Connecting To Better Health: Myofunctional Therapy and Behavior Skills — an ADA Children's Airway Virtual Event

Steve Carstensen, DDS, has treated sleep apnea and snoring in Bellevue, WA, since 1988. He serves as a consultant to the ADA for sleep-related breathing disorders, has trained at UCLA’s mini-residency in sleep and is a Diplomate of the American Board of Dental Sleep Medicine (AADSM). He lectures internationally, advises several sleep-related manufacturers, directs sleep education at the Pankey Institute and is a guest lecturer at Spear Education, University of the Pacific and Louisiana State Dental Schools. For the AADSM, Dr. Carstensen has served as a board member, secretary-treasurer and president-elect. From 2014 through 2019, he was the editor of Dental Sleep Practice Magazine. In 2019, he co-authored A Clinician’s Handbook of Dental Sleep Medicine.

Dr. Carla Damon is a board-certified pediatric dentist and co-founder of Beyond Pediatric Dentistry, a private practice in Dallas, with co-founder Dr. Loria Nahatis. The practice is limited to pediatric patients, with special emphasis on airway screening and treatment, performing infant frenectomies and providing a more wellness-based approach to dental care. Dr. Damon is co-founder of the DFW Airway Collaborative in Dallas, a multidisciplinary group that serves to bring together providers that recognize the need for a team approach to sleep-disordered breathing and airway issues amongst children and adults.

Sharon Moore is a speech pathologist with four decades of clinical experience across a wide range of communication and alimentation disorders. She has worked in clinical settings in Australia and London. Currently, she runs a private practice in Canberra, Australia, managing medical and dental specialist referrals for patients of all ages. Orofacial myofunctional principles are fully integrated into management of disorders of function in the upper airway, including breathing, swallowing, chewing, phonation, speech and breathing during sleep. 

Sharon has a special interest in early identification of craniofacial growth anomalies in non-syndromic children and airway obstruction in sleep disorders. Recently, an acknowledgement of the role of myofunctional therapy in management of sleep disorders has hailed a new era of relevance for her work in the upper airway and affirmation of her chosen clinical direction. She believes there has never been a more important time for medical and dental colleagues to work as a team with significant health morbidities of sleep disorders in all ages now widely known. She is author of the book Sleep Wrecked Kids: Raising Happy Healthy Children One Sleep at a Time.

Dr. Loria Nahatis graduated from Baylor College of Dentistry in 2004 and completed her pediatric residency at Baltimore College of Dental Surgery in 2006. She is a board-certified pediatric dentist and co-founder of Beyond Pediatric Dentistry in Dallas.  Her focus in pediatric dentistry is optimal craniofacial growth and development. She has realized from personal experience that if a child’s craniofacial growth is off-track, it affects their ability to breathe, sleep and thrive. She is proud to give her young patients and their parents valuable tools that help not only with improving dental health, but overall health and well-being too. She is dedicated to making a difference in every child she sees, working with a collaborative approach to oral healthcare.

Leyli Norouz-Knutsen is the co-founder and managing director of The Breathe Institute. She is known for her uniquely fine-tuned ability to streamline organizational management structures, optimize collaboration and communication, drive impactful media and branding campaigns and inspire innovation and entrepreneurship. Leyli has over a decade of experience in higher education, non-profit, board management and operations as a director at both the University of California Los Angeles (UCLA) and San Diego State University (SDSU). Since leaving UCLA’s Anderson School of Management in 2007, Leyli's extensive background in healthcare-specific consulting and corporate strategy parlayed perfectly into co-founding The Breathe Institute. She also serves on the board of The American Academy of Physiological Medicine & Dentistry (AAPMD).

Dr. Soroush Zaghi graduated from Harvard Medical School, completed his residency in ENT (otolaryngology, head and neck surgery) at UCLA, and completed his sleep surgery Fellowship at Stanford University. He now serves as medical director of The Breathe Institute, where the focus of his sub-specialty training is on the comprehensive treatment of nasal obstruction, mouth breathing, snoring and obstructive sleep apnea in children and adults.

He is very active in clinical research, with over 80-plus peer-reviewed research publications in the fields of neuroscience, head and neck surgery, Myofunctional therapy and sleep-disordered breathing. Dr. Zaghi is particularly interested in studying the impact of tethered-oral tissues (such as tongue-tie) and oral myofascial dysfunction on maxillofacial development, upper airway resistance syndrome and obstructive sleep apnea, especially as it relates to pediatric populations. He is an invited lecturer, author and journal reviewer for topics relating to the diagnosis and management of sleep-disordered breathing and tongue-tie disorders in children and adults.

This session will prepare the dentist and their team to communicate with the pediatric airway patient and their parents. They will learn the do's and don'ts of starting a conversation with a parent regarding potential signs and symptoms of airway-related issues. Every attendee should walk away from this presentation with pearls of knowledge to apply to their practice in order to help parents understand the importance of airway health and sleep.

Learning Outcomes:

• Learn the importance of the dentist’s role in implementing screening protocols for sleep-disordered breathing and how the dental team can effectively communicate this with patients.
• Understand common concerns parents and caregivers have when treating the pediatric airway patient and how to effectively communicate the importance of sleep-disordered breathing, early growth and development options and referral recommendations.
• Discover impactful communication tools to use with small children when it comes to early airway intervention and get them ready for early treatment.

The focus of this presentation will be to provide a perspective on how functions of face, mouth and throat support dental and occlusal health, and their relationship to systemic health in both the body and dysfunction and treatment will be presented alongside interactive practical demonstrations.

Learning Outcomes:

• Describe how myofunctional science is relevant to dentistry and whole health implications
• Identify the ‘Siamese twins’ of myofunctional science: structure and function
• Discuss key markers of OMDs, and simple correction strategies
• Review the critical role of dentists in early identification of OMDs

Children are under more environmental stressors than ever before—allergies, screen time, lack of sufficient sleep and/or quality of sleep. This session will prepare dentists and their teams with pearls of knowledge to implement in their practices right away. Attendees will learn how to help patients establish healthy habits that will last a lifetime.

Learning Outcomes:

• Learn the importance of nasal clearing and how to implement this small but powerful habit in patients.
• Understand the importance of other healthy habits that can make an impact on a child’s life, including sleep hygiene and nutritional choices.
• Discover how to implement healthy habit recommendations as part of a practice’s treatment routine to get children motivated to breathe, sleep and thrive!

Pediatric healthcare providers are in a unique position to screen and monitor for myofunctional and upper airway function disorders that may impact long-term craniofacial and airway development. Chronic mouth breathing and low resting tongue posture in actively growing children is associated with palatal growth restriction, alterations of craniofacial development, altered head posture, attention issues, poor school performance, relapse of orthodontic treatment, and increased risk for obstructive-sleep apnea later in life.  This presentation will provide an overview of the entire spectrum of sleep-related breathing disorders ranging from mouth breathing to upper airway resistance syndrome, snoring, and obstructive sleep apnea in pediatric populations. The emphasis of the presentation will be on understanding how addressing sleep and breathing issues early on can make a huge impact on the overall health and quality of life of their patients. Participants will learn to not only screening and refer patients with symptoms of mouth breathing and myofunctional disorders but more importantly to actively participate in management and prevention through encouragement and support of nasal breathing and tongue posture with myofunctional therapy, lingual frenuloplasty, and dental orthodontic treatments.

Learning Outcomes:

• To appreciate the impact of mouth breathing, tongue-tie, and myofunctional disorders on the overall health, growth, development, and sleep quality of pediatric populations.
• Understand that comfortable nasal breathing requires the following conditions: lips pressed together, tongue resting high on the roof of the mouth with adequate tongue space and tongue mobility, as well as a patent nasal passage.
• Be able to screen for and identify the clinical signs of mouth breathing, mentalis strain, tongue-tie, tonsil hypertrophy, dental wear, and narrow maxilla as risk factors for sleep-disordered breathing among patients in your practice.
• Learn to screen and monitor for signs of sleep-disordered breathing by interpreting two-minute video camera recordings of sleep patterns as provided by parents.
• Understand the strengths and limitations of current treatment paradigms and help influence the direction for future research.

One major factor that limits the progress we can make in airway research is a high degree of confirmation bias, which makes it difficult to reach consensus when ideas clash between team members who see the problem from different perspectives. In this lecture, we will explore biases that are present all around us in clinical practice and real-life, and discuss the role of high-level clinical research in the form of systematic investigation to help us learn, unlearn, rethink and make new discoveries. Participants will learn about research methods and be invited to participate in our IRB-approved research projects, on topics ranging from mouth taping and nasal breathing, tongue-tie surgery, myofunctional therapy and dental orthopedic remodeling. This session is perfect for those who want to get involved in research, test what they think they know and learn how to learn.

Learning Objectives:

1. Understand the strengths and limitations of current research and treatment paradigms.
2. Empowering new discoveries, informing clinical best practices and improving patient outcomes.
3. Establish and maintain important connections within the airway/health community, moving towards the goal of true interdisciplinary collaboration.