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.

Martha (Signature)

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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The Benefits of Dental Bone Grafting

When I first started my practice back in the early 1980s, dental bone grafting was still a relatively complex surgical procedure that required live donor bone or bone marrow, usually harvested from healthy bone in another part of the patient’s body, in order to be successful. Dental implants were still a fairly new procedure, and the success rates of both treatments were variable at best, mostly due to higher risks of infection.

Today, dental bone grafting and implant placement are safer and more effective than ever before. Advances in synthetic bone materials have almost eliminated the infection risks that were so much more common when working with live donor bone. The process is much easier on the patient, requiring less surgical time and reducing post-operative pain to a minimum. In the last few years, the addition of bioactive proteins to these synthetic bone materials has improved grafting even further by speeding the process of wound healing and enhancing both bone and gum regeneration around tooth roots and implants.

Even for patients who are not considering an implant to replace a tooth that needs extraction, a bone graft now offers us the chance to preserve the shape and strength of the bony ridge long after the tooth is gone. This is important not only for the health and strength of the teeth surrounding the extraction site, but also for the possibility of implant, bridge, denture, or partial placement in the future.

The bony ridges of our jaws get their shape from actively holding the roots of our teeth in place. When a tooth root is extracted and not replaced with an implant or a bone graft, the ridge begins to resorb and reshape itself. Without that root tip, implant, or another section of bone to hold onto, the ridge will shrink in both height and width over time. The result over a period of years is often a section of bone that is narrow, short, and fragile. Implant placement becomes far more complicated in these areas, and sometimes is simply not possible.

But implant placement isn’t the only tooth-replacement option that can be complicated by thin, fragile bony ridges. Traditional dentures and partials always fit better when the bony ridge is thick and strong. Ideally, modern dentures and partials are now anchored with implants as well, in order to avoid the slipping, clacking, and messy adhesive solutions that were so common for our parents or grandparents. Even bridges placed over extraction sites can be esthetically compromised by bone resorption if the bone shrinks away from the suspended false tooth enough to show a gap. Simply put, thin and fragile bony ridges make every tooth replacement option more difficult, less comfortable, less successful, and sometimes even impossible.

A bone graft after an extraction may increase the cost of the procedure initially, but the cost of not replacing that bone over a period of years may add up to far more discomfort and expense than the initial savings justifies. I encourage everyone facing a tooth extraction to talk with your dentist about the pros and cons of proactive bone grafting in order to make the right long-term decision for your body. As always, current patients of mine are encouraged to call the office or bring their questions and concerns to any regularly scheduled dental appointment. Our goal is to offer you the most complete information about the potential long-term effects of all the treatment choices available to you, and to help you make the decision that best supports your health goals.

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Keeping Your Mouth Cancer-Free

It’s hard to offer any solid guarantees about any type of cancer prevention. Genetics and environment can certainly play a role. Some cancers have been correlated to habits like smoking, while others appear to sometimes have a viral component, and still others seem to simply come out of nowhere. But even though we still don’t know everything about why cancer starts in one person and not another, we do know a great deal about the everyday habits that can significantly increase your chances of developing cancer in the mouth regardless of other factors. In fact, as far as researchers can tell us so far, the risk factors for oral cancer are overwhelmingly related to controllable lifestyle choices.

Of all the potential risk factors for oral cancer, smoking tobacco, using smokeless tobacco products, and drinking alcohol regularly and in excess continue to be the highest-risk lifestyle choices a person can make. And for those who combine smoking or smokeless tobacco with drinking regularly, this risk is compounded significantly.

Now it is true that in comparison to the incidences of other types of cancer, statistically oral cancer is still relatively rare. However, individuals are not statistics, and for those people who do develop oral cancer, the effects can be devastating. Whole portions of the tongue, cheek, and jawbone can be lost in the most severe cases. Even with the current advances in prosthetic reconstruction, the structure of the face and the function of the jaw will never be quite the same after that kind of damage. So why risk it at all when the simple choice to not use tobacco and to drink only in moderation could be the key to preventing oral cancer from ever developing?

Unfortunately, the answers are not that simple. Alcohol and the nicotine found in tobacco both have addictive properties, and once a person starts a habit with one or both, it can be very difficult to break it. Certainly, helping our children to avoid starting these habits at all is the best first step in the fight against oral cancer. But many pre-teens, teens, and young adults still remain unaware of the risks. It is an undeniable characteristic of youth to believe in invincibility, but it is also striking how undereducated many young people still are about how the choices they are making right now could affect their health in the long-term.

Of specific concern right now is the growing use of smokeless tobacco products among teenagers. A recent study published in the Journal of the American Academy of Pediatrics, indicates that 5.6 percent of American teenagers use smokeless tobacco products. That seems like a small number, but it shouldn’t. The most recent 2012 US Census data estimates that there are 21.2 million 15 to 19 year-olds living in the United States. That means that well over a million American teenagers are likely using smokeless tobacco products right now. What is even more disturbing about the research findings is that the majority of these students using smokeless tobacco tend to perceive all tobacco products, smokeless or not, as less harmful overall.

Clearly, we need to do a better job of informing young people of all the dangers associated with excessive tobacco and alcohol use. In that effort, I have created a new resource this month discussing the multiple ways that cancer can affect the mouth so that you will be able to have more informed conversations with your children about all the potential dangers of starting these habits.

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Self-Care for the Holidays

At this time of the year as the holidays come into full swing, it’s easy to forget all the little things we might normally do to take care of ourselves. Our schedules are packed with social gatherings, holiday shopping, and family commitments, leaving many of us tired, stressed out, and quite often more headachy than usual.

Getting lost in all the excitement and activity that always seem to define these final weeks between Thanksgiving and the New Year happens to all of us, so be kind to yourself and don’t waste time with regrets about what you should have done these last few weeks. Take a breath, let whatever is in the past stay there, and start again today with a few simple steps to keep you on the right track for self care in the New Year.

We all tend to indulge a little too much in holiday food, alcohol, and caffeine at this time of year, so if you find that you are having headaches more often than usual – or you aren’t sleeping well – start by taking a look at those areas first. Make sure you are drinking enough water each day. Monitor how many hours you are spending in front of the computer shopping for gifts or making travel arrangements, and make sure you take breaks to stretch your legs, neck and shoulders – and to rest your eyes.

You might also try stretching your jaw a few times a day, especially if you notice yourself clenching or grinding your teeth. Ice or a cold pack on the back of the neck, forehead, or over the eyes can also provide significant relief from many types of tension headaches.

If you have a little more time to spend on yourself, you might also take a moment to review some of our articles in The Headache Series. Each one deals with a specific subset of headache triggers that might very well contain a suggestion or solution to the headache that you may be having right now. This month, we’ve also added a new section to the series covering hormone imbalances, medication interactions, and rebound headaches, as well as several other possible environmental irritants and triggers.

Identifying the source of your tension headache or migraine is always the first step in finding a way to prevent them from occurring in the future. I hope you’ll take a moment for yourself during this busy time of year to check in with your body and start making a few simple changes to your daily routine right now instead of waiting for the New Year to begin.

It’s never too soon to start taking better care of yourself, and what better gift for the holidays could you receive than a pain-free transition into the coming year?

Martha (Signature)