Kathryn Haraldson, DDS

02/01/2024

Not every tongue tie causes problems, but this mother was right on it! Her doctors were not listening.

Here’s a tongue-tie in a 6-year-old I saw today.

The presenting concern was frustration and lack of progress with speech therapy. Two to three years later, with many changes in therapists, going in many different directions, the last therapist said everything was fine for her age.

Still grappling with persistent speech concerns, mum has also sought ENT evaluation.

The ENT diagnosed a tongue-tie but said to leave it. Mum was confused as despite a history of breastfeeding challenges including pain, latching difficulties, and symptoms of air-induced reflux, multiple lactation consultants, and all her speech therapists have not noted it prior.

She has had surgery to insert grommets to help address mild hearing loss, and removal of adenoids. A year later, she is still having ongoing ear infections, requiring constant rounds of antibiotics, and an x-ray has confirmed regrowth of the adenoids. The ENT has said to have them out again, but through a friend, mum has started to question whether it could be the mouth that could be contributing to the speech problems.

She had a very slow transition to solids. She would only like smooth purees and took a long time to eat as soon as texture was introduced. Mum describes her as the slowest eater she has ever seen in her life.

In the mouth, I see one of the strongest red flags of breathing problems – teeth grinding related tooth wear. She has a constricted palate and tongue-space.

It turns out she is a hot and sweaty sleeper, with a history of disturbed and fragmented sleep. She is not refreshed in the morning, and there are significant concerns with emotional regulation, and anxiety.

This is not an uncommon story. I feel a deep sense of despair for parents doing their absolute best to get answers and experiencing years of conflicting advice and dismissal of their concerns. Often parents are frustrated and overwhelmed to tears during consultation. And there needs to be a day where people are not driving for hours or flying in to get answers.

I’d like a future where every lactation consultant, speech therapist, ENT specialist, dentist and more is trained to understand that we need to pay attention to tongue elevation.

We need the tongue to lift well for

✅ Efficient drainage during breastfeeding
✅ Good swallowing and eustachian tube clearance
✅ Speech perception and articulation
✅ Palate development
✅ Good breathing and sleep

And when we allow compensations and overuse muscles of the face, jaw, and neck during oral functions, the ultimate problem is that we don't develop the proper tongue tone and posture for good breathing, sleep, and a child to thrive to their full potential during the day.

We need to question whether breastfeeding, chewing, swallowing, and speech problems could be related to how the muscles of the mouth are working. And if we recognise those same muscles are those that affect how airway grows and functions – we need to be in-tune for signs of airway problems in children.

As professionals, let’s start recognising the whole child – not just the immediate concerns but laying the foundation for a thriving future. Check out Inspiration by Integration 2024: A Practical Guide to Children's Airway Health - which will spark lots of new conversations on integrative care.

Parents, find empowerment in connecting the dots, and gain confidence in advocating for your child to build more professional curiosity and collaboration.

09/03/2023

Tongue-tie release at 7.5 months – a one week review

This bub had a rough start to life.

She was stiff, could only look to one side, had to be held upright, and was constantly crying and screaming.

They saw many health care professionals who said it was colic, and purple crying, and that some babies were more vocal than others, and not to compare children.

They sought consultation with IBCLC Mel Johnson from Pure Placentas - Perth Placenta Encapsulation Specialists who referred her to osteopath Dr Sweatal Shah at Northern Osteopathy and to us for tongue-tie assessment.

Mum described Dr Sweatal as their saviour. Through multiple osteopathic visits, she was becoming a less tense and happier baby. Although tension was releasing, adjustments were not holding.

Prior to their appointment with me, they had also been doing oral exercises prescribed by their IBCLC, to reduce her gag reflex, and prepare her for tongue-tie release.

One week post tongue-tie release mum reported:

* Osteopath reported an immediate shift in how she was holding her neck. Will only require one more review in two weeks.
* Tummy time was not a 2 minute ordeal – she could now do 15 minutes without screaming
* Would also wobble and arch back when sitting – she could now sit unassisted for 20 minutes, and grab toys without toppling
* Feeds through the night were more efficient – down to 15 minutes from 45 minutes
* Free range to move her arms- can lift them both up now
* Overall able to enjoy more baby moments with her

Thank you to Mel and Dr Shah for their comprehensive preparation and support to achieve this outcome.

Disclaimer:

Any surgical procedure carries risk, and individual results may vary.��Before proceeding with this surgery, you should seek a second opinion with an appropriately qualified practitioner.

09/02/2023

Accelerated teeth grinding related dental wear, combined with airway reflux

Here’s a case of severe dental wear in a 6-year-old I saw today. And I’m sharing this to highlight, that we need to address root causes.

She was referred to us by a chiropractor for consultation regarding teeth grinding.

Both her regular dentist, and specialist pediatric dentist had made mum aware she had severe tooth wear due to grinding, and that she was prone to needing fillings. She has had multiple fillings, and sealants to protect her worn teeth.

Teeth grinding in children one of the strongest red flags that a child is having breathing difficulties during sleep. This is not something I was taught in dental school. We now understand it is often a stress response to a narrowing of the airway. The jaw muscles are recruited to re-open the airway which protects against sleep apnoea and oxygen deprivation. The only problem is that children don’t enter deep sleep, and this can be linked to restless and un-restorative sleep, and difficulties with emotional regulation, behaviour, sitting still, attention, and concentration. Some children in a constant fight-or-flight state due to the chronic stress of breathing difficulties may present with anxiety or have more troubles getting to sleep. Many children that I see are medicated with melatonin. The underlying airway problem is not addressed.

We often do not see significant tooth wear related to teeth grinding because enamel is the strongest substance in the body. It is even harder than bone.

When we see severe tooth wear, it’s important that we keep digging deeper as to find out why.

Many times, it is because there is airway reflux, and the pooling of aerosols of acid in the mouth. It is the combination of acid and teeth grinding that deteriorates the teeth quickly. The scooped our wear facets are examples of severe dental erosion of the inner softer and yellow dentine layer of tooth, from acid pooling in the mouth.

Airway reflux occurs when a child has increased efforts to breathe through a narrowed airway. This creates vacuum pressures that allow stomach acids to aerosolize into the throat and mouth. It can irritate and contribute to swelling of the adenoids and tonsils, or result in symptoms like chronic cough, throat clearing, post-nasal drip, or “spew burps.” Often it gets misdiagnosed as asthma, and children are medicated for this.

Whether it be the constant need for fillings, teeth grinding, behavioural problems, difficulties falling asleep, or asthma-type symptoms, let’s not overlook poor airway and breathing dysfunction as contributors.

I don’t necessarily need a sleep study to decide on treatment – in this case, there are very clear risk factors of poor airway, and it is clear to me that this child is not sleeping well, and her day-time function is suffering for it. To get to the bottom of this – we must check the jaw structures, tongue posture (including ruling out tongue-ties), and obstructions inside the nose and throat, and adopt a combination approach to manage all.

08/09/2023

This is an incredible story! Never underestimate the power of the release!

We are so grateful to this mother for taking the time to share her daughter's experience with tongue-tie release at 15 years 10 months.

It's not uncommon for for me to hear parents report their paediatrician said something like, "I don't believe in tongue-ties." But for each story like this shared, I hope more minds can be opened.

"Jenna was born in a country hospital in 2006 with a severe tongue tie and only one formed kidney (Unilateral Renal Agenesis). At the time, we asked the medical staff about having the tongue tie “snipped” but were assured that it was only ever done for cosmetic reasons, and that if it didn’t affect her speech in the future then not to worry. Being my first child, I didn’t question it, and as my own family hadn’t had any history of tongue tie, I had no other sources of help or information available; also given the kidney situation, we were mostly focused on making sure that was ok and didn’t really think to ask more questions about the tie.

As a baby, she struggled with both feeding and sleep. I was unable to breastfeed despite my best efforts, but at no point did anyone suggest it may have been related to her tongue tie (insert mothers guilt here!). We put her on formula by the end of the first week, and while she was getting some food down, she would projectile vomit after almost every meal, and had terrible wind pain. Eventually we changed her to a formula with a thickening agent, and that seemed to work a little better. She loved solid food and never complained about any pain - actually, she never once mentioned that it hurt to chew a steak until she was 15 years old in the Sparkle office!

Her sleep situation was disastrous, I nicknamed her “the midnight kid” by the age of 1 as it was impossible to get her to sleep before that time, once finally asleep she would sleep for a few hours, regularly up and down but always with intermittent snoring. She met all her milestones and once she began talking, she didn’t stop! There was a small period of switching R’s for W’s, but once we picked that up and practiced it with her, it wasn’t long before she was pronouncing her words correctly.

Around the age of 14 Jenna experienced some very low points. Her mental health was suffering and it was a very hard time for her. We found a wonderful therapist, and with help and guidance from the GP she tried an antidepressant medication and Melatonin to sleep. Unfortunately Jenna was the exception to the rule, and the antidepressant medication had an adverse effect on her. She experienced a rapid increase in intrusive thoughts, depression and anxiety, so she stopped taking them. As a family, we are neither “for” nor “against” medication of children - we were so frightened of what might happen, of how sad and miserable she had become, that we were prepared to try absolutely anything to help her feel better, and ultimately to keep her alive. Whatever works, right?

In 2022 (15yrs old) we visited the dentist for a check up, and to discuss the possibility of braces as her bottom teeth were becoming quite crooked. He recommended we contact Sparkle Dental and discuss the possibility of a tongue tie release. He explained that there had been a lot of research done in regards to the benefits of a tongue tie release, and that it would assist the braces to helping keep her teeth straight once the braces were off.

We visited Sparkle, and with every visit, we were blown away by the research and information Shereen and Karli shared with us. The links between the tongue functioning properly and the release of “happy” chemicals in the brain when it hits the N-Spot, the way it affected the way she ate, what she would eat, the inability to get good sleep… all the pieces fell into place for us. Once she (begrudgingly if I’m honest) had done her tongue exercises and strengthened the muscle, and frequented the Osteopath for body work, it was finally time for the release. She was asked to try and touch her toes before the surgery - Jenna had NEVER been able to touch her toes, despite also having joint hyper mobility, and she couldn’t do it. She reported to me that she felt all of the tension in her shoulders and neck release WHILE undergoing the procedure, and that was pretty incredible! Once the procedure was done, she rested a while and then tried to touch her toes once more, and it blew her mind that she could actually do it! It became her party trick for the next few weeks, showing anyone and everyone who’d pay attention.

I remember saying to Shereen that I wished I’d known all these things when Jenna was a baby, as it would have saved her from so much pain and distress. However, I am so glad this was suggested when it was, as we have noticed some incredible changes in our daughter since the procedure. She sleeps well, no need for Melatonin anymore. Her general mood improved almost immediately - and for the most part, has stayed in a good healthy space. She happily eats a steak with no pain. She is motivated and excited for life and her future, and we will all be forever grateful that we were pointed in this direction."

Disclaimer:

Any surgical procedure carries risk, and individual results may vary.
Before proceeding with this surgery, you should seek a second opinion with an appropriately qualified practitioner

05/24/2023

So true! Do your young kids have spacing between their teeth? If not then they should!

Did you know that lack of spacing between the baby teeth is a sign of severe dental crowding problems ahead?

But it's not just a dental problem. It means jaw and airway development has gone off track, and there is some degree of constricted tongue space.

My preferred age for assessment for early intervention is no later than the age of 5.5 - 6 years old, and well before the first upper adult teeth come in.

If a parent has concerns about their child’s mouth breathing, snoring, teeth grinding, disturbed sleep, or speech, earlier assessment may be of benefit as I have intervened with palate expansion in children from age 3.5 years.

I use a removable palate expansion device called the Biobloc Expander that not only widens the palate but stimulates a wider arch of bone around where the front teeth should sit. This makes more space for adult teeth to fit in. It doesn’t necessarily guarantee avoidance of braces, but it does stimulate new bone in a way that is not achieved as simply in later childhood, and it can reduce the complexity of future orthodontic treatment.

Here’s an example of the appliance and the spaces and bone we aim to create around the baby teeth.

https://www.facebook.com/photo/?fbid=585285280264967&set=a.257905903002908

I’ve been seeing a few patients aged 7 years of age that I wish I could have seen a bit earlier. By then, sometimes the upper lateral incisors have been blocked out and are on course to erupt into the wrong zone no matter what new bone we can create.

Disclaimer:

Any orthodontic procedure carries risk, and individual results may vary.
Before proceeding with treatment, you should seek a second opinion with a specialist orthodontist.

05/24/2023

Interesting! Have your vitamin D levels tested yearly!

In my dental practice, there are sometimes inquisitive patients that ask very good questions.

When we are looking at a child with crooked teeth, they are asking why it has happened.

Why don’t our jaws grow to fit 32 teeth like they used to?

Well in the 1930s, a dentist hypothesized that our diet was the root of dental disease. Both tooth decay and crooked teeth occur when we move off an ancestral diet.

See humans traditionally eat foods high in animal fats, and the reason is because they are high in fat soluble vitamins.

In one generation, human teeth deteriorate when we are deficient in these critical nutrients that help our body to grow strong bones and teeth.

Fat soluble vitamins include Vitamin D.

Vitamin D is the molecule that our bodies form when we expose ourselves to strong sunlight.

It’s also carried in animal foods, housed in saturated fats, and accompanied by other nutrients like vitamin A, and K2.

Fast forward 100 years, and we can explain how deficiency in vitamin D stunts the growth of our jaw.

Human s***m has been detected to have the VDR (vitamin D receptor), that means it’s listening for vitamin D.

Vitamin D deficiency is known to affect the fertility of males. Does it also affect how a child’s jaw grows in utero?

Have you noticed how many babies are born with recessive chins these days? I see many young children in practice with concerned parents, with narrow palates and small recessed jaws.

A human baby will have thousands of vitamin D receptors once it is developed. To me this indicates that relative deficiency before conception will have a butterfly affect later.

In mice Vitamin D deficiency is known to affect:
1) Testosterone levels
2) Morphology of te**es
3) Fertility

With vitamin D’s role in skeletal formation, I feel that deficiency at conception plays a huge role in the development of the jaw and dental arch.

Have you or a family member had vitamin D deficiency?

05/14/2023

A recently published including 10,000 children followed from birth found a connection between early ear and upper respiratory problems with the development of autistic traits.

The findings are not enough to prove causation, but this link does not completely surprise me.

I think we need to pay more attention to mouth breathing and oral rest posture, early on in life.

The mouth has a very high concentration of sensory receptors, and sensory input and processing will be altered when the mouth rests open, and the tongue sits low. It is my observation that these children are most prone to mouthing fingers, chewing shirt collars, and other objects.

Open mouth breathing will also be accompanied by altered swallowing – and this can contribute to symptoms like sucking and swallowing of air and reflux like symptoms, excessive drooling, difficulties swallowing solids, and poor eustachian function, glue ear, and conductive hearing loss.

This 2-year-old had all the above, and a history of two separate surgeries for grommet insertion, and removal of adenoids. There is ongoing speech delay, disturbed sleep, and symptoms of ASD and ADHD.

I don't really have all the answers to this problem, and not every mouth breather will tick every single symptom.

Regardless, I do think that healthcare needs to look at oral dysfunction as being a root cause of many common symptoms in children, and there is value in greater attention and an integrative team approach to address this early to minimize the compounding of problems.

I look forward to more new research exploring these links to help find more answers for families.

Here is the link to the new study:
https://www.bristol.ac.uk/alspac/news/2023/ent-research.html

04/08/2023