I Can't Breathe, And My Teeth Are Shrinking!

Years ago, I could swear people were coming to me with signs of freshly ground tooth enamel or broken teeth and crowns. I could literally watch the teeth being carved down over the course of hygiene visits. So I would ask them if they were aware of a habit that would make that happen. "No," they would shrug. "I don't." The only thing I and my patients could agree on was that they didn't grind their teeth during the day.

I know tooth wear is not typical. In fact, our brains do not allow our teeth to touch, even when we eat. If they do touch, it's called parafunction, or an abnormal function. So I was puzzled for a long time. It's frustrating when you know there's a reason for an occurrence, but you can't identify it.

What I started to recognize around 2005 was that patients informed me more often about obstructed breathing in their medical histories. Then I started to make a tally of which of these patients had tooth damage  and which didn't. And then I compared them to the patients who were not claiming obstructed breathing disorders. I noticed that all patients I saw who had a sleep breathing disorder were manifesting tooth wear.  The literature showed that this was occurring in a cause-and-effect fashion: When your airway closes, your brain instructs your jaw to move to open your airway. Your teeth can be in the way, and over time, will suffer damage in attempts to remedy obstructed airflow.

We work closely with specialists to determine if you have a breathing disorder, and we treat sleep breathing disorders with oral appliance therapy. We just so happen to treat teeth as well. Call us to schedule an appointment today.

Am I A Doctor or a Dentist?

I had the craziest call yesterday. The caller was angry that we would require a treatment consultation for a patient's gastric reflux disease and nutritional habits. "He's not a real doctor," she said. "Is he a nutritionist and a physician?" Yeah, yeah, I've seen "The Hangover." Don't worry. I'm sleeping at night.

The caller claims she filed a complaint with the Washington Dental Service, accusing me of violating privacy and treatment guidelines because I was practicing outside of my scope of dentistry and practicing medicine without a license. For a moment, let's forget about how this caller is a grandmother of 2 pediatric patients I saw for comprehensive examinations. And let's also forget about the fact that this caller was asking us to violate HIPAA regulations and disclosure laws. Let's stay focused on the issues of the kids for a moment, and what I feel must be clearly understood by patients and parents alike.

I sat with the mother of these kids prior to exam and talked about the reasons they were here. Mom was loking for a dentist who could perform sedation procedures for her anxious daughter. Mom was also concerned about visible cavities. So I led Mom through the decay risk assessment form that we issue to every patient who is at moderate or high risk for tooth decay. We discussed medical histories, nutirional habits, the scope and level of supervision for the dietary and oral hygiene habits of her teen and preteen kids. I heard what I think is pretty typical for a family: a little hands-on supervision with nutrition at home, kids are mostly self-managed away from the house at school. Hygiene supervision is self-directed. I also discovered some crucial information about the teenager--a history of mild to moderate episodic gastric reflux. So now it's time for the clinical exam.

I sit with the teenager and diagnose 16 teeth with first stage tooth decay or greater. This means there is likely a medical component to the cause of her decay. I also learn that there is a history of hay fever and the occasional need to medicate for it, along with the history of medicating the reflux. I drill down with the patient about her current symptoms of reflux, discovering some tipoffs to continued reflux. She has a few--occasional epigastric pain, morning cough and morning need to clear her throat with mucous discharge occasionally, a mild reddening of the upper airway tissues, routine late night eating. She also has a significant potential to improve her hygiene habits, and could reduce how much soda she consumes regularly.

Not only is it my obligation to treat tooth decay, it's also my duty to inform the parents of minors about the influence of medical conditions on their children's mouths. So Mom and I agree to schedule a consultation for executing a treatment plan to address GERD and tooth decay treatments for their teenager.

Let's understand why I am discussing any medical issues or nutritional issues. There are so many medical conditions that affect the mouth. Acid erosion and tooth decay are a real side effect of gastric reflux disease (also known as GERD). I have to be well informed about the clinical signs, symptoms, diagnosis, testing, and therapies, because GERD puts teeth directly in danger. I refer all my patients with this clinical presentation if they are not under the care of a physician for the conditions.

In my practice, we are experts in everything we become responsible for treating. We are one of the first healthcare facilities a patient will visit for a diagnosis of cardiovascular disease, sleep breathing disorders, diabetes, oral cancer, migraine headaches, the list goes on. I routinely train and acquire continuing education for these medical issues. We also team up with surgeons, gasteroenterologists, ENT, cardiologists, sleep medicine, internal medicine, and family physicians on a regular basis. I visit medical clinics and provide no-cost educational sessions for physicians to become better acquainted with the strong connections between medicine and dental health.

So, yeah, I know medicine. It's called oral medicine. And I've been practicing it since I became a dentist. Medical dentistry is now the recognized standard of care.

Have You Checked Your Breathing Lately?

Poor breathing during sleep is a concern for 1 out of 4 adults. It is clled sleep-disordered breathing, and it can be responsible for sleep apnea. Kids are becoming increasingly more common patients with the disease.

The most popular emerging issues I am seeing in my practice are obstructive breathing disorders. A blocked airway can occur because of obesity, or anatomic differences in the head, jaws, neck, and/or throat. When breathing is not optimal, it creates a cascade of medical problems.

Obstructive airway disease is life-threatening. It can lead to high blood pressure and congestive heart disease. It increases a person's risk for stroke and heart attack. And sleep breathing disorders can complicate other diseases and their management.

As I continue my education and membership in the American Academy of Dental Sleep Medicine, I have learned there are only 2 ways for patients to address this disease: You treat it and live longer, or you don't treat it, and you live a shorter life with complications.

I have started to attend grand rounds with the local sleep medicine specialists at North Sound Sleep Center in Everett, I see the impact breathing disorders have on various patients; these patients who suffer have common characteristics. I compiled a self-test anyone can take to identify their risk for sleep breathing diseases. Here it is:

I have been told that I snore.
I have been told that I stop breathing when I sleep, or I have challenges with breathing efforts.
I am sleepy during the day even if I slept throughout the night.
I have high blood pressure.
I have been told that I sleep restlessly, I am always "tossing" and "turning" while asleep.
I tend to sweat excessively during my sleep.
I frequently awaken with headaches or jaw pain in the morning.
I have been known to fall asleep/nod off behind the wheel or other inappropriate times.
Others and/or I have noticed a recent change in my mood or personality.
I am consistently fatigued during waking hours.

I am overweight.

If any of these items apply to you, you need to see your primary physician or call our dental office for a more complete evaluation. Working together, we can get you the right care.

Cascadia's weekly prescription

Over the years, I have become increasingly aware of which patients have higher risks for obstructive airway disorders (OAD), also known as sleep apnea. What was at first a suspicion has now turned into an important screening procedure at every patient examination for my patients. I routinely examine the airway and offer a brief medical survey to patients who appear to be at greater risk for the disease. In collaboration with their specialists, we have treated patients with OAD to improve their quality of life.

I have been reviewing literature and websites for several years, and feel that the Academy for Dental Sleep Medicine is a decent resource for learning more about diagnosis and treatment for the disease. This site also offers you a self-test to determine if you should visit a doctor to determine if you can be treated for this debilitating disease. You can also visit our site to take the self-test.