The Untethered Podcast

• Tongue Tie Diagnosis: Why Function Matters More Than Appearance

  In this episode, Hallie Bulkin addresses what she calls "one of the most misunderstood topics in our field" : tongue tie diagnosis. She challenges the common clinical practice of relying on visual assessment—hearing clinicians say, "it looks tied" or "it's a mild tie"—and emphatically states that function is what determines a diagnosis, not appearance.Hallie introduces a 4-step framework for making confident, clinically sound decisions : Function, Form, Impact, Decision. She emphasizes that the appearance-based mindset often leads to both over- and under-diagnosis of ties, and that true diagnosis requires observing the tongue's mobility, coordination, and control within the entire system.Hallie also stresses the importance of addressing compensatory movements, which she believes mask true movement and should not be taught as a form of "survival mode". For optimal outcomes, treatment must focus on function and consider the whole connected system—airway, jaw, spine, and nervous system.In this episode, you’ll learn: ✔️Function is the key determinant of a tongue tie diagnosis, not the visual appearance of the tissue✔️ The risk of the "appearance-based mindset" leading to over- and under-diagnosis✔️ A four-step clinical reasoning framework for assessment: Function to Form to Impact to Decision✔️ Why a short or tight-looking frenulum may not restrict movement, while a hidden posterior tie can create major functional restriction✔️ Compensatory strategies often mask the need for a release and take more energy, leading to a "survival mode"✔️ Diagnosis requires a functional limitation PLUS a meaningful impact on the person's life (e.g., feeding, speech, sleep quality)✔️ Why functional readiness must be assessed to determine if and when the body is ready for a lingual release.✔️ The release is not a "magical instant fix"; therapy before and after is crucial for neuromuscular reeducation and success.✔️ Treatment must consider the whole connected system (airway, jaw, cervical spine, nervous system), not just the tongue in isolation.RELATED EPISODES YOU MIGHT LOVEEp 347: Airway First: The Pediatric Dentist's Essential Role in Treating Tongue Ties and Growth IssuesEP 348: Tongue Ties, Sleep Apnea & More: The Patient-Centered Approach to Airway DentistryOTHER WAYS TO CONNECT & LEARN💬 Let’s hang out on social: Instagram | Facebook | LinkedIn⭐ Love the show? Leave a quick review — it means the world to me!• Free F.A.S.T. Myo Screening Packet: https://FastMyoScreening.com• Find a myofunctional therapist: https://www.themyodirectory.com Hosted on Acast. See acast.com/privacy for more information.

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• Ep 350: Sleep Struggles This Season? The Surprising Role of Tethered Oral Tissues

  In this episode, Hallie Bulkin discusses the complexities surrounding tethered oral tissues, specifically tongue ties, lip ties, and buckle ties. She emphasizes that not all ties require surgical release and that the decision should be based on functional impacts such as speech, feeding, and sleep. Hallie highlights the importance of thorough evaluations and the role of therapy in determining the necessity of a release. She advocates for a patient-centered approach, considering individual goals and the overall impact on health and function.In this episode, you’ll learn: ✔️Not all ties need to be released; it depends on function.✔️Function is the key driver in determining the need for release.✔️Research is often behind clinical practice by about 17 years.✔️Therapy can sometimes eliminate the need for a release.✔️Evaluations should focus on how tethered tissues impact daily life.✔️Compensatory strategies can mask the need for a release.✔️Patient goals should guide treatment decisions.✔️Open mouth posture is a significant indicator for evaluation.✔️Therapy before and after release is crucial for success.✔️Individualized treatment plans are essential for optimal outcomes.RELATED EPISODES YOU MIGHT LOVEEpisode 200: Functional Impact: When A Tongue Tie Is ACTUALLY A Tongue TieEp 348: Airway Dentistry Demystified: Kassi Klein on Tongue Ties, Sleep Apnea & Childhood DevelopmentOTHER WAYS TO CONNECT & LEARN💬 Let’s hang out on social: Instagram | Facebook | LinkedIn⭐ Love the show? Leave a quick review — it means the world to me!• Free F.A.S.T. Myo Screening Packet: https://FastMyoScreening.com• Find a myofunctional therapist: https://www.themyodirectory.com Hosted on Acast. See acast.com/privacy for more information.

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• EP 349: Myofunctional Therapy Explained: Root Causes, Airway Health & Collaborative Care

  In this empowering episode, Hallie Bulkin sits down with Angela Richwine, RDH, BASc, QOM, COM®, to dive deep into the world of myofunctional therapy and collaboration in healthcare. Angela opens up about her personal journey into the field, the pivotal moments that shaped her practice, and how her passion for helping others led her to uncover the root causes behind oral and airway issues.Together, Hallie and Angela explore the importance of interdisciplinary teamwork, patient education, and parent advocacy in achieving better outcomes. They shed light on the growing awareness of myofunctional therapy, the challenges professionals face in bridging knowledge gaps, and the need for continuing education to deliver truly holistic care.This conversation is a powerful reminder that myofunctional therapy is not just about correcting habits - it’s about understanding the “why” behind them, empowering patients, and transforming lives through collaboration and education.In this episode, you’ll learn:✔️ How Angela’s personal journey led her to specialize in myofunctional therapy.✔️ Why collaboration among healthcare professionals enhances patient care.✔️ The critical role of patient education in lasting health outcomes.✔️ How parents can advocate for their children’s oral and airway health.✔️ The importance of addressing the root causes, not just the symptoms.✔️ Why continuing education is essential for myofunctional therapists.✔️ How understanding the mouth as a “gateway to health” changes everything.✔️ The power of listening to patients and setting clear therapy goals.✔️ How to navigate misconceptions and raise awareness about myofunctional therapy.RELATED EPISODES YOU MIGHT LOVEEvidence vs. Pseudoscience in Myofunctional Therapy with Hallie Bulkin & Robyn Merkel-WalshEP 341: From Dental Hygiene to Myofunctional Therapy with Hallie Bulkin & Ashley DoradoOTHER WAYS TO CONNECT & LEARN💬 Let’s hang out on social: Instagram | Facebook | LinkedIn⭐ Love the show? Leave a quick review — it means the world to me!• Become a Certified Myofunctional Therapist™ (CMT®): https://www.themyomethod.com• “Turn on your Myo Eyes” free webinar: https://www.feedthepeds.com/myo-webinar• Free F.A.S.T. Myo Screening Packet: https://FastMyoScreening.com• Find a myofunctional therapist: https://www.themyodirectory.com Hosted on Acast. See acast.com/privacy for more information.

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• EP 348: Tongue Ties, Sleep Apnea & More: The Patient-Centered Approach to Airway Dentistry

  In this engaging conversation, Hallie Bulkin and Kassi Klein explore the intricate world of airway dentistry, discussing Kassi's personal journey into the field, the importance of understanding craniofacial development, and the need for a patient-centered approach that focuses on the underlying reasons for patients' concerns. They emphasize the significance of collaboration among various healthcare providers to ensure comprehensive care, the balance between functional and structural treatment approaches, and the critical role of assessing tongue ties and other oral tissues. The discussion also touches on common myths surrounding airway health, the impact of sleep apnea on children, and Kassi's vision for the future of airway dentistry.In this episode, you’ll learn:✔️Kassi's journey into airway dentistry began with her mother's health issues.✔️Understanding craniofacial development is crucial for effective treatment.✔️Finding the 'why' behind patients' concerns enhances care.✔️Collaboration with other healthcare providers is essential.✔️Functional treatment approaches must complement structural changes.✔️Assessing tongue ties is vital for proper oral development.✔️Symptoms like ear infections can indicate underlying airway issues.✔️Common myths about airway health can mislead parents and providers.RELATED EPISODES YOU MIGHT LOVEEpisode 200: Functional Impact: When A Tongue Tie Is ACTUALLY A Tongue TieEp 347: Airway First: The Pediatric Dentist's Essential Role in Treating Tongue Ties and Growth Issues (with Dr. Anita Gouri)OTHER WAYS TO CONNECT & LEARN💬 Let’s hang out on social: Instagram | Facebook | LinkedIn⭐ Love the show? Leave a quick review — it means the world to me!Free F.A.S.T. Myo Screening Packet: https://FastMyoScreening.comFind a myofunctional therapist: https://www.themyodirectory.comConnect with Kassi Klein, DDS, D.ABDSM: https://www.linkedin.com/in/kassi-klein/overlay/about-this-profile/?trk=people-guest_people_search-cardhttps://www.instagram.com/breathesleepandairway/?hl=enhttps://www.zocdoc.com/dentist/kassi-klein-dds-610392 Hosted on Acast. See acast.com/privacy for more information.

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• Ep 347: Airway First: The Pediatric Dentist's Essential Role in Treating Tongue Ties and Growth Issues

  In this episode, Hallie Bulkin welcomes special guest Dr. Anita Gouri, a board-certified pediatric dentist, to dive deep into the critical, often-missed connection between pediatric dentistry and a child's overall airway health and development.Dr. Gouri shares her personal journey into airway and tissue-focused dentistry, motivated by her own daughter's and nephew's feeding and developmental challenges due to undiagnosed tongue ties.They emphasize the absolute necessity of a multidisciplinary approach, stressing that therapy (SLP, OT, IBCLC, etc.) is optimal before and after a tongue tie release for the best outcomes and to avoid reattachment or unresolved symptoms. The conversation extends to older children, discussing the importance of an airway evaluation before prescribing ADHD medications and the dramatic life-changing results of early palatal expansion to open the airway.In this episode, you’ll learn:✔️ Dr. Gouri’s personal experience discovering her daughter's tongue tie at age 7, long after dealing with feeding issues, colic, and difficulty eating non-pureed foods. ✔️ Why pre- and post-operative therapy (like with an SLP, OT, or IBCLC) is 100% crucial for optimal outcomes following a tongue tie release. ✔️ The importance of getting an airway evaluation before putting children on ADHD medication. ✔️ Key signs of pediatric airway issues during sleep, including mouth breathing , tossing/turning/restless sleep , and the often-missed red flag of hyperextension of the neck. ✔️ The dramatic benefits of early palatal expansion (as early as 3 or 4 years old) to open the airway, often resolving issues like chronic infections (like croup) and snoring , even if the child does not have a crossbite. ✔️ How simple strategies like sleep hygiene (removing dust mite harbingers like stuffed animals and blankets) and dietary changes (like kicking gluten) can reduce inflammation and improve breathing. ✔️ Why a "quick snip" of a tongue tie may not address the entire posterior tie, which can lead to later issues like speech problems.RELATED EPISODES YOU MIGHT LOVEEpisode 204: Progressing Through Play and TOTs with Dr. Brita DestefanoEpisode 293: Finding a TOTs Release Provider with Hallie Bulkin, MA CCC-SLP, CMT®, CPFT™OTHER WAYS TO CONNECT & LEARN💬 Let’s hang out on social: Instagram | Facebook | LinkedIn⭐ Love the show? Leave a quick review — it means the world to me!Free F.A.S.T. Myo Screening Packet: https://FastMyoScreening.comFind a myofunctional therapist: https://www.themyodirectory.comConnect with Dr. Anita Gouri: https://nocavitykids.com/meet-dr-gouri/ Hosted on Acast. See acast.com/privacy for more information.

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