Sleep Apnea and Teeth Grinding

Image result for sleep apnea and teeth grindingImage result for sleep apnea and teeth grinding 

Many patients who visit our office each day experience bruxism and it’s clear that they grind their teeth. It may be evident with wear facets forming, or it may be in the beginning stages where the patient experiences headaches upon waking or other TMJ symptoms. Bruxism is usually treated with the patient wearing a night guard of either hard or soft plastic material. However, studies now show that tooth grinding at night may be closely linked to sleep apnea with the treatment involving a CPAP machine.

Although the reason for bruxism is unknown, many factors seem to contribute to the condition. These factors include alcohol, smoking, stress, caffeine, fatigue, and sleep apnea. It’s estimated that eight percent of the general adult population experience bruxism and most are Caucasian males. So, what’s the link between clenching and grinding and sleep apnea?

There are two types of sleep apnea. Today’s focus will be on Obstructive Sleep Apnea (OSA) because it’s linked to bruxism. OSA is the most common type of sleep apnea and is caused by airway blockage when the soft tissue at the back of the throat collapses.

When the soft tissue collapses, the body fights to keep the airway open thus repositioning the jaw and grinding the teeth. This scenario happens over and over during the night as a defense mechanism with the body trying to keep the blood oxygenated.

By treating the patient with an occlusal guard, we may be overlooking the real cause of the grinding, and this could be detrimental to the patient. The next time we evaluate a patient with bruxism, consider having the patient consult with their primary care physician to see if a sleep study is in order. Not only will we save your teeth, but we may also save your lives.


tooth implant

Peri-Implantitis is an “infectious disease that causes inflammation of the surrounding gum and bone of an already integrated dental implant, leading to loss of supporting bone.” Most inflammatory episodes are caused by plaque biofilm colonizing around the implant. Peri-Implantitis begins as Peri-Implant Mucositis which is an inflammatory condition of the mucosa and can be compared to Gingivitis because it’s reversible and doesn’t include bone loss.

Without proper treatment, Mucositis can progress to Implantitis by involving the mucosa and supporting bone. Implantitis is characterized by Crestal Bone level loss along with bleeding upon probing and exudate, and there may or may not be deepening of the pocket around the implant.

It’s estimated that one in five patients will exhibit Peri-Implantitis and the shocking part is that many patients will never have any symptoms of Peri-Implant Mucositis or Peri-Implantitis. Either condition can also occur immediately following placement of the implant or years later.

Risk factors for this condition include smoking, diabetes, osteoporosis, periodontal disease of natural teeth, poor home care, compromised immune system, and bruxism. Sometimes, there is no reason at all for Peri-Implantitis. The good news is that it’s rare and treatment is available.

Symptoms of the disease include deepening pockets around the implant, exudate, bleeding, progressive loss of supporting bone, swelling, metal thread exposure, and mobility of the implant.

Causes of this disorder are soft bone, vertical bone graft placement, implant size too big for the site, lack of tightness when placing the implant, overheated bone, excess cement at the implant site, malocclusion, occlusal overload, and bruxism.

Treatment options consist of thoroughly cleaning the area, site-specific and/ or systemic antibiotics, bone grafting, surgery, and removal and replacement.

As stated earlier, the patient may have no symptoms so a thorough exam including radiographs at each appointment may keep the implant from failing. Reassure the patient that just because one implant may have failed or developed peri-implantitis, it doesn’t mean that the second one will fail or develop any complications.

Why do I have to take an antibiotic before dental procedures?

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As a patient, you may be wondering why it’s recommended you take an antibiotic before dental procedures. What does your oral health have to do with your general health? In a word, everything. It’s like the old song, “The knee bone is connected to the leg bone.” Everything is connected, and it’s imperative that you adhere to the guidelines set by your physician if they have advised you to take an antibiotic before dental appointments. There are two major reasons you would require an antibiotic before dental appointments; artificial joint placement and certain heart conditions.

Do you have any artificial joints? Knee and hip replacements are very prevalent today, and the chances are that you or someone you know has had this operation. If so, your surgeon will probably require you take an antibiotic before dental visits in light of the human mouth having up to one thousand different bacteria. While this is normal, some are good and help you while others can be harmful. When you have a dental procedure, these bacteria can enter your bloodstream, go to the site of the prosthesis, and cause a severe infection. While this chance is remote, the resulting infection can be very serious requiring a hospital stay and possibly surgery. Taking a prophylactic antibiotic will help ensure that you have protection against this bacteria.

Do you possess any heart maladies such as a heart transplant, a damaged heart valve or artificial heart valves, a heart murmur, mitral valve prolapse, or rheumatic heart disease? Again, the human mouth hosts lots of helpful and harmful bacteria. During a dental visit, this bacteria can infiltrate the bloodstream and go to the heart causing a rather dire situation. Bacterial endocarditis is an infection which can affect the lining of the heart and heart valves. While the AMA guidelines have changed over the years, at present writing, premedication is no longer necessary for most heart murmurs and mitral valve prolapse. Having a heart transplant or artificial heart valves still requires prophylactic premed.

While there are many opinions regarding the need for antibiotic prophylaxis and the overuse of these medications leading to antibiotic resistance, your physician should be the one who determines whether or not you need this type of intervention based on your specific medical history.

Alcohol and Oral Health: A Guide for Patients

Alcohol Oral Health

A visit to the dentist’s office is a great opportunity to ask questions about the best ways to care for your teeth, but what sort of advice should our healthcare professionals be giving us? There are some areas where the best advice is very clear cut, such as cutting down on added sugars, for example, which are proven to cause cavities, and brushing regularly to remove plaque build up and keep the mouth fresh and clean. There are other areas, however, which are a little more unclear, such as alcohol consumption.

Alcohol: Good or Bad?

The main dilemma surrounding alcohol consumption from a health perspective is that there are both advantages and disadvantages. On one side of the coin, wine and beer are shown to contain a number of different vitamins and minerals which can be beneficial to the body, and moderate alcohol consumption could even help to protect against heart disease. Research studies have also been published which strongly suggest that moderate alcohol consumption could reduce the risk of certain types of cancers, including colon cancer, ovarian cancer, and prostate cancer, and also minimize the risk of stroke.

It appears that, from a general well being point of view, moderate alcohol consumption can be beneficial, but what about from an oral health standpoint? Unfortunately, there doesn’t appear to be any well documented evidence suggesting that alcohol could provide any benefits to oral health. In fact, around 75 percent of upper aerodigestive tract cancers are thought to be related to alcohol and tobacco use, alcohol has been shown to damage oral tissue, and it could also increase the risk of cavities because of the high sugar content. Overall, excessive drinking could wreak havoc on general oral health.

Everything in Moderation

So what sort of advice should your dentist be giving you regarding alcohol and oral health? Ultimately, there’s no right or wrong answer here, although many dentists will come back to the old saying ‘everything in moderation’. Due to the large number of health benefits associated with moderate alcohol consumption, it would be irresponsible to suggest that an otherwise healthy adult abstain from drinking alcohol completely. However, it would be equally irresponsible to advocate drinking, due to the substantial risks to oral health. ‘Everything in moderation’ appears to be a sensible middle ground.

Looking After Your Mouth

If you do decide to consume alcohol, make sure that you pay special attention to your everyday oral health. While the sugars in alcohol are bad for the teeth, you can help to minimize the effect by ensuring you brush regularly – at least twice a day – as well as floss, and, if necessary, use a mouthwash. This type of oral care routine can help to get rid of sugars from the teeth and lower the risk of decay. If you’re out on the town and don’t have access to toothpaste after drinking alcohol, even a swish with plain water is better than nothing, and it might be worth carrying some sugar-free gum with you at all times, too.

Fun (and Healthy!) Ideas for Halloween


Tooth decay is something that can affect us all, whatever our age is, but the effects on children can often be much more severe than the effects on adults. While a cavity may cause us to experience pain in the area, for children the symptoms can be much worse, and they may find that tooth decay causes problems with eating, speaking, learning, and playing. Unfortunately, tooth decay in children is very common, with around 20% of 5 to 11 year olds in the United States suffering with at least one cavity.

The good news is that there are many ways we can help to reduce the risk of tooth decay in our children, such as purchasing fluoride-enriched toothpaste, for example, and taking them to visit their dentist regularly. However, with Halloween – a holiday traditionally filled with sweet treats – we want to ensure that we’re not encouraging little ones to overindulge in sugary snacks.

The Risk of Sugary Treats

Added sugars in foods and drinks are very closely associated with tooth decay in children, and at this time of year it’s hard to avoid the candies on sale in the grocery stores. According to American Heart Association guidelines, children aged between 4 and 8 years should be having less than 3 teaspoons of sugar per day, or less than 12 grams. A fun size bag of Skittles contains 11 grams of sugar, and 8 pieces of gummy bear candy contains a whopping 21 grams of sugar – way above the recommended amount.

Healthy Halloween Alternatives

If you’re trying to stay away from added sugars and their risks this Halloween, then here are a few healthier alternatives that you can whip up at home that the kids are sure to love:


Compared to Halloween candy, fruit might seem a little boring, but there are lots of different ways you can add the spook factor. A bit of black food coloring can help to transform a regular clementine into a miniature Jack-o-Lantern, for example, or how about dipping strawberries into thick, Greek-style yogurt and freezing to make ghoulish ghost figures? You could even use some Halloween-themed cookie cutters to make fun fruit shapes, like watermelon bats and apple witches hats. The possibilities are endless.


If your kids simply can’t get through the holiday without a little candy corn, why not make them a healthy alternative? Before you put your popsicle molds away for the winter, use them to make “not-candy-corn” popsicles; a sweet yet healthy Halloween treat. Pour in some Greek yogurt first and freeze until firm, then add a layer of orange juice and freeze, and finally a layer of pineapple juice. Once the final layer has been frozen, you’ll have yourself a healthy popsicle that looks just like the real thing (but even bigger!)

Trick or Treat

If you’re looking for something to hand out to Trick or Treaters in your neighborhood, then you really want something that’s the perfect combination of tasty and healthy. A great idea is to melt some dark chocolate and drop teaspoon-sized portions onto some baking parchment. While still wet, sprinkle with some dried fruits, nuts, and ‘superfoods’ like goji berries, and leave to set in the fridge. You may wish to make some nut-free versions of these treats, too, so that everyone can enjoy your healthy snacks.

Halloween Treats – What’s Really Bad for Your Teeth & Some Better Choices


Time to ruin Halloween for kids by telling them what they can and can’t eat during this holiday. Don’t worry, your kids and you (I know you take a candy or two when you think no one is looking, so don’t try denying it lol) still have plenty of tasty treats to enjoy on Halloween, without having to go to the dentist the next week.

Take a look at the worst and best candy a trick-or-treater can bring.

Worst Halloween Candy

These candies are an absolute menace for your teeth. But they are so hard to resist! Unfortunately, they are also the ones a kid yelling “trick or treat!” hopes for when ringing on your door.

  1. Taffy and candy with nuts, coconut or caramel. These are a true menace for your teeth as they can get stuck anywhere in your mouth. Even between teeth, yuck! The longer the food is stuck to the teeth, the more time bacteria has to feed and create cavity acid.
  2. Sour candy. Because of their high acidity these are able to quickly break down tooth enamel. On the positive side, saliva in the mount acts to slowly restore the acid balance.
  3. Sugary snacks. Not all cavity problems are caused by industrial candy. Cookies and cakes are all high in sugar amounts and may lead to tooth decay.

Best Halloween Candy

Ugh, so what are we supposed to munch on on Halloween? Surely there is something in the Halloween basket we can eat? Yes, and here is what:

  1. Sugar-free gum. This treat contains xylitol, which is a natural sugar bacteria can’t create plaque on. Also, sugar-free gums leave no sticky residue like other candy and increases saliva. This way it prevents tooth decay and neutralizes mouth acid.
  2. Sugar-free lollipop and hard candy. These two stimulate saliva and prevent dry mouth. Plaque can build up faster in dry mouth, which increases risk of cavities.
  3. Chocolate with no fillings. Chocolate on its own is not only incredibly tasty, but you don’t have to worry much about cavities either. Without fillings to get stuck on or in your teeth, this is a much better option when you’re looking for something sweet.

There you go! Three types of candy you and your kids should avoid on Halloween and three that you can enjoy without getting a toothache tomorrow. Happy Halloween, everybody!

To Floss or Not to Floss?

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When it comes to our health, there’s always more than one opinion about what’s right. It sounds ironic, but sometimes science isn’t always a science, and there seems to be a lot of wiggle room and opportunity for debate regarding best practices. Alcohol, for example, is said to be bad for us, although red wine is believed to have many health benefits. A similar dilemma, and perhaps more interesting to dentists, is that flossing is said both to spread bacteria around the mouth, and remove it. Which is it? Should we be flossing or not?

Two Sides to the Coin

If you were to ask two different dentists whether or not you should be flossing, you’d probably get two different answers. There’s a lot of confusion – even among the experts – when it comes to flossing, and that’s because there are studies that demonstrate evidence both for and against the technique.

Let’s see what these studies say…

* For Flossing

There are two significant arguments for flossing. The first, of course, is cosmetic, as regular flossing helps to remove trapped foods, especially in people with mild diastema. The second argument is that flossing has been shown to be effective at reducing the frequency of bleeding between the teeth. In fact, in this capacity, flossing could actually be twice as effective as a standard toothbrush. Flossing alongside toothbrushing has also been shown to reduce the risk of gingivitis (a form of periodontal disease).

* Against Flossing

There are some dentists who advise against flossing because of the risk of spreading bacteria around the mouth and increasing the risk of infection. While this can happen, we need to remember that bacteria can be spread around the mouth even without the use of floss, simply during our day-to-day activities. Some also say that flossing is ineffective. As we can see from the research above, it’s not, but it may not be the most effective solution. Antimicrobial mouthwashes, for example, are usually much better.

Time to Toss the Floss?

Whether or not a person wishes to floss should be their own personal decision. There is no right or wrong answer here. Flossing isn’t dangerous or painful when done correctly, and although flossing alone isn’t enough to maintain excellent oral health, it can be effective when used alongside other techniques, such as brushing and rinsing. If a person wishes to floss, dentists should advise that they…

  • brush and then floss, rather than the other way around. This is more effective overall.
  • use around 45 cm of floss, with approximately 2.5 to 5 cm of floss inserted between teeth.
  • gently curve the floss so that it is adjacent to the tooth, and tension can be felt.
  • see a dentist if flossing causes bleeding. This could be a sign of gingivitis or other disease.
  • use floss holders if flossing is difficult, to make the process much more simple.

Vaping and Oral Health

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It’s official: vaping is in. Everywhere you look, e-cigarette stores are opening and film and TV characters (not to mention real life celebrities like Leonardo DiCaprio) are ditching their regular smokes in favor of top-of-the-line vaporizers. Perhaps most noticeable, though, is the debate raging between medical experts over whether or not the practice is safe enough as an alternative to smoking.

The Safety Argument

While some experts claim that the risks associated with e-cigarettes are too high for it to be condoned, others argue that compared to smoking, it’s the safer option by a long way. We’ve heard the experts discuss cancer risks and lung health, but a subject that far fewer people are discussing is the direct impact vaping could have upon oral health.

Mouth Irritation

One common complaint about e-cigarettes is that frequent use can lead to dryness, irritation and soreness of the mouth, throat and tongue. This is in some cases caused by an allergy to propylene glycol, an ingredient found in most e-liquids.

Vapers can also develop canker sores in the mouth; however, this is thought to be a side effect of quitting smoking. Canker sores aren’t typically a cause for concern but they can be unpleasant and unsightly, and can deter people from their normal oral hygiene practices due to the pain and heightened sensitivity.

The Effects of Nicotine

Nicotine – the addictive ingredient in tobacco and e-cigarettes – is a chemical which can cause a whole host of oral health issues. Nicotine is a vasoconstrictor, which means it reduces the amount of blood flowing into your gums. This can cause gum recession and bad breath (as it limits the production of mouth-cleaning saliva). Nicotine is also a stimulant, which means it can cause you to grind your teeth more.

The key point to make here is that both regular cigarettes and most e-cigarettes contain nicotine – and in fact, e-cigarettes tend to contain less. However, because e-cigarettes can generally be used in more locations, it is possible that nicotine consumption from vaping could be the same as (or higher than) smoking for certain people.

Further Studies Needed

At the moment, not enough is known about how vaping affects the health of the mouth or body in the long term. Further studies are needed to firmly establish the risks associated with this practice.

However, when weighed against normal cigarettes, e-cigarettes do seem to pose less of a direct risk to oral health. This is largely because e-liquids contain much lower levels of toxic chemicals than normal cigarettes.

Oral Hygiene Tips for Vapers

Until more is learned about the association between e-cigarettes and oral health, vapers who are concerned about keeping their teeth and gums healthy should keep up good hygiene practices. This means brushing with fluoride toothpaste twice a day, flossing and visiting your dentist for a check up at least once a year.

You can also combat the mouth dryness that vaping can cause by drinking more water, cutting out caffeine and using a mouthwash such as Biotene.

Hey sorry everyone but you probably keep flossing

Couple weeks ago the Associated Press dropped news that pretty much everyone has been waiting for: Little evidence exists that flossing actually does anything. And so the people collectively threw their minty-fresh, waxy threads into the trash and muttered, “Gobdanged dentist.”

But please, let’s all cool off for a moment, reach down into the trash can, and retrieve our floss. Because while it’s true that evidence in favor of flossing is lacking, you should probably still do it. Many dentists have known all along the research isn’t there, and they kept on recommending flossing anyway. Just hear me out—their intentions are pure. (Full disclosure: I was briefly a copy editor at a marketing firm for dentists. It was awful, and it in no way clouds my judgment with this story.)

Dentists tell their patients that flossing removes plaque from between teeth—gunky stuff that can lead to tooth decay and gum disease. That’s the story, anyway. As the AP pointed out in their piece, studies haven’t confirmed flossing prevents decay and disease. And the ones that have shown some sort of benefit have been flawed, relying on too few subjects over too little time. Indeed, because the evidence just isn’t there, the feds last year stopped recommending flossing to the public.

Here’s the thing, though. The lack of evidence for the benefits of flossing is nothing new. “To be honest, many of us in the dental public health community have known for years that the information was sparse,” says Scott Tomar, editor of the Journal of Evidence Based Dental Practice.

So why keep propagating the myth? Why force the public to stick their hands in their mouths? Well, because while the effectiveness of flossing isn’t proven, it’s also not disproven, at least not yet. Scientists are still gathering string—and it’s proving difficult.

Dental Bonding – A Solution to Chipped, Stained OR Gapped Teeth

Dental bonding is a type of cosmetic dental procedure. In which, the plastic materials called composite resins are used on person’s teeth to enhance aesthetic oral appearance. This substance is applied, shaped and polished according to individual’s own teeth tone and size and adapted to remaining teeth structure. It is mainly maneuvered to cure stained/discolored or chipped teeth improving one’s smile.


When should I consider dental bonding?

Dental bonding needs to consider one’s right candidacy at first.

If you are with the following dental issues, you owe a consultation to your dentist:

  • Decayed tooth
  • Minor chips, cracks on teeth
  • Discolored/ugly teeth
  • Teeth gaps (spaces between teeth)
  • Poorly sized and shaped teeth (shorter in line with other teeth structure)
  • Receding gums (enhancing teeth structure to prevent loss to teeth root)

It fixes above oral issues and greatly beautifies facial look!

How is dental bonding performed?

The dental bonding is a special preparation that usually does not require the patient to undergo anesthesia. Fillings for tooth decays or sort of repairing may need it. To create the materials that can match one’s teeth color and tone very closely is the first step.

Next is a bonding process in which, the teeth surfaces are roughened to ensure material’s nice attachment to them. The resins that are specially prepared matching one’s teeth are then applied and shaped as planned. This material will now need to be hardened using special light or laser. Following is a final trimming, polishing and shaping until it looks quite adapting to the remaining structure of teeth.

Dental bonding usually takes from half an hour to an hour to complete.

What are the benefits of dental bonding?

The advantages of dental bonding are tremendous. As compared to other cosmetic dental surgeries, it is less expensive. Bonding will probably not require lab work to be created. They are made easily in offices except there are more teeth involved needing bonding.

Being most advantageous, it mainly does not require much of enamel scratching unlike some procedures like dental veneers or crowns.

Although the dental bonding treatment has some limitations like not too long durability or more vulnerability to cracks and breaks, many people choose it depending on their timely requirements and results. For minor cosmetic requirements, it’s a perfect oral solution.

Is dental bonding long-lasting?

Usually up to 4 years to 10 years span. At the same time, how you care for it will also decide its healthy life. Oral hygiene, prevention from harmful habits/materials is advised. In future, it can also be replaced or repaired with additional touches.

What is post-op care for dental bonding?

Not much, typically! Better oral hygiene, dental care with appropriate teeth brushing and flossing can preserve it well. Regular followup to your dentist for teeth cleaning is a preventive step for any discrepancy.

As we know it’s susceptible to cracks easily, avoid some habits like chewing hard foodstuffs or materials that can cause damage to bonding. If you notice something unusual with it, see your doctor immediately to have it corrected before further worsening.

How much dental bonding cost?

Not much costly against cosmetic dental treatments alike! As demography will vary, the costing will also. One can compare the prices of dental bonding city to city and country to country. Dental tourism is a face that is, at present, in high demand for its lower prices and quality treatments accessible worldwide!