Your nightly snoring has become a major sleep disturbance for you and other family members. But it may be more than an irritation — it could also be a sign of sleep apnea, a condition that increases your risk for life-threatening illnesses like high blood pressure or heart disease.
Sleep apnea most often occurs when the tongue or other soft tissues block the airway during sleep. The resulting lack of oxygen triggers the brain to wake the body to readjust the airway. This waking may only last a few seconds, but it can occur several times a night. Besides its long-term health effects, this constant waking through the night can result in irritability, drowsiness and brain fog during the day.
One of the best ways to treat sleep apnea is continuous positive airway pressure (CPAP) therapy. This requires an electric pump that supplies constant pressurized air to a face mask worn during sleep to keep the airway open. But although effective, many patients find a CPAP machine clumsy and uncomfortable to wear. That's why you may want to consider an option from your family dentist called oral appliance therapy (OAT).
An OAT device is a custom-made appliance that fits in the mouth like a sports mouthguard or orthodontic retainer. The majority of OAT appliances use tiny metal hinges to move the lower jaw and tongue forward to make the airway larger, thus improving air flow. Another version works by holding the tongue away from the back of the throat, either by holding the tongue forward like a tongue depressor or with a small compartment fitted around the tongue that holds it back with suction.
Before considering an OAT appliance, your dentist may refer you to a sleep specialist to confirm you have sleep apnea through laboratory or home testing. If you do and you meet other criteria, you could benefit from an OAT appliance. There may be other factors to consider, though, so be sure to discuss your options with your dentist or physician to find the right solution for a better night's sleep.
If you would like more information on sleep apnea treatments, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Appliances for Sleep Apnea.”
Magician Michael Grandinetti mystifies and astonishes audiences with his sleight of hand and mastery of illusion. But when he initially steps onto the stage, it’s his smile that grabs the attention. “The first thing… that an audience notices is your smile; it’s what really connects you as a person to them,” Michael told an interviewer.
He attributes his audience-pleasing smile to several years of orthodontic treatment as a teenager to straighten misaligned teeth, plus a lifetime of good oral care. “I’m so thankful that I did it,” he said about wearing orthodontic braces. “It was so beneficial. And… looking at the path I’ve chosen, it was life-changing.”
Orthodontics — the dental subspecialty focused on treating malocclusions (literally “bad bites”) — can indeed make life-changing improvements. Properly positioned teeth are integral to the aesthetics of any smile, and a smile that’s pleasing to look at boosts confidence and self-esteem and makes a terrific first impression. Studies have even linked having an attractive smile with greater professional success.
There can also be functional benefits such as improved biting/chewing and speech, and reduced strain on jaw muscles and joints. Additionally, well-aligned teeth are easier to clean and less likely to trap food particles that can lead to decay.
The Science Behind the Magic
There are more options than ever for correcting bites, but all capitalize on the fact that teeth are suspended in individual jawbone sockets by elastic periodontal ligaments that enable them to move. Orthodontic appliances (commonly called braces or clear aligners) place light, controlled forces on teeth in a calculated fashion to move them into their new desired alignment.
The “gold standard” in orthodontic treatment remains the orthodontic band for posterior (back) teeth and the bonded bracket for front teeth. Thin, flexible wires threaded through the brackets create the light forces needed for repositioning. Traditionally the brackets have been made of metal, but for those concerned about the aesthetics, they can also be made out of a clear material. Lingual braces, which are bonded to the back of teeth instead of the front, are another less visible option. The most discrete appliance is the removable clear aligner, which consists of a progression of custom-made clear trays that reposition teeth incrementally.
How’s that for a disappearing act?!
If you would like more information about orthodontic treatment please contact us or schedule an appointment for a consultation. You can also learn more about the subject by reading the Dear Doctor magazine article “The Magic of Orthodontics.”
Dental implants are widely considered by both dentists and patients as the premier choice for replacing missing teeth. Unfortunately, implants aren’t the appropriate choice for teenagers with missing teeth.
That’s because their jaws won’t fully finish most of their growth and development until early adulthood. An implant placed too early could become misaligned as the jaw matures. The best approach for a teenager is a temporary restoration until they’re old enough for an implant.
There are a couple of good options. One is a removable partial denture (RPD), prosthetic (false) teeth set in an acrylic base that mimics gum tissue at the locations of the missing teeth. RPDs, which stay in place by way of metal clips that fit over other teeth, are easy to wear and maintain.
On the downside, an RPD can break if you bite into something too hard. They can lose their fit and may need to be replaced with a new one. And, some teens aren’t quite keen on wearing a “denture.”
Another option is a bonded or Maryland bridge, a kind of fixed bridge. We bond dental material to the back of a prosthetic tooth with portions of the material extending out from either side of it.Â We then bond these extending tabs to the back of the teeth on either side of the prosthetic tooth to hold it in place. Unlike traditional bridges, we can eventually remove it without any permanent alterations to the teeth it’s attached to.
Before we undertake a bonded bridge, though, we must make sure the gums and bone of the surrounding teeth are free from periodontal (gum) disease and are healthy and strong enough to support the bridge. We also need to be sure the patient doesn’t have a deep bite or a teeth grinding habit, which could cause the teeth to make contact with the tabs and break them.
The patient also needs the maturity to responsibly perform diligent oral hygiene: this type of bridge has a tendency to build up disease-causing plaque, so brushing twice and flossing once every day is critical. Not doing so increases the risk of tooth decay or periodontal (gum) disease, which could complicate a future implant.
We can discuss these options after a thorough dental examination of your teenager. Either way, we’ll be able to restore your teen’s smile until we can undertake a more permanent restoration.
Are bleeding gums something you should be concerned about? Dear Doctor magazine recently posed that question to Dr. Travis Stork, an emergency room physician and host of the syndicated TV show The Doctors. He answered with two questions of his own: “If you started bleeding from your eyeball, would you seek medical attention?” Needless to say, most everyone would. “So,” he asked, “why is it that when we bleed all the time when we floss that we think it’s no big deal?” As it turns out, that’s an excellent question — and one that’s often misunderstood.
First of all, let’s clarify what we mean by “bleeding all the time.” As many as 90 percent of people occasionally experience bleeding gums when they clean their teeth — particularly if they don’t do it often, or are just starting a flossing routine. But if your gums bleed regularly when you brush or floss, it almost certainly means there’s a problem. Many think bleeding gums is a sign they are brushing too hard; this is possible, but unlikely. It’s much more probable that irritated and bleeding gums are a sign of periodontal (gum) disease.
How common is this malady? According to the U.S. Centers for Disease Control, nearly half of allÂ Americans over age 30 have mild, moderate or severe gum disease — and that number increases to 70.1 percent for those over 65! Periodontal disease can occur when a bacteria-rich biofilm in the mouth (also called plaque) is allowed to build up on tooth and gum surfaces. Plaque causes the gums to become inflamed, as the immune system responds to the bacteria. Eventually, this can cause gum tissue to pull away from the teeth, forming bacteria-filled “pockets” under the gum surface. If left untreated, it can lead to more serious infection, and even tooth loss.
What should you do if your gums bleed regularly when brushing or flossing? The first step is to come in for a thorough examination. In combination with a regular oral exam (and possibly x-rays or other diagnostic tests), a simple (and painless) instrument called a periodontal probe can be used to determine how far any periodontal disease may have progressed. Armed with this information, we can determine the most effective way to fight the battle against gum disease.
Above all, don’t wait too long to come in for an exam! As Dr. Stork notes, bleeding gums are “a sign that things aren’t quite right.” Â If you would like more information about bleeding gums, please contact us or schedule an appointment. You can read more in the Dear Doctor magazine article “Bleeding Gums.” You can read the entire interview with Dr. Travis Stork in Dear Doctor magazine.
The various structures in your mouth — your teeth and gums, of course, as well as periodontal tissues that hold teeth in place within the jaw — all function together to create your smile. This includes muscles like the frenum, a fold of muscle tissue that connects the gums to the upper lip, which helps pull the lip upward when you smile.
Unfortunately, an overly large frenum could contribute to an unattractive space between your two upper front teeth. The problem occurs when the frenum grows beyond its normal range and runs between the front teeth to connect with the gums behind them at the forefront of the roof of your mouth. The resulting space that may develop can be closed with orthodontics, but unless the excess frenum tissue is addressed the space may eventually reopen.
The frenum is just one cause among many for a noticeably wide space, including bite problems (malocclusions), finger-sucking habits or missing teeth. We would, therefore, need to examine your mouth to determine the exact cause before beginning any treatment. If indeed the frenum is the source of the problem, it will be necessary to ultimately remove the excess portion through a procedure known as a frenectomy.
A frenectomy is a minor surgical procedure performed by a periodontist, oral surgeon or a general dentist with surgical training. After numbing the area with local anesthesia, the tissue behind the teeth is dissected or reduced in size with a small scalpel or a surgical laser. The wound is then closed with a few stitches; any post-surgical discomfort is usually minimal and managed with non-steroidal anti-inflammatory pain medication. The wound will completely heal within a few weeks.
Most frenectomies are performed after orthodontics to close the space. Removing it prior to tooth movement may result in scar tissue that prevents the space from closing. It’s also easier for the surgeon to gauge how much tissue to remove after space closure to avoid removing too much, which can leave a “black” triangular hole where gum tissue should normally be.
Treating an abnormally large frenum isn’t difficult, but it needs to be coordinated with orthodontic treatment for the best outcome. The end result is a smile that’s both healthy and attractive.
If you would like more information on teeth spacing problems, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Space between Front Teeth.”
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