wellness

Read Karese’s book, Accomplished

Main Takeaways:

Now is the time to offer myofunctional therapy for patients.

Myofunctional therapy will help differentiate your practice.

Consider elevating team members to be myo therapists.

Offer teletherapy options for better and easier access.

Your patients will want to do myofunctional therapy.

Quotes:

“It was a beautiful pediatric dentist that wound up shining the light for me that a lot of [my children’s issues were] all related to how they were using their orofacial muscles. That put me down into the hole, and I dove deep into that rabbit hole of myofunctional therapy and how oral function really does disrupt craniofacial growth and cognitive development. A lot of what's going on with our sleep is impacted by our breathing. And a lot of this stuff, yes, I caught it when my children were younger. But if it's not addressed — why is it so important, to get back to answering that question, is because all of this stuff compounds. It doesn't self-resolve. It's not that typical answer that's given by the pediatrician where, ‘They'll grow out of it.’ It actually compounds into different issues, and we wind up with adults that have obstructive sleep apnea, or that have TMD that is very difficult and painful for them, and they're in their young twenties. You're like, what's going on? We wind up with all these various issues that wind up compounding as they get older. And so, it's incredibly important to catch everything early. But if they're not caught early, it's important to start resolving it — because as you get older, it's going to turn into a number of things that we do not want to see in our dental chair.” (4:50—6:12)

“Myofunctional therapy, I like to compare it to personal training. I say that it's personal training of all the muscles below the eyes, but above the shoulders. We work with that wonderful orofacial and some of the oropharyngeal muscles to really help eliminate dysfunction that might be happening there. So, for a lot of our patients, that might be asymmetry. That might be overdevelopment of certain muscles. That might be underdevelopment of certain muscles. But essentially, we're going to be getting to the root of what's going on, why is there dysfunction, and then making those changes that are going to help. That way, we establish habituation of proper muscle function and proper oral rest posture, which I think not enough people talk about, especially in dentistry.” (7:17—8:05)

“There is a way for everything to sit at rest. Our tongue, at rest, should be lightly suctioned up against the roof of the mouth, from the incisive papilla all the way back to the soft palate — just a very light suction. It's not an active suction hold. Our teeth should be slightly apart, about two to three millimeters of freeway space. Our lips should be closed, and we should have predominant nasal breathing. That's the way that we should be most of the day when we're not eating or speaking.” (8:05—8:33)

“We know that our teeth are always in constant motion, or can be in motion, because the periodontal ligaments take certain force, and all the forces of occlusion, and so forth. So, our teeth are in motion. But that tongue and the force that it applies on the teeth creates an impact as to where those teeth are sitting in the oral cavity. When you have your tongue lightly suctioned up against the roof of the mouth, that palate is going to take those soft tissue pressures and forces, and it's going to grow and expand. When we have that tongue sitting down, floating in the middle of the mouth, now we have all of those pressures that would have been on the palate against the teeth. And so, that's going to alter the way the teeth are. Sometimes, it might be more where you have a Class II with a very prominent overjet, or it might be an open bite where the tongue has created its own space to rest in between those teeth. Or, then you have that tongue that might be lying down low and resting along that mandible, and that's going to really apply those same pressures outward on that mandible. That's where we get some of our Class III form and development. And so, it's always going to be the tongue [that wins]. It's always going to be the tongue. The tongue will win, but it's the counter forces between the tongue and the lips and having everything be balanced, and that's where your myofunctional therapy comes in. That really helps to retain those positions. That way, we're not constantly in this battle of shifting.” (9:56—11:27)

“There is nobody more primed and prepped for [myofunctional therapy] than a GP because, honestly, we are the only people really looking at the upper respiratory system in the same way that there would be any other competitive space. So, let's talk about medical. Nobody is looking in that area the way that we are. When we ask our patients to open up, we have a direct view, hopefully, into their oropharynx. If we cannot see their oropharynx, if that soft palate is low, you can't see that uvula, that tongue is up in a defensive posture, that's already — boom. You’ve found somebody who has an airway issue. When they open and you can't see their oropharynx, you know there's something going on. If you look at their palate, you're at the floor of their nasal cavity, because the roof of the mouth is the floor of the nose. And so, if you see a vaulted palate, if you see a narrow palate, what does that mean for the state of their nose? Well, that's going to be constricted space there. So, already, you as a GP looking at only two areas, can you see their throat? Can you visualize a nice, healthy, wide palate? If not, that's two strikes. Your third strike could be just looking at the mandible. Is the mandible recessed? The mandible is the anterior and lateral borders of the upper respiratory tract. So, if their mandible is recessed, what does that mean about their airway? You can take a glance, and you can get a good view of what might be going on with your patient in front of you. So, there is nobody more primed. That's the number-one reason why you should care, because you can make a big difference — just that one little glance.” (12:02—13:36)

“Things are evolving. We are evolving as people. If we're not evolving in dentistry to start servicing our patients at a higher level, to start providing more dynamic services, to start being able to give them these things that they're looking for — holistic solutions, more options — we can help them in different ways that help to, one, build trust, because 60% to 70% of people, it has been researched, do base trust as the main factor why they stay with a dentist. That's going to be a big thing that can help build trust. You're able to look at their airway, and you can tell them something that's going on. These are the things that help you to stand out, grow your practice, and help maintain your patient base. That way, you don't have to worry about any sort of marketing. Your marketing is actually your patients going out and spreading the word within your community that, ‘Oh my gosh, the doctor is offering us so much more than just scraping our teeth or just filling our teeth.’” (14:50—15:54)

“There are not enough myofunctional therapists. But there are so many different things that we can do about that to resolve that issue. One, it can be as simple as referring out to someone who sees people through teletherapy. Teletherapy is a phenomenal way to still address a lot of the issues without having to be in-person with patients. There are dozens upon dozens of myofunctional therapists who see people through teletherapy and telehealth services. You can also elevate a member of your staff. So, a member of your staff, like your registered dental hygienist on staff, would be able to go and get training, and then you can provide that as an in-office service. That is a beautiful way to now — not only are you screening in-office, but you can help to treat in-office. Amazing. Or you can use a service that does have the ability to provide you with teletherapy services for your patients in a membership format.” (16:37—17:41)

“It doesn't have to be, ‘If there's not [a myofunctional therapist] in my community, I can't help with any of these issues.’ It can be any number of ways that you can help your patients just by making a quick referral out, resourcing someone from your own team and helping them to maybe grow in their career in a different way that they may have been looking to that would help you with your staff retention, or implementing a system that's going to do it for you.” (17:48—18:16)

“One of the beautiful things about myofunctional therapy is that if I go back to that correlation that I made earlier with it being like personal training, it is very much where we're working on muscles. We have to get muscular strength and engagement. So, we do that through exercises and activities. These exercises and activities are very much instruction-based, so it's not as tactile, like physical manipulation, that we have to do. It's more visual cues and verbal cues to help patients do these instructions for these exercises. That's going to be where a patient, as long as they have internet access and a web camera and they're able to actually meet with the therapist virtually, they'll be able to get and achieve all the same results as somebody who is working in-person because it's an instruction-based therapy. So, they’re doing these exercises and performing them with the therapist, and then at home. In between sessions, they're doing two to three times a day. They're reviewing these exercises so that they can master them and gain that strength and awareness of those muscles.” (18:29—19:37)

“Your patients would not only do [myofunctional therapy exercises] — they would also love to do it. What we find, more often than not, is that it's really about how you explain these things. A...