Here is an interesting article about sleep apnea solutions. Our office provides an extensive complement of night-time apnea and snoring solutions. Ask us about aveoTSD — the latest simple, inexpensive, and noninvasive anti-snoring medical device.
Dr. W.
By Brent Arends
Is there room for two gold standards in the world of sleep? In 2011, most sleep physicians still put CPAP in the gold category, with oral appliances taking the second-place silver slot. If Sheri Katz, DDS, has her way, that hierarchy may someday be a bit more nuanced—perhaps with CPAP at 18 karats and oral appliances at 14.
CPAP has the benefit of time and the respect that goes with it. Among patients, however, oral appliances frequently carry a significant preference advantage. “Given the option, about 70% of patients choose oral appliances,” says Katz, president of the American Academy of Dental Sleep Medicine (AADSM), Darien, Ill. “Oral appliances are noninvasive, convenient, discreet, easy to travel with, and it’s a therapy that works. Dentists who are interested in participating in this field must take the correct training and know the proper protocols. We need more dentists to do this, but only as many as we can properly train and accredit.”
As a sleep apnea sufferer and oral appliance user herself, Katz believes wholeheartedly in the efficacy of dental sleep medicine. Despite evidence and consumer preference, she knows respect in the medical community is built on positive experiences. “Satisfaction depends on patients working with qualified dentists,” stresses Katz. “Sleep physicians and other referring specialists are going to be disappointed if they send [a patient] to just anyone, and the patient is not titrated properly or brought through a proper protocol. By the same token, we can be disappointed by blindly putting everyone on CPAP. If we work together and build relationships, we can form effective teams.”
AADSM membership is growing quickly every year, and the Dental Sleep Medicine Facility Accreditation Program, launched earlier this year, figures to make it easier to find qualified dentists. “How can the public, referrers, and third-party payors—including Medicare—identify who is well trained in the field?” asks Katz. “Every dentist can make an impression and probably get some sort of device inside a patient’s mouth. But should they be doing this if they do not have the proper training? The answer is no.”
Katz hopes that AADSM facility accreditation will serve as a seal of approval to guide entities beyond mere state licenses. “State licensure has really been more of a tax revenue source, and not successful in identifying who is really competent,” she says. “The facility accreditation process demands that we demonstrate our knowledge through a policies and procedures manual. Facility accreditation requires certain levels of education, so many hours in the field, and eventually a board certification, which we offer.”
DIFFERENT DECADES, DIFFERENT ATTITUDES
When Katz began practicing dentistry in 1978, CPAP had not yet been invented. Restorative dentistry ruled dental school curriculums from coast to coast, with only occasional showings from the so-called “fringe” disciplines of orofacial pain and TMJ.
Steven Scherr, DDS, graduated from dental school just 3 years after Katz began practicing, and he had “never heard of sleep apnea” up to that point. A little more than a decade ago, that all changed when a physician asked him to make an oral appliance. “I hardly knew what sleep apnea was,” admits Scherr, owner of the Sleep Disordered Breathing and Facial Pain Centers of Maryland, Pikesville, Md. “I figured I would try anything once, and it worked out. The patient was thrilled. She had tremendous success, and felt much better. The referring physician sent more patients, and his partner sent even more. Within 2 years, 50% of all my patients were referred for treatment of sleep-related breathing disorders.”
Scherr’s growing stable of referring clinicians represents an overall awareness in the medical community that mirrors a massive push in the consumer media. Initially skeptical physicians have taken the time to read the research, and converts are now embracing the idea that CPAP is not the only viable treatment for sleep apnea.
The American Academy of Sleep Medicine (AASM) opened the door by publishing practice parameters in 2006. The report concluded that oral appliances are indicated for use in patients with mild to moderate sleep apnea.
Don A. Pantino, DDS, agrees that medical understanding has taken “a huge jump” in oral appliance acceptance, and he predicts that will only grow. “In 2006, we looked at the new data and oral appliances were doing well,” says Pantino, who owns a private dental practice in Islip, NY. “As a matter of fact, they should be offered as a first-line therapy for mild and moderate patients. Patients should be educated and given a choice. The conventional wisdom is still that CPAP is more effective for severe patients. However, if that does not work, it is OK to try an oral appliance or combination therapy.”
With the research question partially answered, concerns shifted to insurance companies that largely would not pay. As of January 2011, however, a custom fabricated mandibular advancement oral appliance used to treat OSA is covered if certain criteria are met, according to a new local coverage determination. “CMS officials did not make that decision lightly,” says Scherr. “In this economic age, medical directors would much rather not introduce a new therapy that they must pay for. But they also did an extensive literature review, and they felt the literature strongly supported the use of oral appliances for the treatment of sleep apnea.”
Recognizing the growing importance of dental sleep medicine, officials at Tufts University, Boston, ultimately installed a formal dental sleep medicine curriculum—a move in line with the university’s past accomplishments within the nonrestorative realms. Pantino, an adjunct professor at Tufts, points out that as recently as 1999, sleep garnered about 2 hours of instruction during a 4-year medical school stint—a time frame he views as absurd in light of the fact that humans spend one third of their lives sleeping.
Even in 2011, promoting sleep at the dental school level is necessary. With this in mind, Pantino has used his role as president of the American Board of Dental Sleep Medicine (ABDSM) to help develop a digital PowerPoint presentation to introduce the academy and explain the importance of a sleep curriculum.
Beginning in March 2011, students have an opportunity to learn through accompanying modular lessons in the classroom setting or online. Call it an educational initiative or even a marketing tool, but it is all part of an ambitious goal to convince 100% of dental schools to develop formal dental sleep medicine programs.
Pantino believes a greater focus in the academic setting will naturally lead to a cultural shift among dentists who, at the very least, should be actively checking for signs of sleep apnea within every patient. “Every patient who snores or suffers from hypertension, diabetes, depression, and obvious anatomical landmarks should be considered,” says Pantino. “As medicine goes toward a more holistic approach and we screen for more things, oral appliances make perfect sense. So many patients are going to be diagnosed, and CPAP can be noisy, painful, and not ideal for everyone. When oral appliances are properly applied, with the right adjustments, and administered to the proper patients, they can have a remarkable benefit.”
And given enough time and evidence, that old gold standard may gradually change. “In general, it takes 15 to 20 years to get new advances through the system, and then another 5 to 10 for insurance companies to catch up and pay for them,” adds Pantino. “The gold standard is usually the first thing out there. I make it clear to my patients that I really want them to try the CPAP, and if it works, that is wonderful. I am not here to sell patients appliances. I am here to make sure they get the best therapy that is going to work for them.”
In today’s challenging economic climate, people find themselves having to make every dollar they spend count. As a result, individuals considering cosmetic dental work face the additional problem of not having such procedures be covered by dental insurance. For some, that puts treatment a little farther out of reach.
While it may be a common perception that cosmetic dental procedures are completely elective, many prospective job seekers have come to realize that having an unattractive smile could make the difference between being hired and being passed over for employment.
One of the most common methods used to improve flaws in a person’s smile has been the use of dental veneers. These are typically thin shells of porcelain that are bonded to the surfaces of a patient’s teeth and can be used to correct a variety of problems: from unsightly old fillings to crooked teeth or chips in the teeth. They can also close gaps, lengthen short teeth, or permanently brighten discolored teeth.
Porcelain has been traditionally chosen for the job because it looks natural, transmits light beautifully, and has excellent color stability. The life expectancy is also good, with many veneers lasting up to fifteen years. Unfortunately, at $1,000 to $2,500 per tooth, they can also be rather expensive.
Nevertheless, apart from the cost, their many advantages have made them a popular choice. There are several disadvantages, however. Among these is that most porcelain veneer procedures are irreversible. This means that the slight amount of tooth reduction necessary to create a natural appearance commits the patient to future veneers. Also, in most cases, multiple visits are required – with anesthesia. And should a veneer ever become damaged, or should it break, it is not easily repaired. It typically requires replacement.
Fortunately, an alternative form of treatment exists. As long as the dentist does not have to restore tooth decay as well, it can generally be performed without anesthesia.
This is known as a direct composite resin veneer. Instead of using porcelain to cover the tooth, a dentist places a very thin layer of composite resin – essentially, a tooth-colored filling material – over the tooth in order to create a similar effect. Whereas in the past, this solution sometimes resulted in a dull, lifeless appearance for a tooth, current composite resins available to dentists have improved significantly. Products on the market today have enhanced physical and optical properties that also allow the dentist to accomplish a dramatic change in a patient’s appearance in as little as one visit. Many composite resins can also be placed with little or no alteration of the tooth’s structure. Every person’s case is different, however. Your dentist should be able to give you an idea of what will be required to obtain the optimal esthetic result for your case. Expect to pay anywhere between $350 to $695 per tooth.
What if you break or chip a composite resin veneer? The repair is usually easy to accomplish in a single visit and at a significantly reduced cost to replacing a porcelain veneer. Are there any disadvantages? Frankly, these are among the most technique sensitive of all dental veneers. The skill of the dentist and their attention to detail are critical elements in achieving a good result.
Talk with your doctor about which options are right for you. It may still be possible for you to enjoy the benefit of veneers – at nearly half the cost. Most dental offices today offer flexible financing options, many of which are interest free. Your perfect smile may be much closer than you think!
“Doc, I think I have a cavity. Every time I drink some soda, my tooth hurts.”
Experience tells me it’s certainly possible, so I’ll naturally take a look – but quite often, I already know that what is causing the discomfort is an entirely different issue. Patients are often surprised when I explain that while I understand this area hurts, it’s not a cavity.
Hot, cold, air, or sweets – the triggers can be different for different people – but the effect is the same: dental pain. For some, it can be mild or tingly. For still others, it can be excruciating and intense. And yet, this can occur without decay.
So what’s going on? Often, it has to do with changes to the tooth enamel. This protective outer layer of your tooth is both the hardest substance in your body and it acts as an insulator to the inner and more sensitive dentin layer, as well as the pulp. Hard as it is, enamel is still subject to changes that can have consequences for your comfort and tooth function.
So what causes enamel to become damaged or thinned?
In a word – life. But here are a few practices or habits that tend to accelerate changes:
— Dietary factors such as acidic drinks (sodas, fruit juices, wine) and foods — Teeth clenching and grinding — Dehydration of teeth caused by a dry mouth condition (medications or insufficient water intake) — Digestive problems such as acid reflux — Damaging habits (using your teeth in ways you shouldn’t, such as opening things with them) — Improper brushing (overly aggressive or excessively abrasive)
The result of thinned enamel – also referred to as enamel erosion – is sensitivity. Gum recession can also produce a similar result because this exposes the root surface, which is not covered by enamel. Nevertheless, the result is comparable. The teeth hurt.
Yet another popular activity – tooth whitening – can lead to sensitivity due to the cleansing activity of peroxides that are used to remove stain and debris within and between the complexes of enamel rods (the basic unit of tooth enamel). It also removes something called smear plugs (debris in the dentin tubules), and this increases the conductivity of fluid that exists in the tooth’s inner layer, the dentin. When the fluid backs up – once again, you experience pain.
In many cases, desensitizing toothpastes can help. The active ingredient is typically potassium nitrate. It usually takes several weeks of continued use to experience relief. If this does not resolve your symptoms, your dentist may be able to administer a desensitizer that provides instant relief. Any persistent pain should be evaluated by a dental professional in order to prevent more serious and expensive problems.
Bad teeth may not only have negative consequences for your health, they can cost you a job.
Many people with visibly unattractive teeth go through life avoiding eye contact with strangers for fear of having to smile back or even to make small talk. Not infrequently, when such people do talk or feel compelled to smile, they cover their mouths with their hand.
Unfortunately, in a job interview, this will not go over well. Yet, for the person with dental problems, to smile or talk would compel them to reveal something they are deeply embarrassed about – their teeth. There is an old saying that you don’t get a second chance to make a first impression. And first impressions are typically based upon appearance. Your teeth, or even your breath, can either enhance or completely destroy your chances of landing that new position.
Teeth that are blackened by decay, are crooked, discolored, or even missing may not just be embarrassing – they may turn off prospective employers. Also, hiding your smile during an interview can be one of the worst things you do. A smile and a confident response project self-assurance and make a person appear likeable.
This is just one of many subtleties employers may take into account when interviewing a prospect. Teeth that are stained by coffee, tea or cigarettes may distract the interviewer from what is really important – you and your qualifications.
Likewise, coffee and cigarettes leave a smell that can be easily detected. Apart from not showing visible stains, a prospective job-seeker should also avoid certain other foods shortly before their interview. The most obvious offenders are garlic, onions, anchovies or tuna. But it is also prudent to steer clear of such lunch meats such as salami, pepperoni or pastrami before your interview. Strong cheeses, such as Roquefort, Camembert, or Bleu cheese also leave persisting odors and, similarly, should be avoided.
Women are cautioned to avoid getting lipstick on their teeth. Softer shades or lip gloss are preferable to bright red. Lipstick on your teeth can give you the appearance of being careless or hurried – which may also sink your prospects the moment you open your mouth to speak.
In today’s economy, competition for work is fierce. Applicants need every advantage they can get to land the job. Applicants’ teeth need to be as good looking as the way they dress, comb their hair, or even shine their shoes, because employers can afford to be selective with so many qualified people looking for work.
Recent research conducted in the U.S. estimates that those prospects with well-maintained teeth experience as much as a 58% higher chance of finding a job than those whose teeth are perceived as unattractive. It also seems that potential employees who have invested in dental treatment with cosmetic dentistry are regarded as more professional, congenial, and trustworthy.
Individuals seeking employment can increase their chances of getting work by taking several steps before their interview. These include getting a dental examination, completing unfinished restorative work and possibly even having cosmetic dentistry. The number of job seekers getting their teeth whitened and getting porcelain veneers placed (as a way to increase their chances of hiring success) is increasing for these very reasons. So what do you do if you can’t afford a Hollywood smile? Don’t worry, there are affordable answers.
If you need a lot of work and it is out of your reach, temporary cosmetic solutions such as a Snap-On Smile® can make a dramatic change in your appearance – very often at less than one quarter the cost of a more permanent solution. This is on the order of a functional, but temporary, smile design that snaps over your natural teeth. Once you land the job and start making an income, you can consider something more permanent!
In today’s society, people don’t seem to exercise their option to consistently take in healthy food. Consequently, many people are not getting many of the critical vitamins that they require. B12 vitamins are actually one of the essential nutrients in the B complex of vitamins that the body needs to function well.
When an individual does not have the proper vitamins, it takes a toll on their body. Vitamin B12 deficiency warning signs can fall into the categories of both mental and physical .
Individuals that don’t have an adequate intake of B12 might find it difficult to concentrate. They can experience both confusion and disorientation even if they are quite young. If the deficiency is sufficiently extreme, it can cause a person to experience episodes of delusion. Vitamin B12 deficiency affects the nervous system.
This can cause a person to experience numbness in the arms or legs. People that suffer from a Vitamin B12 deficiency might also have trouble maintaining their balance and could possibly experience frequent headaches.
A lack of Vitamin B12 can also affect the digestive system. A person may experience nausea, which can also lead to vomiting. Heartburn and bloating are two additional problems that could be actually associated with having a B12 deficiency. Many individuals experience unwanted weight loss.
A vitamin B12 deficiency can even cause constipation or, conversely, diarrhea. The latter can lead to anemia, which is actually a complication that, when severe, may generate serious illness.
There are a few other side effects that are not always recognized as a vitamin B12 deficiency. Many people manifest depression which was actually initiated by a vitamin B12 deficiency. Certain other sources directly link a deficiency of B12 to fatigue. B12 vitamins are needed to provide the body with the stamina people need to get through each and every day.
When a person does not receive enough of the vitamin, it can become remarkably difficult to do execute some of the most seemingly mundane activities. Persons may additionally experience shortness of breath while executing those actions. That is why it is recommended that folks who experience symptoms of a vitamin B12 deficiency to consult a physician immediately. There are a number of treatment choices available for those that have such a deficiency, but it is always better for the person to seek help before it becomes a problem.
Paul Easton writes about many different subjects. Learn about Vitamin B12 Shots and weight loss as well as the effects of B12 injections. More information and articles about B12 can be found at http://www.VitaminB12supplements.org
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
Search by Topic
Get Access To The AWESOME Health Course
In this 12 week program, you’re going to discover how to achieve AWESOME health and double your energy with natural, tested, and scientific strategies. Just click on the image below:
