The Hidden Power of Your Tongue with Myofunctional Therapist Sara Mercier, RDH, BS, AOMP, MAS

00:00 - Dr. Andrea Moore (Host)
Welcome, welcome, Sarah. I'm so excited to have you on the podcast. Thank you so much for being here. Thank you for having me yeah. Start a little bit with who you are and what you do, and then we'll dive into all the details and maybe a little bit of how you got into what you do as well. 

00:17 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
Definitely so. My name is Sarah Mercier, I'm a registered dental hygienist and I'm an orofacial myofunctional therapist and not many people know what that is, but that's why you're here today and we'll go over that. So I am a dental professional, as I said, and going down the rabbit hole of airway medicine and dentistry is how this all started. Funnily enough, I'm a patient of myofunctional therapy, orthodontics, airway medicine just like all my clients and many of my followers on social media. So it really is very personal for me because I know what it feels like to be a child with these issues, who then slips through the cracks and becomes an adult with these issues. And luckily, I feel very fortunate that I'm a dental professional and I just happened to dive into this world and be able to not only you know help myself, but help other people as well. So that's really how I got started and kind of my background. 

01:15 - Dr. Andrea Moore (Host)
That's amazing. Yeah, I feel like some of the best professionals are ones who experienced it themselves. I mean, that's why I do what. 

01:20 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
I do and it just. 

01:22 - Dr. Andrea Moore (Host)
It just helps when you just understand it from that very visceral and personal level. So, yeah, why don't you start by telling people what the heck myofunctional therapy is? Great question, great start, yeah. 

01:33 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
So myofunctional therapy is also synonymous with orofacial myology or orofacial myofunctional therapy, so you might hear it called any of those things. 

01:49
The most common is. It kind of got condensed down a little bit to myofunctional therapy. But you'll know all about this because you are a PT. You're a physical therapist, so you work on the function of muscles and tissue and how that affects the skeleton and the whole body system. So orofacial myofunctional therapists were focused on the muscles and the function of the mouth and kind of of the face. I kind of say like in this upper region, you know, from forehead to kind of neck area. And we're not, most of us are not physical therapists. Most of us are speech, language pathologists or registered dental hygienists like myself. There are some OTs, occupational therapists, physical therapists as well, but the majority of myofunctional therapists are SLPs or RDHs. So we really have that extra special training in head and neck anatomy. I mean, as a dental professional, that's boop. That is our area, that's what we focus on. So it's really important to look at the muscle function. 

02:43
Look at what we call proper oral rest posture. Funnily enough, it's actually important. Where does your tongue sit in your mouth? How do your lips move? How do your cheeks move? How does your tongue move? That can affect your sleep, it can affect your airway, how you breathe. It can affect your nervous system. It can affect orthodontic history needing braces, not needing braces. So myofunctional therapy. 

03:11
We work with the goal of achieving what we call proper oral rest posture, which is the tongue should be lightly suctioned to the roof of the mouth, and I tell all my clients it should be lightly suctioned on its own. 

03:20
So if you feel like you're exerting force to have to get your tongue up to the roof of the mouth, that's a red flag that there may be some what we call tethered oral tissues, like a tongue tie that's involved, that is keeping your muscles from moving properly how they're supposed to. So the tongue should be lightly suctioned to the roof of the mouth, the lips should be gently closed at rest and you should always be breathing to your nose. That goes for when you're sleeping, when you're awake, even when you're doing physical activity, unless you run like a mile and then at a certain point you're going to have to let more of that carbon dioxide out and get more oxygen in. But for the most part like if you're lifting weights at the gym, if you're playing a sport intermittently, like football, where you have a break in between, you should be able to do that activity fully with only nasal breathing, and most people say what are you talking about? That'd be impossible for me to do. So that's really the goal of myofunctional therapy, what we're trying to do. 

04:16 - Dr. Andrea Moore (Host)
Oh, that's so interesting and I'm like I'm going to first ask you a personal question, then with that because that actually is a great question I've had in the past and I kind of forgot about it until you brought that up, and then we'll go into more just general symptoms and what people to look out for. But yes, I feel like I have a pretty good resting posture if I breathe through my nose. But oh my gosh, just like walking upstairs or even just going on a walk, I notice like totally mouth open and if I try to keep it closed it's like I have air hunger. 

04:52 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
So what's? What is like physiologically happening that's causing that? Yeah, great question. It could be a multitude of different things, it can be a combination of things, it could be one thing, and so really it comes down to process of elimination. 

05:00
Many things can block the airway. It can be as simple as your tongue is not suctioned to the palate so it's kind of falling back, and your tongue, lightly suctioned to the roof of your mouth, creates a little pressure chamber in your mouth. It creates positive pressure. You may have heard of a CPAP which people use if they can't breathe while they're sleeping, and CPAP stands for continuous positive airway pressure machine. So that CPAP machine is creating positive pressure in your mouth and in your airway to open it. Your tongue is supposed to be your body's CPAP, and also during the daytime, not just when you're sleeping but the daytime. So if your tongue is not in the right posture you're not creating that positive pressure that opens the airway. You may even feel like, oh, your tongue, your airway is a little restricted. It be your tongue could be falling back during the day or at night and actually blocking the airway, and so you're not getting as much air in through the nose as you would. If you open your mouth to breathe in, it should be just as easy for you to breathe through your mouth as it is to breathe through your nose, and vice versa. 

05:59
So if you feel like, oh, I feel that air hunger and I'm not getting enough in through my nose, we need to say wait, why could you have, maybe, a deviated septum? Could you have enlarged turbinates, the pieces of tissue in the nose that can get inflamed? Do you have enlarged tonsils, adenoids? Maybe your tongue is in the right place, but you got hit in the nose and you have a deviated septum? Well, in that case, we can't myo your way out of a deviated septum. That's why we work with a team, right? So that would be an ear, nose and throat doctor, an ENT. We'd say, hey, I'm working on the tongue posture, I'm trying to teach them to breathe through their nose. We got to physically make it easy for them to breathe through their nose or they can't. So there could be many reasons, could be multiple, of those things we just discussed going on that makes it harder to breathe through the nose than through the mouth. 

06:43 - Dr. Andrea Moore (Host)
Oh, that's so fascinating, thank you. And and let's just even connect, like the obvious here, of it's like why is it important to get air in, right, and I think sometimes we we skip over that piece, but it's like we got to get oxygen in and I'm sure you can speak to the importance of that, even more so about what happens if we aren't Definitely and so, even like just talking about respiration, just talking about the air and breathing right Cause there's other things that we'll get into but respiration and breathing in air, when you mouth breathe, you don't create nitric oxide. 

07:15 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
The only time you create nitric oxide is in the nasal cavity, when you break breathe air in and out through the nose. Nitric oxide helps get oxygen into the red blood cell. It's a natural antimicrobial, it's an antibacterial. So if you're breathing through your mouth, first of all you're not making nitric oxide, which is good for your vascular system, but you are also now just having all of these pathogens from the air and allergens, pathogens. Everything goes straight into your lungs, straight into the upper respiratory tract, which is not healthy, right. But when you breathe through your nose, it's a filter and it also is creating that nitric oxide which if, especially if you're an athlete, you're going to get better performance output if your blood vessels are dilated and contracted properly, right. So that's important, just the way you breathe, then that also affects where your tongue is. You can try something, and so can the breathe. Then that also affects where your tongue is. You can try something, and so can the listeners. I want you to suction your tongue to the roof of your mouth and now try to breathe in through your mouth. You can't. You're only going to breathe in through your nose, right when your tongue is suctioned, you can't breathe in through your mouth. So in order to mouth breathe, if you're having trouble nasal breathing and your mouth breathing, your tongue has to fall down to the floor of your mouth in order for you to breathe in, get air in through your trachea from your mouth. So when the tongue is low in the mouth, that causes a bunch of different problems. One is that airway obstruction could happen, like we talked about. Another one is your tongue is the scaffolding for your jaw. So this is extra important for infants, for children, for adolescents to have proper tongue posture because it literally helps grow the face wide and forward, where it's supposed to be. So if your tongue is not suctioned to the palate, you don't have any force that's being exuded on your top jaw, helping your teeth grow in into a nice wide, u-shaped arch, like we want to see. The more room you have in the mouth, the more tongue space you have, the less chance of that jaw the top or bottom jaw blocking the airway, the less chance of the tongue being forced back into the airway because it has nowhere to go. And also your maxilla, your top jaw, is the floor of your sinus cavity. So if you have a narrow top jaw you're also going to have a narrow sinus cavity. And when you say it's hard to breathe in through the nose, maybe you just don't have enough real estate up there because you have a narrow, vaulted palate right. So the tongue is super important to be resting where it's supposed to be, to get the jaw to grow, to grow properly. 

09:38
But then it's also important again, like we said, for that nitric oxide and then, as well as the nervous system, we have our vagus nerve. 

09:47
It's our rest and digest, calm down nerve. And we do have an innovation. One of the many innovations is in our soft palate. When you suction your tongue lightly to the roof of your mouth and this is a problem for a lot of people with tongue ties is maybe you can get the front half or third of your tongue up, maybe even two thirds, but the very back third of the tongue, that's in the in the oral cavity, doesn't reach the soft palate and so you're not activating that vagus nerve innervation on the roof of the mouth telling you to calm, to rest and digest. So it can also cause some nervous system dysregulation because now we're breathing inappropriately, which stresses out our nervous system. You know we talk about meditation and breathing why? Because breath is directly connected to our nervous system, so the tongue really plays a huge role in all of those different things. Mouth breathing is not going to give you the same results in any of those capacities, like nasal breathing. 

10:41 - Dr. Andrea Moore (Host)
Oh it's so, it's so fascinating, like nasal breathing, oh it's so, it's so fascinating. And really that connection with the vagus nerve is where I really kind of started going down the rabbit hole of this and finding it, because a lot of my work with chronic pain is based on nervous system regulation. And I think the first time I saw this connection but totally had no reference point at this time yet was I had a patient who he was a guy and he had all kinds of chronic pain and he had horrible congestion, like really inflamed sinuses all the time and he would only mouth breathe. And it just became so obvious how much attention it created. And I was like I got to the point where I'm like, dude, I don't know what to do with you If you can't breathe through your nose, like everything we're doing felt so pointless. 

11:29
So I just was like look, I need you to go. Yeah, See, an ENT go. I was like I didn't know anything about my functional thing. I have no idea what his, I couldn't even tell you what his mouth looked like at this point, but I was like I just need you to be able to take a breath through your nose, Cause it's like he would just had been mouth breathing for years and the amount of tension in his body was just. 

11:49 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
I bet. 

11:50
And then it becomes a habit, right. So it becomes a habit where part of it is necessity. And same thing with my functional disorders where part of it is oh well, my tongue is going to be low in my mouth and maybe my mouth is going to open that open mouth posture because I need to breathe, but then it gets. You know, you know all about as a PT, you're a specialist in neuromuscular, you know education and reeducation. So that nervous system has now created a habit. So not only do we have to fix the, the anatomy, but we also have to fix the brain function of that habit that's been formed, right? 

12:24 - Dr. Andrea Moore (Host)
It's so interesting so I didn't actually tell you this. My son just got a tongue tie surgery at the beginning about a month ago. It was actually partially because I've just, you know, gone down rabbit holes, Like he was right on the edge and but he had some speech issues and he's got ADHD and I was like honestly, I think I'm more doing this. 

12:42
He's at his face. He's seven, so when he's little, so he's still growing, and I was like I think I'm just at this point doing it prophylactically to make sure that his throat grows properly if he's. 

12:53 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
Yeah, well, he already has symptoms. Right, we're talking about breathing and speech, those are all. Those are already reasons enough. 

12:58 - Dr. Andrea Moore (Host)
Yeah and so. But it's interesting because since he's had it, I actually feel like his, his, he has, his mouth is open more and he's like he has this with his tongue because he's got a lot of I mean, I think he has other core and like neuro stuff going on. I think it's like a sensory thing, but I'm like, oh, I almost feel like his tongue has more mobility now? 

13:18
oh, definitely, it's like it's like now, it's the retraining of okay, I know that you know how to keep your mouth closed and now that you have more access to motion now you really have to learn how to keep your mouth closed. It's kind of funny, because I'm like I don't want to give them a complex about it, but I'm like, dude, close your mouth and that's why we always talk about. 

13:34 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
It's super important to do, you know, myofunctional therapy before any release so that we can get the body ready and make sure we get the best results possible. Make sure the doctor can access all the deep fascia because right now it's in weak muscle if we don't do myo first to get it strong. So once we get that tongue strong it can elevate better, the doctor can do a better surgery and then we're gonna get better healing after. And just because you do a tongue tie release doesn't mean your tongue is magically going to know what to do. I tell people what would happen if you were born and congenitally like your upper arm of your right hand was connected to your side, like you had a webbing of skin, a webbing of tissue and you could only use like your forearm. You would have learned how to do different things and how to pick things up and how to move your hand and dexterity. You would have learned something completely different. And then now, as soon as we cut that skin, first of all you're going to have to rehab, especially the upper arm that has no muscle tone because it's never really worked properly before, but you're going to have to see a physical therapist to learn weight, like what is the normal function of this? It's the tongue. I don't know what it is. 

14:36
As a dental professional, it always blows our minds in dentistry that, like people and especially insurance companies don't get me started on that they assume that the mouth is separate from the body. I'm like I don't detach your head from your body to clean your teeth and then put it back on. So whatever medications you take, whatever you do systemically is going to affect your mouth and vice versa. So the tongue and all of that you know. So when oral surgeons or orthodontists don't refer to myofunctional therapists, it's basically the same thing as an orthopedic surgeon doing a knee replacement and then not referring the patient to physical therapy. Just because you do the surgery and just because you change the anatomy doesn't mean you're going to change the neuromuscular system, right? Oh my gosh. 

15:19 - Dr. Andrea Moore (Host)
Yeah, so well said. And yeah, while we're on it, I was going to say yes, i've've heard, I've heard you preach it and heard so many other preachers. We were lucky to have a local um pediatric myofunctional therapist here but, it's like, yes, therapy first, therapy first. So we did that for, I think, about three or four months, and that's great. Then we got the tongue tie and then, um, the tongue tie release, and now we are still still doing it so, yeah, it's only a month out, you've got there's plenty of time. 

15:47 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
And honestly, in my opinion, I work with adults and children. I really specialize in complex adults, like jaw surgery cases, but I see people of all ages the kids seem to bounce back way faster as far as like changing their habits because they've got. Your son has seven years of bad habits, whereas adults some of us have like 40, you know, 30, 40 years of bad habits. So he's yeah, he's on the right track, for sure. 

16:10 - Dr. Andrea Moore (Host)
Yeah, I was surprised at I had very two very differing opinions on um, because the dentist said if she was going to do it she wanted him to go under anesthesia so he could do sutures and otherwise she um didn't feel, feel, you know, she was just like I, she's like you can do it without, but I really, really would do it. And then the myofunctional therapist actually was very hesitant to have him go under anesthesia and she's like I think you'd just be better off waiting until he was older. 

16:40
so, yeah, I mean we ended up doing it with anesthesia and he did fine, and mainly from the and so I'd be curious to hear your take on it mainly from the standpoint of and I'm like my thinking could have been wrong. 

16:52
whatever it's done, it's done. I'm not going to. I'm like, if his mouth and jaw is growing now, it didn't, I'm like that would be waiting years, I feel like, until he's, you know, ready to conceptualize that better. And so I'm like at that point then hasn't the growth happened? And I didn't want to risk one longer patterns of being there but then also his jaw growing and not having like the palate growth and needing all other kinds of I don't know Right. 

17:19 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
No, that's. I mean. That definitely makes sense. Your your train of thought. 

17:22
So, specifically for anesthesia, most of us and the mentors that I've been trained by like Dr Zaghi at the Breathe Institute, dr Jasmine Elmore in North Carolina anesthesia is not ideal because tongue suction is what elevates the back of the tongue more so than the doctor using an elevator right, so they have to use an elevator, they have to lift the tongue up, but that doesn't elevate the back of the tongue and that's where a lot of fascia is hidden. So, like the doctors that I work with, they usually take a break from doing tongue tie releases until they can do it with just local anesthesia. And we usually start around. Age five is when we start doing local anesthesia. They don't feel anything, they don't have to be sedated. It's kind of like doing a filling, right. The only time you'd have to be sedated is if you have severe dental phobia or some type of phobia. You know we do it sometimes in dentistry because it's going to take too long. The tongue tie release takes 15, 20, maybe 30 minutes. It's not like a couple hour long procedure or anything like that. So, generally speaking, you can get a better release without anesthesia because the patient can suction. 

18:26
Now when we have infants, yeah, and so when we have infants we're not able to do sutures right Because they're going to be moving around a lot. It's too, it's too dangerous with infants. So we do laser, usually laser, so that there's minimal bleeding, minimal tissue damage, things like that. We do laser. And then the adult, the parent, has to do stretching every like four hours or so, so like wake them up in the middle of the night, stretch the wound to prevent reattachment. And a lot of infants who get this done as infants a lot of them I can't give you an exact estimation, I'd have to go through records but a good, a good chunk of these infants who get this done as an infant. They may need a revision, which is, you know, revising it, where we go back in and release anything that wasn't released the first time around, but it makes a huge difference. Even if it wasn't a hundred percent when they were an infant, it still makes a big difference as long as you work with the right team body work, nervous system work. 

19:22
It's not just about the tongue, it's about everything. So when we have an infant, um, usually the tongue tie release providers stop doing the releases around age one and a half, two, and then we wait until age five because the risk, the risk of missing so much tissue, and then also we don't want to traumatize them Right, and like they're not old enough to suction, but they're going to be too old to be like, wait, your mom and dad have to stretch my tongue every four hours, so that two and a half, like two to five, honestly the risks and like the bad connotation with it unfortunately kind of outweighs the benefits. So then we wait until about age five. Most kids age five are good. Some are like a little immature and they need to wait till they're maybe five and a half, maybe six. But then once we get to the five, five and a half six, we put a little bit of numbing gel underneath their tongue, give them a little bit of local anesthesia. They don't feel a thing. So to be honest with you, I've never had a child go into. I mean, I've had children. So the you know, basically doing the release under general anesthesia just makes a higher risk that more fascia is going to be missed and you're going to need to do another release, which anytime you have to do another release. Now we're increasing the scar tissue right. So we're causing some, some buildup. So that's not ideal. 

20:41
As far as stitches go, that, doctor is a hundred percent% right. We want to place stitches because of healing, so wounds heal a very specific way. All over the body it doesn't matter, it's just our healing system right. So it first starts with we have a wound, inflammatory markers get sent out in our bloodstream, we bring white blood cells and we also bring clotting factors. So first we're going to form a scab and then that scab is going to slowly turn into a scar. That happens in the mouth, that happens if you cut your arm, your leg, whatever. 

21:13
Now just ask yourself this what other doctor is going to leave a giant gaping wound and not stitch it up? I can't think of any, and maybe you can, but I can't. And that's because we want to heal wounds with what we call primary intention healing. There's two types of healing primary intention and secondary intention. Primary intention is where you get a good, clean cut. You put the edges of the wound together, you stitch it up and then the wound is going to heal from the bottom down in a very thin hairline, as small as possible. So that's going to make sure that we get the least amount of scar tissue forming as possible. If you leave a giant open wound bed, you're going to get secondary healing, which is secondary intention healing, which is where it heals from the bottom up. So you're getting layer by layer by layer it starts kind of like it's like a triangle right where it starts at the bottom up. So you're getting layer by layer by layer it starts kind of like it's like a triangle, right when it starts at the bottom thinner, and then it just is going to get thicker and wider and wider and wider until it gets to the top of where the wound originated. So you're going to have a much better healing experience as far as less scar tissue and faster healing. 

22:17
Better healing Less scar tissue means less restriction after the tongue tie release, especially people. I myself have hypermobile Ehlers-Danlos syndrome and I work with a lot of hypermobile people and we have connective tissue problems. It's a connective tissue disorder. Scars are connective tissue. So especially with people who know they're double-jointed, they're hypermobile, they have EDS, they have HSD, something like that you always want to play stitches because we can't afford to allow that connective tissue to thicken beyond what it probably is already going to do for us. 

22:50 - Dr. Andrea Moore (Host)
That makes so much sense. Yeah, and yeah, bringing it back into kind of these bigger disorders, do you feel see the higher incidence of myofunctional, like a need for, like a tongue tie release or myofunctional issues with someone with Ehlers-Danlos or other? It's really interesting because I think it's pretty. 

23:08 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
I mean we don't have enough studies and we don't have enough data to say anything. I feel like not every single person with tethered oral tissues, like tongue tie and myofunctional disorders, not every single person who has those disorders is hypermobile, but the majority of people who are hypermobile have those problems. And why is that? A couple of reasons. One big reason is hypermobile people. Ebs patients are more likely to have one of two variations Either they don't have a frenum at all, which is unusual. 

23:40
The frenum is the piece of skin underneath the tongue. It's a problem if it's too short, too tight or impedes function, usually with tongue ties and all of that it's all three of those things are a problem. But people with hypermobility sometimes don't have that piece of skin barrier at all. It's just kind of like smooth muscle and it's kind of unusual. Or they have tethered oral tissues. They're very rarely like any normalcy in there, right that in my experience. The other thing is like on my social media algorithm. I'm hypermobile and I talk about that stuff a lot, so I'm pretty sure like that definitely influences who finds me. 

24:13
So I'm like why am I finding all these hypermobile patients? Because the algorithm works. That's why, and so the patients who are hypermobile also have a huge, huge contributing factor that contributes to these myofunctional disorders, and that is your palate is often narrow and vaulted if you're hypermobile, because our connective tissue is too loose. That's why your joints are more loose, your stabilizers are more loose. That includes the muscles that help develop the face. You don't have that rigid scaffolding than a normal person would have, and so the bones aren't being spread and grown like they're supposed to be, so they're kind of loosey, goosey, just growing more up instead of getting that, that push and that movement from the, from the forces. 

24:58
So much so that even one of the diagnostic criteria for EDS and even Marfan syndrome is a narrow vaulted palate. That's how prevalent it is. It's a diagnostic quality. So when you have a narrow vaulted palate, automatically you're going to feel like you don't have room in your mouth for your tongue. So your tongue is also fighting to help grow your jaw. But now you have a narrow palate where it doesn't feel like it fits from like day one, so then it's more likely to fall down, to feel like it's not being squished. And now, oh now we're mouth breathing so it kind of starts the ball rolling on all of these things with that hypermobile group. 

25:35 - Dr. Andrea Moore (Host)
Oh, that's so interesting and, yeah, I think there's probably definitely a lot of people listening that are hypermobile as well, because it is a population I tend to see as well and in terms of, I guess, the benefits of addressing it, because I think one of the things when people have chronic pain, it can feel like there is this laundry list of things to address, like I got to look at diet. 

25:57
I got to look at you know the nervous system. I need to look at my past trauma. I need to look at diet. I got to look at. You know the nervous system. I need to look at my past trauma. 

26:09
I need to look at my exercises, I need to look at whatever else is going on. There's autoimmune issues Well, you know, so on and so on. Where how would you know if this is something that should be a priority for someone, or something where it's okay? No, maybe address those other things first, and I know that is not an easy question to answer by any means. 

26:25 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
Yeah, no, that's a great point and you're right, and I tell people all the time because I'm a huge proponent of a team of healthcare providers I'm, you know, the myofunctional therapist and then I want you to work with an airway team, including like what does your bite look like? What does your airway look like? Again, we can't Mayo your way out of some of these other issues. Just like you know, you're doing physical therapy with these patients and if they have a terrible diet and their gut microbiome is all messed up, their nervous system is going to be messed up. Like you're kind of just spinning your wheels, right, and so I tell people all the time I know it can feel overwhelming, but let's start with the low hanging fruit. Something that's really easy, that you know isn't going to, you know, take a lot of like extraneous things that you have to do, right, and that's different for everybody. So maybe we have a patient who they're they have a lot of symptoms from these tethered oral tissues and they also have a pelvic tilt and they're breathing wrong, right, well, you can try to work on the pelvic tilt and the breathing, but if they have a piece of connective tissue under their tongue that runs all the way down the center of their body in that deep frontline fascia. That's restricted. You might get some improvement, that's great, but you're not going to get a hundred percent. 

27:40
And so I always say, like process of elimination, I have some clients where let's say that they need a tongue tie release, they need jaw surgery, they need myofunctional therapy and they need physical therapy. That can sound extremely overwhelming. That was a lot to even just name off, let alone like get started working with those professionals. But I always say you don't have to do everything at one time, we just have to have realistic expectations. And no, don't get frustrated. If you don't feel a hundred percent better with one of these modalities, we know you're not going to feel a hundred percent better with one modality. 

28:11
If you have a pelvic tilt and you're breathing wrong but your neck hurts, I mean sure you can do some neck PT, but you know that you're going to have to work this patient on their breathing and their pelvic tilt or that's connected to their spine, which is connected to their neck. So it's a no brainer and it's no mystery why it's not working a hundred percent. So don't get discouraged, don't get frustrated, just know, okay, I did one of those things Now we're on to the next on the list, right, and so I think that's the biggest thing is just not feeling so overwhelmed with you have to do everything at one time, but just celebrate the little wins along the way and know that you know at least there's an answer. My biggest concern, even as a patient myself, is nobody knows what is wrong with me, and I know something's wrong. That's a much bigger issue, in my opinion, than knowing that's wrong, knowing how we can address it and we just haven't done it yet. At least you know like what the game plan is Right. 

29:03 - Dr. Andrea Moore (Host)
Totally, and are there any for somebody who doesn't have, like, very obvious dental issues or, like you know they? They're like well, I can, you know, I can pose my lips, I can breathe through my nose, you know, do I? I don't know, I can't tell if I like, I feel like I fall into that where I'm like, I don't know if I have a, I've never gotten evaluated. 

29:27
I don't know if it's too short or if I have a tongue tie and I have like other vague symptoms. Right, I'm like, well, my hips are always kind of tight and I do no PT and stuff for them. Um, do you find the degree of obvious mouth symptoms that you would see correlate to the degree of other symptoms? 

29:52 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
Does that make sense? Usually, sometimes, like not always, but usually, and honestly, now that I'm thinking, I just answered you probably too soon, because now that I'm thinking about it I'm like, honestly, you know what? Like we can look and say oh, your tongue is restricted, but it doesn't look that restricted, right? 

30:13
Just like you could look at a really hypermobile person and you're like oh, you're super hypermobile, I'm surprised you don't have any pain. And then you can look at somebody who has you know more on the lower end of the spectrum the whole. I guess the answer is it's a spectrum, right. And so you can look at somebody lower on the end of the hypermobile spectrum and they're in a ton of pain and you're like why are you in pain? But you are super bendy and you're not in pain, right? There's so many different factors that go on, including like Do they have POTS? Do they have nervous system dysregulation? Do they have mast cell activation syndrome? There's so many other factors. So, for example, some things I even have. If anybody's interested, you can go to my website, revealmyotherapycom, and the first thing that pops up is a questionnaire Do you suffer from any of these symptoms? And if you answer yes to a certain number of them, or so many of them, it's going to tell you. It's going to pop out an answer like eh, you're. You know you probably aren't a candidate. Or yeah, you're a candidate for my functional therapy. 

31:07
Things like do you wake up tired? Do you get tired during the day? Do you need coffee in the middle of the afternoon to stay awake. Do you snore? Has anybody said that you snore? I've had some people be like oh no, I don't snore. My spouse, my partner, would have told me that I snore and I'm like, but both of you are sleeping and they're like, oh and I'm like, okay. So if you're choking or snoring, if it's not loud enough to wake the other person up, you guys are both like. It's like the blind leading the blind, right. So the question is how do you sleep? As far as what? Do you feel well rested? Do you feel like you can take on the day? Or do you feel like, oh, I definitely could sleep more if I wanted to? Or like I feel like I just ran a marathon last night in my sleep. Maybe you did because you were choking. 

31:46
So, unless you've had a sleep study to say that you don't have any airway obstruction or any type of sleep apnea or upper airway resistance syndrome, anytime you wake up tired, not well rested, you feel like you could sleep more, not well rested, you feel like you could sleep more. That's a huge red flag. Something's going on, something's not right. Also, do you have, do you have, neck and shoulder tension. Do you have chronic allergies? Do you have a chronic post-nasal drip? Do you have? Do you have to frequently take medication for allergies? Do you have indigestion issues? You get gas and bloating. 

32:21
How you chew your food and how your tongue moves and how you swallow is going to affect how you digest your food as well as did you swallow too much air instead of you know, not no air, which is how you're supposed to do it? So there could be symptoms that people have no idea are directly connected to their myofunctional disorders or their dental disorders, and and they really that's where it stems from. I work with a lot of patients who have TMD issues which are not necessarily like their bite is good. Their bite is in what we call centric occlusion in dentistry. It's lining up fine. Their TMD is due to muscular reasons as well, as you know. Maybe they're a mom who's had three kids. They've never done pelvic floor PT. Your pelvic floor is directly connected to your jaw, and then I look at their tongue. I'm like, well, no wonder why. Like, like, let's worry about the you know, let's fix those things and then see how you feel. It's funny that you mentioned that your hips are tight. 

33:13
I actually have a client of mine in the past. She is a PT and so I saw her and her son and this PT was getting back surgery. She had a history of back problems and her back was tight, her hips were tight, and so she was having another PT colleague of hers treat her and just doing the myofunctional therapy alone, the treating PT was like oh wow, like your back feels less, you know, tight and your hips feel much more loose. That was just with Mayo. Then, when we did her tongue tie release, she was like oh my gosh, this is like the most flexible I've ever seen you. And she's like this just happened like overnight. It wasn't like I mean right away, after some practicing in the Mayo it helped. But literally from one day to the next, as soon as she got that tongue tie release done, it released so much tension and so much fascia that even her PT who's you guys are the specialist. 

34:03 - Dr. Andrea Moore (Host)
We're like oh no, there's a difference here, like it's for sure different. Yeah, that's so cool. Yeah, that's where I have a friend who got it done as an adult and she had all these like neck issues and whatnot. I can't remember the exact reason. She even went down that that rabbit hole, but she said she like literally woke up the next morning and her hips were like she's like I have never she does fitness stuff, and so she was like I've never felt them so open Like it was just, and I was like oh, that's, that's so, it's nuts and it's um it makes sense and it's frustrating because then it's like, oh, like, as, as a PT, I'm like I never want to be working. 

34:39
I always have like a you know a thing of I never want to be doing a treatment on someone. That is kind of not pointless, but like oh like if they could just do something else. 

34:51
You're missing a big piece of the puzzle, right? I never want to miss a piece. And it's like now I know like this much about my own. I'm saying a tiny butt where it's like dangerous. Because then I'm like, oh no, like I have someone's cervical pain and I'm like I can see that your tongue is all kinds of, you know, not moving Right. So I'm like, oh gosh, like I don't want to like keep you in PT if what you need is myofunctional therapy, but I don't yet know Usually, honestly, usually they need both. 

35:11 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
To be honest with you, and I always say, like I always say you know many years of dysfunction in your mouth, the chances that you have dysfunction in your posture, your breathing, your pelvic floor is almost guaranteed. So not only do you need myo, but you need PT as well. So, honestly, it's an and not an or situation. So I think it's super important what you do like, it's critical what you do, and just as much as it's critical that we treat all areas right. But you're a specialist in referred pain especially. 

35:43
You can see a patient who's like my knee is killing me and you're like well, it's coming from your arch of your foot right or it's coming from your shoulder. The same thing is true with the mouth. So you may see a patient who's like oh, my cervical spine is messed up. Like me, I have myofunctional disorders, but I also have hypermobility. So is the hypermobility the number one reason for, like, my myo issues? No, I had a tongue tie also. But do I need PT for my neck and for my back and for my hypermobility? Absolutely. Just doing one of those things is not going to fix me a hundred percent, because there's two different sides of this coin. 

36:17 - Dr. Andrea Moore (Host)
No, that makes so, so much sense and I think that's something that, especially now, with insurance becoming crappier and crappier and um, it's the state of the world basically generally um it's like, but the truth is it's like, it's it's tough to like access services or be able to afford services and things like that, and so it's. Yeah, I know, I know, I know I get frustrated or have a hard time sometimes when I see someone who I'm like. Oh, you need this and this and this and I'm has a ton of anxiety about it is unsure about it. 

36:51
It's like their outcomes are worse, their healing isn't as good. And if you know, let's say they can't be activating their vagus nerve or toning their vagus nerve or however you would put it with a tongue, because I don't know the correct way to say it you know, activating their vagus nerve, or toning their vagus nerve, or however you would put it with a tongue Cause I don't want the correction to say, you know, and that's keeping their nervous system in a high state. Then you know it's like which? Where do we start? Which came? 

37:28 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
first, yeah, I'd say, wherever they can honestly like something is better than nothing. And if they're like, well, I can't afford both and my insurance is going to pay for this and I found somebody I like next to me, I'd say go do that first, like it's better than sitting around and doing nothing. Right, and if you you know, for example, if you, I would say I would stop when I got to a point where we're plateauing and where we're not making any progress with Mayo, with PT, with any of these things, because if you're making improvements, there's still improvements, even if they're a little bit right. This is what I have a huge problem with with P, with kids especially, who are kept in speech therapy for years and years and years. And I'm like why are we in speech for years and years and years and we're plateauing a lot of? You know, one day this is going to become general curriculum where you know all demo professionals, all SLPs, learn about tongue tie, myofunctional disorders, you know, in their programs. But until then there's a. You know the majority of the field isn't even aware to look for these things. They have a child trying to say their R's especially. Their tongue is stuck to the floor of their mouth. When you say the letter R, the back of your tongue has to come up and reach the palate. If there's a rubber band pulling it down to the floor of the mouth, that's just a no brainer, that that's going to be a problem, right. So it's no wonder that that child is stuck and they're not progressing. So, in my opinion, once you reach a plateau, once they're like, hey, I mean I'm maintaining and they can probably maintain on their own and you're not making any more progress, it's kind of a waste of money, I agree, and it's a waste of time and resources. So I would get them where they need to be, where they feel that they're at least stable. They're not going backwards. If we stop progressing now, it's time to look at the other puzzle pieces and figure out also I mean, this patient has autonomy, right. So you can tell them this is what I see, this is what I think you need. I tell my patients all the time and I tell my clients all the time I'm not here to waste your money, I'm not here to waste your time and for my functional therapy. 

39:33
The way I do Mayo is different than some other therapists who have a schedule the way that I do Mayo is I give my clients Some exercises. I basically I teach them how to do them, I monitor them. I do all virtual Mayo, by the way. So I send them like a Mayo kit of all the tools and supplies we're going to need. But I make sure they're doing the exercises correctly and then they practice those exercises at home until they've mastered them. So maybe I have an exercise where I want them to do 20 repetitions. 

40:02
We start they can only do three or four correctly and then their form suffers. So I say stop, I want you to do four correctly. That fifth one, it's getting sloppy, stop there. I tell people it's just like the gym. You have to have correct form. Just like PT, you have to have correct form or you're not working the right muscles. So I'll give them that exercise and I'll say every day, try to add in one extra repetition or two and work your way up as you get stronger, as you practice, just like the gym, you're going to be able to get up to all of those reps Once you can. Now we're ready to meet again and do the next level. So and that's just my personal experience of the best results possible and you cannot possibly graduate from my Mayo program without having achieved proper tongue posture, proper swallowing technique and all of those things. 

40:49
The only thing that really differs is, let's say, you decided you don't want to do a tongue tie release. I'd say, well, hey, you're never going to achieve the back of your tongue floating up, but you can suction it up. You just have to be aware of it 24 seven. And that's not how it should be. But it's better than nothing, right. And if they're okay with that, they're okay. 

41:09
I'm not here to tell them you have to do a tongue tie release. Even just knowing where to keep your tongue is going to be beneficial. Is it going to be a hundred percent? No. And as long as you're very upfront about that, in my opinion, like that's the most ethical way and the most helpful way to do it is to share with them. I tell them you're going to need PT. You have to relearn how to breathe. Maybe your neck and shoulder tension will go away. 60% when we do your tongue tie release. And you're going to say, well, what about the other 40%? Do that PT work? And then you're going to be chipping away at that stone, right? But I always say, as long as you're making progress, it's not hurting, it's only helping. It's when you stagnate and you stop going forward, and then you just keep repeating the same thing over and over and over. 

41:51 - Dr. Andrea Moore (Host)
I feel like that's kind of a waste. I totally agree, and I see that in PT all the time. Or I'm just like, oh, it makes me want to pull my hair out. I'm like what have you been doing? 

41:56 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
for the last six months, cause we tend to see people who have failed. Traditional PT and they describe it and it's. 

42:02 - Dr. Andrea Moore (Host)
It's funny. Actually just this morning I had a parent was telling me just you, it's funny. Actually just this morning I had a parent was telling me just you know, of course, since I'm a PT, I'm sure you get this. People just start telling me about their PT. 

42:09 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
And he's like you know what do you? 

42:10 - Dr. Andrea Moore (Host)
think, and I'm like is it working? And he's like yeah, I think feel a little better. 

42:14 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
I'm like cool Cause what he was saying okay, that's probably not how I would approach it. It I was just like but it's working for him, so who cares? The proof is in the pudding. I feel like right, if you're telling me, I'll give you an example. 

42:38
I had a client who did her tongue tie release. She really needs jaw expansion and, technically, jaw surgery. She's going to be doing Invisalign. The orthodontist recommended like, hey, you could do expansion and jaw surgery. We's going to be doing Invisalign. The orthodontist recommended like hey, you could do expansion and jaw surgery. We could still make a little bit of tongue space with. Like Invisalign, it's better than nothing. 

42:52
Is it fixing the whole problem? No, she's like oh, when I do my, when I did my Mayo and I did my tongue tie release, she still has to mouth tape which, technically, if we addressed all the problems, you shouldn't need that bandaid. It's a bandaid, but you know whatever. So she's like I don't care, I'll just keep mouth taping and I feel good. I'm like who am I to tell you to just go do jaw surgery? I'm like you're the patient and you know what, as long as you understand the risks and the benefits involved. We're not doing substandard care, we're not being unethical. I mean it would be unethical if you know she needed jaw surgery and we just did something that shoved her jaw further back into her mouth. But if she doesn't want jaw surgery, she doesn't want jaw surgery. Like, who are we to tell her she needs it, but she feels fine? So I'm like if you want to spend money on mouth tape and you know that's not ideal, but it is what it is and it helps you feel good behind you a hundred percent. 

43:47 - Dr. Andrea Moore (Host)
Yeah, yeah, I'm very, very similar. I love, I love just the education, the understanding, and then it's like ultimately the person has to make the choice that feels right for them, right, and they can always make it. Do no harm, in my opinion, like do no harm. 

43:56 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
also be upfront and honest. And then if we again are like hitting a plateau, then don't keep charging them money to just waste their money, and I feel like that's the most ethical honest way to go about it. 

44:08 - Dr. Andrea Moore (Host)
Absolutely, I know, I don't. I'm like I don't know how people see somebody without, like, seeing constant improvement, because I'm like I don't I mean speaking of honesty, one of the things that I absolutely love about your Instagram is Sarah does these like celebrity analyses of their myofunctional therapy and I just feel honestly, I feel like I've learned so much from them and it's just fascinating. And now I'm like you must walk around all day just looking at people, because I used to look at people's gait and I'm like now. 

44:39 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
I just look at people's mouth, I don't understand what I'm seeing but I'm like, ooh, that's not right. 

44:44 - Dr. Andrea Moore (Host)
And one, they're super educational. I think they're really, really fascinating. But what I found fascinating is in the comments, to see how upset people get about this. Because people are upset that it feels like you're picking on their appearance and I think we really are living in a culture more and more where it becomes harder to just say facts and be honest and that they're not a judgment. It's just like a hey, here's what's affecting you. So I don't know if you want to speak to that and why you chose to do that. 

45:14 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
Yeah, that's such a great point. Well, first and foremost, I am a dental healthcare professional. I'm looking at the mouth all day, every day, my regardless, right. So that was already my specialty. Now it's just honed even more where I'm kind of like broadening the scope a little bit. But I was always looking at the mouth right and I feel like my, my takeaway from it is there's something that I notice is the mouth is on the face right, and so if I were to say like, oh, this person's fingers are longer than usual and they also have really, you know, they have long, skinny limbs, hey, that looks like it may be like Marfan syndrome, I don't know if anybody would be. Oh, I'm sure some, of course somebody would. But like I don't know if a bunch of people would be as upset about that as me, saying they have a long, elongated face shape, which we call adenoid face, to. I feel like people take that more personally because the face is such a personal subject. I guess I mean, I understand that. I think a lot of it, too comes from fear and I think a lot of it is projection. So I this is very interesting to me. 

46:20
I'm neurodivergent as well. I am slightly on the autism spectrum, which is a hundred percent why my personality is the way it is. I'm just very blunt and straightforward as it is. That's how I talk. That's how I talk to people. I know that's how I talk to people I don't know. To me and this is kind of getting into the weeds a little bit to me being upfront, being honest, being direct is being respectful, because I'm not trying to sugarcoat, I'm not trying to beat around the bush, I'm not trying to play a game with you. I respect you enough to be straightforward with you. You're an adult. I expect that you don't need to be BS. Basically, and. 

47:00
I realized like, over the time, I'm like that's literally what goes through my mind is is disrespectful. I feel like it's disrespectful to insult your intelligence by not being straightforward. That's how I feel. So I think a lot of this also comes with intention. We know what my intentions are and my intentions are good. They're all there about is education. 

47:18
I think somebody could be gorgeous. Some people will say you're talking about all these mild disorders and they're still beautiful. And I said I never said they weren't like you can. You can have a different shape of teeth or you can have a narrow palate and people still find you attractive. I mean they. I was actually interviewed for an article, an online article, and they talked about rodent men I don't know if you've ever heard of that where there's like a fad going around of rodent men and that's like guys who have that elongated face shape and kind of set back jaw are starting to get some traction and some looking at that. I'm like Jason Allen white is a perfect example. He's got that rodent face. Look, I didn't name it, don't come for me Like I would. That's what it's called. But people are like saying, oh, they're so hot, they're so, you know, attractive. And I'm like I never said they weren't, even if that's not my cup of tea. 

48:07
We're not talking about appearance here, we're just talking about medical facts. So when I talk about somebody's palate or somebody's you know, whatever if I say you have gingivitis which of course I can't diagnose if you're not my patient but if I look at somebody, I say it's highly likely that they have gingivitis, they have recession, which is periodontal disease. They should see a dentist. Of course we're never diagnosing on the internet. We're just talking about red flags that should be investigated, right. But if I see somebody and I say like, oh, as a dental hygienist, it looks like there's calculus there and it looks like there's inflammation, people aren't going to say yeah, but they're beautiful, why are you picking apart their appearance? And I'm like that's okay. So for me I'm coming at it strictly from a medical standpoint, just like I would talk about dental health. But I think it's because it's the face. It's a little bit more touchy of a subject. And then when I go to people's profile picture who comment things like that, I'll notice many of them have the same issue. So now they feel either personally attacked or they feel insecure about it. And now they're projecting. And now I called somebody ugly, which never happened, but to them it felt that way. So I'm not time from social media. That's where 97% of my business comes from. 

49:29
People reach out to me on social media. They say I never knew any of this before. I saw your review. It caught my eye and I realized oh my gosh, I have the same problems and you help me. And I've had people we've met for a con, you know, consultation. They start crying because they're like nobody's been able to help me before, and so there's been times when I'm like should I even keep doing this, because so many people get bent out of shape about it? But it's those patients who tell me I am so glad that you did this because I, you know, I never got that information before and now I was able to help myself. So that's why I do what I do, and I'm a patient myself. I'm a patient who looked in. I've done my own, my overview, where I talk about my face, I'm like I'm perfect. I have my own disorders too. And then also, when we look at, you know, the patients who wouldn't have seen it otherwise, I mean the. In my opinion, the benefits outweigh the risks of you know getting people upset. 

50:26 - Dr. Andrea Moore (Host)
I think so. Yeah, keep doing what you're doing. I know where I'm like is it? 

50:33 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
is it like, am I wrong here? And I'm like because I know where my heart is and I know, like, what I'm saying and what I mean by it, and I just want to help people. And I know that I'm not doing it maliciously, I'm not talking about, you know, somebody's weight, somebody's this, somebody's that it's literally bone structure and half the time. And people are like, well, they can't help it. I know they can't help it. That's why they are where they are and that's why they need our help, because this is no fault of their own in any way, shape or form. It's not their fault. So I think some people get defensive, thinking like, oh, you're telling me that I'm wrong, I'm bad, it's nobody's fault. We just have to, you know, medically address. It's not anybody's fault. You know we have a random patient who, out of the blue, gets cancer. It's not their fault, but we still have to treat it. 

51:14 - Dr. Andrea Moore (Host)
Yeah, yeah, I think people I noticed it in PT even if I just say something like oh, this side is weaker, you know. There it's like I have to be really careful. Or you know, like once I get to know the person better I can kind of gauge how I can say things. But I definitely notice people can take things very personally, as if it's like some moral failing. That exactly Right. And I just always try to be like yeah, you and 99% of people have you know, don't? 

51:37
know how to breathe or things like that. So it's yeah, I love that you pointed out. I think it brings awareness and personally I love seeing the way you answer people, the comments. I feel like it cracks me up and is like I'm like go you. 

51:53 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
I try to insert a little bit of humor in it just to keep us not in the weeds. 

51:57 - Dr. Andrea Moore (Host)
You know I'm highly I feel like I never comment on your stuff, so I'm totally that like person who I just like rarely comment on anyone's stuff and I'm very entertained and very grateful and very educated by it. 

52:08 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
So thank you very much. 

52:09 - Dr. Andrea Moore (Host)
So where can people find you if they want an assessment, cause I know you do everything virtually and myofunctional therapy does beautifully, virtually, as I've heard and we've experienced ourselves, so yeah, yeah, it's great, Thank you. 

52:19 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
So I can be found on social media my handle on Instagram, TikTok, Facebook. Everything is at healthy mouth underscore, healthy life or, if you look up, reveal myotherapy. I'm there as well and you can also go to my website. Like I said, there's that questionnaire you can fill out to find out. Are you a candidate? There's an FAQ page of what is myo. How long does it take? Do you take insurance? Like all the common questions that we get is at revealmyotherapycom. 

52:50 - Dr. Andrea Moore (Host)
Awesome, and I'll link to it all in the show notes. Thank you so so much, sarah. This was so so helpful. 

52:56 - Sara Mercier, RDH, BS, AOMP, MAS™ (Guest)
Thank you so much, dr Andrea. It was great to talk to you. Have a good rest of your day, you too.