SLEEP APNEA AND ITS EFFECTS written by our hygienist, Dona Fujioka

SLEEP APNEA is the frequent stoppage of breathing caused by relaxed tissues in the throat during sleep. The breathing pauses may last between 10 to 20 seconds and can occur up to hundreds of times per night.95% of the millions of people who suffer from apnea have not and may never be diagnosed.

TYPES OF SLEEP APNEA

OBSTRUCTIVE- most common type. Occurs when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (snoring).

CENTRAL- less common type. Involves the central nervous system. It occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore.

COMPLEX- a combination of obstructive and central sleep apnea.

Untreated sleep apnea results in daytime sleepiness, fatigue, slow reflexes and poor concentration. It can also lead to serious health problems including diabetes, high blood pressure, heart disease, stroke and weight gain.

SIGNS AND SYMPTOMS

- LOUD AND CHRONIC SNORING
- LONG PAUSES OF BREATHING
- CHOKING, SNORTING, OR GASPING DURING SLEEP
- DAYTIME SLEEPINESS

SIGNS AND SYMPTOMS OF SLEEP APNEA IN CHILDREN
- continuous loud snoring
- may adopt strange sleeping positions
- bedwetting
- excessive perspiration at night or night terrors
- CHANGES IN DAYTIME BEHAVIOR:
o Hyperactivity or inattention
o Developmental and growth problems
o Decreased in school performance
o Irritable, angry, or hostile
o Breathing through mouth instead of nose

NOT EVERYONE WHO SNORES HAS SLEEP APNEA, AND NOT EVERYONE WHO HAS SLEEP APNEA SNORES.

• THE BIGGEST TELLTALE SIGN IS HOW YOU FEEL DURING THE DAY.*
Scientists are now examining the relationship between heart disease and sleep apnea.

These are known:

People with coronary artery disease whose blood oxygen is lowered by sleep disordered breathing may be at risk of ventricular arrhythmias and nocturnal sudden death. CPAP treatment may reduce this risk.

Apnea may cause coronary artery disease and hypertension

In obstructive apnea, the right side of the heart may suffer damage because it has to pump harder to support the extra effort of the lungs trying to overcome the obstruction of the airway.

Central apnea may cause high blood pressure, surges of adrenaline, and irregular heart beats.


RISK FACTORS FOR OBSTRUCTIVE SLEEP APNEA

Overweight
Male
Related to someone who has sleep apnea
Over the age of 65
Black, Hispanic, or a Pacific Islander
Smoker

PHYSICAL ATTRIBUTES THAT CAN CAUSE SLEEP APNEA

Thick neck receding chin
Deviated septum enlarged tonsils or adenoids (common
In children)


LIFESTYLE CHANGES THAT CAN HELP SLEEP APNEA

Lose weight avoid alcohol, sleeping pills, and sedatives
Quit smoking avoid caffeine and heavy meals
Maintain regular sleep hours

BEDTIME TIPS FOR PREVENTING SLEEP APNEA

Sleep on your side prop your head up
Open your nasal passages try the tennis ball trick

MEDICAL TREATMENT FOR CENTRAL AND COMPLEX APNEA

Treating the underlying medical condition causing the apnea
Oxygen while sleeping
Breathing devices

CPAP- Continuous Positive Airflow Pressure- most common treatment for moderate to sever obstructive apnea.

DENTAL DEVICES FOR SLEEP APNEA
Mandibular repositioning device
Tongue retaining device
SURGERY

May remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose, or reconstruction of the jaw to enlarge the upper airway.

SOURCES: Melinda Smith, M.A.
Lawrence Robinson
Robert Segal, M.A.

HPV and Oral disease

With all the recent dialogue about the HPV virus I felt it would be good to clarify why your dentist is concerned.

The Human Papilloma Virus (HPV) is a common sexually transmitted disease that has been associated with cervical cancers in woman. There are two vaccinations that are currently available for girls before they become sexually active. Although these vaccines appear safe the decision should be run by your doctor to determine whether they should be administered.

Evidence is growing that shows a strong correlation of cancer of the mouth and throat associated with HPV. The rate of increase is alarming and seems to be a result of the increase in oral sex. In fact there are more oral cancers detected every year than cervical cancer. Experts estimate over 34,000 cases of oral cancer detected every year. More than half of these are HPV related.

Your dental team should be performing a visual oral cancer exam on a regular basis. Beginning cancers usually are not detected by the individual who has it and it can be very difficult to spot in the back of the mouth. There are several diagnostic tests your dentist can perform to make this detection easier to accomplish.

If a warty bump appears your dentist may elect to observe it for a while to see if it will disappear on its own or recommend a biopsy. Although biopsy is the most definite way to confirm the nature of the bump we certainly do not want to biopsy everything we see in the mouth. Again, there are tests available help make this determination easier by “looking” under the primary layer of tissue with dyes and fluorescent lights.

Oral cancer exams are no longer performed on middle aged smokers and drinkers. They should be performed on young adults who have no history of smoking. In the future I expect an oral diagnostic test will be readily available for HPV.

Your dentist (me included) does not encounter HPV lesions very often in the general practice. The numbers will confirm that it is still not a very frequent occurrence. The alarming factor is the upward trend of HPV related STD’s and what it may mean in the future. As a precaution it is best to submit to a quick visual inspection of oral cancers by your dental team. Hopefully, the exam and test will be uneventful.

Oral Fungal Infections

As I was channel surfing recently I came across a science show concerned with fungus. The fungi group ranged from molds and mildew to edible mushrooms and yeasts for baking. There is a fungus that is the largest living organism on the planet and fungi that invade the body. It was rather creepy, but mankind has been living with fungi since we first popped up on the scene. The microbes that make up the fungus group are diverse and can reproduce sexually, asexually, and by the spread of spores.

Your dentist is on the front line to help control and fix the damage caused by all the harmful microbes that can inhabit the mouth. There are over 30 different bacteria that cause tooth decay and over 60 that cause gum disease.

Virus infections can alter the body’s susceptibility to bacteria and infect the soft tissue in and around the mouth. They can create painful repetitive sores and be just a nuisance or be very fatal. But let’s discuss the fungus group of microbes and why your dentist is concerned.

The most common fungal infection of the mouth is called candidiasis or thrush. These fungi are normally present in the body and are warded off by the healthy immune system. When something interrupts or overloads the immune response the fungi can become rampant. This is called an opportunistic infection and can result in a burning sensation, tenderness and pain. The cheeks or tongue will get a whitish coating that can be scraped off. Your dentist is trained to spot these signs and prescribe the correct remedy. Usually nystatin troches 4-5 times a day for 2 weeks will kill the fungus.

Conditions that alter the immune system include diabetes, chronic dry mouth, chemotherapy, inappropriate use of steroid inhaler, HIV/AIDS, mononucleosis, stress, and nutrient deficiencies.

Fungus infections can occur under dentures and in the corners of the lips. I have prescribed antibiotics and people have developed fungal outbreaks. Topical nystatin creams with mild steroids like triamcinoclone provide excellent results.

Oral fungus infections do not occur over night and take time to develop and spread into surrounding tissues. If you think you have symptoms do not hesitate to contact your physician or dentist for treatment. Fungal infections can spread down the throat and into the digestive tract and become very serious.

Why are dentists serious about gum disease?

Gum disease or gingivitis is present in ninety percent of the population. The disease is painless and seems to have no effect on our daily routine. Besides bad breath the consequences of gum disease seem remote. Why then is your dental team so concerned about gingivitis?

Research is showing that the bacteria that live between your gums and teeth can become very toxic to your immune system the longer they are left alone. In other words they get nastier and more menacing to your body.

How long of a timetable remains uncertain and varies with the individual. However, the research shows that so called good bacteria can change into bad bacteria over time. By disturbing and mixing up the bacterial colonies in your gums with brushing and flossing seems to reset this timetable back to square one. If this reset mode occurs a few times a day we hope that the bad bacteria are selected against and will not pose greater problems down the road. It is your dentist’s hope that this routine becomes a daily habit.

People who brush only once a day or once a week put themselves at greater risk of developing a more serious condition. If left undisturbed the bacteria will become more virulent and become more damaging to the surrounding tissues and immune system. It is much harder to reverse this condition and some people never respond well to our best therapies.

Oral therapies include prescription rinses, more frequent dental cleanings, antibiotics, and gels. Gum surgery and bone grafting may be needed to hopefully keep teeth longer. Extractions may be required. This is serious dentistry that could have been prevented with good habits. But what happens to the immune system?
Research has shown that chronic inflammation (i.e. arthritis and infection) increases the load on the body’s immune system. The immune system can become overloaded and not respond well to other conditions that may arise. A weakened immune response can allow opportunistic oral bacteria to have a more devastating effect upon their host (you).

This is where gum disease can take someone who is not vigilant about their oral health. Your dentist is your guardian against this outcome.


For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dietary Influences on Teeth

In previous articles I have discussed the worn dentition. What are the dietary influences on tooth longevity?

Teeth age along with the rest of the body, but I have seen teeth prematurely wear out for many reasons. Some teeth are diseased or traumatically damaged while others simply erode away. Let’s look at tooth erosion.

Tooth enamel is the hardest substance in the body. The next hardest is bone. It changes during a lifetime. Tooth enamel formation is completed by the time it comes into the mouth. The enamel shell will become hardened and polished due to wear. It will chip and crack, wear and erode, and possibly decay. Unlike bone the tooth enamel will not grow back on its own once it has eroded.

Signs of erosion include hypersensitivity, dimples in the chewing surface of back teeth, cupping of the leading edges of your front teeth, shortening of the length, wear on non-functional areas of teeth, increased translucency of front teeth, loss of surface texture and a smooth glazed appearance to the tooth surface.

Chemical erosion can occur from gastro-esophageal reflux disease (GERD) or eating disorders (Bulimia or Anorexia). More commonly chemical erosion occurs from the foods we eat. Cola drinks, carbonated sodas, grapefruit juice, apple juice, orange juice, lemonades, raisins, dried apricots, and pickles have all been shown to have moderate to severe erosive potential.

I enjoy consuming all of the items listed above and do not suggest to eliminate or change your diet dramatically. However, if the adult male drinks an average of 8.6 cans of soda a week then it is wise to not sip the sodas and constantly bathe the teeth for long periods of time. It is best to wash out the soda with a glass of water afterwards. If children are attached to sippy cups don’t fill them with fruit juice. Milk is a better choice and has a low erosive effect on their teeth. Remember that it is the frequency of exposure that matters.

Home remedies include use of toothpastes with fluoride additives. Some toothpastes (Sensodyne ProNamel) are formulated to recharge the tooth surface with fluoride to make it less affected by chemical erosion. These are available over the counter. Other toothpastes actually restore the calcium content and harden soft spots or early cavities. Presently, these dentifrices (Recaldent and MI paste) can only be purchased through your dental office and are more expensive than your regular toothpastes. However, I do believe that in the long run the cost savings will be tremendous.

For those of us who have “weak” teeth it is especially prudent to consider what we can do to make them stronger and what we can do to prevent weak or susceptible teeth from erosion. Likewise, for people who have had appreciable dental work performed it is imperative to prevent our dental work from failing due to breakdown and leakage-just another form of erosion.

Being conscious of how we consume foods will prolong our good dental health.

Electric Toothbrushes-Are they better?

Your dentist may have suggested that you start using an electric toothbrush after years of using hand brushing. Why? Are they better and more effective? What’s wrong with my normal brushing? They are how much?

These are typical responses I have witnessed in my dental practice. I think electric toothbrushes are great and that everybody should invest in one of the good products you find on the store shelves. Sonicare, Oral-B electric, and Roto-Dent are three that provide the finest in electric toothbrushes.

Now let’s investigate whether they are better than hand brushing. For many people with normal sized mouths and straight teeth manual brushing will maintain a good clean environment for optimal health. When mouth sizes are small and teeth are crowded and tight electric brushes will easily attack difficult to reach areas.

Your dentist may have noticed that you brush too hard and are wearing away the teeth and causing gum recession. Using electric toothbrushes with less force will be less erosive on your teeth and still clean very effectively. The very back molars are sometimes forgotten or impossible to clean with hand brushing. The electric brushes will clean even if you just “hold” it against the tooth.

Most dentists will advise to spend at least two minutes when brushing. This is also very true with electric brushes. Electric brushes are no shortcut for hand brushing and are not meant to be “faster”. However, they will provide more brush strokes per tooth per second of use and ultimately get your teeth cleaner.Which electric brush is better? I like all of them. In fact I have three different brushes I use daily. Sonicare by Phillips and Oral-B Professional by Braun are the big over-the-counter brushes. They have robust motors and a long battery life.

Sonicare has an ultrasonic wave action and pulses the toothpaste between the teeth. Oral-B has an oscillating round brush that scrubs the tooth surface. Roto-Dent is sold through dental offices and has the finest brush fibers available and is preferred for people with tooth erosion and fragile gums. It is a simple rotary round brush.

My advice for brushing is to be gentle but thorough. Giving yourself at least two minutes in the morning and before bedtime for brushing is best. Don’t try to rush through and press harder on the brush. Pressing harder will not achieve better results and could lead to early tooth wear.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Think Bacteria!

Why do some people have dental disease and others do not? Bacteria cause dental decay and gum disease. How each individual’s immune system responds to bacteria and the day-to-day care each of us gives to limit the effects of bacteria will determine who will be at risk for developing dental diseases.

First, we all have bacteria in our mouths and it is impossible to sterilize your mouth. Second, there is no drug or antibiotic that will cure dental decay or gum disease. Maybe some day there will be, but not at the present. Let us see why this is so.

Research into both types of major dental disease has isolated over 32 types of bacteria that can cause dental decay and even more bacteria that break down the gum and bone structures that hold the teeth soundly in place. To compound the problem the list of bacteria keeps growing every few years as scientists continue their research. This means that dentists and dental hygienists look to prevention rather than a cure to limit the damaging effects of the millions of organized bacteria that burrow into the teeth and gums.

I haven’t seen any literature that states that bacteria do this on purpose or that they even have a brain. However, all living matter seems to have a will to exist and propagate. The damage occurs when too many unchecked bacteria overwhelm the hardened tooth structure and the immune system that protects us. The dental decay causing bacteria thrive in an acidic environment and the acids produced by them will eat away at the tooth enamel. The bacteria associated with the gums will generate a battleground of bacteria vs. immune cells. Bleeding, puffy gums, and bone loss are signs of this battleground.

If you desire to maintain the health of your teeth and gums you must help your immune system overcome this invasion. First, limit the food source. This means removing any easily digested foods-like sugar-from the teeth. Remember that bacteria can divide into two bacteria in twenty minutes. They need something they can eat and digest really fast.

Second, brush each tooth for five seconds (about 2 minutes for the whole mouth). Floss or use special brushes between the teeth. This is most important. In my experience most dental disease occurs in these areas. Your hygienist or dentist may prescribe special toothpastes and oral rinses to help.

Third, try to maintain a healthy diet. Bacteria love junk food and sugar-our bodies do not. Limit the consumption of fruit juices and sodas. These beverages will make the mouth acidic and help to grow the harmful bacteria.

Fourth, see your hygienist on a routine schedule. This may vary from every three months to just annual visits. Your dentist will recommend a personal schedule depending upon your needs. Dental disease is chronic and mostly slow in nature. It will take a lifetime of good oral care to minimize the amount of dental work.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com