DoctorDurante

Sunday, March 29, 2009

Snoring & Sleep Apnea: How a Dental Appliance Can Help

A person who has sleep apnea stops breathing for ten or more seconds while sleeping, then wakes enough to start breathing again and falls back asleep. This can happen as many as 60 times a night. It's a problem because sleep isn’t simply a blackout: it runs in cycles of lighter and deeper sleep, which are disrupted when breathing stops. Someone suffering from sleep apnea can be in bed for 8 hours but wake up exhausted, because of the frequent disruption of his or her sleep cycles.

If someone who sleeps with or near you has sleep apnea, you’ll probably hear loud snoring, then an abrupt silence, then a snorting or choking sound as the person starts breathing again. On the other hand, if you’re the one with the problem you may not realize it: people with this sleep disorder often don’t remember waking up in the night. You will nevertheless feel the effects of lack of sleep, which include morning headaches, excessive sleepiness during the day, and irritability. Left untreated, sleep apnea can make you unable to function well during the daytime and can lead to high blood pressure, heart attack, or stroke.

The way to find out if you have sleep apnea is to visit a physician specializing in sleep disorders, who will make a diagnosis based on your medical history, a physical examination, and an overnight sleep study to find out the number of times your sleep is interrupted during the course of a night.

How is sleep apnea treated? That depends on the reasons for the apnea. The milder form—fortunately also the most common— is obstructive apnea, in which the muscles of the throat relax so much that the airway collapses. Your physician may suggest not sleeping on your back, losing weight, or quitting smoking. For some, a simple dental appliance that repositions the lower jaw and tongue may be all that's needed. This same dental appliance is, incidentally, used to prevent or lessen snoring.

Sleep apnea is a condition that must be diagnosed by a physician, not a dentist. If a physician confirms that you have the problem, or if you snore and want to stop, I’ll be happy to make a custom-fitted dental appliance and adjust the fit to make it work as effectively as possible.

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net . The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

Sunday, March 22, 2009

Why Replace a Lost Tooth?

The obvious reason to replace a lost tooth is so you can eat as efficiently as you did previously. If you lose one of your molars, you lose the chewing area between it and the corresponding molar above it: a quarter of your chewing surface. If you lose a canine, you’ll have to tear at that beef jerky with the other side of your mouth.

Besides the loss of function, there is the fact that your other teeth may shift to fill in the gap: that’s what usually happens. Of course, statistics don’t determine what will occur in your particular case, but there’s a reason for the statistics. Teeth push and lean against each other, both within the same arch and from the opposing arch (that is, your upper and lower teeth). If the lost tooth is “missed” by the adjacent teeth or opposing teeth, the teeth that remain will shift until the forces are in balance again. The results of that are unpredictable. Molars may end up not meeting the opposing molars as neatly. New gaps between teeth can become traps for food particles, leading to tooth decay and gum disease, hence to loss of more teeth.

The most common ways to fill spaces left by missing teeth are bridges and implants. These have different maintenance requirements from your own teeth, but the amount of time you need to maintain them is small, compared to the number of times you probably use the teeth in a day. If you’re a candidate for either one, we can discuss which is best suited to you.

If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net. The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.

Sunday, March 15, 2009

Air Abrasion

There ought to be a more attractive name for air abrasion: it sounds a scrape, but in fact it’s the most wonderful invention in decades for patients who hate dental drills. And that would be about 100% of the patients I’ve seen in my 25 years of practice.

Air abrasion uses a fine stream of aluminum oxide to scour away decay. Think of it as a sandblaster geared to the scale of an ant: it’s extremely small and precise. When I use air abrasion, I usually don’t have to give you an anesthetic injection (no needle!), and you can eat or drink as soon as the filling is set, without worrying about whether your numb lip is hanging down to your chin.

Air abrasion is also much quieter than drilling and produces no vibration. The worst that can be said about it is that it produces a fine dust, which I mostly vacuum away as I work. Whatever isn’t vacuumed out, you simply rinse out with water. In the 12 years I’ve been using this technique, not a single patient has said he wished I'd used the drill.

What’s the catch? Air abrasion usually can only be done on cavities that are not already causing pain. I’m able to use air abrasion on more than half the cavities I treat. You can increase your chances of being treated with air-abrasion by having regular check-ups, so that we catch and treat cavities early.

Sunday, March 8, 2009

Dental Check-Ups: How Often Should You Have One?

The standard recommendation for dental check-ups is every six months. Why? Because in 6 months, a new cavity is less likely to eat through the tooth into the nerve, causing you serious pain. Also, if you have your teeth professionally cleaned every six months, it's less likely that plaque and tartar will cause gum disease.

That said, 6 months is an average. Several factors affect how often you, as an individual, should have a routine check-up.

1. Dental hygiene

Are you diligent about brushing and flossing? Cavities are caused by bacteria feasting on the sugars in food remnants. If you brush and floss every 24 hours or so, fewer food particles and bacteria will be there to cause damage. As you get older, you may have to up your dental-hygiene routine. For example, if your gums are receding or your teeth have become crooked, there may be new places vulnerable to cavities that need to be carefully cleaned.

My family uses a toothpaste that has prescription-strength fluoride and an electric toothbrush that runs for two minutes and beeps at 30-second intervals, to tell the user when to start brushing a new section of the mouth. I also floss with dental tape rather than plain floss (round in cross-section). If you want, ask me for the latest name-brand recommendations when you come for your check-up; they change too often to put up on the web.

2. Heredity

All teeth are not created equal. Some people are born with grooves in their molars that are too narrow for toothbrush bristles to reach into. If you have that sort of teeth, minute food particles will get stuck there even if you brush and floss meticulously, and it's likely that you’ll eventually develop cavities in your molars. Catching such cavities sooner rather than later will prevent pain and help preserve your natural teeth.

3. Food & Drink

As I mentioned in the post on sealants, the absolute worst thing for your teeth is food or drink that’s full of sugar, and that stays in your mouth a long time or that you munch for hours on end. Unless you buy sugar-free versions, all the following can have significant amounts of sugar:

Sodas
Fruit juice
Lollipops, boxes of M&Ms, breath mints
Cough drops
Hostess Twinkies and similar snacks

The list of ingredients on packaged food is given in order from the most prevalent to the least. If one of the first 3 ingredients is sugar, corn syrup, fructose, or dextrose, I don’t buy it as a snack and we don’t keep it in the house. An exception now and then (at a party or at a friend’s, for example) won’t have a big effect if you avoid sugars most of the time.

You probably know if you’re cavity prone for any of the above reasons. If you don’t, ask me to tell you based on your existing records, and we’ll talk about how often you should come in for check-ups.

The money spent on check-ups is considerably less than the cost of filling major cavities. And one of the great benefits of catching cavities early—before they become too expansive—is that they can be fixed with a relatively new technique, air abrasion. Air abrasion involves no needles and no numbness. More on that in a future post, or read the Academy of General Dentistry’s description here.

Thursday, February 26, 2009

Why Get Sealants for Your Child?

When I was a kid, I loved rock candy, which is pure sugar. Sugary candy that you keep in your mouth for a long time and sugary soda that takes a while to drink are just about the worst things you can do to your teeth. Combine them with less than fanatical toothbrushing habits, and it's no surprise that by the time I was 20, I had a mouthful of silver fillings. So did most of my friends.

My daughter may very well turn 20 without a single major cavity. Part of the reason is that we don't keep candy in the house. Part of the credit goes to the sealants I put on her teeth when she was 9 years old. Sealants have been around for about 30 years and have made a tremendous difference in how many cavities kids get. They're a sort of plastic coating over the molars that takes minutes to apply, and lasts for years. The cost is roughly equal to half the cost of filling one major cavity. Best of all, getting sealants put on is a pain-free process that can save a lot of pain down the road.

Of course you should teach your child to brush and floss, but why not give them a little help while they learn to do it efficiently? I have office hours that will allow you to bring your child in without disrupting his or her school or after-school activities, or your work schedule. (Click here for hours and location.)

Sunday, February 8, 2009

Some of My Happiest Patients Are Those Who Have Had Root Canals

The words “root canal” are synonymous with pain: “I’d rather give birth than have a root canal.” Yet some of the patients who leave my office with the biggest smiles are those who’ve had a root canal.

A root canal is a last-ditch attempt to save a tooth by cleaning out infected soft tissue inside the tooth. It's done because saving your own tooth is usually more convenient and less expensive than having the tooth extracted, then replacing it (with an implant or a bridge) so your teeth stay lined up and your bite remains stable. For a long time, however, having a root canal meant a lot of drilling and a lot of pain.

In the 25 years I’ve been practicing, root canal procedures have improved greatly: better pain control, better treatment techniques, better results. When I was a teenager, watching my dentist make people pain-free was one of the things that inspired me to choose a career in dentistry. (More on this on my website.) That's why I always schedule adequate time to let the local anesthetic take effect. (You can also request nitrous oxide, if you wish.) I also use a top-notch dental lab that produces crowns that usually fit on the first try, and that match your own teeth.

Some patients who’ve been seeing insurance-approved dentists for years come back to me for root canals and other difficult procedures. When it comes to such procedures, a dentist who accepts an insurance payment as full payment is at a disadvantage: he is often forced to rush because he's seeing patients in half-hour slots, and he may have to choose a dental lab not because of the quality of its work, but because its lab fee is low enough to be covered by the insurance company’s payment. (Read more about my policy on insurance payments.) I take pride in providing my patients with the finest quality of care, which includes scheduling adequate time for procedures and using the knowledge and experience gained over 25 years in practice to make each visit as pleasant as possible. That’s why some of the happiest patients are those who have had root canals.