Getting some ZZZ’s: Beyond Teeth

I don’t snore… I just dream of being a motorcycle! Classic.

 

The more research that comes out, the more we are finding a link between sleep apnea and oral conditions. Basically, with a few simple questions and by looking in your mouth, I can screen you for sleep apnea!

We used to think that most Apnea patients are overweight middle age males that snore. We’re finding this is not the case. We see this a lot in kids (likely due to englarged tonsils) and females with perfectly healthy BMI’s! Consider Jenny, she is pretty much healthy and doesn’t snore, but she doesn’t feel like she sleeps particularly well, but doesn’t have time to be tired. She has her 2 cups of coffee in the morning and is always finding stuff to do and to work on. She’s stressed out because of how many things she has on her plate, but doesn’t want to stop them because otherwise she would finally realize how exhausted she really was if she wasn’t “kept busy”.

Consider Johnny, 8 year old kid with enlarged tonsils who also doesn’t sleep well. He snores, grinds his teeth at night, and sometimes gasps for air. He has night time urination, acts out in class, and his pediatrician thinks he should be on ADHD medicine because he can’t concentrate. Sound familiar?

 

I don’t have to tell you how big a deal sleep is! Yet we all take it for granted. If I told you that there was something you could change that would decrease your odds of a heart attack by 23:1 would you do it? Sleep apnea has a heart attack risk factor increase of exactly that much as compared to smoking which is only 11:1 or High Blood Pressure which is 8:1.

Additionally, there are some stats that say if you have uncontrolled high blood pressure even with medication, you have a 83% likelihood of having Sleep Apnea. The other big kicker is GERD, or gastric reflux. Having GERD means you a 60% likelihood of concurrently having Sleep Apnea.

How do we screen for sleep apnea? Well, for one there are some questions we can ask. Have you been told how much you snore? Are you often tired during the day? How likely are you to fall asleep while watching TV. Do you wake up tired? These can be flawed because watching golf will almost certainly put me to sleep =)

We then take a look at your airway to see how much constriction there is. The teeth can be very telling of apnea. The neat thing about our bodies is we are adaptable and of course we HAVE to breathe. So at the expense of our teeth and sleep, our body’s responses to apnea is a microarousal where we either move around during our sleep (causing fragmented or poor quality sleep) or we thrust our jaw in order to open the airway, this can cause a very particular pattern of wear on the teeth. We can also see changes to the tongue and the gums. Take for example, do you notice a difference between these two mouths?

 

With apnea the pressure in our abdomen changes which is why it increases our risk of having acid reflux and will secondarily cause frequent night time urination. Look at what reflux can do to our teeth!

If we see these risk factors, we will likely refer for a sleep study. An at home study can be prescribed as a further screening tool, but an in lab Polysomnograph is needed for a formal diagnosis. Once diagnosed there are a few things we can do to treat Apnea. One is a CPAP machine. These are very effective but some people aren’t able to tolerate them. Doesn’t this fella look comfortable?

Another is a mandibular advancement device. This is a mouth guard that holds the lower jaw forward. It can be much more comfortable and a great option for someone who can’t tolerate a CPAP. There are some drawbacks to this such as slight tooth movements and this device can worsen TMJ symptoms if you already have TMJ issues.

Lastly there are surgical interventions. If the apnea is being caused by deviated septum or in the nasal region that can be fixed by an ENT. If the obstruction is from the throat area, surgeries like a UPPP can be done.

The takeaway here is that Sleep Apnea can have some serious consequences but the good news is dentists are now screening for this and there is treatment out there! If you or someone you know has suspected sleep apnea, please have them contact their primary care physician or give us a call! Keep Smiling ! 🙂

 

 

 

 

Kids and Sports Guards

Summer is quickly drawing to a close. What that means for some families is back to school and back to sports!

Lets use August’s Smile Blog to talk about protecting your teeth and your kids teeth during sports activity!

Did you know that 5 Million teeth are injured or knocked out every year! This leads to about 500 million dollars a year spent on replacement or fixes. About 40% of these are sports related!

The first and most important thing I think mouth guards can protect against in trauma to the Jaw Joints. Any forces to your jaw during contact sports can lead to compression or even fracture of the areas around the joint. It can also lead to more forces directly transmitted to the head and cause brain injuries like concussions!

Your teeth are at risk of injury too! They can be luxated which means pushed out of position, avulsed or knocked out, or fractured.

Fracture: Depending on the fracture, the tooth can sometimes easily be treated with a filing or crown, sometimes root canals can be necessary, but sometimes fractures in the root mean the tooth cannot be saved! See your dentist after this, the sooner the better but likely these injuries do not need to be seen immediately. The X-ray above shows a tooth fractured at the root which is likely cannot be saved. The picture above shows a tooth that has been fractured on the crown portion which can be saved easily.

Luxation: If a tooth is pushed out of position, you will need the tooth to be repositioned and splinted. Sometimes these teeth may end up needing root canals. If your dentist is not available within a number of hours, an urgent care or ER can likely help with this.

 

Avulsion: If a tooth is knocked out, time is absolutely of the essence here! Ideally you want to seek treatment within 1 hour! A lot of times the tooth can be replanted and splinted. Make sure to take the avulsed tooth and place it in Milk, Saliva, or Sterile Saline. There is also a product called “save a tooth” which can be bought online made specifically to store avulsed teeth in transit to the dentist or medical professional for replantation.

Protecting your teeth is as easy as a $5 mouth guard from Academy

You can spend all the way up to a couple hundred for custom fit with custom colors and writing. Here is professional UFC fighter Roger Narvaez with a guard we made him.

 

The moral of the story is that prevention is key, but if something does happen the best thing to do is to act quickly.

Keep Smiling !

Get Wise about Wisdom Teeth

Its summer! Time for the kids to relax, swim, and generally relax. For teenagers and young adults, summer is a great time to take care of their wisdom teeth. My mom was the original person who told me that my wisdom teeth coming in does NOT actually impart any wisdom on me or mean that I was getting any wiser… thanks mom. Regardless, wisdom teeth can cause a whole host of issues and we’ll discuss the ins and outs of wisdom teeth here.

 

Wisdom teeth are the 3rd set of molars that will begin to erupt anywhere from the mid teens to early 20’s. The majority of people literally do not have room for these teeth. The consequence is that these teeth will not erupt correctly. These teeth can also be impacted which means they are side-ways and will not erupt (or come completely out of the gum) without intervention. The reason we as dentists suggest extracting these teeth is because they are seldom functional teeth. Even if there is enough room, they are the hardest area to keep clean and will often times become decayed or cause decay on the molars in front of them! I personally have seen so many issues and complications and issues with these teeth.

The problems that can happen with impaction or only partial eruption of the wisdom teeth is that they can cause a defect in the gum tissue which can lead to bacteria and food impacting the area and cause 1) Decay or Cavities 2) Pericoronitis 3) Resorption into the 2nd molar.

  • Decay can spread and eventually cause tooth pain or infection. We especially do not want to see a non functional wisdom tooth causing decay on a perfectly functional 2nd molar and cause a need for a restoration or worse, extraction of the 2nd molar too!
  • Pericoronitis is when the gum around a partially erupted tooth gets infected and inflamed. This can be very painful and requires antibiotics and the 3rd molar to be extracted.
  • Resorption can happen when the wisdom tooth is horizontal and starts to externally resorb away the 2nd This can lead to loss of the 2nd molar as well!

In my opinion, the best time to extract the wisdom teeth are when we do it BEFORE symptoms occur. This can lead to a better patient experience, less surgical complication, and hence less post operative discomfort. It has also been shown that recovery in young adults is much faster and less painful than surgery in older adults (over 35). Part of this reason is that in young adults the roots are not completely formed yet in the wisdom teeth and the bone is not as dense making for the extraction process to be much easier.

In our practice, sometimes wisdom teeth need to be referred to a specialist. The reason for this is because some wisdom teeth can be complicated and require further training which the specialist has. Also, in most cases, the most pleasant way (ok pleasant and extractions don’t go together but bear with me here…) to have your wisdom teeth removed is under IV sedation. If done correctly by someone with the correct training, IV sedation should be a safe procedure. Yes there have been some incidences in the news about sedations that have gone wrong, but in my opinion, this was from a lack of training and/or not following protocol.

So, a story about my personal experience….my wisdom teeth were erupted and in normal position (not horizontal) but were causing my gums soreness. I had my wisdom teeth removed the summer after my freshman year of college, which is longer ago than I care to remember.  I had the IV sedation done which went fine, and although there was soreness, discomfort, and some minimal swelling from the removal of the teeth, I only had to take one dose of pain medication and I was out running errands that same evening. By the end of the week I was eating normal foods and feeling 100% again. With varying degrees of angulation and impaction, you can expect varying levels of post operative discomfort and swelling, but all of this can be managed and will prevent much more serious issues in the future.

Don’t be afraid to consult with your dentist about your wisdom teeth. Thanks! Enjoy your summer! And keep smiling !

 

 

Dental Hygiene Trends

How cool is it that we can see dental hygiene topics trending on Social Media? From coconut oil pulling to charcoal tooth pastes, at least oral health care is on people’s minds.

The idea behind oil pulling is to swish 1 tsp of coconut oil for 20minutes and it allegedly draws toxins out of your mouth. Seems like an awful long time! It only takes 2 minutes to floss (we’ll talk about that more in a second). At this time I see no hard in doing this, but the benefits may or may not be as advertised.

Now as far as the charcoal toothpaste, it uses activated charcoal (which has traditionally been used as a filtering substance and even used to treat poisoning in the hospital). However, the reason it works to “whiten” teeth is because of how abrasive it is. It removes surface stains and plaque more easily. However, without any conclusive studies on whether or not this more abrasive paste is doing damage to our gums and/or enamel, it’s hard to recommend it at this time.

With these and other trends bouncing around,  the best thing to do is still traditional flossing and brushing.  I know, I know…. but you probably knew I was going to say that anyway! The whole point of all this is to remove a film that grows around the teeth called Plaque. This plaque contains bacteria and can produce acidic by products after eating carbs and sugar which causes enamel breakdown or can calcify and become tartar which can lead to gum disease.

Here’s a video on the proper way to floss: https://youtu.be/aTWyx0iI01o

I always tell my patients you have to imagine you are squeegeeing between the teeth on BOTH sides each time it goes between the teeth. You’ll be surprised by how much plaque is removed. Once you do this right, you’ll realize how much junk you’re leaving in your teeth if you don’t floss. Yuck!

After you brush, try scratching the front surface of your teeth (especially near the gumline) with your finger nail, if you are still removing a white sticky film, you may not be brushing effectively enough. It’s a delicate balance, I always tell my patients not to brush too hard as you may injure the gums and cause abrasion and recession of the gums, but we have to make sure we are removing the plaque.

That’s it! See y’all next time and remember to SMILE 🙂

First Post !

Welcome! We are excited to announce that we have revamped our website. This has been a long time coming. My goal was to create a website that could be more interactive for patients to get to know us better and where we could share tid bits of knowledge to help everyone improve their oral health!

Please have a look around. I am excited about the new Blog Feature and will post articles, thoughts, and information on a regular basis.

In the mean time don’t forget to check out our Facebook page: https://www.facebook.com/dchangdds/

Please do not hesitate to let us know if you have any question and don’t forget to SMILE! 🙂