Obstructive Sleep Apnea and Snoring

Does it seem like you go to bed early, get your eight hours of sleep and still feel tired? Perhaps you are not getting the sleep you think you are. Many of us suffer from obstructive sleep apnea or OSA.

Sleep apnea literally means sleep without breathing. Try holding your breath 10 to 60 seconds thirty or more times an hour. Without our awareness this can happen when we are asleep. Over time this can lead to hypertension, heart disease, weight gain, depression, diabetes, impotence, GERD, liver disease, memory dysfunction, strokes, and death. As a concerned health provider I decided to see if I had sleep apnea and, if so, what remedies existed to treat this silent killer.

I recently tested an “at-home device” for diagnostic screening of sleep apnea. This device slips onto your finger tip and measures pulse and oxygen levels while you sleep. It was discovered that during my sleep cycles my blood oxygen levels were dropping below acceptable levels and my heart rate climbed to the high eighties. I suspected I had a problem when I would awake several times a night without any reason. My dentist recommended a sleep study test at a sleep laboratory and I complied. The sleep lab is very similar to a nice hotel room except the technician affixes monitoring cables to your legs and head to measure such things as random limb movements and REM sleep cycles.

The results showed a mild sleep apnea condition existed so I returned to run another test that included the assistance of a breathing device called a CPAP machine that would exert positive air pressure when I inhaled. This made breathing a lot easier although the CPAP would occasionally dislodge if I rolled over on my side. Regardless, I saw positive results with REM sleep patterns and higher oxygen blood saturation levels. The only problem was finding a more comfortable alternative to the CPAP mask.

Not to be deterred an oral device was ordered for me to help keep my jaw from falling back into a slack position and blocking my airway. Although I have prescribed these devices for many years I have not had a reason to wear one. I have not yet had a third sleep study done to monitor the success of the device, however I have been told that I don’t snore much anymore. These dental devices can be effective in keeping the jaw in a more forward position to allow good breathing and good sleep. They are small and portable and do not make any noise that would keep others awake in your room. The fees range from $500 (for light to moderate snoring) to $2500 (for mild to moderate OSA).

As with any device made for OSA it is highly recommended that a follow up sleep study test be performed to gauge the effectiveness and make any adjustments that are required.

How Do I Get A Cavity? by Dona Fujioka, R.D.H.

Dental caries (cavities) stems from a dental disease that can be prevented. With the combination of biofilm (dental plaque) and fermentable carbohydrates, with an acidic (low pH) environment in the mouth, dental caries occur.

Tooth surface goes through a process of demineralization (mineral loss) and remineralization (mineral gain) several times a day. When dental plaque is present, its presence creates a condition of unsaturation and supersaturation. Unsaturation occurs during acidic conditions (low pH) in the biofilm when there is less minerals present. This is common in the presence of fermentable carbohydrates. Supersaturation happens when there is an increase in minerals (from saliva or calcium fluoride formulations) and an increase in pH due to reduced or lack of fermentable carbohydrates present or different buffering systems. The increase in the saturation level stops the mineral loss of the enamel and allows minerals to return to the partially demineralized enamel. This process is essential in the development of a cavity. A cavity develops when more minerals are lost than gained during the demineralization and remineralization process. The good news is that an early carious lesion (cavity) can be stopped as long as it is non-cavitated.

Non-cavitated carious lesion can be reversed in several ways; decreasing the amount of dental plaque, reducing the frequency of carbohydrate ingestion and increase in the amount and concentration of fluoride.

Understanding the disease process rather than just treating the condition is a better way of looking at dental caries. With a better understanding, it allows for a preventive approach, especially for those who are at high risk.

Biomarkers in Saliva Help Detect Early Stage Pancreatic Cancer by Dona Fujioka, R.D.H.

Research and studies are ongoing using saliva and its constituent biomarkers to aid in early disease detection, the monitoring of its progression and the prediction of therapeutic outcomes. Salivary biomarkers for disease detection, such as oral and systemic, is showing promise where blood markers are still proving ineffective.

An example sited by Dr. Wong is in pancreatic ductal adenocarcinoma. This is the most common, and also one of the most deadly forms of pancreatic cancer. His studies have shown that salivary diagnostics may be helpful in the fight against this form of pancreatic cancer.

In a study published in Gastroenterology, changes in the molecular signatures were found in the human saliva with an early stage pancreatic cancer. By analyzing the altered gene expression, biomarkers in saliva were found to be different between a patient with pancreatic cancer and one who did not have the disease.

One surprising finding is that various systemic diseases that were studied (pancreatic cancer, breast cancer, lung cancer, gastric cancer, ovarian cancer) have yielded highly discriminatory salivary biomarkers; particularly using their diagnostic tools. More studies are needed to confirm this early promise of using saliva samples, and its ease of obtaining samples, to identify diseases.

Snoring and Sleep Apnea by Douglas Urban, DDS

We all know what snoring is and how it affects those around us. Half of snorers may suffer some level of sleep apnea or sleep “without breath”. A simple test can be conducted at home in your own bed that can screen your sleep pattern and help determine if a monitored sleep study test should be ordered.

Sleep apnea is characterized by pauses in breathing from a few seconds to a minute. These pauses can occur a few times during the night or over a hundred times an hour. It can result in low blood oxygen saturation levels causing oxygen starvation of the body organs. The pulse rate will rise as the heart tries to pump more oxygenated blood to the body. This stress can result in strokes, hypertension, heart disease, weight gain, depression, diabetes, impotence, GERD, liver disease, memory dysfunction and death.

Your dentist can help detect screen sleep apnea patients by checking for worn or flattened teeth, scalloped tongue, enlarged tongue and uvula, extra boney growths and excessive gum recession. Your dentist can order a diagnostic at-home test (this can be free of charge) and have a sleep center read and interpret the results with you to help determine your risk for sleep apnea.

Sleep study tests can determine the incidence of breathing cessation. A medical doctor can confirm a diagnosis of sleep apnea after carefully reviewing the results of a sleep study test. These tests monitor such things like the blood oxygen level, REM cycles, and the frequency of obstructive episodes per hour.

You can ask yourself these questions to see if you should seek help. What are my chances of dozing when I sit and read, watch TV, sit in public places, wait for red lights while driving or sit as a passenger in a car? What is the likelihood of falling to sleep after lunch? If you are tired or fatigued easily during the day it would be very prudent to consult with your physician for advice.

Treatments for OSA can vary from anti-snoring devices made by dentists, sleeping on specially tilted pillows, neck slings, or wearing nasal cushions attached to positive pressure air pumps (CPAP). As with all treatment options these CPAP pumps cannot be tolerated by everyone and may have a limited success with some individuals. 

I recently tested the at-home device for diagnostic screening of sleep apnea. It was discovered that during my sleep cycles my blood oxygen levels were dropping below acceptable levels and my heart rate climbed to the high eighties. No wonder I would occasionally wake up sweating!  A sleep study test is currently being ordered and I will keep you updated.

If you know you’re snoring or your loved one is keeping you awake at night please talk to your physician or dentist to help determine the seriousness of the problem.

For answers to your dental questions, contact

                                                    Douglas Urban, D.D.S.

                                                    Cerritos, CA 90703

                                                    562 924-1523       

                                                    DrDouglasUrban.com

USING SALIVA TO HELP DIAGNOSE AND ASSESS PATIENT’S HEALTH; BOTH IN MEDICINE AND DENTISTRY by Dona Fujioka

Salivary diagnostics has been an ongoing and developing technology used to assess and diagnose a person’s health. It has been found that the saliva provides many of the same molecules found in the systemic system. These include tissue levels of natural substances, and large variety of molecules introduced into the body for therapeutic, dependency or recreational purposes, emotional status, hormonal status, immunological status, neurological effects and nutritional and metabolic influences. Collection of saliva has been made so easy for the clinician, that a saliva sample could be collected in a minimum amount of time.

Salivary diagnostics is currently used to diagnose diseases or conditions based on certain biomarkers present in the saliva. Among these conditions are cardiovascular disease, diabetes, pancreatic cancer, and viral and autoimmune diseases. In dentistry, saliva is used to test for the presence of HPV (Human Papilloma Virus), which is one of the most common sexually transmitted diseases in the United States. There are more than 100 different HPV types. HPV-16 and -18 are the high-risk types associated with oropharyngeal cancer. It is the 10th most common malignancy, with more than 30,000 diagnoses yearly. There is a 50% survival rate, killing one American every hour. The survival rate is the lowest of the major cancer sites.

Another disease diagnosed in dentistry is periodontal disease. There are now tests that allow us to find out the person’s susceptibility to periodontal disease (My PerioID). A test is also available to determine the pathogens or bacteria involved in causing the infection (My PerioPath). Identifying the specific pathogens allow us to treat the condition with antibiotics specific to the bacteria present. A more personalized therapy will yield a better outcome.

With the ease in collecting saliva, salivary diagnostics is an avenue that should be implemented to help assess a person’s health. Determining a person’s systemic susceptibility to oral disease allows for early detection and treatment of diseases.


SOURCE: Salivary Diagnostics in Medicine & Dentistry: A Review
Herbert I. Bader DDS

Is Invisalign For You? By Mary Fiedler, D.D.S., Our Invisalign Dentist.

Is Invisalign for you? Would you like an improved smile with straight teeth without metal braces? Invisalign and Invisalign Teen may be just what your smile needs. Clear, thin aligners are custom fit to your teeth and will gradually improve your smile in as little as 5 months. Patients are thrilled with the results and often wish they had started Invisalign sooner.

Invisalign treatment has successfully improved the smiles of millions of patients all over the world. These invisible braces fix many orthodontic issues such as crooked teeth, overbite, under bite, spaces between teeth, and more. The comfortable and clear aligners gently and gradually move your teeth into the proper position – without non removable braces.

How Invisalign works involves extensive research coupled with professionally diagnosed treatment plans for each patient. With Invisalign, we have successfully treated many teenage patients, as well as all ages of adults, including a patient in her eighties. We have also treated patients who have had relapse after traditional braces. Treatment time varies between patients, but the average treatment time ranges from just 5 months to 12 months.

After photographs and precise impressions are taken of your teeth, custom aligners are fabricated to meet the professionally diagnosed treatment plan for your case. Delivery of the first set of aligners involves verifying proper fit and placement of a few small tooth colored attachments on your teeth. You will wear each set of aligners, one aligner for the upper and one for the lower teeth, for two weeks. It is important to wear each set of aligners for approximately 22 hours each day, removing for meals and teeth cleaning. After two weeks of wear, you switch to your next set of aligners. You will be given three sets of aligners at each appointment.

Follow up appointments are scheduled at 6 week intervals where we evaluate your orthodontic progress, the proper fit of your aligners, verify the health of your teeth and gums, and deliver the next three sets of aligners. The custom and precise movement of your teeth is very gradual with each aligner, just 0.25mm of movement of specified teeth. But, within just a few months, your improved straighter smile is evident. Before long, your case is complete with your beautiful new straight and healthy smile. Clear retainers are given to you to maintain your new smile. Actual Invisalign cases are shown below for a case with crowding and another with spacing before treatment, both with beautiful and healthy straight teeth after completing treatment:

Selecting Invisalign over traditional braces is often something patients consider. There are many advantages (shown below) of Invisalign over traditional braces, including often shorter treatment time, being virtually invisible, ease of use, home care, comfort, health, and more. You can even bleach your teeth during treatment, enabling a whiter straight smile to occur during the orthodontic improvement of your teeth.

The health benefits with straightened teeth are important too. You may be surprised to know that the benefits of having properly aligned teeth extend far beyond a confident smile. According to the American Dental Association, straightening your teeth can actually affect your overall dental health. Straightening your teeth can reduce your risk for tooth decay and gum disease.

Swollen, red gums can often be the result of having teeth that are crowded or too widely spaced. Plaque and tartar build up around mal-aligned teeth is often heavier due to difficulty in at home care. These are also signs of periodontal disease. When teeth are properly aligned, it helps the gums fit more securely around the teeth and is easier to keep your teeth clean. This allows for the strongest and healthiest defense against potential periodontal problems. In our dental practice, we see less tarter and plaque build up on our Invisalign patients, during and after treatment, as well as healthier gum tissue.

Having healthy gums and teeth during orthodontic treatment is important too. One of the biggest problems of having traditional braces is removing all of the food that gets trapped around the brackets and wires. This can lead to plaque build up, swollen gums, and possible tooth decay. Fortunately, with Invisalign the clear aligners are removable, so it is easy to continue brushing and flossing your teeth as you normally do.

Straight teeth and healthy gum tissue are a window to the health of your body. Your teeth and gums – and how they look to others when you smile – say a lot about your overall health. Tooth decay and gum disease are caused by bacteria. Left untreated, they can cause mouth sores, tender or bleeding gums, bad breath, and possible tooth loss. Studies by the American Dental Association have shown that oral infections can also lead to more serious ailments such as heart disease, stroke, pneumonia, and diabetes. Invisalign aligners make daily oral hygiene easier, thus reducing the risk of possible problems.

Correctly aligned teeth can help alleviate problems caused by an improper bite, speech or chewing difficulties, jaw problems, or wear on the tooth enamel. Invisalign effectively addresses all of these orthodontic issues, so that you’ll have the confidence of a great smile and increase the likelihood of improved oral health. If you would like to have these improvements to your smile and overall health, please give our office a call to set up a consultation appointment.

Dentistry for Kids by Douglas Urban, DDS

This article was published in the Cerritos Community News on Friday, April 20, 2012.




This article is specifically aimed for children 0-5 and their primary care givers (aka moms). Having a child in most cases is a natural event that once it starts it goes to finish in spite of us. Caring for a child’s health, however, is a little more daunting. First, it does not come with an instruction manual. There is a lot of resource material available about taking care of babies but sometimes the dental component is overlooked. Think of the mouth as the entryway for the child’s digestive system and then you realize it needs more attention.

As dentists we are trained to take care of problems (fill cavities) when they develop. A natural extension of taking care of problems is to prevent problems. Dentists are better serving their patients if they do not have to fill cavities.

For instance we know that caries are caused by 32 different kinds of bacteria. The bacteria from the mother’s mouth are most likely to infect the baby’s mouth in the first few months. So when the teeth finally start to erupt they will have the same decay problem as the mother. Wouldn’t it be prudent to reduce the likelihood of transmission? Moms can be encouraged to chew xylitol-containing gums and be prescribed antimicrobial rinses during the first six months. Education on the proper dental care is most important for the parent who is responsible for monitoring the types of foods and mouth cleaning.

Okay so your child is over 1 and you missed out on the prevention of transmission. Dentists can provide a caries risk assessment and provide recommendations for you.

In a nutshell we determine low to high-risk children by asking a lot of questions and performing a 2-minute inspection of the child’s teeth. Also, a test for cavity causing bacteria can be performed to give a good estimate of the child’s risk.

How do you protect your child’s teeth if you are medium to high risk? I recommend brushing your child’s teeth with fluoridated toothpastes (just a pea sized amount on the brush) and selectively flossing those teeth with white spots (early cavities).

Also, I suggest NOT using fruit juices in bottles and sippy cups. The constant bathing of children’s teeth with juice can lead to cavity disaster. Please use water. In areas with less than optimal fluoride in the tap water I prescribe fluoride supplement drops when the child turns 3. Dentists can place a non-toxic pleasant tasting fluoride varnish on teeth. It may be necessary to see the dentist more often-say every 12-16 weeks until stability and protection can be determined.

Prevention involves a committed dental team and the child’s mom. Remember at early stages of life cavity forming bacteria can be transmitted. Both mother and child should ask their dental team about what can be done help prevent “filling cavities”.

This prevention starts immediately and the child should be checked at six months to start this assessment.