Myofunctional Therapy, UARS, Tongue-ties, MSE & Jaw Surgery - Nicole Goldfarb | JawCast #46

[@JawHacks]

Nicole's Excellent Interview with Dr. Michael Gunson: kzbin.info/www/bejne/qJ2vY32ApJl8n5o

[@josiemaromi6981]

Nicole Goldfarb reminds me of Diane Bahr! Diane Bahr is a speech language pathologist with a focus on proper airway development. She wrote "Nobody Ever Told Me (or my Mother) That!" and "Feed Your Baby and Toddler Right." 📚

[@airwaycircle]

Thanks for the shout out!! This was great!

[@HannahWint]

Ron, I had no idea your recessed jaws were from extraction and retraction orthodontics. I feel so incredibly validated and encouraged that you have found fixes even with only 24 teeth. I'm ready for my healing journey. I'm ready to breathe through my nose. I'm ready to stop having chronic headaches. I'm ready to stop the chronic sinus pain from inflammation with nowhere to go. Thank you for giving all of us hope.

[@avalex6603]

I come back to watch this video about once a week! So much gold from Ron and Dr Goldfarb!

[@adameastwood9705]

Currently doing myofunctional therapy after 7mm expansion as a 30 year old male. This was a fantastic conversation and I thank you for all your great content Ron. Hope to see you around since you live so close!

[@Thinkagain1234]

Are you Austin-based? Who did your expansion?

[@christianbacigalupi9427]

I’m 32 looking close to moving forward with a marpe appliance. Would love to chat about your experience if you have bit

[@teethree141]

WOW I WISH NICOLE WAS MY MYOFUNCTIONAL THERAPIST. shes so knowledgable. my invisalign was giving me sooo much pain. so im thankful yall touched on that topic! I had the mind procedure 2.5 months ago and literally my nasal breathing is like night and day, but now tht I have invisalign its been hard to sleep at night d/t to the grinding and the pain. Its almost impossible for me to keep my tongue up when i have it in

[@MeatLogg]

My original DJS from 26 years ago was miserable; however, my recent MARPE with surgical assist was extremely easy. No coughing up blood or anything like that; did it all in the office and woke up and went right home. Night and day difference

[@GreaterGoodPrevails]

I got a consultation with Zaghi, they referred me to an in-house myo. I like this lady, would love to learn from her.

[@RyGuyLifts]

Let's go Nicole! By far the best myo therapist out there

[@taracotta4246]

so much good information, thank you for this interview!

[@shuikai272]

11:24 I think this is more likely dental relapse due to MARPE + RPE hybrid expanders, than skeletal relapse. It seems that the skeletal relapse is pretty low if you just let it consolidate. "You shouldn't need retention appliances", no you shouldn't lol. Retention appliances are to hold the teeth together following dentoalveolar movements.

[@tjam4229]

Ron, @ 1:03:23 you said you would link the discussion with Dr Gunson in the video description… can you do that? Thanks! 🙏

[@fladtheinhaler9226]

At 1:20:30 pulling the tissue under your chin forward opens up the airway. I think that is why a genioplasty helps with sleep apnea even though it doesnt pull the tongue forward.

[@anniecoombe8698]

Thank you for this video, so so validating! My journey is so similar.

[@HelianaFranko]

Great information. Thank you for sharing!

[@RichHandsome]

Man amazing interview!! Will listen to this atleast two more times 💯

[@MeatLogg]

Ron, I think you'd find this very interesting. Apparently, there now exists a way to expand the upper jaw forward, rather than moving it forward, similar to MSE w/ surgical assist but in the anterior/posterior dimension. It's called "Anterior Maxillary Distraction". It should be much cheaper and less involved (perhaps just a simple office procedure like I did with the surgical assist for MARPE) than a LeFort I. It's just a question now of which providers will offer such. I think it will be tremendously useful. There is a good video involving the young man that had it done in India (you'd have to search for what-is-anterior-maxillary-distraction-or-amd). It appears that the surgical cut is approximately between the premolars and first molar, so everything in front of that would expand forward

[@druidactual]

This is fantastic, thank you Ron.

[@christinal434]

I was advised definitely no tongue tie release until I'm expanded, otherwise I will probably get really bad sleep apnea. There's also just no space for it yet😅

[@RotMaxxer69]

Same. But expansion is expensive AF... life sucks lol

[@stoictrader7432]

That jaw is looking sharper video after video, great work. I was looking for ways to deal with my teeths, and I founded your videos, great content Ron. You gave me hope. I'm a guy who had 8 teeth extracted for braces too (premolars and wisdom). I would like to know if you had 4 or 8 implants to fill the spaces created by the MSE

[@JawHacks]

No implants brother. Thanks for the compliment and I wish you well.,

[@stoictrader7432]

@@JawHacks thanks brother. Would you recommend to get implants to fill the spaces created by an expander?

[@JMSsssssss]

I've had scalloping across my tongue for as long as i can remember, and I've NEVER heard anyone mention scalloping until this video! I have terrible gum recession despite otherwise great dental health. It feels like my lower jaw sits back too far when i bite. I often have pain in all my teeth, i think related to other muscle tension. Feels like a mess. But i am no spring chicken. Would it be worthwhile to have a conversation with you?

[@dougiesakurai3386]

Scalloping could be a sign of bruxism, which could also be a sign of apnea. If the back of your tongue has a yellow tinge, that could be a sign of reflux. Getting a sleep study would answer a lot of those questions.

[@infinityboom1842]

Hi Ron, do you recommend not taking out retainers even if the person has a good mewing posture? I've had MSE and now braces, so I'm wondering if I should get a fixed retainer or no retainer at all at the end of the treatment. Cheers!

[@Theolddaysaregone]

He made a video about that: kzbin.info/www/bejne/bWnYfJ6NhLyEaNU. I know that there is some debate about this. I think Mike Mew recommends a fixed retainer (I have to say I absolutely not recommend this. I had one and changed to plastic retainers worn at night. The fixed retainer gave me some gum and dental hygiene issues) and says that "you might consider letting yourself free some day and try without retainer for some time."

[@Theolddaysaregone]

Perhaps you could try plastic night retainers and don't use them for a couple of months and see what happens. If it doesn't work you can put them on again. Be aware you should not do this more than a few times because you can get loose teeth.

[@JawHacks]

Yeah I still stand by that video.

[@infinityboom1842]

@@Theolddaysaregone thanks for the recommendation

[@Theolddaysaregone]

@@infinityboom1842 You're welcome

[@Intoxicated_Flipflop]

Ronald keeps gettin younger and more chad-like every time I see him

[@JawHacks]

Thanks brotha

[@23BronJames]

I was going to say the same thing! Bro are you just mewing?

[@JawHacks]

@@23BronJames Just living my best life bro. Keeping it clean.

[@23BronJames]

@@JawHacks Love that! Same here! 💪

[@JawHacks]

@@23BronJames No doubt keep at it

[@Palasha-v3k]

Is it ever advisable to do maxillary expansion such as MSE or EASE etc. Post double jaw surgery? Previously had MMA surgery and a genioplasty but still have OSA issues and limited space for my tongue and am looking into this option. One orthodontist said he can do it 12 x months post op.

[@magsue3363]

It's not easy to get a tongue tie release here in the UK. I have a posterior tongue tie which is easy for me to see now that I've had it explained. I've always wondered why I can't keep my tongue sucked up. NHS simply won't do anything unless it's a huge problem. I would love to access myofunctional therapy in the UK but they are so far behind and very resistant.

[@Aguonelis]

@magsue3363 I am from east europe, Lithuania. I firstly went to lithuanian myofunctional therapist. But her knowledge wasnt enough. So i contacted myofunctional therapist from united states because they are best there. We were doing distance video calls, she guided me what scans i had to do, what doctors to visit. After that she did evaluation about my airway. So i have done tongue tie release, which made my neck much more flexible, because it was very tight. Later with here advice i done tonsilectomy my snoring droped from 60 min per night to 5 min per night.

[@magsue3363]

@@Aguonelis that's great :) I hadn't thought about trying to speak to a myofunctional therapist from other countries because I didn't think they'd be allowed. So that's great to know. Thanks for your reply

[@kaseyyrenae]

some say toothborne expanders can expand the palate and grow bone in adults.. while others say it only tips teeth and there’s no scans that show it expands the maxilla like the news claim. which one is it? I’ve also spoke to some who get amazing results mewing and chewing alone. can the tongue expand the structure as an adult or is it just teeth moving? the suture doesn’t close at all as an adult and can grow with constant forces, right?

[@funkotic]

Hard mewing increases the suction hold force, you cant hard mew allways, but when you can you should

[@funkotic]

By hard mewing I mean chin tucked as much as it decently comfortable

[@thatboyjodh]

Damn i was doing it wrong the whole time. I was hard down there and mewing. I thought that’s what hard mewing is

[@christinal434]

I fantasize about expansion and jaw surgery too!! 😂😅

[@alex.2929]

Hey Ron, ultimately when talking about MSE or even mewing and the expansion of the palate we are talking about width. Making your palate wider ultimately will help airways. but in a functional and aesthetic sense I believe forward growth to be more important. I've been able to achieve a decently wide palate. Luckily I have never had the issue of a narrow palate. I've actually developed a bit of a cross bite from unequal expansion in my mouth. That being said, while we can all maybe benefit from having wider jaws, how do we address more forward growth? In the video, you joke with Nicole that we could all benefit from more forward expansion. Surely there is a hypothetical way to address this, such as thumb pulling - however it takes so much constant force, I don't see how thumb pulling could really make a difference.

[@magnum0pus982]

Facemask can give you a couple mms forward growth in a couple months. MMA surgery can give you 8-12mms forward growth. Mewing can according to Mike Mew give 1mm forward growth a year. You see how Ron looks better year after year. I think that is the forward growth he's been getting from mewing

[@shuikai272]

Sometimes I hear like, facial development is all about tongue posture, or it's all about chewing, or it's all about genetics. I think the reality is like, it's unclear how much is genetic vs environmental, but I do think that after thinking about this a lot, if the environmental theory (growth) is true, you want to have good oral posture AND chew foods that have adequate resistance, not one or the other. I think that tongue posture, or maybe I should say mouth breathing is going to most influence eruption of the teeth, gummy smile, downwards grown skeletal profile, etc. basically I think it is going to influence the growth vector, and chewing is going to encourage growth of the facial bones. So I think it makes sense to me that you would want to be doing both. In terms of adults who stopped growing, I think they're going to need help from some type of treatment. Even if you correct the growth vector, if you have no growth then it doesn't matter. You need to restart the engine so to speak. Even if you're steering in the right direction it's not going to really matter if you have no propulsion.

[@marcoturra5086]

Thank you Ronald super interesting. But can jaw surgery enlarge the palate and advance it at the same time?

[@JawHacks]

Yes. Soon I will be releasing an interview with an oral surgeon named Dr. David Alfi. We discussed this very question.

[@marcoturra5086]

Ok thanks. Could you please also talk about prices?

[@bluecresc5804]

1:48:30 tomgue release

[@tjam4229]

At 2:05:15 “Mount AirMore” ;-)

[@barneys8644]

Create communicater

[@miniweeddeerz1820]

this video is absolutely phenomenal.

[@haelienicole]

Crying in 30 years of stomach sleeping 😭

[@tha1thaonlythatsme]

Hey everyone! Does anyone know of any Texas orthodontists (specifically the dfw area) who offer mse?

[@JawHacks]

John Karotkin as well as Wael Kanaan. Both in the Houston area however.

[@MZ-iq9nz]

At minute 10 sorry but that doesn’t work on me my lower jaw go backwards and it’s even worse from my position I can’t breathe I can’t maintain my tongue there and my lower jaw goes even further behind which is worse

[@healthychelsea7919]

My ortho successfully split my maxilla without arms.

[@RichHandsome]

12:00, 39:00

[@jefreywith1f924]

In regards to airway specialists who belong on Mount Rushmore, I'm wondering if Nicole knows the where abouts of Dr. Nelson Powell and Dr. Robert Riley of Stanford University, who both did my MMA and UPPP surgery back in 2010. I'm sure their retired by now. Dr. Kasey Li first learned his craft from working with these 2 pioneer giants in sleep medicine surgery. Thru 3d imaging that was brand new back then, it showed my pharngenial airway space at the narrowist was 5 to 6 cm. That's half the size of a mormal adult. I was 52 at the time. A sleep study showed my AHI index was severely high. So high that cpap was of no value to me anymore. My oral cavity was described to me as being retro. Very narrow with a high arched palate. A tongue to large for my mouth and no place to park it. I was a severe mouth breather since a child, and back then, Dr. Powell and Dr. Riley nor myself were aware of the negative effects of mouth breathing on facial development, sleep apnea, cognitive impairment, and other major health issues like diabetes, GERD, high heidal and paraphasogial hernia for which I almost died from apart from wanting to commit suicide too. Both of these doctors were promently mentioned in Dr. William Dement's book Promise of Sleep who is known as a father of sleep medicine. A must-read for anyone who wants to know everything their is to know about sleep, such as quality of sleep( reaching all the sleep stages 1 thru 4 for a significant period of time) being just as important as quantity of sleep.

[@lena990]

So what was the solution for your high narrow palate? mMA doesn’t fix that I though

[@jefreywith1f924]

It didn't fix it. I still have a high arch palate and a V-shaped maxillory arch, but I'm happy to say my sleep apnea is in the normal range now. Back in 2010, the gold standard to open up airways for sleep apnea was UPPP and MMA. Powell and Riley, working together, developed what they call the Sanford Protocal to treat sleep apnea. A comprehensive approach that addresses multiple areas not just one. Phase 1 UPPP surgery addressing soft tissue problems to enlarge breathing space such as tonsillectomy, uvulectomy, and genioglossus advancement. After this, you're given a sleep study and reassessed. If your ahi is not in the normal range, you go on to Phase 2 MMA surgery, which has a higher success rate. The MMA surgery was able to enlarge my pharnyx from 5 cm to 12 cm. Unfortunately, that wasn't good enough.The severity of my sleep apnea went from high to just moderate, and I couldn't get higher than stage 2 sleep cycle. Not until I became a nasal breather and taped my mouth up at night was I able to get my sleep apnea in the normal range for the first time ever. Out of the many sleep doctors I went to, none of them recommended taping my mouth up to sleep. Even after I proved to them that it works with a successful sleep study score, they still were skeptics obviously because they have nothing to financially gain from it.

[@lena990]

@@jefreywith1f924 do you know your intermolar width? I also mouth tape at night but since I haven’t had surgery (which I am planning on and need) it’s quite claustrophobic. However I experimented with taping and without and I sleep much better taped. Do you plan on trying to do anything for your high arched palate or are you satisfied from your improvements now?

[@shuikai272]

@@jefreywith1f924 When you mouth breathe your tongue falls down. When you're nasal breathing and the tongue has accessibility to rest on the roof of the palate it will sit there as you are asleep, and the tongue will brace against the soft palate, basically holding the tongue in place, reducing collapsibility.

[@Ben-zg8xk]

Anyone know any MSE providers in Australia

[@yasinabshir8174]

Just so that you don't mislead others, it wasn't in the Quran, rather it was in the hadith of the Prophet Muhammad in which he mentioned not to sleep on their stomach.

[@_.sebk_845]

Beautiful woman

[@visionvixxen]

What happened to the way she looks?!?

[@bluecresc5804]

1:37:30 yawn

[@HHindsight]

uhg I'm thinking about jaw surgery and it's like fuck my ass, I'm going to be robocop if I ever even get to sleeping well

[@zzarks1994]

I can't even mew my maxilla is Intense