The Pediatric Breathing Project with Dr. Piya Gandhi, DDS

How Speech, Oral Function & Airway Health Are Connected with Courtney Scaggs

• Dr. Piya Gandhi, DDS • Season 1 • Episode 7

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Episode 7 | The Pediatric Breathing Project
Speech, Tongue Ties & Airway Health with Courtney Scaggs, M.S., CCC-SLP

In this episode of The Pediatric Breathing Project, Dr. Piya Gandhi sits down with Courtney Scaggs, M.S., CCC-SLP, speech language pathologist and founder of Space City Speech, to explore the critical connection between speech development, oral function, tongue ties, myofunctional therapy, and pediatric airway health.

Together, they discuss how airway issues can show up in speech patterns, why narrow palates and oral restrictions can affect articulation, when speech therapy may need deeper structural support, and how collaboration between dentists, speech therapists, ENTs, occupational therapists, and myofunctional therapists can create better outcomes for children.

They also cover early speech milestones, red flags parents should watch for, prolonged thumb sucking and oral habits, when therapy may be plateauing, how to know when it’s time to dig deeper, and what both parents and providers should look for in a truly collaborative care team.

Whether you’re a parent navigating speech concerns or a provider interested in interdisciplinary airway care, this episode offers practical insights into how these systems are deeply connected.

In This Episode We Cover:

✔ How speech and airway health are connected
 ✔ Tongue ties, oral restrictions and articulation
 ✔ When speech delays may signal deeper functional issues
 ✔ Narrow palates and their effect on speech sounds
 ✔ Myofunctional therapy vs traditional speech therapy
 ✔ Thumb sucking, oral habits and tongue posture
 ✔ When therapy plateaus and what to do next
 ✔ Early speech milestones and red flags
 ✔ Why pediatric airway treatment requires a team approach
 ✔ What providers should look for in collaborative referrals

Connect with Courtney Scaggs

🌐 Space City Speech
 https://spacecityspeech.com/about-dr-courtney-scaggs/

📱 Instagram
 https://www.instagram.com/spacecityspeech/

________

The Pediatric Breathing Project with Dr. Piya Gandhi explores how airway health, jaw development, and sleep impact childhood wellness. Parents and practitioners will learn to spot early signs of sleep-disordered breathing and discover practical solutions for healthier futures.

If you’re a parent, dentist, pediatrician, or healthcare professional passionate about giving children the best start in life, this podcast is your guide to better breathing, better sleep, and better development.

Piya Trehan Gandhi, DDS

BOARD CERTIFIED PEDIATRIC DENTIST, AIRWAY AND TONGUE TIE RELEASE SPECIALIST

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Resources from Dr. Piya Gandhi:



Dr. Piya Gandhi, DDS:

Welcome to another episode of the Pediatric Breathing Project. I am your host, Dr. Piya Gandhi, and I am here today with my good friend and colleague, Courtney Scaggs, owner of Space City Speech here in Houston, and she is going to be chatting with us today about, all things speech language pathology, myofunctional therapy, and how we collaborate in treating pediatric patients for airway disorders. So welcome. Thank you. Thank you so much for being here.

Courtney Scaggs:

Thanks for having me.

Dr. Piya Gandhi, DDS:

So tell us first a little bit about yourself, your practice, kind of what brought you into the field of speech, but also then myofunctional therapy and airway and tongue ties and. All the things that we do.

Courtney Scaggs:

So I feel like I have a unique kind of pathway to myofunctional therapy. A lot of people that I meet that are in this field kind of came to it later in their profession are through personal experience. But for me, it's something that I kind of fell into right after grad school. The while, actually while I was in grad school, I was exposed to it. Um, I moved to Texas in 2017.

Dr. Piya Gandhi, DDS:

Okay.

Courtney Scaggs:

Um, for my last externship of grad school. It just so happened to be with the president of the International Association of or Facial Biology. She was my supervisor.

Dr. Piya Gandhi, DDS:

That was Christie? Christy Gotham. Okay. It

Courtney Scaggs:

was a crazy story how it all happened.'cause you know, my original externship fell through and then it was phone calling people and just it's crazy. Randomly ended up on her phone line, had no idea who she was. Um, and she took me on within two weeks of me moving here, which is. Crazy.

Dr. Piya Gandhi, DDS:

Wow.

Courtney Scaggs:

So I think it was meant to be.

Dr. Piya Gandhi, DDS:

Yeah.

Courtney Scaggs:

Um, but did my externship there. So trained under career that last semester of college and then moved on and did my clinical fellowship there, and then immediately started working towards my certification of Ora Facial Biology after that.

Dr. Piya Gandhi, DDS:

So. And what does that entail certifying yourself in?

Courtney Scaggs:

Uh, it's changed since Sunday originally. Did it? I started it in 2018, so the process has definitely involved since then, but. When I did it, I had to take my 28 hour introductory course, so I went and did that in Napa for my birthday with Christie, which was great. And then I had to do, we have about two years to do like a 50 question, multiple choice test and 10 questions that are written essay style. Then from there, if we pass that we have an onsite visit. Right, which I did at your office.

Dr. Piya Gandhi, DDS:

Yes, I remember that.

Courtney Scaggs:

So a full day of someone observing us with pediatric and adult clients giving us feedback. We have to submit like lots of info before that about the patients that we're gonna be seeing. Um, it was a pretty intense process and I took the time kind of. To see patients learn what I was doing. Really get in depth with it. Yeah. A lot of people go through it and finish it in like two years. Okay. But for me, I stretched it out and it took me about five years to finish the whole process. Um, because I wanted to feel like I really had a handle on it when I finished.

Dr. Piya Gandhi, DDS:

Yeah.

Courtney Scaggs:

Um, so by the time I did my onsite, I was like super confident what I was doing and I was like, oh, this is easy. You've

Dr. Piya Gandhi, DDS:

been doing it.

Courtney Scaggs:

Yeah. Yeah. But it definitely is because I kind of took my time on everything and COVID didn't help either.

Dr. Piya Gandhi, DDS:

And just to touch on, not all people doing myofunctional therapy had this certification, is that correct?

Courtney Scaggs:

That's correct. Okay. Um, and it's, there's lots of different certifications out there for Myo. Um. For speech therapist, myofunctional therapy falls under a scope of practice. So as long as you're sufficiently trained, um, that's what our scope says, then you are good to practice.

Dr. Piya Gandhi, DDS:

Okay.

Courtney Scaggs:

So there are tons of incredible myofunctional therapists out there that don't have any certifications. Um, so it's more about just like connecting with them, seeing what their skillset is. Yes. Seeing how comfortable they're delivering therapy. Um, but yeah, for me it was just kind of deepening my practice. Love that. Learning more about it. So definitely not necessary. I'm glad that I did it.

Dr. Piya Gandhi, DDS:

Yeah. So, um, in your practice, what, what all, I mean, it's not just you, you have now a team of therapists. Um, so what does your practice provide? Um, you know, what age ranges do you see? Just kind of tell us a little bit more about your kind of day to day and your team.

Courtney Scaggs:

Yeah. So we've had a lot of growth this year. Yes. This has been a really crazy unexpected year for us. Um, but we have a team of seven now.

Dr. Piya Gandhi, DDS:

Amazing.

Courtney Scaggs:

Uh, it's, and they're

Dr. Piya Gandhi, DDS:

Congratulations. Great.

Courtney Scaggs:

Thank you. Thank you. And they all have very specialized kind of areas that we work in for speech therapy. We have nine areas that we are able to treat, plus mayo that kind of goes into the feeding area for us. And I would say on our team, we cover about seven of the nine areas. We have someone that specializes in cleft palate and augmentative communication devices. We have someone who specializes in stuttering and cluttering, which is amazing. Um, we have someone who specializes in feeding. We have someone who specializes in autism. We just have kind of a wide range. Um, but we currently have myself and two other therapists that are doing myofunctional therapy on our team. Um, and they. Also have their own specialties.

Dr. Piya Gandhi, DDS:

Yeah.

Courtney Scaggs:

Um, one of them has an RDH background, so she does only myofunctional therapy. Sure. No speech, no feeding. And then our other therapist does speech myofunctional therapy and feeding, which is great. Um, so a really just

Dr. Piya Gandhi, DDS:

yeah.

Courtney Scaggs:

Wide range of things we see Amazing. Six months and up.

Dr. Piya Gandhi, DDS:

Okay.

Courtney Scaggs:

Um, but for the three and under population, we're really only seeing language right now. For those little ones, we're just referring them to someone who that's their specialty. So yes.

Dr. Piya Gandhi, DDS:

Sure. Yeah. And, um, as a parent, um, how do you decide. Who, like do we see a speech language pathologist? Do we see a myofunctional therapist? Do we see a feeding therapist? What are some of the things that as a practitioner, you would look forward to direct them to the right type of provider?

Courtney Scaggs:

Um, so the question that I always ask on our intake is, are there any speech or feeding concerns? That's like my first line of defense. And if that's a yes, then they go with a speech therapist.

Dr. Piya Gandhi, DDS:

Okay.

Courtney Scaggs:

Um, if they say no, then. You know, I come ask a few more questions and see have there been any history of language delays? Are there any coexisting conditions? Um, what's your diet like currently?'cause sometimes they're like no feeding concerns. And then we get in there and they're all eating tanned foods. I'm like, well, there's something else going on. So, um, and one of the nice things about our practice is that if you end up. With someone that's not the right fit. We have the flexibility to move you around.

Dr. Piya Gandhi, DDS:

Yes.

Courtney Scaggs:

Um, so it's like some of our, that's awesome. Patients will start with Myo only and then our myofunctional therapist is like, I think there's something speechy going on here. So they finish their, I love that. Myo. And then start speech. So

Dr. Piya Gandhi, DDS:

that's great. As a parent, the convenience of not having to switch practices. Yeah. Um, and obviously this is a podcast that focuses on. Pediatric airway. Mm-hmm. And we're speaking with you as a speech language pathologist. So how is this con, like how are all these things connected? Because I know most parents are gonna say, well, how is a speech language pathologist? Connected to an airway at all, just like they question that with dentists. But I would love for you to explain how all of this is connected and your role in, um, pediatric airway health.

Courtney Scaggs:

Yeah, so I would say one kind of thing before we jump all the way into that is our team is really good. Even the ones that aren't fully MI trained or really good at identifying Yes. When something is myofunctional.

Dr. Piya Gandhi, DDS:

That's great.

Courtney Scaggs:

So if they start traditional speech therapy and they're like, ah. They sound really just like back of the throat stuffy. I looked at their tonsils. They're huge. Like, I'm gonna keep monitoring them, but I just wanna put it in your brain that there might be something myofunctional going on here, and then we will get them transferred over to someone that has experience. But, um, we definitely see impacts on voice quality and speech sound quality based on airway concerns. Um, a lot of our kids that sound really stuffed up, that impacts how their speech is coming out. They sound like they're kind of talking. Through a muffled, like something is over their mouth almost, but it's just their tonsils.

Dr. Piya Gandhi, DDS:

Okay.

Courtney Scaggs:

Um, and then the other big impact that I see airway wise is with narrow pallets on. Especially with R, that is like the most specific sound that I hear. Um, and I look in and I can see it's narrow. Our tongue needs to stabilize inside of our back molars to make a really sharp R sound. So a lot of times if there's not enough space, it kind of hits on the bottom side. So that teeth and creates just that softer, almost valve like sound.

Dr. Piya Gandhi, DDS:

Yeah.

Courtney Scaggs:

And you also see it for, it sounds like SHCH where the air is escaping over the sides, like a lateral list that. Fleshiness. Yeah. Because it's not fitting in there as tightly as it should be. So,

Dr. Piya Gandhi, DDS:

and um, what about like, from a tongue tie perspective mm-hmm. How does that impact speech sounds and Yeah, what you're dealing with?

Courtney Scaggs:

Lots of different ways and it kind of depends on. Where if it's a posterior tie versus an anterior tie, um, we use our tongue to make all sorts of thumbs. Um, and a lot of times we'll see higher palettes with tongue ties, so they're having to bridge a really big gap.

Dr. Piya Gandhi, DDS:

Sure.

Courtney Scaggs:

To make speech. Sounds like Ts, DS. K is Gs depending on where the tie is. Um, and sometimes. They just can't, um, they just don't have the structure to support the function that we're looking for. Yeah. Um, so we try a lot of traditional therapy first, and if we're not seeing progress, then that's when we're like, it's time to look into the structure is a little bit more

Dr. Piya Gandhi, DDS:

and. When, and I'm all about trying therapy first. I think that really discerns like what we need to do next. Um, but what I do see the pattern that happens, um, is that sometimes therapy will go on for months and months, years and years. And they've been plateaued. And you know, my concern is obviously burnout, but also whatever we're doing is not enough. Mm-hmm. So. This is probably more patient specific, but let's say I'm a parent, my kid's in therapy, how long am I sitting on a plateau? Oh, before I look into something else. So as a therapist, if you see like how, how, mm-hmm. Approximately how long?

Courtney Scaggs:

I mean, during our evals, I tell parents, let's try this for two to three months. Okay. If there's no progress being seen at that two to three month mark, that's, you know, 12 ish sessions with the cancellation here or there. Something is going wrong. Got it. Sometimes it takes those 12 sessions to establish rapport. Sure. You know, create, start to create the basis for the sounds. Um, but at that point we should be seeing progress and our practice doesn't have a lot of lifers. Yeah. We want kids to be graduating, we're doing EV events every year. If they're not making progress, you know, there's a few one-offs that really need some additional support, but. Kids aren't lingering around our practice.

Dr. Piya Gandhi, DDS:

And I think you bring up a good point. Um, therapy shouldn't be for life. No. Um, and I think that that is a misconception. Yeah. Because I have seen many kids that have been in therapy for years. Mm-hmm. First of all, that's a huge expense and a lot of time commitment and. You know, a lot of effort on these kids. Mm-hmm. Um, but therapy is supposed to get us to it the next level, and then we're supposed to move on. So if it's not doing that, we either need to change the type of therapy or look into something else. So I love, I love to hear that, um, that perspective. Yeah. Of, of, of, you know, you know, your, your practice in general, um, along those lines. When should a, a person start therapy, or I should say a child start therapy? Because I'm a proponent of if we think there's something going on, let's just go get a consultation. Absolutely. Um, as opposed to what I hear from some parents is that, you know, their pediatrician provider is saying, well, let's just wait to see if they catch up.

Courtney Scaggs:

Mm-hmm.

Dr. Piya Gandhi, DDS:

Um, so obviously it's individualized. There's this discrepancy. I see this more. With speech delay on the little ones when they like, are not saying the right number of words. Mm-hmm. So, uh, if you could give us like a quick ballpark of by this age we should have generally this amount of Sure. Of words and things like that. And, um, what parents should be looking for.

Courtney Scaggs:

It's a lot. And I will say, you know, I, on our Instagram have broken down all the milestones by age, love that.'cause it really changes rapidly. And I even like to look at the pre-language skill. Mm-hmm. So even before that first work

Dr. Piya Gandhi, DDS:

being said. Yes. Like the cooing and the Yes.

Courtney Scaggs:

Like we, that's why we work with kids as young as six months because we're working with kids who are not yet babbling. Yes. Not yet imitated. Yeah. In actions. Like there's things that come before language. So we're looking.

Dr. Piya Gandhi, DDS:

When I see a silent baby, I'm like, that's a red flag. Yeah.

Courtney Scaggs:

Let's pretend what's going on. Um, and I, we are also very much the team of not wait and see. We would rather you come in, get an evaluation, you're gonna either leave with a full plan or peace of mind. Yes,

Dr. Piya Gandhi, DDS:

I totally agree.

Courtney Scaggs:

And you can always come and do it again. Like I tell families that if you come in at 11 months and everything's within normal limits. You can come back in at two years. Like it's okay. Yeah. At least you know. Um, we also offer screenings, so if you're not willing to like jump into the full evaluation, you can sit, meet with me for 15 minutes, we can talk about it. I can do a formalized screening if you want, but oftentimes I love that just like talking through milestones and any like, yeah, I would recommend further assessment or I think you're probably on the right track. Um, but a big thing is we should be hearing words by 18 months. There are not true words by 18 months.

Dr. Piya Gandhi, DDS:

Red flag.

Courtney Scaggs:

Red flag. Um, and that is a time that I would definitely intervene because after that it just snowballs.

Dr. Piya Gandhi, DDS:

Yeah.

Courtney Scaggs:

The expectations for 18 months and like forward is crazy. Things change so fast and that last six months before two years, um, so that's when I would say is a really good time. Be two months to check in. And that's usually when pe like pediatricians are thinking about binge charts as well.

Dr. Piya Gandhi, DDS:

Yeah.

Courtney Scaggs:

Um, but. We'll see even earlier. So just referencing all those milestones by age and kind of looking at what your child has and if they're missing one. I wanna panic.

Dr. Piya Gandhi, DDS:

Yes,

Courtney Scaggs:

but if they're missing two three of their milestones or never met ones for the previous age group. Probably

Dr. Piya Gandhi, DDS:

starts to snowball, like you said. Okay. Awesome. Um, and how do you see, um, like oral habits play a role in, um, speech development and oral development? Um, what, what are some things in your practice that you do to help parents eliminate those things? What are your recommendations on when they should be eliminated?

Courtney Scaggs:

So oral habits, to me, when I see them, that's like an indicator of something deeper. Mm-hmm. So I think it's functional for me to know that those things are going on, but when I see them, it's not just, oh, this is like just a habit, a routine, there's something else going on. So it kind of signals us to look further.

Dr. Piya Gandhi, DDS:

Okay.

Courtney Scaggs:

Um, we see a lot of speech impacts with extended, um, sucking, extended pacifier use anything that is. In the middle of the front teeth. Um, it ends up opening that gap in the teeth a lot of times and the tongue's used to going forward and back. So it's just pushing right into that gap. And that's where we see things like lisp, ager because the tongue is in between the teeth. Um, we kind of approach it from a few different ways. We try and get some more functional oral input. Like chewing. Yeah. And the molars. Um, and we also. Try and do elimination through positive reinforcement. So we'll get out like a full poster, um, and trying to start small. So the first small prize is after two days. Yeah, no, no thumb sum sucking. Um, and I've even had to scale it back before where we can't just get through the afternoon. Right. They try the afternoon for a week. They can't get like through that after school place. So individualizing it for each client, but slowly building up small, tiny rewards over time.

Dr. Piya Gandhi, DDS:

Do you use any adjunctive things like um, like bitter essential oils on the thumb, or things like myo munchie?

Courtney Scaggs:

I use a lot of Mya Munchie.

Dr. Piya Gandhi, DDS:

Okay.

Courtney Scaggs:

Use a lot of chewy tubes too.

Dr. Piya Gandhi, DDS:

Chewy tubes. Yeah. Any thumb guard or you don't do any of that?

Courtney Scaggs:

Mm-hmm. I'm recommend that.

Dr. Piya Gandhi, DDS:

Okay. That's

Courtney Scaggs:

not my first line.

Dr. Piya Gandhi, DDS:

Okay.

Courtney Scaggs:

I've seen it be effective at nighttime if they can't get past that kind of barrier.

Dr. Piya Gandhi, DDS:

Okay.

Courtney Scaggs:

But I always start from a positive reinforcement place first because I want it to be a fun, functional, motivating thing. And trying to find the right time to do it is really important too. Um, like I think a lot of families think, oh, we'll just knock this out over Christmas break. And I'm like, there's so much chaos, so much going on and so much chaos. That is when your child is probably gonna be,

Dr. Piya Gandhi, DDS:

you need it the most, right? Yes.

Courtney Scaggs:

Um, so trying to find times where it's kind of calm. I always also ask the child if it's something that they wanna eliminate because I need them on board. Yeah. I can't eliminate a habit that someone doesn't wanna get rid of. So trying to make sure there's intrinsic motivation as well. And usually they're ready. Like we do a lot of that habit elimination at the four or 5-year-old, and they're ready. They don't wanna do it at school anymore. Like they sure they want it gone as well.

Dr. Piya Gandhi, DDS:

Um, I am just curious to hear your thoughts. Um, and I have a feeling I know what you would say, but, you know, in, in school, for example, and I don't use these, but we were taught to put in one of those thumb cribs.

Courtney Scaggs:

Mm-hmm.

Dr. Piya Gandhi, DDS:

Um, and same for like the thrusting habit that comes from Yeah. Uh, you know. Prolonged thumb sucking. Um, what are your thoughts on something like that?

Courtney Scaggs:

They have a very specific use and that is to stop a habit, which is great in theory, but it doesn't teach the correct habits that should be happening. It doesn't teach the correct resting posture. It doesn't teach the correct swallow pattern, so we. When I see those and I often see, well, the thrusting has stopped, but we're not, now we're compensating in other ways. Our areas escaping from the sides. We're just having something different going on. Um, and we also, we really focused at our practice on trying to keep things very positive. Yes, when it comes to the mouth. Um, 'cause you know, we want our kids to feel comfortable with us in there, then in there, then moving around. We don't want it to be a scary experience and something like that.

Dr. Piya Gandhi, DDS:

Can be.

Courtney Scaggs:

Can be.

Dr. Piya Gandhi, DDS:

Yeah.

Courtney Scaggs:

Um, so not my favorite. Yeah. It's not something I would ever personally recommend, but I do, you know, see people in my office with them and

Dr. Piya Gandhi, DDS:

Yeah.

Courtney Scaggs:

We, we make that work.

Dr. Piya Gandhi, DDS:

And I think this is like important for dentists to hear. Mm-hmm. Because this is what we were trained to do.

Courtney Scaggs:

Sure.

Dr. Piya Gandhi, DDS:

And the thing we were not trained to do at any point was collaborate with a speech language pathologist or myofunctional therapist. Yeah. You know, it was just, we, we have to. Talk to the parent and figure out how, you know, to use a thumb guard or yucky nail polish or this crib appliance. Um, and you know, at least in my experience, these kids sometimes are hanging onto this habit because things are not working well. Like you said, it's something deeper going on. Either the tongue is not working well and it's not. Sitting in the roof of the mouth, like the thumb or the pacifier is, um, and I'm gonna say this and uh, you're gonna wanna kill me.'cause we talked about not talking about body work, but when I think about habits, you know, that's also a nervous system dysregulation. And so what we do in our practice is, yes, we refer to you because we want the tongue moving correctly and getting that up in the palate and getting the positive reinforcement from eliminating the habit. But we also incorporate the body work Yeah. To help regulate the nervous system. And um, this kind of touches on how even something that seems as simple as a thumb sucking habit that parents think they're gonna knock out takes a team approach. Mm-hmm. It's not just me, it's not just you. It's not just the body work, it's not just the parent. It's like all of us working together. And you also touched on we need the kid on board too.

Courtney Scaggs:

And sometimes I'll bring an occupational therapist Yeah. To you if I'm seeing it, a sensory seeking. Thing, but then I'm saying full body, yes, sensory seeking. Then I'm like, oh, this might not be about the mouth at all. This might just be a piece of a bigger puzzle.

Dr. Piya Gandhi, DDS:

Yeah.

Courtney Scaggs:

So there's been times I've seen like lots of sensory seeking, crashing, jumping, all of that, and also thumb sucking and I'm like. Let's get ot.

Dr. Piya Gandhi, DDS:

It's all, yeah.

Courtney Scaggs:

All of these things under control.

Dr. Piya Gandhi, DDS:

Yeah. Do you have um, any go-to OTs that you work with here?

Courtney Scaggs:

Do I do,

Dr. Piya Gandhi, DDS:

I would love to wear who they are. Two

Courtney Scaggs:

great ones. Um, Lizzie Simon in the Heights with Sensationally thriving. She is incredible. Um, she's great at collaboration and I love her. And then, um, the team member at Children's, there are fun, especially Lauren Evans. Okay. She is great. I know she's very full these days. She's very popular. That's

Dr. Piya Gandhi, DDS:

what happens with the good

Courtney Scaggs:

therapist I know. And she's a great handwriting therapist, which is completely different than what we're talking about, but it's nice to kind of have her for different things

Dr. Piya Gandhi, DDS:

and she's a great, great team. Okay. Very good to know. Um, and all of this just touches on, um, the fact that we have to use a team

Courtney Scaggs:

Yep.

Dr. Piya Gandhi, DDS:

On, for all of these kiddos, whether, whether it's speech related or feeding or airway, because the reality is, is they're all kind of connected. Yeah. And so, uh, what I love about working on a team is the different. Perspectives and different eyes that we see on the same kid. Yes. Um, so, um, yeah, talk to me about your, you know, when you see a kiddo with an airway disorder or the large tonsils or the feeding, um. How do you organize a team?

Courtney Scaggs:

Yeah, it's a great question. Um, we, I kind of say that as speech and myofunctional therapists. I feel like our job is to come up with a plan because we are pulling like lots of different things. We're looking at speech feeding. Swallowing and sleep. Like we're able to look at all of the aspects. Um, and so from there we can make recommendations about who you need to see on your team. We have a section in our reports that's like, consult with an airway focused dentist. Um, consult with an airway focused ENC. Mm-hmm. Whatever it is. We have that in there and that's part of our recommendations. Um, it has helped us learn to be more flexible in how we do treatment. I think as speech therapists we're used to being like evaluation, treatment. Dismissal. That's like the normal path of things.

Dr. Piya Gandhi, DDS:

Yep.

Courtney Scaggs:

But when there's myofunctional or structural concerns, it's never straight and narrow. Like a lot of times we'll do the evaluation, start treatment, they go into expansion. Yeah. Take a break. We pick back up right after, and then we finish it out. We do some io, then we do some speech, we do it at the same time, and then it's dismissal. Um, so it's definitely, we've learned to be more flexible. Um, but kind of our timelines there for sure.

Dr. Piya Gandhi, DDS:

Yeah, no, and I think, um, flexibility is just the word in pediatrics in general. Um, especially with more and more of these collaborations happening, because I know, you know, on the ENT side, like, uh, sometimes we'll start expansion and then we. Need to address tonsils and adenoids. Mm-hmm. The great part is, is a lot of the ENTs in Houston will do the removal with the expando still in. Yeah. Which is huge. Um, and that way we're not totally interrupting treatment. But one thing is, you know, and I, the expanders that we use in general have a lot of mm-hmm. Coverage in the mouth. Yeah. And I know it can impact, uh, speech even more. Mm-hmm. So, you know, I tell parents we might make things a little bit worse before we get better. Yeah. Um, I'm curious from your standpoint, for the kiddos that you've seen, start with speech. Mm-hmm. Go into expansion and then come out and pick up, um, what that trajectory looks like for them.

Courtney Scaggs:

It's quick. I mean, a lot of them. Are a little bit on the older side, so they kind of getting that little bit of knowledge before they go into expansion. They start with a really strong base when they come out. So it's not like we're starting from scratch. Like they have a base, they know where their time should be, they know how their sound should sound. Um, and then with the little ones, like we're still able to do speech if expansion is in, if it's certain. Sounds like if they're working on Yes. P's, b's, m's, anything with the lips, we can still keep going. Yeah. Keep doing speech. Same with language. Um. There's things we can work on a lot of times, you know, with expansion still. And so it's really, people ask all the time, like, can we keep doing speech with expansion? And it's very much case by case.

Dr. Piya Gandhi, DDS:

Okay. Yeah. Yeah.

Courtney Scaggs:

Type of expander.

Dr. Piya Gandhi, DDS:

Yes.

Courtney Scaggs:

Rules, kid, all those things.

Dr. Piya Gandhi, DDS:

Yes. Um, you touch on this just a little bit now with the certain speech sounds, but um, we've talked about tongue tie. Mm-hmm. But how do lip ties play a role? If they do.

Courtney Scaggs:

Yeah. Very rarely do I see lip ties have a role in speech. Sometimes I'll see them in feeding, like difficulty clearing a spoon.

Dr. Piya Gandhi, DDS:

Okay.

Courtney Scaggs:

With your lips, if you're seeing your child use their teeth or flip their spoon over all the time to try to clear, um, very rarely do I see it come up in speech. Sounds it just. It seems to be more of a feeding impact. Okay. And when I see something that physically I'm like, Ooh, that looks maybe a little tight, but I'm not seeing any functional speech or feeding impacts, that's when I really like referring back to dental professionals. Okay. Because I say, oh, you know, I'm not seeing any functional impact Yes. On these two areas, but there could be lots of functional impacts from a dentition point of view. Yeah. Like I always reference when. I got my lip tie released because I was having gum recession.

Dr. Piya Gandhi, DDS:

Yes.

Courtney Scaggs:

So there's so many things that are outside of my scope of practice that still need to be covered. So I, that's when I flip it back,

Dr. Piya Gandhi, DDS:

and this is where the team looking at it from two different perspectives, because when I contact our functional therapists. I wanna know, is this impacting function? Yep. Um, from your perspective, because I'm not looking at speech, I'm not looking at feeding. Um, you know, I'm not really taking a deep dive in the myos sector either. Um, and so then we get everyone's perspective. So we're treating appropriately, not over treating or under treating. Yeah. Either. Um. From, uh, a tongue tie treatment standpoint, what does pre and post-op therapy look like?

Courtney Scaggs:

It's very individualized. Yes. And it's, I know, I feel like a broken record that I keep seeing, but it is

Dr. Piya Gandhi, DDS:

true,

Courtney Scaggs:

it's very individualized and that's something that our practice really prioritizes, is individualized care. And some kids don't need a lot of prep. They already, you know, have desensitization on their body. The families just need to be taught exercise and resting posture, and they pick it up really quickly. Um, some families, you know, whole time.

Dr. Piya Gandhi, DDS:

Yeah.

Courtney Scaggs:

So we really caution against saying like, specific timelines for things before we get started.'cause it's hard to predict Yeah.

Dr. Piya Gandhi, DDS:

What

Courtney Scaggs:

things look like. Um, but we do have some kind of benchmarks that are important to us to be met before we're like, you guys are good to go for this. Um, and one of the biggest ones is not even actually about. How the exercises look, but it's just that they're being done.

Dr. Piya Gandhi, DDS:

Yes.

Courtney Scaggs:

That the family has time to do exercises every day at the time, like the family is able to incorporate that into their life and they're ready to take it on. They understand what's expected at the end of it. Um, we also want the child to feel very relaxed and prepared for the procedure. A lot of it is not even physical work, but just talking about. What's coming up? Kids have so many questions.

Dr. Piya Gandhi, DDS:

Yes. Yeah.

Courtney Scaggs:

I'm never, never shocked when they have these really intense questions about what a release is gonna look like. Yeah. Because they're really inquisitive, um,

Dr. Piya Gandhi, DDS:

and they have no filter. Right. Which is great.

Courtney Scaggs:

So they're like a loser. Yeah. Like they're always so curious about what's gonna happen. So we spend a lot of time talking about what that's gonna. Look like drawing pictures is what it's gonna look like. Reading Catherine's book about all that looks like, just like prepping them for this experience. And then of course there is like functional prep of making sure

Dr. Piya Gandhi, DDS:

they're

Courtney Scaggs:

ready. They're ready. Like physically.

Dr. Piya Gandhi, DDS:

Yes.

Courtney Scaggs:

Um, but it's more than just, I think a lot of times families come in and they're like, okay, we're here for the stretches where we found these on YouTube. Yeah. But it's way more than just stretching. Yes. For readiness. And then after is the same way too. We're looking at kind of how the wound's healing, talking to you about how it's healing. Making sure, kind of troubleshooting things, if they're having pain or if they're feeling uncomfortable, if they're worried about how their speech is sounding. Just kind of talking through those things and then also working on exercises for healing and function.

Dr. Piya Gandhi, DDS:

And if there are any dental providers listening, um, as a speech language pathologist, what are you looking for in a provider when you're, when you want them as part of your team?

Courtney Scaggs:

That's such a good question. Uh, I, first and foremost, I'm just looking for clear communication. That's one of the things I like about your office so much, is that I know that I can call and I can be like, can I talk to Dr. Gandhi and I know you'll call me back. Like, it's not, you're not hard to get ahold of. Yes. Um, and I also know that you're gonna be honest with me. If I send someone to you that's not ready, you're gonna tell me, which is huge because it is like our professional practices that are on the line for these things. Yes. And I don't absolutely take a risk. So if there's something that needs to be done, I would rather the provider be honest with me and tell me. It's not gonna hurt my feelings. Sometimes we miss things. We're all

Dr. Piya Gandhi, DDS:

users. Yeah, absolutely. I'm the same way.

Courtney Scaggs:

So I appreciate that kind of honest line of communication. And I know on the flip side of that too, if I call you and I'm like, what, what? I don't think we're ready for all of this that your office is gonna accommodate. They're gonna reschedule. They're not gonna be upset that they're not ready. Like there's just open communication there. Um, also just making sure that they are working with myofunctional therapist and speech therapist. It's always you know, a little concerning to me. If I, 'cause I, anytime I get a temp tear release, I'm calling a provider to get more information. I'm asking what their pre post-op recommendations are, what they're using. You know, everything when their follow ups are. I wanna know the whole thing.

Dr. Piya Gandhi, DDS:

What are your thoughts on sutures?

Courtney Scaggs:

Uh, I think it's appropriate. I think that it's appropriate for certain patients and not for others. Um, once again, it's just kind of a case by case of what they need. Um, there's a lot of like. Clients that we see with extra support needs that really need extra support. Yes, it comes to healing. No ectomy. So I think it's another thing where it's case by case. And I do, that's another question I always ask when I call, is do you do sutures? Um, at all. Yeah. Because you know, some offices absolutely not. Some,

Dr. Piya Gandhi, DDS:

yeah,

Courtney Scaggs:

sometimes. Um, but I feel like that's really important for me to know. I also wanna know, they're gonna touch base with me afterwards, like as this, do we finish? And I'm never gonna hear about this patient again. Is it continued collaborative care. Um, so those are kind of the things I look for with providers. And I honestly just want someone that's confident, like when they're talking to me, if they're saying a lot of, I don't knows, or I'm not so sure, you know, we'll do it if you want. I want someone that's gonna tell me like, we do this because X, Y, Z.

Dr. Piya Gandhi, DDS:

Yeah. There's a process and the system

Courtney Scaggs:

reasonings behind things. Yeah. So those are the things you look for.

Dr. Piya Gandhi, DDS:

Cool.

Courtney Scaggs:

And I'm pretty picky. I want my patients mean a lot to me, so we want them to be in good hands and we're lucky that we have great providers here. But

Dr. Piya Gandhi, DDS:

yes, Houston has a great network Yeah. Of people. So it is, um, and it still doesn't seem to be enough for the number of patients that need this type of, of, or, um, any like final thoughts that you wanna share with our listeners, parents, practitioners,

Courtney Scaggs:

whoever. Yeah, I would love to just give a little spiel about Space City, please. I missed that at the beginning.

Dr. Piya Gandhi, DDS:

Go for

Courtney Scaggs:

it. Um, but we are a practice that I kind of created, um, to meet a need. So we're a community-based practice. We have an office here in Houston, but we also see patients virtually all throughout Texas. We do in-homes, in daycares, in private schools, kind of all over the place. Um, and when we're doing Mayo in daycares or in private schools, we actually have the families come and meet us. Because we, Myo doesn't really work if it's isolated without caregivers there. But the schools we work with are great and they, I love that caregivers to come in and support the clients, but our kind of philosophy is just creating these confident communicators. We want everyone to go out there and be able to communicate confidently.

Dr. Piya Gandhi, DDS:

We love working with you and, thanks for spending the morning with us as well. Thank you.

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Dr. Piya Gandhi, DDS

Host
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Courtney Scaggs, M.S., CCC-SLP

Guest