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All posts by Maurice Quirke

Snoring – not my problem?

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Sleep Apnoea is a sleep breathing disorder that is characterised by repetitive pauses in breathing during sleep. Pauses occur several times per hour and last for over 10 seconds. As the blood-oxygen levels decrease, the brain awakens the individual which often leads to a loud gasp or snort. Sleep apnoea is associated with snoring, witnessed pauses in breathing, and excessive daytime sleepiness.

Sleep apnoea is usually a chronic condition with most people having sleep apnoea for years before being diagnosed. When breathing appears to stop or becomes shallow, the sleeper comes out of a deep sleep and moves to a light sleep or awakens. This results in poor quality sleep, resulting in excessive daytime sleepiness.

Sleep Apnoea can be very serious when untreated because –

There’s an increased risk of heart attack, high blood pressure, obesity, stroke, and diabetes;

It makes irregular heartbeats, or arrhythmias, much more likely;

It increases the risk of heart failure; and

There’s a greater risk of having a driving incident, or work-related accident.

There are several treatment options for sleep apnoea. One of the options is the oral appliance. Currently, there are approximately 200 different oral appliances available worldwide. We concentrate on using 3 of these appliances to give an effective range of treatments at a level of cost to suit most patients.

Also called Mandibular Advancement Devices (MAD), these sleep apnoea mouth pieces are custom made by us to conform to the specific shape of the patient’s teeth and mouth. Not only do they work against sleep apnoea, they are also effective in treating snoring.

If you, or your partner, suffer from apnoea or snoring, give us a call on 051 421453 to arrange a consultation about your treatment options.

How to Properly Brush and Floss

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Brushing and flossing are of paramount importance to oral hygiene.  Though bi-annual professional dental cleanings remove plaque, tartar and debris, excellent homecare methods are equally valuable.  Proper brushing and flossing can enhance the health of the mouth, make the smile sparkle and prevent serious diseases.

Reasons why proper brushing and flossing are essential:

  • Prevention of tooth decay – Tooth decay is one of the leading causes of tooth loss, and its treatment often requires complex dental procedures.  Tooth decay occurs when the acids found in plaque erode the natural enamel found on the teeth.  This phenomenon can easily be prevented by using proper home hygiene methods.
  • Prevention of periodontal disease – Periodontal disease is a serious, progressive condition which can cause tooth loss, gum recession and jawbone recession.  Periodontal disease is caused by the toxins found in plaque, and can lead to serious health problems in other parts of the body.  Removing plaque and calculus (tartar) from the surface of the tooth using a toothbrush, and from the interdental areas using dental floss, is an excellent way to stave off periodontal problems.
  • Prevention of halitosis – Bad breath or halitosis is usually caused by old food particles on or between the teeth.  These food particles can be removed with regular brushing and flossing; leaving the mouth healthier, and breath smelling fresher.
  • Prevention of staining – Staining or the yellowing of teeth can be caused by a wide variety of factors such as smoking, coffee and tea.  The more regularly these staining agents are removed from the teeth using brushing and flossing techniques, the less likely it is that the stains will become permanent.

The Proper Way to Brush

The teeth should be brushed at least twice a day; ideally in the morning and before bed.  The perfect toothbrush is small in size with soft, rounded-end bristles and no more than three months old.  The head of the brush needs to be small enough to access all areas of the mouth, and the bristles should be soft enough so as not to cause undue damage to the gum tissue.  The American Dental Association (ADA) has given electric toothbrushes their seal of approval; stating that those with rotating or oscillating heads are more effective than other toothbrushes.

Here is a basic guide to proper brushing:

  1. Place the toothbrush at a 45-degree angle where the gums and teeth meet.
  2. Use small circular motions to gently brush the gumline and teeth.
  3. Do not scrub or apply too much pressure to the teeth, as this can damage the gums and tooth enamel.
  4. Brush every surface of every tooth, cheek-side, tongue-side, and chewing surfaces. Place special emphasis on the surfaces of the back teeth.
  5. Use back and forth strokes to brush the chewing surfaces.
  6. Brush the tongue to remove fungi, food and debris.

The Proper Way to Floss

Flossing is a great way to remove plaque from the interdental regions (between the teeth).  Flossing is an especially important tool for preventing periodontal disease and limiting the depth of the gum pockets.  The interdental regions are difficult to reach with a toothbrush and should be cleansed with dental floss on a daily basis.  The flavor and type of floss are unimportant; choose floss that will be easy and pleasant to use.

Here is a basic guide to proper flossing:

  1. Cut a piece of floss to around 18 inches long.
  2. Wrap one end of the floss around the middle finger of the left hand and the other end around the middle finger of the right hand until the hands are 2-3 inches apart.
  3. Work the floss gently between the teeth toward the gum line.
  4. Curve the floss in a U-shape around each individual tooth and carefully slide it beneath the gum line.
  5. Carefully move the floss up and down several times to remove interdental plaque and debris.
  6. Do not pop the floss in and out between the teeth as this will inflame and cut the gums.

If you have any questions about the correct way to brush or floss, please ask your dentist or dental hygienist.

 

Tell me about dentures

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Dentures & Partial Dentures

A denture is a removable dental appliance replacement for missing teeth and surrounding tissue.  They are made to closely resemble your natural teeth and may even enhance your smile.

There are two types of dentures – complete and partial dentures.  Complete dentures are used when all of the teeth are missing, while partial dentures are used when some natural teeth remain.  A Partial denture not only fills in the spaces created by missing teeth, it prevents other teeth from shifting.

A Complete denture may be either “conventional” or “immediate.”  A conventional type is made after the teeth have been removed and the gum tissue has healed, usually taking 8 to 12 weeks.  During this time the patient will go without teeth.  Immediate dentures are made in advance and immediately placed after the teeth are removed, thus preventing the patient from having to be without teeth during the healing process.  Once the tissues shrink and heal, adjustments will have to be made or the denture may need to be replaced entirely.

Dentures are very durable appliances and may last many years, but may have to be remade, repaired, or readjusted due to normal wear. They are however, probably the worst option for replacing missing teeth as they are bulky, are difficult to adapt to, have potential inherent stability problems and can interfere with speech initially.

Reasons for dentures:

  • Complete Denture – Loss of all teeth in an arch.
  • Partial Denture – Loss of several teeth in an arch.
  • Enhancing smile and facial tissues.
  • Improving chewing, speech, and digestion.

What does getting dentures involve?

The process of getting dentures requires several appointments, usually over several weeks.  Highly accurate impressions (moulds) and measurements are taken and used to create your custom denture.  Several “try-in” appointments may be necessary to ensure proper shape, color, and fit.  At the final appointment, your dentist will precisely adjust and place the completed denture, ensuring as natural and comfortable a fit as possible.

It is normal to experience increased saliva flow, some soreness, and possible speech and chewing difficulty, however this will likely subside as your muscles and tissues get used to the new dentures.

You will be given care instructions for your new dentures.  Proper cleaning of your new dental appliance, good oral hygiene, and regular dental visits will aid in the life of your new dentures and is crucial in maintaining your oral health.

Do I have gum disease?

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Signs & Symptoms of Periodontal Disease

Periodontal disease (also known as periodontitis and gum disease) is a progressive condition and the leading cause of tooth loss amongst adults in the developed world.  Periodontal disease occurs when the toxins found in plaque begin to irritate or inflame the gingiva (gum tissue).  The resulting bacterial infection, often known as gingivitis, will eventually lead to the destruction of the gum tissue and underlying bone.  If periodontal disease is not treated, it can also lead to loose teeth or tooth loss.

There are many common types of periodontal disease including aggressive, chronic, necrotizing periodontitis, and periodontitis associated with systemic diseases.  Each of these types of periodontal disease has its own distinct characteristics and symptoms, and all require prompt treatment by a dentist to halt subsequent bone and tissue loss.

Common Signs & Symptoms

It is extremely important to note that periodontal disease can progress without any signs or symptoms such as pain.  This is why regular dental health checks are exceptionally important so that disease can be identified at as early a stage as possible. Described below are some of the most common signs and symptoms of periodontitis.

If you have any of these signs or symptoms, the advice of a your dentist should be sought as soon as possible:

  • Unexplained bleeding – Bleeding when brushing, flossing or eating food is one of the most common symptoms of a periodontal infection.  The toxins in plaque cause a bacterial infection which makes the tissues prone to bleeding.
  • Pain, redness or swelling – A periodontal infection may be present if the gums are swollen, red or painful for no apparent reason.  It is essential to halt the progression of the infection before the gum tissue and jaw bone have been affected.  It is also critical to treat the infection before it is carried into the bloodstream to other areas of the body.
  • Longer-looking teeth – Periodontal disease can lead to gum recession.  The toxins produced by bacteria can destroy the supporting tissue and bones, thus making the teeth look longer and the smile appear more “toothy.”
  • Bad breath/halitosis – Although breath odor can originate from back of the tongue, the lungs and stomach, from the food we consume, or from tobacco use, bad breath may be caused by old food particles which sit between the teeth and underneath the gumline.  The deeper gum pockets are able to house more debris and bacteria, causing a foul odor.
  • Loose teeth/change in bite pattern – A sign of rapidly progressing periodontitis is the loosening or shifting of the teeth in the affected area.  As the bone tissue gets destroyed, teeth that were once firmly attached to the jawbone become loose or may shift in position.
  • Pus – Pus oozing from between the teeth is a definitive sign that a periodontal infection is in progress.  The pus is a result of the body trying to fight the bacterial infection.

Treatment of Periodontal Disease

It is of paramount importance to halt the progression of periodontal disease before it causes further damage to the gum tissues and jawbone.  The dentist will initially assess the whole mouth in order to ascertain the progress of the disease.  When a diagnosis has been made, the dentist may treat the bacterial infection with antibiotics in conjunction with nonsurgical or surgical treatment or both.

In the case of moderate periodontal disease, the pockets (under the gumline) of the teeth will be completely cleared of debris using a procedure called scaling and root planing.  The pockets may be filled with antibiotics to promote good healing and kill any bacteria that remain.

Severe periodontitis can be treated in several different ways, such as:

  • Laser treatment – This can be used to reduce the size of the pockets between the teeth and the gums.
  • Tissue & bone grafting – Where a considerable amount of bone or gum tissue has been destroyed, the dentist may elect to graft new tissue by inserting a membrane to stimulate tissue growth.
  • Pocket elimination surgery – The dentist may choose to perform “flap surgery” to directly reduce the size of the gum pockets.

If you have any further questions about the signs and symptoms of periodontal disease, please ask your dentist.

Cracked Tooth

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Cracked and fractured teeth are common dental problems. As people retain their natural teeth longer (due to advances in dental technology), the likelihood of cracked teeth increases. There are many reasons why teeth may crack, for example, biting on hard objects, trauma, grinding and clenching of teeth. All of these behaviours place the teeth under extra strain and render them more susceptible to cracking.

When tooth enamel is cracked, pain can become momentarily debilitating. When no pressure is exerted on the crack there may be no discomfort. However, as the cracked tooth performs a biting action, the crack widens. The pulp and inner workings of the tooth then become exposed, and painful irritation occurs. As pressure is released again, the two parts of the crack close back together, and pain subsides.

If left untreated, the pulp becomes irreversibly damaged and constantly painful. The resulting pulp infection can affect the bone and soft tissue surrounding the tooth. Other risks of non-treatment include extension of the crack resulting in eventual fracture of the tooth. The future prognosis of a fractured tooth is determined by the extent and location of the fracture.

Symptoms of a cracked tooth may include:

  • Unexplained pain when eating.
  • Sensitivity to warm and cold foods.
  • Pain with no obvious cause.
  • Difficulty pinpointing the location of the pain.

 

What kind of cracks can affect the teeth?

There are many ways in which a tooth can be cracked. The specific type of crack will determine what type of treatment is viable. In many cases, if the crack is not too deep, root canal therapy and a crown can be performed and the natural tooth can remain in the mouth. In other situations, the tooth is too badly damaged and requires extraction.

Here is a brief overview of some of the most common types of cracks:

Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.

Oblique supra-gingival cracks – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. Little pain will result, because the tooth pulp (that contains the nerves and vessels) will usually remain unaffected.

Oblique sub-gingival cracks – These cracks extend beyond the gum line, and often beyond where the jawbone begins. When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival cracks are painful and may require a combination of periodontal surgery (to expose the crown), and endodontic treatment to place a crown or other restorative device.

Vertical furcation cracks – These cracks occur when the roots of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can often save the tooth.

Oblique root cracks – These cracks tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and usually below the jawbone. Root canal therapy may be possible; depending on how close the fracture is to the tooth surface. However, extraction is almost always the only option after sustaining this classification of fracture.

Vertical apical root cracks – These cracks occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such cracks are eventually extracted.

How are cracks in the teeth treated?

There are many different types of cracked teeth. Some can only be seen using X-rays, while others are clearly visible to the naked eye. Some cracks cannot be detected on X-ray or visually and are diagnosed from the clinical symptoms.

In cases where the tooth root is affected, root canal therapy is the most viable treatment option. The pulp, nerves and vessels of the tooth will be removed, and the resulting space will be filled with gutta-percha. A crown or filling will be added to stabilize the tooth and it will continue to function as normal. Some teeth will need specialist referral to determine if they can be reasonably restored.

As a general rule, it is better to treat identified cracks at an early stage as their tendancy to extend often results in a need for more extensive treatment.

When the crack is too severe for the tooth to be saved, the dentist will perform an extraction. There are a number of restorative options in this case, such as bridges, dental implants and partial dentures. All of these structures can restore biting, chewing and speaking functions.

If you have any questions or concerns about cracked teeth, please ask us.

 

What’s your happy meal?

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Today’s nutritional approaches to oral health go beyond “don’t eat sugar.”

Good nutrition

“Adequate nutrition is important in disease prevention, and nutritional counseling is becoming an increasingly important tactic in preventive dentistry,” said Kevin Sheu, DDS, senior dental consultant at Delta Dental. “The quality and consistency of foods, their nutritional composition and the combinations in which they are eaten can affect oral health, including the likelihood of tooth decay.”

Ongoing research indicates that antioxidants and other nutrients found in fruits, vegetables, legumes and nuts may strengthen immunity and improve the body’s ability to fight bacteria and inflammation, all of which can help protect the teeth and gums. And some foods and dietary habits even have distinct effects on the mouth’s ability to handle cavity-causing bacteria attacks.

For example:

  • Calcium-fortified juices, milk and other dairy products are rich in calcium and vitamin D and help promote healthy teeth and bones, reducing the risk for tooth loss. Adding powdered milk to cooked dishes helps those who don’t like milk or cheese to get some of the calcium needed to protect teeth and jawbones.
  • Cheese unleashes a burst of calcium that mixes with plaque and sticks to the teeth, protecting them from the acid that causes decay and helping to rebuild tooth enamel on the spot.
  • Crisp fruits and raw vegetables, like apples, carrots and celery, help clean plaque from teeth and freshen breath.
  • Antioxidant vitamins, such as vitamin C, and other nutrients from fruits and vegetables help protect gums and other tissues from cell damage and bacterial infection.
  • Recent studies indicate that fresh cranberries interrupt the bonding of oral bacteria before they can form damaging plaque.
  • Folic acid promotes a healthy mouth and supports cell growth throughout the entire body. This member of the B vitamin family is found in green leafy vegetables and brewer’s yeast.

You may already know that cavity-causing organisms feed on the sugar in foods such as soda, chocolate milk and candies and convert it to acid, which attacks tooth enamel and causes tooth decay.

  • But did you know that acidic foods and drinks can wear away your enamel, leaving your teeth sensitive, cracked and discolored?

Timing is everything

A diet that promotes good oral health is not just about the foods you eat or avoid — when and how you eat them is equally important.

  • Foods that take a long time to chew or that you hold in your mouth (such as cough drops) can damage teeth as they retain sugar in the mouth longer than do other foods.
  • Instead of snacking on sugary, carbohydrate-rich or acidic foods throughout the day, eat these foods just during meal times in order to minimize the amount of time teeth are exposed to acid. In addition, the body produces more saliva to help digest larger meals, which washes away more food and helps neutralize harmful acids before they can attack teeth.

Information courtesy of the Academy of General Dentistry.

Controlling your biofilm (cleaning the kitchen)

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This is the third in a series of posts about biofilms and how they relate to you.

We have learned that biofilm (plaque) builds up on your teeth, or oral appliances, and the net effect is to cause disease, either decay or gum disease. The most common way of removing biofilm in an oral health context is by regular brushing and flossing. You can equate this to the necessity to regularly clean your kitchen surfaces, shower or bath in order to maintain a healthy environment in which to live.

The more regularly this happens, the less opportunity those bacteria have to develop into those teeming cities of goo we described earlier.

Antibiotic Control of Biofilm

Although gum disease can be controlled by proper oral hygiene (toothbrushing, flossing, rinsing), gingivitis (the mildest form) is still experienced by most of the population at some point in life; a smaller proportion (30% to 40%) experience periodontitis (the severe form). Treatment of oral infections such as gum disease and decay requires removal of the biofilm and calculus (tartar) from the teeth and gums by surgical or nonsurgical procedures, sometimes followed by antibiotic therapy. This means that the biofilm needs to be regularly removed by your hygienist or dentist if you want to try to prevent the progress of the disease process. Unfortunately, these infections are not completely responsive to antibiotics. For this reason, oral infections are chronic diseases that require ongoing treatment and daily care by proper oral hygiene measures. Prevention is certainly the best strategy.

Chemical Control of Biofilm

When good oral hygiene practices fail to prevent the development of biofilms, toothpastes and mouthwashes with chemotherapeutic agents can be used. These agents can kill microorganisms in the biofilm. Chlorhexidine, triclosan, and essential oils and minerals–agents proven to kill the harmful bacteria–can reduce the degree of plaque and gingivitis, while not allowing disease-causing microorganisms to colonize.

How do biofilms form?

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This is part 2 in a series of posts about Biofilms.

Where Biofilms Form

Biofilms happily colonize many household surfaces in the bath and kitchen, including toilets, sinks, countertops, and cutting boards. Poor disinfection practices and ineffective cleaning products may increase the incidence of illnesses associated with pathogenic organisms encountered during normal household activity.

Basically, they can form on any damp surface which has not been properly cleaned. From an oral health point of view, they form on the tooth surface, both root and crown.

How Biofilms Form

  • Free-swimming bacterial cells land on a surface, arrange themselves in clusters, and attach.
  • The cells begin producing a gooey matrix.
  • The cells signal one another to multiply and form a microcolony.
  • The microcolony promotes the coexistence of diverse bacterial species and metabolic states.
  • Some cells return to their freeliving form and escape, perhaps to form new biofilms.

In this way, biofilms can spread over large areas of surface if given enough time. In an oral health setting, it is possible to detect biofilm (plaque) formation just 20 minutes after you have cleaned your teeth.

Next time, we will write about the effects of uncontrolled biofilm and how to control it.

What is biofilm?

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This will be the first in a number of posts about biofilms. This is not about cinematic experiences involving Richard Attenborough and lovely furry animals but about something you encounter every day of your life.

What Is Biofilm?

You may not be familiar with the term biofilm, but it is something that you come into contact with every day. The plaque that forms on your teeth and causes tooth decay and periodontal disease is a type of biofilm. Clogged drains also are caused by biofilm, and you may have encountered biofilm-coated rocks when walking into a river or stream.

Biofilms form when bacteria stick to surfaces in some form of watery environment and begin to excrete a slimy, gluelike substance that can stick to all kinds of materials–metals, plastics, soil particles, medical implant materials, biological tissues.

Biofilms can be formed by a single bacterial species, but biofilms more often consist of many species of bacteria, as well as fungi, algae, protozoa, debris, and corrosion products. Essentially, a biofilm may form on any surface exposed to bacteria and some amount of water.1

Dental plaque is a yellowish biofilm that builds up on the teeth. Biofilms contain communities of disease-causing bacteria and their uncontrolled accumulation is associated with cavities and gum disease (both gingivitis and periodontitis).

In the past, scientists studied bacteria by looking through a microscope at cells suspended in a water droplet. Today, scientists believe that the disease-causing bacteria do not exist as isolated cells, such as in the water droplet, but rather they stick to various wetted surfaces in organized colonies that form diverse communities–biofilms.

Think of biofilm as a teeming city of bacteria, the foods they live on, the waste products they create and a glue which sticks the whole mess to a surface.

Next time we will look at how biofilms are created.