Sugar: Not Just About the Cavities

Sugar and inflammation are tightly linked.

Many years ago, when my son was very young, I asked a pediatrician how much juice to feed him. At that time, I was under the impression that young people needed juice for energy and vitamin C. The pediatrician looked at me and asked, “Why would you give your son dessert to drink?”

Of course, because of further research and changes in the way our culture views food, we now know she was exactly right. Juice is really glorified sugar water. And the evidence of negative health effects is mounting against sugar.

The Alarming Effects of Sugar

Sugar can have serious health consequences for your teeth and entire body.I have read many articles about sugar consumption from sources like the AMA, the American Heart Association, the NIH, Environmental Nutrition, and the CDC. Although the exact numbers vary, sugar consumption in this country ranges from 100-150 lbs per person per year. I know that our consumption has been going down a bit, but clearly not far enough. Have you ever carried around a 10-lb bag of sugar for very long? 100 pounds is astounding to me.

It is widely accepted that sweets have been linked to tooth decay. But if tooth decay is present in your mouth, some other type of “decay” is happening in your body.

How Sugar and Inflammation Are Linked

Inflammation has become a catchword in conversation. I’d encourage you not to ignore it even though it’s thrown around casually in many health discussions. Sugar feeds inflammation. Long-term chronic inflammation is at the root (no dental pun intended) of all our chronic diseases. I will write more on that in future blogs.

For example, an article from the Journal of the American Medical Association in March of 2014 studied a population of more that 31,000 adults. The study concluded that those who consumed 17-21% of calories as added sugar had 38% greater chance of dying from heart disease. The risk nearly triples when it is 25% of calories in the diet.

Other studies connect excessive consumption to cancer and even Alzheimer’s disease. In his most recent book, “The Case Against Sugar,” American science writer Gary Taubes links the explosion of sugar consumption in the US to our climbing rate of diabetes. Sadly, we may not even know how many other illnesses are caused by excessive levels of this carbohydrate in our modern diets.

One thing is clear: On the whole, we’re eating an excessive amount of sweets. The American Heart Association recommends that women consume no more than 6 teaspoons a day of added sugars. This is a teeny amount. Generally, women eat 22 teaspoons per day.

Resolve to Cut Sugar Out of Your Diet

Many of us don’t truly know how much of the sweet stuff we are consuming. We may even think we are consuming healthy sweeteners like brown rice syrup (which may also contain arsenic!), but the reality is that the body treats all sweeteners the same. If we want to improve our health, we need to cut way back.

My brother visited a few years ago and we had this discussion. He was happily eating his bran cereal (with sugar), juice, and sometimes toast for breakfast. He was astounded after adding up the sugars in this “healthy” breakfast. And he suffered almost daily headaches. His joints hurt. He took a nap during lunch at work. He also dreamed about eating cake, etc., at night.

Sweeteners are sneaky and addicting. They are in our salad dressings, lunch meat, coffee drinks from Starbucks, breads, and more. Avoiding candy bars alone isn’t enough to protect against harmful effects.

It’s a new year. As we make resolutions about how to improve our lives, I encourage you to look at sugar. You will improve your own health as well as that of your family if you just don’t have it around.



“The Case Against Sugar” by Gary Taubes

AMA. JAMA 2014; 311(12): 1191

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The Problem with TMJ Surgery

I’ve been successfully treating TMJ disorders with conservative splint therapy, orthodontics, and reconstructive crown and bridge work for more than 25 years. During that time, I’ve encountered less than a handful of patients who could only be helped with joint surgery. I have, however, consulted with and treated dozens of patients who have been plagued with continuing pain and the inability to chew correctly following TMJ surgery on one or both joints.

Unlike splint therapy, orthodontics, and reconstructive crown work which all focus on gently encouraging the joints to find a better position on their own through repositioning the way the teeth fit together, joint surgery often physically forces the TMJs into a completely new anatomical position. There is no ability for the joint to ease back and forth between positions or make the minute adjustments so often required to adapt to the constantly changing landscape of the mouth. The joint is simply moved or shaved, and there is no way for it to move back if the new position is not ideal.

Forcibly moving the joint with surgery may help create more room for the disc to move freely and correctly, resolving pain and functional issues associated with locking and popping, but surgery almost never takes into consideration the most important function of the jaw: making the teeth fit together for chewing. Too often, I have heard clients recount stories of being told to simply stop chewing and stay on a soft diet for the rest of their lives when their teeth no longer fit together after TMJ surgery. A long-term soft or liquid diet is not ideal for anyone, nutritionally or otherwise. And for a person in their 30s, 40s, or 50s? Never chewing again is simply not a good enough answer.

Unfortunately, the inability to chew is not the only potential negative outcome of TMJ surgery. Some patients experience recurrence of pain symptoms, locking, and popping within a few years after the surgery. The most unfortunate cases I see are in patients who undergo surgery and then end up in the same pattern of symptom management that they were in before the treatment. These individuals find themselves back in an orthotic to control pain and locking, experience severe pain flare-ups several times per year, and require regular physical therapy, chiropractic adjustments, or massage therapy in just to maintain the most basic levels of function.

There are certainly circumstances where TMJ surgery may be the only answer, but those cases are extremely rare and usually involve some sort of trauma. The most successful case of TMJ surgery I have ever seen was a surgical unlocking of the discs done on a patient whose discs were displaced through a blow to the chin sustained during a bicycle accident. Again, these cases are the exception rather than the rule. I caution all my patients not to put themselves into the surgery category until all other treatment options have been ruled out or exhausted.

TMJ disorders exist on a broad spectrum of severity, with most cases being transient or easily managed with non-permanent changes to the the teeth or joints. In order to help you better understand this spectrum and the variety of non-surgical treatments available that may be of help, I’ve created a new resource entitled The Benefits of a Non-Surgical Approach to TMJ Dysfunction. I hope you will share this information with anyone you know who suffers with TMJ-related pain and dysfunction. As always, current or prospective patients are always encouraged to call or bring questions about their specific circumstances to their next regularly scheduled appointment.

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Not All Nightguards Are The Same

There are many different philosophies when it comes to constructing a nightguard. In its simplest form, the primary function of a nightguard is to protect the teeth from the destructive actions of clenching and grinding during sleep. Upper nightguards with a flat surface are a popular and simple solution to to this problem. However, after more than 30 years of studying and treating bites, joints, and airway issues, I have found that while many upper nightguards may protect the teeth from tooth-on-tooth damage, they often disregard important elements of a balanced bite and an open airway.

Traditional upper nightguards are generally made by taking a single impression of the top teeth and palate, and then sending that single impression to a laboratory to have a simple nightguard made. Little attention is given to the physiology of the joints and muscles, resulting in many upper nightguards that actually shove the lower jaw backwards, causing pain and compression in the joint space. Many of these nightguards are also constructed with a flat biting surface for the bottom teeth to slide against. The idea is that the teeth are grinding around anyway, so why not give them full freedom to do so?

The problem with that concept is based on a fundamental misunderstanding of why people clench and grind in the first place. Stress can certainly play a role, but nighttime clenching and grinding can also be a physiological effort to open the airway or to find a more comfortable resting place for the teeth that better supports the joints and muscles. A flat plane that the teeth literally skate around on can actually causing grinding to increase as the muscles and joints struggle to find any resting place at all.

Upper nightguards can also exacerbate breathing problems, especially for those people who already snore, suffer from allergies, or have any form of sleep apnea. Most upper nightguards are fairly thick across the palate. This construction crowds the tongue further back into the throat, constricting the airway. When this happens, patients will often stop wearing the nightguard even if they don’t know why because it feels claustrophobic or simply “too big”.

In my practice, I always recommend and construct lower nightguards for my patients. Even if a patient has no known joint or breathing issues, my goal as a neuromuscular dentist is to always protect the balance that already exists. A lower nightguard allows more room for the tongue and, when constructed properly, holds the lower jaw in a neutral, relaxed position to support the joints and muscles.

When we make a lower nightguard, impressions of both the upper and lower jaw are taken, and a bite registration is used to determine the ideal relationship between the upper and lower teeth when the joints and muscles are at rest. A bite, or resting place, is carefully constructed into the surface of the nightguard. This bite is not a locked position, but rather a subtle suggestion to the teeth to settle into a more relaxed position when not engaged in a grinding activity. Full freedom of movement is still possible and careful attention is paid to potential interferences when the jaw moves forward and side-to-side during the final fittings.

A nightguard is a simple device in theory, but like any other treatment or device that introduces a change in the body, great care must always be taken to reduce or eliminate any unnecessary and unwanted changes to other systems. If you are considering a nightguard, or you have questions about the construction and efficacy of your current nightguard, I encourage you to seek out an opinion from a neuromuscular dentist. Current patients or individuals who would like to become patients within my practice are always encouraged to call or schedule and appointment to further discuss my approach to nightguard construction and to determine if a nightguard is the correct appliance to address all your functional needs.

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Inflammation: Friend or Foe?

As a dentist, I work with the body’s inflammatory responses nearly every day. Bacteria builds up around a tooth, and the gums swell with blood in an effort to fight the growing infection. This can happen for the simplest of reasons: a change in diet or home-care habits being the most common. But sometimes the mouth can have a more generalized reaction. Instead of inflammation developing in a single, localized area of infection, the gums swell and bleed uniformly throughout the entire mouth. Gingivitis like this may still be a reaction to too much bacteria all throughout the mouth, but sometimes gingivitis can develop even in a healthy mouth where plaque and bacteria are seemingly under control. Stress, dietary or environmental allergens and irritants, or an underlying systemic inflammatory disorder can all contribute to the development of chronic inflammation in the mouth.

Inflammation anywhere in the body is never a good sign, but in most cases it is a normal response to a physical injury, a localized infection, or an allergen. Your body is trying to help you fix the problem by sending extra blood to the area to speed healing and fight unwanted intruders. In a healthy system, this inflammation subsides as soon as balance is restored to the area: the bone is set, the infection is under control, or the allergen has been removed and processed out of the body. Sometimes, however, the body can get stuck in an inflammatory response even though the allergens, infecting bacteria, or physical injuries have been resolved. When this happens, inflammation is no longer a helpful partner in defending and healing your body. Inflammation and the immune system that triggers it are now at odds with your body – seemingly attacking otherwise healthy systems for reasons we still don’t completely understand.

What we do understand so far is that inflammatory disease anywhere in the body seems to be multifactorial in nature. Stress, diet, environment, and physical activity all seem to have a role in the progression or stabilization of nearly all chronic inflammatory conditions. Systemic inflammatory conditions also seem to have a unique relationship with inflammatory conditions of the mouth. We still don’t know if that relationship is actually causative, but the correlations between the two are extremely strong.

Inflammation, like pain, is a message from your body that something is wrong somewhere. Understanding that message can be tricky sometimes, especially when the body’s inflammatory response is the problem. To help you begin unravelling what your body may be trying to tell you, I’ve created a new resource article this month entitled Inflammatory Disease and the Mouth. It is my hope that anyone who has or suspects they may have a chronic inflammatory condition will read this article and share their concerns, questions, and self-observations with their medical and dental providers.

As always, if you are a current patient of mine, or you would like to become a patient, please feel free to call my office during our regular business hours with any questions or concerns you may have about inflammation in your mouth or a suspected inflammatory disorder.

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Listening to Pain: The Key to Healing

In my practice, I treat many patients who suffer from chronic pain. Malocclusion, or a misaligned bite, can stress the facial muscles, compress and malform the TMJ, and cause a great deal of pain in the jaw joints, face, head, ears, and neck. But in all the years I’ve been treating TMJ and chronic pain, I’ve never seen a patient who’s sole source of pain was exclusively from a bad bite or compressed joints. Chronic pain is nearly always multifactorial. There may be a primary underlying cause, but lifestyle habits and stress levels can not only crank up the volume on an existing condition like TMD, but also create a great deal of pain all on their own.

Many patients we work with have travelled a long journey trying to understand the clinical reasons for their pain. They have visited doctor after doctor, receiving different diagnoses, treatments, and medications. Some even undergo surgery in an effort to find some kind of relief, yet still they have pain. Unfortunately, many of these patients we work with are often completely unaware of how their own lifestyle habits and stress levels could be hindering their ability to heal. This is not the patient’s fault. As healthcare practitioners, it is our job to help patients understand not only what we can do to help them, but perhaps more importantly what they can do every day to help themselves.

No doctor can possibly understand what it feels like to be in your body better than you. Pain is your body’s way of telling you something is wrong. With a little time and careful listening, many patients can uncover physical habits and lifestyle choices that create or exacerbate their pain all on their own. Doctors can run tests and take x-rays, but a doctor does not live with you 24-7. Only you know that every time you skip breakfast, you end up with a headache. Or that every time you do a particular weight-bearing exercise, your teeth and jaw ache afterwards. Or that every interaction you have with a co-worker, friend or family member seems to trigger a migraine. Just by paying attention to when your body experiences pain and what is happening in and around that moment, you can gather more information about the possible triggers for your pain than any doctor ever could.

Now, can another person actually cause you physical pain just through conversation? Probably not, but the stress of that conversation may cause you to clench your teeth, tighten your shoulders, and breathe more shallowly. All of those things will definitely give you a doozy of a headache. Medication may help in the short term, but the ultimate cure for that kind of pain is to learn how to interact differently with the people in your life who cause you stress, or to eliminate those relationships altogether if possible. Medication can not do that for you, but practical tools do exist to help you manage relationship stress and decrease its effect on your physical body.

Pain is not a comfortable experience for anyone. It is not meant to be. Your body is trying to get your attention. Listen, look inward, and try to understand its message. You may be surprised at how much information you will receive.

In order to help you do just that, this month I have created a tool that will allow you to see more clearly the many messages your body is trying to send you through your pain. The Daily Headache Diary is a tool for you to use in conjunction with the entire Headache Series. By tracking your diet, medications, and answering a series of questions each day about your habits, you will begin to see if there are any patterns in your daily or weekly routine that regularly coincide with headache pain. That information is incredibly valuable. Even if you do not know what to do with it right away, keep listening, share your new understandings with your treating physicians, and try some of the simple adjustments suggested in the Headache Series to see how much headache pain you can reduce or eliminate all on your own. We are each our own best healers when it comes to chronic pain. Trust your body. It does not lie.

By the way, this is also a helpful tool for other types of pain.

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