Latest / The theunhingedhygienists’s Podcast / Crooked Teeth Are a Warning Sign, Not the Problem | Dr. Ben Miraglia, DDS | EP33

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Crooked Teeth Are a Warning Sign, Not the Problem | Dr. Ben Miraglia, DDS | EP33 · The theunhingedhygienists’s Podcast

• Anastasia Dallas: This I swear to God with Lauren Kennedy: Today we have to dance in to see it. Do you have any idea how big it's recording? We got ourselves a big Anastasia Dallas: is it recording already? Good lord. Lauren Kennedy: old fish to talk to today, boys and girls. So you successfully hit the record button without even knowing it. See, Anastasia Dallas: I love my life. All right. Lauren Kennedy: hmm. Well. Anastasia Dallas: Who do we have here? So I just want to say we're gonna start with this because we have so many things to ask. But 20 years ago, there was a general dentist in Westchester who looked at a standard plan for crowded teeth, pull a Lauren Kennedy: Mm-hmm. Anastasia Dallas: few, pull everything back, and said, What if the teeth aren't the problem, guys? He called it the dark and uncomfortable time, or as Lauren Lauren Kennedy: Mm. Anastasia Dallas: and I called it unhinged. Welcome, Lauren Kennedy: Yes. Dr. Ben Miraglia: Yeah. Anastasia Dallas: Dr. Ben Moralia. Lauren Kennedy: Yay. Dr. Ben Miraglia: Thank you very much for having me. Great to be here. Anastasia Dallas: We're so excited for you to be here. So Lauren Kennedy: You are definitely a big influence in my life. I'm a myofunctional therapist and Tiziana I have been hygienists forever and ever. And it's really exciting when we see the whole idea of the unhinged hygienist was to break molds, but then also just remember what we're all trained to do and kind of work to your full scope. Dr. Ben Miraglia: Yeah. Lauren Kennedy: And it's amazing to have a leader in the industry, a dentist who is really interested in pushing through. the status quo, because the way we've always done it, those dreaded words are something that just piss us off all day at at work. So Dr. Ben Miraglia: Yeah. Lauren Kennedy: thank you for having the courage to go through your dark and uncomfortable time. Dr. Ben Miraglia: Yeah. Lauren Kennedy: do you want to start by telling us all about that and what got you to be the way you are. Dr. Ben Miraglia: Yeah, definitely. I I started out, I graduated in 1993 from dental school. So Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: basically 33 years in dentistry, but the first decade I spent fixing the teeth. Crown and bridge and implant reconstructions, and I fixed a lot of teeth in 10 years. But during that time, as a family care practice, we were referring the kids out to the orthodontist. So every kid would come in and we would do their checks, their hygiene, their sealants, all these little things and When you're young and new to dentistry, you can do the fillings on the kids, working with the kids is easy at that age. So I Lauren Kennedy: Okay. Dr. Ben Miraglia: did that. Well, when you're sending all of the kids over to the orthodontist, you get to see you're following them then, because they're coming every six months to see you. And I'm watching it and I'm watching it, and for ten years it was like ten years of disappointment, but slowly building. You know, why are we taking out those teeth? It didn't even look that crowded. But you know, four years in dental Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: school, I had 20 minutes of ortho training. So what did I know? But Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: What what I knew was I didn't see a lot of crowding, but now I don't see four premolars. So this this didn't add up. Lauren Kennedy: Yeah. Dr. Ben Miraglia: Then of course, the bite, the struggle to get the bite right, the struggle to close some spaces, the struggle to get some teeth to move and others, and and basically just watching all this and then being asked to do bonding, fill in spaces, or adjust the bite. And what do you mean? The braces are all done, but I have to do equilibrations, but it doesn't it looks like too much cutting to me. These are 12-year-olds, 14-year-olds. I don't want to cut that much to get that to fit. And and then the TMD, the TMD problems, kids were getting headaches and having jaw problems. I was being told to make night guards for 15-year-olds. And it just didn't sit well. The biggest issue was the bicuspid extraction. that was the one that pushed me over the top. I couldn't take it anymore. I'm trying to have conversations. I maybe you could imagine what I was hearing, listening to a specialist talk to a GP. There's this. yeah, there's this known conversation that happens between the ortho specialist and a GP a couple decades ago where we might not have had the most professional conversation going on and been spoken to respectfully. And sure enough, I got too frustrated over the conversation not going well and me being told I don't know anything and stop asking questions and Lauren Kennedy: Yeah. Dr. Ben Miraglia: things like this. I said, fine, I'll do it myself. Those were my those were my last words. Lauren Kennedy: Good. Dr. Ben Miraglia: I had never taken an ortho course in my life. But after 10 years of frustration and then these phone calls going sideways and not being able to have alternatives to extraction, those were my last words when I hung up the phone. I said, What did I just do? I don't even know what to do. Well, sure enough, I had to start looking for a different approach. So I knew what I didn't want Lauren Kennedy: Hmm. Dr. Ben Miraglia: and I knew what I didn't need. Now I needed to find the opposite. I found expansive orthodontics. I started taking courses. I started learning about early treatment as young as three years old. And with Lauren Kennedy: Hmm. Dr. Ben Miraglia: expansion, And appliances and other things that were available, and you start getting a piece at a time. Because now there is no good education going back 25 to 23 years ago. This is not built to take and be comprehensive at the time. I'm going here, I'm going there, I'm catching a piece. It probably took me five years just to catch the Mayo piece. I didn't even know that existed for another Lauren Kennedy: Yeah, yeah. Dr. Ben Miraglia: five years into practice. But meanwhile, I dropped the hand piece, stopped fixing teeth, and started growing jaws. And we We started working on three to five year olds, really any age, but as young as three to five. And once we started working on these kids, that uneasy feeling of what am I doing? Because this is crazy when you think about no one else is trying this. I'm learning from a few other people who are few and far between. It just took weeks because within weeks we could see the difference. In weeks of seeing the changes and the differences, and then realizing you you shouldn't focus on the teeth. It's not about the teeth. It's about the jaw structure and the muscle function. And as soon as you get the muscles and the jaws going in the right direction, they breathe better, sleep better, and heal. And so Lauren Kennedy: Mm-hmm. Mm-hmm. Dr. Ben Miraglia: within weeks we started noticing symptoms fading. And then months, kids are healing. And then as the years go by, you see their teeth and bites start to correct, and their teeth were going where they belonged. And a lot of these kids were turning 12 and not even eating braces then. So we had this incredible experience going on. It probably was the best thing that ever happened to me because it changed the dynamics of my whole office and community to be able to help a child by treating their cause, not their symptoms. So this took 10 years basically for me to do enough to feel comfortable teaching it. I didn't start teaching this. I was early in the teaching place for clear liners. You know, I started with the legacy company way back when, same thing over 20 years ago. I started teaching that early because again, I incorporated the expansive orthodontics into clearliners. And started doing the aligners without any IPR and without attachments. And sure enough, that was going well enough. I started teaching that. So I've been in that space for quite a while. But I was uncomfortable teaching how to treat children because I still consider myself new and didn't have enough, let's say, volume and experience. So I spent 10 years treating kids, compiling information in cases, but then I had 10-year follow-up on a lot of these kids. So if they were three, I had 13. If they were 10, I had 20 years old. I started teaching ten years in, which would have been in 2012. In 2012 I started teaching other doctors. Since then, a lot has happened. But that that's basically that's how I got into it and I I start to I start to vomit words. Lauren Kennedy: It's a lot. No, that's so were you making your own oral Anastasia Dallas: Keep going. yeah. Lauren Kennedy: appliances? That's what you were Dr. Ben Miraglia: No. Lauren Kennedy: doing? Dr. Ben Miraglia: I work with two two different companies supply the removable appliances that I use for kids and there's one laboratory that makes my expanders. So, Lauren Kennedy: Okay. Dr. Ben Miraglia: you know, I should ask first. You know, I I'm not really here to sell anything or promote anything. I'm here to have a great conversation and make awareness. It's about awareness. But if if you want Lauren Kennedy: Mm-hmm. Yeah. Anastasia Dallas: Absolutely. Dr. Ben Miraglia: me to answer those questions directly and tell you where or what I use, I'm happy to say it. I just don't want to be selling anything. I want people to become Lauren Kennedy: Course. Dr. Ben Miraglia: aware and learn there are options for your children. Lauren Kennedy: There are. That's the thing. Dr. Ben Miraglia: Not so much I don't have anything to sell. Lauren Kennedy: Because people Anastasia Dallas: Yes. Lauren Kennedy: do not know that there are options. And other dental professionals don't know that there's options. And Dr. Ben Miraglia: Right. Lauren Kennedy: so I think that's what's curious is I feel like Tosia and I often feel like we're pounding out new pathways to try to find the the niche that we are discovering every day. We're peeling our own little onion. And I'm thinking about you 10-15 years ago when you said I'll do it myself. And here you are doing it yourself and creating these products in the chair with the client as you go, building your wings as you flew, basically, right? As you fell. Dr. Ben Miraglia: yeah. Lauren Kennedy: And like just the creativity and the cause we're all like dealing with this imposter syndrome. It's hilarious to think that you did 10 Dr. Ben Miraglia: Mm-hmm. Yeah. Lauren Kennedy: years of work and you were like, I'm still too new. I can't do it. Like, Anastasia Dallas: Yeah. Lauren Kennedy: how do we have that? But Dr. Ben Miraglia: Yeah. Lauren Kennedy: do you still follow those first cases? Dr. Ben Miraglia: Yeah, as a general dentist, most of these kids are still in my practice. Some of them are 30 and 35 years old, because I'm over two Lauren Kennedy: Yeah. Wow. Dr. Ben Miraglia: decades in it. And so we have been treating kids for over two decades. I have most of them still in the practice coming in to see us. Some of them are getting married, a few of them have children now. we've been a generational office. We always had the the child, the parent, the grandparent, in a couple of instances the great grandparent. We've always had generations. But to follow them as Lauren Kennedy: Yay, that's so nice. Dr. Ben Miraglia: the time went by, a lot of amazing things happen when you keep your patients for that long. Which is unique to a general dentist, but not so the case for the orthodontic specialists. They don't necessarily keep them decades later. Early Lauren Kennedy: Yeah, sure. Dr. Ben Miraglia: treatment, one of the fascinating things, not only just symptoms that fade away, but the long-term result of watching these kids, we we now have a very low wisdom tooth extraction rate because we grow the jaws early and we get our muscle and breathing right. In our practice, we only send one out of four kids to have their wisdom teeth out. We have 75% of those wisdom teeth come in. Those, of course, are kids we treated. Lauren Kennedy: Wow, mm-hmm. Dr. Ben Miraglia: That's not the general population. the regular population who doesn't get muscle function, myo, and expansive ortho early, they're going to have their wisdom teeth out at a high rate. Traditional modeling. But in our practice, the kids we treat, Lauren Kennedy: Mm-hmm. Yeah. Dr. Ben Miraglia: three out of four, keep them. We have 32 teeth and three out four kids. And nasal breathing without symptoms Lauren Kennedy: Wow. Dr. Ben Miraglia: and without medicine. Like that, it's a long list of things, but it's a different set of goalposts now. It's incredible to follow it. Anastasia Dallas: So I have a question, because I feel like for myself, a lot of orthodontists and general dentists, when we refer them out, they say, well, we need to wait till all their adult teeth are in. We're we're can they say we're we're conservative. And I told one person once, I'm like, well, they call it conservative. What I hear is they're just waiting for problems to happen, so then they can do full ortho. Waiting for problems to persist and become worse. So I don't know if that's conservative. I that's very reactive. We're wanna Dr. Ben Miraglia: It's not Yeah. Anastasia Dallas: be proactive. So how do you Dr. Ben Miraglia: Yeah it Anastasia Dallas: find providers? Cause a lot of times it's hard to ref like where do we know we're referring to? Like what questions should we be Dr. Ben Miraglia: Right. Anastasia Dallas: calling and asking, setting up lunch and learns, meeting these doctors, orthodontists to kind of see where they're at? Because I don't want to just refer to any orthodontist. Dr. Ben Miraglia: Exactly. So getting back to that wait, because a lot of parents are told to wait, wait, wait, wait for the permanent teeth. Now that happens to come from somewhere. Number one, it's a tooth-focused approach. So a tooth-focused approach is the traditional orthodontic specialty. So they're waiting for all the teeth to get there. So it it you know what it is? It makes sense, but it doesn't make sense. So it makes sense when you focus on what the training was and what their focus is. And when well, if they're trained to move the teeth and not really grow the jaws early, you're gonna wait for the teeth. So waiting for the teeth becomes their normal, which that's how that makes sense. But Lauren Kennedy: Yeah. Dr. Ben Miraglia: it doesn't make sense to wait for the teeth because those are the symptoms. So those of us looking at the jaw development recognize you need to treat that child the day you meet them because you will already have the signs and the symptoms of underdeveloped jaws. So if you think a child would need braces at 11 or 12, you have reason to start treating them now. But if you don't know what to do or how to do it, the weight becomes the default. So you have someone who's tooth-focused, tooth movement-driven, not focused on jaw growth, breathing, sleeping, and symptom list, they'll be told to wait. What I teach parents is: if someone says to you as an opinion, your child's eight or whatever age, and they say, Let's wait, I I want to translate that for you. The person who's saying, Let's wait till the teeth are here, they're telling you this. I don't know how to treat your child now. I don't know early treatment. I don't do early treatment. I haven't been trained in early treatment. I don't focus on the jaw growth. I don't focus on the muscle. I don't focus on myofunctional therapy. I don't do those things. So I I make a whole new statement on what waiting is. It's just coming from someone who is focused on treating the teeth later. They're not focused on earlier, so they don't know earlier. They just don't know what to do for your child. So there's two problems out there. One is parents are told to wait. And then the other one that is locked in with what you were saying as far as waiting is a lot of parents are told, they'll grow out of that. So Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: I hear those two things a lot. Let's wait for the teeth and they'll grow out of that. Absolutely not. Anastasia Dallas: I've heard that severe crowding, primary teeth, and they're like, Well, when the adult Dr. Ben Miraglia: Yeah. Anastasia Dallas: come that when the adult teeth come in, everything might align. And I'm just like, Where? Where would they align? There's no room for primary Dr. Ben Miraglia: No. Yeah. And that Lauren Kennedy: Doesn't make sense either. Anastasia Dallas: teeth. Where are the adult teeth gonna come in and fit? Dr. Ben Miraglia: It's a total myth. The dental research dating back over a hundred years ago from Dr. Bogue and Del Mar Delbert, I think, and Lamar, there are published articles that say that if the baby teeth are together without spacing, it's an absolute certainty that you'll have crowded permanent teeth. There is no growing Lauren Kennedy: Yeah. Dr. Ben Miraglia: early childhood malclusion does not self-correct. Those are like the formal research words. Early childhood malacclusion does not self-correct. So when you see baby teeth with a lack of primary spacing, You are guaranteed to have crowded permanent teeth. You cannot spontaneously correct it on your own. And of course, we Lauren Kennedy: Mm. Dr. Ben Miraglia: know we have those baby teeth together because of the muscle dysfunction. And if you've got the muscle dysfunction, that doesn't self-correct. That has to be trained. And then releases Lauren Kennedy: Yeah. Dr. Ben Miraglia: are needed and things like this. So yeah, the parents hear these two things quite commonly. Let's wait or you'll grow out of something. And that's usually the symptom list as far as like what they'll grow out of. They hear let's Lauren Kennedy: Okay. Dr. Ben Miraglia: wait from the orthodontists, but they hear you'll outgrow that or you'll grow out of that from the pediatrician. meaning the symptoms that they might bring up that they're struggling with. So the you're yeah. Lauren Kennedy: Exactly. That's how do we get a different mindset into the pediatricians? Cause most of us aren't going to see those kids until they're three. And you think about what a pacifier Dr. Ben Miraglia: yeah. Lauren Kennedy: or a bottle is doing to their face during all of that Dr. Ben Miraglia: Mm-hmm. Lauren Kennedy: time. Is there do we already know is there some sort of dental or oral training for pediatricians? I mean, they look at tonsils, but they tell us they're going to grow Dr. Ben Miraglia: Yeah, we're trying. Lauren Kennedy: out of that too. Dr. Ben Miraglia: Yeah, we're trying. sadly, way back when dental and medical were broken in half and separated out as if we're not even part of the body. Meanwhile, the oral cavity is how the mouth goes, the human goes. Like this is this is Grand Central right here in the oral cavity. And sure enough, we got taken away. But since dental was taken away from medicine, medicine has absolutely no oral cavity training. They don't know the first thing about the mouth. Lauren Kennedy: wow. Dr. Ben Miraglia: So we we have a big disconnect in what they would know. They look at teeth like the Orthodox does. They don't look at much beyond the teeth. They know nothing of muscle function and tongue function and ties and things like this. And going back to Anastasia's question, we're told to wait until 11, how do you know where to send parents? Like how do parents know where to go if you're told to wait and your child's seven or eight or nine and you're looking at their teeth going, well that looks really bad. Maybe we should do something now and you're told to wait. That's part of where the education took that next step. 10 years in when I started teaching it, it took a few years. Within a few years, a colleague of mine that was also teaching on the circuit with the Clearliner world took notice of what I was doing. The two of us formed a company. We now train other dental and pediatric dental offices to do this. So basically, we have an educational company to train doctors who want to learn how to treat these kids. But over the last eight years, we've trained, we've trained, I think, 700 offices now around the country. We built a doctor locator. So we have a doctor locator on that website where a parent or another professional could go, look at the map, look at the dots, and then you learn this office knows how to treat a child as young as three. Anastasia Dallas: That's great. Dr. Ben Miraglia: So some offices want to treat kids and adults, some just want to do adults, and some just want to do kids, depending upon the office. We have it all highlighted on that map. So how a parent would know is we try to make the social media work for us and do things for parents that are parent-centered so that they could learn. If you have questions about your child's growth. And they're breathing and sleeping in teeth, and you're not hearing good things because we believe they should be treated now. Go to this map, check out the locator, and see if there's an office near you. Now we're getting more and more of them, so that it's likely we could find someone within a couple hours of them. So that that's another thing. If you want me to say exactly what it is, I'm happy to share. Just didn't want to be pr too promotional. I I'm your I'm your I'm a first-time guest. I want to be respectful of you. Lauren Kennedy: Hey, you there's no rules here. We're no Anastasia Dallas: You're doing it's fine. There's no rules. We also it's not even it's educating more than anything else, right? We wanna we wanna help people have the resources to be able to go out and get the Dr. Ben Miraglia: Okay, yeah, so Lauren Kennedy: Yeah, absolutely. Yeah. Dr. Ben Miraglia: Yeah. Anastasia Dallas: help that they need. Dr. Ben Miraglia: That's why we built it. This is built to help people. So if you are a dental professional and you would like to make a referral, you can go to the locator. The website is www.airwayhealth solutions.com. So airwayhealth Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: solutions.com, you can go right to the doctor locator. And if you are in the dental community, hygienist, dentist, and you're watching this, and let's say you're not treating kids three, four, and five years old, but you'd like to refer one to someone who can, go right to that map. It'll show you where you are. You can find the state you're in, look in there and find a bubble that's tagged, and send that child or family to that office. They know how to do it. I've trained all those offices. Every one of those dots, we've trained them all. They're prepared Lauren Kennedy: Good. Dr. Ben Miraglia: and ready to help people. So we we built that to provide two sources for doctors and their teams. Number one would be a referral. You can go to that map and send a patient somewhere where they won't be told these are normal things, you'll outgrow it, or wait till you're older. You would be treated when you're met if you have. Basically, underdeveloped jaws and have symptoms. So that's one direction. The other direction, for the doctor and team who are interested to take the next step and learn how to do it themselves, we have the education there too. So two opportunities. The entire goal is to get children treated earlier. The earlier Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: you treat the child, the healthier they will be. The later you treat Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: them, the more you're focusing on the symptoms of the teeth. That does not make a healthy child and that child might be doomed to medication forever. There's a bad pathway going on, which we'll get into as we talk about some of these symptoms that parents Lauren Kennedy: Yeah. Dr. Ben Miraglia: are struggling with and where it heads without good treatment. Lauren Kennedy: That's scary. And Anastasia Dallas: No, that's really great. Yeah, it is. Lauren Kennedy: but I'm who I'm super happy there are people and places and this resource that is available for people because I we see it every single day. We hear it at I don't know where to go, I don't know who to turn to, I don't know who to trust. Because people already have this inherent distrust of dentistry. And for Dr. Ben Miraglia: Yep. Lauren Kennedy: and because I mean, even in my own life, I had some friends who I could see the dysfunction in their young kids, and I said, Hey, this is something that I see a pattern of, and their pediatrician said it was fine. And so they didn't do Dr. Ben Miraglia: Yeah. Lauren Kennedy: anything. And what can you do? I'm like, I'm only one person. And if the doctor, the kid doctor, who is the person you see all the time, said This is the thing. you have to trust them. So that's it's frustrating. We're really running Dr. Ben Miraglia: Yeah. Yeah. Lauren Kennedy: an uphill battle against old way. Mm-hmm. Anastasia Dallas: That you said the teeth are the symptom, not it's the muscle and everything else that's connected. Because I always tell people, I don't really care about teeth. I Dr. Ben Miraglia: Right. Anastasia Dallas: care about everything that those teeth are connected to because Dr. Ben Miraglia: Yes. Anastasia Dallas: the oral systemic connection is real. And if we can actually help you, we spend more time with patients than anybody else. We just need the resources to be able to have those referral systems, those collaborations with healthcare providers. So I love that. I don't I know dentists who do single teeth dentistry and it drives me crazy 'cause it's like there's so much more that we should be doing. Dr. Ben Miraglia: Right. Anastasia Dallas: that's a responsibility as healthcare providers, I feel. So Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: Yeah, definitely. That that was my first ten years. I was fixing the teeth and then I realized, boy, I I think I missed my window, but t Anastasia Dallas: Yeah. Dr. Ben Miraglia: ten years late is I got in when I got in, you know, it's never too late I guess. But now I'm trying to teach everybody. Lauren Kennedy: That's true. No. Anastasia Dallas: We all didn't start off this way, right? We all started Lauren Kennedy: Nope. Anastasia Dallas: off I literally what was it, twenty twenty four Dr. Ben Miraglia: Yeah. And Anastasia Dallas: where I went to the I DM conference and a light bulb went off and now I'm like, here we are, let's do this. Dr. Ben Miraglia: Mm-hmm. Yeah, and so Lauren Kennedy: Well Dr. Ben Miraglia: here here's our pathway. Help the kids out a little earlier Anastasia Dallas: That's right. Dr. Ben Miraglia: is is better. Lauren Kennedy: It's interesting. I have, I wonder, through your traditional training and where you've gone, what do you think is the thing you had to unlearn that was beat into you in dental school? Like how Dr. Ben Miraglia: yeah. The the the toughest one was to learn to s ignore the teeth. I'm trying to say it the right way, like ignore the teeth. Just like Anastasia had said a moment ago, like don't care about the teeth. Ignore the teeth. 'Cause all Lauren Kennedy: Yeah. Dr. Ben Miraglia: everything that's pounded into you for four years is class one, the canine, the molar, all these things. And none of that has to do with the jaw development. That's just to focus on the teeth. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: Well If you don't have your jaws right, you can't breathe well, you can't sleep well, you're gonna be unhealthy at any age. And it starts early. Lauren Kennedy: Yeah. Dr. Ben Miraglia: So that three-year-old with primary teeth and no spacing is already a mouth breather or worse. Already Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: has sleep fragmentation, will already have a symptom list. So the three-year-old is unhealthy thanks to lack of primary spacing. So the the basically my biggest hurdle was ignoring the teeth. Ignore the teeth. And you have to keep saying it over and over and over, because again, dental school. Lauren Kennedy: Look past it. Look past it. Dr. Ben Miraglia: Dental school four years, then a residency fifth year, did an attending year, that's a sixth, and then 10 years of practice. 16 years of staring at the teeth, and 16 years of focus on the teeth, like 24-7, Lauren Kennedy: Yep. Yeah. Dr. Ben Miraglia: 365. And then you're like, wait a second, everything I'm doing is not about the teeth. It's about Lauren Kennedy: Exactly. Dr. Ben Miraglia: everything else but the teeth. So ignoring the teeth was the hardest part. Now today I know. I mean, 23 years later, it's not about the teeth at all. But in the end, what do you get? Lauren Kennedy: Sert Dr. Ben Miraglia: You get 32 teeth right where they belong. You get you get Lauren Kennedy: Right where they belong. Dr. Ben Miraglia: yeah. It's like it's the symptom. They're the their sh the teeth are telling you. The teeth are the ones screaming for help at age three. The teeth are the symptom telling you to help me out, right? But then in the end, you get Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: them all where they belong without even addressing them. It's getting the jaw growth and the musculature back. your teeth go where they belong. So it ends up being easier when they're 12 if you do the early work. The 12-year-old needs very little because you've got the jaw Anastasia Dallas: Mm-hmm. Lauren Kennedy: Yeah. Yeah. Dr. Ben Miraglia: growth, the musculature. And the teeth and bite then correct. Then you do little later on. But yeah, the the saddest part about the whole thing is starting 23 years ago and being this far in, I can tell you today, and it's you know it's frowned upon to say always, never, none, always. All these words, Anastasia Dallas: Yeah. Dr. Ben Miraglia: they're extreme words, but meanwhile, I don't meet any healthy kids anymore. So when we meet a three to four-year-old and we see that lack of primary spacing, which is almost every single child. Anastasia Dallas: Mm-hmm. Dr. Ben Miraglia: They come with a symptom list. Three to four years old. When we're doing those sleep breathing questionnaires with parents, they have three or more symptoms already at age three to four. Lauren Kennedy: Hmm. Dr. Ben Miraglia: And when you track time and you look at that five to seven, ten-year-old, twelve-year-old, the older the child gets, Lauren Kennedy: Okay. Dr. Ben Miraglia: the more they the more symptoms they have, and the worse symptoms they have. It just increases over time. These kids Lauren Kennedy: yeah. Dr. Ben Miraglia: are deteriorating right in front of the dental community. From three to twelve, these kids are getting worse over time. More symptoms and worse symptoms while we're watching them. And meanwhile, it's all about the jaw growth and development because they can't breathe well. And when they can't breathe well, they can't sleep well. And when you sleep fragment anybody for days to weeks to months to years, well, here comes inflammation, here comes that list. And these kids have symptoms that they're struggling with in every direction. And we, now that you're in it this far, you learn how young they're medicating these kids is becoming disgusting. Becoming disgusting. Lauren Kennedy: Mm-hmm. Anastasia Dallas: Yes. Dr. Ben Miraglia: The medication we're seeing two, three, and four-year-olds getting medicine for things that they should not be getting medicine for, but it's focusing on the symptom. So again, Lauren Kennedy: Yeah. Dr. Ben Miraglia: the medical community, the same one that says, you don't have a tongue tie, will prescribe ADHD medicine to a four-year-old. Okay? And so yeah, we're going in the wrong direction. But that's the reality is I do not meet healthy children. I meet unhealthy children. And we have a different approach. We way back when we were looking at the teeth as our symptom. Lauren Kennedy: Yeah. Anastasia Dallas: Yeah. Isn't that wild? Yeah. Dr. Ben Miraglia: To point out, hey, are my jaws underdeveloped? Because the teeth are the primary teller of that story. No, no spacing in the primary teeth. My jaws are small. That means the breathing problems behind the scenes. Let's ask questions to see if we do have a breathing problem behind the scenes, and sure enough, you learn. So we began this looking at one child at a time. Let's see how we're doing, right? Over time, now we know the mantra in the office is the child is unhealthy until proven otherwise. The next child who walks in the door, they are unhealthy until proven otherwise. Show me those teeth, show me that bite, show me the jaw growth, show me the symptom list, show me the questionnaire. If you can show me a child who has their teeth where they belong, age appropriate, and has no symptoms, mmm. I call that a unicorn, we call that a unicorn. So we do not meet healthy kids anymore. They're struggling by the age of three, and that lack of primary spacing is probably the number one sign that anybody could see. There's no gaps. The second thing that I think A lot of kids show is grinding. The grinding. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: So many kids grind their teeth. By three, four years old, you see it already. That's Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: another telltale sign. the teeth are telling you I have a jaw growth problem. The grinding is telling you I got the breathing problem. Because once your jaw's Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: moving, that's protective. That that mechanism of moving the lower jaw around is helping the air Anastasia Dallas: Yeah. Dr. Ben Miraglia: go in and out. So if you can't breathe well, your lower jaw is gonna fly around to help the air go in and out. So that's it, that's the you got the teeth with the lack of space saying, My jaws are too small. You got the grinding telling you I am not breathing well. And that adds help me instead of weight. Lauren Kennedy: That does add help me. That I don't understand. There's so many people who think that that's normal, right? So we're told that adults grind because we're stressed. So that must be the same reason that children grind. And I'm like, what does this baby have to be stressed about? Like that doesn't, and if you stop, and I think there's so many times that it's common sense, right? And I don't I don't know how we it is nonsensical. And then Dr. Ben Miraglia: Yeah. Yeah. It's nonsensical. Nonsensical. You know how many times a parent will come in and say that the the pediatrician or the pediatric dentist, whoever they might have asked, about the grinding of the teeth. I was asking them about my four-year-old who's grinding their teeth and they they were told they're under they're under stress. And so I'm in my office I'm hearing this, I'm going I'm looking at this four year old. I'm Lauren Kennedy: Yeah, airwaist dress. Dr. Ben Miraglia: looking at the fairway. I'm looking at the family. We're in Westchester County, New York. So we're in middle class and above Westchester County, New York. Do you make your child pay the mortgage? Does your child have Lauren Kennedy: Yeah. Dr. Ben Miraglia: to is your child working two jobs or one job? Do you know it's I'm asking I'm asking these silly questions because it's not stressed. The other one that I get a lot is, they'll outgrow the grinding. And yet, when you ask the Anastasia Dallas: Heard that. Dr. Ben Miraglia: follow-up question, because the dental community, when the dental community says the child will outgrow the grinding, it's normal at this age, they'll outgrow it. I ask the follow-up to that is how many adults grind their teeth today? And the same person will answer almost all of them. So many people are so so if the kids are grinding their teeth and they're gonna outgrow it, the adults wouldn't be grinding Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: their teeth. So you're telling me the kids are gonna outgrow grinding, but most of your adults are grinding your teeth. It's not they're not gonna outgrow it. They they get that quick. So that wins a lot of people over fast. You're not outgrowing any of it. You're grinding your teeth because you're not breathing well. And it doesn't matter what Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: age you are. Now, stress, do people internalize stress? Yeah, can you make an ulcer? Can you clench? I think you can develop a habit of doing that. And some people bite cheeks, bite nails. There are definitely things you can do, but Lauren Kennedy: It's beautiful. Dr. Ben Miraglia: when you're asleep and you're not aware, your brain takes over. So during sleep, you're grinding your teeth because your breathing is the problem. If you're gonna grind during the daytime and you wanna call it a habit like biting your nails, I could go for that. But not in the sleep. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: In the sleep you grind your teeth because you're breathing poorly, and that has to be addressed. Somebody's got to fix that. The medical community doesn't have answers for that. Lauren Kennedy: People always say how do I flip save? Yeah. Yeah. I know. Anastasia Dallas: love your passion. I just love your passion and you just you can tell that you're just this is just amazing. So I just want to know Dr. Ben Miraglia: Thank you. Anastasia Dallas: what's the most frustrating thing another dental professional maybe has ever said to you about your approach to how you're doing things? Dr. Ben Miraglia: well, frustrating, angering. There's a lot of those. One was, you and your partners in your practice are gonna get sued. You're gonna lose your license. Lauren Kennedy: Of course. Dr. Ben Miraglia: You're gonna one was you're gonna destroy that child's jaw. Lauren Kennedy: Yeah. Dr. Ben Miraglia: You're so aggressive what you're doing, and the things we're doing earlier s basically myofunctional therapy with some removable appliances that are soft like a sponge. So nothing Anastasia Dallas: Mm. Dr. Ben Miraglia: aggressive we're doing, anything like this, Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: but you're gonna rip apart the child's jaws, you're going to disfigure them for life. I've heard so many things over over the two plus decades. Unbelievable. Anything. And and it comes through the parent because when the parent has another consultation and they'll start to ask or talk, the other side of the table just gets really angry and starts yelling at the parent Lauren Kennedy: Yeah. Dr. Ben Miraglia: and saying wild things that then come back and they and they end up choosing treatment with us. We treat those kids. But some of the wildest stuff is yeah n Unprofessional to say the least. It's just unprofessional. Nothing coming at me is based that on research or any type of Lauren Kennedy: Yeah, Dr. Ben Miraglia: having a common sense approach to why we Lauren Kennedy: Yeah. Dr. Ben Miraglia: would wait until twelve. I can't imagine meeting a child that should wait until twelve anymore. It's just it's all there to see between three and five. You get in early, you help that child get the jaws growing, get the breathing back, get the sleeping back. That's how you get a healthy child out of it. You can straighten all the teeth you want at age 12, you're not going to change the breathing. It's too late and you're working on the wrong thing. You're working on the symptom. Should be no surprise the relapse rate from that technique is terrible. Anastasia Dallas: those people who are telling you those things are probably the ones that say I've been doing this for thirty years this way and it's Dr. Ben Miraglia: Hmm. Anastasia Dallas: fine. Lauren Kennedy: It's always been done this way. Yeah. Well, that's why people get so emotional because you're challenging Dr. Ben Miraglia: Yeah. Lauren Kennedy: that something that they have spent their life really believing in and learning and investing in. And it always Dr. Ben Miraglia: Yeah. Lauren Kennedy: cracks me up when people are like, I don't believe in that. And I'm like, airway health is not a religion. It's not Dr. Ben Miraglia: Yeah. Lauren Kennedy: it's fact. Like this is right here. So The proof is right here. what is the earliest age that you like providers to really start looking at airway of the kids? Dr. Ben Miraglia: Sure, as a general dentist, I'm comfortable at age three. However, the infant should be looked at at birth. it starts right there, because right after birth, someone should evaluate the tongue, lip, and cheek ties. Because that right there can make a difference in the nursing. And so if a parent would like to have the nursing opportunity, then I think that at birth the infant should be looked at for tongue, lip, or cheek tie to make sure that there can be a good latch, a good seal. And then and then the good nursing, and then it could be done with comfort and success. So earliest would be birth, basically ties. Evaluate for ties to see, you know, Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: if there's anything there. Not just the nursing, it doesn't stop at the nursing because the ties can affect just regular swallowing patterns, which affect breathing and sleeping. So you can choose to go right to bottle, which is fine. My wife had to go back to work. So if you have to go back to work, you're not doing the nursing for the very long, you go into the bottles. But meanwhile, the ties do have an effect on muscle function, growth, breathing, and sleeping. So if you've got an infant who's getting to the bottle earlier, but you recognize, well, we're not sleeping very well, and it's not coming along. We have that colicky baby, they're so upset all the time. Well, it could very well be that a tongue lip or cheek tie is affecting the positions of the muscles, the function of the muscles, and the breathing. And if the breathing's not good, the sleeping's not good. So now you have a little one who has no way to tell you I'm sleep deprived. So it's gonna be just cranky all the time. So it it's a lot more than just the nursing, but that's day one. But after that, it's still you need that child to have proper sleep cycles in order to grow well and have everything function properly. So the ties are early. By six to nine months old, there's an opportunity, which we I don't I don't do the early stuff, but the it needs to happen early. It can't wait till three, because at three and four I see they're already unhealthy and I'm trying to help out these kids. Meanwhile, upstream, the problem is upstream. So birth would be ties evaluation. By six to nine months old, I like to refer people to same thing here, I don't receive any financial benefit from these things, but baby led weaning and solid starts are two helpful places to go. Baby led weaning has a book, how to introduce solid foods to my infant. They also have Instagram, you can follow BabyLed Weaning and Solid Starts. it's basically speech, language, pathology, and feeding experts, feeding specialists who help train parents how to feed their child appropriately early because Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: The human the human existence didn't begin with soft food early. It began with hard food early. And that hard food began six to nine months old. So we used to Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: transition from the nursing to the hard foods, not to soft. And that's where things went sideways. So if we could get back to that, but that we're so many generations away from that, we have no knowledge of this handed down at what used to be. So we have to relearn this. So I I refer parents or new parents to if they would like to explore a different opportunity early. Baby led weaning solid starts because I would love more kids to be healthier by three to four and not have to train everybody in the world to help these kids out. It's too too many kids are unhealthy today. After that, Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: we look at things like well, this I would be saying specific things. It's okay to share specific things. I don't get paid for any of this. It's not Lauren Kennedy: Do it. Dr. Ben Miraglia: a it's not a pitch or a sales. Anastasia Dallas: Do it. Do it all. Dr. Ben Miraglia: Yeah. I I like myo munchie a lot. And so I will Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: try to get people to go see my functional therapists who use it. So I start at age three, I'm missing that window because six to nine months old, and that infant can start with myomunchie. They have tools for these ages. Myomunchy is an excellent tool between six and nine months old as the years are going by, it works the jaw muscles. And so if they're working those jaw muscles, you get your growth. So I'm a fan of myomunchy, and usually I'm getting them to myofunctional therapists early who use those on younger kids. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: And so between myofunctional therapy, feeding specialists, speech language pathology, Lactation consultants, there's a world of people out there, body workers. You got osteopath, craniosacral, all kinds of body workers out there can help early on. Could because again, posture and breathing all go together. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: So we're trying to get the parents in earlier because zero to three, a lot can happen to get that child on the right track. And then it would lessen the burden of that already unhealthy kid three to four, where now the dental community needs to start responding more. We just don't have people doing it. So we're again the dental profession is tooth focused. Lauren Kennedy: That's true. Dr. Ben Miraglia: I'm in the fringe. I'm in the fringe right now with my 700 people I've trained nationwide to help out because we have 200,000 dentists, we have 10,000 orthodontists, and how many are doing early treatment and doing it well? Not just saying Lauren Kennedy: Not enough. Dr. Ben Miraglia: I'm an airway thing. How about doing the treatment early well and you know, knowing how to help a child? So yeah, I just try to get involved earlier by referral. But three, I'll start treating. Lauren Kennedy: That's wonderful. I'm glad you're doing that. Hmm. Dr. Ben Miraglia: Thank you. Anastasia Dallas: I know a mild functional therapist, that's pretty amazing. And I'm sure she's got some questions. Lauren Kennedy: She has a lot of questions. She has Dr. Ben Miraglia: Good. Lauren Kennedy: a lot of questions. I wonder what is the relationship that we could develop with ENTs? Because I'm Dr. Ben Miraglia: Yeah. Lauren Kennedy: super frustrated by the tonsil conversation that I have to have with Dr. Ben Miraglia: Mm-hmm. Lauren Kennedy: parents and ENTs and the dentist. And and like I can think of this little kid right now. He's eight years old and he's very small. He has size three tonsils. And I I at least got his mom doing neti pots and keeping his nose and trying their mouth taping. I mean, they're doing, they're trying to do a bunch of things. And I'm like, could you and they've been to two ENTs here in Vegas who have said he's fine, he'll grow out of it. And I'm like, he's gonna grow around them, not Dr. Ben Miraglia: Yeah. Lauren Kennedy: out of them. And also you could see, I mean, he's he's teeny weeny. I'm like, that Dr. Ben Miraglia: Yeah. Lauren Kennedy: that little baby has never gotten a human growth hormone spurt. Dr. Ben Miraglia: That's right. Lauren Kennedy: And Trying to explain this because and it's frustrated. It we're hamstrung as hygienists, because of course we're only hygienists, and it's just like, but I'm like, I'm staring into the abyss of your child's face. And this is what I see because I look at a lot of these every single day. And Dr. Ben Miraglia: Yeah. Lauren Kennedy: it's is it a chicken and an egg thing? Like is airway because of tonsils? Is tonsils because of airway? Like, Dr. Ben Miraglia: great question. Lauren Kennedy: yeah. Dr. Ben Miraglia: Yeah, that's where I would start, right there. So again, the medical and dental community have been separated. So I'm Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: gonna give you the two perspectives. One perspective coming from the ENT or the medical community is that if your tonsils and adenoids are big, you'll have a breathing problem. Tonsils and adenoids cause your poor breathing. Well, it's the opposite. That's the myth. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: It's the mouth breathing. That causes your tonsils and adenoids to overgrow. So your breathing problem is there first, and it causes that overgrowth. Basically, you're misusing the system. So if we go back to where this all started, there's a there's a definitive cause for malinclusion or underdeveloped jaws and crowded teeth. It's the early soft diet. That's what started this whole problem. When humanity switched from hard food early to soft food early, the malinclusion rates rise, and it's every culture that's ever been studied. When they went from their natural Aboriginal lifestyle to that Western industrial lifestyle and then started trading for food. The early soft food gives you weak muscles. The weak muscles Lauren Kennedy: Mm-hmm. Mm-hmm. Mm-hmm. Dr. Ben Miraglia: become dysfunctional. They do not grow your jaws. You end up with crowded teeth. Lauren Kennedy: I think. Dr. Ben Miraglia: Because prior to soft food, there is little to no evidence of malocclusion in the human race, around the planet, anywhere. It's a new phenomenon. Lauren Kennedy: Yep. Yeah. Dr. Ben Miraglia: But it times perfectly with soft food early. And that soft food early, weak muscles, small jaws, crowded teeth. But small jaws equals poor breathing. So this is all together going on. So now you have the nursing leads into the softer food. The softer food gives you the weak muscles, the smaller jaws. That creates the change from nose to mouth breathing. Because as soon as you get that soft food going and your jaws are not growing well, your brain will decide: you know, the airflow through your nose is not good enough, and your mouth starts to open. So you get the soft food. Weak muscles, smaller jaws, it triggers the difference between nose and mouth breathing. Your brain is not satisfied with the airflow through the nose. It starts opening your mouth. Opening your mouth changes your muscles even worse. So now your musculature is really not doing anything for jaw growth and development. All the dysfunction comes after the brain switches you to mouth breathing. Sure enough, you accelerate into the malclusion. So two perspectives going on here. One is that you have a community in dentistry that says mouth breathing causes malacclusion. And it's the reverse. The underdeveloped jaws, the underdeveloped jaws, the malclusion was there first. And that's how Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: you become a mouth breather. Mouth breathing makes your malocclusion worse. It doesn't cause it or start it. So you have the early soft food, the weak muscles, the smaller jaws, that's your pathway to mouth breathing. Now you can't breathe well through your nose. Once you start mouth breathing, you will have a worse maloclusion. That's why early childhood malocclusion doesn't self-correct, but it also gets worse over time. So do the symptoms. So basically, with the ENT, The medical community thinks, your tonsils and adenoids are so big, that's why you have your breathing problem. Nope. The transition from nose to mouth breathing. When you breathe through your nose, the air goes up and around and through this system. It hits the nasal cavity, then the adenoid, then the tonsil last. But as soon as you start to mouth breathe, the air goes directly into the back of the throat and hits the adenoids, and tonsils basically tonsils first and hits the adenoid on the way up. So if you think about Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: breathing, this is your nostril, my fingertips are your nostril, and the air is going to go up and around. So the knuckle is the adenoid, and back here is going to be the tonsils on the sides. When you breathe Anastasia Dallas: Mm. Dr. Ben Miraglia: in your mouth, it's a T stop. It's no longer a J for smooth airflow. The air goes right into the tonsil, and then when it hits a T, it goes both ways. Some air goes to the lung and some air comes up the other way when it comes straight into that wall. Basically, mouth breathing is the trigger for the inflamed, swollen, or larger tonsils and adenoids. You're basically using the bat the vacuum in reverse. So now you flip the vacuum in reverse and all the junk goes into the wrong spot. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: So sure enough, we're breathing through our mouth early, and we get the bigger tonsils and adenoids. So now I'm gonna tie this into experience and research. There's a really nice amount of research out of Stanford University, Dr. Christian Guy Mineau showed most of the kids who get their tonsils and adenoids remain mouth breathing and they grow back. And so Anastasia Dallas: Yeah. Dr. Ben Miraglia: very few kids, very few kids have tonsils and adenoids out and actually have resolution of OSA, like the worst breathing. So I believe one of the papers that was written had a 40% rate. 40% of the kids who had tonsils and adenoids still had OSA after it was done. And 56% got back to OSA. The remainder was 60%, but 56 out of the out of the 60 went back to OSA within 36 months. Because removing the contents wasn't the answer. The contents are not the problem. Does it make it worse? Yes. So you have your underdeveloped jaws, that'll give you your poor breathing, and the poor breathing makes your tonsils and adenoids get bigger. So they make your breathing worse. They're not the cause of it. So removing tonsils and adenoids, my experience has been that most of the time they will grow back because the child will still be a mouth breather. The opposite. I don't like taking them out. So I can tell you in my own practice, one out of a hundred, one out of a hundred needs them out. Here's why. We get in there and we get the expansion going. Return the Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: child to nasal breathing. So I like growth. So I know you're gonna see three and four tonsils. I get it. I see them too. When those tonsils come in like that, We don't take a slower approach, we'll go a little quicker. We're gonna go expanders and mayo immediately. Now, expanders plus myo, if I can get the jaws bigger real quick, I get a bigger space to breathe, then I need the Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: muscles to get the nose breathing right. If we go expanders Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: and mayo and the child flips to nose breathing, they shrink. So treat Lauren Kennedy: Hmm. Dr. Ben Miraglia: the cause. Anastasia Dallas: Mm. Dr. Ben Miraglia: If I'm saying the cause is the poor breathing, I would treat I would treat the anatomy first. Get the breathing back to nose breathing and watch them shrink. And that happens to most of the kids. Yes, most of the kids we treat have large tonsils and adenoids. So medium to large is what we're seeing. But only one out of a hundred will end up getting them out because we give them the nose breathing back, and the child who can return to nose breathing has them shrink. So now Lauren Kennedy: Yeah. Dr. Ben Miraglia: you have a solution in the cause category. Whereas when the ENT sees the large ones, and I know they're refusing to take out three, sometimes the three, they'll say, no, no, they're Anastasia Dallas: Mm-hmm. Dr. Ben Miraglia: fine, they'll outgrow it. But even the ENT who says, all right, I'll take them out. When they remove them and you watch that child from 12 to 36 months, they're going to grow back. And they'll still have OSA later on. This research shows that. So removing them isn't treating the cause. Removing tonsils and adenoids is treating a symptom. And the analogy I talked to parents about and other professionals, because this is an easy one to see, is a pixie stick. So everybody knows what a pixie stick is. It's a tube full of sugar. It's our the Anastasia Dallas: Yeah. Dr. Ben Miraglia: dental world's worst nightmare, but it's it's Lauren Kennedy: Yeah, yeah. Dr. Ben Miraglia: a fun snack at Halloween. A pixie stick is full of sugar, but it's a straw. So the we're gonna equate our airway. Anastasia Dallas: Mm-hmm. Dr. Ben Miraglia: There's a you could have a garden hose or could have straw. Most kids are having a straw. Well, if you take that straw and you dump out the contents, you still have the same size straw. That's what tonsil adenoid removal is. You're taking out the contents of a straw. Your straw is the same size. The child who gets their tonsils and adenoids out first is treating the Lauren Kennedy: Mm, yeah. Dr. Ben Miraglia: symptom. And without any other effort or treatment is going to revert back to the same problem they had because they cannot breathe through their nose. So they grow back. Lauren Kennedy: Mm-hmm. Mm-hmm. Dr. Ben Miraglia: So the point is. Take the straw to a garden hose. That's step one. That's what expanders do. That's what myofunctional therapy does. We need the we need the garden hose back. So that's expanders to open things up. Get that tongue space back and immediately get the musculature functioning right. So if we can get the size, that's the expander work, then get the muscles right, you get a nose breather. If you get a nose breather, you can watch them shrink. So we we I prefer that pathway. I'm not opposed to taking them out. I would just like to try everything else first. Because those are body parts, Lauren Kennedy: Of course. Dr. Ben Miraglia: they're part of the lymphatic system. I'd I'd like to keep if I could. We're we're at a one out of a hundred rate for removal because of earlier treatment and I like to focus on getting the size back for the breathing. I hope that's all right. Lauren Kennedy: I love that. It's amaz Anastasia Dallas: Yeah. Lauren Kennedy: I don't think I've ever had anyone talk about doing expansion in order to give the space to allow For the nasal breathing and the tonsils. That's Anastasia Dallas: Mm-hmm. Lauren Kennedy: very thank you. Thank you for that. That makes my heart Dr. Ben Miraglia: Yeah. No problem. Lauren Kennedy: happy. Cause of course I don't want to send a kid to surgery. And I believe I'm a I'm a minimalist. I want body parts to stay. So that's okay. Wonderful. Dr. Ben Miraglia: Yeah. When you just think of it a little differently, when you see the big tonsils adenoids, you you want fixed expanders because fixed expanders can get you quickly nasal breathing. And so once you get that size back and you can get the nasal breathing going and you get the myel going on the musculature, you could watch those shrink. And that's going to happen most Lauren Kennedy: Wonderful Dr. Ben Miraglia: of the time. And the the sad reality is just removing them only is going to have growth. They're going to regrow. You can't get a it's very rare to get a nose breather out of the removal of tonsil adenoids. Because underlying anatomy is still a straw to breathe through. It's not enough Lauren Kennedy: Sure. Dr. Ben Miraglia: for the brain to like it. Lauren Kennedy: It's still the same pixie stick. Yep. Yeah. Dr. Ben Miraglia: Still the same pixie stick. We need a garden hose first. That's expanders. Expanders really give you the tongue space and the widening of the airway so you get your airway back that way. Anastasia Dallas: So is all expansion the same? Dr. Ben Miraglia: No, no, not even Lauren Kennedy: Ooh. Dr. Ben Miraglia: close. In fact, there's only one way to do it right. So unfortunately, this becomes a very hot topic, third rail. Nobody likes hearing Lauren Kennedy: Mm, mm. Dr. Ben Miraglia: this, but I'm gonna say it because I've got over two decades. Yeah. Anastasia Dallas: Please say it. Lauren Kennedy: Dangerous. Dr. Ben Miraglia: So yeah, this is the danger zone right here. This is where everybody gets all angry. But the Lauren Kennedy: Yeah. Dr. Ben Miraglia: there's a lot, there's a lot of orthodontic research, and they call it on early intervention. So decades ago, the orthodontic community did research on early intervention. So way back when the age for referral for ortho was 11 years old. That's where it began at 11 years old. It got to seven a few years ago. But it was 11 for a reason. It wasn't 11 based on nothing. Well, what was the reason? It was the research they did. What the orthodontic community did was a lot of research, and I think there's no less than 32 independent published papers from the ortho specialty that show what early treatment amounts to. And they had a conclusion. Early treatment is ineffective. Early treatment is unstable. Early treatment doesn't work. Early treatment is useless. Early treatment should be avoided. No one should be treated early because it doesn't stay. It relapses almost on every child. The rate of relapse for early treatment was so big that the conclusion was do not do anything early. Wait until 11. Wait until the teeth are there. Now, that's a legitimate, these are all legitimate conclusions they drew. And I'm using the words early treatment on purpose. When you get to the articles and you dig into them, Then you see what it was. Because it's one thing to say early treatment was ineffective because all I do is early treatment, and I see success on every child. We have no failures in treating kids early. So I'm like, what is going on that they couldn't do this in 32 papers? They showed it was so poor. What was the early treatment? An upper expander only. An upper expander only is useless. An upper expander only Lauren Kennedy: Yeah. Dr. Ben Miraglia: is unstable. An upper expander only offers you no change. An upper expander only offers you no stability. An upper expander only so when they said early treatment is ineffective, an upper expander only is ineffective. So the the commonalities in all the research was they used an upper expander only, no myofunctional therapy, zero. So you had nothing in the musculature. And the third item, nothing for releases. Tongue, lip or cheek. There were nothing on releases. So here's the thought process that I'm going to go through because I'm thinking about an upper expander only. And you could do this too. If you put an upper expander only, how many millimeters can you go before you would say, I can't go any farther because the lower teeth are not moving? You know, when you use an upper Anastasia Dallas: Right, right. Dr. Ben Miraglia: expander only, the lower teeth are not getting wider. So, an upper, Lauren Kennedy: Eight. Yeah. Anastasia Dallas: This makes sense. Dr. Ben Miraglia: how far can you go? Three millimeters, maybe four. If you move an upper three to four millimeters wider, you have to stop because you don't want to go into that scissor bite. We don't want the upper lingual cusp outside the lower teeth. That's a really bad bite to have. So you're not allowed to expand the upper lingual cusp outside of the lower buccal cusp. We can't do that. So if you can expand three to four millimeters with an upper expander, what might you think is gonna happen when you take it out of the mouth? The upper is gonna shrink right back to match the lower, which is exactly what happened. That's what the research showed. Early treatment was Lauren Kennedy: Collapse, yeah. Dr. Ben Miraglia: ineffective, no stability, it doesn't work. An upper expander only doesn't work. That's a more appropriate conclusion. Upper expander only does not work, it's ineffective, it's useless. Because you're limited to three to four millimeters, and the moment you take that out, the upper is soft, the lower is hard, your bite will drive it right back to the same width. So I have seen for over two decades the number of children who come in to our office, and they're eleven, and they are here for a second opinion because they had an upper expander only when they were eight or nine. They had this expander on top. And they come back to see me for an opinion because they want to know if there's anything else you can do, because we were told at the office that gave us the expander when they were eight that now we have to take out the teeth. Because an upper expander only almost always gets followed by an eleven-year-old getting told you're gonna take out your bicuspids now. And the sad reality, Anastasia Dallas: Is that still a thing? Dr. Ben Miraglia: yeah, that's still happening. The rate is five to twenty percent. So five to twenty percent of premolars are getting extracted. The range five to twenty, we'll talk about this later, but it's socioeconomic is the difference. Five to twenty. In affluent areas, the extraction rate of bicuspids is about five percent, and in the non-affluent areas it's twenty percent. So there's there's a whole thing there. Now we know it's not genetic, of course. Lauren Kennedy: Yeah. Dr. Ben Miraglia: So the whole thing about going back to the upper expander only, my experience over the two and a half decades has been any child who comes in and has a history of an upper expander only will have exactly the same width they started with, will have the same crowding, the same symptoms, the same everything, nothing's different because it is useless. It follows the research. Exactly what the research said it would do. So early treatment was labeled as ineffective, but really upper expander only is ineffective. So then you learn when they use an upper expander only and they get to age 11. The crowding is too severe, they're still too narrow. And of course, the quoted sentences they'll say are to the parents, well, we did everything we could early with the expansion. That's the most we could do. But now you're still too crowded, so we have to take out your bicuspids. Here's the crazy part. When I request the records and you get the measurements, don't forget that expander had to be made when they were eight or nine. They have a model. If you measure the distance between the upper molars when they were eight or nine, when they got their expander, and then you measure the 11 year old in the chair, the number's the same. So they have no gain from it, which follows the research. It's exactly what you'd expect. There is no 11-year-old Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: that had an upper expander at eight or nine and then has a wider arch than they did when they had that model, because it shrinks back to match the lower. So you're not going to find it be effective by research and then by experience. So here's what I do: I use upper and lower expanders. It's what I was taught. And so since I was taught that over two decades, the thousands of kids I've treated and then the tens of thousands that have been treated by other doctors I which I have trained. They all get two expanders. Why would you put an upper in when the 32 papers published say that's ineffective because you can't go far enough. Now, if you want room for the teeth, that's one thing. That's one level. Making a little room for the teeth is actually the easy part. But if you want your breathing back, you need more than that. Because now you need the tongue space and you need the garden hose. So to Anastasia Dallas: Mm-hmm. Dr. Ben Miraglia: go from straw to garden hose, that's not three or four millimeters. Three or four millimeters gives you a small improvement in the breathing, but guess what happens when you take away an upper expander after three or four millimeters? That little improvement goes away. Lauren Kennedy: Perhaps yeah. Dr. Ben Miraglia: You end up with the same symptom list. So all of this adds up. The puzzle fits, it works. When we do an upper and lower expander, here comes the controversial part. We do a minimum of eight millimeters of expansion in both arches, and we also achieve a minimum intermolar width of 40 millimeters between three and fourteen. So in Lauren Kennedy: Wow. Dr. Ben Miraglia: between three and fourteen, the distance in between three and fourteen should be 40 millimeters minimum for any child that you're thinking about helping for their crowding, breathing. Sleeping symptoms. So if you're airway driven, you'd have to think beyond the first 28 teeth. Because remember, up to age 11 or 12, you only have to fit 28 in. That's easy. The hard part is making sure Lauren Kennedy: Yeah. Dr. Ben Miraglia: do you have the jaw size for all 32? Now, what does correspond is if you have the jaw size for 32 teeth early, they'll fit in later. Anastasia Dallas: Mm. Dr. Ben Miraglia: But what really does correspond to is you've got the jaw size for nasal breathing 24-7-365. That's your child who sleeps through the night breathing through their nose. has no sympathetic drive, has no symptom list, and has no medicine involved in your life. So I use upper and lower fixed expanders. You can do this at any age. So I use those all the way through 19. The teenagers get fixed expanders. It doesn't matter what age you are, that's a whole nother controversial thing. Meanwhile, we're helping that 14, 15, 16 year old who's on a list of medications, who measures Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: 29 millimeters when they should be 40, and we bring them to 40. So I teach Lauren Kennedy: Well hell. Dr. Ben Miraglia: and do upper and lower fixed expanders. You're gonna get eight millimeters at minimum. We're gonna go to 40 minimum. When you get to those minimums, I can tell you you will almost always have a nasal breathing child that will sleep through the night and have their symptom list reduced. And the next thing is when they come out, instant myofunctional therapy. You're going right into myo, because while I can catch you up, that's a physical change. I haven't done anything for your muscles. That's part two. Mile is difficult with my expanders in there. Yeah, they're in the way. I know they're in the way. But for the few months I need them, I can give you the space to have for the right Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: muscle work. Then we go into heavy muscle work. So it's full mile. And then if they decide releases are indicated, we do that. So yeah, I'm I'm the oddball out there. I'm the one doing an upper and lower expander. I don't think I have an example of doing one expander only in my entire two and a half decades. I teach doctors never to use one only because the research says it's bad. I can show you that over and over and over. We teach it in the cases that we Lauren Kennedy: What? Dr. Ben Miraglia: show. You need two expanders. The ortho will tell you you can't do that. that's how you're gonna cause problems. Meanwhile, no, the ortho specialty with their technique that's currently being used, traditional braces at 11 or 12, that's where the problems come from. Treating too late, treating the symptom. So I used to be nervous about all this. Now I'm not, I'm very confident. It's been a long time. It's a lot of lot of treatment Lauren Kennedy: You've got the proof. Dr. Ben Miraglia: being done like this. And you need two expanders in those kids, and that's how you get their nose breathing back, that's how you get their sleep back, that's how you shut off the sympathetic nervous system. That's how you get a C Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: student to become an A student. That's how you get a kid who who can't do anything right to do it all right. They're just malfunctioning because they can't sleep well. I would tell Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: you the biggest problem I have with what's going on today is the medication. It's almost a sole purpose now. I didn't have that at the beginning. It took a while to figure this out, but the children we're med over-medicating the kids. we are over-medicating the kids. I do have a big problem with the ADHD medication list. I know the child has the symptoms. I'm well aware of that. I'm not about Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: the symptoms aren't there. They're there. Every one of those Anastasia Dallas: Mm-hmm. Dr. Ben Miraglia: symptoms is there. That child and family are struggling. And I get it. When you don't have answers, you sometimes resort to the Anastasia Dallas: Yes. Dr. Ben Miraglia: medicine. But I'm also here to say that in two and a half decades, if you can restore the nasal breathing child and you shut off the sympathetic nervous system at night and they have a full proper sleep cycle set through the evening or overnight, that child's gonna wake up and have better behavior. So the ADHD symptom list, I'm a full believer, is based on the sympathetic nervous system overdrive. It is mouth breathing. You don't have to have OSA. You do not, the child does not have to have an OSA diagnosis. They just need to be mouth breathing at night. A child whose mouth is open at night cannot have proper sleep cycles. So mouth breathing alone is enough for sympathetic drive. That fragments your sleep. And when your sleep fragmented, your brain doesn't clean itself and it doesn't clean you for the next day. So you wake up different. And when your brain is not clean, you are not ready for the next day, you cannot function properly, Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: and one day just keep compounding over and over a day and night day. And then you go to school for six hours, you're expected to behave and focus, have attention. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: All the words they use, it's sleep deprivation. So the poor breathing at night gives you the symptom list during the day. Our experience in our office is that when we give those kids early treatment, grow the jaws, get back to nasal breathing, and it always includes nasal hygiene and myofunctional therapy. Like these are three things Anastasia Dallas: Yeah. Dr. Ben Miraglia: going on together. Nasal hygiene. Myofunctional therapy, and then whatever we need to grow the jaws, appliances, expanders, removable, fixed, whatever it is. All of that combined. The moment the child is nasal breathing overnight, that's when their symptom list goes away. So we know if we meet the child before they get medicine, they'll never get it. Because when the symptoms are gone, you don't need it. When we meet that kid on medication, we can get them off it because we can get the symptoms to reduce. And when the symptoms reduce, then the medical community is willing to start reducing the dosages. And then as the dosages come down, the symptoms don't return. So the child has asymptomatic and there's an end point to the medicine. Saddest part is the medicine is so highly addictive, it can take years to wean the kids off of it. So we meet we meet nine and ten-year-olds who are taking four and five medications now. And so if you have a child who's taking two ADHD meds and an anti-anxiety and antidepressive by age nine, those four medicines can take six months each to remove, one at a time. So you're not allowed to reduce them all, you can only take one away. You have to reduce one over six months, then you go to the next one. The addictive component of those produces withdrawal symptoms. So when you look at what they're treating, the medication treats the symptom list. It's not offering long-term success at all. So if you think about the kids who get the ADHD medicine under 10 years old, if you track it over time, you start seeing that ADHD medicine below 10 years old is translating into teenagers who then graduate to anxiety and depressive meds getting added to their regimen. But when you track it over a longer period of time, you start noticing in the 20s they are switching over to pain meds. So it becomes ADHD, anxiety, depressive, pain med. That's a trajectory that's too significant to ignore. So that's Lauren Kennedy: Well Dr. Ben Miraglia: not a solution. And it's short term Anastasia Dallas: It's not a problem. Dr. Ben Miraglia: maybe helping with some of these ADHD symptoms, but long term we're worsening these kids. And we are producing an addictive state because these are amphetamines. Amphetamines in a child is what it is. So one of the driving forces now, it used to be way back when when I started, I don't want anybody having extractions. day one, if you ask me 23 years ago, why am I doing this? I can't take any more extractions. There should be none. Twenty-five years later, not only have we never extracted a single tooth, because that would be incredibly ridiculous to take a tooth out. It's easy to have room for 32 teeth. We have a 75% rate of 32 teeth. It's and we we would love to be 100, but that's where we are today. The the next level going along the way was Wait a second. Never mind keeping all the teeth. That was too easy. A goalpost to have. The real goalpost is the real goalpost is non-medicated. A non-medicated Lauren Kennedy: Yeah. Anastasia Dallas: Yeah. Dr. Ben Miraglia: child. So if you think about the goals of all of this, it's I need nasal breathing, 247-365, and and non-medicated. Then you could Lauren Kennedy: Yeah. Dr. Ben Miraglia: say 32 teeth with a beautiful smile. if you were giving me the list of things, the importance. Yeah, it's a bonus. And Lauren Kennedy: That's just the bonus. Well, creating Anastasia Dallas: Yeah, yeah. Lauren Kennedy: a good, healthy generation because we're all so sick and being attacked by our environments and everything else. And and if Dr. Ben Miraglia: yeah. Anastasia Dallas: Yeah. Lauren Kennedy: I mean the whole reason for early intervention is obviously to create a healthy adult. And, you know, it's nice to that there's these possibilities out there to make that happen. But you're right. I Anastasia Dallas: Mm-hmm. Lauren Kennedy: mean, I just had a patient tell me they got their five-year-old grandson just this week. He started on an ADHD med. And I immediately Dr. Ben Miraglia: Yeah. Lauren Kennedy: was like, tell me about his sleep. Dr. Ben Miraglia: Yep. Lauren Kennedy: because no one had ever asked those questions. Dr. Ben Miraglia: And that five-year-old will have lack of primary spacing and probably a deep bite. You'll be looking at crowded deep bite, is the most common. The most common thing you'll see is a crowded deep bite. But they could have an open bite, they could have overjet, they could be class two. But you're gonna you're gonna see it in the teeth right away. You'll see the grinding. And then if they were asking them the symptom list, it would be there. But again, what does the medical community know about the mouth? They're not asking those questions. They Lauren Kennedy: They're not. Dr. Ben Miraglia: were they were trained to ask for the symptom list. And of course, that's ADHD is diagnosed by having two sources report six symptoms for six months. The school and the parent gets a form. If you look at the Connors test Lauren Kennedy: Yeah. Dr. Ben Miraglia: or the Connors forms, it's like 20 it anywhere the differences are 18 to 25 symptoms based on which one you choose to use. They're all sleep-deprived symptoms. When you read those items, you're like, I would have that if I didn't sleep well. I'd have that if I didn't sleep well, I'd have that. Lauren Kennedy: Yeah. Yeah. Dr. Ben Miraglia: And that symptom list is, sure, a five-year-old, yes, they're gonna show up with six symptoms for six months by two sources. The school says they have it, the parent says they have it. look at that, you got it. Here's your amphetamine. That's how it, there's no blood test. Lauren Kennedy: It feels like we're Anastasia Dallas: Right. Lauren Kennedy: making it fit. we're making these symptoms Dr. Ben Miraglia: Mm. Lauren Kennedy: now fit where we want the pharmaceutical world to go. Because I don't know. And Dr. Ben Miraglia: Yeah. Right? Lauren Kennedy: it's amazing. the I wonder in your experience, what's the surprise, the most surprised reaction you get from patients with the different symptoms? Like when we start talking about bed wetting or Anastasia Dallas: yes. Dr. Ben Miraglia: Right. Lauren Kennedy: night terrors or the ear tubes, and people are like, what Dr. Ben Miraglia: Yeah. Lauren Kennedy: does that have to do with any of it? Anastasia Dallas: They get defensive very quick sometimes. Dr. Ben Miraglia: Everything. Yeah. And it's meanwhile, it's a direct cause. The underdeveloped jaws are your direct pathway to bedwetting, night terrors, and ear infections. that's exactly right. And it's all the soft tissue dysfunction and the breathing. All of those things can be tied to those. And when you address the breathing through jaw growth and development, those go away. In our office, we're probably ninety-nine percent cure of bedwetting, cure of night terror, cure of ear infection. So the kids do not get another ear infection. They do not get ear tubes when they come to see us because all of that is driven through the breathing and the musculature. And as soon as you solve those two things, nasal breathing Lauren Kennedy: Hmm. Mm-hmm. Dr. Ben Miraglia: with proper muscle function doesn't get bed wetting, night terror, or ear infection, doesn't grind their teeth anymore. The digestive issues go away. The Lauren Kennedy: Yep. Dr. Ben Miraglia: digestive issues are directly related because if you're in sympathetic drive while you're sleeping, you're not getting your proper digestion. Most digestion occurs when you're sleeping. That's the parasympathetic component. We're supposed to be in rest and digest, that's parasympathetic. Instead, we're in fight or flight. That's sympathetic drive. Mouth breathing Lauren Kennedy: Hmm. Mm-hmm. Dr. Ben Miraglia: is that. And the biggest problem is that everybody wants to focus on OSA. It's not about OSA. You don't need to be OSA to have these problems. You just need to be mouth breathing. Mouth breathing is where unhealthy starts, not OSA. So I try to teach an analogy to help people see. Everybody understands stage one, two, three, four diseases. Like when you get a stage Lauren Kennedy: Okay. Dr. Ben Miraglia: one disease, you're happy to hear stage one instead of four. But if you learned you had a stage four disease, the fear and the nightmare that that is to learn you have a stage four disease. So this is not a thing, it's just my analogy. Obstructive sleep apnea is stage four disease. It's your stage four disease. It's the worst you could be. So we're talking about breathing. The worst breathing you could possibly have, your stage four would be OSA. You know what stage one is? Mouth breathing. Lauren Kennedy: Now it's breathing. Anastasia Dallas: Mouth breathing. Dr. Ben Miraglia: And what human being would ever go to a doctor and hear, you have stage one, come back when you're stage four. Lauren Kennedy: Yeah. Yeah. Let it progress. We're gonna watch it. Yeah. We're gonna Yeah. Yeah, yeah, exactly. Yeah. Dr. Ben Miraglia: Have stage one, let's wait. You have stage one, come back later. We'll check you. Yeah, we're gonna watch that. Let's check in six months. Come back in a year. We have a recall program. Yeah. So crazy to think about that breathing is not addressed the same Anastasia Dallas: Right. Yeah. Dr. Ben Miraglia: way because I'm telling you, mouth breathing is stage one, but mouth breathing is going to be OSA if we don't do anything about it. Just Lauren Kennedy: Yeah. Dr. Ben Miraglia: because you have people saying OSA is so rare in kids, it's like three to five percent. Well, I'm gonna say 99% of kids are mouth breathing right now, and because that recognizing. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: This is a lot of kids we've looked at over these years. It's a very high number of kids with underdeveloped jaws, and that Lauren Kennedy: Yeah. Dr. Ben Miraglia: gives you the poor breathing. They go together. Crowded baby teeth or baby teeth with a lack of spacing comes with poor breathing. And we're not addressing it early enough. We're not we're not looking at it as a severe condition. I think mouth breathing is a severe problem because of what it does to the sleep. Mouth breathing ruins your sleep. And that's why you have a five-year-old that you just learned is taking an ADAD medication. And I'm gonna tell you, I can predict that pathway. That medication is gonna be an increased dosage. And then when it doesn't do enough, they're gonna add a second one. And then a third. Anastasia Dallas: Mm-hmm. Lauren Kennedy: Yeah. Dr. Ben Miraglia: And this is gonna be a nine or ten year old taking multiple medications. It it's very rare that it's one. I've seen this too many times over. And if there's Lauren Kennedy: Hmm. Dr. Ben Miraglia: anything you could do to guide that child to somewhere to evaluate their sleep and breathing, take a look at the locator map on AHS. Airway Health Solutions, the locator map, if you could find someone and say, just please have this checked, you might have an alternative. It's unfortunate. But you mentioned five years old. Most most people have no idea what is the youngest you can prescribe ADHD meds to. It's age two. It's two. Yeah. Lauren Kennedy: What? Dr. Ben Miraglia: Two to four. And here's here's another one. I'm gonna this Anastasia Dallas: They even swallow a pill? Lauren Kennedy: Why? Dr. Ben Miraglia: is you're gonna get your mind blown in a in twice in ten seconds. It's age two, and you know when it was two thousand fourteen, twelve years ago. That legislation, two, three, and four were added in two thousand and fourteen. The New York Times broke an Lauren Kennedy: Gee, Dr. Ben Miraglia: article. Lauren Kennedy: wonder who was behind that? Hm. Dr. Ben Miraglia: the pharmaceutical company, what they did was they put 10,000 children on it, age two, three, and four. They put 10,000 kids on it to write papers that said it helps with the ADHD symptoms. They got the approval for age two. Prior to that, it was age five. So it ratcheted down. You can follow it way back when, back in the 80s, this was for teenagers. This started out. I know. No. Yeah. Lauren Kennedy: But we can't address food and sugar and colors and dyes in our environment. We can't address the things that we're ingesting, but we're gonna allow big pharma to pump two-year-olds full of amphetamines. Dr. Ben Miraglia: Two, three, and four. yeah. And now now we have we have incredible numbers. It's not ten thousand anymore. That was done in two thousand twelve, thirteen Lauren Kennedy: Wow. Dr. Ben Miraglia: to prove it's correct. In two thousand fourteen, the legislation was put through, and that group, the two, three, four year olds were added in twelve years ago. So you have a lot of kids getting that medication at young ages. Soon as you have symptoms, you got it. Basically it opens up a new market. How do you make more money? Open up a new market. Lauren Kennedy: Of course it Of course. Dr. Ben Miraglia: Change the numbers. Take a look at blood pressure and cholesterol for a good example. Just lower the numbers, Anastasia Dallas: Same, yeah. Lauren Kennedy: yeah. Dr. Ben Miraglia: you open up another few million. You got a few more million customers. Yesterday I didn't have it. Today I do. Yesterday I'm healthy. Today Lauren Kennedy: Of course. now it's become the average. Yes. Anastasia Dallas: Yeah. Dr. Ben Miraglia: I'm not. Give me my medicine. It's nuts. It's nuts. But this is what's going on. They don't know. Nobody knows. Ugh. Anastasia Dallas: And what's sad is a lot of parents don't know. They just listen to whatever their providers and this is why this is conversation Lauren Kennedy: Of course they don't know. Anastasia Dallas: is so important. Lauren Kennedy: They just want relief. Cause you imagine. Yeah. Yeah. Dr. Ben Miraglia: Yes, they they need help. You got it. The symptoms are real. The symptoms are real. The struggle is real. That is a battle all day at home and all at school. So of course, people need help. They need relief. But the medical community addresses the symptoms only. And sadly, our model is symptom and pharmaceutical delivery. That that is mostly the medical model. It's a funnel. What are your symptoms? And Lauren Kennedy: Yeah. Yep. Dr. Ben Miraglia: at the bottom pops out your medicine. Like this is the way it's going mostly. And sure enough, in the dental community, we actually have the solution for this because it's an oral cavity issue. So and I know you said food and nutrition. Yeah, these are the other big pi peces. my world is the is the oral cavity and I have seen it. The small jaw, the poor breathing, the poor sleeping is direct correlation. And then if you asked me what is the second biggest problem, you know, I would go, well, after jaw growth, because we all have these small jaws, we gotta get the jaws. I would say we gotta turn to nutrition next because these kids are eating the wrong things. They're eating and drinking everything wrong. And so we gotta Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: get the nutrition back. Craziest part of nutrition is it's no longer the difference between what we would say is healthy food and fast food. Because you gotta look at your healthy food, is it? Where did it come from? What's been sprayed on it? Yeah, there's a lot Lauren Kennedy: No, everything's processed. Yeah. Dr. Ben Miraglia: the healthy food has been altered. So it's all Lauren Kennedy: Yeah. Dr. Ben Miraglia: it's very difficult to eat healthy now. It's not about, I went to the farmer's market I went to this, that. You gotta do your research to find stuff that wasn't treated before it got to you. It doesn't have to be just going to fast food anymore. It's a whole different world there. So you got that going on. And then the other hot topic out there is a little bit beyond me, but it's the early vaccine schedule. I think parents have to do a lot of their own research on that. There's Lauren Kennedy: Mm-hmm. Mm-hmm. Dr. Ben Miraglia: a lot out there to look at, but my world is the Jaws. We gotta get these Yeah, we we gotta get more kids treated. Yeah. Anastasia Dallas: Yep. Right. So one quick question. For Lauren Kennedy: Thank you for doing it. Thank you. What yeah. Anastasia Dallas: parents maybe listening right now who have kids in ortho, who have an expander. Their kids are mouth breathing. There's a lot of inflammation. Where do they go from there now? Should they go to the the website and try to find a provider and go that way? What would you recommend? Dr. Ben Miraglia: Yeah. Yeah, I would say most parents who have gone down the braces only route or had an upper expander only would probably recognize their child has breathing and sleeping conditions. So Anastasia Dallas: Yes. Dr. Ben Miraglia: I I would tell the parents go to the www.airwayhealth solutions dot com, go to the doctor locator, look at your state, your region, find a bubble there that's a pin and go to that office for an opinion because at least they were trained to do things earlier, but Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: We also do train through teenage and adult years, because just because, yeah, you know, a lot of 15-year-olds had their teeth pulled out. And now, of course, we have 50 and 60 year olds who are struggling with the same things, but for decades. Anastasia Dallas: Right. Dr. Ben Miraglia: So we do teach how to treat any age. It's from three on up. We can treat any age. I would like to treat earlier than to have someone suffer for decades with inflammation and medication, because it's not really working out, but go to the website. one piece of advice I give I like to give parents is do not let anybody take any teeth out. It's never right. It is never right. There is no reason to take out any tooth that applies to baby teeth and permanent teeth. Because when I was first thinking about premolar extraction, we ought to avoid that. And we we have a solution for that. It's early growth and development of the jaws and the muscle work. But then you we I started learning about hey, they're taking out the baby canines too early. They're taking out baby canines on eight and nine-year-olds to make room for teeth. That's subtractive. So I I Lauren Kennedy: Hmm. Dr. Ben Miraglia: learned in the reverse model that they they would see the crowded incisors. And the ortho and the pediatric dental community was taking out the baby canines to make room. They were telling parents, we're gonna take these teeth out to make room. When you're eight and nine, you don't take out the baby canine to make room for the permanent canine. You're taking out the baby canine to make room for the four incisors to spread out. And when the four incisors Lauren Kennedy: No. Three more years. Yeah. Yeah. Dr. Ben Miraglia: spread out, you just blocked the canine, which means they're gonna take out the first premolar that comes in. So the baby canine extraction it precedes the four-by-extraction. So Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: the the probably the number one message for parents would be. Do not let anyone take out teeth anytime ever. Not baby teeth or permanent teeth. That's always subtracting and making you smaller and worse. And the second thing Lauren Kennedy: Yeah. Dr. Ben Miraglia: would be: your gut instinct is right. The mom is always right. When they have the gut instinct, something's wrong and has to be treated. If you're told to wait or it's normal, that's not okay. You just gotta go to the next office. Keep looking. That's what the website's for. You go there and you look for the locator to find someone who knows how to treat your child now because your intuition is correct. They could have treatment now to help them. And extractions are never good. There is never a reason to take out teeth. And then the one exception would be look, if you get the cavity that destroys it and you can't fix it, I got it, I got it, I know there's always that one out there. Lauren Kennedy: Yeah, yeah, yeah. Dr. Ben Miraglia: Because someone would say, Well, what about the blown out to come on? We're talking about orthodontics and drug. Yeah, it's not dental disease. Yeah. Yes, multiple. Lauren Kennedy: We're not even talking about dental disease at this point. Okay. Do you have hygienists in your office? Cause Anastasia Dallas: Yeah, no, we're not talking about yeah. No. Lauren Kennedy: what do you train your hygienists to look for and say to the parents Dr. Ben Miraglia: Yeah. Lauren Kennedy: and the families? Dr. Ben Miraglia: Yeah, right away. So they do all know about the lack of primary spacing. Now what used to be in the devil community, the hygiene world would know to tell parents, if the baby teeth are together, save for braces. Like you're gonna need braces. The crowding's coming. We just approach it differently. We say, the baby teeth are together. Now you you're gonna have crowded permanent teeth. Years ago it used to be waiting for braces, but now we know the teeth are a symptom and there's something more going on. And we can see there's some grinding of the teeth going on, the warning enamel. We start asking questions. So we'd like to, based on seeing these baby teeth together, we want you to fill out some forms. That's where the pediatric sleep questionnaires come in. Now we start asking about mouth breathing versus nose breathing, day or night. Does your child snore? Do they grind their teeth? Do they thrash around? Do they wake at night? Do they have nightmares? Do they have digestive? All of these things are in that form. Bed wetting, nightmares, ear infections. When you go through that list and Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: Again, the parent checks off boxes because we just don't meet three and four year olds that have a blank form. Soon as we see it in the teeth, we can say the thing like the permanent teeth will be crowded. But instead of waiting for braces, we do it a little differently now. We'd like to ask more questions. We want to learn more about your child. Are you having some struggles at home and here they might be? And then we ask about the behavior and things like this too. Soon as we start asking questions, the parent's light bulb starts going off. And then they start asking good questions, saying, These are related. Lauren Kennedy: Hmm. Dr. Ben Miraglia: Yes, they are. And we were told it's normal. Our eight year old who's bedwedding six nights a week, we're told they'll outgrow it. It's normal. Now we we meet twelve year olds who are bedwedding seven nights a week. We have twelve year olds who come in bed wedding twice a night and they go through three bed changes. This is how Lauren Kennedy: War now now. Anastasia Dallas: Really. Dr. Ben Miraglia: bad this is. So you know right now the CDC has statistics that say ten percent of all kids bedwed up to the age of twelve. These are horrific Lauren Kennedy: Well. Dr. Ben Miraglia: numbers. But we start asking these questions based on so basically the hygiene starts leading the question. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: Of we see these baby teeth together and they look so cute together, but we know that's gonna be crowded teeth later. It used to be we'd wait for braces, but now we wanna ask you more questions about your child. We gotta learn a little more. There's opportunities to help earlier when we see this. We don't wait until 12 anymore. That's when the questions are coming out. Now the parent knows, Anastasia Dallas: Mm-hmm. Dr. Ben Miraglia: yeah, those teeth are gonna be crowded later on. It's kind of a given. Now that we start asking these questions, now someone has to make that bridge. So that's the handoff. basically it's almost like the routine you would talk about where the hygiene starts to screen. There's a handoff, the doctor makes a diagnosis. And sure enough, Anastasia Dallas: Mm-hmm. Dr. Ben Miraglia: that questionnaire gets inserted right in the middle. doc, hey, Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: you know, little Susie is here for her cleaning appointment. We cleaned her teeth and we took a bite wing. Would you check those? And Anastasia Dallas: Mm-hmm. Dr. Ben Miraglia: we noticed how close those baby teeth were together. We saw a little bit of the grinding. We asked parents a few questions. We learned a few things about little Susie today. Would you please check her bite? Check her bite is like our handoff. Check her bite is the doctor's cue. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: I know already I gotta diagnose this malocclusion. Anastasia Dallas: Yeah. Lauren Kennedy: Yeah. Yeah. Dr. Ben Miraglia: I got underdeveloped jaws, I got crowded teeth, deep bite, all these things. And I know the questionnaire's going, and sure enough, that's Lauren Kennedy: Yeah, bro. Dr. Ben Miraglia: when that leads to the consult. It leads from the screening to the handoff to the questionnaires, the consult, and then we put it together so the parent gets that bridge. What we see in the mouth, what they see in the symptoms at home. And how these are related and what we do about it. How do we start now and what's in it for your child? So it's always nasal hygiene, jaw growth and development, myofunctional therapy. That's like the three categories we have to get involved with early. And the myofunctional therapy leads to the fourth, which could be friend and releases if they're found to be restrictions that could help that child. So yeah, the hygienist is the key role right there. They they get to see and play with that child for the time in the chair. And that's where the screening begins. So it would be awesome if we could have every hygienist trained to screen. And then make a handoff, and then the doctor again, they'll feel threatened at first. Don't worry, you don't have to treat a four-year-old, just gotta know where to refer If you see it, if you see it. Anastasia Dallas: Right. And that's why I'm Lauren Kennedy: Yeah. Anastasia Dallas: so excited because I talk about airway all day, every day. And Dr. Ben Miraglia: Yeah. Anastasia Dallas: I'm the only one. But now the doctor I work with, it's like I've lit some spark in him. He went to an airway course. Lauren Kennedy: He's listening. Anastasia Dallas: I sent him some of your stuff and it's just I'm like Dr. Ben Miraglia: Right? Okay. Lauren Kennedy: Mm-hmm. Anastasia Dallas: 'cause sometimes, they just need to hear it over and over again. Yep. Dr. Ben Miraglia: Yeah, it's out there. And you know what? It does slowly build. There are doctors who Lauren Kennedy: That's true. Right. Dr. Ben Miraglia: are happy to refer. And we're okay with that. I just want to meet you where you are. If you could just screen and refer. We've got Anastasia Dallas: Yes. Yep. Dr. Ben Miraglia: enough people out there want to help these kids or teens or adults Anastasia Dallas: Mm-hmm. Dr. Ben Miraglia: out, so just send them Lauren Kennedy: Yeah. Dr. Ben Miraglia: to a place. Don't worry, Anastasia Dallas: Yeah. Dr. Ben Miraglia: we won't do the fillings on them. We'll just do the growth and airway and you'll get your fillings. But we have inspired Lauren Kennedy: Exactly. You won't steal them. Wow. Anastasia Dallas: Okay. Dr. Ben Miraglia: we have inspired a few doctors to take the training. I have had doctors come to the course and The the one that really stands out is this he was so funny. New York City dentist comes to the class, he goes, you know, I just I see your name everywhere. You teach a lot of courses, airway. I don't do any of that. I I do I treat adults only. I know you treat a lot of kids, but I wanted to just see what you do. At the end of the day, he came up. This was like an eight-hour program on treating kids early. He goes, I think I'll have to treat every kid I see now. He had never treated a child in his life. He was a 20-year dentist reconstructing mouths in New York City. He built a separate center. And all he does is treat kids now. He had to get associates to the other. He stopped fixing teeth. He couldn't unsee it. And now he treats every child he meets. Lauren Kennedy: Wow. Exactly. Dr. Ben Miraglia: And it totally came out of nowhere. And he was the one who came up at the beginning and said, I'll never treat a child. You I'm just here to see what you do because I treat adults. And meanwhile, now, Lauren Kennedy: You can't unsee it. Dr. Ben Miraglia: yeah. So we've won a lot of people over. But if I can get people to refer or Anastasia Dallas: Yeah, once you see it, you can't unsee it. Mm mm. Dr. Ben Miraglia: treat, I don't care what category you land in, you just have to know that we don't extract teeth anymore. And we do treat early, and it does help the child. Yes, the jaw growth helps Lauren Kennedy: Good. Dr. Ben Miraglia: the breathing, the sleeping and it's it's helpful. It's not a fat. Yeah. Anastasia Dallas: No, I had so many questions. Lauren Kennedy: Ma'am. So many. I don't even know. We have to have part four, five, and six with you. Dr. Ben Miraglia: Yeah. We yes, there's a lot to talk Anastasia Dallas: Yeah. But you've given me Dr. Ben Miraglia: about. Anastasia Dallas: such a great perspective on so many things right now Lauren Kennedy: Yes. Anastasia Dallas: that I didn't even put together. So thank you. Lauren Kennedy: Yeah, thank you. Where can we tell people Dr. Ben Miraglia: You you're welcome. And I'm sorry. Anastasia Dallas: Ha ha Lauren Kennedy: to follow you and find you and hear more of your gems? Where do you want to lead people? Dr. Ben Miraglia: Yeah, so we we do have Instagram, you can check out Instagram, Airway Health Solutions. The website is very helpful, lots of information in there, and plus coursework. if you feel like you want to learn more, there's coursework. There's introductory level courses for the doctor who's just curious. We have small Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: introductory programs to like for the airway curious people who are like, let me see what he's talking about. All the way Yeah, we call it Airway Curious, because hey, you I I Lauren Kennedy: Airway curious. Yeah. Dr. Ben Miraglia: hear the word out there so much. What's airway? What's airway? What's airway? Maybe I should see what's going on. Lauren Kennedy: Yeah. Yeah. Dr. Ben Miraglia: We have that airway curious course just to give you a taste of what we're doing and not Lauren Kennedy: Yeah. Dr. Ben Miraglia: necessarily throw you in the deep end. But we do have all the way to full treatment. I do teach teach full technique to treat anything from three to any age based on growth and development. And most of my treatment is non-surgical intervention. So I focus on a lot of non-surgical intervention. Of course, that's Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: more with the teens and adults, where we do that. The kids is always growth and development, non-surgical and kids. And then we do have adjunct faculty who will bring you down the surgical road where There are some adults who could benefit from having some jaw surgery procedures or MARPE and Dome and all these other things that are out there. And just because I don't do it doesn't mean it it isn't helpful. So we just bring in faculty who is who are experts at that too. So we we do have a full comprehensive program there. So that's helpful for education and awareness, certainly. For parents, maybe slightly different direction. You know, they would definitely check out the baby-led weaning and the solid starts, not related to me, but just a way to start earlier. Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: And then there's one other direction I could give parents to go learn more is a company called Tooth Pillow. And so toothpillow exists because you can treat children as young as three early. Removable appliances are effective. I've been using them for more over two decades, and there are different companies that make them. But we built tooth pillow to help treat children remotely, where if they don't have a local dentist by them treating at age three to five, which again that's more rare still today. If you don't have a dentist using removable appliances and myofunctional therapy and in that three to five year old range and you want treatment, you can look into tooth pillow and submit your child's records and fill out forms. So we built that for a parent to actually use their phone, take pictures of their child, send them in with a full pediatric sleep questionnaire. And in there, what we do is we evaluate that child for remote treatment. So we have a dentist representing every state. So I have all 50 states covered. And if your child could be treated with Myofunctional therapy and removable appliances, we can do that remotely. Myofunctional therapy is done through Zoom. We have an entire team of myofunctional therapists nationwide who treat these children through scheduled appointments to do myofunctional therapy remotely if they don't have someone local. And the appliances we developed rulers basically that parents can take pictures of so I can send them appropriate appliances to use that support the myo. So an hour a day plus overnight plus the myo. If we recognize releases, we try to locate someone to go get that. You can't do release remote. It is not direct to consumer. It is not a direct-to-consumer model. You have to go through a doctor's appointment and diagnosis to get to treatment. So that's why every state is covered. We have a doctor in every single state because you need a license in the state you're treating the patient. It is remote treatment. So it's remote treatment by a doctor with a support team, which we would call our assistants and our hygienists and our myofunctional therapy team behind the scenes. We monitor through, obviously, we have an app, we have a website. But we built a lot of information in there connecting the dots. So parents could start with toothpillow as a website, toothpillow.com, just to learn more. Because all the things we're talking about, we build it out in there. And then there's the research in there and the other ways to learn more. And we want parents to learn more to have choices. I don't care where you go and get treated. If you have someone local, you should go there. If you don't, if you're looking at this and looking at three to four hours of driving and you have four kids, the remote model might work for you and your family. We've helped a lot of Lauren Kennedy: Mm-hmm. Dr. Ben Miraglia: people over the last few years. And I would say now we're probably at around fifteen thousand kids have been treated remotely, and that's over about four years, but in in cases where they just don't have someone local, that's a good choice because no treatment is not helping the child. They're getting worse. Anastasia Dallas: So now I'm gonna go reinstate my New York license. So Dr. Ben Miraglia: Yeah. Lauren Kennedy: Hey, when you when you get off the phone, you tell Brittany she needs to reschedule with us. Dr. Ben Miraglia: Yeah, yeah. Anastasia Dallas: We had that was a while ago, right? We had done all that. Lauren Kennedy: Yeah. She's Dr. Ben Miraglia: You had her Lauren Kennedy: hard to get a hold of. She's funny, so we'll s Dr. Ben Miraglia: on it. She's busy. So she's obviously she's my number one myofunctional therapist. She's within forty five minutes. Lauren Kennedy: Yeah. Dr. Ben Miraglia: I send everybody here to her office. And she Lauren Kennedy: Yeah. Dr. Ben Miraglia: is also one of our lead myofunctional therapists at Tooth Pillow. So she does a lot of the remote treatment. She's very good with remote myo. And so Lauren Kennedy: Mm. Yeah. Dr. Ben Miraglia: she does a lot of that. She supports us a lot there. Yeah. Her and Laura Eckert. Yeah. Lauren Kennedy: That's good. You've got a good team. I think it's great. You've got a beautiful product. And well thank you so much for being here with us. Thank you for your time. Yeah. Anastasia Dallas: Yep. Yep. And we love what you're doing. Yes. And for everyone listening, I'm sure Dr. Ben Miraglia: I appreciate that. Anastasia Dallas: you don't want to miss this episode because you are going to learn something. And I'm sure you're going to have to share this with someone you know that has an airway situation or is mouth breathing because I feel like 90% Lauren Kennedy: No. We all just learned buds. Yeah. Please. Which is everyone. Anastasia Dallas: of the population. Dr. Ben Miraglia: Mm-hmm. Anastasia Dallas: So go follow us, subscribe, all the platforms. I hope to have you on I hope Lauren and I, we both want you on again 'cause I feel like we could have talked for Lauren Kennedy: For sure. Anastasia Dallas: another three hours. But thank you. Dr. Ben Miraglia: Easy. Lauren Kennedy: I can't believe it's been an hour and 23 minutes already. I don't even know how that happened. it's been it's amazing. Thank you for your knowledge and your passion. Dr. Ben Miraglia: no, ten minutes. T it's been ten minutes. We just started. Anastasia Dallas: Warren, what do you remember I didn't push record, remember? Dr. Ben Miraglia: I'll come back anytime. There's plenty to talk about. I'll come back anytime. Lauren Kennedy: Right? my God. We've just been talking. But thank you so much. Thank you to everyone listening. Thank you. We appreciate it too. All right. Until next time. Okay. All right. Bye. Anastasia Dallas: But yes. Awesome. Thank you so much. And we'll see you all next Wednesday. Yes. Thank you. Dr. Ben Miraglia: Thank you. Until next time. See you soon. Thanks again. Lauren Kennedy: Thank you. Anastasia Dallas: Thank you.