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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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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Exercise, Nutrition, and Your Teeth

Exercise and a healthy diet are the cornerstones of a healthy lifestyle. But being healthy is about much more than simply looking slim and fit. Many very athletic adults and teenagers believe that their boosted metabolisms allow them to eat pretty much anything they want to so long as they continue to look slim and fit. But the consequences of a poorly constructed diet on the internal systems of your body, on your teeth, and even on your athletic performance, are the same regardless of how much you weigh or how healthy you may appear on the outside.

A diet filled with excessive amounts of highly refined sugar and grains, as well as foods and beverages that are high in acid, can have equally negative effects on the teeth and bodies of extremely active people as they do on sedentary individuals over time. And when it comes specifically to the teeth, very active individuals may actually be at a higher risk of tooth decay when consuming sugary or acidic foods and beverages during workouts in order to stay fueled and hydrated.

A quick burst of energy from a gel, sports beverage, or even a candy bar, may be exactly what you need to push you through the last leg of your athletic performance or training session, but that quick energy generally comes from a highly-concentrated combination of simple sugars and caffeine. Citric acid, and other acidic flavor enhancers, are often in the mix as well. Sugar and acid in the mouth create the perfect environment for cavity-causing bacteria to multiply and thrive. And introducing these elements into the mouth during intense exercise, when the saliva flow is often compromised, leaves your teeth even more vulnerable to these bacteria and accelerated tooth decay.

Certainly, there are many preventive measures that we can all take before, during, and after exercise to help protect our teeth and our bodies from the negative effects of the concentrated forms of sugar and acid we might consume during a workout. Our newest resource article, entitled Oral Health for Athletes, outlines several adjustments you can make the way you care for you teeth and fuel your body during a workout or race in order to better protect your teeth from accelerated decay.

For everyone, regardless of your level of athleticism, the first and best preventive measure you can take in protecting the health of your teeth and your body is to eat a well-balanced diet low in sugar and refined carbohydrates, and filled with plenty of whole fruits and vegetables, lean sources of protein, some whole grains, and moderate amounts of healthy fats. A strong metabolism should never be an excuse to regularly offer your body inferior sources of nutrition. No matter how athletic any of us may aspire to be, we should all be practicing healthy dietary choices every day and teaching our children that eating well isn’t just about protecting our health today or fueling an athletic performance next week – it’s about building and maintaining a healthy foundation for a vibrant and active lifestyle for years to come.

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What Your Child’s Sleeping Habits May Be Telling You

It’s easy to misinterpret certain types of sleep behavior in children as simple signs of deep sleep or dreaming. A little snoring or minor limb movement on occasion are certainly nothing to worry about, but when your child begins to snore chronically, breathe irregularly, or thrash physically during sleep, it may be time to consider whether or not he or she might have some form of sleep disordered breathing.

Obstructive Sleep Apnea (OSA) is one of the most common forms of sleep disordered breathing in adults, but children can also suffer from it – especially when there are other contributing factors present like excessive weight, chronic allergies, or specific jaw and bite alignment issues. Unfortunately all of these conditions can be intricately interrelated, sometimes making it difficult for a parent and a medical provider to successfully treat the OSA completely without addressing multiple factors at once.

What makes OSA so serious for both children and adults is that in its most severe form, it can be fatal. Thankfully, those cases are still extremely rare. However, medical research is now demonstrating that OSA and other types of sleep disorders in children and adults can manifest daytime symptoms that mimic mild to moderate forms of ADD and ADHD. Mistreating these cases with ADHD medication (typically stimulants) is dangerous on two levels: Your child could potentially be taking medication he or she does not need; and he or she could still have an underlying sleep disorder that remains unaddressed and potentially even exacerbated by the medication. 1

This month, I’ve added a new resource to The Airway Series that expands and explains these important issues in discovering and treating breathing and airway development issues in children. It is my hope that eventually all children will be screened for the underlying conditions that can lead to OSA, and that preventive measures like functional orthodontic treatment, healthy eating, and plenty of exercise are pursued before the pathological conditions related to OSA ever have a chance to develop.

As always, I encourage you to share this material as much as possible with your friends and family, and to bring any questions you may have about your own children with you to your next regularly scheduled appointment.

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