We all know how much better we feel after a good night’s sleep: refreshed, energized and ready to handle — even excel at — our day-to-day responsibilities. Yet millions of people, young and old, are robbed of a good night’s rest by sleep-related breathing disorders such as sleep apnea, in which the soft tissues in the back of the throat block the airway during sleep. This temporarily disrupts airflow, causing numerous “micro-arousals” (sleep interruptions) that we may not even be aware of. A lack of sleep can make us drowsy, irritable and unfocused. In children, these typical symptoms of sleep apnea can lead to mistaken diagnoses of Attention Deficit Hyperactivity Disorder (ADHD).
The relationship between sleep apnea and behavioral problems has been highlighted in several recent scientific journal articles, including a major study published several years ago in Pediatrics, the official journal of the American Academy of Pediatrics. The lead author, Dr. Karen Bonuck, said at the time: “We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems. The biggest increase was in hyperactivity, but we saw significant increases across [other] behavioral measures.” Therefore, an accurate diagnosis of a child’s behavioral problems — leading to the right treatment — is crucial. While sleep apnea must be diagnosed by a physician, treatment for the condition is often provided by a dentist.
What can be done for children suffering from sleep apnea? The most common treatment is surgical removal of the tonsils or adenoids. This treatment can sometimes be performed by an oral and maxillofacial surgeon, a dentist who has received several years of post-graduate surgical training. There are several other procedures oral surgeons can perform to open the airway, depending on what anatomical structures are blocking it.
Sometimes a child with sleep apnea can benefit from a procedure to expand the palate (roof of the mouth) to enlarge the airway. This is not a surgical treatment but rather an orthodontic one. An orthodontist (a dentist who specializes in moving teeth) will fit the child with a palatal expander, a butterfly-shaped device that gradually separates the two bones that form the upper jaw and roof of the mouth. This is often done to prevent crowding of teeth and other bite problems, but has been shown in some cases to improve airflow.
There is another dental approach used to treat adults and older children, whose jaw growth is complete. It’s called oral appliance therapy, and it involves wearing a custom-made device during sleep that resembles a sports mouthguard or orthodontic retainer. An oral appliance can maintain an opened, unobstructed, upper airway during sleep in various ways, including: repositioning the lower jaw, tongue, soft palate and uvula; stabilizing the lower jaw and tongue; increasing the muscle tone of the tongue.
If your child has been diagnosed with sleep apnea, we can help you find the best treatment approach. For more information, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Sleep Disorders & Dentistry” and “Snoring & Sleep Apnea.”
It's normal to have occasional mouth dryness—that "cotton mouth" feeling when you first wake up or after eating a spicy meal. It soon dissipates, though, leaving you no worse for wear other than the memory of an unpleasant sensation.
For some, though, the unpleasant sensation becomes a chronic condition known as xerostomia, in which their mouth feels dry most of the time. And, it can have far-reaching consequences beyond a mere irritation if not treated.
Among the numerous causes for xerostomia, the most common appears to be over-the-counter and prescription medication. An estimated five hundred medications have dry mouth as a potential side-effect, from antihistamines to antidepressants. And because people over 65 are more likely to take medications, they also have a high occurrence of xerostomia.
A person with certain systemic diseases like Parkinson's Disease or undergoing radiation or chemotherapy for cancers of the head and neck may also encounter dry mouth. For example, an autoimmune disease called Sjögren's syndrome, primarily affecting postmenopausal women, can dry out the mouth's mucous membranes.
Chronic dry mouth isn't normal, and often a sign of a health problem that should be examined. And it can lead to more problems with your oral health. Because dry mouth is most likely a reduction in saliva, which helps buffer decay-causing acid and provides antibodies to fight bacteria, having less of this vital fluid can increase your risk for both tooth decay and gum disease.
So, what can you do if you're plagued by persistent dry mouth? If you suspect your medications may be a factor, talk with your doctor about whether one of them may be the underlying cause for your symptoms. You may be able to switch to an alternate medication without dry mouth side-effects.
You can also increase your water intake during the day, including drinking more before and after taking medication. And there are a number of products like the artificial sweetener xylitol found in gums and candies that can boost saliva. Your dentist may also be able to recommend products that increase saliva.
Above all, be sure you keep up daily brushing and flossing, as well as regular dental cleanings. Taking care of chronic dry mouth could help you avoid dental problems later.
If you would like more information on preventing and treating chronic dry mouth, 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 “Dry Mouth.”
There are plenty of hilarious videos of groggy patients coming out of wisdom teeth surgery to keep you occupied for hours. While many of these have turned everyday people into viral video stars, every now and then it really is someone famous. Recently, that someone was Seattle Seahawks quarterback Russell Wilson.
The NFL star underwent oral surgery to remove all four of his third molars (aka wisdom teeth). His wife, performer and supermodel, Ciara, caught him on video as he was wheeled to recovery and later uploaded the clip to Instagram. As post-wisdom teeth videos go, Wilson didn't say anything too embarrassing other than, "My lips hurt."
Funny videos aside, though, removing wisdom teeth is a serious matter. Typically, the third molars are the last permanent teeth to erupt, and commonly arrive late onto a jaw already crowded with other teeth. This increases their chances of erupting out of alignment or not erupting at all, remaining completely or partially submerged within the gums.
This latter condition, impaction, can put pressure on the roots of adjacent teeth, can cause abnormal tooth movement resulting in a poor bite, or can increase the risk of dental disease. For that reason, it has been a common practice to remove wisdom teeth preemptively, even if they aren't showing any obvious signs of disease.
In recent years, though, dentists have become increasingly nuanced in making that decision. Many will now leave wisdom teeth be if they have erupted fully and are in proper alignment, and they don't appear to be diseased or causing problems for other teeth.
The best way to make the right decision is to closely monitor the development of wisdom teeth throughout childhood and adolescence. If signs of any problems begin to emerge, it may become prudent to remove them, usually between the ages of 16 and 25. Because of their location and root system, wisdom teeth are usually removed by an oral surgeon through one of the most common surgeries performed each year.
This underscores the need for children to see a dentist regularly, beginning no later than their first birthday. It's also a good idea for a child to undergo an orthodontic evaluation around age 6. Both of these types of exams can prove helpful in deciding on what to do about the wisdom teeth, depending on the individual case.
After careful monitoring throughout childhood and adolescence, the best decision might be to remove them. If so, take it from Russell Wilson: It's worth becoming the star of a funny video to protect both current and future dental health.
Most of what goes on inside our mouths—good or bad—is fairly predictable. But every now and then, people encounter something out of the ordinary. A good example is lichen planus.
Lichen planus are rare skin lesions that can occur on various parts of the skin, including inside the mouth. The name comes from their lacy appearance, which resembles a fungus that grows on rocks or trees called lichen.
Being similar in appearance, though, is all that lichen planus has in common with its fungal namesake. It's believed that the sores are caused by a reaction of the immune system mistaking some of the body's cells as foreign.
But don't let the exotic sounding name alarm you—true lichen planus is considered a benign mouth sore. You may not even realize you have it until your dentist notices and points it out. But the lesions can sometimes cause mild pain or burning, especially if they occur near the gums or if you indulge in spicy or acidic foods.
As we said, these lesions aren't considered dangerous. But in a small number of cases, oral cancer was found to develop later. It's unclear whether the lesions were related to the cancer, or if what were diagnosed as lichen planus lesions were actually pre-cancerous cells mimicking the appearance of the benign sore.
In any event, your dentist will probably continue to monitor the lesions and possibly conduct regular oral cancer screenings to be on the safe side. You may also want to stop using tobacco or alcohol products to further decrease your risk of oral cancer.
As to managing lichen planus, it starts with a daily habit of brushing and flossing. You'll also want to avoid spicy or acidic foods like citrus fruits, tomatoes, peppers or caffeinated drinks, especially during flareups. If the lesions are causing discomfort, your dentist may also prescribe a topical steroid to apply to them.
Since it's quite possible you won't know if you have lichen planus (as well as other types of mouth sores) unless your dentist observes them, you should keep up regular dental visits. Having your dentist check your entire mouth, not just your teeth and gums, will help both of you stay on top of your oral health.
If you would like more information on mouth sores, 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 “Lichen Planus.”
In an ideal world, your family's dental needs would mesh seamlessly with the family budget. Alas, it's not always that way, and it can often be a head scratcher figuring out how to pay for needed dental work.
You can reduce treatment costs with dental insurance, which could conceivably cut your bill in half. But dental policies often have payment caps and coverage limitations on materials and procedures. And unless someone else like an employer is paying for it, you'll have to subtract the premiums you're paying from any benefits you receive to reveal what you're actually saving.
Even with dental insurance, you can still have a remaining balance that exceeds what you can pay outright. You may be able to work out a payment plan with the dentist for extended treatments like braces, but this might not be possible in other cases.
That leaves financing what you owe with loans or credit cards. For the latter, it's highly likely your dentist accepts major credit cards. But since many cards charge high interest rates, you could pay a hefty premium on top of your treatment charges the more you extend your payments on a revolving account over time.
Your dentist may also participate with a healthcare credit card. Although similar to a regular credit card, it only pays for healthcare costs like dental fees. Interest rates may also be high like regular cards, but some healthcare cards offer promotional periods for paying a balance over a designated time for little to no interest. But late payments and overextending the promotional period could nullify this discount.
You might save more on interest with a loan that has a fixed interest rate and payment schedule rather than a credit card with revolving interest (although credit cards may be more suitable for smaller expenditures while a fixed loan works better for larger one-time charges). One in particular is a healthcare installment loan program, one of which your dentist might be able to recommend, which is often ideal for paying dental costs.
Paying for your family's needed dental care can be financially difficult. But you do have options—and your dentist may be able to assist you in making the right choice.
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