Sleep Dentistry

Obstructive Sleep Apnea and Sleep Dentistry

There is probably, in my opinion, no other condition that impacts general health as much as sleep apnea does. Imagine that during your sleep someone chokes you for a whole minute, and repeats this every 5 minutes throughout the whole night. Worst of all, you are not aware of this happening.

In our office we take sleep apnea very seriously, mainly because it seems to be an underlying factor for many conditions. Furthermore, I have noticed that most of my patients who have had braces as teenagers after having had four sound teeth extracted for the purpose of “creating space,” invariably suffer from a multitude of deleterious effects, such as excessive tooth wear, orthodontic relapse, stunted jaw growth, jaw-joint dysfunction, a mid-face deficiency, flat face with lack of proper lip support, insufficient jaw sizes to accommodate proper tongue position, snoring, and sometimes sleep apnea. Many times sleep apnea is an accompanying condition in these patients, due to the fact that the smaller jaws will just not accommodate the tongue, which tends to fall back and obstruct the airway during sleep. As dentists we have to be able to identify the incidence of this serious disorder, and offer treatment after obtaining a diagnosis by a physician.

ADULT SLEEP APNEA FACTS:

  • Obstructive Sleep Apnea, or OSA for short, afflicts 20 million Americans. 9% of men and 4% of women have OSA.
  • Statistically, most heart attacks happen in the early morning hours. Many of these can be blamed on O.S.A.
  • The Anales Medicina de Interna reported in 1999 that patients with untreated sleep apnea have a 37% chance of dying within 8 years.
  • Nasal breathing and an ample oxygen supply encourages nasal and sinus epithelium to produce Nitric Oxide, a tissue mediator which prevents the blood from clotting, protects arteries and dilates blood vessels.

 

CHILDHOOD SLEEP APNEA FACTS:

  • Most growth hormone is produced during the first few hours of sleep.
  • 90% of growth and tissue repair happens during NREM stage 4 sleep.
  • According to the American Academy of Pediatrics, all children should be screened for sleep apnea and treated immediately.
  • Chronic tonsil and adenoid enlargement is the most common cause of childhood sleep apnea
  • Since enlarged tonsils and adenoids are a major cause of sleep apnea and mouth breathing in children, consequentially smaller jaws and dental crowding are also common findings.
  • A survey in the journal Pediatrics from 2001 determined that children who snored during early childhood tended to show poor performance in middle school.

HIGH RISK FACTORS FOR O.S.A.

  • Being overweight
  • Snoring (not all snorers are sleep apneics)
  • Small or underdeveloped jaws
  • Lower jaw too far back in relation to the upper jaw.
  • Narrow upper airway diameter
  • Increasing age
  • Alcohol/tobacco/sedative use

SIGNS OF O.S.A.

  • Snoring, intermittent, with occasional gasping for air
  • Excessive daytime sleepiness
  • Non-refreshing sleep
  • Fatigue and irritability
  • Morning headaches
  • Gastro-esophageal reflux

CONSEQUENCES OF O.S.A. – sleep apnea is considered an independent risk factor for the following conditions

  • Poor memory
  • Increased auto and work-related accidents
  • Poor performance
  • Depression
  • Decreased quality of life
  • Heart problems, increased chances for developing high blood pressure, arrhythmias or stroke
  • Increased risk for adult type II diabetes

Diagnosis of OSA

Because OSA is a life-threatening medical condition, a multidisciplinary approach is necessary to address it. A physician should be involved in diagnosing the presence and degree of sleep apnea. A physician should also conduct an examination to determine if other correlated health conditions exist, such as hypertension, cardiovascular disease, diabetes and chronic fatigue.

Watch-PAT100

We are proud to carry this FDA approved, compact and ambulatory system of sleep monitoring.

In the comfort of your own home, it is a welcome alternative to a stressful and expensive hospital-based sleep study. Based on the results of this study, an on-line pulmonologist’s diagnosis is obtained which allows us to implement treatment much sooner.

Treatment of OSA

For mild to moderate cases of OSA, a dentist may fabricate an oral appliance to allow the airways to remain open for sufficient air to flow into the lungs during sleep. This treatment is far more tolerable than the conventional CPAP machine, which many patients of OSA find very cumbersome to use. (A CPAP is still a requirement for severe sleep apnea cases). In our office, we conduct a thorough evaluation of the multiple contributing factors and signs of sleep apnea, including daytime sleepiness and nighttime sleep evaluation scores. Homeopathic and naturopathic treatment many times provides additional support in improving sleep quality or addressing the hormonal, biochemical and physiological ravages of this condition.

Sleep hygiene

Among other things, the following habits should be implemented to improve sleep quality.

  1. Do not eat dinner within 3 hours preceding bedtime.
  2. Follow a regular sleep routine by not staying up late and not oversleeping.
  3. Cut back on alcohol, soda and caffeine.
  4. Take an herbal supplement or a hot herbal relaxing tea half an hour before bedtime.
  5. Take a warm bath before bedtime.
  6. Do not eat snacks, watch TV or read in bed.
  7. Follow a light and individualized exercise routine, preferably in the morning, and one hour before dinner.
  8. Do not engage in activities that are stressful or mentally challenging before bedtime.
  9. Shut off all lights.

Teeth Bleaching (internal/external)

A tooth may discolor after trauma, if the nerve dies, or even some time after a root canal treatment.  It looks unsightly, especially if it is a front tooth.

The office of Dr. Sarkissian offers a procedure to bleach a tooth simultaneously externally and internally. During the procedure the chamber is opened to allow the bleach to be applied from the inside as well as the outside.

An unattractive tooth like this

Internal-External-Bleaching-01

can be transformed into this Internal-External-Bleaching-09allowing the patient to show a wide smile again.

Get more details about the procedure to whiten a discolored tooth elsewhere on this blog.

Jaw Orthopedic – Bite Opening In Adults

Bite and Normal Jaw
The lower jaw (pink) is a double-hinged bone that is suspended between two joints. Its distance from the skull is technically determined by the height of the teeth, just like columns holding up a roof. The “columns” are high, the jaw-joint is healthy and the tongue has room to fit inside the mouth.

Normal jaw relationship

Bite and Normal Jaw – Facial Profile
The esthetically pleasing profile usually reflects the healthy jaw and teeth with full lip support, and a forward positioned mouth. The face reflects harmony.

Bite and Normal jaw (2)

Collapsing Bite
The teeth are worn down (the columns are shortened) and the jaw has approached the skull. The TMJ (jaw-joint) is under strain and the lips have collapsed inwards.

Collapsed bite adult tx ( 0)

Collapsed Bite
The Jaw-joint has been jammed deeper and backwards into the skull. The delicate disc is usually popping in and out of place every time the mouth opens and closes, creating that characteristic “click”.

Collapsed bite adult tx (2)

Collapsed Bite – Reposition Jaw
An orthotic that fits over the lower teeth will allow the jaw to vertically reposition itself and function in a physiologically corrected position. It takes at least 3 months for the jaw-joint and the muscles to adapt to this position. During this phase certain symptoms such as muscle spasms, tenderness, and headaches will generally improve.

Collapsed bite adult tx (3)

Collapsed Bite – Teeth Build-Up
As symptoms improve, and the patient is comfortable functioning in the open position, the bite is restored to the new vertical dimension. The orthotic is sequentially cut back and the teeth built up with onlays or overlays.

Collapsed bite adult tx (4)

Collapsed Bite Restored
Eventually all the teeth are restored and the orthotic is discontinued. The jaw-joint is in a physiologically corrected position and the teeth have been restored to full anatomy.

Collapsed bite adult tx (5)Collapsed bite adult tx (6)Collapsed bite adult tx (7)

Licorice Root

Licorice root

Licorice root (Glycyrrhiza glabra) is a yellow root that is one of the main ingredients in Chinese medicine. It is described in Shao-Han-Lun (established during the later
Han Dynasty, in China) that Licorice

  1. harmonizes all drugs and detoxifies the adverse effects of herbs,
  2. is used as a flavoring agent to mollify various drugs and to treat coughs and sore throat,
  3. works synergetically with other drugs, and
  4. has a liver detoxifying action.

Two compounds in licorice, licoricidin and licorisoflavan A, were found in a study to be very effective in inhibiting the growth of bacteria that caused cavities and gum disease. (see Reference)
Licorice is a potent liver cleanser and a tonic for the stomach. It is a very valuable remedy in treating Hepatitis C, GERD, eczema, colds and coughs.  It is a natural stimulant of the body’s own natural cortisone, which makes it beneficial in treating infections as well as allergies. It is, however, contraindicated in those who have high blood pressure.
Deglycyrrhizinated licorice (DGL) is used as a remedy for peptic ulcers and oral canker sores. (see Reference)

Recipe for licorice tea by Dr. Sarkissian

Ingredients: 7-10 slices of actual licorice root, half a teaspoon  of fennel seeds, 5 pods of cardamom (crushed)  and a small slice of ginger root, 2-3 leaves of sage.

Simmer the above except the sage in a pot of water over a light flame for 10 minutes. Add the sage, cover and let steep for another 20 minutes. Drink throughout the day. Add organic honey to taste, unless diabetic or treating gum disease (we don’t want more sugar bathing plaque.) Useful for stomach upsets, detox, for colds, and for mouth ailments.

Nattokinase – Enzymes From Fermented Soy

A staple in the Japanese diet, natto is made from boiled soy beans fermented with a bacterium called Bacillus natto. It’s a natural blood-thinner which dissolves abnormal blood clots, improves circulation, reduces triglycerides and prevents strokes.

Dr. Hiroyuki Sumi discovered its actual extract, nattokinase, which can be taken as a supplement.

Nattokinase - Food

In dentistry I like recommending it as an adjunct in treating abscesses, improving bone circulation and in reducing inflammation.

Lumbrokinase – Enzymes from Earthworms

Dried earthworms and ground-up earthworm powder, believe it or not, were (and probably still are) used in traditional oriental medicine.

Today, Boluoke® is a product containing purified enzymes extracted from earthworms.

Earthworms Boluoke

Just like polyphenols in green tea, and curcumin in turmeric, the group of enzymes called lumbrokinase is now known to be the most valuable ingredients in earthworms. It is, currently, one of the most potent natural blood-thinners for those suffering from heart disease.

Birth of a Tooth

birth of a toothJust like the birth of a child, the “birth” of a tooth, or as we call it its ERUPTION through bone and skin, is an awe-inspiring and miraculous phenomenon in nature. It is an interplay of such complex physiology, that the true and exact nature of what guides eruption of teeth has eluded scientists to this day. Truly, how can an entity of such architecture and beauty, made up of all 3 embryonic layers, form out of virtually nothingness, grow inside a protected “bud”, bore its way through bone and tissue, emerge into an outer-world environment so hostile, and yet be designed to survive a whole lifetime??? (Doesn’t that sound familiar?)

Laser Dentistry Misconception

To allay the fears and misconceptions surrounding laser dentistry, here are some facts on laser dentistry:

  1. The laser “drill” does not produce heat when acting on the tooth structure. Instead the laser energy targets the water inside the tooth substance and makes the tooth molecules “explode”, thus eroding the tooth as its pulses hit its surface.
  2. The laser exerts its effect without even touching the tooth surface. A sapphire crystal tip at the end of the laser “handpiece” directs the energy of the laser pulses onto the tooth from a distance of 1-3 mm above the surface.
  3. Laser energy coming out of the tip loses its effectiveness already at a distance of a few millimeters beyond the target, therefore all tissues surrounding the tooth are completely safe.
  4. Since bacteria are made up of little bubbles of water, there is no germ that is spared the laser pulses, as they explode as soon as the ray hits them.

Cracked Teeth

Teeth are made up of all three embryonic layers. The innermost layer, the pulp, is pure tissue with blood vessels and nerves. The middle layer, dentine, is somewhat like bone, minus the actual blood, but nevertheless perfused with millions of tubules filled with a nutrient liquid and nerve extensions. 10% of this layer is made up of water, and gives the tooth its elasticity. The outermost layer, enamel, is the hardest substance in the body, and is still 4% water. (That is what  the laser “waterlase”  targets when we use it to “drill” through enamel.

The outermost shell, enamel, is bonded to the underlying layer of softer dentin via an interface that i consider a biological marvel. This phenomenon renders the tooth extremely durable as a unit, to an extent that its architectural design allows it to survive a whole lifetime of chewing – unless this design is violated  by caries, and subsequently amalgam fillings. The tooth is then bound to crack and crumble under stress.

Occasionally a severely blunt trauma to an intact tooth will cause it to chip, and rarely, to crack.

Whether filled or intact, a cracked tooth that is not actually split in two will produce obscure and dull pains which are worse when one presses onto the tooth and then lets go. There may even be increased sensitivity to cold and air.

These photographs illustrate some examples:

cracked toothThis tooth is one of the rare instances where a completely intact tooth cracked under extreme chewing pressure. A green dye was used to reveal the crack.

poorly bonded toothA poorly bonded composite, along with a heavy bite, had weakened this tooth, and a crack was found spanning the whole length of the tooth when the filling was removed.

zirconia crownThe tooth was restored with a metal-free zirconia crown strong enough to withstand the chewing pressure.

Crack under amalgamThis tooth had a large amalgam filling. After the filling and the decay are removed, almost always cracks are revealed, which occasionally span the whole length of the tooth.

two teeth with amalgam damageAmalgam fillings, being unstable alloy metals with different expansion and contraction characteristics, and placed into the most ridiculously unbiological cavity form designs taught by dental schools,  violate the physiological architecture of teeth, which become unstable and crack under pressure.

two teeth with amalgam damageAfter the amalgam was removed using mercury exposure precautions, and the decay was cleaned out, full-length cracks were observed. Whether or not such teeth are lucky enough to escape a root canal, their integrity has to be reinforced with a bonded onlay or in heavy chewers, with a zirconia crown.

Homeopathy and Toxicity in Dentistry

Dr. Sarkissian gave a talk to attendees of the 2012 Freedom Health Expo in Long Beach.

You can watch his talk here…

and refer to the slides he presented in the gallery below…