Show Notes
Overview In this episode, I sit down with Dr. Peter Catalano - an otolaryngologist, rhinology fellowship director, and pioneer of minimally invasive nasal surgery. Dr. Catalano has held appointments at Mount Sinai School of Medicine, the Lahey Clinic, and Tufts University, and has spent over three decades developing and publishing on targeted nasal airway surgery. I've had the privilege of working with Dr. Catalano on a major article addressing mouth breathing, and our conversation here is one of the most important I've had on this platform. We go deep into the science of nasal airflow, the structural and institutional barriers preventing children from getting the care they need, and the very real consequences (neurological, behavioral, cardiovascular, and craniofacial) of untreated mouth breathing and sleep-disordered breathing. We also address the myths and dogmas that continue to persist in both the ENT and orthodontic worlds, and what it's going to take to break them down. If you've ever wondered why the two worlds of dentistry and medicine remain so siloed on this issue, or what it means for patients when they fall through the crack, this episode is for you. Timestamps 0:00 – Introduction and Dr. Catalano's background: ENT, skull base surgery, academic appointments at Mount Sinai, Lahey Clinic, and Tufts University 4:10 – How Dr. Catalano's career trajectory led him from engineering to medicine to rhinology — and the philosophy of fate and the "hidden angel" guiding his path 9:12 – The MicroShaver revolution: meeting Dr. Setliff in South Dakota and the aha moment that changed everything about minimally invasive sinus surgery 11:13 – The unexpected discovery: patients reporting they stopped snoring after sinus surgery, and how that led to a focus on nasal airway and sleep-disordered breathing 13:18 – [Ad] Early Orthodontic Treatment Comprehensive — a two-day hands-on immersive course with Dr. Daniel Camacho, Fort Lauderdale, FL, November 13–14. Click the link in the show notes to register. 14:27 – The 2009 Singapore breakthrough: Dr. Deyun Wang and computational flow dynamics — why no one actually knew how air moved through the nose until then 19:32 – Why previous nasal surgeries failed for OSA, and what "follow the airflow" means for surgical targets between the eyes 20:30 – Why making big holes in sinuses made things worse — and why the sinuses don't actually ventilate during breathing 23:58 – How the superior airway and structures like the uncinate process and concha bullosa became key surgical targets, producing a 15–20% improvement in airflow 26:08 – The insurance dilemma and medical-legal risks that prevent ENTs from performing airway surgery — even when the data is clear 30:03 – The ferret studies and the "never operate under 16" dogma: how flawed 1980s animal models became entrenched standard of care for pediatric ENT surgery 35:48 – Parallels to hormone replacement therapy and the rampant hypocrisy in academic medicine — how good studies get buried and bad ones persist 40:55 – How Dr. Catalano fought back against an insurance company, changed their pediatric sinus surgery policy, and survived multiple attempts to have his medical license revoked 47:12 – The Harvold monkey studies: why the obligate nasal breather argument is wrong, why the studies are foundational, and what it means that no one could repeat them today 58:07 – Children don't just "outgrow" airway obstruction: why the lymphoid involution argument is true but dangerously misleading when 90% of craniofacial growth is complete by age 8 1:13:57 – CBCT in ENT and orthodontic practice: why orthodontists need to learn to read the full image, how Dr. Catalano and Dr. John Walker found hidden tumors, and why rhinology-focused ENTs already use equivalent imaging 1:17:33 – Nocturnal enuresis and airway: the pituitary/ADH connection, why these children ask about bedwetting the moment they wake from surgery, and the anecdotal but compelling clinical evidence 1:27
More from The DOC Podcast
Episode Summary In this episode, I sit down with Dr. German Ramirez for an in-depth conversation about early orthodontic treatment, craniofacial growth and development, bone biology, and the critical role of nasal breathing in facial development. Dr. Ramirez shares his remarkable training journey from Colombia to Australia to Tufts University, his pioneering research on the mandibular condylar cartilage, and his passionate case for treating children early rather than waiting until age seven. We dig into the six dimensions of diagnosis, the connection between bruxism and airway, why AHI is a flawed metric for pediatric sleep-disordered breathing, and how collaborating with ENTs and sleep physicians can transform patient outcomes. This is a must-listen for any orthodontist or dentist who wants to understand the biology behind proactive, functional orthodontic care. Timestamps 0:00 — Introduction & Guest Background Introducing Dr. Ramirez and his credentials. 2:07 — Dr. Ramirez's Training Journey From Colombia to Brazil to early ortho training. 6:25 — Mandibular Condylar Cartilage & Bone Biology Growth potential persists into the 90s. 8:41 — Why Early Treatment Matters Mandible grows more in first five years. 10:55 — Sleep, Breathing & the Orthodontist's Role We normalize anatomy, not treat airway. 15:06 — Responding to "No Need to Treat Before 7" Six-dimension diagnosis vs. isolated single-problem studies. 21:05 — Functional Evaluation: Mouth Breathing & Nasal Breathing Identifying mouth breathers and cellular hypoxia effects. 26:47 — The Tongue as Palatal Expander Nasal breathing first, then tongue positioning. 29:57 — Collaborating with Medical Colleagues CBCT, ENTs, and a cleft palate story. 37:27 — Tonsils, Adenoids & Post-Surgery Relapse Why habits persist and relapse rates soar. 41:38 — AHI Limitations & Study Design Problems AHI is a flawed pediatric sleep metric. 47:47 — Bruxism & Airway Connection Tongue protrusion causes grinding — here's how. 51:47 — Resistance to Change in Orthodontics Technology-driven vs. biologically-driven education disconnect. 56:17 — Genetics vs. Environment in Craniofacial Growth Epigenetics and the genetic window concept. 64:56 — Muscle, Bone & Diet Muscle stimulation drives bone growth over time. 72:02 — Communicating with Child Patients "Nose for breathing, mouth for eating." 81:28 — Closing & Contact Info Books, courses, and upcoming lectures worldwide. LINKS: Airway videos: https://www.youtube.com/watch?v=3h0JgmmLj_Q&ab_channel=TMJ%26SleepTherapyCentre Dr. Ramirez’ website: https://www.kidsmalocclusions.com/ Pediatric Airway-focused Myofunctional Orthodontics: https://a.co/d/b1wQhD9 Dr. DeLuke’s Early Treatment Course: https://theorthocoach.com/courses/phase-i-arch-development/?portfolioCats=99
In this episode, I sit down with Dr. Julia Sadove-Lopez - a dentist, parent advocate, and founder of Oris Wellness - to explore a side of pediatric airway health we haven't covered enough on this show: what it's actually like for the parents trying to navigate it.
In this powerful episode, I sit down with Melissa Methven - a former flight attendant turned dental hygienist, widow, author, and breathwork facilitator - to discuss the hidden mental health crisis in dentistry. Melissa shares the story of her husband Scott, a beloved dentist in Wasilla, Alaska, who died by suicide in March 2022 after years of suppressing the pressures of the profession: student debt, perfectionism, emotional labor with patients, chronic pain, and escalating substance use. Melissa opens up about her own suppression and the physical toll it took on her body, the signs she wishes she'd seen sooner, and how she found healing through community, faith, and breathwork. She also reads from her book The Truth Behind the Smiles and offers actionable solutions for dental schools, including mental health education, peer communities, and a dental-specific crisis hotline. This is a raw, important conversation about breaking the silence around depression and suicide in the dental profession, and the hope that comes from living your truth. Timestamps: 0:00 — Introduction & Content Warning 2:41 — Welcoming Melissa & Scott's Story 3:50 — The Pressures of Dentistry & Early Signs 9:33 — Hiding Behind the Smile & Physical Symptoms 13:28 — The Common Dental Struggle 16:19 — Why We Suppress — Roots & The Perfect Illusion 19:51 — Scott's Fear & Writing the Book 25:30 — Feeling Stuck, Faith & Moving Forward 34:50 — Faith vs. Religion & Signs from Beyond 42:41 — Dental Statistics & Solutions for the Profession 47:15 — Tools for Healing & Helping the Kids 57:59 — Being of Service, Fulfillment & Closing 73:06 — Outro LINKS To Purchase Melissa’s Book: https://a.co/d/8nYzyTO Melissa on FB: https://www.facebook.com/tremblaymel/ Melissa on IG: https://www.instagram.com/melissamethven/ Join The DOC Community on Facebook for more great content and discussions: https://www.facebook.com/share/g/1Cb9rkQVde/ Check out the DOC CE Courses: https://theorthocoach.com/ce-courses/ Website: theorthocoach.com YouTube: @theorthocoach Instagram: @theorthocoach
I'm excited to welcome Nicole Vento back to The DOC Podcast for the fourth installment of our five-part series with the Vento family on creating generational wealth. Nicole is a financial advisor, CPA, and CFP who leads the investment committee at her family's firm, and she brings a rare dual perspective with her CPA background combined with institutional trading experience at Goldman Sachs and J.P. Morgan Private Bank. In this episode, we dig deep into the investment and tax-efficiency side of wealth planning, breaking down retirement accounts, ETFs vs. mutual funds, estate planning, 529 plans, the student loan crisis, Trump accounts, charitable giving strategies, and the discipline and mindset it takes to achieve financial freedom. Whether you're just starting out or you've been building wealth for decades, Nicole delivers practical insights you can apply to your own financial journey. Be sure to pick up a copy of the Vento family's book, *The Generational Wealth Code*, linked in the show notes below. **Chapters & Timestamps:** - 0:30 — Episode Intro - 3:06 — Welcome Back, Nicole - 11:09 — Why You Need a Fiduciary - 16:50 — Understanding Retirement Accounts - 47:02 — ETFs vs. Mutual Funds: Tax Treatment - 54:46 — Estate Planning & Step-Up in Basis - 1:03:35 — Education Planning & 529 Plans - 1:10:05 — The Student Loan Crisis - 1:22:44 — Trump Accounts: A New Savings Vehicle - 1:27:36 — Charitable Giving Strategies - 1:33:11 — Discipline, Delayed Gratification & the Margin Mentality - 1:37:39 — Closing & Contact Info - 1:38:54 — Disclosure **Links & Resources:** The Generational Wealth Code: https://a.co/d/0iHwEITG Join The DOC Community on Facebook for more great content and discussions: https://www.facebook.com/share/g/1Cb9rkQVde/ Check out the DOC CE Courses: https://theorthocoach.com/ce-courses/ Connect w/Dr. Mike: Website: theorthocoach.com YouTube: @theorthocoach Instagram: @theorthocoach Connect w/Nicole: Web: Ventotaxandwealth.com Email: [email protected] Office: 718-980-9000
Dr. Bret Christensen is an Army veteran, orthodontist, and one of only five orthodontists in the country board-certified in sleep medicine through the American Sleep & Breathing Academy. He owns and operates Christensen Orthodontics with locations in Lewiston, Grangeville, and Moscow, Idaho. In this emotional and wide-ranging episode, Bret opens up about losing his son, surviving a widow-maker heart attack at 45, undergoing open-heart surgery and getting a pacemaker, all while transforming his practice from traditional extraction-based orthodontics to a data-driven, airway-focused approach. He shares thousands of patient records showing that skeletal expansion dramatically improves nasal airway volume, his discovery that toddlers as young as two-and-a-half can be treated, and why he believes the AAO is standing in the way of progress. Plus, a surprise visit from his granddaughter Everly - the child who changed everything. ⏱️ Timestamps / Chapters