J. Peter St. Clair, DMD Blog

Your dentist is here to address the greatest debate of our time: manual vs. electric toothbrushes. The choice between old school and new school dental care is in your hands, but do you know which is best for you? Learn more about your toothbrush options here!

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In March I completed a “mini-residency” program at Tufts in dental sleep medicine. In a nutshell, dental sleep medicine is the dentist’s participation in the treatment of sleep breathing disorders such as obstructive sleep apnea. Although the concept seemed relatively simple to me at the beginning of my journey, there is always more to the story.

About 7 years ago, I took a one-day class in dental sleep medicine. I found it intriguing how many signs and symptoms dentists see on a daily basis which could be relative to possible sleep breathing issues. For most of us, when we are “asleep”, we are unconscious and have no idea what is going on behind the scenes. However, a lot can be learned by observation and some simple questions.

The more I learned, the more I had trouble ignoring the many red flags I was seeing in patients. Wanting to delve deeper, I signed up for the program at Tufts. The program consisted of a rather intense literature review of the subject and many hours of lectures by both dentists, who have been in the field of dental sleep medicine since its start about 30 years ago, as well as sleep medicine physicians. Many sleep medicine physicians are ENTs or pulmonologists. Since the program at Tufts, I have also joined a national dental sleep medicine mentoring group to continue to learn more.

Incorporating what I have learned to help patients has been slow. Dentists and physicians don’t typically have a lot of interactions together. However, the relationship between the two is very important in the treatment of obstructive sleep apnea.

Obstructive sleep apnea is a medical problem and needs to be diagnosed by a physician. Of the many things I have observed in my short time treating patients in this arena, one thing is clear: patients do not talk to their doctors or dentists about sleep very often. Many of the issues that people live with (snoring, fatigue, grinding/clenching, hypertension, TMJ issues, etc.) deserve a conversation in relation to sleep.

When I ask patients about snoring, for example, I often hear, “I don’t think I snore but my husband/wife snores like crazy”. Just because you and/or your spouse snores, does not mean you have sleep apnea. Benign snoring is simply fluttering of soft tissue in the back of the throat with no obstruction of the airway space. However, it still is a medical diagnosis and in most cases cannot be established unless some form of sleep monitoring is done. Both sleep apnea and benign snoring are treatable….and it should be treated because it is disrupting to others.

Witnessed apnea events, on the other hand – that is a person visually and/or audibly witnesses a bed partner pause breathing during sleep – are a significant sign that there very well may be a sleep breathing disorder. Oxygen to the body may be depleted during these events. This should be discussed with your physician.

The key takeaway this week is to have a conversation with your doctor if you don’t feel you are sleeping well. If your bed partner is consistently snoring loudly or pauses breathing during sleep, have a conversation with your bed partner and decide if this is an issue which should be addressed. If there is no one sleeping in the room with you, email me and I’ll give you an app to evaluate how much noise you are making.

Sleep breathing issues are very much underdiagnosed, can be dangerous, and are very treatable. Talk to your physician and dentist about it.

What is your definition of oral health? Is there even a standard definition of oral health? One thing is clear, the definition of oral health is not solely the absence of pain. Pain is also not necessarily an indication of poor oral health.

It wasn’t until the year 2000 that oral health was brought to the forefront of the surgeon general’s report as a critical component to overall health. This was an important event, but unfortunately never amounted to much in terms of being incorporated into most healthcare policies.

In 2005 at the World Congress of Preventive Dentistry, participants from 43 countries made it clear that oral health is an integral part of general health and overall well-being. They even concluded that oral health is a basic human right.

In 2011, the United Nations recognized oral disease as an integral part of other non-communicable diseases such as diabetes, cardiovascular disease, stroke, chronic respiratory diseases and cancer. This association with these other diseases was based on common social determinants such as socioeconomic status, diet, tobacco and alcohol use, and not on the basis of transmission. However, there is still no solid definition of what oral health really is.

According to a more recent column in the Journal of the American Dental Association, the American Dental Association is working on a proposed definition of oral health. The authors of the column state, “A proposed definition is necessary to achieve a common understanding of the scope of oral health, to help understand the array of complex oral and systemic health issues facing dental and medical professions now and in the future, and to provide a rationale to position oral health professionals as partners within primary health care.”

The authors go on to say that the definition of oral health needs to align with the current definition of dentistry. That definition currently states, “dentists are responsible not only for the evaluation, diagnosis, prevention and treatment of diseases and conditions of the oral cavity, the maxillofacial area and adjacent areas but also for assessing their impact on the human body.”

As new tests and knowledge in the area of oral health increases, the days of simply recording missing and decayed teeth and poking patients with instruments to chart periodontal (gum) issues may not be enough to best serve patients. What we can learn from things such as genetic testing and salivary diagnostics will change the way we interact with our medical colleagues and greatly benefit our patients.

In conclusion, the authors state, “As the definition of oral health evolves and likely will continue to evolve well into the future, no matter how oral health is defined, the message remains: Oral health is essential to an individual’s general health and quality of life.”

There are great things on the horizon that will significantly impact the way your mouth is evaluated. These will not only benefit your teeth but will also mean an overall healthier you. However, dentists and physicians need to work together better for the benefit of the patient.
Watch for a discussion on that topic next week.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. 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. You can view all previously written columns at www.stclairdmd.com.

October is almost gone, which means only 2 months left in 2017. Where did the time go? It’s crunch time to get everything done that we haven’t gotten done during the rest of the year. For those with dental plans, it’s also the time of year to consider utilizing unused dental benefits.

Unused dental benefits go directly back to the insurance company, which generates hundreds and hundreds of thousands of dollars for the insurance companies each year. Dental insurance companies count on the fact that many people will not claim their $1000 or so in benefits by the end of the calendar year. Those with dental insurance should look for legitimate means to use these benefits before they are lost.

For example, maybe a crown has been recommended by your dentist but you have procrastinated about it. It would make sense to consider using those dental benefits before the end of the calendar year. This allows a whole new round of dental benefits to be used for unexpected dental needs next year and maximizes the value of the premiums paid for this year.

Remember, insurance companies are in the business to make money. They don’t want you to use your dental benefits. If the balance (co-payment) you will owe for the dental work that needs to be done is too much for you, consider financing the balance through your dental office. Most dental offices offer interest-free financing to patients for up to 12 months – some do in-house and others use third-parties. Financing your balance in this way may make more financial sense than throwing money away to fund the insurance company’s wallets.

Another thing to consider as the end of the year approaches is the use of flex spending accounts. Many employers offer pre-tax flex spending accounts for healthcare expenses. Often underutilized, these are excellent mechanisms for saving about 20 percent on needed dental care or for other healthcare related expenses. If you are paying for part or your entire dental plan premiums, you may want to take a close look at what you are paying vs. what you get. It may make sense to fund an available flex spending account with that premium money instead of, or in conjunction with it.

For example, if you are anticipating the need for $3000 in dental care, opting to place the $3000 in a flex spending account can save the income tax on those monies and can usually be used as soon as January 1st. If you have money left in a flex spending account, remember to check with your employer to determine if that money needs to be used by the end of the year. You don’t want to lose that money either.

As you begin to make financial decisions for the end of this year and for the upcoming year, consider a discussion with your dental office’s financial person. They are often an untapped wealth of information and can usually thoroughly and knowledgeably discuss your dental financial options with you.

Maximize your hard earned dollars.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. 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. You can view all previously written columns at www.stclairdmd.com.

Last week I discussed teenager sleep patterns and issues. This week we start a conversation about sleep for the majority of those reading this column.

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 when I stay up later than my normal bedtime, my amount of sleep hours is less and my quality of sleep tends to be lower. This has an impact on the way I feel the next day.

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

Have you been told that you snore? Do you often feel tired, fatigued, or sleepy during the daytime? Do you know if you stop breathing or has anyone witnessed you stop breathing while you are asleep? Do you have high blood pressure or are you on 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? (Note: anyone of any size can have sleep apnea)

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. 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. You can view all previously written columns at www.stclairdmd.com.

When we were all young children, most of us got plenty of sleep, and for that matter, we didn’t think much of it. Our parents told us it was time for bed and we went to bed. We slept until the morning at which time we were woken by our parent’s gentle touch.

As we progressed into our teenage years, our responsibilities increased. This typically led to staying up later and getting up earlier to be able to keep up with these added responsibilities. Today, it seems that getting enough good sleep is even more of a challenge for our teenagers.

One of the contributing factors of this teen sleep crisis is that parents are not as strict with setting rules for sleep as they were when their children were younger. It is not uncommon for teenagers to say to their parents they are going up to their room to do homework and then go to bed.

I recently asked my daughter (a freshman in college) what time she generally “packed it in” and settled down to fall asleep. She told me that after she finishes her homework she will lie in bed and watch something on her laptop until she feels sleepy. This trend is an antithesis to good sleep and one that must be discussed with every teenager by their parents.

Rules about electronics, which include cell phones, computers, games and the television, are especially crucial. In a study done by the National Sleep Foundation, it was determined that teens who have electronic devices on prior to going to sleep, get an average of 30 minutes less sleep. There are other studies that show that the quality of sleep is also greatly affected by this same practice.
Another, more obvious rule that parents must enforce, is the consumption of caffeine at night. Any form of caffeine should not be consumed after dinner. Studies indicate that caffeine in the system accounts for almost a full hour less of quality sleep. We, and our teenagers, cannot afford this deprivation of sleep.

We all start our days at different times. For the teenager, getting up to get ready for school can start pretty early. There is a “start school later” movement that recently received a powerful boost from the Centers of Disease Control and Prevention (CDC). The CDC report showed that teenage students have biologically different sleep patterns and needs than in other stages of life. Starting school a half hour later or more provides the teenager the opportunity to consistently get a better night’s rest.

For the teenager, managing homework and extracurricular activities is also definitely a barrier to sufficient sleep. We as parents must discuss this with our children to provide support with time management. If necessary, we must also not be afraid to discuss this with teachers and coaches if our teenager is struggling to get everything accomplished, thus affecting their sleep patterns.

As adults, many of us have our own routines that could use a revision to get more quality sleep. That is a subject for another time. As parents, it is our responsibility to guide our children to practice good habits. Discussing and enforcing better sleep habits is a gift that keeps on giving.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. 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. You can view all previously written columns at www.stclairdmd.com.

If you feel a sudden twinge in your teeth, you should never ignore it—in fact, it’s time to investigate! Tooth sensitivity can be caused from many different things, and your dentist is here to help you unveil your dental problems “root” cause.

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The more we learn about the body through research and science, the more aware we become about the interconnectedness of all the systems. For example, we now know and continue to learn about the relationship of sleep and its effects on the rest of the body. Sleep breathing disorders, namely sleep apnea, is something that should be routinely screened for by physicians and dentists. While sleep apnea is not necessarily an “oral disorder”, it presents in ways that can be easily screened by a dentist. The key here is the practitioner thinking “outside the box” and treating each patient’s total-body health.

You may have heard the phrase “the mouth is the gateway to the rest of the body.” The mouth is connected to the rest of the body, and the only healthcare providers who spend time examining this area are your dental team. The days of the dentist being just the “tooth fixer” are gone.

The average physician spends seven minutes every two years with a patient. There may be a 5 second glance inside the mouth during those visits. If you see a dentist on a regular basis, we (dentists and hygienists) spend an hour twice a year concentrating on a very specific region of the body. There is a lot of information available within that tiny little space.

For example, everyone has heard of gum disease. While many see periodontal (gum) disease as a tooth or oral health problem, the fact is, it is a bacterial disease, and bacteria can travel throughout the body. About a dozen of the nearly 7,000 types of oral bacteria can wreak havoc on the body, not just the oral cavity.

In a study that looked at blood clots from acute heart attack and stroke patients, researchers found that oral bacteria in the clots were 16 times more concentrated than in the surrounding blood. I think it is safe to say that sometimes there is more going on than what we can see in the dental chair.

Some dentists recommend salivary testing, as they believe that it is a crucial part of diagnosing and reversing oral bacteria and inflammation. The salivary tests can show whether patients have abnormally high levels of the specific bacteria associated with heart disease, diabetes, and other total-body conditions. Diagnosis can then lead to treating the bacteria with a combination of antibiotics, antimicrobials and specific homecare techniques. In a perfect world, this information would be shared with the rest of the patient’s medical team to be able to provide comprehensive total-body care.

This is the same reason many dentists are now screening patients for sleep-disordered breathing. Sleep affects the functioning of the entire body. For a dentist, there is more to screening for sleep apnea than simply asking patients about snoring. Bruxing (grinding), clenching, gastric reflux, and TMJ issues are also signs of a possible sleep disorder. Some believe that many patients who grind or clench their teeth at night do so to open their constricted airway. In addition, experts feel that many children diagnosed with attention deficit disorders have airway problems that are contributing to, or causing the problem.

Nutrition is another area that should have more emphasis from dentists. While dentists often talk to patient about how sugar affects teeth, they should also be educating patients on how other foods, such as processed carbohydrates, cause body-wide inflammation.

This just touches on some of the systemic issues which can be screened for and make a huge difference in patient lives. There is a link between your mouth and the rest of your body.

Now, everyone is looking for ways to save money while making their lives easier with do-it-yourself tutorials. In addition to the home improvement and cooking videos, you will find many dental-related tips online. Among the most popular DIY dentistry information currently trending on social media involves the use of charcoal toothpaste to resolve stubborn tooth discoloration. The results are simply amazing as the black substance provides drastic results without having to visit a dentist. While there are many claims raving about its success, is it really safe for your teeth?
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You’ve spent spend thousands of dollars to straighten your teeth or your kid’s teeth with an orthodontist and the goal is to keep them that way. However, long-term compliance of retainers is an issue. Adults who have had braces tend to be better with retainer compliance. Here is the latest research and my thoughts on keeping your kid’s teeth straight.

Studies show and should not be surprising, that the average patient compliance decreases dramatically the longer a patient is out of treatment. Retainer use is abysmal at five years following treatment.

There are basically three methods used to retain teeth after braces: a clear, vacuum-formed retainer (typically referred to as an Essix retainer), a hard, pink, plastic retainer with a wire in the front (typically referred to as a Hawley-type retainer), and a bonded wire, which is splinted to the back of the teeth. Obviously, the bonded wire has the best compliance because nothing has to be “worn”, but it has its own issues – namely, it only keeps the front teeth straight and flossing compliance is poor because it can be difficult.

The most recent studies I have seen suggest using the clear, vacuum-formed retainers for a year or two and then moving into the Hawley-type retainer. The reasoning is that it is has been shown that kids are more compliant initially with the clear retainers because it is a relief to get rid of all the wires. However, after a while, those types of retainers lose their “memory” and are also difficult to keep clean. Return visits to the orthodontist for retainer checks also decrease as time goes on.

Another great system for long-term retention after orthodontics is a system developed by Invisalign called Vivera. Here’s how it works. You have impressions taken after orthodontics with your teeth in their ideal position. Invisalign creates a digital model of the teeth that stays on file. They send you (4) sets of retainers, which look like the Essix-type retainers, although they are made from the harder type Invisalign material. At the end of the first year you throw out the retainers you have been using and use the second set for another year. This provides excellent retention for four years.

Every year you change the retainers the new retainers feel a little tight because the teeth have moved slightly over that time. However, the “new” retainers were made from the original model, therefore the teeth are moved back to their starting position. After the four years you order another (4) sets of retainers made from that stored digital impression. Guaranteed retention provided there is good compliance. The cost of the (4) sets of Vivera retainers is about $600. That’s $150 per year to guarantee the teeth stay straight.

Of all the choices available, however, my preference is a bonded lower wire on the lower front teeth and a hard plastic custom-made nightguard for the upper. This keeps all the teeth straight and also provides protection of the teeth from grinding and clenching, which is a very common problem. This option also lasts the longest, which is the most cost effective.