The Daily Grind

Do you wake up with a sore jaw? Do you notice your teeth wearing down? Do you have chronic neck and shoulder pain problems? Do you have a feeling of fullness in your ears? Do you dream a lot at night, feeling tired during the day?

Many people clench and grind their teeth during the night and don’t even know it. This can lead to serious problems for some people. Clenching and grinding is common during times of stress and when someone has airway issues like sleep apnea. Although many people clench and grind about 10-20% develop symptoms. These symptoms can come on suddenly when the body’s ability to adapt to the habit reaches a breaking point. People can feel ringing in the ears and muscle pain in the face that radiates down to the neck and shoulder.

A misaligned bite or some other trauma (from birth to a sports collision injury) can set you up for problems that can flare up down the road. There are a variety of reasons and causes for jaw problems the public knows as TMJ. Women tend to be affected more with these issues than men. Men will clench, grind and wear down their teeth but many times are unaware because they feel no pain. The most common and non invasive way to treat “TMJ” symptoms is with custom made appliances. These are made by your dentist who will follow and monitor your progress. Many times your dentist will recommend or prescribe an anti-inflammatory or muscle relaxant to help in the treatment. Tufts University studies have shown magnesium citrate to be helpful in relieving muscle tension. Physical therapy is another way to treat tense facial and neck issues. Stretches, massages, and ultrasound can help relieve contracting muscles. Many times the ultimate therapy is a combination of a dental appliance and physical therapy. Once muscles have been relieved, the appliance can help maintain stability of jaw and neck muscles.

When jaw pain is related to a true anatomic jaw joint problem then things can be more complex. Imaging, like an MRI is useful in accessing damage to the joint and getting a good diagnosis. These issues are not as easily corrected but can be managed. In rare cases surgery maybe a consideration to help stabilize the joint, but there is no guarantee for success. The ADA has recently stated non invasive procedures should always be considered first as the standard of care.

Accessing your habits and changing a few things can be effective as well. Take breaks if you sit in front of a computer all day and do some stretches. Keep your key board low and the monitor high. Take up yoga from a certified yoga instructor. Avoid sleeping on your stomach. Avoid excessive gum chewing or opening your mouth too wide if you are prone to jaw issues. Rest your tongue behind your upper teeth and close your lips to keep your jaw slightly open and uncontracted. Make life changes to reduce stress if possible. If stress is unavoidable, take a hot shower or bath before bed time and have some chamomile tea.

Melting Away Your Enamel

In this world of carbonated beverages, fruit juices, and sour candies, we are eroding the enamel off our teeth at alarming rates. The process of enamel erosion is starting with our children. More children today are exposed to soft drinks and sweet and sour candies than a generation before. Besides our teeth, the acidic levels in the food and beverages we intake affects our digestive system, leading to GERD, gastro esophageal reflux disease.

Water has a neutral PH of 7, carbonated drinks have a lower acid PH ranging from 3.7 – 2.5. Some candies have a PH range from 3.0 to 1.6. Enamel erosion begins at a PH of 4.0. Some of these acidic food items can actually burn the gums and cheeks. On average, the acid attack lasts 20 minutes but can be longer with prolonged exposure like sipping a beverage or sucking and chewing candy. The acid weakens the enamel and wears it away. Signs of tooth erosion are sensitivity, discoloration and transparency of the enamel.

The best way to prevent this erosion is to limit your exposure to beverages and food items which are high in acidity. There are many new types of toothpaste that claim to help remineralize your enamel. It is best to talk with your dentist to help manage the erosion you may have. It is recommended to avoid tartar control or whitening toothpastes because they contain abrasives that can further wear weakened enamel.

Think twice before you reach for that soft drink or package of Skittles!

Know Yourself, Know Your Doctor

In our busy lives, it is hard to take time out for ourselves. If health issues arise, we rely on the “quick fix” or the new product that gives immediate results. We will often settle for less than adequate outcomes, because we just don’t have the time. The reality is that exercise, medical care, and dental care need and require adequate time.

It is important to allow your doctor the appropriate time to gather the information needed to make an adequate diagnosis, and learn what your needs and concerns are. This is commonly called the co-diagnosis appointment. In dentistry, making time to assess a situation allows for thorough treatment planning that directly affects the final outcome.

For example, cosmetic dentistry takes time and care. First, what are the patient’s expectations, and can they be met? Secondly, is there an understanding about how treatment will be rendered and are the expenses and payment methods clearly understood. Taking the time to feel comfortable with the whole process is the beginning. Accepting the time frame to accomplish the steps needed, allows for the best results. Know yourself, know your doctor, and great dentistry can be accomplished. Your dentist can provide what you allow him or her to provide.

TMJ/Facial Pain

The world we live in is stressful and it is having an adverse affect on our medical and dental health! Stress is linked to inflammation and inflammation is linked to many of the ailments we deal with.

In dentistry, stress can affect many aspects of oral health. Dental and medical studies have clinical evidence of the association of periodontal disease with heart disease, diabetes and other medical issues. Headaches are also linked to dental issues such as clenching, grinding or abscessed teeth.

Many people find themselves with cracked teeth and sore facial muscles due to clenching; and often are not aware of this habit. Their dentist is often the first to point out evidence of fractured and worn teeth.

When we chew our food, our teeth rarely contact with enough force to damage our strong enamel. Enamel wear and fracture is directly related to tooth to tooth contact. Enamel wear can also be caused by acid reflux, bulimia or habits such as sucking on lemons.

While we sleep our central nervous system monitors our heart and respiration. We are unaware of the extreme force we can place on our teeth if we clench or grind. The amount of pressure our facial muscles exert can be 3-4 times more than what we would tolerate if awake.

Over a long period of time, clenching and grinding can damage teeth by causing fractures, nerve damage and severe wear. Often times, root canal therapy maybe required. In order to restore severely worn dentition, comprehensive treatment may include crowns, veneers, implants and orthodontics.

The muscle soreness or headaches related to clenching or grinding (bruxism) is very different from the pain related to TMJ or migraines. Migraine headaches are vascular. TMJ pain is directly related to the jaw joint which is very complex. It is important to discern what types of headaches or facial pain a patient is having so that a proper treatment sequence can be followed. Facial pain due to nocturnal muscle activity can be successfully treated by a fitted and adjusted occlusal guard, which can be worn while sleeping and if necessary during the day. Adjustment and follow-up appointments are essential in helping achieve the best results.

Most occlusal guards are stream-lined, so that if daytime use is necessary, the guard can be worn comfortably. It is essential that subsequent appointments are maintained. If muscles are tight they go through physical changes while in occlusal therapy. These changes affect the fit of the guard. The follow-up adjustments follow these muscular changes. Patients often ask how long they must wear their guard. The reality is indefinitely.

At the office of Dr. Peter Lecca, we specialize in preventing and treating these types of dental injuries. In our office we have a certified lab technician that works side by side with us to deliver precise comfortable restorations. We also work with a team of local specialists to ensure quality results.

Sleep Apnea

Sleep Apnea is a pause of breathing during sleep. This pause can be for 10 seconds or longer and can occur 30 times or more per hour affecting the ability to reach a deep sleep. People affected with sleep apnea often snore, make choking sounds and even clench and grind their teeth. Those affected have fatigue and excessive daytime sleepiness.

The decrease in air flow that occurs with sleep apnea puts stress on the cardio-vascular system which can lead to high blood pressure, increasing the risk of stroke and heart failure. Those people who suspect they have sleep apnea can get a diagnosis from a certified sleep center.

One way to treat sleep apnea is with behavioral changes. Sometimes sleep apnea occurs because of the position you sleep in; most commonly sleeping on your back. By changing a sleep position you can decrease apnea and improve sleep. Obesity also contributes to sleep apnea. Weight loss will decrease the sleep apnea index by 25%. Unfortunately, behavioral changes are difficult for people to start and maintain. There are also dental appliances designed to treat sleep apnea. Many time these appliances can be very effective but must be fitted and adjusted with care. Sometimes the appliances can cause or worsen jaw problems.

The best method to treat sleep apnea non surgically is with a CPAP (continuous positive airway pressure). There are different types of masks that are worn during sleep. Air pressure is used to keep the air way open. The air is heated and humidified. The lowest possible pressure is calibrated per patient to determine how much is needed to keep the airway open.

It is important to follow a treatment protocol if diagnosed with sleep apnea. Many times your dentist can pick up on signs during an exam. Severe attrition from clenching and grinding is a clue of restless sleeping which may lead to the diagnosing of sleep apnea. It is important to wear a bite guard to protect your teeth from this powerful destructive force that occurs nocturnally. A bite guard is not the same as a “sleep apnea dental appliance” as it does not force the jaw into a specific position to open the airway. It can be used in conjunction with a CPAP nasal canula.

The important thing is to be able to get a good night’s sleep. Your over all health depends on allowing your body and mind rest time.

Quality of Dental Materials

In a world where contaminants from imports are a concern, a recent story about an Ohio woman who received lead contamination from crowns and a partial made overseas has caused alarm in the dental world. The ADA is working on a protocol to ensure public safety, particularly where lead contamination is found in dental prosthesis.

Some dental labs outsource within the U.S. as well as internationally. Most of the outsourcing to foreign labs is crown and bridge. Foreign lab importing must be regulated by the FDA. Ultimately, labs should stand behind the material content of work outsourced or done on the premises. Labs should provide a detailed written statement of assurance.

For the dental patient it is important to have trust in your dentist and the laboratory he or she uses to create the crown and bridge delivered. The best material for dental treatment is gold. In dentistry, it is called the “Gold Standard”. If porcelain crowns are created with a metal substructure, it should be high noble gold. There are many non precious metals used that are cheaper but not as biocompatible as gold. Porcelains and stain should also be of the highest quality. It is suspected the Ohio case had lab contaminants in the porcelain stains used.

Many patients go overseas or to discount dental offices to save money. It is important for the dental patient to have full confidence in the materials used and of the safety precautions enforced. You often get what you pay for.

Dentistry is not inexpensive, but making an investment in quality can be a long lasting healthy investment.