Birth, Baby!

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Welcome, this is Birth, Baby.

Your hosts are Ciarra Morgan and Samantha Kelly.

Ciarra is a Birth Doula, Hypnobirthing Educator, and Pediatric Sleep Consultant.

Samantha is a Birth Doula, Childbirth Educator, and Lactation Counselor.

Join us as we guide you through your options for your pregnancy, birth, and postpartum journey.

Hey, everybody, today we have Dr.

Jared Poplin with us.

He is the owner of Poplin Pediatric Dentistry.

And disclaimer, if you have not yet listened to the episode that was released right before this one with Naomi Catrone, I highly recommend listening to that first.

And this is gonna be a really awesome after.

So if you listen to this first, you might have questions that were unanswered, and we may have answered them in there.

So thanks so much for being here with us today, Dr.

Poplin.

We're really excited to have you.

Awesome, thanks for the invite.

Yeah.

So to start us off, can you tell us what is a pediatric dentist?

What is your kind of role in all of this?

Yeah, so a pediatric dentist is somebody who has done at least an additional two years of residency on top of four years of dental school.

Our specialty is really taking care of kids from the time that they're born through generally young adulthood.

I still see kids through when they're done with college, I enjoy watching them grow up and seeing what they're doing during that time as well.

But some of us go on and take additional continuing ed classes and a lot of different things.

The two things that I focus most on are tethered oral tissues or tongue and lip ties.

And then also some of the early orthodontic growth and development and screening for sleep disorder breathing, sleep apnea type issues as well.

That's really cool.

It's neat how in any profession that you're in, there are little nuanced areas that you can get into.

And it's cool that you found those things that you have a passion about.

We talked to Naomi a little bit about ties, well, the definition of a tie.

But we mostly focused on tongue ties.

And you just mentioned lip ties.

We barely mentioned it in there.

Can you explain what the types of ties are like the difference between a tongue and a lip tie?

Can there be one on the top?

Could there be one on the bottom only, that sort of thing?

Yeah, so there's at least seven freedom attachments or ties.

And this is where some of the semantics come in a little bit.

And Naomi and I sometimes go back and forth on.

I tell people, and again, verbiage does matter.

But just to make it easy, sometimes I say at least, everybody has at least seven ties or seven freedom attachments.

We have what are called buckle or cheek freedoms.

We've got an upper lip tie or freedom, a lower lip freedom, and then one underneath the tongue as well.

So really, it's just a piece of tissue that's attached.

Generally, something that people don't understand is that tissue should peel away in utero more at around the 10 to 11 week mark.

And so even on little bitty babies, we've got a lot of compensation patterns that you have to overcome.

And it's not just as easy as me cutting something.

And we really need some oral rehab to go along with it.

And I think that's something that a lot of people don't understand is there are all of those attachments and they all play a role.

But generally, from an infant standpoint with feeding, it's going to be the tongue is the primary issue.

And then the lip tie is usually secondary.

Sometimes the buckle or cheek ties come into play as well, but not too often.

Yeah, we don't hear a whole lot about the cheek ties or the buckle ties.

But, you know, I hear all the time.

Well, it used to be a thing.

We used to have this all the time.

And, you know, it's kind of the chicken or the egg thing.

And it's well, did we not know about it?

So we weren't diagnosing it?

Or is it there's something going on within our genetic makeup or evolution over time where we're seeing more of this?

Can you touch on that a little bit?

Where do you think this is coming from?

And is it more common than it used to be?

I think you're right on the point that it's more of a we're looking for it more.

And so, you know, back 30, 40, even 50 years ago, when formula really started coming out more, it was much easier to just say, just give them a bottle of formula.

And now we're kind of turning back around to being a little bit more on the healthier side of things and all the pros of breastfeeding.

And even if it's bottle feeding with breast milk, but we're looking more for it, trying to head that direction.

And so from a kind of how many people have tongue and lip ties, the American literature says that it's somewhere around five to 10 percent, which is still a pretty large number of the population, if you will.

However, there's some literature out of Brazil.

I think it was in 2020 that says that that number is actually closer to about 35 percent.

And so if you look for it more, you're going to find more of it, obviously.

And I really think that's the big difference.

And my understanding with the big discrepancy in those numbers is that they are required in Brazil to actually look for tongue and lip ties before discharge at a hospital.

So, you know, we don't have that here.

And if I have somebody that's referred to me from a hospital, like it is a really significant tie, that's all they ever see.

So I really think that it's not necessarily more common, but we look for it more.

Yeah.

And because those people that ask that question generally are the people who think this is a big money grab.

Right.

They're like, they're only doing this because it's a moneymaker and they're getting kickbacks.

These lactation consultants are getting kickbacks, which Naomi was very clear on in her episode.

She's like, I get a commission based on how many of these we do, you know.

So can you tell us in the grand scheme of things on moneymakers in your practice, where does that lie?

Is it the big moneymaker?

And you're like, shoot, I could just focus on this and pay for a brand new million dollar home?

Or is it not so much?

No, it's not really that at all.

I mean, do we make money off of it?

Absolutely.

But I can with the time that we take with our patients and parents, with the fee that we charge, you know, I can make probably five times as much doing general dentistry on those days with, you know, crowns and fillings and just regular hygiene visits with the number of patients that you can see over the same amount of time.

So the way that our schedule goes is, you know, with the babies, we schedule our babies for hour long visits.

And again, from a hygiene side of things, I could see at least four people in that same amount of time.

And from doing a crown with the laser that we use not having to numb, I mean, it takes less than 10 minutes.

So, you know, really the dental side of it makes more sense financially on my end than it does to do tongue and lip tie stuff.

What really got me into it right off the bat a bunch of years ago.

So my twins are almost 11 now, and both of them had issues that I had no clue about.

This isn't something that we're taught about in dental school or medical school or residency for that matter.

I did one of these in residency 15ish years ago.

And so once, you know, my son had a lot of the body tension type things.

My daughter was the projectile vomitor and led me to go down the path of, well, let's learn a lot more about it.

And that's really the thrill that I get out of it is just seeing babies get better and then, you know, doing these on older kids with speech issues and all of that as well.

So it just makes a big difference throughout the whole span.

It's cool to be able to do something and see an immediate result rather than, you know, telling a two year old to brush their teeth every day and, you know, see what comes from that.

But I'm sure it's really rewarding to be able to see like I'm actually, you know, making a difference here.

But I think it is really important for people to understand you're not you're not making the money off of this.

And this is, you know, more of a passion project and the necessary work than, you know, I'm trying to bolster our wallets here.

So that's good to hear.

I mean, even on it.

And I don't know exactly what all you all talked with Naomi on.

I mean, we'll see somewhere generally 10 to 12 ish patients a day on the tongue tie side of things.

And we there are some days that we may only do two or three procedures and other days that we do all of them.

It just, you know, it depends on what is the right thing for each family and go from there.

Yeah.

Yeah.

Which is which is great.

I think that we talked a lot in the last episode about knowing, you know, that the release does not need to be the first step in this process.

And that's a really important part in it.

You know, there are practices that don't practice that way that do, you know, this as the very first step.

I see a tie and I'm going to clip it or laser it or whatever.

And that's going to be the first the first step.

But that brings me to my next question.

What is the procedure like?

What are the what are the different options for it?

And what would somebody expect to experience when they bring their baby in for something like this?

So starting out, you know, we do a 10 to 15 minute visit generally with Naomi.

Sometimes it's one of her folks that's in there if she's out of town or something like that.

But generally, it's a 10 to 15 minute visit with her, just a rundown of, you know, what are the issues right now and also what are the goals?

And if we cannot meet the goals by doing a procedure, especially or the parents aren't ready, then that's something that, you know, let's talk through it and not go doing something if it's not going to meet our goals.

So we do kind of a rundown with her.

It's by no means a full lactation visit.

You know, it's not an hour, hour and a half visit like that.

But do get a little bit of that side of things.

Then I come in and really look more from the structural and functional part of it, whereas Naomi's looking at mostly the function.

I come in and look at the structural aspects of it.

We put our heads together and along with the parents, you know, either recommend doing a procedure or not.

From there, if it's something that they do want to do, then Naomi will have them put gloves on, get in the mouth, practice doing the stretches for the aftercare side of things.

And if they are willing and able to do that well, then we go from there and proceed with doing treatment.

Last week we had a mom that just wasn't going to happen as far as the aftercare goes.

So let's take a step back, go home, practice for a week or two.

And if you're ready to do that part of things, then let us know and let's get back in and do a phrenectomy.

So, you know, we get hands in the mouth, go from there.

And then procedurally what we do is we use a swaddle blanket.

I always have two of my team in with me during the procedure.

Naomi's usually one of those.

And I use what's called Solea or a CO2 laser for the procedure.

I think CO2 is absolutely the best way to go for doing releases.

There's another CO2 laser on the market called light scalpel.

That's not a bad laser either.

The main reason I like Solea so much is there's an aiming beam that actually shows me where I'm going to be doing a release before I step on the pedal and start cutting where the light scalpel doesn't have that.

So that's probably one of the biggest differences between the two from a release standpoint.

There's also obviously doing things with scissors or a blade.

A release can be done well using scissors, so I don't want to make it sound like it cannot be.

Generally, the problem is there is a little bit more bleeding that goes along with it, so most of the time a complete release isn't done.

Again, as much as I love my laser, that's not the only way to do it, but again, I think with minimal bleeding, most of the time no bleeding at all, we can do the best, most complete release that way.

I've never seen a release, but you're saying laser, and I'm just picturing...

You have to come over sometime.

Yeah, I need to come see one.

I'm picturing a spy laser that's coming in and it's shooting across the room and this whole thing.

What are we talking about with lasers here?

Can you give a little bit of a description for mostly me?

Yep.

So a CO2 laser specifically, it is a very precise lightsaber, if you will.

I know that sounds kind of crazy, but it's not going to cut through something that I don't want it to cut through.

Lightsaber.

I love that.

It's only cutting two microns at a time, tiny, tiny, tiny bit at a time.

What a CO2 laser does is it literally vaporizes the tissue, very, very precisely, tiny bits at a time.

And so doing that is very, very clean cut.

You know, and there are different types of lasers as well.

So that's, I think, a really important part of things also, is not just going to somebody that has a laser.

There are also lasers that are called diode lasers, which I have one of those as well, and there are some uses for it.

But they actually work as a cottery unit.

It's a hot tip that physically touches the tissue and burns it.

So it also gets the job done.

But when you burn the tissue and cut that way, you end up with more scar tissue generally.

So I mentioned that there are times to use it if there's a little vein, a little vessel that's running through the freedom, then that's what you want to use.

So it's a much cleaner environment, and you can actually see what you're doing.

So there are pros and cons to go along with it.

But CO2, in my opinion, is definitely the better way to go.

The more you're explaining this, Dr.

Poplin, the more I think that you just got into this because you get to play with lasers.

And as a kid, you were just like loving the laser beams and all that.

You're like, I get to just, you know, have fun with all these cool technology pieces that work.

It is fun.

I'm not going to lie.

It is a lot of fun.

I actually started out with a diode laser, and I wanted something better.

And that's when I switched to CO2 and really saw the big differences between the two.

When you're doing this, does the baby react big?

Like, is this a...

And are the parents right there?

So I know that you guys are doing it, but are the parents in there while it's being done?

And how much crying can they anticipate?

Babies cry when you take their temperature under their arms, so it's kind of relative, but still.

So as far as do the babies react, the answer is yes.

I mean, we are cutting tissue.

I mean, it is really generally pretty minimal reaction.

Like you said, they're going to cry when changing a diaper.

They're going to try to cry when taking temperatures, all that kind of stuff.

So they are going to cry some.

A crying baby is a good baby, okay?

A baby that holds their breath and is not crying at all, that gets me worked up a little bit.

So crying is breathing from that aspect.

I know that sounds kind of bad sometimes, but that's reality.

As far as our parents in the room, they are not.

I used to tell folks that I wouldn't ever tell anybody no.

And then I had a couple of parents about pass out on me, and I need my focus to be on the baby, not on the parents.

And that way we can do the best job that we can.

And so, you know, after that happened, I'm really very adamant about that it's just me and my team in there.

And the total procedure time away from the parents is generally less than five minutes.

And so, again, we swaddle the baby, do the procedure, take pictures afterwards as well, which we had taken pictures before, and take after pictures back to mom so she can feed.

And then I'll come in a few minutes after that and show them the after pictures, go over all the after care again and make sure there aren't any questions and go from there.

I'm going to cheat and ask something that was totally not on our list.

One is you said that these babies are, you know, of course, they're going to cry a little bit.

And the parents aren't in the room and that you wouldn't tell them, no, it's funny because, you know, as you evolve in your business, whatever it is, you have things that you said in the beginning.

And you're like, now I've had something that's kind of proved otherwise.

For ages of kids that this is being done to, I know that any age technically can have a release done.

But what I remember when my son was little and they were talking to me about a certain point, you can't just do it as an inpatient procedure.

You have to put them under.

What are kind of the age ranges?

And is there anything that you're using to kind of numb them and help with the pain?

Perfect.

Great question.

Let's start with the numbing aspect.

And so from a zero to two year old, let's start there.

So topical anesthetic or the jelly stuff that we usually use at the dentist, benzocaine is actually black boxed until two years old.

OK, so for that, I don't use any jelly numbing agent at all.

OK, it can cause basically the best way I can describe it is breathing issues.

But it's something called met hemoglobulinemia.

It's where the oxygen doesn't come off of the hemoglobin and get into the body.

So it's basically like you're not breathing even though you are.

So that's the reason that I don't use that on kids under two.

The other option is just to get in and give a shot with anesthetic that way, which is a possibility.

A shot is going to hurt just as much as doing the procedure does.

It really does.

On the other side of that as well is when we do an injection, you fill that tissue up with a little bit of liquid, and it throws the anatomy off a little bit.

So I think it is best to not do anesthesia at that age.

After two years old, then we can start using the topical, and then the injections don't bother us quite as much.

Normally, I try to talk parents out of doing a procedure unless there's really significant issues between about one year old up to around four years old.

So to your point of, well, you know, there's a point where it's like, we just can't do it in the office well, and that usually holds very true.

It's not a hard no, especially if there are really significant feeding issues or speech issues at two years old.

But at the same time, I've had maybe a handful of patients that I try getting my fingers in the mouth, and I literally just cannot do a procedure in office and do it safely.

So from there, it's either not doing it at all until we're able to tolerate and cooperate better, or it's going to the hospital.

And I do my cases at Dell Children's and being put completely to sleep under general and doing it that way.

When we are put to sleep, I do put sutures in, the same as I would do on older kids and adults, that minimizes the amount of the aftercare and the stretches that you have to do right off the bat.

It doesn't negate doing them at all.

It just, you know, minimizes at some.

And so that is also the really hard part between that one to four range is that, you know, even if I can get a procedure done, the aftercare that goes along with it usually doesn't go very well because the parents are getting their fingers bit off, you know, six times a day.

I was going to say, I'm trying to imagine trying to do aftercare with my very spicy.

She's four, but it would not happen.

She'd bite me.

You guys saying a four year old, one to four is not good.

I'm like, I don't, my four year old sure would not have cooperated like you're talking about.

He's now six.

I still don't think he would cooperate with that.

You'd still have to.

That's probably true.

You must be a kid whisperer.

Yeah, as we get a little bit older as well.

So generally the four and up and some even three and a half year olds can do well.

But the same as we do, you know, whether it's PT, bodywork, speech feeding therapy, you know, all the IV CLCs with sub training, the different kind of therapy modalities on the infants.

We also do what's called Myofunctional Therapy on older kids and adults.

So with that, it's a similar type thing where you don't just go in and cut something and say, see you later, go do stretches.

They do at least a month worth of therapy beforehand and at least a month afterwards.

And so having a goal in mind for them and really having them set up for success generally works very, very well.

So the therapists that I work with are fantastic and kind of have them set up ready to go.

But yeah, usually four and up, 95 percent of them are awesome for doing procedures.

You have some really great kids coming into your office.

You keep saying after care.

And I know that, you know, I think I don't know if it was you or if it was Naomi was talking about like, you know, six times a day for four weeks or something.

Can you tell us a little bit about what it is?

Like, what are they doing?

So in reality, what you're doing, and this is it sounds really bad.

And I'm really very open with our families about this is by stretching the aftercare is basically stretching a scab open.

OK, sounds miserable.

But any time you have a cut on the body, it's going to try to heal back right where it was.

That's the body's goal for healing.

And so our goal is, well, we don't want it to heal back there.

And as I mentioned on the older kids, well, we put stitches in and that helps minimize things on babies.

It's pretty much impossible to put stitches in a little bitty baby.

And so stretching something out, stretching that scab out is really, really important.

The mouth heals really, really quickly.

And so that's why you mentioned this six times a day for the four weeks that we talk about.

And so consistently keeping that scab kind of opened lets it heal further back to where we put it.

So the word that everybody loves in our tongue tie world is reattachment.

And so we don't want reattachment, which is, you know, that's true.

We don't want excessive reattachment.

You know, reattachment is really just a fancy word for scar tissue.

It has to heal somewhere.

It has to reattach somewhere.

We just want it to reattach or heal as close as we can to where we made the cut, if you will, not reattach back where it was.

And so that's really the big, big part of that.

So the timeline on reattachment and why we say four weeks is the body's healing process goes through different phases.

And generally through about the second week, end of the first and through the second, up through the end of the third week, the healing process goes through a phase called the constriction or the contraction phase of healing.

And so things are actually tightening up a little bit.

And so it's not uncommon for the first week or two for feeding to be going better.

Some good feeds, some bad feeds.

I tell people it's going to be kind of like a roller coaster ride for the first couple of weeks.

And then the third week, a lot of times things will actually plateau or even regress just a little bit.

And that's because the body is going through that tightening phase.

It's a completely normal phase of healing.

And so we've got to keep stretching through that until you get to about the fourth week, it loosens up again.

And so that's the reason why we want those four weeks of the stretching and the aftercare to get through it.

I don't think three times a day for a week is enough by any means.

It really needs to be more than that.

That sounds like a lot.

I understand why it's important to talk to parents beforehand and figure out if they're going to be able to commit to doing those things, because a lot of parents may not have the capacity to do that, especially with a baby who's not thrilled about having a finger in their mouth with that.

And then it was pointless to even get the procedure done in the first place.

You kind of put them through it for nothing.

I remember I was a postpartum doula overnight for a family that had a baby that had a revision.

Sorry, a release.

I keep saying the wrong thing.

And old habits die hard.

And he had had a release.

I was going to have to do it on my overnight, you know, and they showed me how before.

And I was like, his mama.

And I was having a hard time with it.

You know, I had to put my little glove on and go into his mouth.

But when you know that you're doing it so that you can have a long term positive effect on their feeding, on their speech, on their, you know, muscle tone and or future orthodontic problems, all of these things.

I mean, it is worth it.

But as a postpartum parent, that can be really daunting.

So I really just appreciate all of the work that you guys do on the front end to help prepare parents for this, because I think that that's what's missing with a lot of the practices that perform these releases.

And that collaborative care model that you guys do with Naomi and being able to, you know, kind of be hitting it from all angles and getting those done.

You don't often hear a doctor say things like bodywork.

You know, you might be one of the only doctors I've ever heard talk about bodywork, but it is such a multifaceted situation.

So what is if you had like something that you really wish that more people understood about ties or about releases or about this procedure, whatever.

What is kind of a takeaway that you hope that people get?

You know, probably five years ago, I had no clue about bodywork.

So my eyes have really opened up a lot and, you know, changing mindset.

I mean, like you mentioned earlier, is I said that I would never do something and then things change a little bit.

Right.

But bodywork is very important.

The aftercare, just going back to some of those things a little bit.

And this goes to what I want people to know.

And I mentioned the myofunctional therapy on older kids.

And it's the exact same thing on babies as far as I can cut something.

But just because I cut it doesn't mean it's going to work properly.

And so we really encourage getting back to their LC speech feeding therapist, you know, those kind of things as far as getting the muscle tone coordinated, proper, all of those things, and it's not just us cutting something and saying, see you later.

And so that's probably one of the biggest things for us is really trying to work as collaborative as we can.

And I know, you know, Naomi's the one that's here with me on these procedures, but sending them back to the provider that they came from.

And that's one big thing that we really try to focus on as well.

Sometimes folks sneak through the cracks a little bit.

But when I really started doing a lot of these just on my own as, you know, a lot of folks coming off of Facebook that hadn't seen anybody.

And so it was a little bit more of the Wild West, if you will, of me trying to assess function and structure and everything.

And there are some things that that is not necessarily my specialty.

And so now we're really focusing on getting, well, what are the issues and having referrals from a lactation consultant already or, you know, whoever their feeding therapist is and what are the main issues?

And again, can we meet the goals of those issues?

So that's probably the biggest takeaway for me that I would like to share is that, you know, it's not just me cutting something that makes it better immediately.

So it's so important.

I think so I'm a lactation counselor and I do, you know, a lot of a lot of things.

Ties are not my specialty.

And so when I have a suspicion about a tie, I'm referring out to other people.

And there's other things that we're bringing in.

And even with, you know, childbirth and doula work, it's this whole collaborative practice.

And I think that's what's missing a lot in really just in the way our health care system in general is set up.

It tends to be like, well, I'm you know, I see this person and they're going to handle everything.

And it's not necessarily the best way to do it because there's just no way that one person can have the specialty to handle every thing.

And especially when it comes to something as nuanced as, you know, oral ties, it's important to have the whole picture and make sure this is what's best for the whole dyad to be able to work with.

So I think that's really important.

So how can people find you?

And as of this recording, which is in February of twenty four, are you taking new patients?

So finding us, our website is drpoplin.com, just derpoplin.com.

And our all of our information is on there.

Got a Facebook page as well.

Poplin Pediatric Dentistry.

Yes, we're taking new patients.

Generally, we see our infants on Mondays.

I really try to focus on babies just on one day of the week.

That way we do have the ability to have Naomi or again, one of her IVCLCs with us and not just spreading things out and appointments out throughout the week and really not getting as collaborative of care as we should.

So that's why I just focus one day a week on the infant side of things.

I know parents really like that immediate gratification.

And I know that's really hard to wait.

But one of the things that Naomi mentioned in her episode with us is if somebody can get you in right away, like same day or next day, as tempting as that may seem, ask yourself maybe why?

Why are they able to do that?

And so asking those other questions about that collaborative care and do you have a lactation consultant you're working with or whatever, all of those things are so important.

So we're so thankful that you came on here and helped shed more light on to the doctor side of the Thai issue.

And we're really excited for our families to be able to listen back to this when they're at a crossroads of am I going to do this or not?

Am I going to seek out more of the process of release?

So thank you so much for being here and taking time out of your day.

We know that you're a busy guy.

I appreciate the invite.

It's great to see you guys.

Yeah, thank you so much.

Thank you very much.

You all have a great night.

You too.

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