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.

Snap ON Smile

Is a great smile make- over option that is affordable, easy, reversible and painless that can be used as a temporary or a more permanent enhancement.

Snap on Smiles offer an excellent alternative for missing, crooked, stained or discolored teeth, teeth with spaces where implants, bridges and other restorative alternatives are not an option.

Snap on smile is also a comfortable and affordable alternative to patients unhappy with the fit and feel of a removable partial denture.

Snap on Smile is manufactured using a proprietary dental resin that is thin, yet strong. The processing starts with taking precise impressions of the upper and lower jaw with instructions to the lab of the desired shade and other characteristics of the desired restoration. A second appointment about three weeks following the impression visit is for seating of the Snap on Smile.

Snap on Smiles can be made for upper or lower teeth and have proven to be a life changing and confidence building alternative to the more expensive and invasive restorative options. Maintenance is simple with some specially formulated cleaning and disinfecting solutions. 

Call 909 627 6699 for a free consultation of visit our website for more information www.smileartistrychino.com

MINI IMPLANTS or Small Diameter Implants

Dental Implants are small metal screws that are surgically placed in the bone and are considered the most important innovations in the history of dentistry. 

Many denture patients have difficulty holding their dentures securely in the mouth because of reduced bone quantity. Dental implants have allowed these patients to restore a good fit and function of the dentures.

Types of dental implants:

There are many types of implants and the ones most currently used are the ones in the shape of a root of tooth. Dental implants vary in length and diameter. Small diameter implants are only 2mm in diameter.

Small implants are needed in mouths with significant bone loss where very little jaw bone is remaining to place standard implants Alternatively, patient can undergo bone- grafting to surgically enhance bone formation but many patients prefer non traumatic procedures or overall health may limit surgical intervention.

Uses of small diameter implants:

Retention of Lower complete denture

Retention of Upper complete denture

Retention of Removable Partial dentures

Anchoring Fixed Bridges

Single tooth replacement

The number of small diameter implants necessary to facilitate the above functions depends on the quality and quantity of remaining bone and needs to be addressed on an individual basis.

Advantages of Mini Implant:

Surgery is minor and usually with no complications

Simple placement

Retention of dentures is immediate

Lower cost compared to standard implant options

Almost anyone with an ill-fitting denture is a candidate for mini implants. The difference in the fit and function is immediate and is a source of instant gratification for the patient and the dentist.

Call our office at 909 627 6699  if you would like to schedule a consultation.  Visit www.smileartistrychino.com for our practice information.

Antibiotics and Dental Procedures

The mouth is packed with various strains of bacteria, which in a healthy individual maintain optimal oral health. During daily routines like chewing, brushing or flossing, the bacteria can enter the blood stream but don’t present a problem for most of us  when the immune system is healthy. In compromised health, bacteremia (bacteria entering blood stream) can cause infections elsewhere in the body.

Specific heart conditions and orthopedic implants such as artificial joints have known to be the more vulnerable sites for potential infections. 

Antibiotic prophylaxis, or preventative use of antibiotics prior to a dental visit is recommended in conditions like-

-Artificial heart valves

-History of infection of the lining of the heart or heart valves known as Infective Endocarditis

-A heart transplant

-Congenital heart conditions like Cyanotic congenital heart disease

-Defects repaired with a prosthetic device

The criteria for antibiotic prophylaxis is periodically updated by the American Heart Association and the American Dental Association depending on current research and development. Currently, the AHA recommends prophylactic antibiotics only on patients with a history of endocardial bacterial endocarditis.

American Associations of Orthopedic Surgeons in their revised guidelines no longer recommend antibiotics for patients with artificial joints.

In an abundance of caution, our office coordinates with the patient’s physician to determine the appropriate antibiotic protocol. 

Visit www.smileartistrychino.com to E mail us at lovemydentist@gmail.com

Wisdom Teeth

Wisdom teeth are third molars that normally erupt between the ages of 17 and 21.  Since they are the last teeth to erupt into the mouth, usually at the time of young adulthood; an age associated with budding maturity and wisdom; they are more popularly known as "wisdom teeth".

Wisdom teeth, when properly positioned can add to being able to chew well but are not always necessary for optimal function.  Because of their position so far back in the mouth, they can be difficult to clean.

As we, as a society; evolve into consuming more refined foods, which require lot less vigorous chewing, the need for teeth and the corresponding jaw size diminishes. The Aborigines of Australia, supposedly still have their 42 teeth.!

 Wisdom teeth are often impacted  as a result of the discrepancy in the size of the jaws and the number of teeth.  When impacted, the third molars are trapped beneath the gum and bone and against the teeth in front of them.

 The 3 major categories of impaction are-

Horizontal Impaction or a sleeping tooth is where the third molar grows into the mouth horizontally , heading straight towards the root surface of the second molar. These teeth, unless symptomatic are best left alone.

Angular Impaction  is a third molar growing into the mouth at an angle, only partially erupting and trapping food deposits often resulting in pain, swelling  and infection. These are the teeth most likely to need removal to prevent  pain, infection and teeth migration.

Vertical Impaction is  less common and is generally found when the jaws are under developed. Often, these impactions do not cause any pain and are  discovered in dental exams with radiographs ( X rays).

Wisdom extractions can be  performed under local anesthesia and pain or anxiety- reducing medications are available when appropriate.

Teeth positions have a significant bearing on facial profile and timely removal of  impacted teeth is an important aspect of managing facial forms and dental health.

Visit www.smileartistrychino.com for information on additional services or to schedule an appointment.

Why does my filling need to be replaced?

A tooth that has decay or fractures will need either a filling or other restoration depending on the extent of decay.  Poor oral hygiene, a poor diet, gum recession or a lack of saliva can contribute to tooth decay. Para functional habits like clenching and grinding and traumatic occlusion are usually the cause of teeth fractures.

Choices of restorations

Composite filling: Is a tooth colored plasticed material that is bonded to the tooth when a small area of tooth that is decayed needs to be restored.  This is a popular option considering the capability of matching shades to the tooth, conservative prep design preserving natural tooth and affordability.

Amalgam filling: This option has fallen out of vogue because of potential mercury toxicity, silver color compromising aesthetics and the technique requiring removal of a lot of tooth structure to achieve mechanical retention. Many dental offices no longer offer this procedure.

Onlay/Inlay: Is a lab processed restoration usually chosen when a small area of the tooth needs to be restored with better seal and marginal integrity for long term success. It is a two visit procedure that entails a higher cost for lab fabrication. These can be processed in tooth colored porcelain or gold based on patient preference.

Full coverage crown: restores the entire coronal portion of the tooth and is usually indicated on endodontically treated teeth (root canal), extensive breakdown of tooth from fractures and/or decay. They are lab fabricated and also entail two visits.  Crowns can be fabricated in gold, non precious metal or various porcelains depending on patient preference, cost considerations and aesthetic demands.

 A dental filling usually lasts many years before it needs replacing. However, teeth are subject to constant stress from chewing, clenching and grinding. All of these can cause a filling to gradually wear away, chip, crack or fall out.

Reasons for replacement

Recurrent decay
Fracture of filling
Fracture of tooth
Material upgrade

Regular dental examinations are important to maintain soft tissue health, assess existing restorations and maintain bite and functionality of the mouth.  Detecting a failing filling early can reduce damage to tooth and eliminate the need for more invasive and complicated procedures.

Visit www.smileartistrychino.com or call 909 627 6699  for more information. Feel free to stop by our office on 10th street in Chino, California.