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Posts from 2017

Highly effective and tolerable oral appliance for sleep apnea and snoring

Obstructive sleep apnea (OSA) is characterized by habitual snoring, chronic fatigue and daytime sleepiness. In an apnea episode, breathing stops for a time (often more than 10 seconds). Pauses in breathing during sleep occur due to a narrowed, blocked or floppy airway. Untreated obstructive sleep apnea may lead to high blood pressure, heart disease, sexual dysfunction and stroke.

Male sex, obesity, aging and mouth and facial abnormalities are risk factors for OSA. Due to the increasing recognition of the role of head and facial anatomy in the existence of OSA, research on the use of oral appliances to manage OSA have stepped up. There has since been ample evidence of the improvement of sleep and modification of health risks with the use of oral appliances.

In one study published in the Journal of the American Dental Association, oral appliances were said to reduce the severity of respiratory disturbances during sleep by about 60 percent, with an overall patient acceptance rate of 75 percent.

Mandibular advancement devices (MADs) are the most common class of oral appliance used for the treatment of OSA. They mechanically protrude the mandible (lower jawbone) with the aim of preventing collapse of the upper airway. A Canadian-based study presented in Annual Meeting of the American Academy of Dental Sleep Medicine last year revealed that mandibular advancement appliances could safely and effectively treat mild to moderate OSA. Long-term efficacy and high patient tolerance were reported.

The researchers found that sleep apnea treatment remained effective between 31 and 53 months after beginning oral appliance therapy. Participants reported high compliance, wearing their appliance 7.1 hours a night, 6.4 nights a week. Daytime sleepiness, fatigue severity, and quality of life also remained improved. A very positive effect on blood pressure and heart rhythm were noted.

Although CPAP (continuous positive airway pressure) is the common therapy for OSA, its tight-fitting face mask is cumbersome for most patients. The surgical approach also requires careful planning and, though it is effective, it is not without risk and complications.

More than 18 million Americans suffer from OSA.

Tongue piercing can cause gapped teeth

Oral piercing may be hip, but if the effect includes crooked teeth and life-threatening complications, it's too high a price to pay, especially if you are going to shell out thousands of dollars in orthodontic treatment later.

A case report by researchers from University of New York at Buffalo, published in the Journal of Clinical Orthodontics, reported a 26-year-old woman who developed a diastema (space between teeth). For seven years, she had tongue piercing and habitually pushed the barbell-shaped stud between her upper central incisors (frontal upper teeth), causing a large space to form. Another study involving high-school students in Buffalo, New York who wear oral piercings revealed that three-quarters of these students played with their piercings.

A separate finding by the Mayo Clinic that involved college students found that 17% of all body piercings had complications both mild and severe. Tongue piercing has been associated with bleeding, fractured or chipped teeth, gum trauma, scar formation, eating problems and speech difficulty. Ugly teeth is just the visible side effect; life-threatening infection from viruses such as hepatitis B and C and HIV can also be acquired through unsterile instruments. The lead author of the case report, Dr. Sawsan Tabbaa from the UB School of Dental Medicine, warned that in worst cases tongue piercing could result in brain abscesses.

Oral piercing has been the subject of many studies spanning different countries. A study of 10,503 in England, published in the British Medical Journal, reported that tongue piercing is the fourth-most popular type of body piercing. The study also found that one in 100 piercings resulted in hospital admission.

Another analysis on 400 young adults, conducted by Dr. Liran Levin from the School of Dental Medicine at Tel Aviv University, found that about 15% to 20% of teens with oral piercings are at high risk for both tooth fractures and gum disease. He also warned that piercing of the oral cavity can cause death. Inflammation of the area can cause edema (swelling), which disturbs the respiratory tract (airway).

Smoking delays healing of wound in extracted tooth (and other oral surgery)

Tobaccos and cigarettes contain a toxic, odorless and colorless substance called carbon monoxide that injures the walls of blood vessels, causing scarring and subsequent blockage of blood flow. Poor transport of blood deprives the injured site of adequate blood and slows down healing. Tissue healing begins with clotting (hardening) of blood around the wound to seal the bleeding.

Carbon monoxide also takes away oxygen from the blood by attaching to hemoglobin first before oxygen does. Hemoglobin in the blood carries oxygen to the tissues. Tissues deprived of oxygen experience cell death.

Also, nicotine is a vasoconstrictor (narrows blood vessels), thus reducing nutritional blood flow to the wound. Nicotine also triggers the release of cholesterol and stored fat, which may lead to fatty plaque buildup inside the blood vessel. And because blood pressure is high from a narrowed blood opening, fats are mobilized in the bloodstream, leading to clogging. Either way, the end result is atherosclerosis (necrosis, or hardening of the arteries). Recent studies show that prolonged exposure to nicotine gives rise to formation of new blood vessels that supply a lifeline to plaques, causing further congestion and loss of blood vessel elasticity.

The chain of events does not stop there. Nicotine also makes blood coagulate (clot), increasing the risk of blood clots blocking a blood vessel (thrombosis). It also suppresses cells that produce collagen (responsible for tissue integrity) and white blood cells of the immune system that fight infection. This explains why smoking increases the risk of gum infection. Wounds in the mouth that do not heal well or quickly are susceptible to infection, resulting in failure of dental treatment, implant or surgery.

What happens here is also the pathogenesis (course of events) of major illnesses like lung diseases, diabetes, stroke and heart disease. Cigarette smoking accounts for nearly 440,000 deaths every year in the United States.

Get that gorgeous grin!

Cosmetic dentistry is a new branch of general dentistry that combines the science and art of maintaining oral health and function.

While general dentistry deals with treatment and prevention of dental ailments, cosmetic dentistry adds esthetic elements so you can flash a winning smile. It requires specialized skills and materials to create a more natural-looking effect on the teeth.

Some of the procedures include dental braces, retainers, implants, porcelain veneers, tooth bonding and teeth whitening.

Chips and cracks, spaces and stains are some problems that need cosmetic dentistry. With teeth discoloration due to coffee and smoking, whitening may be the solution. Stain-removing gel on a mouth tray is placed over your crowns for brighter teeth. While this procedure can be done at home, you have to visit a dentist first and carefully follow the instructions; otherwise, the desired effect will not be realized.

A dental bridge is used to restore one or a few teeth and is attached between two teeth. A less expensive approach is placing a wire at the back of the next tooth to keep the bridge in place.

Visit your cosmetic dentist to see what options are available to improve your appearance, and flash that gorgeous grin!

This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your healthcare professional and should not be relied upon to determine diagnosis or course of treatment

Relationship of Serial Dental X-ray Exposure and the Risk of Thyroid Carcinoma

 Researchers in the UK have observed that between 1975 and 2006, the incidence of thyroid cancer in the UK has increased with the numbers of dental X-ray exposure from 1.4 to 2.9 per 100,000 people.

 Found in the front of the neck, the thyroid gland is easily exposed to the ionizing radiation.

 The researchers noted that these findings are consistent with earlier observations of the direct relationship between dental X-ray exposure and thyroid cancer.

 However, the researchers stressed that their conclusions should be treated carefully, as they investigated mostly self-report study participants without the benefit of X-ray records. Adequate records include the participants' age, frequency and roentgen dosage. They also believe that there is a direct relationship between the rare thyroid cancers and roentgen exposure; however, large-scale and more sophisticated studies are necessary to prove the causes of cancer.

 The researchers also highlighted that if the link between thyroid cancer and radiography were established, the use of lead collars will have to be considered for necessary dental evaluation, and X-rays will not be part of routine dental procedures.

 This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your healthcare professional and should not be relied upon to determine diagnosis or course of treatment.

October 2018
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Established 1955

John Lupini, DDS, MS, is the director of True Orthodontics, which specializes in early orthodontic treatment, teeth straightening, Invisalign alternatives, and treats children and adults. True Orthodontics serves all of the downriver communities including but not limited to Southeastern Michigan, Wayne County, Monroe County, Macomb County, Oakland County, Downriver, Trenton, Grosse Ile, Woodhaven, Trenton, Riverview, Wyandotte, Melvindale, Ecorse, River Rouge, Detroit, Taylor, Westland, Garden City, Lincoln Park, Allen Park, Dearborn, Dearborn Heights, Romulus, Belleville, Huron Township, Van Buren Township, Flat Rock, Rockwood, Gibraltar, Brownstown, Monroe, Frenchtown, Newport, Carleton, Southgate and surrounding communities.