It has been estimated that 60% of men and 40% of women between the ages of 40 and 60 years of age snore. Snoring occurs when there is a partial obstruction of the airway which causes the palatal tissues to vibrate. Obstructive sleep apnea occurs when the airway is completely blocked for certain periods of time. As many as 20 million people in North America may have sleep apnea. Snoring is a social problem, particularly for the spouse, but obstructive sleep apnea poses a significant health risk for the patient in that it can lead to irregular heartbeat, high blood pressure, heart attacks and strokes.

SLEEP APNEA

Sleep apnea is a type of breathing disorder which is a serious, potentially life-threatening condition characterized by brief interruptions of breathing during sleep.
There are basically three types of apnea:

1. Central Apnea

The upper airway is open, but no oxygen is getting into the system. This occurs because the patient is not getting a chemical response from the brain to stimulate the lungs and the diaphragm to assist with breathing.

2. Obstructive Sleep Apnea

The lungs and the diaphragm are functioning normally, but no oxygen is entering the system because there is an obstruction in the upper airway.

3. Mixed Apnea

This is a combination of central and obstructive sleep apnea.

Oral appliances are only indicated for use in patients suffering from obstructive sleep apnea (OSA).
The signs and symptoms of OSA include snoring, excessive daytime sleepiness, gasping or choking during the night, non-refreshed sleep, fragmented sleep, clouded memory, irritability, personality changes, decreased sex drive, impotence, and morning headaches.

Factors that affect obstructive sleep apnea are as follows:

• Age
• Obesity
• Alcohol
• Sedative Hypnotics (sleeping pills)

Children can also snore and suffer from obstructive sleep apnea. Often they are highly allergic and their airway is blocked due to enlarged adenoids, tonsils or swollen nasal mucosa. Clinical signs would indicate a turned up nose, allergic shiners under the eyes, mucous draining out of the nose, mouth breathing, and a nasal sound to the voice. Other signs are bed wetting, irritability, difficulty in concentrating at school and hyperactivity

At the present time, obstructive sleep apnea is defined as a medical problem and the diagnosis must be made by a medical doctor or sleep physician (pulmonologist) who is specially trained in the area of sleep medicine.

The dental profession has an important role to play in the treatment of patients with snoring and sleep apnea. If 60% of men and 40% of women between forty and sixty years of age snore, this is a huge problem. Snoring is a serious social problem for the spouse, but obstructive sleep apnea can be a life threatening situation for the patient in that it can lead to irregular heartbeat, high blood pressure and strokes.

At the present time, obstructive sleep apnea is a medical condition that is being controlled and treated mainly by the medical profession. Despite the fact that in September 1995, the American Sleep Disorder Association finally endorsed oral appliance therapy as the third currently acceptable treatment method for snoring and sleep apnea, the vast majority of the medical doctors are not aware of the value of oral appliances

As time goes on, the public is going to become more aware of the health risks associated with snoring and sleep apnea. It is the dental professionals responsibility to educate their members, the public and the medical profession about the important role that dentists and oral appliances play in the treatment of snoring and obstructive sleep apnea.

People choose aesthetic dental procedures/surgery for various reasons-to repair a defect such as a malformed bite or crooked teeth, treat an injury, or just improve their overall appearance. Whatever the reason, the ultimate goal is to restore a beautiful smile.

For these and many other reasons, aesthetic dentistry has become a vital and important part of the dental profession.

Common aesthetic dental procedures can be performed to correct misshaped, discolored, chipped or missing teeth. They also can be used to change the overall shape of teeth-from teeth that are too long or short, have gaps, or simply need to be reshaped.

Some of the more common procedures involve:

• Bonding – A procedure in which tooth-colored material is used to close gaps or change tooth color.
• Contouring and reshaping – A procedure that straightens crooked, chipped, cracked or overlapping teeth.
• Veneers – A procedure in which ultra-thin coatings are placed over the front teeth. Veneers can change the color or shape of your teeth. For example, veneers have been used to correct unevenly spaced, crooked, chipped, oddly shaped or discolored teeth.
• Whitening and bleaching – As the term implies, whitening and bleaching, a rapidly increasing procedure, are used to make teeth whiter.

Which techniques should be used to improve your smile? A dental exam will take many factors into consideration, including your overall oral health.

One of the most common jaw disorders is related to a problem with the temporomandibular joint, the joint that connects your lower jaw to your skull, and allows your upper and lower jaw to open and close and facilitates chewing and speaking.

People with temporomandibular joint disorders (TMD) often have a clicking or popping sound when opening and closing their mouths. Such disorders are often accompanied by frequent headaches, neck aches, and in some cases, tooth sensitivity.

Some treatments for TMD include muscle relaxants, aspirin, biofeedback, or wearing a small plastic appliance in the mouth during sleep.

Minor cases of TMD involve discomfort or pain in the jaw muscles. More serious conditions involve improperly aligned joints or dislocated jaws. The most extreme form of TMD involves an arthritic condition of the jaw joint. Traumatic injuries also can cause jaw dislocation.

In these cases, jaw surgery, may be required to correct the condition. Some jaw surgery can be performed arthroscopically.

Conditions such as prolonged or untreated gum disease can actually cause gums to separate from teeth and form opportunistic pockets for bacteria and other debris; decay can also cause further deterioration.

Left untreated, these pockets can lead to serious infections that cause bone loss, making tooth extraction very likely.

A procedure called pocket reduction, or flap surgery, was developed to correct this problem. The procedure involves scraping away hard deposits such as tartar or calculus and reshaping damaged bone, with the eventual goal of reducing the size of the pocket and allowing the tissues to firm up around the teeth.

For some patients, a local anesthetic is administered to the affected area. Then, a small scaling instrument and/or ultrasonic cleaning device are used to remove the deposits.

After cleaning, the root may need to be smoothed, or planed, to restore it as much as possible to its original shape. Planing also allows your gum tissue to better attach itself and heal properly.

When restoration procedures such as root canal therapy, crowns, or fillings are not enough to save a tooth, it may need to be pulled, or extracted.

Tooth extraction procedures today are far less painful than ever before, thanks to powerful anesthetics and sedatives. In many cases, a patient who has tooth pulled experiences little or no discomfort, and only minor bleeding.

Before a tooth is extracted, the area surrounding the tooth is numbed with a topical/and or injectable anesthetic such as Novocaine.

Patients with extracted teeth sometimes need to take an antibiotic, and at the very least, take precautions following the procedure to ensure that infection doesn’t occur.

Smoking, vigorous brushing and rinsing, and drinking liquids through straws are discouraged during the post-operative period because they hinder healing and may cause the wound to open. Cold compresses applied to the outside cheek near the extraction area can help reduce any swelling and promote faster healing.

Wisdom Teeth

Wisdom teeth are the third and final set of molars that erupt in the back corners of the upper and lower normal adult mouth. Unfortunately, most people experience problems from wisdom teeth; in most cases, this is because the teeth erupt too close to existing permanent teeth, causing crowding, improper bites, and other problems.

If wisdom teeth are causing a problem and are not pulled, they can sometimes become impacted. Impacted wisdom teeth can be extremely painful, as well as harmful to your oral health. Symptoms are easy to spot: severe discomfort, inflammation, and some kinds of infections.

Many people need to have their wisdom teeth extracted to avoid future serious problems. In general, the lack of the four wisdom teeth does not hamper one’s ability to properly bite down, speak or eat.

If you experience any of the following symptoms, you may have an impacted wisdom tooth:

• Facial swelling
• Infection
• Pain
• Gum swelling

All teeth have between one and four root canals.

Many tooth problems involve infections that spread to the pulp, which is the inner chamber of the tooth containing blood vessels, nerves and other tissues. When the infection becomes worse, it can begin affecting the roots. A traumatic injury to a tooth can also compromise the pulp, leading to similar problems.

A diseased inner tooth brings a host of problems. Pain and sensitivity are some of the first indications of a problem, while inside, a spreading infection can cause small pockets of pus to develop, leading to an abscess.

Root canal therapy is a remarkable treatment with a very high rate of success. It involves removing the diseased tissue, halting the spread of infection, and restoring the healthy portion of the tooth. In fact, root canal therapy is designed to save a problem tooth; before the procedure was developed and gained acceptance, the only alternative for treating a diseased tooth was extraction.

Crowns are typically used to restore a tooth’s function and appearance following a restorative procedure such as a root canal. When decay in a tooth has become so advanced that large portions of the tooth must be removed, crowns are often used to restore the tooth.

Crowns are also used to attach bridges, cover implants, prevent a cracked tooth from becoming worse, or an existing filling is in jeopardy of becoming loose or dislocated. Crowns also serve an aesthetic use, and are applied when a discolored or stained tooth needs to be restored to its natural appearance.

Procedures

A tooth must usually be reduced in size to accommodate a crown. A cast is made of the existing tooth and an impression is made. The impression is sent to a special lab, which manufactures a custom-designed crown. In some cases, a temporary crown is applied until the permanent crown is ready. Permanent crowns are cemented in place.

Crowns are sometimes confused with veneers, but they are quite different. Veneers are typically applied only to relatively small areas.

Caring For Your Crowns

With proper care, a good quality crown could last up to eight years or longer. It is very important to floss in the area of the crown to avoid excess plaque or collection of debris around the restoration.

Certain behaviors such as jaw clenching or bruxism (teeth grinding) significantly shorten the life of a crown. Moreover, eating brittle foods, ice or hard candy can compromise the adhesion of the crown, or even damage the crown.

Bridges are sometimes referred to as fixed partial dentures, because they are semi-permanent and are bonded to existing teeth or implants. Some bridges are removable and can be cleaned by the wearer; others need to be removed by a dentist.

Porcelain, gold alloys or combinations of materials are usually used to make bridge appliances.

Appliances called implant bridges are attached to an area below the gum tissue, or the bone.

Crowns and bridges are the most effective procedure for replacing missing teeth or bite problems.