Posts for category: Oral Health
It’s common for kids to be less than enthusiastic about visiting the dentist. For some, though, it’s even more of a challenge: A child with extreme anxiety and fear during dental visits could interfere with them receiving the dental care they need. The impact could even extend into adulthood.
Recognizing the need to reduce this high anxiety, dentistry has used a number of pharmacological tools for many years that relax a child during dental care. Sedatives have often been the only choice for reducing anxiety, especially during extensive procedures and treatments. But now there’s a promising new approach in dentistry that doesn’t depend on drugs.
Cognitive behavioral therapy (CBT), a psychotherapeutic method used for decades to treat depression, phobias and eating disorders, has been investigated recently as a possible approach for relieving children’s dental anxiety. During CBT, trained therapists use specific behavioral techniques to help patients develop mental and emotional strategies for dealing with stress.
During the usual course of CBT therapy, a therapist meets in counseling sessions with patients weekly over several months to help them change their routine thinking or behavior surrounding a stressful issue. Initially, the therapist guides the patient toward understanding the underlying causes for their negative reaction to the issue. They then work with the patient to devise an objective way to test whether those emotions and beliefs about the issue are true.
Using this effective method for changing behavioral and emotional responses for dental anxiety has had encouraging results from initial research. One study found CBT successfully reduced dental anxiety among a majority of a group of European children ages 9 through 16 who participated in the method.
CBT isn’t an overnight cure, often requires a number of months to achieve results. But for children who suffer from extreme fear of professional dental care, this drug-free method may provide long-term benefits that extend well past their childhood years.
When you awake in the morning do you still feel exhausted? Are you irritable during the day, unable to think or focus clearly? Is your loud snoring bothering your bed partner?
If you answered affirmatively to any of these questions, you may have sleep apnea. This happens when an obstruction (usually the tongue) blocks the airway during sleep, preventing you from breathing. Your brain notices the drop in oxygen and wakes you to re-open the airway. The arousal lasts only a few seconds, and you may not even notice. But because it can happen many times a night, these waking episodes can rob you of the deep sleep your body needs.
Sleep apnea is more serious than simply waking up grumpy. Over time, it could contribute to dangerous health conditions like high blood pressure or heart disease. If you’re noticing any of these signs, it’s important then that you undergo a complete examination by a physician or dentist trained in sleep-related issues.
Fortunately, there are ways to reduce sleep apnea. One of the most common is continuous airway pressure (CPAP): This method uses a small pump that pushes pressurized air through a face mask worn while the patient sleeps. The forced air keeps the airway open and reduces apnea episodes.
While it’s an effective method, it can be uncomfortable and cumbersome to use—some people can’t tolerate wearing the mask while they sleep. But if your sleep apnea symptoms are mild to moderate, your dentist may be able to provide an alternative therapy with a specially designed oral appliance.
Similar to a mouthguard or retainer, a sleep apnea appliance worn during sleep holds the lower jaw forward, which helps move the tongue away from the airway. It’s much less cumbersome (and noisy) than a CPAP machine. And your dentist can custom design and fabricate your appliance for a comfortable fit.
Not all cases of sleep apnea can benefit from such an appliance, or even from CPAP therapy. Extreme cases could require surgery to remove tissues blocking the airway. But most sleep apnea patients don’t require this invasive intervention. Getting checked by a qualified medical professional could open the door to a more convenient and effective way to a better night’s sleep.
The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.
In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?
The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.
Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.
So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”
Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.
If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”
In many parts of the country, summer is often a synonym for "blast furnace" and can be downright hot and miserable. If you find yourself in such a climate, it's imperative that you drink plenty of water to beat both the heat and heat-related injuries. Your teeth and gums are another reason to keep hydrated during those hot summer months.
Your body needs water to produce all that saliva swishing around in your mouth. When you have less water available in your system, the production of this important bodily fluid can go down—and this can increase your risk of dental disease. That's because saliva performs a number of tasks that enhance dental health. It helps rinse the mouth of excess food particles after eating that could become a prime food source for disease-causing bacteria. It also contains antibodies that serve as the first line of defense against harmful microorganisms entering through the mouth.
Perhaps saliva's most important role, though, is protecting and strengthening enamel, the teeth's outer "armor" against disease. Although the strongest substance in the body, enamel has one principal foe: oral acid. If the mouth's normally neutral pH becomes too acidic, the minerals in enamel begin to soften and dissolve. In response, saliva neutralizes acid and re-mineralizes softened enamel.
Without a healthy salivary flow protecting the mouth in these different ways, the teeth and gums are vulnerable to assault from bacteria and acid. As they gain the upper hand, the risk for tooth decay or periodontal (gum) disease can skyrocket. Keeping yourself adequately hydrated ensures your body can produce an ample flow of saliva.
By the way, summer heat isn't the only cause for reduced saliva: Certain prescription medications may also interfere with its production. Chemotherapy and radiation, if targeting cancer near the head or neck, can damage salivary glands and impact flow as well.
If you have reduced saliva from medication you're taking, talk to your doctor about switching to an alternative prescription that doesn't affect saliva production. If you're undergoing cancer treatment, be extra vigilant about your oral hygiene practice and regular dental visits. And as with summer heat, be sure you're drinking plenty of water to help offset these other effects.
Even when it's hot, summertime should be a time for fun and relaxation. Don't let the heat ruin it—for your health or your smile.
Each year doctors treat about 150,000 new cases of severe facial pain. If you're one of those people, you don't have to suffer—there are ways to gain relief from these painful episodes.
Those recurring episodes are known as trigeminal neuralgia (TN). As the name implies, the source of the pain are the trigeminal nerves, which originate in the brain stem and extend on either side of the face. Each is divided into three branches (hence the "tri" in trigeminal) that serve the upper, middle and lower parts of the face and jaw.
TN can involve one or more of these branches, resulting in mild to severe pain that can last for several seconds. Jaw movements like chewing or speaking can trigger an episode, as well as a light touch to the face.
There are various proposed causes for TN, including links with inflammatory disorders like multiple sclerosis, which damages the insulating sheathing around nerve cells. The most common cause, though, appears to be a blood vessel pressing against the nerve. The compression causes hypersensitivity in that area of the nerve so that it transmits pain at the slightest sensation.
Other conditions like jaw joint pain disorders (TMD) or a dental abscess can cause similar pain symptoms, so it's important to get an accurate diagnosis. If your doctor does identify your condition as TN, you may then need a comprehensive approach to treatment involving a team of care providers, including your dentist.
For the most part, TN can be managed, beginning with the most conservative approach to gain relief, often with medications to block the nerve's pain signals to the brain or decrease abnormal nerve firings. If that proves insufficient, though, more intensive treatments are available.
One possible treatment for an impinging blood vessel is a microsurgical procedure to expose the affected nerve and relocate the vessel. While this can be effective, the surgery does carry some risk of facial numbness or decreased hearing. If the risks are too high for conventional surgery, an alternative procedure uses a precise beam of high-dose radiation to relieve the pressure from the vessel.
The most important thing to know about TN, though, is that it is possible to control it and relieve future pain episodes. If you're experiencing these symptoms, see your dentist or doctor for an exam and accurate diagnosis.
If you would like more information on trigeminal neuralgia, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Trigeminal Neuralgia: A Nerve Disorder that Causes Facial Pain.”