One in ten Americans has diabetes, a serious condition that may increase the development and severity of other health problems—including gum disease. Because of this latter connection, dental providers join other health professionals during November's National Diabetes Month to call attention to this chronic disease and its effect on health and well-being.
There's another health condition with a diabetes connection that isn't as well known: obstructive sleep apnea (OSA). It's also of keen interest to dental providers, as dentists are often involved in the discovery and treatment of this common sleep disorder.
OSA is the temporary blockage of the airway during sleep by the tongue or other anatomical structures. The subsequent drop in oxygen awakens the body to remove the obstruction. People with OSA may not realize they have the condition, but their bed partner can often attest to their snoring, snorting and gasping for breath during the night. Such episodes can occur several times per night, depriving the person of sufficient sleep.
Chronic OSA can contribute to the development of other health problems, among them Type 2 diabetes. It can do this first by interfering with the metabolization of glucose (blood sugar). It may also increase the body's resistance to insulin, the primary hormone regulating glucose.
Fortunately, properly managing OSA can lower your risk for diabetes, and that's where dentists may be able to help. For one thing, we dentists are often the first to notice early signs of OSA—sometimes even before our patients do.
According to the American Sleep Apnea Association, as many as 80% of the estimated 22 million Americans with OSA may not know they have it. But dentists often identify OSA indicators while examining patients: signs like an enlarged tongue or tonsils, or patients falling asleep in the exam chair. While we can't formally diagnose OSA, we often refer symptomatic patients to a sleep specialist.
Dentists also offer an alternative to the most common OSA therapy, which is continuous positive airway pressure (CPAP). This therapy employs a motorized pump that delivers pressurized air into the throat via face mask to keep the airway open during sleep. Although effective, some people find a CPAP machine noisy and uncomfortable to use.
Alternatively, dentists can provide an oral device that can often help patients with mild to moderate OSA that's worn in the mouth during sleep. Most of the various types of these appliances either reposition the lower jaw with a hinge mechanism to keep the throat open or pull the tongue away from the airway through a suction effect.
Diabetes is one part of a chain reaction that can bring unexpected challenges to your health, including to your teeth and gums. You can slow or even stop its development with proper diet, exercise and good, restful sleep. Dealing with OSA is often part of that equation—and we may be able to help.
If you would like more information about the prevention and treatment of diabetes, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Oral Appliances for Sleep Apnea.”
Pain can tell you things. Not verbally, of course, as in, “Hey, your appendix is inflamed!” But the quality of your pain—dull or sharp, constant or intermittent, acute or general—can point the way to the actual problem.
That's especially true of tooth pain, which could signal any number of dental problems. Looking at its characteristics, though, can narrow the search. Here are a few examples.
Sharp, momentary pain. This could be an indication of a number of possible dental problems. If it occurs for a few seconds after eating or drinking something hot or cold, it might signal a small area of tooth decay, a loose filling or early signs of gum recession. The latter could be a symptom of periodontal (gum) disease, so you should seek diagnosis and treatment as soon as possible.
Sharp pain when biting. Like tooth sensitivity, this could be a sign of decay or a loose filling, or it could indicate a fractured (cracked) tooth. If it's the latter, you may need an endodontist, a specialist in interior tooth problems, if you want the best chance for saving the tooth.
Dull ache in upper teeth. This might not be a dental problem at all, but radiating pain from an infection of the sinus just above the upper posterior teeth. The infection could also have begun with one of the molar teeth and advanced into the sinus. You'll need to see your dentist for any teeth or gums involved and possibly a physician to address any potential sinus infection.
Constant throbbing pain. That horrible toothache that won't stop could be the nerves in the tooth's interior under attack from decay. The primary means for saving a tooth with deep decay is a root canal treatment to clean out diseased tissue and replace it with a filling or a crown. You should see a dentist even if the pain suddenly subsides—this may only mean the nerves have died, but the infection is still active.
These are just a few of the problems, including true dental emergencies, that oral pain can signal. For any instance of pain in your mouth, see your dentist as soon as possible.
If you would like more information on tooth pain and what it might indicate, 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 “Tooth Pain? Don't Wait!”
You can't correct a poor bite with braces or clear aligners overnight: Even the most cut-and-dried case can still require a few years to move teeth where they should be. It's a welcome relief, then, when you're finally done with braces or aligner trays.
That doesn't mean, however, that you're finished with orthodontic treatment. You now move into the next phase—protecting your new smile that took so much to gain. At least for a couple of more years you'll need to regularly wear an orthodontic retainer.
The name of this custom-made device explains its purpose: to keep or “retain” your teeth in their new, modified positions. This is necessary because the same mechanism that allows us to move teeth in the first place can work in reverse.
That mechanism centers around a tough but elastic tissue called the periodontal ligament. Although it primarily holds teeth in place, the ligament also allows for tiny, gradual tooth movement in response to mouth changes. Braces or aligner trays take advantage of this ability by exerting pressure on the teeth in the direction of intended movement. The periodontal ligament and nature do the rest.
But once we relieve the pressure when we remove the braces or aligners, a kind of “muscle memory” in the ligament can come into play, causing the teeth to move back to where they originally were. If we don't inhibit this reaction, all the time and effort put into orthodontic treatment can be lost.
Retainers, either the removable type or one fixed in place behind the teeth, gently “push” or “pull” against the teeth (depending on which type) just enough to halt any reversing movement. Initially, a patient will need to wear their retainer around the clock. After a while, wear time can be reduced to just a few hours a day, usually during sleep-time.
Most younger patients will only need to wear a retainer for a few years. Adults who undergo teeth-straightening later in life, however, may need to wear a retainer indefinitely. Even so, a few hours of wear every day is a small price to pay to protect your beautiful straightened smile.
If you would like more information on orthodontic retainers, 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 “The Importance of Orthodontic Retainers.”
Even though coronavirus lockdowns have prevented TV hosts from taping live shows, they're still giving us something to watch via virtual interviews. In the process, we're given occasional glimpses into their home life. During a Tonight Show interview with Seahawks quarterback Russell Wilson and his wife, R & B performer Ciara, Jimmy Fallon's daughter Winnie interrupted with breaking news: She had just lost a tooth.
It was an exciting and endearing moment, as well as good television. But with 70 million American kids under 18, each with about 20 primary teeth to lose, it's not an uncommon experience. Nevertheless, it's still good to be prepared if your six-year-old is on the verge of losing that first tooth.
Primary teeth may be smaller than their successors, but they're not inconsequential. Besides providing young children with the means to chew solid food and develop speech skills, primary teeth also serve as placeholders for the corresponding permanent teeth as they develop deep in the gums. That's why it's optimal for baby teeth to remain intact until they're ready to come out.
When that time comes, the tooth's roots will begin to dissolve and the tooth will gradually loosen in the socket. Looseness, though, doesn't automatically signal a baby tooth's imminent end. But come out it will, so be patient.
Then again, if your child, dreaming of a few coins from the tooth fairy, is antsy to move things along, you might feel tempted to use some old folk method for dispatching the tooth—like attaching the tooth to a door handle with string and slamming the door, or maybe using a pair of pliers (yikes!). One young fellow in an online video tied his tooth to a football with a string and let it fly with a forward pass.
Here's some advice from your dentist: Don't. Trying to pull a tooth whose root hasn't sufficiently dissolved could damage your child's gum tissues and increase the risk of infection. It could also cause needless pain.
Left alone, the tooth will normally fall out on its own. If you think, though, that it's truly on the verge (meaning it moves quite freely in the socket), you can pinch the tooth between your thumb and middle finger with a clean tissue and give it a gentle tug. If it's ready, it should pop out. If it doesn't, leave it be for another day or two before trying again.
Your child losing a tooth is an exciting moment, even if it isn't being broadcast on national television. It will be more enjoyable for everyone if you let that moment come naturally.
If you would like more information on the importance and care of primary teeth, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Importance of Baby Teeth.”
A full night's sleep isn't a luxury—we all need it for a healthy mind and body. But 50-70 million people in the U.S. aren't getting enough sleep because of a chronic sleep disorder like obstructive sleep apnea (OSA).
OSA happens when a sleeper's airway becomes blocked (most commonly by the tongue), cutting off oxygen to the brain. The body rouses from sleep to overcome the blockage. This awakening could last only a few seconds, after which the person immediately goes back to sleep. But it can occur hundreds of times a night and interrupt deeper sleep needed for a good night's rest.
Sleep disorders like OSA are a significant medical problem that could contribute to serious health issues like high blood pressure or cardiovascular disease. If you're experiencing fatigue, irritability or your family's complaints of you snoring, you should see a physician for diagnosis and treatment options.
You should also consider another health professional who could be helpful in dealing with OSA—and may even be able to provide a treatment option: your dentist. Here's how.
A dentist could discover your OSA. Because of twice-a-year dental visits, dentists often see patients more frequently than other healthcare providers. A properly trained dentist could pick up on signs and symptoms of sleep disorder, including patients falling asleep and even snoring while in the dentist's chair.
Dentists are familiar with the mouth. Few healthcare providers focus on the oral cavity like dentists. Besides the teeth and gums, dentists also have extensive knowledge of the tonsils, uvula and tongue that often play a role in sleep disorders. As such, a dentist may notice abnormalities during routine exams that might contribute to airway obstruction during sleep.
Dentists provide a treatment option. Many OSA patients use a CPAP mask to maintain an open airway during sleep. But CPAP therapy can be uncomfortable for some. For mild to moderate cases of OSA, dentists can create an oral appliance based on the patient's mouth dimensions that prevents the tongue from sinking back into the throat.
If you believe you may have OSA or a similar sleep disorder, by all means speak with your doctor. But also mention it to your dentist—your dental provider might hold the key to a better night's sleep.
If you would like more information on how we could help with your sleep apnea symptoms, 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 “Sleep Disorders & Dentistry.”
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