Specialized room for care of infants

After opening my practice from scratch 7 years ago, it has been one of my babies.  I never anticipated being a dentist who treats newborns, it's been a journey since I graduated in 2002.  The path started a long time ago when I was trained using a WaterLase as an associate at another practice.  Looking back at 2009 when my first daughter was born, we spent more than our fair share of appointments with a pediatric ENT doctor.  Jump to five years later when my second child was born with a restricted lingual frenulum. "Hard to do" doesn't begin to describe what it was like to release my own child.  But I did it, and cried with happy tears after, since it improved our nursing dramatically.  Jump forward almost 3 years when I started opening my mind to the idea that I could be the provider for people with tethered oral tissues for others.  What a journey I have been on, a very exciting journey at that.   Well, my baby (practice) has just had a new development!   I am super happy to announce that I remodeled my office to open a infant frenectomy specialized room.  It's the perfect space for examining and treating the young ones.  Afterward, mom and dad can privately take their time feeding and soothing their little child without being rushed.   In addition, it is allowing us to accommodate more patients every week.   An investment in the part of my practice that has become a passion for me, well worth it!

Also Read : A day of learning with tongue tie professionals

HSA, dental insurance and benefits

                                        End of year approaching too quickly?

                                        End of year approaching too quickly?

The end of the year rush filling your calendar has begun.  We recommend you give yourself the gift of good oral health and ring in the new year with a great smile. Many people have realized they haven't used their dental insurance from their employer to maximize their benefit.  Others haven't used any of their dental insurance.  Is this you?  And, can we still see you?  We are saving space for new patients to enter our practice. Research by the National Association of Dental Plans, only 2.8% of people with PPO dental plan participants reached or exceeded their plans annual maximum.   That leaves a lot of money that the dental insurance company get to keep and is a waste for you.  Dental insurance companies count on making millions of dollars off of patients who never use their insurance benefits because many of these plans provide coverage up to a certain dollar amount annually.  We know insurance companies do not encourage customers to use benefits, and most patients are too busy to sift through their policies to determine what might remain on them. 

We can explain how your insurance works once we gather the specifics.  Dental insurance almost always has a maximum benefit per year.  It doesn't cover everything you need, but acts more like a coupon.  For instance, many plans cover two cleanings and exams per year and is covered at 100%.  The least expensive dentistry is always preventative.  Every plan is different so we call to verify specifics.  Pre-tax dollars in the form of an HSA or FSA card can be used to pay for treatment and to purchase electric toothbrushes and Waterpik flossers.

Also Read : 5 Dental Care Tips For Healthy Teeth and Gums by Life Smiles

Traveled to learn from the best

I am so thankful that Dr. Mikel Newman in Indianapolis allowed me to shadow him for a day recently.   He and his team treat infants, children and adolescents, and boy were they busy!  For the frenectomies they release, the dentist has been using the Light Scalpel CO2 laser longer than I have (even though I have quite a few more grey hairs).  I took more away from the visit than I expected and really appreciate how he truly cares for the little ones.  He has done a tremendous job learning about breastfeeding and it shows in the counseling his gives his families.  Integrating this very specialized service within a general dentistry practice was something his practice has done very well.  As for my team, we are ironing out the wrinkles and making systems flow better since I am not a pediatric dentist.  It makes me giggle when a parent of a little one asks me if I see adults, and then in the afternoon an adult may ask if I see kids.  My adult patients are adapting to seeing many babies, car seats and nursing mothers when they arrive for their dental cleaning.  So many comment after learning about tongue-ties "I didn't know that was a thing."   Since implementing the small changes I learned, I have became a more well rounded tethered oral tissue practitioner.  

My goal to educate myself led me to start having conversations with local pediatric ENT's.  I traveled all the way to Eagan (much quicker than Indianapolis) to pick a local children's Ear, Nose, Throat Physician's brain.  Being an MD gives him a different perspective on the tongue tie and airway patients.  I am continuing to seek providers in the Twin Cities who will give excellent care to little children.

On a similar note, Life Smiles hosted the third meeting of the Twin Cities Tongue Tie Professionals Group last week in Plymouth.  Our focus was on the importance of body work, specifically chiropractic care and cranial sacral therapy (CST). I find it extremely helpful to spend face to face time with the people that I refer to. Knowing these women who care so much, gives me confidence in how families will be related to and the babies cared for.  Investing time into relationships also builds a true team, because ankyloglossia is not a snip or clip and you're done type of problem.   Unfortunately, many healthcare professionals don't have that same viewpoint of the complexity of frenulums impact on overall health and wellness.  Scissors releases in the hospital that are incomplete may resolve some symptoms early on.  When that occurs, parents are confused as to why they are struggling so much.   As I have opened my dental practice to laser frenulum releases, I have committed to learning as much as I possibly can, and not getting comfortable with what I know right now.  There will always be more I can learn and people to learn from which will benefit my patients.   The coming year presents more awesome learning experiences which I cannot wait to attend!  In January a local meeting regarding pediatric airways is on my calendar.  In April I will be joining a symposium on laser dentistry in Florida (who can complain about Orlando?).  The coming summer has me booked to an international conference in Canada.  Cool, eh?

Also Read : Interceptive orthodontics for children

A day of learning with tongue tie professionals

This year has a been a year of great professional growth through education for me.   I had the opportunity today to shadow two IBCLC (board certified lactation consultants) while they worked with clients.  I have been on the receiving end in my personal life of help from professionals, but today I was viewing as a healthcare provider.  My goal is to learn more about nursing, to expand my knowledge beyond a few books read and personal experience.  Thanks to Liz and Gigi Lull with Enlightened Mama for the time.  

The second meeting of a group of healthcare providers in the Twin Cities with direct "ties" to infants with tongue tie met at Minnetonka Pediatric Therapy.  We discussed wound healing, protocols for stretches and findings of a study from Woodwinds Hospital in Woodbury.  The prevalence of tongue and lip tie appears to be increasing, necessitating greater awareness from nurses, lactation professionals, chiropractors, dentists, speech therapists, physical therapists, doulas and midwives of the problems.    

Learning everyday and loving it!

Also Read : Why do my teeth feel fuzzy?

Interceptive orthodontics for children

Have you ever thought you got the same crowded teeth your mom or dad had?  

Or have you thought you have "too many teeth for the size of my mouth"?  

Does your child breath noisily or snore?

Who in your family grinds their teeth at night?

Is your six year old still wetting the bed?

What am I doing asking these weird questions, as if they are related to each other?  Aren't I a general dentist?  Yes,  and I am also a proponent for healthy breathing and healthy people.  I would be the first person your child would see who would ask questions like these and recognize the connection between poor sleeping, deep bite, tongue tie, grinding, gagging and ADHD.  The cause of most bad bites can be blamed for these symptoms and many more. My blog is a general article and I am not saying every health problem discussed is caused by an airway problem.  Not every person with ADHD has a bad bite and not all poor sleeping is caused by this.  However, research has been done to support how widespread breathing disorders are and how they contribute to health problems. I am learning from experts about what causes a bad bite, called a malocclusion.  Anthropologists have proven that approximately 95% of bad bites are not caused by genetics.  Wow, that was news to me!   I hear every day that "Johnie" got his dad's crowded teeth.  In the past I was guilty of evaluating a child's bite, and would suggest saving money for future orthodontics.  How little did I know that early interceptive orthodontics can not only prevent and solve malocclusions, but can improve the health of my patients. 

Anthropologists have studied thousands upon thousands of skulls of many different cultures across the world and over time and found malocclusions to be very rare except for recent times.   Has a genetic change happened that quickly from one hundred years ago?   Other than a rapid change in genetics across the world and across all cultures, what could be the cause?  The working theory of the rapid increase in malocclusion across the world is not only which foods we eat, but literally how we eat.  Different muscle strengths, or weaknesses, along with our more processed diet, do not promote strength of tongue and jaw muscles.  Tongue strength and the motion of swallowing can have an imbalance with lip strength. Our families may be at fault, but by how and what we are fed as babies and children, not because of genes passed down.

The following is a concept that may take a couple of reads to comprehend.  The proper growth of our upper and lower jaw, occurs primarily when we are very young.  Our upper jaw is supposed to grow almost entirely forward, with the help of the tongue living against the roof of our mouths.  When our tongue doesn't live there and flatten out our palate, but rather on the floor of our mouth, we develop a narrow upper arch and a high palate.  Our face looks longer when the upper jaw grows more downwards than forward.

 One consequence of this is crowded teeth, which often leads to an extraction orthodontic plan and retraction of the front teeth to close the missing teeth gaps on the side. If you are an adult, you may have had teeth removed for braces.  Others who didn't have braces live with crowded teeth.  Many people have a deep bite or big overbite.  Others have the same source of the problem but present with an open bite (front or side teeth cannot touch). In addition, an underdeveloped lower jaw decreases the space the tongue has to lift in.   The big deal about narrow dental arches is it creates a restricted airway in the nasal, oral and laryngeal (throat) airways.  What is the one thing our bodies need most urgently every single minute?  No, it's not chocolate.  The answer is air.  Did you know that it is never OK for a child to snore?  Loud noisy breathing and snoring is a sign that there is an obstruction.

The implications of a compromised airway are huge! A small nasal airway leads to mouth breathing and vice versa.  Mouth breathing doesn't filter the air we breath, doesn't humidify the air well, doesn't warm the air well and doesn't stimulate the release of a very important chemical compound called nitric oxide.  Nasal breathing does this all!  In addition, mouth breathers actually take in too much air and release too much carbon dioxide.  The driver for our breathing is interestingly not our need for oxygen, but our need to get rid of our waste gas, carbon dioxide.  When we expel more carbon dioxide than we should, we enter into a negative loop of chronic hyperventilating.   Have you woken up with a dry mouth?  You were mouth breathing.   Are your tonsils inflamed?  That may be caused by irritation by drawing in air.  Do you have dark circles under your eyes?  Venous stasis is the official term and is caused by mouth breathing.  Do you have asthma?   Mouth breathers only exchange only the top 2/3 air in the lungs, leaving one third of the air un-exchanged, leading to many cases of asthma.  An interested book I have read recently is called "Close your Mouth" by Patrick Mckeown.

What does this all have to do with dentistry?  Great question, I am so glad you are wondering!  I used to recommend all children see a dentist by the age of 1.  That is still the case, except for when I see babies to do a laser tongue tie release.    I am connecting all the dots of airway, sleep disordered breathing, malocclusion and general health.  Let's say for example, that you were born with a tongue tie.  Your mom likely couldn't nurse you for long and switched to a bottle.  I have nothing against bottles since both of my children had them since I work outside the home.  However, the significance of a tongue tie, is that the tongue cannot live on the roof of the mouth, creating a wide and normal height of the palate.  When a pacifier (I have used them for my children so no judging here) or a bottle is introduced, something foreign is between the tongue and it's natural habitat, the palate. When the tongue is tied, the upper arch becomes narrow, and since the roof of the mouth is also the floor of the nose, the nasal space is reduced.  The palate can often be so high as to deviate a septum in the future.  So this child grows up breathing through their mouth.  Fast forward to age 2 or 3 or 4 when they are getting so many ear infections and their tonsils/adenoids are so large that they need surgery.  Perhaps the ear infections were contributed to by inflammation of adenoids which blocks the drainage of the ears, the Eustachian tubes.  Also the posterior part of the tongue is supposed to make a seal with the palate when swallowing.  This proper swallow creates a small vacuum which can open the Eustachian tubes.   Eating slowly, having difficulty swallowing, grinding teeth, hyperactivity, difficulty waking in the morning, night terrors, a gag reflex, snoring, sleepiness during the day are a few of the many symptoms that may point to a mouth breathing problem.  A current theory of why people grind their teeth at night is that our brain wants to improve the air quality while we sleep.  When grinding the jaw around, our airway is opened by the jaw moving forward.

Also Read : What is a posterior tongue tie?

And what do you do about it?  My job is not only to give you information on the current health of your mouth, but also suggestions for optimum health.  It is possible to train your mouth to be closed, and become nose breathers.  How is that possible when a nose is always stuffy?  I recommend people see an ENT and an allergist to diagnose contributing problems to nose breathing.  Many people will have a referral to a sleep doctor and an Oral Facial Myologist.  We recommend nasal strips, nasal sprays, breathing exercises and sometimes bite splints or orthodontics.  Chiropractors are often a part of the team by releasing restrictions that interfere with your bodies natural ability to heal and function optimally. Each person is an individual and a plan is made that makes sense for the patient (and their family if a child).    There is no formula that fits all, so careful thought is given to each person.  Some children are really good candidates for a system called Myobrace

The big picture for me as a general dentist, is that I am in a great position to spot health problems.  There is a saying that goes like this "the more you know, the more you see."  A great reward for me is really seeing my patients, and being able to help in ways that are above expectations for a dentist.  Being a dentist is not about being a "tooth doctor" for me, but a doctor who really wants to improve your health.

What is a posterior tongue tie?

As a laser dentist who sees a lot of babies, I get asked about posterior tongue ties every day.  I thought explaining what this is would answer a lot of questions.  Here I go...

We all have seven frenums in our mouths.  Our tongue only has one frenum, and it is the midline under the tongue.  When a person is "tongue-tied" it means that tissue is restricting their function.  We gather a thorough health history and ask a lot of questions, not just evaluating the child's weight gain. So, to determine if a frenulectomy is recommended, we discuss symptoms and physical findings.  For babies, I evaluate what they are doing with their tongue by having them suck on my gloved finger and watching their mouth and tongue move.  For children and adults, I ask they to go through some range of motion exercises.

An anterior tongue tie is tethered tissue that can be more readily seen.  Oftentimes, the frenum creates a fence-like barrier to prevent a finger from sweeping the floor of the mouth from one side to the other.  Many people can see the tight tie when the baby is crying.  These restrictions often insert towards the tip of the tongue and may create a "cute" little heart-shaped tongue.  Anterior tongue ties can be very thin like a guitar string or very thick like a Twizzler stick.  Many of these ties prevent the tip of the tongue from normal movement up, to the sides and out of the mouth.  All anterior ties have a posterior component.  Even if the front part of the tongue is "clipped" and the tongue tip is free, the deeper (or further in) part remains.  The significance of this is that a deeper frenum attachment restricts the upward movement of the mid and back portion of the tongue.  A posterior tie is problematic by interfering with normal suck, swallow and breathing functions.  Often times it leads to gagging, gulping of milk, spitting up, symptoms similar to reflux, excessive gas, nasal congestion upon waking, chomping on the breast and a tongue thrust motion.  There are many other complications including but not limited to improper rest position of tongue, which leads to a narrow maxillary arch, which leads to poor facial growth.  A future consequence is often malocclusion, mouth breathing and sleep disturbances.

Many people who have problematic tongue ties don't have an attachment in the front (anterior part).  Unfortunately, they are often much more difficult to see.  As a trained laser dentist who releases posterior tongue ties, I examine the baby from the 12 o'clock position with the baby laying flat.  My pointer fingers go under the left and right sides of the tongue and the tongue is elevated.  My finger tips are nearly touching.  Examining this way allows me to see if a posterior tie exists.  I take a photo and also feel for a restriction by sweeping across the floor of the mouth.  That area should feel soft, without a hard cord of tissue in the midline.  After practicing dentistry for 15 years (seeing thousands upon thousands of people) and going through continuing education on restricted oral tissues, I am able to give an accurate diagnosis of a tethered oral tissues.  I am a general dentist, which means I treat all ages.

Also Read : Twin cities professionals discussing tongue ties

Many health care providers are not trained in what to ask of parents regarding the symptoms that may be caused by a problematic frenulum attachment.  Often a tongue depressor is quickly used while the parent holds the baby upright or is in a car seat.   An absent or poor examination combined with myths regarding tongue-ties (that is passed down through educational system) leads to people hearing that oral tethered tissues do not affect suck, swallow, breathing for infants.  Personally, I remember being taught in dental school that if they have a tongue tie, a surgeon needs to sedate the person and do an extensive procedure called a z-plasty.  Also, I was told that a thick or low labial frenum,  will eventually trip and tear it when the child falls on their face.  Really?  Thankfully lasers can easily treat these problems without sedation, without sutures and a long healing time.   I am amazed that we were taught to tell parents that a potential trauma will solve an anatomic and functional problem.   My blood pressure is raising as I continue to write.  I am upset with the lack of knowledge in general for health care practitioners and moms being told it's a problem with a lazy baby, too heavy of a let down, or that the child just needs to "get it eventually."  I also hear that a tongue tie is "a little tight" but will probably be ok if the child is gaining.   Breast feeding success is so much more than just a measure of weight gain.    I know what you are going through if you are a nursing mother reading this, because I have been there.  The problems are not in your imagination.

Twin cities professionals discussing tongue ties

Dr. Geisler is pleased to be hosting a lunch today with the discussion surrounding infant tongue and lip ties.  Lactation specialists, cranial sacral therapists, chiropractors, pediatricians, orthodontists, speech pathologists and oral facial myologists will gather for the first time.  There will be learning from everyone and an opportunity to meet the other professionals in the west metro of Minneapolis who are invested in helping moms and babies breastfeed.

Also Read : 5 Dental Care Tips For Healthy Teeth and Gums by Life Smiles 

How much radiation am I getting?

Dental Radiation from X-rays

                Dental radiographs (X-rays) are a useful and necessary technology to educate your dental professional on your oral health that cannot be viewed clinically (visually).  We examine the films for evidence of decay, periodontal disease, infected teeth and other pathologies.  The frequency and type of films needed is up to your dentist, with your approval of course.  No two people are alike, so films are recommended on an individual basis.

                Radiation exposure is typically measured in units called millirem (mrem).  The average person receives about 620 mrem of radiation, a year, from natural and manmade sources combined.

                Here is an example of different types of radiation and the amounts they give out:

0.1   mrem from a single digital x-ray

5 mrem from a round trip, coast to coast, plane ride

35 mrem from sunlight and other cosmic radiation for 1 year

40 mrem food and water for 1 year due to radioactive trace elements

228 mrem breathing normally for 1 year due to the radon in the air

1,000 mrem for a full body CT scan

10,000 mrem when the first clinical signs of radiation injury appear.

                Radiation is cumulative; however, with digital dental radiographs (X-rays), the dose is minimal. When Dr. Geisler prescribes dental X-rays for accurate assessment and diagnosis, you can feel relieved and assured that you are in a safe range of exposure.

Also Read : Interceptive orthodontics for children