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.

Pushing A Wheelchair With Our Feet

Heard a funny observation this morning on the way into work: you ever wonder why there are people who are bound to a wheelchair, yet they somehow find a way to push themselves across the street with their feet, all the while remaining seated in the chair?

Then I picked through the morning's literature review, and the disabled wheelchair riders may be similar to patients suffering a sleep breathing epidemic. The increase in middle-age and elderly population's use of medication "sleep aids," and the rising prevalence in sleep disordered breathing that goes undiagnosed. It is a silent epidemic on the rise, and those who suffer it may be able to navigate through their lives with no clear understanding of their breathing disability.

In recent studies, it was observed that over 90% of women and over 80% of men with moderate to severe obstructed breathing disorders were living undiagnosed prior to survey.

Middle age and elderly individuals have a greater prevalence of sleep breathing disorders, most of them being obstructive sleep breathing type. Many sufferers have other associated conditions that make their condition worse, like the rising prevalence of chronic allergic rhinitis and sinus congestion, and the rising incidence of obesity.

With that being said, I have witnessed a great number of patients in my practice that are candidates for a sleep breathing evaluation. And a majority of those patients I refer are confirmed with sleep breathing disorders by our specialists.

We routinely screen our patients for a risk of airway obstruction. Call us today for an appointment.

The Less I See You, The Better!

I think it's common knowledge that humans with teeth go to the dentists twice a year. But I hope to give you a better explanation for why it's a good thing.

Maintenance or hygiene visits are all about risk management. Most patients have a measurable amount of risk for tooth decay and periodontal disease. If you have had a history of tooth decay, for example, that's a standard that holds true in evidence-based literature: You are susceptible to decay, therefore, you should have an inspection done every 6 months.There's a lot of risk factors to consider. But your dentist can help you understand what those are.  Here at our office, we issue a risk management sheet explaining your factors for decay and how to treat those risks.

Periodontal disease is similar, but there are different factors to consider. If you are a smoker, a diabetic, or have a history of gum and bone damage from an infection, you should see the dentist at least twice a year. For some people, those factors don't exist. If you don't have any risk of decay, and you don't have a history of gum disease, you probably don't need to see me so much. That's why it's not necessary to see all patients twice a year.  Some patients only need to be seen once annually for examination. The cliche still holds true: Flossing Each Day Keeps the Doctor Away.

I'm Worried About Dentistry, So I Took A Pill!

Every now and then a patient will come in and explain they had to "take a pill" to be less anxious. I totally understand the rationale. Millions of people avoid coming to see guys like me, and have to take measures to relax. I'm a big fan of how effective that choice is for patients.

But self-medicating comes with significant risks. Take, for example the aforementioned patient. She drove herself to the visit while under the influence of the drug. I don't care if it's a time-release capsule or there is a late onset of effect from the drugs. That's a black-and-white no-no without a driver or an escort. It's a recipe for impaired judgement, a motor vehicle accident, or an accidental injury.

May people are surprised when I tell them it is a serious medical risk without close monitoring and controlled prescribing and dosing efforts. "But I feel perfect!"  some say. Most every common sedative will create respiratory depression, or mess with the brain's ability to regulate stable and consistent breathing. Then there's the physical changes to balance and communicating. The ability to reason starts to diminish. And most patients I see are using at least one other medication. Some patients metabolize or process the drugs differently; some get quick effects, some get little effect. That needs close management. There are countless drug interactions with sedatives. And those interactions need to be studied and managed for patients prior to taking the drugs.

So back to the question: why do patients self-medicate with sedatives instead of letting us administer them? It's mostly due to cost avoidance, in my experience. I get that. But I can't take on the liability of  patients using sedatives unless I can closely monitor administer, and control the drugs. And there's the point: risk management and monitoring patients while using sedatives will cost money. But ultimately the costs are lower given the numerous risks every patient faces.

We Have Evolved. It's Official!

Interesting article I read about the correlations between the introduction of  local anesthetic for dental treatment in kids and the reduction in 3rd molar formation and ocurrence. See below.

Spear article

Don't Run With Scissors, Don't Pour Gas On A Fire

My 3-year old daughter wanted to do some artwork last week. Upon the request to "go get some scissors," she ran to the office and ran back with the shears flailing in front of her face. Parenting Rule #856, Don't Run With Scissors, was then practiced for the umpteenth time.

There's plenty of new rules emerging in the dental world as we learn about the long-term effects of soda on teeth. My hygienist sent me a link about the wisdom of not drinking soda--'cause it's bad for your teeth--with a new twist. Not only does soda rot your teeth, it does it faster than we thought, and probably as well as meth and cocaine.

Methamphetamine and crack cocaine users suffer from dry mouth when using. Lethargy and thirst also increase, and users often turn to soda consumption to increase energy and satisfy the dry mouth. The triple whammy is that in addition to a dry mouth and acid erosion from soda, smoking the drugs will burn, erode, and decay teeth. It's like pouring gas on a fire.The photo below is pure meth mouth.

Non-drug users can suffer the same devastating results after long-term soda use. Caffeine will reduce the flow of protective saliva, and the pH of soda is so acidic, it will erode enamel quickly. This is a patient who has enjoyed Coke and Diet Coke for a decade.

 

 The good news is that soda erosion is manageable. Neutralizing the acidity of the soda immediately after drinking it will reduce the risk of this kind of decay. Chewing sugar-free gum, drinking water, or brushing your teeth are all effective choices. 

Putting A Spare on a Bad Axle?

If you haven't already given this idea some thought, wait no longer: I am a mechanic in some respects, and a doctor of the mouth in most. But Automovite specialists and I have something in common. We want to do the best job we can with any client, and minimize the liabilities for ourselves as well as the clients with any given job. We have challenges limping some clients along depending on  the severity or complexity of their problems.

One example of this occurred this morning. A patient called this morning complaining of continued pain with his severe periodontal disease after we began non-surgical treatment. He elected to retain a poor tooth instead of removing it, and now I'm guessing he is hurting because the continued infection has flared up. And he prefers to have me call his pharmacist to treat his pain and infection.  When I reviewed his case, I noted that the area where he was complaining has truly severe bone and tissue infection with little hope for medication to solve. In addition, he plans to transfer his care to another provider.

When your car has a problem, like a bad axle or suspension, it's tough to call the mechanic and have them send out a tow truck to put the spare tire on. Furthermore, your mechanic will have a tough time assessing the extent of the current damage without having your car up on the lift in the garage.

The same holds true for a change in conditions in the mouth. Even from week to week, periodontal disease and failing teeth are in flux. A prescription for pain control may be a poor choice for a number of reasons, both medical and dental. Some issues can't be resolved with prescriptions. Narcotic medication management is something we take seriously, and we do not provide narcotic medications without seeing patients directly. And from the medical-legal standpoint, making an assessment and treatment over the phone is risky for patients and providers.

Thanks for understanding we dentist types want the best for your your medical health, your teeth. And your cars.

CNN Stirs the Pot

Elizabeth Landau is a health writer for CNN. She posted a blog article about some connections between dental x-rays and the increased risk of brain tumors. There was another article I studied about a year ago that covered the same essential issues. In this entry, Landau informs readers about connections between x-rays and meningiomas. I believe the same information was televised on ABC today.

Concerns about radiation exposure are well-founded. There is countless research that has been conducted to illustrate risks associated with x-rays. As a healthcare provider, my obligation is to exercise the best possible judgement about exposing my patients to any radiation. I have to be sure that the value of exposure outweighs the risks of not exposing patients. X-rays are a vital diagnostic tool for determining my patients' treatment choices. Non-maleficence and beneficence are my key criteria when ordering any tests or imaging. In some cases, I can diagnose problems and find solutions without the need for x-rays. I can also request imaging from other doctors to help patients avoid redundant x-ray exposure. Thes are all strategies that result in a win-win for patient exposure and their treatment planning.

Landau's article is pertinent, in that it reviews the latest findings in some outlying research about the effects of radiation on patients. But she suggests that we ask ourselves about the necessity of x-rays when it comes to our own care, as well the care of our children.

I feel something doesn't sit right about this article after I digested it a couple of times. I'm not sure why she quotes a Yale researcher as a clinical expert who describes her IMPRESSION of needless dental x-ray exposure, yet we don't see any evidence of overexposure published here. In my opinion, I'd like to see researchers make a connection between the number of doses and the presene of thyroid, brain, or head and neck cancers. I read quite a bit of literature on dental x-rays and the discussion is always focused on a commitment to minimize patient exposure, because radiation effects have already been established. In essence, Landau is presenting information we already know to be in existence, but she finishes the post with a call to action for parents to question the necessity of x-ray exposure for their children.

To me, this blog entry seems like a pot getting stirred. As a parent and a clinician, I know all patients are going to need diagnostics. Repeated exposures are the exception rather than the rule. Periodic exposure occurs in dentistry. But the reality is that most patients, including my kids and myself, will not require ROUTINE periodic exposure. There is a difference. And that difference is based on our risk for disease.

If you suffer from a skeletal or orthopedic disease like osteoporosis-induced skeletal fractures, you're going to have a greater number of periodic exposures to x-rays to measure bone damage and/or healing after treatment. Similarly, if you get cavities all the time, you're going to get more periodic exposures to identify emerging problems or the performance or integrity of previous treatment. If you have no cavities over the course of 3-5 years, your risk level of disease is relatively low. But, if you have recurrent or stubborn diseases, imaging and testing are tools to measure how your diseases are improving or worsening. In my practice, I don't routinely order x-rays every six months or even every 12. It's case by case, and always based on risk. And sometimes I can utilize x-ray records from other doctors. These are strategies that limit your exposure. The key here is that we're practicing evidence-based health care to determine a need for your x-rays. Non-maleficence, beneficence, jurisprudence are all in play.

Even with my emphasis on risk-based utilization of x-rays imaging, dentistry has further minimized exposure by using newer imaging technologies. Digital x-ray systems require significantly less radiation energy per exposure than historic equipment and techniques. Exposure times are reduced.

If you feel you or your family are being overexposed, please contact me here on the blog, or at chris@cascadiadentistry.com. I'd be happy to discuss any and all concerns or questions about this issue.

What's Your Dental Score?

How do you rate your finest hotels and your memorable restaurants? With a rating score, of course. You know what you're getting when you see the 5-star ratings.

Your dental health should be just as easy to identify. In the past, it hasn't been easy to understand where you stand on your health, much less how your mouth is doing. There's a lot of factors that come into play when you are talking with your doctors about your level of risk and if you have a significant level of disease--it can get pretty overwhelming.

Enter MyDentalScore.com, a new tool used to more easily identify your risk for disease. The website offers a comprehensive analysis of your dental health, by analyzing several key details about your mouth and summarizing with an easy to understand score. Your scores will guide you in making the best decisions about how to care for the three most common diseases in dentistry: cavities, periodontal disease, and oral cancer.

Give us a call or drop us some email to discuss how to address your scores today!