Contemporary Family Dentistry
Breathing Easier: Making Sleeping Restful
If snoring, nighttime clenching, or labored breathing are keeping you or someone you know from getting a good night’s sleep, there may be something wrong with their breathing function during sleep. When we sleep, muscles necessary for breathing relax much more than during waking hours. In most cases, this process causes no problems. However for some, when muscles relax excessively or airway obstruction is present, breathing is compromised and sleep is restless.To compensate some people’s jaw muscles actually tighten to try to improve the airway.
What is sleep disordered breathing?
Sleep Disordered Breathing can affect both adults and children. In adults, the airway loses its muscle tone during sleep, collapses in on itself, and as a result oxygen is blocked from entering the lungs. In children, lack of oxygen during sleep is generally caused by either enlarged tonsils or adenoids or a malocclusion of the teeth and/or narrow jaw and nasal passages.
When the muscles of the throat and tongue relax, they begin to sag and obstruct the airway and make breathing labored and noisy. As pressure to breathe builds, muscles of the diaphragm and chest work harder. If the airway walls collapse, breathing will be completely blocked. When breathing is blocked, snoring will be followed by a brief lapse in breathing until the sleeper gasps for air and awakens. Most often, the awakening is so brief that the sleeper does not remember it. Some people compensate for their physiological changes by tightening their jaw muscles to reposition the mandible, and of a self-induced CPR.
When these interruptions of breathing occur, oxygen in the blood drops causing a spike in blood pressure. Over time, these episodes can lead to serious medical issues such as hypertension, stroke, gastroesophageal reflex and cardiopulmonary problems. Basically your body’s physiological systems are not getting the rest they need to recover and prepare for the next day due to the lack of oxygen.
Determining the source of the problem
At Contemporary Family Dentistry, we work closely with general physicians, ENTs, pulmonologists, cardiologists, and other sleep specialists to conduct a complete medical screening and assessment and develop a treatment plan. Using CAT Scan and Acoustic Reflection Technology – a painless and non-invasive technology that uses sound waves to produce an image of airways – we will determine the location and cause of the obstruction, narrowing or collapsing.
Treatment through dentistry
For many patients, Sleep Disordered Breathing does not require surgery and may be treated successfully through dentistry. Often lifestyle changes such as diet, exercise and side sleeping coupled with sleep dentistry will make significant improvements. If the Sleep Disordered Breathing is due to a malformation in the orofacial area, we can provide acoustic reflection and CAT scan technology and oral appliance therapy to correct structural problems that result in airway narrowing or collapse.
There are several ways to treat snoring and sleep apnea. The most common is with a device called a CPAP machine. CPAP stand for continuous positive air pressure. It is usually applied through a tube to a mask that covers the nose. The air pressure that is generated splints the structures in the back of the throat holding the airway open during sleep.
Treatment can also be accomplished with surgery to the soft palate, uvula (that thing that hangs down from the roof of your mouth), and tongue to eliminate the tissue that collapses during sleep. More complex surgery can reposition the anatomic structure of your mouth and facial bones but this is done only in extreme cases.
Oral appliances that treat snoring and obstructive sleep apnea are small plastic devices, worn in the mouth, similar to orthodontic retainers or sports mouthguards. Oral appliance therapy involves the selection, design, fitting and use of a specially designed oral appliance that, when worn during sleep, maintains an opened, unobstructed airway in the throat.
Currently, there are over 40 different types of oral appliance available. Oral appliances may be used alone or in combination with other means of treating OSA, including general health and weight management, surgery or nasal continuous air pressure (CPAP).
Teeth Gringing & Clenching
Do you clench or grind your teeth?
Approximately 44 million Americans suffer from chronic teeth grinding and clenching, a condition called bruxism, which often results in tooth damage. Many people are unaware that they are grinding their teeth because it most often happens while they sleep. They may wake with a headache, toothache, earache or sore muscles of the jaw and head region. But often, the condition goes undetected until the affected individual is alerted by a family member or by a dentist who notices symptoms..
What is Bruxism?
Bruxism affects men, women and children and can develop at any age. Three out of 10 kids grind or clench their teeth usually before the age of 5. Although the exact causes of bruxism are not well documented, several factors are involved. With children, the condition can be a response to jaw growth, losing or getting new teeth, ailments such as allergies or ear infections, malocclusion or airway obstruction. In children as well as adults, stress often contributes to bruxism. Other factors include sleeping problems, an abnormal bite or a collapsed bite and airway due to missing teeth.
Effects of Bruxism:
In rare cases, bruxism does not cause any damage. But if the grinding is severe and frequent, it can result in worn down tooth enamel, chipped teeth, abractions (pictured above), increase in temperature sensitivity, erosion of gums and supporting bones, breakage of fillings or other dental work, TMJ dysfunction, and muscle tension in the face, head and shoulder regions. All of which have a negative impact on the appearance of the patients smile.
Diagnosis and treatment:
At Contemporary Family Dentistry, one of our areas of expertise is in the diagnosis and treatment of bruxism. Regular dental checkups are important to detect damage in the early stages. We can diagnose and treat irregular wear on teeth and determine the source of the facial pain that may result from bruxism.
Based on the examination and diagnosis, one or more treatments may be recommended. A custom-made appliance can be worn while sleeping. Designed to fit your teeth, the custom-made appliance is a small, simple device that fits securely and comfortably on your upper teeth or lower front teeth and prevents contact between the upper and lower molars. Other treatments may involve reducing high spots on the teeth to even the bite or possibly reshaping the biting surfaces with inlays or crowns. In some cases of daytime bruxism, a small appliance that fits the lower front teeth is also necessary.
Obstructive Sleep Apnea
Sleep is interwoven with every facet of our health and well-being, our moods and behavior, energy and emotions, marriages, jobs, our very sanity and happiness. There are over 80 known sleep disorders that occur due to stress, health conditions and other factors. Today, with dentistrys new knowledge and diagnostic skills, many times we can provide assistance for the snoring or sleep apnea patient. Working together with the pulmonologist or sleep doctor and other health care professionals brings effective team management to the patient to minimize or correct the problem.
Facts About Obstructive Sleep Apnea:
- Sleep disorders are prevalent in 70 million Americans
- Thousands of hours are lost on the job with the cost in U.S. production exceeding $60 billion annually
- Ninety percent of snorers exhibit some apneic tendencies
- Hypertension is present in approximately 50% of patients with obstructive sleep apnea (OSA)
- Vascular pressure in the brain increases with OSA increasing the risk of a stroke
- Sixty percent of males and forty percent of females over 60 years of age snore (female snoring increases after menopause)
- Left untreated, snoring increases risk of heart attack and stroke
- Drowsiness is blamed for some 200,000 to 400,000 automobile accidents annually
- Frequently, complaints from poor sleeping habits include daytime fatigue, headaches, irritability, cardiovascular problems, memory loss, reduced sex drive and inability to focus. A few of the medical and dental conditions that lead to snoring can be evaluated such as a small, retruded jaw and airway obstruction routinely, lifestyle and behavior changes are recommended as well, such as:
- regular exercise
- weight loss
- limiting alcohol intake
- limiting nicotine intake
- stress management
- restricting sleeping pills
Our complete screening to identify physiologic and behavioral predisposing factors includes:
- Complete medical/dental history
- Intraoral exam and evaluation of the head, neck, facial area, teeth, and supporting structures.
- Checking the upper airway for obstruction, the vault of the palate, the oropharyngeal airway space, hypopharyngeal airway space, size of the tongue, the position of the mandible, etc.
- Upper and lower dental impressions
- Specialized x-rays to assess whether or not the patient is a sleep appliance candidate; Lateral cephalographs and z-rays of the upper and lower dental arches for study of the jaw position and airway potential.
- TMJ disorder/occlusal exam because the lower jaw moves in multiple directions, it is important to establish the best position of the lower jaw to increase the airway. We determine the most effective position using up-to-date equipment like a pharyngometer which measures air volume. Then we make full mouth impressions for a laboratory to fabricate a custom FDA-approved airway dilator appliance.
- Sometimes an instrument is used to measure throat and nasal airway.
How Sleep Appliance Therapy Works
A conservative treatment is to make a dental appliance for patients to wear during sleep. Appliances are light and easy to wear. Its purpose is to move the lower jaw forward and downward, causing a positive change in jaw and/or tongue position which opens the airway. An appliance worn during sleep helps prevent the airway from collapsing by creating extra airway space.
Advantages of an oral appliance over other therapies include:
- Cost effectiveness
- Good patient acceptance
Since various types of intra-oral appliances are available, our office determines which FDA-approved appliance option is best for the particular snoring or sleep breathing problem.
Other traditional treatments normally suggested include: CPAP and UPPP Surgery.
For patients who snore, snore with mild sleep apnea, have mild to moderate apnea, have apnea but cannot tolerate CPAP and refuse surgery, or have found both CPAP and surgery to be unsuccessful; an oral appliance our office provides is a conservative and often successful alternative.