J. Peter St. Clair, DMD Blog

Last week I introduced Part 1 of “In Search of Better Sleep”. For this week’s column to make the most sense, I would encourage you to read that column first. It can be found at www.thetowncommon.com.

In case you don’t have a chance to read it, here is a brief recap: I have been involved in treating patients with sleep apnea for a few years. These are patients who have been diagnosed with sleep apnea by a physician, but were unable or unwilling to use a CPAP machine. The next line of defense to treat this progressive disease is a dental appliance which prevents the lower jaw from falling back during sleep. Despite all my education on this topic, I grew frustrated. Not only was I not treating as many patients as I wanted, I also had way too many patients, who I knew had issues, but would have a “normal” sleep study. I decided I needed more education.

Relatively speaking, the research in this area of medicine is early in its development. There is clear evidence that sleep disordered breathing affects more people in more ways than was thought in the past. As the research continues, more people will be able to be helped to breathe and sleep better.

Although there are many people with obstructive sleep apnea who need treatment, with either CPAP, a dental appliance, or some other form of treatment, there are many more people who have the same signs and symptoms as people with apnea and poor sleep, but they “pass” a sleep study. There is also a diagnosis called Upper Airway Resistance Syndrome (UARS), which is not talked about much. I’ll discuss this is a future column, but if you “passed” a sleep study (especially if you’re on the younger side) and have the symptoms of sleep apnea, UARS should be considered.

In most cases, problems related to the airway start very early in development, and progress throughout life to finally show up in a sleep study as apnea when a person is older. It is an evolutionary/developmental problem. Dentists have an extremely important role to play in helping to identify these issues in all phases of life, especially in children, where most of these problems begin. Identifying them early can allow intervention through orthodontics and other non-invasive therapy, and completely change the course of development, leading to a life of better breathing and better health.

For adults, because they have stopped growing and have signs and symptoms related to breathing issues, but would otherwise “pass” a sleep study, there is help available. Identifying those people, controlling the problems causing these issues, and offering ways to a more permanent resolution is where medicine and dentistry must grow together.

Sleep apnea is the end stage of this breathing disorder. Treatment for those with sleep apnea is typically either the “gold standard” of CPAP, wearing a mask on your face for the rest of your life, or wearing a dental appliance in your mouth for the rest of your life (although it may not work forever), or major surgery to fix the anatomy that is causing this progressive disease. The goal is to not get to the end stage of this disease.

As I learn and share more about this topic in the future, you will be amazed at some of the things that are related to breathing issues, such as ADHD, developmental issues, memory problems, TMJ pain, poor quality sleep, snoring, and a host of other things. While research in this area is ongoing, there is plenty of scientific evidence already out there to support this information. Breathe well.

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

Almost ten years ago I took a weekend course at Tufts University School of Dental Medicine entitled “Sleep Dentistry”. This was not a course in putting patients to sleep for their dental work. This particular course was an introduction to treating people who had been diagnosed with sleep apnea (a sleep breathing disorder) by a medical doctor, and could not tolerate (or would not even consider) the use of the dreaded CPAP machine.

CPAP, which stands for Continuous Positive Airway Pressure, is a facial mask which blows air through the nose to create an “air stent” to basically hold the airway open during sleep. Patients with sleep apnea have been diagnosed with a progressive disease in which breathing is decreased at least 90% for more than 10 seconds multiple times an hour. Most people know someone who has been diagnosed with this disease, and either uses a CPAP machine, or cannot use it.

The “sleep dentistry” part of the equation is that for those who have been diagnosed with sleep apnea and cannot use the CPAP machine, the next line of defense is often a dental device. This is worn at night to hold the lower jaw slightly forward and not allow the jaw to fall back during sleep. Holding the lower jaw (mandible) forward brings the tongue muscle forward and helps to prevent the tongue from falling back in the mouth during sleep and obstructing the airway.

I was excited about this course I had taken at Tufts, and thought that I was going to start treating and helping countless people I heard about who were not able to tolerate, or didn’t want to use CPAP. The problem I found was that sleep apnea needed a medical diagnosis, which meant that patients had to have already had a sleep study with a physician, have failure in the use of CPAP, and then somehow find their way to my office. I was frustrated. I wasn’t treating that many patients, but knew (or at least thought), I must need more education.

So, I enrolled in a mini-residency program at Tufts for 8 months. This was a much more intensive program with heavy emphasis on the science behind the disease, which included more reading of scientific papers than I had ever done. The program was great, and I felt I had now “figured it out”. That was 4 years ago.

I was much more knowledgeable about things to look for in patients, and was referring many patients to physicians to be evaluated. Some patients would end up having a sleep study, be diagnosed with sleep apnea, go on CPAP, and then come back to my office and say, literally, “you changed my life.” There is no greater feeling than that. Even though I didn’t get to treat them with my fancy dental appliance, they were being treated for a disease that was slowly (or not so slowly) killing them.

There were also those patients who had the sleep study, were diagnosed with sleep apnea, were not able to (or didn’t want to) use CPAP, and were referred back to me for dental appliance therapy. Great!!! However, I quickly became frustrated again. Far too many patients, with classic symptoms such as snoring and daytime fatigue, were returning to me, saying they had a sleep study that showed they did not have apnea. Now what?

I’m a dentist, not a physician. Sleep problems are medical problems and need a medical diagnosis. And, although I knew that many of these patients may have sleep issues that were out of my control as a dentist (there are over 100 sleep disorders), many of these patients had dental signs such as wear on their teeth, grinding and/or clenching problems, TMJ pain, and other anatomic issues that I had learned about that were likely related to breathing problems.

…….continued next week

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

Happy New Year! As most of us are back from a few extra days off, time marches on and our daily routines are back in full force. One of the things reinforced with me during my short break was how important sleep is.

My body has become accustomed to a certain amount of quality sleep. I have always had difficulty sleeping past a certain time in the morning, regardless of what time I go to bed. On the days over this holiday period that I stayed up later than I normally do, my amount of sleep hours was less and my quality of sleep tended to be lower. This had an impact on the way I felt the next day. Sleep “hygiene”, including regular bedtime, is so important.

There are many reasons for poor quality sleep. Everything from a poor mattress, poor pillow, sleep position, medical issues, diet, alcohol consumption, and work schedule can have an impact on the quality of sleep that we get. Although some people can notice subtle changes in sleep quality, many others do not realize that some of the issues they have routinely can be caused from poor sleep quality.

Sleep plays a vital role in good health and well-being throughout our lives. The way you feel while you’re awake depends in part on what happens while you’re sleeping.

Sleep helps your brain work properly. Studies show that a good night’s sleep improves learning. Studies also show that sleep deficiency may cause you to have trouble making decisions, solving problems, controlling your emotions and behavior, and coping with change.

Sleep plays an important role in your physical health. For example, sleep is involved in healing and repair of your heart and blood vessels. Ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, high blood pressure, diabetes, stroke, sexual dysfunction, ADHD, obesity and depression.

Sleep issues can affect the young, the old and everyone in between. The many changes that take place in our bodies as we age can increase the risk of sleep disorders.

Sleep apnea is one of many sleep disorders. It is a serious, potentially life-threatening sleep disorder that affects approximately 18 million Americans. It comes from the Greek meaning of apnea which means “want of breath”. People with sleep apnea have episodes in which they stop breathing for 10 seconds or more during sleep.

People with sleep apnea usually do not remember waking up during the night. Some of the potential problems may include morning headaches, excessive daytime sleepiness, irritability and impaired mental or emotional functioning, excessive snoring, choking/gasping during sleep, insomnia, or awakening with a dry mouth or throat.

Some simple questions to ask yourself are: Have you been told that you snore?

Do you often feel tired, fatigued, or sleepy during daytime?

Has anyone ever told you that you stop breathing while you were asleep – or- Have you ever woken yourself up with a gasp?

Do you have high blood pressure or are you on more than one medication to control high blood pressure?

Is your body mass index greater than 28?

Are you a male with a neck circumference greater than 17 inches or a female greater 16 inches?

If you answered yes to more than two of these questions, or if there is anything else in this column that makes you believe you may not be getting the quality of sleep you would like, please discuss these with your physician.

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

At the end of each of the past 16 years, I have used this space to publish these 21 Suggestions for Success authored by H. Jackson Brown, Jr.

Cut this out and put it on the refrigerator. Read this list often and take these suggestions to heart. The more of these you achieve, the better place you are for having your best year ever in 2022.

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The two things you’re supposed to do to clean your teeth: Brush & Floss. Any of you have your hygienist get on your case about not flossing? You may be the best brusher in the world, but if you’re not cleaning between your teeth, we know it. Cleaning between the teeth is essential for good oral health, AND good overall health.

To reiterate, we need to think about brushable surfaces vs. non-brushable surfaces in the mouth. Floss, which is basically a piece of string, is great after eating corn-on-the-cob. Other than that, using an oral irrigator (water flosser), is much better at cleaning the non-brushable areas in the mouth.

Clinically, we usually see significant improvement in patients who add oral irrigation to their homecare routine. However, if you look at the research available, it is weak, just like that for flossing. There are just not a lot of studies that have been done. But anecdotally, I can tell you it is a game-changer for many.

The Waterpik® packaging says that oral irrigation is 3X more effective than floss. These claims are from “independent” studies; basically, their own research. While floss can be effective for some, many people get much better results with oral irrigation. Disease starts in the areas that you cannot brush. Brushing alone is not enough for anyone. A jet stream of water is great at disrupting the millions of bacteria living under your gumline. (more…)

If you have kids, and you take them to the dentist, I am sure you have heard about sealants. Many, if not most dentists recommend dental sealants.

A dental sealant is a flowable resin, generally placed on permanent 6 and 12-year molars. It is placed in the grooves on the top of the teeth. Its purpose is to help prevent decay from forming in this area, which is the most common place for dental decay to occur. It does nothing in the prevention of decay between teeth, or on any of the other 20 teeth in the mouth – although the molars are generally the first teeth to decay.

Make sense so far? Now for the controversy. In my opinion, sealants have a very limited application. Let me take a step back and give you some information to help you see where I am coming from.

There are actually many different techniques to place sealants. The way we are taught in school, and the way most dentists determine if sealants are recommended, is how deep the grooves in the tooth are. Sealants are placed if that little sharp tool (dental explorer) doesn’t stick in the tooth. The surface of the tooth is cleaned (to the best of the operator’s ability) and the sealant is flowed into the grooves of the tooth and cured with an ultraviolet light. (more…)

Last week I discussed the importance of communication in any relationship, specifically the healthcare provider/patient relationship. Trust is mutually built as this relationship develops over time.

“There’s not enough time in the day.” Have you ever used this excuse? I said this yesterday to someone. We all tend to waste a lot of time, or at least don’t use the time we have as effectively as we could. You would think that in our technology-filled world, time management would be easier. Some of this technology actually gets in the way by adding even more of a time commitment to things that reduce interpersonal communication.

Here’s an example. It’s time to buy a new car. There are many different car brands and within those brands are many models. No matter what dealership you go to, they will gather a minute amount of information about you, or maybe none at all, but guaranteed, they have a car on their showroom floor that they tell you is the right car for you. They will spend a countless amount of time talking about the many new features that their brand has, and the options between different models. If the salesman worked for a different brand, or if you went to a different dealership, you would hear the same reasons why that brand is right for you. Their goal is to sell you a car. (more…)

Patients see things differently than dentists. Often, what is important to dentists is not important to patients and vice versa. This seems like the hysterical discovery of the obvious, but dentists often have a blind spot when it comes to seeing things from a patient’s viewpoint.

We often have a similar blind spot in our ability to communicate with patients. When asked to rate their ability to communicate with patients, 60% of physicians rated themselves in the top 10%.

Dentists would probably have similar results.

Communication is key to any relationship. Why then do healthcare professionals, dentists specifically, often have poor communication skills with their patients? There is no one answer to this question, but we (dentists) all struggle with communicating with patients at some level. (more…)

Happy Thanksgiving! While we may be giving thanks for the many blessings in our lives, we also often need to battle the stressors.

This time of year always seems more stressful, but stress in general is hard to avoid. We worry about school, work, finances, illness, children, relationships, and more. Some even worry about how much they worry. Not to add to your stress, but you should be aware that all that worrying could have a negative impact on not only your general health, but also your oral health.

According to an article in the Journal of Periodontology, there is a strong relationship between stress and periodontal disease (gum disease). In addition to stress, other psychological factors, such as anxiety, depression, and loneliness are linked to an increased likelihood of periodontal disease. (more…)

One of the most difficult areas to address as a dentist, are issues concerning aging patients, specifically those who require assisted or nursing care. Dental care tends to suffer with these patients and often leads to failing teeth. Prevention is key.

Whether you are the one making decisions for someone else, or you are older and can make your own decisions, it is easy to let home care and regular dental visits decrease as time goes on. Dental health needs to stay at the top of the priority list for many reasons. Quality of life and the link between oral health and systemic health are two big ones.

Older patients will often say, “I don’t need to fix that. How much longer do I really have to live?” And every time I respond the same way, “If you told me that you knew you weren’t going to be around next year I’d say I would agree with you…..but you’ve been saying the same thing for 15 years.” It’s worse when the patients lose key teeth, when they had the opportunity to keep them for their lifetime. (more…)