The Chris Voss Show - The Chris Voss Show Podcast – The MARPE Advantage: Your Essential FAQ Guide to Skeletal Expansion, Airway Health, and Increasing your Clinical Value Kindle Edition by Dr. Jeremy Manuele

Episode Date: June 6, 2025

The MARPE Advantage: Your Essential FAQ Guide to Skeletal Expansion, Airway Health, and Increasing your Clinical Value Kindle Edition by Dr. Jeremy Manuele Amazon.com Vegasorthodoc.com The One Book Every Airway-Focused Provider Needs to Read—Before Offering MARPE! Are you ready to confidently treat narrow arches, airway issues, and skeletal discrepancies—without surgery? The MARPE Advantage is your go-to FAQ guide for mastering Mini-Implant Assisted Rapid Palatal Expansion (MARPE), one of the most powerful non-surgical tools in modern orthodontics. Whether you’re a general dentist, orthodontist, oral surgeon, periodontist, pediatric dentist, or airway-focused provider, this book gives you a clear roadmap to offer skeletal expansion with clinical clarity, greater predictability, and life-changing outcomes. Written in an easy-to-follow FAQ format by board certified orthodontist and airway advocate Dr. Jeremy Manuele, this guide answers the real questions providers face when considering MARPE—from how it works and who it’s for to how to avoid complications and build team alignment. You’ll discover: · The science behind MARPE and how it compares to traditional RPE and jaw surgery · How to identify ideal candidates using CBCT imaging and skeletal maturity · The biggest myths that hold providers back—and the facts that set you free · How to communicate the benefits to your team and your patients · Real case examples, clinical troubleshooting tips, and workflow strategies for success Whether you’re just learning about MARPE or ready to elevate your treatment protocols, this book provides the knowledge and confidence to make skeletal expansion a valuable part of your airway-focused care model.

You wanted the best. You've got the best podcast, the hottest podcast in the world. The Chris Voss Show, the preeminent podcast with guests so smart you may experience serious brain bleed. The CEOs, authors, thought leaders, visionaries and motivators. Get ready, get ready, strap yourself in. Keep your hands, arms, and legs inside the vehicle at all times. Cause you're about to go on a monster education rollercoaster

with your brain. Now, here's your host, Chris Voss. Hi, this is Voss here from the Chris Voss Show.com. Oh, still wasn't a big show. That voice of mine is getting kind of high there, man. I might want to back off the Michael Jackson rubber bands. Anyway, guys, welcome to the big show. As always for 16 years, 24 episodes, we've been bringing the Chris Voss show and you've

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solely their own and do not necessarily reflect the opinions of the host or the Chris Foss show. Some guests of the show may be advertising on the podcast, but it is not an endorsement or review of any kind. We have an amazing young man on the show. He is the author of the new book called The Marpie Advantage. Did I get it? Nailed it. The Marpie Adv? Nailed it. Yeah. The more the Marpy advantage, your essential fact. Wait. FAQ. Yep. I kind of pulled a fact.

Did you hear the 10 T come in there? Yeah. You know, acronym FAQ. Fact. You know, it sort of fits in the fall part. I guess. I want to get it right here. So we'll edit that out.

So he's the author of the latest book called the Marpy advantage. Your essential fat guide to skeletal expansion, airway health, and increasing your clinical value by Dr. Jeremy men welly, and we're going to talk to him about some of the interesting things, maybe how you can sleep better, live better, do better, and he'll change your life and you'll be six inches taller. I don't know what that would be. I just making up stuff at this point. That's not going to happen.

The attorney said scratch that. Dr. Manuele is the Vegas ortho doc. You've probably seen him on YouTube. He is not your typical orthodontist. He is a board certified specialist in orthodontics and dento facial orthopedics. Or yes. Wow.

I just learned a new word. Dento facial watch for the only fans. facial orthopedics or yes, wow. I just learned a new word, dental facial. Watch for the only fans. Dr. Manuele is the, at the forefront of re-inviting how we think about breathing, facial development and their profound connection to health and performance, especially in kids and adults who are silently suffering from airway related issues.

Welcome to the show, Jeremy. How are you? Doing well. Thanks for having me, Chris. Glad to be here. Jeremy, how are you? Doing well. Thanks for having me, Chris. Glad to be here. I learned a new word today. Dental facial.

Dental facial. Yeah. Kind of where the bones and teeth interact and meet. Yep. That's it. Well, that sounds like my school. Yeah.

I'm going to, I'm going to start messing with people. I'm going to have Starbucks whenever coffee and they're going to be, what's your name put on the cup there and it'll be dental facial. Yeah. All right. I love it. Jeremy, we're going to be, what's your name? Put on the cup there and it'll be dental facial. Yeah. They'll love it. Jeremy, we're going to share the look. So Jeremy, tell us your dot coms. Where do you want people to find you on the interwebs?

Sure. Yeah. Best place to find me is at Vegas ortho doc.com. And from there you can get everywhere else. Yeah. There you go. So do you help install casino machines in people's mouths? Is that how that works? Or what? I just on my spare time, you know, trying to keep my day job, but you know, we'll see. Do you make it so you can go up to their jaw and you can pull like a lever and it comes down and

goes, jean jean jean jean. And that's the technique right there. Yeah. You explained it perfectly. I guess we can stop there. You know, those folks get the grill like everybody, those rappers, the grill, you can have a casino grill lights up and noise. Yeah. You can win a grill at the casino. Yeah. Check it for, make sure you wash it. So anyway, Jeremy, give us a 30,000 overview. What's inside your new book.

Sure. Yeah. So this new book is actually specific tailored to practicing dentists, orthodontists and other dental specialists who want to learn more about non-surgical adult palate expansion. So it essentially helps to teach them the techniques behind adult palate expansion, why you would do it, how you incorporate it into your practice, and a lot of the physiology behind the benefits of having your upper jaw expanded in an adult if you're having struggles. Pete Slauson Why does it seem, I'm feeling a little bit

of pain when I think about this. Dr. Ben Houdini Oh, yeah. Pete Slauson You know, Dr. Ben Houdini Yeah, no, it's a new concept, right? You know, 20 years ago, the only way to change an adult jaw would be through some form of jaw surgery. And that was sort of the way that it was done. And you have a longer recovery, the risks are higher. A lot of times you're in the hospital. So non-surgical expansion for adults really started to come out about 10 to 15 years ago, it was being developed, but only about five years ago did the imaging

and the planning ability and also the appliances that we're able to use for that, where they really refined. And at that point we were able to predictably get upper jaws and males, females, non-growing patients, adults expanded. The oldest adult that I've expanded is about 71 years old. We expand all ages if their upper jaw is small and if it's going to benefit them. Wow. It's the upper jaw. That seems, you know, I can see on my lower jaw might be easy to be expanded because it's kind of hanging there, but the upper jaw is That seems, you know, I can see how my lower jaw might be easy to be expanded because it's kind of hanging there, but the upper jaw is kind of attached to my skull.

Last time I checked. Exactly. Yeah. It's a fascinating process. Yeah. So the lower jaw is actually one bone. So after birth, it's one bone. So you can't really expand the lower jaw unless you do some form of surgery to cut it and

make it two bones. Then you can, then you can expand it. But the upper jaw is naturally two bones. And so when you expand the upper jaw, the two halves of the top jaw separate, you get a little gap between your front teeth and everything else that's attached to your skull actually bends. And so as your jaw is widening, all of the other bones in the face are actually bending

out. And that's how you get to the benefits of the nasal breathing. So the upper jaw bone itself is actually the floor of the nasal cavity. So as you're expanding the upper jaw, the nasal cavity is widening and air can pass through it more easily. Boy, that sounds like one of the worst hangovers I've ever had. I think I've had that hangover. Just overnight, and in Vegas, by the way.

Having anything in your mouth, but for sure. Yeah. Yeah. After a night in Vegas down at the Spirit Rhino, I'm not sure what that means. Anyway, kicking back that wild turkey, J.D., those were the bygone days. This is pretty interesting. So who does this help as a consumer out there? Who are the people that this benefits, or are you just doing this for fun? consumer out there, who are the people that this benefits or you just doing this for fun? Yeah, mostly for fun, but there really are subsets of patients that this helps. So there's three reasons that people seek this out. So one is that they can't breathe or they can't sleep. So they can't get air in through their nose or they're sleeping, they're waking up tired, they're waking

up multiple times during the night, they're having apnea events. And so that's one subset of patients who will seek out maxillary expansion as an alternative to things like CPAP or jaw surgery or other things they either don't want or can't tolerate. Pete Slauson So, this can help with the CPAP people that wear the Darth Vader mask at night and shit? Dr. Ben Pratt That's correct. It definitely can help. It's more nuanced than that, right? Not all sleep disorder breathing, not all sleep apnea is the same, but certainly if the sleep apnea is being caused by your inability to breathe through your nose, then it's going to improve and or sometimes even cure that via expansion. So that's

one subset is- Can it replace the CPAP maybe in some cases? In some cases it can. I would say mild to moderate. A lot of times it can replace the CPAP completely. More severe CPAP is it's typically going to reduce your reliance on the CPAP and or allow you to lower your pressures and or you know possibly you can manage it with more like a mandibular appliance or something else that's more comfortable. A mandibular appliance? Yeah, yeah. Like just go over something in your mouth? What's going on there? Yeah, so the mandibular appliances what they do is they move the lower jaw forward And so the lower jaw is attached to the tongue and everything else comes forward with it So when you bite into the appliance your lower jaw is artificially moved forward and that can open up your airway and help you

Sleep and so a lot of patients who can't or won't tolerate CPAP will do mandibular advancing appliances for that reason. I think we've got some people on the show that have done that. They make the mouthpieces stuff and they talked about it, but I was kind of like, I don't know. I'm not a real fan of putting stuff in my mouth while I'm sleeping because I'm paranoid I might swallow it. Yeah, you know, obviously you have to make sure that it's fabricated correctly. Have you ever met anybody that swallowed anything while they sleep? I mean, I don't know. I heard this. I think it's fabricated correctly. Have you ever met anybody that swallowed anything while they sleep? I mean, I don't know. I heard this. I think it's a conspiracy theory, but people eat 500 spiders with their mouth open when they're asleep in their lifetime or something. I don't

know if it's true. So besides the spiders, I mean, by and large, people don't swallow things very often when they sleep because the body's natural reflex to spit things out of the mouth typically happens whether you're awake or not. But you do definitely want to make sure you don't because the body's natural reflex to spit things out of the mouth typically happens whether you're awake or not. But you know, you do definitely want to make sure you don't have little pieces flying around in your mouth. I mean, you've aspirated things like that. So make sure you have if you do an appliance, make sure you do go to somebody that knows what they're doing with those. I don't make sleep appliances. Again, we focus more on

the underlying cause of the anatomy and the soul. But there are great practitioners out there who do sleep appliances and you'll want to make sure you go to somebody who knows what they're doing when it comes to those. I can't get his home Depot sleep appliance. Yeah, you know, I think give it a shot, you know, a couple of two by four, some screws probably be all right. You're giving me a whole mess of content to go screw with people.

I can fuck up Starbucks now and then I can go to home Depot. Which isles the mandibula appliance on? Uh, What is that? I think it's an air conditioner. It's air conditioner for your mouth. Some people need that too. So this is kind of a newer technology. That's probably why a lot of people haven't heard from this, just to clarify that. Because I was a two-wear this stuff when I started hearing about it. Like I said, we have people in the show. I was just like, yeah, that seems kind of been a new. Yeah. You know, it's interesting because I think part of it is the more people become educated about breathing and how that relates to their sleep and their overall health, then they start to seek out solutions for those issues that

they may be experiencing. So yes, not very well known in the community at large. It's becoming increasingly more well known within the dental community as more and more practitioners are jumping on board and treating cases and publishing their results. It's now catching wind, especially in orthodontics and general dentistry, a little bit in surgery, oral surgery as well. You know, I just want to get that top area to separate so I can have that cool space in my teeth. Like David Letterman fan. Yeah. Yeah. Plus you can whistle through it, right? You know, a little practice and pretty good. Yeah. Didn't the one, the gentleman who's a football player, he has a little list too. I think he's on good morning America. He has that kind of too. I think he had a list to work on. But he's a great guy. Yeah. He has a lot of stuff to follow and match and you can make the gap that size.

Now if I just master Letterman's beard he wears nowadays, that thing is fucking epic. It's like something from Rumpelstiltskin, Sleeping? Is that the one? Drive the Right Fable? I don't know. So we talked before the show, I've had TMJ on my life. There was a time where it was really bad. Like I could sit and pop it and hit big noise across the room. And, you know, it had its own zip code and phone number.

It seems to have calmed down in my old age, but still there, there's a huge lump there. And, you know, it kind of pumps, it pops, but I don't mess with it. I leave it alone. It seems to leave me alone for the most part. But, you know, I do, I'm a big guy and I do, I've been told that I snore very loudly. And my mom says, you need to get Darth Vader mask thing. And she doesn't sleep well and she has it. So no one I've ever met. When you get them to be honest, they tell you, they still sleep well.

And it's kind of like people who sell you an MLM. I think that's how I feel about it. I'm just not shaming anybody or shitting on it, but it does of like people who sell you an MLM. I think that's how I feel about it. I'm just, I'm just, I'm not shaming anybody or shitting on it, but it does feel like people are selling me an MLM when they sell it. When you look at the data on CPAP, typically it's about 50% compliance. So you get about half of the people out there that will stick with it. And then the other half, just for whatever reason, you know, either it doesn't work on them or they just can't. I had a friend who paid all the money to get the CPAP in his chest. Jared Larkin Yeah.

Pete Slauson He was like 30 grand or some crap. Jared Larkin Okay. Pete Slauson And yeah, he doesn't even use it. It doesn't work for him very well. Jared Larkin Interesting. Pete Slauson And I'm just like, that's in your body now. Jared Larkin Yeah. Pete Slauson That's kind of like putting Neuralink in your stuff from some guy who's heavily addicted to ketamine. It's, what is it? What day is it? It's five 30, 2025.

And the Washington Post is reporting about a severe ketamine addiction of a certain number one billionaire. That's where the joke reference comes from. You'll have to Google it. Anyway, we mentioned, so this can help my TMJ or people that have TMJ. I know people that have surgery for it. Yeah, so that's kind of the next big subset

of patients who seek this out is patients who are seeking functional improvements. So TMJ is one of the functional improvements that you can achieve with this. Also just getting the teeth to fit together. So some people teeth can't fit together properly because their upper jaw is too small and their teeth end up hitting on top of each other. They end up breaking them down, eating crowns, root canals, all those types of treatments. Are those the people I've seen where sometimes their teeth are kind of offset? You can see that the, the one, you know, every other tooth is behind

the other one a little bit. Yeah. Crowding. Yeah. Yeah. Yep. Yeah. So when the teeth are crowded, they don't fit together either.

And if they're crowded because the upper jaw is too small, we can widen it. And that's going to make more space within the upper jaw. It's going to start out between the front teeth, but then we're going to use that space, move the teeth into it. Of course you finish without a gap in the teeth straight. But by expanding the upper jaw, you can get the function better. So you can get their teeth to actually fit together the way that they should. And that's the link back to the TMJ disorders. So if the bite is functional and your bite is not forcing your jaw to go into an unnatural position,

like many patients who have TMJ disorder, that's what's happening. Their teeth are pushing their jaw into an unnatural and uncomfortable position. And then that causes inflammation in the jaw joints, which translates to pain for many people. And so if we get the teeth to fit together, ideally, by starting with making the jaw ideal, then the TMJ is not having all that stress on it that it used to have.

And the symptoms can often go away completely. Wow. Yeah, there's a lot of times where I bite my tongue, man. I just about, I've just about bit it off sometimes. And I'm like, I'm 57 and I haven't learned to fucking chew yet. Like, and maybe that's from that, I guess. No, it's yeah. If your, if your teeth are making your jaw go somewhere unnatural, it can be very, very uncomfortable. So every time you put them together, it can be, you know, that inflammation starts to happen. Then your bite shifts further and it becomes a very painful and sometimes progressive problem. Pete Slauson

And here, I just thought I was going the wrong glory holes. Anyway, it's Vegas jokes. I don't know what that means. But you can find it in Eastern and Sunset jokes. So, I noticed on the thing, it talks about how it can, it can, where was it? I saw it. It can improve your smile, I think it was. Jared Slauson Yeah. So, that's the third big reason why people seek this out. If they feel like one of two things, a, if they feel like their smile is narrow and they want a more broad smile, then they'll seek out this treatment.

And then also if they feel like they're not showing enough of their teeth, like when they smile, if they're not showing all their teeth, or they want to show more of their teeth, then as we expand, the teeth will drop down a little bit and so it can improve how much of the teeth that you show as well. Pete Wow. That's really, I mean, that's wild. I had no idea. I thought this was pretty locked in up here. And I thought if you're going to do any, I've seen those natives, you know, and you ever seen that where they, I think they do something to their lower jaw and it like, it will hang down and expand there in Africa. And, or they, you know, they do, I think they do something to their lower jaw and it like will hang down and expand there in Africa. And are they, you know, they do, I think they do something with their jaw. Maybe it's the upper jaw, but no, I think it's usually hanging out there and then you just look at it and you're

like, you can't close that thing. I mean, that's, you must snore like a, one thing you talk about, is it normal for children to snore? That seems a little bit odd that they would snore at that young age because, you know, they're not overweight yet. Yeah, you know, a lot of parents think that snoring in children is normal, but it's really not and it's typically a warning sign for that there may be something else going on. I am a huge advocate of getting kids tested. Doing a sleep test, you can either go to a sleep center and do that or even just doing more of the ones that you can do at home. But getting some information if your child is snoring consistently. You can either go to a sleep center and do that, or even just doing more of the ones that you can do at home. But getting some information

if your child is snoring consistently. With snoring, it's indicative of some sort of airway obstruction, whether that's the tongue, the tonsils, the adenoids, something caused by the jaw size itself. There's something that's causing those tissues to vibrate and snore. And when you're a child, the tissues should be nice and firm and healthy.

There shouldn't be anything wrong with them. They don't get saggy like they do in adults. So if you're snoring as a child, that's only going to get worse as you age if it's not addressed. Pete Slauson Now, I know that effects on the brain of lack of oxygen, I've seen people on Twitter. And also just not getting sleep can deregulate, you know, if I don't get my sleep, man, there's murdering that's going

to take place. The judges won't do it anymore. Exactly. And you won't apply that with the kids, right? I mean, so a lot of parents whose kids get diagnosed with ADHD actually have sleep disorder breathing. They did a study and they took this group of kids that was diagnosed with ADHD and on stimulants and they also had large tonsils and adenoids. And so they sent them to get their tonsils and adenoids out and then they were retested for the ADHD criteria

and almost half of them didn't meet the criteria anymore. And yeah, exactly. And as you know, ADHD is a brain thing. It doesn't like just go away. So what happened was they were actually misdiagnosed. They had sleep disorder breathing. But the symptoms are the same. If you look at the symptoms of an ADHD kid, they're very similar to the symptoms of a really tired kid. And you know, that's one of the first things that I always like to recommend as well

when I have patients come in, and they report a history of ADHD ADHD or they're on stimulants or other ADHD medications, that's the first thing I'm going to ask them is if they've ever gotten a sleep study. I don't rule out any problems that there may be with the sleep. Can it help you if you have meth teeth, you know, get those teeth brought together? Yeah, you know, we got people for that. Get off the meth first folks. So what else do we know about this technology? I guess it's fairly safe and FDA recommended, is that the people who give our site? Yeah, so basically adult, a pallet expansion in general, the younger you are, the easier

it is to do. So we'll expand, sometimes kids as young as four or five, if they're having documented sleep problems, most patients, if they need expansion and we see them early enough, we'll expand them around the age of seven. And you can use traditional type expanders all the way up to the child's 12, 13, 14, maybe even 15. But the older you get,

the less these expanders work in moving the bones. So as you continue to grow and your bones are firming up, it gets more and more difficult to actually separate the bones when you expand. So you might put a normal expander in a 16 year old, let's say, and you might turn that expander and you might see the teeth move out, but it's gonna be very difficult to get the actual bones,

the two bones to move apart, get the gap between the teeth and actually get the upper jaw wider. Starting in the teenage years and then going all the way into adulthood, that's when we start to add what are called temporary mini implants or micro implants into the jaw to support the expansion. So in addition to the expander connecting to the teeth,

there are many implants and depending on how old you are and what your bone looks like, depends on how many of those you need, that anchors the expander to the jaw itself, which allows for us to predictably open and widen that jaw. Pete Now, what does this thing look like? I can see something on the cover of the book that looks like it's inside the mouth. Jared That's exactly what it looks like. Pete Okay. So, for people that are listening, because most

people consume it through the thing is what is this sort of contraption you've got in your mouth? You only use it when you sleep or you walk around with your day like braces or something or what's going on there? Yeah. So the expander is fixed in your mouth typically for about six to nine months, depending on how much inside the mouth. Yes. For about six to nine months, depending on inside the mouth. Yes. For about six to nine months, depending on how much expansion is needed. So there's, there's a portion of it with most of these expanders that connects to the teeth. And then there's a portion of it that connects to the bone via little temporary mini implants. And so those implants are placed at the same time the expander is placed. Of course you're numb for that procedure. It's an in-office

procedure. You're not in-office procedure. You're not sedated or there's no, there's no like general anesthesia. What if you really want gas though? You know, that good gas. You'd have to, you'd have to go to somebody else to get those placed then. Yeah. So again, like super high anxiety and you wanted the gas or you wanted, if you wanted to be sedated for it, there are practitioners that can, you know,

that can place the implants under anesthesia, but I don't do that. I'm just coming for the gas. Yeah, just the gas. Yeah. I think you can buy it online now. And you said six months, you might have to wear it. Six months, yeah. So there's an adjustment period in the beginning. Most adults are not used to having anything in their mouth full time. And so when you have the expander, sometimes it's a little bit different learning how to speak again with it, you know, swallowing, you have to learn all these patterns over again, typically about the first week or so is when patients will go through that

adjustment period and relearn those things. I'm gonna have to go on your website and see what this looks like in the mouth. Because I mean, yeah, it looks, I mean, from the, it looks like from the cover of the book, it's, it's in there and kind of springy, springy, stretchy loaded. And it looks like one of those, I don't know, compression outward things. And, you know, it looks like big enough to where, you know, it might be hard to eat or something. I'm not sure I want a girlfriend to have this. Yeah. You know, it's an adjustment, right? So like chewing the food, moving it all around. Yeah. All those things you have to adjust to for sure. If you Google custom Marpe, so custom M A R P E, you can get some visuals of

what it looks like in the mouth. And then there are some on my website as well. If you scroll down, I got an only fans up. Uh, let's see. I don't know. Oh, wow. Holy crap. Whoa.

That's a piece of steel there. It is 3d printed. Holy. Holy moly. Wow. It looks like alien took over the inside of someone's mouth and exactly has implants in there. Wow. But I guess, Hey man, if it works, then it works. Is insurance cover this sort of thing? How does that work? Yeah. So typically with orthodontic insurance, there's a limited benefit to what you have, you know, a thousand, 2000, 3000. So whatever your benefit is, uh, you'll get it, uh, you know, toward your treatment overall. So it helps. I might have nightmares of what I just saw in the freaking, cause there's two people,

they got their mouth like why? So you got to search another term now since you're Googling. So search, search jaw surgery. Yeah. Search jaw surgery. Oh, is this going to be, I'm one of those bad blood guys. And if I see blood, I start passing out. All right. Maybe don't then, but yeah, when you compare what that looks like to, you

know, it becomes a lot easier to digest and sell. I just imagine my first 10 divorces and I think that's painful enough as it is as a reference point. So let's talk about what else, and now, so this book is targeted towards other orthopedic people in the business. Other orthodontists, other dental dentists. Get up to speed on the technology as it were. Correct. Yeah. So again, it's still relatively unknown and less well known in the dental

industry because there's not a lot of people out there who have sought out the training to do that. They're not training for these things in residency or in the dental training. So you're not getting any education on it. So if you want to learn about it, you have to basically attend additional training. So one of the things that I have is an online course for dentists. It's about eight hours long and it goes through the physiology behind it. How wide do you want the jaw? How do you measure it on the x-rays?

And then it goes through the appliance design. How do you design the appliance to achieve that? It also goes through the airway physiology. So why does it through the airway physiology. So why does it improve the airway? How can you know by looking at the imaging and asking the right questions if it is going to improve your airway and sleep? So all of that's covered in the course and the book is a supplement that helps. It basically allows you to understand some of the things that are in the course at a more rudimentary level.

Yeah. Yeah. Well, it's interesting. I suppose it can add some revenue stream to the thing. some of the things that are in the course at a more rudimentary level. Hmm. Yeah. Well, it's, it's interesting. And I suppose it can add some revenue stream to the thing. I think the book implies, you know, it can give people things, but you know, the more options you can have, like I said, that's a, everyone always tries to, like an MLM, get me to join the, the Darth Vader mask, a sleeping group. And I'm just not sold on it.

I've met too many people. At first they start talking to you and you're like, hey, so this is an MLM, right? And they're like, no, you'll be able to sleep like a baby. I sleep good all the time. And then you start hanging out with them and they're like, oh man, I can't sleep last night. I'm like, I thought you had a paid mask.

And they're like, I don't know, five people in my downline. You're like, I know, like, ah, I see what's going on here. So. Have you ever had a sleep study? Have you ever actually gone in and- No. I sleep like shit. I don't have to study it. Hey, you know had a sleep study? Have you ever actually gone in and sleep like shit?

I don't have to study it. Hey, you know how to sleep good in my world? Edibles. Or if you don't, you'll, you know, you'll forget about it or not care. One of the two, right? I can't feel my legs, but no, you do. If you want to sleep good, edibles are good. But you know what? Sometimes after years, they didn't work as good. You got to take 500 of them or something. I don't know. Don't do that folks. This is a joke. Texas has a warranty too now. I just saw that going. What else do we need to know about this? Or do we want to talk maybe about some of the offerings that you have at your clinic there in Las Vegas? Dr. Ben Feroldi Yeah, for sure. Yeah, I know that pretty much sums it up. I mean, airway function,

anesthetics are kind of the three know that pretty much sums it up. I mean, airway function, anesthetics are kind of the three things that people look for with expansion. There's a lot of other information on the website you can get, vagusortho.com. I am in the process of writing a more patient focused book so that patients can read it. So hopefully by the end of this year, the beginning of next year, we'll have that out. I see where you're going there. You've got the patient book and then the patient will read the book and then go bugger their orthopedic doctor and then their doctor and then they'll be like, hey, you got to buy the other book for you.

Yeah. You'd be surprised at how many patients that we see that do that. They'll go and they'll try to find the local provider to do that for them. So one of the things we haven't talked about yet is, again, this is a fairly niche topic. So one of the things that I do is online consultations for patients seeking out this treatment specifically. And it's not necessarily for me to treat them. It's for them to have a good understanding on if they're actually a good candidate for this and why or why not. And what are the expected changes that would happen? What are the considerations with designing the appliance? So on Vegasortho.com, you can go to the get consultation,

fill in some information about what your situation is, what your struggles are, what you're looking to achieve with expansion, and then you'll send in all of your imaging, which you can obtain locally. And once we have the imaging, we'll go through and we'll dissect it and let you know, are you a good candidate? Yes or no.

Why or why not? What does the anatomy look like? What are the bones look like? What does the nasal passageways look like? Are there constrictions? Are the tonsils and adenoids enlarged? All those things. We'll go through that in detail and send you a video consultation about your case specifically, so that you can know if you're a good candidate or not.

If you are a good candidate, what are the things that you need to consider? How is it gonna affect your smile? How's it gonna affect your face? What are things gonna look like afterwards? All of these are questions that people have that are answered via those consultations So we've done them for people in Switzerland in Japan in Mexico in Canada All over the world who are learning about this procedure and then seeking out information about it. Well, yeah, I mean, sleep's a real important thing. It gets harder as you get older. What about people who have asthma? Does it help with people who have asthma?

Yeah, you know, asthma is very, very interesting. And so one of the root causes of asthma is what they call over breathing. And so here's a fun fact. Do you know how many people died of asthma before we had asthma medications? How many? Zero. So what happens is, and it's not funny, but what happens is when patients start taking asthma medication and it helps their symptoms, but it also makes them become more reliant on that medication. So if they don't have it and they have an asthmatic crisis, they can asphyxiate and essentially die. Thankfully that's common even today. But with asthma, one of the root causes is actually over breathing. And what I mean by over breathing, most commonly it's associated with mouth breathing. And so these patients are exhaling their carbon dioxide

at a higher rate than is normal. And if you exhale too much of it, it can trigger spasms due to the physiology that takes place when the carbon dioxide is lost that way. And so that's why one of the things that you may have always heard is that, if you have asthma, become a swimmer. And swimming is good for kids who have asthma.

The reason for that is not that they're breathing out of their mouth when they swim, it's that they're not breathing as much when they swim. And so with asthma specifically, if a child can't breathe through their nose, they're going to have to breathe through their mouth. And so if we expand them and allow them to breathe through their nose better, if they're nasal breathing, they are not going to be releasing the carbon dioxide at that higher level and over breathing, which is going to reduce their asthmatic symptoms. Pete Slauson Wow, man! I learned a lot today. You know, I know some people on Twitter that are over breathing and they should just stop permanently.

No, I'm just kidding. Maybe less, but I don't know. They might, they actually probably need more oxygen because clearly they haven't had enough oxygen, some of the ways they think. So what else do we need to talk about that you offer at your service there? Can this is something people have to come in for, right? I can't just order this off Amazon. That's correct. Yeah. And initially like depending on, you know, where they live, they'll have to find a provider that is, you know, that knows how to do this. So most orthodontists and dentists today either don't know about this or don't know how to do it.

And so you'll want to find somebody that has experience in expanding wherever you live. We do treat some patients from out of town or different places, but it really just depends on the complexity of the case and what you need orthodontically and whatnot. But I would say a lot of patients that we see for consultations online, we don't end up treating just because they would be better treated by a local orthodontist in their area. Here's an idea. You need to offer packages. So if you're in Vegas, I fly in, I stay at the Blasio and then I have have I don't know VIP at Spirit Rhino and then somewhere in there I get the surgery done and I just bill my insurance

for all of it. There you go, just loop it together. Illegal? Illegal? I don't know how to help. I can't remember the city outside of Vegas but nevermind. Yeah you can just write it off. You know you come in you do get a little blackjack, spend the kids' college fund,

and then you get your teeth fixed. So at least you got that going for you. Exactly. See, this is why they pay me $5 a day for this. Yeah, you got all the good ideas. The good ideas. Yeah, so other things that we do that are more unique, so one of the things that patients often know about, but don't know what to do about is

how much teeth they show when they smile. So you have some patients that show all of their teeth and some of their gums and sometimes even a lot of their gums. And they call that like a gummy smile. And so other patients, like when they smile, they only show their bottom teeth or they don't really show much of their top teeth at all. So those are kind of the two ends of the spectrum and depending on what you want your smile to look like, that can be adjusted orthodontically. So it used to be that in order to adjust that you would have to have some form of surgery where they would actually

break the upper jaw and move the whole thing either up higher or down lower. But now what we do is we use those same temporary mini implants that we use on the expanders, we place them other places, and we use those to anchor and actually either move all of the teeth up toward those pins or push them down away from the pins and change the amount of teeth that you show when you smile. Pete Wow. You know, I've seen some beautiful women that they'll have a smile and they're, I mean, they're beautiful women, but they'll, you'll see that gummy thing there and it can vary. But you know, it's, it's a, you know, you're just like, maybe you shouldn't smile so large

there, but that's great that that can be repaired. Yeah, that's awesome, man. I mean, I might start expanding my dating pool. Can the Oregon expansion work on other parts of the body asking for a friend? I'm not sure you want to put that much steel down there. So as we go out, give people your final pitch out, how can they reach out to you? How can they learn to know more? And of course, we're going to pick up the boat. You know, one of the, one of the things that I enjoy doing is providing a good evidence-based education. So if you go onto YouTube and you search Vegas OrthoDoc, there are a number of videos that

we post on all of the types of procedures that we're talking about today, but also a lot more about the science behind those procedures and why they are effective. And you can actually see on the imaging those things that we were talking about and discussing today. Additionally there are you know actually full-length lectures I do teaching at the dental school and so you can find like full-length videos as far as going through cases diagnosing and treatment planning these cases. You know if you're curious about it I mean obviously a lot of doctors watch those videos but we have a number of patients who really get into this and they want to see all the

videos as well. So, those are all there on Vegas OrthoDoc on YouTube. And then VegasOrthoDoc.com has the links for everything else that we have going on, specifically the online consultations. Any books that we drop will go there first and anything else related to expansion you can find on that website. I've learned a lot today and, and seen some pictures that will give me nightmares. So yeah, it's, I mean, that's, I don't know what to say about the whole thing, but thank

you very much for coming to the show. We really appreciate it, Jeremy. Of course. Thanks for having me, Chris. Thank you. And thanks so much for tuning in. Got the order of the book, wherever fine books are sold. It's called the Marpie advantage, your essential fact, fact guide to skeletal expansion, airway health,

and increasing your clinical value. I just want to go to fact on that with a T. F A Q, F A Q. Oh, yeah. F A Q. I don't know what's going on. It's Friday. Anyway, thanks for tuning in. Go to Goodreads.com, FortressCrisposs, LinkedIn.com, FortressCrispouse, CrispspouseOne, on the Tik Tok. And all those crazy places on the internet. Thanks for tuning in. Be good to each other.

Stay safe. We'll see you next time.