It is not uncommon for me to get a strange look when I ask a patient about snoring in the dental office. After an explanation about some of the reasons I include this on my medical history form, the patient will often say, “Well, I don’t snore but my spouse (usually husband) does. In fact, we sleep in separate bedrooms.”

A better way to ask someone about snoring is to ask, “Have you been told you snore?” Snoring can be a huge nuisance to the bed partner and is actually very detrimental to both people. For those without a bed partner, snoring can be assessed with apps such as Snore Lab, which measures snoring levels throughout the night.

Snoring is a sign of a restricted airway, which means that there is a possible depletion of air getting into the lungs and thus the brain. You spend approximately one third of your life sleeping, which means if you live to 90 years old, you may have spent 30 years sleeping. Oxygen depletion during sleep has both short-term and long-term consequences. I have read multiple studies which suggest a reduction of oxygen to the body can take 6-10 years off of your life. Sleep is one of the most mysterious states of being – we don’t know a lot about what is going on during sleep without it being recorded. Wouldn’t you want to know if your body wasn’t being oxygenated properly?

A restricted airway can be caused by numerous different factors. Many times, it is developmental and starts early in life. As we age, this risk for developing a restricted airway increases with things like gaining weight, muscle tone laxity, and even sleep position. Snoring is a fluttering of soft tissue in the back of throat due to there not being enough space for air to pass through. Not only does snoring have the potential to affect your brain and the way you feel on a day-to-day basis, it also disturbs the sleep of the person sleeping next to you….and in some cases, people in other rooms.

Snoring does not mean you have sleep apnea (a serious disorder measured by a sleep test,) but is a significant risk factor. If you do have sleep apnea, you need to know this so that it can be treated and you can live a better quality of life. If you don’t have sleep apnea and just snore, this can also be treated, and you may be able to make it back into your own bedroom.

Aside from snoring, if you have any of the following: familial history of sleep apnea, history of daytime drowsiness, history of clenching/grinding, history of TMJ disorder, history of mood disorders/depression, witnessed apnea events (gasping at night), large tongue with ridges on the sides, tooth wear, high blood pressure, gastric reflux, large neck (Males >17 / Females>16) – you should discuss this with your physician and/or your dentist.

There are different ways to treat snoring and/or sleep apnea including positional therapy (sometimes a wedge pillow strapped to your back so you can’t roll onto your back), a CPAP device (positive air pressure through the nose to keep the airway open), or a dental device (to keep the jaw and tongue from falling back).

Just like exercising and good eating habits are good for the body, quality sleep vital to good health. Just because you get 7-8 hours of sleep doesn’t mean it is good sleep. Don’t hesitate to talk with your doctors about your sleep issues…..and encourage the loud person sleeping next to you to do the same.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have, please email them to him at jpstclair@stclairdmd.com

I understand that periodontal disease is a major cause of tooth loss in adults, but is there anything I can do about it?

Gum disease—periodontal disease—often progresses slowly, without pain, over a long period of time. This is one reason why it is common among older adults. The longer the disease goes undetected and uncontrolled, the more damage it causes to gums and other supporting tissues. Although periodontal disease is caused by bacteria, other factors can increase the risk or severity of the condition. These include food left between the teeth, tobacco use, badly aligned teeth, ill-fitting bridges or partial dentures, poor diets and some systemic diseases such as diabetes.

Although periodontal disease is common, it can be controlled but is often a life-ling commitment. In its early stages, it can be reversed. Treatment of advanced cases may require surgery. If you notice any of these: bleeding gums when you brush; red, tender or swollen gums; gums that have pulled away from the teeth; pus between your teeth and gums when the gums are pressed; loose teeth or teeth that are moving apart; any change in your bite; any change in the fit of your partial dentures; constant bad breath or bad taste…….this may mean you have severe gum disease and are losing your teeth!

Prevention is key!

My dentures don’t feel as comfortable as they once did. Before I see the dentist, should I try some different products myself to try to improve them?

Your dentures were made to fit precisely. If they are cared for properly, they do not change shape. They can become loose due to natural changes in the gums and bone supporting them. As the jawbone begins to shrink, so do the gums. In addition, the teeth wear over time and become less effective during chewing. Most dentures should be replaced every 5-8 years.

When your dentures do not fit properly, see your dentist as soon as possible so adjustments can be made. Professional relining of the denture may extend its lifespan.

Do not try to change the fit of your dentures yourself. This can damage them and make them unrepairable.

If I have full dentures, do I really need to see the dentist as often as before?

Even if you no longer have your natural teeth, you should see your dentist once a year for an oral examination. The dentist will examine your mouth to check for any problem with the gum ridges, the tongue and the joints of the jaw, as well as screen for oral cancer. For a variety of reasons, many older adults are more susceptible to oral diseases, including oral cancer. About 95 percent of all cancers are found in people over age 40. However, many of these cancers are treatable if detected early. Oral tissues are also checked for signs of other diseases that can first manifest themselves in the mouth.

I am currently taking medication that my physician prescribed for me. Can this affect my dental treatment?

When your dentist asks for your medical history, be sure to provide complete, up-to-date information on your health. Inform your dentist if you have experienced recent hospitalization or surgery, or if you have recently been ill. Also tell the dentist the names, doses and frequency of any medications you are taking, whether prescription or over-the-counter products, and the name of your physician. This information will help the dentist to select the most safe and effective method of treatment for you.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have, please email them to him at jpstclair@stclairdmd.com

Liz H:  I was recently told by a dentist that I need a root canal, a post, periodontal crown lengthening surgery and a crown. The total cost of treatment is $3500! Do I have any alternatives?

That is a difficult question to answer without seeing the specific case, but here are some thoughts. There are quite a few things to consider. The first is the general condition of the teeth. If you have numerous other dental problems that need to be addressed, you must prioritize these and decide if the cost of doing them all is something you can afford, or if treatment needs to be spread out over time. The last thing you want to do is spend $3500 on one tooth, and then be out of funds to address the other problems.

Let’s assume that this is the only tooth that needs to be addressed. I would look at your past history of dental problems. If you have had limited problems with a low rate of dental decay in general, this treatment may be the best option. If you have had a problem with dental decay, the best alternative might be to extract the tooth and do a dental implant. The cost of the treatment would be about the same, and there would be no chance of recurrent problems with decay.

Extracting the tooth and not replacing it can lead to teeth shifting, bite problems and a decrease in function. If the cost of treatment is beyond your means, ask the dentist if there are options to stretch the payment out over a period of time.

Tom Q: My son has been in braces for over a year and has multiple teeth with decay. What should we do?

My first question would be – Why does he have so much decay? Although there are many factors, diet and home care are most likely the culprits for the problem. If the decay can be easily fixed, the diet can be controlled (i.e. decrease sugar intake), and his home care can improve (including a prescription fluoride toothpaste), that would be the best way to go, and the braces treatment can move on. If the decay is extensive and his compliance is poor, the best thing to do may be to remove the braces and wait until improved conditions are met before continuing with the braces.

Linda T: My dentist keeps telling me that I need a bunch of crowns. I don’t have any pain and the crowns seem excessive and costly. Why can’t I just wait until something happens and fix the problem when it arises?

You can wait. However, there is probably a good reason the treatment is being suggested. Often, being proactive in replacement of aging large fillings can prevent bigger problems to come. The purpose of a crown in this situation is to protect the tooth. Waiting for “something to happen” can often mean more treatment down the road such as root canals or gum surgery. If you have multiple teeth that need this treatment, ask for a treatment plan to sequence the treatment over time. This is better than waiting.

Each person’s situation is different. Many of us complain about not having enough time to do things. Then, when we examine how we spend our time, we realize that re-prioritizing our time (getting rid of time suckers) frees up time to do things that are most important to us. The same can be said about where we spend our money.

One thing is for sure; ignoring is never a good option.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have, please email them to him at jpstclair@stclairdmd.com

Isn’t tooth loss inevitable in the later years?

Today, older adults are keeping their natural teeth longer because of scientific developments and the preventive emphasis in dentistry. This improvement was seen in the results of a survey released by the National Institute of Dental and Craniofacial Research. They showed that among persons in their 50’s and 60’s, the rate of losing all teeth has dropped 60 percent since 1960.

Good oral hygiene and regular dental care are important throughout your life, whatever your age. By practicing good oral hygiene at home and visiting your dentist regularly, you will prevent dental problems and save time and money as well.

There are two things that cannot be disputed when it comes to oral health:

• Quality of life is better with a healthy mouth full of teeth
• Your mouth is the gateway to the rest of your body. If you care about being healthy, you should take the steps necessary to have optimum dental health

At my age, why should I bother with oral hygiene and going to the dentist?

Thorough daily brushing and flossing of your natural teeth are essential to keep them in good condition—especially as you age. Plaque, the sticky, colorless layer of bacteria that causes tooth decay and periodontal (gum) disease, can build up quickly on the teeth of older adults, particularly when they neglect oral hygiene. This can increase your risk for tooth decay and periodontal disease.

A few simple steps can help you maintain good oral health throughout your life. Brush your teeth twice a day with a fluoride toothpaste, and clean between your teeth daily with floss or interdental cleaners. Be sure to see your dentist regularly for exams and professional teeth cleaning. Professional monitoring of your oral health status is essential.

Should adults be concerned about cavities?

Tooth decay is not just a child’s problem. Adults of all ages can have cavities. The causes for tooth decay are the same for everyone, regardless of age. Decay results when the bacteria in plaque feed on the carbohydrates (sugar and starch) in our diet to produce acids that can cause cavities.

Decay rates can change throughout our lifetime for various reasons.  Adults are more likely to have decay around older fillings or other dental work.  Decay of the tooth root is also common among older adults. Root caries (decay) occur when the gums recede, exposing the softer root surface, which decays more easily than tooth enamel.

Tooth decay is also promoted by dry mouth. This condition, called xerostomia, occurs when the supply of saliva is greatly reduced. It can be caused by many types of medications (such as anti-histamines, anti-hypertensives, and anti-depressants) or radiation therapy to the head or neck. Saliva is needed to lubricate the mouth, wash foods away and neutralize the acids produced by plaque.

 Allowed to continue, dry mouth can lead to rampant tooth decay. If you think you have this problem, be sure to discuss it with your dentist or physician. They may recommend a saliva substitute and/or fluoride products to help prevent decay.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have, please email them to him at jpstclair@stclairdmd.com

This week the topic has nothing to do with dentistry. It is a topic that some will be able to relate to and others may not. It is a topic that some may appreciate and others may criticize. It may be something you have thought about before or maybe have never thought about. It is about thinking outside the box and being comfortable with the uncomfortable.

Regardless of your line of work, there comes a point when we all get comfortable with where we are and how we do things. Initially, that is a good feeling, but eventually it is a feeling that challenges us in our own growth. It is impossible to go through life doing things the same way and feel content forever.

In my 25th year in this profession, I do very few things the same as the way I was originally taught. I am constantly learning, but often struggle with how to apply things I learn, or whether to apply them at all.  However, being uncomfortable with being comfortable challenges me to grow.

Many of us, and especially people in a service-related industry, which I can relate to the most, can exhaust ourselves trying to predict and control what other people think about us as individuals and about the work we do. This feeling is a trap and very self-limiting.

Do people understand me? Do they like me? Do they know how much I care about what I do? Do they care? These questions can paralyze us into inaction. These feelings can cause us to never even come close to reaching our full potential. We “play it safe” too often, and need to consider going outside our comfort zone to realize growth, both personally and with our work.

Has this thought ever crossed your mind: “What in the world is my purpose while I’m here on this planet?” We have to have purpose, otherwise we are lost, and we have to have faith or we remain lost.

We all go through the various stages of life and experience joy and happiness, sorrow and pain, confusion and temptation. Some struggle with these things more than others, which can also impede our growth as individuals.  Each of us looks for the things in life that brings us more joy and happiness rather than other things listed above. However, focusing on “what’s in it for me?” can be just as destructive.

Constant growth in mind, body and spirit are essential to mature as individuals. We need to be mature enough to recognize that each of us has our own set of resources, and be able to determine how these resources can help others versus being a roadblock.

We all have our faults, admitted or not. Most of the time we are unable or unwilling to express our faults to anyone because of pride. We want everyone around us to think that we have no “issues”. It takes awareness to allow for self-reflection and at least admitting to ourselves where we need to improve in our personal and professional lives.

This is difficult to do alone. Your best bet is to work together with someone close to you who also has similar intentions so that you can hold each other accountable. Perhaps one of those areas you wish to improve is your own health.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have, please email them to him at jpstclair@stclairdmd.com

In last week’s column, I wrote about some specific differences between dentists and dental practice philosophies. But, what makes for an ideal doctor, dentist, nurse, physical therapist, or any other care giver? Patients shared their views in a study which appeared in an issue of Mayo Clinic Proceedings. It’s based on nearly 200 patients treated at the Mayo Clinic in Arizona and Minnesota.

In phone interviews with people who had no professional ties with the Mayo Clinic, the patients described their best and worst experiences with their Mayo Clinic doctors, with confidentiality guaranteed. The doctors seen by the patients came from 14 medical specialties.

Here are the seven traits listed by the patients, along with the patients’ definitions of those traits:

• Confident: “The doctor’s confidence gives me confidence.”
• Empathetic: “The doctor tries to understand what I am feeling and experiencing, physically and emotionally, and communicates that understanding to me.”
• Humane: “The doctor is caring, compassionate, and kind.”
• Personal: “The doctor is interested in me more than just as a patient, interacts with me, and remembers me as an individual.”
• Forthright: “The doctor tells me what I need to know in plain language and in a forthright manner.”
• Respectful: “The doctor takes my input seriously and works with me.”
• Thorough: “The doctor is conscientious and persistent.”

That list isn’t in any particular order. The researchers didn’t check whether confidence was more important to patients than respectful treatment, for instance. The Mayo Foundation funded the study.

The traits covered doctor’s behavior, not technical know-how. That finding “does not suggest that technical skills are less important than personal skills, but it does suggest that the former are more difficult for patients to judge,” the researchers write. They add that patients may tend to assume that doctors are competent unless they see signs of incompetence, the researchers add.

One patient put it this way in the study: “We want doctors who can empathize and understand our needs as a whole person. We want to feel that our doctors have incredible knowledge in their field. But every doctor needs to know how to apply their knowledge with wisdom and relate to us as plain folks who are capable of understanding our disease and treatment.”

The opposite of those seven traits would be: timid, uncaring, misleading, cold, callous, disrespectful, and hurried. Can healthcare ever be high-quality if the patient-doctor interaction is any of these?

I hear so many deeply touching stories from patients who have had such positive experiences with doctors and nurses during tough medical situations. People who are cared for in this way receive much more than physical wellness.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have, please email them to him at jpstclair@stclairdmd.com

Exposure to poison ivy, getting food poisoning, having a toothache arrive seemingly out of nowhere – these situations sure bring about unpleasant thoughts. Watch where you step and be careful about what you eat, but for now, get ready to focus your attention on those toothaches. If you’ve ever bitten down too hard, been hit in the mouth while playing sports, or woken up due to a toothache, it is a tough situation to endure. When you experience any of the tooth pain symptoms or other issues discussed below, you should act instead of ignoring them. Read on to learn what problems necessitate you should call your emergency dentist in Rowley.

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No two dental practices are alike! Each takes on the characteristics of the practitioner and the supporting team. Every office/patient interaction is the key to how that office “feels” when you walk in the door.  Some practices may feel “clinical and efficient”, while others feel somewhat more home spun and laid back.  This approach is often reflected in the office’s treatment preferences as well.

In my experience, all dentists will suggest what they feel to be the very best plan for any given patient.  The differences between the treatment suggested by one dentist and that of another reflects that dentist’s preferences based on his or her experience. Thus, differing treatment plans do not necessarily reflect any deficiency in either dentist’s judgment.  

I presented a complex case situation to a group of 15 dentists this past week. Even among this group of like-minded dentists, there were many different opinions as to how to approach this patient’s care. Some dentists said they would not do anything, while others offered very sophisticated treatment plans.

It is important to remember that there are numerous ways to treat the same situation, and it is always important for the dentist to tailor the treatment plan for each patient’s specific circumstances.  A major part of those circumstances may be financial, and since different treatment plans can vary a great deal in cost, it is helpful if the dentist takes the patient’s ability to pay into account. 

Think of treatment plans like various models of cars at dealerships.  All of the models are new, have warranties and will work well out of the lot.  The higher end models, however, have some advantages not found in the less expensive models.  Some options add years to the life of the car. Some add to the appearance and enjoyment of driving it. 

Dental treatment plans are like that too.  Saving a badly damaged tooth with a root canal and a crown will preserve it for a long time, but it is a larger investment than the alternative extraction.  Replacing a missing tooth may be done with an implant or fixed bridge (not removable), or a removable partial denture. One is a larger investment than another. The implant, for example, provides a more natural solution, but requires a higher level of care. A dentist should be able to explain the advantages and disadvantages of the various options, and allow the patient to make the decision. 

All dentists who have graduated from an accredited dental school should be technically competent to perform any procedure that they personally feel comfortable with.  But it is important to remember that each one is an individual, and no two dentists can perform exactly the same technical procedure in exactly the same way. 

As a patient, you have no way to be able to judge the quality of the clinical treatment performed. Did it hurt? Does it look and feel good? Do I feel the investment was worth it? Those are the parameters most patients use to assess success. This starts with the trust in the dentist/patient relationship.

Over the years, I have developed a deep respect for those who practice dentistry. Many of my colleagues have impressed me with their technical abilities, and others with their communication skills. There are many great provider options for patients to choose from.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have, please email them to him at jpstclair@stclairdmd.com

Studies have shown a link between teeth grinding, clenching and headaches. There are also links to people who have sleep breathing disorders, and those who take serotonin uptake inhibitors (SSRI). Some brand names of these drugs are Celexa, Lexapro, Prozac, Paxil and Zoloft. Many people grind and clench their teeth for many different reasons – let’s not forget STRESS!

For people who grind or clench, the muscles that open and close the jaw can become painful from overuse, causing a range of symptoms from tension to migraine headaches to jaw joint (TMJ) problems to tooth pain. Here is a simple test – look at your tongue in the mirror without sticking it out. Are the borders smooth? If they are ridged, you are probably doing something outside of normal function.

Bruxing (grinding) and clenching teeth is defined as abnormal tooth contact (parafunction). Ordinarily, teeth should only be in contact while eating and swallowing, which is about 10 to 15 minutes on a daily basis. People who grind or clench their teeth during the day, or while sleeping, can have their teeth in contact for as much as six hours a day or more. Researchers say that one night of grinding is equivalent to 80 days of normal wear. Read that last sentence again.

Clenching can be just as bad, and in some cases, worse than grinding. The average person puts about 200 lbs. of force on back molars during function, but a person who clenches can put up to 1000 lbs. on the molars. This is a lot of force for the teeth to withstand. Fractured teeth are seen on a regular basis in dental offices due to clenching. Typically, a person will come in saying that their tooth broke while they were eating something soft. While that may be the case, often times clenching and/or grinding has weakened the tooth prior to it breaking.

The American Dental Association estimates that 95 % of the American population suffers from a grinding or clenching problem at some point in their lives. Some people do so much damage over time that they need a lot of dentistry to restore their teeth back to normal function. The key is early diagnosis and treatment.

Many patients do not realize, and some refuse to accept the fact that there is a problem. The reason for this is because many, if not most, do not have symptoms. The masticatory system is a very adaptive and forgiving system. Some even think their symptoms are just normal. However, if a problem is identified, accepted, and treated, it can help prevent numerous potential issues down the road.

Therefore, successful therapy starts with acceptance of the pathology present. In addition to behavior modification, nighttime bite splints can be very effective. They should be worn every night, not just when it “seems” like you have been grinding or clenching. It’s like wearing a knee brace. You wear the brace to support the knee to help prevent more injury.

Some patients require daytime splints because their issues are affecting them during the day, and a “night” guard might not be enough. Over-the-counter appliances are typically not recommended for a variety of reasons. 

Ask your dentist whether you have any of the signs associated with grinding or clenching, and especially talk to your dentist if you have any symptoms. If the reason can be identified as to why this happening, it will direct the provider to offering the best solution for your specific situation.

One last thought: Read the first paragraph over. In most people, there is a reason for the grinding and/or clenching. There is a lot of interconnectedness between sleep and other issues. Sometimes, if you fix one thing, other things go away.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have, please email them to him at jpstclair@stclairdmd.com