Snoring and Sleep Apnea

It is estimated that 30-50% of patients snore while sleeping- the incidence of snoring increases with age and men snore more frequently than women. Most people are unaware that there is professional help available for snoring.

A related condition, sleep apnea or obstructive sleep apnea (OSA) is a condition where the breathing space in the back of the mouth is closed off. OSA causes significant pauses in breathing and can be life threatening.

Dentists are associated with the treatment of both snoring and OSA. However, a team approach is a safe and effective means to treat these conditions. Dentists work with dental laboratories; sleep technicians and board certified sleep physicians as a team to curb snoring and sleep apnea.

Causes of snoring are partial or complete closure of airway is the cause of snoring as seen in:

Obstruction of nasal airway

Weak throat muscles

Lower jaw being too far back closing off throat

Sleeping posture- sleeping on back causes closure of breathing space

Fat accumulation in and around throat

Loss of muscle tone related to aging

Use of muscle relaxants including alcohol and sedative hypnotics

Snoring Effects:

Sleep deprivation

Social and marital challenges

Increased potential for heart attack and stroke

Snoring can be reduced or eliminated with relative ease but the associated condition of OSA needs more consideration. The pauses in breathing in children and adults happen between 5- 30 times an hour and causes daytime fatigue, slow reaction time and vision problems. About 15% of the American population suffers from sleep apnea. It is a serious condition that can be life threatening. Since OSA is associated with snoring, it must be addressed as part of the treatment for snoring.

Types of Sleep Apnea:

Obstructive sleep Apnea- occurs when soft tissue in the back of throat relaxes during sleep and blocks airway and causes loud snoring

Central Sleep apnea- much less common condition and occurs when the nervous system fails to signal the muscles that control breathing

Complex Sleep apnea- a combination of OSA and central sleep apneas and is associated with significant medical problems

All forms of sleep apnea often go unnoticed and can become serious when left untreated over time.

Snoring and Sleep Apnea Treatments:

Continuous Positive Airway Pressure (CPAP)

Anti snoring oral appliances / mouthpiece for snoring

Surgery

Medications

Losing Weight

Stopping Smoking

Sleeping on Side

Over the Counter Nasal Sprays

Nasal Strips or Clips

Anti Snoring Pillows

CPAPs and anti snoring devices are the most used and most successful treating options. Severity of snoring and OSA condition is measured by a sleep monitoring device to select appropriate treatment. Assuming that the OSA is not severe, sleep apnea dental appliances can easily control snoring and OSA.



Potential Side Effects of Oral Appliances:

Jaw/facial pain

Bite Changes

Tooth Pain

Jaw Joint Pain

Drooling

Dry Mouth

Sound, restful and peaceful sleep is possible. Cost of our sleep apnea dental appliances, or our mouthpiece for snoring are very minimal considering the huge benefits of sound sleep and increased productivity. 

Visit www.smileartistrychino.com for more information on our services.

Teeth Whitening

Do you want your teeth to be whiter? Whitening of teeth is universally desirable and accepted well around the world. It is the most conservative and economical option of improving your smile and self esteem.

There are almost no side effects to this process if the whitening is carried out properly. There can however be too much whitening. A good rule to gauge an adequate white is to match to the shade of white in the eyes.

Some patients also experience sensitivity following whitening but this usually goes away within a few days.

Some tooth shades respond better to whitening than others do.

Discoloration due to a pulp breakdown does respond initially to whitening but the discoloration tends to return over time.

Internal tooth discolorations during tooth development in childhood can often be lightened with some degree of success.

Florosis (excessive floride) can be resistant to significant shade changes but can be aided by whitening

Staining of teeth from a diet comprised of dark color foods such as coffee, tea or chocolate is very easily removed.

Discolorations as a result of aging also noticeably respond to whitening.

Options for teeth whitening:

Veneers and Crowns are a great alternative when the internal discoloration in teeth is significant and whitening is unlikely to significantly lighten the shade. The restorative alternatives are more expensive and extensive but can also correct decay, misshapen and mal positioned teeth.

Bonding is the process of adding a thin layer of resin material over the surface of the tooth to improve shade and minor defects on the surface of the tooth. Although less expensive than a veneer or a crown, bonded restorations can significantly improve esthetics but may discolor over time needing replacement.

At Home Whitening This widely used and hugely successful whitening technique is the most popular one in dentistry. A flexible tray is custom made for your mouth. After adequate instructions are given by the dental staff, you are given hydrogen peroxide to take home with you. Each day you will place a small amount of material into the tray and seat in the mouth for various lengths of time as instructed. The progress is monitored by the dental staff to avoid unwanted effects. Several days later, a significant whitening of teeth is observed. There may be slight sensitivity with the procedure, which goes away in a couple of days.

In Office Whitening is a supervised whitening which takes place within the office. In office whitening uses higher concentrations of hydrogen peroxide compared to at home whitening. The major advantage to doing in office whitening is the result is accomplished much faster but the disadvantage is that there could be more tooth sensitivity because of the rapid pace of whitening. De sensitizers can be applied to the sensitive areas to reduce post -whitening sensitivity.

Cost is moderate for both the options.

A wide range of whitening products are available over the counter (OTC) that produce varying degrees of results. Some work better than others and depend on the degree and the nature of discoloration. In general, OTC products are less effective than the dentist supervised products. Do seek dental professional guidance in selecting the best OTC whitening products to help maintain a shade that blends with your natural teeth and dental restorations. OTC products however, do not have the predictability of professional whitening.

Some degree of whitening is reversed within days of the whitening procedure and stabilizes within a couple of weeks and only slowly progresses towards a darker color overtime. The whitening process may need to be repeated within a year and sometimes months.

Visit www.smileartistrychino.com for details or call 9-09 627 6699 for an appointment.

Treatment Planning for Frail Older Adults (Article 3 of 4)

 Treatment planning  for frail and dependent patients should meet the objectives of preventing pain and infection, maintaining function, preventing systemic complications and improving or maintaining quality of life.

Frail adults live in the community but have varying degrees of functioning limitations.Their treatment options are guided by their level of dependency- no dependency, medium dependency or high dependency status.

For medium dependency adults, the recommendation is to treat teeth conservatively. Restore carious lesions using atraumatic techniques and floride releasing restorative materials. Dentures or removable teeth replacements should be designed to facilitate hygiene and easy removal.

Dependent older adults typically live in long term care settings and are home  bound. For homebound and long term care residents, recommendations include managing discomfort and infection and performing  only procedures necessary for social interactions and normal function.

Early in the interactions with frail or dependent patients, it is important to gauge the patients ability to comprehend treatment recommendations and independently make competent decisions. Patient's financial resources, general health, cognition and  capacity for home care must be taken into account. The benefit from the proposed treatment must be weighed very carefully against the physical discomfort and mental anguish a particular patient may experience.  The focus is to address the patient's primary concern.

For more information call 909 627 6699 or visit www.mydentistchino.com

Prevention and Disease Management for Older Adults( Article 2 of 4)

The rapid growth of population that is 65 and older will profoundly affect dental care in a number of ways.
Risk assessment for this vulnerable group  will help develop the most appropriate prevention plan and treatment strategy.

 Prevention:

Majority of older patients suffer from hyposalivation or Drymouth

Simple preventative remedies  to alleviate drymouth include-

Regular sips of water throughout the day
Limiting number of alcoholic beverages and beverages
Limiting beverages high in sugar and caffeine particularly sodas,juices and sweetened coffee and tea
Avoid spicy and salty foods
Caution using mouth washes containing alcohol
Using  salivary substitutes  such as Oralbalance gel, Biotene Moisturing spray, liquid mouthspray etc
.
In extreme cases, a salivary stimulant may be prescribed which does require consulting with patient's physician. 
Discussion with physician and or pharmacist regarding substitution of medicines causing dry mouth can also be an option.

Caries:
For patients with an increased risk of caries or dental decay, an oscillating tooth brush is best.  Automated toothbrushes remove more plaque than manual brushing alone. It is particularly helpful for patients with limited dexterity and arthritis.

Use floridated toothpaste daily and floride rinses
 Periodic topical application of 5% sodium floride varnish in severe cases of caries.
  This mode is inexpensive, non invasive and shown to reduce decay.

As the old adage goes " an ounce of prevention is worth more than a pound of...."

Visit www.mydentistchino.com or Call 909 627 6699 to contact our office. We are more than happy to help you with your question.

Dentistry for the Elderly (1st of the series)

The aging population is the most important demographic trend.  Nearly 20% of the U S population will be older than sixty five by the year 2030.  As the age of the older adult is upon us, the services rendered should be age appropriate and have lasting value. 

Older adults have the most diverse clinical and physical presentation than any other age group. We could see fully functioning independent adults, frail older adults characterized by numerous medical conditions that impair mobility and dexterity and those who are dependent on help to carry out the normal daily activities.

.  Age is often a primary consideration when developing a treatment plan but it is important to assess each patient’s individual needs and capacities instead of relying on stereotypes of aging. 

The rapid growth of the elderly population affects dentistry in a number of ways. 

1/ the elderly are retaining teeth longer than the previous generation

        Approximately 90% of the seniors who have their natural teeth have    experienced decay with 64 % suffering from periodontal or gum disease.

2/ the body changes that occur with aging often make treatment planning more complex.

3/ medical problems and medications complicate and in some cases exacerbate dental disease.

Limitations in frail older adults create barriers to achieving and maintaining optimum oral health. 

 Visit our website www.mydentistchino.com or Call 909 627 -6699 for more information.

Revisit this site next week for more on prevention and disease management of this vulnerable group.