Form. Function. Physiology.
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On the cutting edge of the decision of if and when to cut.
Our first foundational principle is to put function first.
Our second is to never introduce a simple treatment solution to a complex patient.
We are all trained on the principle of "First do no harm", but sometimes it is a challenge to know where to start in treating complex patients that are affected by restricted oral tissues
Regretfully, many providers are not trained to recognize a complex patient until they discover that a simple treatment approach was not as effective as expected.
The goal of educating providers on the principles and protocols of BabyLase is to provide the techniques, tips and tools necessary to:
- Support the provider in assessing their patients
- Referring for supportive care by additional treatment team professionals
- Developing the skills necessary to deliver quality BabyLase Therapy in a clinical setting
The methods utilized to educate providers include:
- Comprehensive instruction on laser physiology and safety
- Comparisons between different laser wavelengths, manufacturers and techniques utilized to perform oral releases
- Providers treating each other to benefit from their own personal OraLase/SmileLase experience
- Instruction by the combination of the dentist that developed this very targeted therapeutic modality
Conservative, cautious, considerate, reversible and non-invasive.
By respecting the anatomy and physiology as well as honoring the principles of natural function, providers are able to assist their patients in maximizing function before, during and after a surgical release if deemed necessary.
Triad. Dyad. Tongue.
Triad
BabyLase principles and procedures address more than just the perceived tongue tie. It is critical when treating the infant or child to fully understand the triad of the function of the:
- oral environment
- the whole body fascial system
- the neurological bi-directional feedback through the fascia and cranial nerve system
Dyad
The mother-baby unit is referred to as a dyad.
BabyLase therapy involves the treatment of the mother immediately before their baby is treated. Benefits include:
- A mother who can experience the warmth and relaxation of the therapy that their baby will be experiencing during their procedure
- A baby that can experience the benefits of non-surgical and neurologically integrating therapies that have been known to create many improvements in the quality of life for both the baby and their families.
- Optimizing both form and function for mother and child provides a unique opportunity for increases in quality of life
Tongue
Function is more than skin deep ...and dysfunction goes all the way to the core.
The tip of the iceberg did not sink the Titanic and the visible portion of the frenum is not the only structure affecting function.
By adding the BabyLase therapy to any type of surgical release for restricted oral tissues, you provide the patient the opportunity to access releases into the fascial tissue.
Assessing and addressing the complicated posterior tongue tie becomes less complicated when function can be optimized through neurological integration and non-surgical fascial releases by utilizing BabyLase Therapy.
OraLase & BabyLase
OraLase
The OraLase technique is Dr. Nordstrom's innovation using the FDA approved Fotona Lightwalker Laser and the FDA approved FOX ARC 1064 (XLase) to address neurological and structural limitations/restrictions in the oral region.
It is utilized to address orofacial pain and dysfunction by specifically treating the neurological and fascial systems of the head and neck.
OraLase is a very specific application of laser frequency and technique that achieves consistently remarkable results for patients the age of 2 and older.
BabyLase
BabyLase is the application of the OraLase/SmileLase technique as applied to children ages 0-2. It is a highly customized form of the standardized OraLase/SmileLase protocol based on clinical experience and feedback from parents and providers. As a modification of dosage based on age, size and level of function, the BabyLase protocol continues to be refined through active patient care and careful feedback from parents and thorough ongoing functional assessments.
BabyLase has been developed by applying Dr. Nordstrom's OraLase principles to infants and children.
Literature references
E. Blechschmidt: The Beginnings of Human Life
“All modes of behavior (of life) studied with respect to an organic substrate were shown to be based on embryonic developmental processes. Hence the heredity of so-called instinctive functions. What we call instincts are direct continuations of prenatal development processes (i.e.., ontogenetic, but not phylogenetic events). Something that has not been unconsciously initiated by the body in early development could be further developed after birth and practiced later - consciously or instinctively. We recall here the sucking reflex and repeat that unless the lips of a young embryo had been rolled in as a result of its early functions, the newborn would be unable to suck instinctively.”
Ontogeny is the developmental history of an organism within its own lifetime, as distinct from
Phylogeny, which refers to the evolutionary history of a species. In practice, writers on evolution often speak of species as "developing" traits or characteristics.
https://en.wikipedia.org/wiki/Ontogeny
Enlow states: Characteristic features of the mature swallow are:
´ (1) the teeth are together (although they may be apart -with a liquid bolus);
´ (2) the mandible is stabilized by contractions of the fifth cranial nerve muscles;
´ (3) the tongue tip is held against the palate above and behind the incisors;
´ (4) minimal contractions of the lips are seen during the swallow
(Handbook of Facial Growth p.379)
What is evidence-based medicine?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789163/
Quantum physics: The double slit experiment
https://www.youtube.com/watch?v=U7Z_TIw9InA
Majdabadi A, Abazari M. Analysis of Laser-Fat Interaction Through Comparing 980 nm Diode Laser With 1064 nm Nd:YAG Laser, J Skin Stem Cell. 2014 ; 1(1):e17793. doi: 10.17795/jssc17793
Results: The simulation results showed that the penetration depth and temperature rise of 980 nm wavelengths were different from those of 1064 nm wavelength. It appeared that 1064 nm wavelength penetrated to deeper layers of tissue compared with 980 nm. Moreover, temperature rise during 1064 nm irradiation led to temperature increase in allowable ranges
Anatomy, Fascia Layers Adrianna Gatt; Sanjay Agarwal; Patrick M. Zito
https://www.ncbi.nlm.nih.gov/books/NBK526038
WHAT IS PHOTOBIOMODULATION THERAPY?
https://www.litecure.com/about-photobiomodulation/
https://www.youtube.com/watch?v=kn7JXDGpEfI
Photobiomodulation or low-level laser therapy
Michael R. Hamblin, Ph.D
Photobiomodulation has made, and is continuing to make, major progress in obtaining recognition from authorities in medical schools, scholarly journals, the popular press and media, medical practitioners, therapists and other bodies concerned with biomedical science. This progress was very necessary as only about ten years ago the general consensus was that LLLT was “snake oil” and only practised by charlatans. Several influential “systematic reviews” including the Cochrane Database Organization concluded that LLLT had found “no reliable evidence” for efficacy in diseases such as osteoarthritis, rheumatoid arthritis, etc. [5]. Another problem involved the prevailing use of a wide variety of different kinds of light sources (medical devices) and treatment protocols including, illumination parameters (such as: wavelength, fluence, power density, pulse structure, etc.) and the fact that there was no agreement on the treatment schedule. Unfortunately, these variations in study designs led to an increase in the number of negative trials that were published and created some controversy, despite the overwhelming number of positive clinical results that were also obtained [6].
This change in perception that has occurred in recent years can be attributed to several factors, but perhaps the most important among these considerations is the progress that has been made in understanding the mechanisms of action at a molecular, cellular and tissue-based level
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215795/#!po=13.8889
The histochemical structure of the deep fascia and its structural response to surgery
J Hand Surg Br. 2001 Apr;26(2):89-97.
McCombe D1, Brown T, Slavin J, Morrison WA.
The histochemical structure of the deep fascia and its interface with the underlying muscle was examined in ten pigs. This structure was also evaluated after it had been raised as a fascial flap and in another site after the underlying muscle surface had been disrupted. The deep fascial is a simple structure of densely-packed collagen bundles and elastin fibres, and has hyaluronic acid concentrated on its inner surface, which is in contact with the underlying muscle. There is no specialised lining of this surface of the fascia to account for its gliding properties. The post-surgical specimens demonstrated preservation of the structure of the interface between fascia and muscle, including the retention of the hyaluronic acid lining, if the epimysium was intact.
However, if the epimysium was disrupted, the structure of the interface was obliterated
Fascia as a Sensory Organ A Target of Myofascial Manipulation Robert Schleip Ph.D.
http://axissyllabus.org/assets/pdf/Schleip_Fascia_as_a_sensory_organ.pdf
Viscoelastic Properties of Hyaluronan in Physiological Conditions
Mary K. Cowman, Tannin A. Schmidt, [...], and Antonio Stecco
The shear rate dependence of the viscosity, and the viscoelasticity of HA solutions, depend on the relaxation time of the molecule, which in turn depends on the HA concentration and molecular weight.
Temperature can also have an effect on these properties. High viscosity can additionally affect the lubricating function of HA solutions. Immobility can increase the concentration of HA, increase the viscosity, and reduce lubrication and gliding of the layers of connective tissue and muscle.
Over time, these changes can alter both muscle structure and function. Inflammation can further increase the viscosity of HA-containing fluids…
HA is increased in concentration during inflammation, and can be covalently modified
A common observation in inflamed tissues is an increase in the concentration of HA The HA content of injured skeletal muscle is known to be elevated
Stecco et al. documented, with a highly specific HA-binding peptide, the deposition of HA inside the loose connective tissue in three different fasciae of the body: fascia lata, rectus abdominis sheet and sternocleidomastoid (SCM) fascia.
Stecco et al. 20 also documented an increase of the thickness of the loose connective tissue in the SCM fascia in patients complaining of chronic neck pain syndrome.
If the HA content of fascia is increased, the viscosity and elasticity of the HA-containing fluid would be increased, and its fluid film lubricating properties reduced
Raising eyebrows on neuroinflammation: Study finds novel role for 'skin plumping' molecule
Neuroscientists identify surprising brain action of cartilage component hyaluronic acid
FLORIDA ATLANTIC UNIVERSITY
NEWS RELEASE 11-JUL-2019
"We normally think of hyaluronic acid with respect to cartilage formation and also for its role in many processes including cancer progression and metastasis," said Quan. "However, what we have uncovered in our study is a completely unique role for this molecule. We have been able to document a connection between the blood cells and the brain cells, showing that the activating signal passed between these cells is hyaluronic acid.“
Hyaluronan Concentration within a 3D Collagen Matrix Modulates Matrix Viscoelasticity, But Not Fibroblast Response
S.T. Kreger and S.L. Voytik-Harbin
Fascial manipulation aims to interrupt the ‘memory’ of the superficial and deep fasciae with regards to muscular trauma and internal dysfunctions.
J. Stubes et al
STECCO, C., PORZIONATO, A., MACCHI, V., STECCO, A., STERN, R., DE CARO, R.. Analysis of the presence of the hyaluronic acid inside the deep fasciae and in the muscles. Italian Journal of Anatomy and Embryology, North America, 116, Nov. 2011.
Any intervention in the fascial system may have an effect on the autonomic nervous system and on all the organs which are directly affected by the autonomic nervous system.
Recent study showed a layer of hyaluronic acid between fascia and muscle and inside deep fascia, in particular inside the loose connective tissue separating the fibrous sub-layer of the fascia. This means that the fascia thus provides an extracellular matrix that is a gliding lubricant over muscle, permitting the free contraction of muscles, but also a unique matrix for its repair and regeneration.
The American Academy of Pediatric Dentistry Policy on Obstructive Sleep Apnea
https://www.aapd.org/media/Policies_Guidelines/P_SleepApnea.pdf
Trigeminal, Visceral and Vestibular Inputs May Improve Cognitive Functions by Acting through the Locus Coeruleus and the Ascending Reticular Activating System: A New Hypothesis
https://www.frontiersin.org/articles/10.3389/fnana.2017.00130/full
Trigeminal Cardiac Reflex: New Thinking Model About the Definition Based on a Literature Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602726/
Trigeminal Cardiac Reflex and Cerebral Blood Flow Regulation
https://www.frontiersin.org/articles/10.3389/fnins.2016.00470/full
Treating the Phobic and Anxious Dental Patient:
Introduction to Havening Therapy
https://www.havening.org//media/articles/dr_ruden_phobia_article.pdf
The Limbic System - Ronald A. Ruden, M.D, Ph.D.
https://www.havening.org//media/articles/04c490_3b3c1a76d73f4b849027ed7fd2ce8b24.pdf
Increased Cerebral Blood Flow Velocity in Children with Mild
Sleep-Disordered Breathing: A Possible Association with Abnormal Neuropsychological Function
https://www.ncbi.nlm.nih.gov/pubmed/17015501
Not all sleep is equal when it comes to cleaning the brain
https://www.sciencedaily.com/releases/2019/02/190227173111.htm
Spinal CSF flow in response to forced thoracic and abdominal respiration
https://fluidsbarrierscns.biomedcentral.com/articles/10.1186/s12987-019-0130-0
Meaning of the Solid and Liquid Fascia to Reconsider the Model of Biotensegrity
A New Pain-sensitive Organ Has Been Discovered in Our Skin
Stretch force guides finger-like pattern of bone formation in suture
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0177159
Etiology, clinical manifestations and concurrent findings in mouth-breathing children.
Adults with sensorimotor disorders: enhanced physiological and psychological development following specific sensorimotor training
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406001/
More babies getting their tongues clipped to help breastfeed. But is it necessary?
Tongue-tie and upper lip tether release surgeries have increased dramatically in the U.S. without clear data that it helps breastfeeding.
https://www.today.com/health/tongue-tied-babies-more-babies-getting-their-tongues-clipped-it-t158181
Untangling the tongue-tie epidemic
http://medicalrepublic.com.au/untangling-tongue-tie-epidemic/10813
Photons and Neurons
Claus-Peter Richter and Xiaodong Tan
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144413/
Pulsed ND:YAG laser combined with progressive pressure release in the treatment of cervical myofascial pain syndrome: a randomized control trial
Mohamed Salaheldein Alayat, PhD, PT,1,* Kadrya Hosney Battecha, PhD, PT,1 Ahmed Mohamed ELsodany,1 and Mohamed Ibrahim Ali1
• •[Conclusion] PPRT and exercises alone or that in combination with laser therapy were effective in the treatment of active MTrPs in patients with MPS. • •https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344286/
Babylase: Exclusively using 1064nm for a very good reason
Pulsed ND:YAG laser combined with progressive pressure release in the treatment of cervical myofascial pain syndrome: a randomized control trial
Mohamed Salaheldein Alayat, Kadrya Hosney Battecha, Ahmed Mohamed ELsodany,and Mohamed Ibrahim AliPulsed
Nd:YAG laser was effective in decreasing musculoskeletal pain and spinal pain Nd:YAG lasers has 1,064 nm wavelength, which lies in the infrared band of the electromagnetic spectrum and works in a therapeutic window in which there is no adequate concentration of the absorbing material in the superficial layers and is therefore considered a deep penetrating modality. In addition to wavelength, the high power used allows high energy density (50 J/ point) to be delivered to tissues in a brief time (26 s).
The laser reduces pain by direct neural stimulation, which alters pain signal transmission by inhibiting Aδ- and C-fibers and the release of endorphins and enkephalins, which are endogenous pain-relieving chemicals. The infrared laser can reduce pain indirectly by modulating the inflammatory process by reducing the concentration of pro-inflammatory cytokines and increasing the levels of anti-inflammatory cytokines. The infrared laser stimulates nociceptors and leads to an increased pain threshold. MTrPs are characterized by muscle fiber shortening, which results in impaired local circulation, leading to poor oxygen and nutrient supply. The near-infrared laser changes cell metabolism by increasing blood flow and vascular permeability and subsequently decreasing muscular tension. Moreover, the laser stimulates cytochrome c-oxidase and nitric oxide release in the mitochondria and increases the production of adenosine triphosphate (ATP), RNA, and DNA. Using a high peak power of 3,000 W with high energy density delivered to human tissues it may lead to a photothermal effect. Short duty cycles with a brief pulse duration do not permit any thermal accumulation inside tissues, which in turn reflects the safety and comfort of using pulsed Nd:YAG laser to tissues, although there is a need to measure this effect in tissues.
LIterature references on the 1064 wavelength and pBM
Evidence based medicine requires the application of research to new technologies
Questioning the use of new techniques and technologies is common when existing paradigms are challenged.
Below are literature based references to assist the evidence-based provider in coming to their own conclusions on the safety and efficacy of the 1064 mn wavelength in a conservative and non-surgical approach to therapeutic interventions.
The research indicates that the1064 nm is unique in its ability to penetrate to the depth of the tissue restriction while simultaneously providing the well-known benefits of photobiomodulation
Deeper penetration=Better results
Pulsed ND:YAG laser combined with progressive pressure release in the treatment of cervical myofascial pain syndrome: a randomized control trial
"The recent use of pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy for musculoskeletal disorders proved its efficacy in reducing inflammation and pain. The Nd:YAG laser provides high power (3,000 W) at a 1,064 nm wavelength that penetrates deeper than low-level lasers, and it is postulated that it has a photothermal, photochemical, and photomechanical effects"
1064 nm as High Intensity Laser Therapy
The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial
Banu Ordahan & Ali Yavuz Karahan & Ercan Kaydok
"The HILT group demonstrated better improvement in all parameters than the LLLT group. Although both treatments improved the pain levels, function, and quality of life in patients with PF, HILT had a more significant effect than LLLT. "
Skin Structure Level and the Penetration from Different Wavelength of Laser
" The skin tissue contains pigments, water and oxyhemoglobin, which absorb only specific wavelengths. This phenomenon is called selective absorption. For example, the dye laser at 595 nm wavelength targets oxyhemoglobin (red) at a wavelength of 1064 nm. The Nd:YAG laser is for melanin (black), and the 2940 nm wavelength holmium laser is for moisture (colorless). When you familiar with the absorption wavelength of each target tissue, you can select the best laser device. "
HILT
Additionally, HILT may have a direct stimulatory effect on nerve structures, which could increase the speed of recovery from conduction block or inhibition of A-delta and C-fiber transmission.Chow and Armati reported that animal studies using noxious stimuli indicate that HILT devices produce nociceptor-specific inhibition of nerve conduction, leading to inhibited transduction of pain signals from the periphery to the central nervous system. In addition, there is increasing evidence that laser therapy can disrupt neuronal physiology, affecting axonal flow and cytoskeleton organization. These laser-induced changes are completely reversible with no side effects or residual nerve damage.
Authors: Paul F. White, PhD, MD, FANZCA et al
Anesthesiology News
A Comparison of Low-Level and High-Intensity Laser Therapy Devices
https://anesthesiaexperts.com/uncategorized/cold-laser-therapy-acute-chronic-pain-management/
Benefits of Photobiomodulation
Results: Evidence shows that PBM can inhibit nerve function in vivo, in situ, ex vivo, and in culture. Animal studies using noxious stimuli indicate nociceptor-specific inhibition with other studies providing direct evidence of local conduction block, leading to inhibited translation of pain centrally. Evidence of PBMdisrupted neuronal physiology affecting axonal flow, cytoskeleton organization, and decreased ATP is also presented. PBM changes are reversible with no side effects or nerve damage. Conclusions: This review provides strong evidence in neuroscience identifying inhibition of neural function as a mechanism for the clinical application of PBM in pain and anesthesia