Screening for Sleep Apnea – Helpful or Not?

nodding offThere’s a new report on sleep apnea in JAMA, and it has us a little…well, restless. We think it may send the wrong message and prevent people from getting the help they need to get a good night’s sleep.

The report sought to find if screening for obstructive sleep disorder (OSD) or obstructive sleep apnea (OSA) is effective. All in all, it said, there’s not enough evidence to suggest that it is.

“There is uncertainty about the accuracy or clinical utility of all potential screening tools,” wrote the group led by Daniel Jonas, MD, MPH, an associate professor of medicine at the University of North Carolina at Chapel Hill.

It’s estimated that over 18 million people have some form of obstructed sleep disorder, many of whom go undiagnosed. OSA itself has been linked to a number of serious health conditions, including heart disease, type 2 diabetes, and stroke. Hence, the recommendation that dentists and doctors screen their patients.

The current study reviewed 110 studies with more than 46,000 patients. The goal was threefold:

  1. To evaluate primary care-relevant evidence on screening adults for OSA.
  2. To evaluate test accuracy and treatment.
  3. To inform the U.S. Preventive Services Task Force.

While they found that multiple treatments for OSA were able to reduce AHI, Epworth Sleepiness Scale scores and blood pressure, they couldn’t establish if these reduced mortality or improved other health outcomes. But they did find evidence of a modest improvement in sleep-related quality of life.

Results based on insufficient evidence concern Susan Redline, MD, MPH, who noted in an editorial in the same issue of JAMA,

While the USPSTF found insufficient evidence on screening for OSA in asymptomatic adults, high priority should be given to additional studies that generate rigorous evidence that will serve to improve the recognition and treatment of OSA in the population and reduce its attendant morbidity. However, the current recommendations, if misinterpreted, could negatively influence public health if they are used to discourage direct questioning or deployment of short screening questionnaires for identifying patients at high risk for OSA. Encouraging patient and clinician discussion of relevant symptoms and signs of OSA is one way to help address early recognition.

We agree.

As we noted just a couple weeks ago, we dentists we are in a unique role to not only screen and treat patients with OSD, but we see the positive results in our patients. And we believe that even the “modest” improvements noted by the study are beneficial to overall health and well-being.

Image by andy wagstaffe

Alzheimer’s Drug May Solve the Puzzle of How to Regenerate Decayed Teeth

smileIf you’ve ever wished the dental drill would become a thing of the past, you’re not alone. Dentists have long pondered if, and how, decayed teeth could be regenerated, not just restored.

New research suggests one new approach that could soon use your teeth’s own cells to rebuild natural tooth structure. The key lies in stimulating the natural formation of reparative dentin by stimulating resident stem cells in the tooth pulp.

For the study, researchers treated biodegradable, clinically-approved collagen sponges with very low doses of an experimental Alzheimer’s drug called Tideglusib. They then placed the sponges on the damaged teeth of mice. As the biodegradable carrier sponge degraded slowly over time, a significant amount of dentin replaced it, leading to full, natural repair of the tooth.

This works because Tideglusib blocks the enzyme that usually stops dentin growth.

Lead author of the study, Professor Paul Sharpe from King’s College London said: “The simplicity of our approach makes it ideal as a clinical dental product for the natural treatment of large cavities, by providing both pulp protection and restoring dentine.

“In addition, using a drug that has already been tested in clinical trials for Alzheimer’s disease provides a real opportunity to get this dental treatment quickly into clinics.”

This is promising news – not only because most of us will need a tooth restored at one time or another, but because oral health is tied intrinsically to systematic health. Such a restoration would be truly biocompatible.

But just as natural teeth can fail, so can restored teeth. When decay compromises a tooth’s pulp chamber, it can jeopardize the tooth, ultimately leading to a root canal or extraction, both of which have been shown to further compromise overall health.

Certainly the ability to regenerate natural tooth structure offers a promising prognosis for long-term oral health. This is one area of research we’ll definitely be watching for new developments.

Image by Randall Wade (Rand) Grant

Help for Sleep Apnea from Your Dentist? Yes!

sleep apnea diagramMost people with obstructive sleep apnea (OSA) probably don’t know it. In fact, it’s often a sleeping partner who first notices the common signs. After all, the snoring’s not keeping you awake.

But there’s another person who can tell you if you may have OSA: your dentist.

According to a study published last year in the Saudi Medical Journal, dentists have a unique advantage to hone in on the signs of sleep apnea. Because they see into patients mouths more often than physicians do, they have more opportunities to notice indications of airway obstruction – specifically, enlarged tonsils and scalloping along the sides of the tongue.

Other research has suggested even more dental signs of possible OSA, including worn teeth, morning headaches, gum problems, and TMJ pain.

Of the more than 18 million adults in the US affected by sleep apnea, those who are obese are 10 times more likely to report symptoms than their slender counterparts. According to the National Sleep Foundation, many of those 18 million go undiagnosed. Without diagnosis and treatment, the sleep apnea issues compound. OSA has been linked to heart disease, diabetes, depression, memory loss, and more.

Once sleep apnea is diagnosed through a sleep test, dentists can play a role in effective treatment, as well.

Whether you have a history of OSA and use a CPAP device or are searching for help with a recent diagnosis, you may be interested to learn about how less invasive oral appliance therapy can treat mild to moderate cases of sleep apnea. Appliance therapy tends to be more comfortable than CPAP, while also effective in keeping the airway open.

In fact, oral appliance therapy is now the recommended treatment of the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine for adults who are CPAP intolerant or prefer an alternative.

“This evidence-based guideline reinforces the fact that effective treatment options are available for obstructive sleep apnea, a chronic disease that afflicts at least 25 million adults in the U.S.,” said AASM President Dr. Nathaniel Watson. “Although CPAP therapy is still the first-line option for treating OSA, oral appliance therapy is an effective alternative that is preferred by some patients. Sleep medicine physicians and dentists can promote high quality, patient-centered care by working together to identify the optimal treatment for each patient who has sleep apnea.”

Most appliances work by supporting the lower jaw in a slightly forward position. This forward position keeps the tongue from dropping back toward the throat. Over time, this helps tone the tissues that line the throat. Wearing an appliance can sometimes double and even triple the size of the airway opening.

These appliances are not “one-size-fits-all” devices. There are dozens of options available. Only a dentist well-versed in breathing disorders such as OSA can help determine the best choice for your unique situation and help get you on the path to better sleep – and better overall health for the long haul.

Can We Talk Opioids?

opioid painkillersFor the first time ever, the CDC is advising doctors to follow a new protocol in prescribing opioid painkillers: “Go low and go slow.”

But it’s not just doctors who need advice. According to a JAMA study published earlier this year, dentists are among the leading prescribers of these drugs.

Reviewing data from 2,757,273 patients across the country, the authors found that 42% of patients filled an opioid prescription within a week of having a tooth extracted. Teens had the highest proportion of prescriptions filled at 61%, followed by young adults (age 18 to 24).

But that little script from big pharma can dull pain at a staggering risk: addiction and death by overdose. According to the CDC, in 2014 there were 18,893 prescription opioid deaths in the US, the highest number to date.

And the all too often sad reality is that addiction can begin with a dental procedure.

We could play smug and tell you that most biological dentists rarely issue a prescription for any pharmaceutical drugs, especially opioids. But dental prescriptions for opioids can be common after surgeries, and many of us do refer to oral surgeons who may prescribe them.

Pill, Pill, Whose Got My Pill?

While prescribing is part of the issue, so is what happens when someone fills the prescription. In a new study in JAMA Internal Medicine, researchers conducted a national survey of more than 1000 adults who had been prescribed opioids within the past year. As Dr. Bicuspid reported,

The survey found that 20.7% of adults have shared opioid medication with another person, most often to help the other person manage pain. Adults also shared medication because the other person could not afford opioid medication or did not have insurance.

Furthermore, more than half of participants had or expected to have leftover opioids, and nearly half of adults didn’t receive information about safe storage and proper medication disposal.

An earlier study found that, on average, pediatric patients prescribed opioids used only 42% of their medication. Of those with leftover drugs, only 6% of parents said they got rid of them.

Not disposing of unused prescription medication is a problem, because almost half of the patients had a sibling age 12 or older. These adolescents are at risk for drug abuse and addiction, and 90% of adults with substance abuse disorders started using drugs and alcohol before they turned 18, according to a presentation at the recent California Dental Association CDA Presents 2015 meeting.

Serving patients means open and honest conversations that empower you to understand what’s involved in any referral we give. And open and honest communication goes both ways. Many adults and teens who abuse or misuse prescription opioids get the medications from friends and family.

Generally, patients find their way to a biological office because they want to be involved in their own healthcare. But we can’t overlook the fact that teens receiving evaluations for extractions are here because their parents are. These teens need to know, directly from us, what they can expect post-extraction, including pain, and options for managing pain and pain medication responsibly.

Looked at holistically, opioid abuse is not just a prescribing problem. It’s a symptom of larger problems. And getting to the root cause will require all of us.

Image by frankieleon

New EPA Rule Aims to Keep Dental Mercury Out of the Environment

no dental mercury amalgamReady for some good news?

At long last, the EPA has proposed its rule to limit mercury discharges from dental offices. The agency estimates that it will prevent 8.8 tons of metal – half of which is mercury – from from polluting our water supply.

This is a very big deal, for there are about 160,000 dentists in the US who either use or remove amalgam, “almost all of whom discharge their wastewater exclusively to [Publicly Owned Treatment Works].”

Studies show about half the mercury that enters Publicly Owned Treatment Works (POTWs) comes from dental offices. Mercury from amalgam can then make its way into the environment in a number of ways, including through discharge to water bodies. Contact with some microorganisms can help create methylmercury, a highly toxic form of mercury that builds up in fish, shellfish and fish-eating animals.

That would include us. It’s one way those of us who never get a so-called “silver” filling are affected by dental mercury, as well. By reducing mercury discharges, we all win.

So how does the EPA propose we put an end to this pollution? Dentists would be required to use amalgam separators, a technology that catches and traps the mercury before it goes down the drain. (Of course, if it’s still being put in your teeth…) Twelve states already mandate them. We’ve used them in our office for years.

“This is a common sense rule that calls for capturing mercury at a relatively low cost before it is dispersed into the POTW,” said Kenneth J. Kopocis, deputy assistant administrator for EPA’s Office of Water. “The rule would strengthen human health protection by requiring removals based on the use of a technology and practices that approximately 40 percent of dentists across the country already employ thanks to the ADA and our state and local partners.”

Even so, we still have a lot of work to do to create a mercury-free future. Even with the new rule, mercury amalgams will still exist. Untold numbers are already in the mouths of patients. Some dentists continue to place them. Some patients still agree to them.

More, as Charlie Brown of Consumers for Dental Choice notes,

Separators cannot stop dental mercury from reaching the environment via other pathways, such as the cremation of human bodies containing amalgam. So what’s the best way to stop dental mercury pollution? Stop using mercury amalgam dental fillings.


TAKE ACTION!
If you haven’t already done so, sign the Consumer for Dental Choice’s petition that calls on Secretary of State John Kerry to help bring the FDA in line with State Department policy now that the US has signed the global mercury treaty known as the Minamata Convention. Please take a moment to sign and share it through social media or email. The petition is available here.

Cosmetic Dentistry, Confidence-ially

Does confidence sell? The cosmetic dentistry industry seems to think so. A quick Google search shows that building confidence is usually one of the top ten reasons to whiten your teeth.

Be confident on your wedding day with whiter teeth!
Have an interview coming up? Whiten your teeth!
Boost your confidence and self-esteem!
More smiling, more confidence, more success!

You get the drift.

smiling womanCosmetic dentistry ranges from teeth whitening to dental implants after an accident, but the message remains similar: If you want better self-esteem, correct your teeth.

Of course, there are plenty of benefits of having a good smile — from health benefits to better employment/promotion prospects to attractiveness. But is a pretty smile enough to make you completely and totally, 100% happy?

According to a recent study in the British Dental Journal, not really.

The researchers looked at the influence of “personality and pre-treatment contentment” on post-treatment satisfaction. So they assessed patients’ personalities, as well as how patients felt about their faces and bodies both before and after having cosmetic work done. And what did they find?

Although all participants were more satisfied post-treatment with the body overall and their face in particular, those scoring highly on neuroticism were generally unhappier both before and after treatment.

In other words, all were happier about their appearance, but some were happier than others. It largely depended on how content they were before treatment.

In this respect, cosmetic dentistry is like other kinds of physical self-improvement, such as getting a new hairstyle or losing weight. It’s no panacea. Some get a confidence boost, some don’t. Struggles with anxiety, depression, obsession and other troubles can cast a pall.

The degree of “internal improvement” – feeling better about yourself – depends, as ever, on the individual.

Don’t get us wrong: A beautiful smile can help. And we love to provide them – and to do so in a healthy, holistic way that considers your wellness as a whole.

But as for self-confidence, fortunately, it is a less a state of mind than a skill that can be learned. This wonderful TED Talk includes some great tips and tricks you can put to work today:
 

Image by Caden Crawford

Overgrown Gums & Other Dental Anomalies

Gum recession is a pretty common problem. Incredibly overgrown gums? Not so much.

hereditary gingival fibromatosisHence, it was news when a couple of girls – Muriel and Nicole Rayo, ages 11 and 12, respectively – had surgery to correct a condition called hereditary gingival fibromatosis. The sisters’ gums had become so enlarged that their teeth were fully encased, creating both functional and aesthetic concerns.

Not many people inherit this condition – only about 1 in every 750,000. The excessive growth tends to start once a child’s permanent front teeth come in. Not only can this excess tissue cover the teeth but the roof of the mouth, as well.

In severe cases, surgery is the only option – and those of the Rayos certainly qualified as that.

“We see cases of gingival overgrowth, where the gums grow, but it’s partial. It’s really not to the [extent] or the severity of what these two girls had,” said Dr. Maria Hernandez, post-grad director of the periodontal department at Nova Southeastern University.

And according to Miami Children’s Hospital,

Together, the team planned two surgeries, one for each child, to remove the overgrowth of the gum as well as some of the girls’ baby teeth which were also encased in the gums. The surgeries proved to be a success and both sisters were back home and smiling within two days of their surgeries.

This wasn’t the only strange dental case that turned up this summer. Maybe you heard about the Indian teen who had 232 “teeth” extracted. Only they weren’t teeth exactly. They were denticles, tooth-like growths caused by a non-cancerous oral tumor. The growths, which were removed in a six hour surgery, were all attached to the young man’s lower right jaw. Fortunately, doctors were able to save his permanent teeth.

supernumerary teethBut even though this case didn’t really involve teeth, there are indeed cases where a person may have more than the usual 32 permanent teeth – a condition known as hyperdontia. It’s hardly rare. Anywhere from 1 to 4% of the population have a couple extra or “supernumerary” teeth.

Such teeth don’t necessarily need to be removed. However, they can sometimes cause problems – for instance, alignment and occlusion (bite) issues that lead to chronic headaches and neck pain. They can also interfere with the eruption of adjacent teeth or cause crowding, leading to the need for orthodontics.

Most of the time, there’s just one tooth involved, but there have been documented cases of more than 30!

Next time flossing seems like a chore, maybe be grateful you have just the usual number of teeth to tend to.

Supernumerary teeth image via Dr. Steakley

Reducing Toxins in the Dental Office

Mercury is the key ingredient in so-called “silver” amalgam fillings and a known neurotoxin. Despite that, about 75% of all new fillings are made of the stuff, as the ADA continues to insist that it’s perfectly safe. Evidence, however, shows that mercury from dental amalgam may play a role in numerous neurological, endocrine and autoimmune disorders.

This isn’t just a concern for patients. Dental workers are at risk, as well.

1385682_846092542070992_3574722680187190476_nYes, dentists – who, every day, with every patient, year after year, can be exposed to an incredible variety of toxins, ranging from bacteria and other pathogenic (disease-causing) microbes to x-ray radiation, toxic chemicals and heavy metals.

Due to constant exposures to mercury – as well as radiation and chemicals – research has found that dentists have a higher-than-average risk of some cancers (brain, skin and reproductive). Other studies have shown higher rates of suicide and divorce among dentists. Could those be fueled by mercury, as well? Notable symptoms of what was historically called Mad Hatter’s Disease – a condition caused by hat-makers’ prolonged exposure to the mercury used in their trade – include mental confusion, emotional disturbances, pathological shyness and irritability.

There are many potential points of mercury exposure in a conventional dental office, putting both patients and dental workers alike at risk.

Amalgam comes in measured capsules that have to be shaken, then broken into a dappen dish. Inevitably, no matter how carefully it’s done, some is bound to spill. Without proper precautions, some of this will contaminate the air and some may enter the office plumbing and its journey through waste water into the environment. There are waste capsules and scrap amalgam to deal with. If existing amalgams are removed, both mercury vapor and particulate are released.

Imagine working in that environment all day, every day.

It’s why practices like ours go to such lengths to practice mercury-safe dentistry, doing all we can to minimize exposure. You can learn more about proper safety measures here, here and here.

As mentioned, radiation is another major threat to dental workers’ health. While there are standard safety regulations to minimize exposure – the Texas guidelines run over a 100 pages – the fact remains that older equipment used for making x-rays on film emits much more radiation than newer, digital machines. Some have estimated the difference in exposure to be as much as 90% less in digital. Older equipment is also more prone to leakage, providing an even bigger dose of radiation to the dentist and office staff.

Another benefit of digital over film: As we noted before, going digital means we don’t have to keep harsh, noxious chemicals in the office for processing the images. And when we do take images, it’s only when required for proper diagnosis or evaluation of a condition. We believe the risks of radiation are enough that x-rays should never be “routine.”

After all, the most fundamental concept in the healing arts is to first, do no harm…

Hermey’s Holiday Gift List

Remember the scene in Rudolph when Hermey the elf declares what he’d rather be doing than making toys?

An elf dentist? Who’da thunk? Then again, around the holidays, anything can happen – which may explain why at least some of the items on the dentist-elf’s gift list were invented in the first place.

After all, was there really so much demand for a dental action figure, complete with tools?

molarr

Not that Hermey’s own action figure would stand a chance against him!

hermey

For the more seriously – and practically – dental minded, morning joe from a molar may be tough to resist!

molar_mug

Likewise, a spider that dispenses floss. Who wouldn’t want to pretend to use spider web silk to clean between their teeth?

spider_floss

Or maybe your friends would rather get one of these syringe pens (procaine not included, of course) –

syr_pens

or perhaps a more tact-ful gift:

tooth_tacks

An icy grin like this might be better suited for an arch enemy!

419L7VcVDRL

Rounding out our list is this smiley ornament – or should that be ortho-ment? – sure to be a hit among both the upper and lower brackets:

orthornament

Happy and healthy holidays
from Pride Dental!

When Face Pain & Depression Happen Together

What does the mouth have to with the mind? More than you might think!

face_painDepression and jaw, face, head and neck pain have been known to sometimes exist simultaneously – often stemming from the TM joints, the “hinges” that let your mouth open and close. They’re also among the few joints in the body that use articular discs – oval shaped discs made of fibrocartilage that allow for separate movements in those specific joints.

Misalignment, repeated stress or damage to the TMJ eventually leads to a pain syndrome known as temporomandibular disorder (or dysfunction), TMD for short.

The correlation between TMJ pain and depression presents kind of a chicken and egg problem: Is depression a response to the pain or does the pain give rise to depression? A recent study in Acta Odontologica Scandinavica concluded that it may be the former – that “depressiveness increases the risk for chronic facial pain.”

This study builds upon earlier ones of how psychological factors affect pain symptoms. All together, these cast light on the fact that typical treatment with antidepressants or painkillers may never completely address the whole problem.

Rather, the whole patient must be treated for complete health.

When you think about it, it’s kind of odd to deal with symptoms in isolation, as if they’re independent of what happens elsewhere in the body. Holistic dentistry, on the other hand, looks for and treats root causes. We respect the impact dental conditions may have on the body as a whole – and how systemic issues may lead to problems in the mouth.

It may so happen that if you treat facial pain associated with TMD, depression will subside. In our office, Dr. Sprinkle’s first line of treatment is noninvasive and drug-free, employing dental appliances that are easy to use. Patients who come in initially for help with chronic headaches or face pain typically report improved mood and energy levels as their physical symptoms dissipate.

The whole body benefits as the fundamental cause is addressed.

Doctors and patients alike have found what happens in the mouth is reflected elsewhere. We know that periodontal health has an effect on the entire body through the common denominator of inflammation. Other studies have shown the dynamics of oral health and hygiene on other aspects of systemic health. Biological dentists further know how each tooth is connected with other organs throughout the body via the meridian system established by Traditional Chinese Medicine. (You can learn more about those tooth-body connections by using our interactive Meridian Tooth Chart.)

Biological dentistry is cognizant that “what happens in the mouth is reflected in the body, and what happens in the body is reflected in the mouth” – not just physically, but mentally, as well.

Learn more about how we can help you find relief from jaw, face, head and neck pain

Image by Cara, via Flickr