Rethinking When, Why, & How We Treat Patients (w/Dr. Mike DePascale) [Ep.157]

Should 3D/CBCT Imaging be the Standard of Care in Orthodontics? (w/Dr. Dania Tamimi) [Ep.158]

In this episode of The DOC Podcast, I sit down with Dr. Dania Tamimi, an oral and maxillofacial radiologist, Harvard-trained dental educator, and holistic health advocate, for a wide-ranging conversation on why diagnosis must come first in dentistry, and why 3D CBCT imaging is no longer optional for orthodontists who want to truly serve their patients. Dr. Tamimi brings a uniquely multidisciplinary perspective, weaving together radiology, yoga therapy, kinesiology, and craniofacial anatomy to make the case that the mouth and the airway cannot be treated in isolation. Together, we challenge the "tooth straightener" mindset still dominant in orthodontics, break down the science of nasal breathing and its profound impact on facial development, and take a critical look at recent AAO position statements on airway and CBCT. Whether you're a seasoned clinician, a young provider, or a curious parent, this episode will change the way you think about dental imaging, airway, and what it means to truly diagnose. Timestamps: 0:00 — Introduction & Meet Dr. Dania Tamimi 4:01 — Dr. Tamimi's background: oral & maxillofacial radiology explained 4:46 — A parallel career in fitness and why it matters for TMJ 6:55 — "It's all connected" - the TMJ, airway, and the whole body 10:01 — Dr. Mike's airway awakening: how getting a CBCT in 2014 changed everything 12:37 — Why we image: diagnosis is the single most important step 18:38 — CT vs. CBCT: what's the actual difference and why does it matter? 21:58 — Cone beam CT explained: lower dose, dental-specific, and what it can (and can't) show 25:52 — Why is 3D CBCT adoption still debated in orthodontics? 30:09 — Fear, comfort zones, and the cost of not knowing 36:07 — "Knowledge gives you power, fear takes it away" 38:59 — "I don't want to be responsible for what's on the scan" - the liability fear no one talks about 44:07 — Should orthodontists rename themselves craniofacial orthopedists? 52:00 — No such thing as a routine X-ray: why clinical exam must come first 1:13:34 — The science of nasal breathing: nitric oxide, filtration, and why mouth breathing changes your face 1:14:35 — How mouth breathing narrows jaws, crowds teeth, and displaces the tongue into the airway 1:19:01 — Challenging the AAO white paper: "No craniofacial phenotypes can identify airway problems"? 1:23:25 — Can orthodontists read their own scans? How to know when to refer LINKS * Register for the In-person Early Treatment Comprehensive:https://www.earlyorthotreatment.com/ [https://www.earlyorthotreatment.com/] * Join The DOC Community on Facebook for more great content and discussions: https://www.facebook.com/share/g/1Cb9rkQVde/ [https://www.facebook.com/share/g/1Cb9rkQVde/] * Check out the DOC CE Courses: https://theorthocoach.com/ce-courses/ [https://theorthocoach.com/ce-courses/] * Enroll in one-on-one coaching w/Dr. Mike: https://theorthocoach.com/doc-coaching/ [https://theorthocoach.com/doc-coaching/]  * Link to Dr. Mike’s review of the AAO White Paper Update on SDB: https://youtu.be/pKSD_PVO4G0?si=CSxQy4V6tZoe551t [https://youtu.be/pKSD_PVO4G0?si=CSxQy4V6tZoe551t]  * Dr. Tamimi TEDx talk: https://youtu.be/zlYuHwqrsPo?si=30NiJu_UiuPeKRlX [https://youtu.be/zlYuHwqrsPo?si=30NiJu_UiuPeKRlX]  * Contact Dr. Tamimi: https://inspire-imaging.com/ [https://inspire-imaging.com/]

Rethinking When, Why, & How We Treat Patients (w/Dr. Mike DePascale) [Ep.157]

Episode Summary Dr. Mike DePascale is a Connecticut-based orthodontist and co-owner of a multi-location practice with his partner and mentor, Dr. Jeff Kozlowski. In this episode, Dr. DePascale shares his remarkable personal journey from suffering severe obstructive sleep apnea in his early 20s and undergoing orthognathic surgery to becoming a passionate advocate for airway-focused, early-interceptive orthodontic care. The conversation covers the philosophy behind their thriving partnership, why airway is still woefully undertaught in residency programs, how to practically integrate early airway-focused treatment into a busy practice, the critical role of interdisciplinary collaboration, and what it takes to maintain peak fitness while building a career and a family. This is a conversation about so much more than teeth, it's about breathing, thriving, and never settling. Timestamps 0:00 — Introduction to The DOC Podcast and Dr. Mike DePascale 10:57 — Dr. DePascale's origin story: cold-calling medical offices to find his path 12:30 — Diagnosed with severe sleep apnea in his 20s: 3 car accidents, 2–4 hours of sleep a night 15:30 — Choosing orthognathic surgery over CPAP — and how it saved his life 19:00 — Finding Dr. Jeff Kozlowski: choosing mentorship over immediate money 24:00 — What makes a practice partnership actually work: communication, consistency, and commitment 33:00 — Residency training: what it prepared him for — and what it didn't 38:00 — Why airway is barely taught in orthodontic residencies (and what needs to change) 45:00 — The 1968 Salzman Index, Medicaid, and how the system trains orthodontists to pull teeth instead of treat early 53:00 — How to practically integrate airway screening into a busy multi-doc practice 58:00 — Team training, sleep questionnaires, and the power of interdisciplinary referral networks 63:00 — The emotional reality: a mom crying after finally hearing "tongue tie" for the first time after 5 specialists 68:00 — How early is too early? Dr. DePascale's own son: frenectomy at weeks old, T&A at age 2 75:00 — Why orthodontists are uniquely positioned — and obligated — to lead in the airway space 80:00 — Fitness as a non-negotiable: from not finishing a mile to running a 4:53, and why he never gets out of it Links * Register for the In-person Early Treatment Comprehensive: https://www.earlyorthotreatment.com/ [https://www.earlyorthotreatment.com/]  * Join The DOC Community on Facebook for more great content and discussions: https://www.facebook.com/share/g/1Cb9rkQVde/ [https://www.facebook.com/share/g/1Cb9rkQVde/] * Check out the DOC CE Courses: https://theorthocoach.com/ce-courses/ [https://theorthocoach.com/ce-courses/] * Website: theorthocoach.com [http://theorthocoach.com/] * Email: drmike@theorthocoach.com * Instagram: @theorthocoach Thank you for your support of The DOC Podcast, and please share the show with others who may benefit from hearing this conversation!

The Good, Bad, & Ugly of the AAO White Paper Update on SDB and Orthodontics [Ep.156]

In this episode, Dr. Mike breaks down the 2024 update to the 2019 AAO White Paper on obstructive sleep apnea and orthodontics, published in the AJODO in April. After presenting to hundreds of medical, dental, and myofunctional therapy colleagues across the country, he recorded his full presentation for listeners worldwide. Timestamps 0:00 – Introduction, episode overview & why Dr. Mike recorded this presentation 1:17 – Context: Presenting across the U.S. (Houston, Bronx, Long Island) — the near-universal reaction was shock at the document's flaws 3:07 – THE GOOD begins 3:07 – Good #1: Acknowledges the full spectrum of sleep-disordered breathing (SDB), not just OSA 3:55 – Good #2 & #3: Calls on orthodontists to screen all pediatric patients for SDB, emphasizes early detection, and acknowledges multifactorial etiology requiring interdisciplinary care 5:07 – THE BAD begins 5:07 – Bad #1–2: Author panel was 8 orthodontists + 1 librarian (no physicians, no myofunctional therapists); document inconsistently uses "OSA" vs. "SDB" throughout 8:03 – Bad #3–5: Minimal screening guidance (32 signs & symptoms largely ignored); only briefly mentions comorbidities; never discusses the importance of nasal breathing 13:00 – Bad #6: Overall focus is on what not to do rather than guiding orthodontists on how to help patients 14:00 – THE UGLY begins 15:01 – Ugly #1: Reliance on PSG-confirmed OSA to justify intervention — challenges with pediatric sleep studies (access, sensitivity, first-night effect, lack of standardization); what Reference 34 actually says vs. how it was cited 22:40 – Patient case study: Child with AHI of zero but severe signs of airway disease — the ENT said "what does the orthodontist know about sleep medicine?" 26:34 – Ugly #2: "No way to determine if a patient is a mouth breather" — justified by a study of 9 adults on a cycle ergometer; Dr. Kandasamy's 2025 AJODO editorial; what the actual research shows (European OJ, AHA, ADHD literature, microbiome) 36:51 – Ugly #3: "No craniofacial phenotypes can identify SDB" — directly contradicted by Reference 34 and the original 2019 white paper; Harvold primate studies, Hew et al. (2011), Principato's tongue mechanics explained 43:03 – Ugly #4: "Most children with SDB will outgrow it" — both cited references (Refs 17 & 18) actually contradict this claim; cardiovascular, neurocognitive, and ADHD consequences of waiting 53:03 – Ugly #5: "CBCT has no diagnostic value for SDB" — contradicted by Reference 34; what CBCT can detect; the radiation argument debunked 57:29 – Ugly #6: Must refer to a physician for diagnosis before any intervention — ignores lack of access to pediatric sleep physicians; a formal diagnosis does not change the orthodontist's treatment plan for normalizing craniofacial growth 1:00:00 – Ugly #7: Misleading analysis of tongue tie (ankyloglossia) and PSDB — references were miscited; what the scoping review (1,228+ patients) and 2026 systematic review actually concluded 1:07:27 – The evidence-based medicine argument: what David Sackett (founder of EBM) actually said — and how Class I occlusion, ceph norms, clear aligners, and IPR are held to a different standard than airway treatment 1:19:20 – Ugly #8: "Orthodontic extractions have no impact on airway" — the Larson article debunked (patients didn't even necessarily have orthodontic treatment); extractions treat the symptom and ignore the underlying etiology 1:28:20 – Path forward: "Straight teeth bias," the need for a paradigm shift, and the vision for a profession that creates both beautiful smiles and healthy nasal breathers Resources Mentioned * AAO White Paper Update: Sleep-Disordered Breathing in Orthodontics (https://www.ajodo.org/article/S0889-5406(26)00035-1/fulltext)   * Dr. Mike's OrthoTown article: Defining Evidence-Based Orthodontics (https://www.orthotown.com/magazine/article/9835/defining-evidence-based-orthodontics?fbclid=IwY2xjawP14fxleHRuA2FlbQIxMABicmlkETFrVWE3M3EwYWJTRWpEdENTc3J0YwZhcHBfaWQQMjIyMDM5MTc4ODIwMDg5MgABHhwMNgFJyCJB6JMvVDSomu6drLwAym2SI7CDx-eXbuwrUwBxzP6NpyP7HpT8_aem_NmfJlB15aUQgioH6xWUu3A [https://www.orthotown.com/magazine/article/9835/defining-evidence-based-orthodontics?fbclid=IwY2xjawP14fxleHRuA2FlbQIxMABicmlkETFrVWE3M3EwYWJTRWpEdENTc3J0YwZhcHBfaWQQMjIyMDM5MTc4ODIwMDg5MgABHhwMNgFJyCJB6JMvVDSomu6drLwAym2SI7CDx-eXbuwrUwBxzP6NpyP7HpT8_aem_NmfJlB15aUQgioH6xWUu3A]) * Early Orthodontic Treatment Comprehensive – 2-day hands-on course with Dr. Mike & Dr. Daniel Camacho, Fort Lauderdale, FL, November 13–14. Save $1,000 by enrolling before May 31st. Limited to 20 docs. (https://www.earlyorthotreatment.com/ [https://www.earlyorthotreatment.com/]) Connect * Website: theorthocoach.com [http://theorthocoach.com/] * Email: drmike@theorthocoach.com * Facebook: The DOC Community (https://www.facebook.com/share/g/1Cb9rkQVde/ [https://www.facebook.com/share/g/1Cb9rkQVde/]) * Subscribe on Apple Podcasts & Spotify * Subscribe to the DOC YouTube Channel (https://www.youtube.com/@theorthocoach [https://www.youtube.com/@theorthocoach]) Please share this episode widely — with medical, dental, and myofunctional therapy colleagues, parents, and anyone invested in children's health.

Do Kids Outgrow Their Airway Issues? An ENT's Perspective (w/Dr. David McIntosh) [Ep.155]

In this episode, I sit down again with Dr. David McIntosh, an ENT surgeon from Australia and one of the sharpest medical minds I know when it comes to pediatric airway and sleep-disordered breathing. We dig deep into the recently updated AAO white paper, including what it got right, what it got dangerously wrong, and why publishing a document about interdisciplinary care without a single interdisciplinary author is a problem we can't ignore.  Dr. McIntosh also walks me through one of the most eye-opening breakdowns I've ever heard about Scammon's curve, and what orthodontists were never actually taught about what that data really shows. This episode is a must-listen for any dental or medical professional who works with children and cares about more than just straight teeth. Timestamps: 0:02:40 — Welcome & introducing Dr. David McIntosh back to the show 0:04:35 — The AAO white paper update: eight orthodontists, one librarian, and zero medical or myofunctional colleagues 0:09:51 — The quote that stopped Dr. McIntosh cold: "Pre-pubertal OSA tends to resolve naturally" 0:11:34 — Dissecting the flaws in reference #17: small sample sizes, changing scoring rules & selection bias 0:13:01 — Reference #18 from a 2010 Journal of Pediatrics paper that actually contradicts the white paper's own conclusion 0:22:59 — Why the CHAT study should have been their starting point 0:23:09 — The Karen Bonuck study: 12,000 children, 7 years of data, and what early SDB really does to development 0:27:54 — Christian Guilleminault and why he wished he'd never invented the AHI 0:38:16 — Breaking down Scammon's curve: what it actually measures (and what it doesn't) 0:40:25 — The original data came from the spleen and thymus — not tonsils or adenoids 0:53:30 — "I don't care about teeth" — Dr. McIntosh on why craniofacial outcomes are the wrong finish line 0:55:34 — Straight teeth bias: why orthodontists need to think like dentofacial orthopedists 1:04:08 — Mouth breathing and craniofacial growth: why the debate doesn't even matter anymore 1:20:41 — Dr. McIntosh and Bill Harrell's upcoming Airway Breathing Academy — what it is and who it's for I hope this episode challenges the way you think about what we're really treating when we treat children's airways, because it's never just about the teeth. If you found this valuable, please follow me on Instagram at @theorthocoach [https://www.instagram.com/theorthocoach], join our community at The DOC Community on Facebook (link below), and subscribe on YouTube at @theorthocoach [https://www.youtube.com/@theorthocoach]. Your support helps keep these important conversations going. See you next episode. LINKS * Register for the In-person Early Treatment Comprehensive: https://www.earlyorthotreatment.com/ [https://www.earlyorthotreatment.com/]  * Join The DOC Community on Facebook for more great content and discussions: https://www.facebook.com/share/g/1Cb9rkQVde/ [https://www.facebook.com/share/g/1Cb9rkQVde/] * Check out the DOC CE Courses: https://theorthocoach.com/ce-courses/ [https://theorthocoach.com/ce-courses/] * Guillimenault & Huang article in Sleep Medicine Reviews, 2018: Guilleminault C, Huang YS. From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. Sleep Med Rev. 2018 Aug;40:203-214. * Connect with Dr. McIntosh: * Facebook: https://www.facebook.com/david.mcintosh.180 [https://www.facebook.com/david.mcintosh.180]  * Instagram: https://www.instagram.com/dr.mcintosh.ent/?hl=en [https://www.instagram.com/dr.mcintosh.ent/?hl=en]

What's Causing the Chronic Disease Epidemic in Our Children? (w/Beth Lambert)

In this episode, I sit down with Beth Lambert - bestselling author, founder of Documenting Hope, and creator of the CHIRP Study - for a deep dive into the skyrocketing rates of chronic illness in children. Beth shares her personal journey from pharmaceutical consultant to healthcare reform advocate, explains the "Total Load" theory of disease, and discusses the environmental, dietary, and systemic factors driving conditions like autism, ADHD, autoimmune disease, and allergies. The conversation covers vaccines, fluoride, gut health, sleep, and practical steps parents can take today, all grounded in science, and without the usual gatekeeping. Timestamps: 0:23 – Introduction: Meet Beth Lambert 8:01 – Beth gets kicked out of 3 pediatricians' offices for asking about root causes 15:50 – How post-WWII pharmaceutical culture shaped modern medicine 17:57 – Direct-to-consumer drug advertising: the U.S. is one of only two countries that allow it 22:07 – The data: from 2% of kids with chronic illness in 1960 to 54%+ today 24:23 – What's driving the epidemic? Food, air, water, antibiotics, toxins — the "Total Load" 25:48 – Explaining the Total Load Theory and why no single cause explains it all 30:40 – The CHIRP Study: Child Health Inventory for Resilience and Prevention 31:15 – Preliminary findings: more health stressors = worse health outcomes 36:32 – The vaccine-autism debate: why we need open, unbiased science 37:59 – Antibiotics and the microbiome: the biggest signal in the CHIRP data 43:13 – "The science is settled" — why that phrase has no place in real science 54:38 – Fluoride: Beth hasn't used it in 20 years — here's why 1:06:25 – Gut health: why the microbiome is foundational but not the whole picture 1:12:22 – Is it ADHD or is it sleep deprivation? The airway-behavior connection 1:19:57 – Biohacks (peptides, red light, vagus nerve stimulators): helpful tools, not solutions 1:23:16 – Take-home message: clinician-parent partnership and owning your child's health 1:25:37 – Where to find Beth & Documenting Hope: documentinghope.com LINKS: * Epidemic Answers: www.epidemicanswers.org [http://www.epidemicanswers.org/] * The Documenting Hope Project: www.documentinghope.com [http://www.documentinghope.com/] * A Compromised Generation: http://sentientpublications.com/shop/books/all-titles/a-compromised-generation/ [http://sentientpublications.com/shop/books/all-titles/a-compromised-generation/] * Brain Under Attack: http://www.brainunderattack.com [http://www.brainunderattack.com/] * Follow Beth on Socials: @documentinghope   * Join The DOC Community on Facebook for more great content and discussions: https://www.facebook.com/share/g/1Cb9rkQVde/ [https://www.facebook.com/share/g/1Cb9rkQVde/] * Check out the DOC CE Courses: https://theorthocoach.com/ce-courses/ [https://theorthocoach.com/ce-courses/] * REGISTER: 2026 Early Orthodontic Treatment Comprehensive: https://www.earlyorthotreatment.com/ [https://www.earlyorthotreatment.com/]