All posts by kpecoraro

10 Myths About Sleep

Adults sometimes like to brag about how little sleep they get when working on a project or pulling an all-nighter. Instead of congratulating them, it might be best to double check their work. Research by Robbins and her colleagues combed through 8,000 websites to discover what we thought we knew about healthy sleep habits and then presented those beliefs to a hand-picked team of sleep medicine experts. They determined which were myths and then ranked them by degree of falsehood and importance to health.

We sleep about 1/3rd of our lives and science still can’t find a reason why we do. It’s such a fascinating cascade of chemistry, feedback loops and brain activity that still baffles science. There are still mysteries that our Creator uses to prove this stuff couldn’t just evolve. Sleep is one of those mysteries.

Look through these 10 false myths and see which ones you might want to change in your routine…

1. Adults need five or fewer hours of sleep.

“If you wanted to have the ability to function at your best during the day, resist illness better, be mentally strong, how many hours do you have to sleep?” This was the question asked by the senior study investigator Girardin Jean-Louis, a professor in the Department of Population Health and sleep research. The articles suggest 7-10 hours is optimal. There is a lot of research showing that less than 5 hours of sleep per night increases our risks for stroke, heart attacks, diabetes, high blood pressure, and fatal car accidents or work accidents.

Other symptoms that can develop with chronic sleep deprivation include; a weakened immune system, weight gain, a lack of libido, mood swings, paranoia, depression and a higher risk of dementia and some cancers.

2. It’s healthy to be able to fall asleep ‘anywhere, anytime’.

Falling asleep as soon as the car/train/airplane starts moving is not a sign of a well-rested person, sleep experts say. In fact, it’s just the opposite.

“Falling asleep instantly anywhere, anytime, is a sign that you are not getting enough sleep and you’re falling into ‘micro sleeps’ or ‘mini-sleep episodes’. It suggests your body is so exhausted that whenever it has a moment, it’s going to start to repay its sleep debt.”

You feel sleepy because of a buildup of a chemical called adenosine in the brain, which happens throughout the day. Sleeping soundly reduces that chemical (in some of the sleep stages that are disturbed in Sleep Apnea) so that when you wake up, the levels are at their lowest, and you feel refreshed. The longer you stay up at night, the less sleep you get and adenosine levels rise, creating what’s called a sleep debt.

Want to check your level of sleepiness? Take the Epworth Sleepiness Scale and if you’re worried, check in with a sleep doctor who can do more extensive testing in a sleep lab.

3. Your brain and body can adapt to less sleep.

People also believed that the brain and body could adapt and learn to function optimally with less sleep. That too is a myth, experts say. That’s because your body cycles through four distinct phases of sleep to fully restore itself.

Stage one is a light sleep and you are awakened easily. Your brain begins to send signals to disengage you from awaking in stage two, where you will spend most of your total sleep time. Stages three and four contain the deepest, most restorative sleep and the dreamy state of REM, or rapid eye movement sleep. Sleep Apnea and other medical conditions can prevent you from getting into REM (dream sleep) sleep.

“During REM, the brain is highly reactive,” Robbins said. “It almost looks like your brain is awake if we hook you up to two more electrodes and were able to monitor your brain waves.”

REM can occur any time during the sleep cycle, but on average, it starts about 90 minutes after you’ve fallen asleep. REM is when your body and brain are busy storing memories, regulating mood and learning. It’s also when you dream. Your muscles are temporarily paralyzed during REM sleep except for the heart, diaphragm, mouth, and ears, so you can’t act out your dreams and can be awoken if danger approaches.

Some people have night terrors – a sudden awaking where you feel “paralyzed” and unable to speak or move for a moment; this sudden waking from REM sleep is the reason. It takes a second or so for the brain to secrete the chemicals that “re-connect” the brain to the spinal cord and get signals to the motor muscles of the body.  

With normal sleep, you’ll go through several REM cycles, which take up about 25% of your total sleeping time. Typically the “last dream” of the night will be what’s remembered.

Stage 3 sleep, or “deep sleep”, our brain waves slow into what is called delta waves or slow-wave sleep. It’s the time when human growth hormone is released and memories are further processed. “The deeper stages of sleep are really important for generation of neurons, repairing muscle and restoring the immune system,” the author states.

4. Snoring, although annoying, is mostly harmless.

In your dreams, maybe. In fact, “loud, raucous snores interrupted by pauses in breathing” is a marker for sleep apnea, a dangerous sleep disorder that, according to the National Heart, Lung and Blood Institute, increases risk for heart attacks, atrial fibrillation, asthma, high blood pressure, glaucoma, cancer, diabetes, kidney disease and cognitive and behavior disorders.

Using a CPAP machine or a Dental Sleep Appliance

“Sleep apnea doesn’t allow restful stages of sleep for the skeletal system or brain. Patients may sleep many hours but don’t get the proper sleep stages needed for restoration of the brain and body.

You wake up over and over; then they are fighting sleep all day long because they’re so exhausted. We believe it affects about 30% – 40% of the population, and around 10% are diagnosed.”

Children can have sleep apnea from allergies, enlarged tonsils or adenoids or imbalanced jaw growth that is a side effect of mouth breathing. If a child snores even one night per week, is hard to get them asleep or very hard to wake them in the morning, that is possibly a sign of sleep apnea. In children, it will affect the brain development and growth of the face, bite, and TMJ.

5. Drinking alcohol before bed helps you fall asleep.

Do you think a nightcap before bed will help you fall asleep and stay asleep? Dream on.

Alcohol may help you fall asleep, but that’s where the benefits end, the author states. Instead, it traps you in the lighter stages of sleep and “dramatically reduces the quality of your rest at night.” Metabolism of the alcohol continues to pull you out of rapid eye movement and the deeper stages of sleep where you get the feeling of a “good night’s sleep”.

6. Not sleeping? Stay in bed with eyes closed and try and try.

You have to admit, it makes sense: How can you fall asleep if you’re not in bed trying? Yet sleep experts say that continuing to count sheep for more than 15 minutes isn’t the smartest move.

Grinding and Clinching Teeth at night

“If we stay in bed, we’ll start to associate the bed with insomnia,” Robbins said. She equates it to “going to the gym and standing on a treadmill and not doing anything.”

In reality, Robbins said, it takes a healthy sleeper about 15 minutes to fall asleep. If you’re tossing and turning much longer than that, you should get out of bed, change the environment and do something mindless: “Keep the lights low and fold socks,” she suggested.

Some people also believe that it’s just as refreshing to your body to lie in bed with eyes closed but not sleeping. Nope. That’s another pipe dream, experts say.

7. It doesn’t matter what time of day you sleep.

Sleep experts say that’s another myth that can negatively affect your health.

“We recommend that people have a regular sleep schedule because it controls what we call the biological clock, or circadian rhythm, of the body,” Jean-Louis said. “That controls all the hormones of the body, body temperature, eating and digestion, and sleep-wake cycles.”

When your inner clock and the outside world are out of phase, you can feel disoriented, mentally foggy and sleepy at times when you need to be functioning at optimal levels. Just think of what happens when you travel across time zones or when daylight savings time kicks in.

Studies of shift workers, who work unusual hours and live out of sync with their normal biological rhythm, show that they are at increased risk for heart disease, ulcers, depression, obesity and certain cancers, as well as a higher rate of workplace accidents and injuries due to a slower reaction rate and poor decision-making.

8. Watching TV in bed helps you relax.

Come on, we all do it — or we check our laptop or smartphone before we power down for the night. Not so.

“These devices emit bright blue light, and that blue light signals the pineal gland that it’s time to become alive and alert in the morning, because it is the nearly morning “color of light”. “

According to the National Sleep Foundation, blue light affects the release of melatonin, the sleep hormone, more than any other wavelength of light. Watching TV or using an electronic device within two hours of bedtime means it will take you longer to fall asleep, you’ll have less dream state or REM sleep, and even if you do sleep eight or more hours, you’ll wake feeling groggy.

If you or your children can’t make that two-hour cutoff because of homework or late-night work demands, experts suggest dimming the brightness of the screen or installing an app that can warm the screen to the sunset colors. Red and yellow have higher wavelengths and don’t affect melatonin.

9. Hitting snooze is great! No need to get up right away.

Raise your hand if you hit the snooze button. Why not, right?

“Resist the temptation to snooze, because unfortunately, your body will go back to sleep — a very light, low-quality sleep,” says the author.

As you near the end of your sleep, your body is probably nearing the end of its last REM cycle. Hit that snooze button, and the brain falls right back into a new REM cycle. Now, when the alarm goes off a few minutes later, you’ll be in the middle, not the end, of that cycle, and you’ll wake up groggy and stay that way longer.

10. Remembering your dreams is a sign of good sleep.

“That’s a myth, because all of us do experience dreams four to five times a night, IF we are sleeping properly and going thought the full range of sleep stages” Jean-Louis said. “And we don’t remember because we’ve not woken up and disrupted our sleep.”

study out of France showed that people who frequently remember their dreams have higher brain activity in the information-processing hub of the brains. They also woke twice as often during the night and were more sensitive to sounds when sleeping and awake. This heightened “awakens” could be suggestive of obstructive sleep apnea or a Sleep Disorder typical of middle aged women called Upper Airway Resistance Syndrome. The airway becomes hyper-sensitive to narrowing in deeper sleep and will trigger a subtle awaking throughout the night, often associated with clenching/grinding of your teeth. This repeated TMJ loading is frequently one of the triggers for TMJ disorders.

“Now, I will tell you if you have a dream with a strong emotional context, it may come back to you at say, two o’clock in the afternoon, when you have some downtime to relax,” Jean-Louis said. “Sometimes, something would trigger that. But if it is a weird little mundane dream, most of us who sleep well don’t remember those.”

MORE MYTHS

The research team found more myths that we tend to accept as fact, Jean-Louis said, such as “more sleep is always better” (no, you really can sleep too much and harm your health), “taking a nap in the afternoon can fix insomnia” (actually, if you sleep long enough to enter a REM or deep sleep cycle, it can mess up your body clock even more), and “it’s better to have a warm than cool bedroom” (no, you sleep better in cooler temps).

Which means that we could all use a bit of education about good sleep hygiene, a set of habits to form that will set you up for a lifetime of healthy sleep. The National Sleep Foundation has tips, as does our website at WWW. TMJSLEEPSOLUTIONS.COM.

10 Myths About Sleep, By Sandee LaMotte, CNN, Updated 2:06 PM ET, Wed April 17, 2019.https://www.cnn.com/2019/04/16/health/sleep-myths-facts-study/index.html

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Can gum disease be contributing factor in Dementia and Alzheimer’s disease?

Increasing research is saying “YES”.

Some of the aggressive Spirochetes that are found in patients “infected gums” are also found in the central nervous systems (Brain) of patients with Alzheimer’s and dementia.

These spirochetes can “hide” from your immune system once inside the brain and may not show up as an infection or cause a fever or other common symptoms.

The viruses are loosely associated with Lyme disease, which most people have heard of.  It can remain undetected by normal blood tests because it, too “hides” behind the blood-brain barrier, as do other spirochetes.

If your Dentist or dental Hygienist advises you that you have a “gum infection” or “Periodontal Disease” I would advise that you take it very seriously. The consequences of untreated periodontal disease we are learning include heart disease, tooth loss, and more recent research is showing a strong correlation to many disorders in the Dementia realm. And that isn’t anything to ignore.

Periodontal disease (gum disease) is one of the most widespread diseases in the world, and the US. It’s also almost 100% treatable by YOU, the patient.  Most people are just too lazy to take the time to brush properly AND floss twice daily…..when you consider Dementia/Alzheimer’s as a potential disease from not flossing…it might provide a little more encouragement to follow the Dental team’s advice.

Related: https://www.cbsnews.com/news/kris-kristofferson-misdiagnosed-alzheimers-has-lyme-disease/

JOURNAL OF NEUROINFLAMMATION, Alzheimer’s disease – a neurospirochetosis. Analysis of the evidence following Koch’s and Hill’s criteria, Judith Miklossy.  2011, 8:90

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It’s Just Snoring

 

While many people do snore, heavy or severe snoring isn’t part of a healthy sleep pattern. Snoring is a sign that you’re not getting enough air with each breath. Pauses in breathing mean that your airway has closed. This is Obstructive Sleep Apnea. Snoring can also be a symptom of a serious health condition like heart disease.

If anyone tells you that you pause in breathing, snort or gasp while sleeping, or you consistently feel unrested in the morning, you should be evaluated for Sleep Apnea.

Symptoms of serious snoring problems:

  • periodically stop breathing for a couple seconds at a time
  • high volume of snoring is a sign that your body is working really hard to get sufficient oxygen
  • excessive daytime sleepiness

Lifestyle changes that may help include:

  • losing weight
  • not sleeping on your back
  • avoid alcohol or drugs that relax your nervous system
  • quit smoking (It’s proven that stopping smoking immediately makes it easier for a person to breath better.)

Proper sleep stages throughout the night are important for the body to repair and restore different organs and systems while we sleep. We typically should go through 4 sleep stages every 90 minutes or so, throughout the night. Each sleep stage has its job of what gets restored. Snoring, restless sleep, gasping, frequent waking can all be signs that you have Obstructive Sleep Apnea; a potentially deadly condition.

In a study[1] of 744 college aged who had only mild/moderate obstructive sleep apnea and normal blood pressure at baseline were followed for high blood pressure. There was a strong association for young and middle-aged adults to develop high blood pressure because of their mild-moderate sleep apnea. They also had a higher statistical onset of metabolic syndrome (early diabetes). Older adults (over age 60) didn’t develop high blood pressure. Age seemed to be a benefit.

Custom and highly specific orthotic appliances are provided for differing TMD conditions and offer an alternative to CPAP for patients suffering from snoring and Sleep Breathing Disorders.

Credentialed Dentists in Dental Sleep Medicine and TMJ can work with your sleep doctor to design, adjust, and monitor your progress. Oral appliances are easy to wear and travel with. They require monitoring by a trained dentist periodically.

If you or someone you know has symptoms of sleep apnea, such as snoring, we can help get them diagnosed and treated before high blood pressure or pre-diabetes develop. The earlier it is diagnosed and treated, the healthier you will be over the decades.

[1] Mild-to-Moderate Sleep Apnea is associated with Incident Hypertension: Age Effect

Alexandros N Vgontzas, MD Yun Li, MD Fan He, MS Julio Fernandez-Mendoza, PhDJordan Gaines, PhD Duanping Liao, MD, PhD Maria Basta, MD Edward O Bixler, PhD

Journal SLEEP

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9 Tips on Oral Appliance Care

Custom and highly specific orthotic appliances are provided for differing TMD conditions and offer an alternative to CPAP for patients suffering from snoring and Sleep Breathing Disorders. These care instructions apply to all oral appliances, including night guards that may have been provided for clenching and grinding (bruxism).

  1. Store in case provided when not in use.
  1. Wash appliance with non-toxic soap or denture cleaner and brush.
  1. DO NOT soak in or clean with abrasive, damaging products such as: mouthwash, rubbing alcohol, peroxide or toothpaste.
  1. Brush Frequently. Brushing after each meal is recommended since your tongue is unable to remove food particles from under the orthotic. Meticulous oral hygiene is necessary to avoid tooth decay, gum disease or related dental problems. (Please ask us for guidance if you are unsure how to clean your teeth sufficiently.)
  1. It is normal to have more saliva, difficulty speaking and tongue biting in the beginning. Your body will accommodate to the orthotic in 10-14 days and these symptoms typically subside.
  1. It is common to experience new soreness in the temples, neck or other areas such as tooth achiness and sensitivity. Please contact us if this does not subside within 5-7 days.
  1. KEEP AWAY FROM PETS! They love to chew on them and this will result in damage.
  1. KEEP AWAY FROM HEAT! Do not leave in the hot car, put in microwave, dishwasher or boiling water.
  1. DO NOT leave in car or in luggage! They can melt in the heat and shatter in the cold. Keep your orthotic in your purse or carry on luggage to assure temperature is safe.

 

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The Clench and Grind: Bruxism

There are known relationships between sleep disordered breathing, TMJ damage/dysfunction and clenching or grinding. In the dental industry, clenching and grinding is known as bruxing or bruxism.

Because there are varying predispositions to bruxism and inconsistencies in the characteristics of subjects studied, the topic has been controversial in medical and dental journals in the past.

What we do know for sure from studying sleep apnea is when you clench or brux, the jaw muscles contract and therefore open the airway. Your body’s way of getting the air it needs. Just like pulling your hand away from something hot or your eyes blinking to protect them, the body instinctively knows what to do to survive. So, when suffering from sleep breathing disorders (sleep apnea), your body will clench or brux to open the airway.

When sleep apnea is successfully treated with an orthopedic orthotic (oral appliance), the clenching or bruxing subsides and has even been known to reach complete resolution. Likewise, a damaged or misaligned TMJ can contribute to clenching or grinding.

A dental nightguard is not the same as an orthopedic TMJ appliance. It has a different design and mechanical force on the TMJ. Dental nightguards sometimes lessen clenching or grinding, but more often exacerbate it. Although you may be protecting your teeth from each other, you may be causing further TMJ damage.

If you find you are clenching or grinding harder with your dental nightguard that would strongly suggest an underlying sleep breathing problem or TMJ damage that is being exacerbated.

If your current appliance is causing more problems or simply not working, consider having a TMJ specialist evaluate the jaw joints, airway, and the design of your dental appliance to assess if it might be contributing to increased joint pressure or airway constriction.

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Use of Antibiotics for TMJ Arthritis?

Damage to the TMJ ligaments and disc results in joint sounds in most people. Clicking, popping, or grinding noises in the jaw joints (TMJ) indicates that ligaments have torn and the cartilage “disc” is being damaged and isn’t protecting the condyle. Eventually the popping and clicking “goes away” when the joint is rubbing “bone on bone” in a simple explanation.

As soon as the TMJ begins to make noise, the articular bone may start to react in one of 2 ways; the bone may develop osteoarthritis (bony spurs/thickening) as it wears down. If an inflammatory arthritis develops because the pressure is too great within the joint, the bone can rapidly disintegrate. This shows up clinically as pain in a TMJ, clicking/popping, an uneven bite, etc.

Treating TMJ with orthopedic orthotic devices (NOTR bite guards, night guards, or anterior appliances) is a critical 1st step after a thorough exam, imaging, and diagnosis. As in most orthopedic problems, placing the TMJ under a gentle but constant traction will decreases joint pressure, helps stop bone damage, and relaxes the jaw muscles.

In some cases, I utilize tetracycline antibiotics to help stabilize bone as the pressure is being relieved by oral orthotics. We can utilize some properties of the tetracycline antibiotics to help slow the bone destructive pathways as the joint pressure is being reduced with proper orthotics; similar to the effect in periodontal disease with “Periostat” after careful debridement to protect bone loss.

Doxycycline, at low doses[1] (sub-antibiotic dose) interferes with “bone resorption” pathways and can help the TMJ maintain bone and perhaps regenerate some areas that are being affected. If we catch the early signs of bone destruction in the TMJ, it’s often an effective adjunct to orthotic therapy early in treatment. I have found it especially useful in teenage patients whose bone has not reached maturity while being treated with decompression orthotics for TMJ, if this condition exists.

However, the most important thing to remember in treating TMJ conditions is that the TMJ (jaw joint/condyle) is almost 100% of the time in a posterior, compressed position when the teeth are together. This underlying, orthopedic imbalance is the root cause of almost all TMJ pathologies: clicking and popping, joint pain, limited movement, and muscle pain in the head and neck.

Use of low dose tetracycline after using an orthopedic orthotic that objectively decompresses the TMJ can be a useful adjunct to help reverse degenerative TMJ conditions.

 

 

[1] The Anti-inflammatory Properties of Tetracyclines, Weinberg, JM. Cutis. 2005 Apr;75(suppl): 6-11

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Sleep Apnea Diagnosis and Therapy

Sleep Apnea is becoming more prevalent and has been estimated to affect 1/3 of the adult population[i]. In our practice and in general literature, children have a high percentage of Sleep Breathing Disorders which leads to long term facial distortion, TMJ problems, malocclusion, and potential medical problems such as diabetes, obesity, impaired learning.

Dentistry, and especially Dentists trained in Sleep Disorders and TMJ Therapy, can recognize these signs and symptoms early. With interventions before teenage years, it may be possible to reduce or eliminate the progression of the anatomic problems that contribute to adult Sleep Apnea.

The ADA (American Dental Association) in 2018 mandated by policy statement that Dentists provide screening and treatment for Sleep Breathing problems for children and adults. Not every Dentist or Physician/Pediatrician have awareness of the signs, symptoms, and facial/oral signs and symptoms of Sleep Breathing disorders.

Not all people with SRBD’s (Sleep Related Breathing Disorders) are obese, as might be stereotyped. 50% of patients [ii]with Sleep Breathing Disorders aren’t obese but may have neurologic, anatomic, or other contributing factors that affect the airway.

A Sleep Study (Polysomnogram “PSG”) is the most sophisticated sleep evaluation. Other ways to evaluate sleep breathing problems can be high frequency pulse oximetry, Home Sleep Studies, or a bedpartners report of snoring, gasping, twitching/jerking, or toot grinding (bruxing).  Nighttime tooth grinding may be up to 90% predictive of a Sleep Breathing Disorder; especially if a Dental Nightguard is reported to make the grinding worse or sleep worse.

Dentists who specialize in TMJ and Sleep Disorders work with physicians to identify, diagnose, and offer treatment for sleep problems.

Once diagnosed, several treatment options are available to manage the condition so that your body and brain gets the rest and restoration needed each night to help prevent diseases correlated with untreated sleep disorder breathing. These include; Diabetes, obesity, fatigue, poor cognitive function (executive functioning), heart attack, stroke, bruxing that leads to TMJ damage, dental damage such as sore, broken teeth or gum disease.

Once diagnosed, there are options for treatment depending on the diagnosis and severity. Evidence is mounting for multi-mode treatment for Sleep Breathing disorders to allow patients flexibility in treatment other than CPAP. Check back for more on this later.

If you or someone you know has signs of Sleep Apnea, encourage them to get diagnosed and treated. Consult both a Physician and Dentist credentialled in TMJ and Sleep Disorders as a team approach to diagnosis and treatment options.

If you suspect you have a sleep disorder, call us for a consultation.

[i] Benjafield, et al. Global Prevalence of OSA in Adults. Am J. Respiratory and Critical care Medicine: 2018; 197;A3962

[ii] Gray EL, et al. OSA without obesity is common and difficult to treat: J Clinical Sleep Med. 2017;13(1)

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Why might I need a sleep study and how do I get one?

A sleep study would be indicated by consistent snoring, feeling unrested after a night’s sleep (frequently), clenching or grinding of the teeth (indicates a high probability of a sleep breathing disorder), or repeated waking throughout the night. Any treatment a Dentist might provide to diagnose or treat a sleep breathing problem, needs the patient’s physician to manage the process by written permission to the dentist.

If someone witnesses or hears you “stop breathing” or gasping, snorting, jerking awake, it’s almost certain that you have Sleep Apnea. There are several ways to evaluate if you have, or the severity of, a sleep-breathing disorder.

PSG: Polysomnogram:

A very sophisticated evaluation of your entire physiologic and neurologic system during sleep. This is important in cases where patients may have several health conditions that might be related to or affected by Sleep Apnea. It’s the best diagnostic test.

Home Sleep Test:

A much simpler evaluation of basic parameters of Sleep Apnea in healthier patients. It can measure heart rate, breathing pauses, oxygen saturation, some can assess basic brain waves too. These are often used to evaluate the effectiveness of Dental Sleep Appliances after the initial Sleep Evaluation was done.

Pulse Oximetry:

Basically, a medical-grade “Fit Bit” with better accuracy. Not often used and doesn’t pick up much data.

If you mention snoring or fatigue to your Physician, they may not suggest having a sleep study. A dentist trained in TMJ or Dental Sleep Medicine can identify oral and other facial features, historical information and 3D imaging evaluations that would strongly suggest the need for a sleep study.

A sleep study must be ordered by a Physician because of the wide-ranging medical problems that Sleep Apnea can directly cause or contribute to such as:

  1. Hypertension
  2. A-Fib
  3. Heart Attack Risk Factor
  4. Stroke
  5. Frequent Urination Overnight
  6. Clenching/Grinding of Teeth
  7. TMJ Damage from Clenching/Grinding
  8. Neck Pain or Stiffness
  9. Nighttime Headaches/Migraines
  10. Feeling of Fatigue Despite Sleeping 7-8 Hours

A simple “pulse oximetry” test, or information from your “Fit Bit”, may miss critical information that could identify some of these risks based on your medical history and exam by your physician. Most of these conditions are out of the scope, licensure, and experience of Dentist’s to evaluate.

Over my years, we have seen patients who had heart conditions, blood pressure spikes (stroke risk) during sleep that weren’t picked up in their normal medical visits.

For a dentist to provide a Sleep Study, we must contact the Physician and get a written order to dispense a home unit or pulse ox. Dentist’s aren’t legally permitted to diagnose or test for, fabricate a “Snoring” or “Sleep Apnea” appliance without a written prescription from the patient’s Physician or Sleep Physician, which we always obtain.

Snoring IS a form of sleep disorder and must be approached as such.

In our practice, we have different sleep study devices that can be used to assess for the presence of a sleep breathing disorder or assess the success of a Dental Sleep Appliance in treating Sleep Apnea, snoring or other sleep-breathing problems involving oral appliances.

I always notify the patient’s Physician and discuss my findings that would suggest evaluation of a sleep breathing condition. The Physician makes the decision on the type of study that is done.

We work with many physicians and can provide fast, easy, home screenings with physicians written RX of patients we see to for TMJ or facial pain conditions, if indicated.

Contact us today for more information.

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Using earplugs to decrease gagging during dental impressions?

Many people have a heightened gag reflex due to many different reasons, making dental treatment difficult. For those “easy gaggers” and others, the thought of having Dental Impressions of the teeth is stressful because it can stimulate the gag reflex. This reflex is called Arnolds Reflex, named after Freidrich Arnold, an anatomy physician in Germany in the 1800’s.

The reflex arises from the auricular branch of the glossopharyngeal nerve and the vagus nerve which are part of a larger group of nerves that giving sensation and motor control to the throat muscles, among other functions.

In researching this reflex, it’s said that in man and animals a cough can only be induced by stimulation of a structure innervated by the vagus nerve or one of its branches. The auricular branch of the vagus nerve (Arnold’s nerve) gives sensation to the ear canal mainly the front, lower part. Some people with this heightened reflex may stimulate a “throat tickle or cough” when cleaning the ear canal.

Arnolds reflex is said to be present in about 1/3rd of a small sample and is nearly 4 times more common in women than men. In most areas of our skin, stimulation of the cutaneous nerves (such as with clothing, jewelry, watches) rapidly declines so that we aren’t irritated all day by it. The ear canal isn’t, so the sensory signal maintains its strength as a protective reflex as long as the stimulus is present.

In some people with a sensitive gag reflex, gentle stimulation of the ear canal (forward lower part) can be used to block the gag reflex during impression taking. This article suggests use of soft earplugs during impression taking. I have also had success with patients placing their pinky fingers in their ears (pads forward) during impressions. The added stimulus through Arnolds nerve (branch) can decrease the gag reflex in some patients during dental impression. It’s not a “guarantee” due to the complex nature of the neurology, but it’s an easy technique to try!

Forsch Komplementmed. 2014;21(2):94-8. doi: 10.1159/000362140. Epub 2014 Mar 28.

An earplug technique to reduce the gag reflex during dental procedures.

Cakmak YO1Ozdogmus OGünay YGürbüzer BTezulaş EKaspar ECHacıoglu H.

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Licorice instead of flossing?

As we learn more about the benefits of “nature’s medicines” that other cultures use successfully for some conditions, it makes sense to give a few a serious look due to the lack of side effects that most prescription drugs have.

It’s widely reported that oral diseases such as decay, gum disease, abscessed teeth, etc. are a significant source of morbidity across the world. Having disease free, comfortable teeth is important to proper eating. Especially in cultures that need to chew less refined food sources that we are accustomed to.

Licorice has many healing properties directly and from the metabolites of licorice that also shows beneficial secondary compounds. Licorice has properties that are well known to be antiviral, glucocorticoids (natural, powerful steroid compounds that have anti-inflammatory effects in the body- natural glucocorticoids work more effectively than laboratory-made ones), anti-inflammatory, antioxidant, anti-carcinogenic, etc.

Liquorice has been labelled Generally Recognized as Safe (GRAS) by United States Food and Drug Administration (FDA) and has been considered safe for human consumption provided it is consumed in small amounts and by individuals who are not sensitive to glycyrrhizin.  Overuse of liquorice can lead to hypokalemia (low potassium), hypertension, rhabdomyolysis (inflammatory muscle breakdown), muscle paralysis, respiratory impairment, hypertensive emergencies, hyperparathyroidism, among other conditions. These side effects are likely reported with excessive, unmonitored use of licorice. Most prescription medications have longer “side effect” profiles than beneficial effects when I actually read the labels!

Touyz et al. recommended that 250-500 mg of liquorice can be safely consumed up to three times a day for medicinal purposes. The licorice compound has both an anti-inflammatory effect in the mouth and the gum tissue by “inhibiting” the periodontal-disease bacteria from “sticking” to the teeth as effectively. Licorice also has an inhibitory effect on gum-disease-related bone loss.

Some over-counter “cold sore” topical medications contain licorice compounds that help shorten the duration of cold sores.

There are also many studies that are looking at the anti-oral cancer effect of licorice compounds, and show some promise.

So, have some black licorice every day (moderation) and know that it might be helpful to our general health as well as providing a “treat” to the taste buds! At this point it looks like brushing, flossing, and regular visits to the dentist are still the best prevention for periodontal and dental disease…

(excerpts from article. Disclaimer; I recommend you consult with your physician before taking any significant licorice on a regular basis.)Following excerpt from article: Sigurjonsdottir et al. reported that consumption of doses as low as 50 gm/d for a period of 2 weeks can cause a rise in blood pressure [20]. According to the World Health Organization 100 mg/d of liquorice can be safely consumed without any ill effects, however the Dutch Nutrition Information Bureau limits the use of liquorice to 200 mg/d. In a study conducted by Sontai et al., 50% of the 14 study subjects consuming 100e200 mg/d of liquorice had to be prematurely withdrawn from the study due to hypokalemia or edema [21]. Studies have reported that liquorice metabolites can interfere with the pharmacological actions of conventional drugs)

  1. Ayurveda Integr Med. Oct 2018, Oct 31: Sidhu, et al.
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