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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.

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.

 

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.

Sleep Apnoea

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Snoring

Laboured breathing during sleep

Excessive sweatiness and/or restlessness during sleep

Excessive day time sleepiness and/or morning tiredness or head aches

Pauses in breathing and/or choking/gasping/snorting during sleep

 

Awakening due to bad dreams and/or sleep walking

Positions (sleeping in unusual positions; eg. extended neck, sitting up)

Nasal obstruction and mouth breathing

Overweight or underweight

Enuresis (bed wetting)

Attention/learning/behavioural problems

The above handy check list is a great tool you can use for a physical examination to judge the potential your child could be at risk of obstructive sleep apnoea.

Children may stop breathing 40 to 50 times an hour every hour during sleep which can then cause the brain to starve of oxygen, which can than lead to difficulty concentrating at school.

Obstructive sleep apnoea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnoea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnoea is a combination of the two. With each apnoea event, the brain briefly arouses people with sleep apnoea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.

Indigestion and your teeth

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Do you suffer from heartburn, acid reflux or GORD?

These common health concerns can have a detrimental affect on your oral health over time, leading to erosion of tooth enamel. Dr. Maurice Quirke emphasizes the importance of routine dental care and the opportunity it provides for spotting dental concerns early on and discussing overall health issues that can affect the health of your smile.

Tooth enamel plays an important role in protecting your teeth from damage and decay. It acts like a protective shell for the tooth, keeping out harmful bacteria and other dangerous substances that could affect the health of the tooth.

Patients with frequent heartburn and acid reflux will experience a gradual erosion of tooth enamel from repeated exposure to stomach acid which breaks it down over time. In addition, some medications prescribed to treat these health issues can cause dry mouth, which also leads to erosion of tooth enamel as saliva production is diminished.

Signs of Tooth Enamel Erosion

  • Increased tooth sensitivity
  • Tooth discoloration
  • Cracks and chips on edges of the teeth

Our dentists will work with patients to address both the cause and effects of tooth enamel erosion to restore dental health and prevent future damage. He may recommend dietary changes, chewing sugar free gum between meals to boost saliva production and additional oral hygiene products to prevent further loss of enamel. For teeth that have become damaged, cosmetic dental procedures such as cosmetic tooth bonding, dental crowns and dental veneers can strengthen the teeth and restore your smile.

Keeping your smile healthy and functional not only boosts confidence, it allows you to enjoy the best possible quality of life each day.

IV sedation for acute anxiety

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Did you know 50% of people admit to some form of anxiety visiting the dentist, with roughly 1 in 6 avoiding dental care altogether because of it? To ease anxiety dentistry has developed sedation methods that help patients relax during dental treatment.

Many can achieve relaxation with an oral sedative taken about an hour before a visit. Some with acute anxiety, though, may need deeper sedation through an intravenous (IV) injection of medication. Unlike general anesthesia which achieves complete unconsciousness to block pain, IV sedation reduces consciousness to a controllable level. Patients aren’t so much “asleep” as in a “semi-awake” state that’s safe and effective for reducing anxiety.

While there are a variety of IV medications, the most popular for dental use are the benzodiazepines, most often Midazolam. Benzodiazepines act quickly and wear off faster than similar drugs, and have a good amnesic effect (you won’t recall details while under its influence).

Other drugs or substances are often used in conjunction with IV sedation. Nitrous oxide (“laughing gas”) may be introduced initially to help with anxiety over the IV needle stick. Local anaesthetics will also be used to numb the teeth being treated.

If we recommend IV sedation for your dental treatment, there are some things you should do to help the procedure go smoothly and safely. Because the after effects of sedation may impair your driving ability, be sure you have someone with you to take you home. Consult with both your doctor and dentist about taking any prescription medication beforehand. Wear loose, comfortable clothing and don’t wear contact lenses, oral appliances like dentures or retainers, watches or other jewellery.

Our top priority is safety — we follow strict standards and protocols regarding IV sedation and you’ll be carefully monitored before, during and after your procedure. Performed with the utmost care, IV sedation could make your next dental procedure pleasant and uneventful, and impact your oral health for the better.

If you would like more information on IV and other forms of sedation, please contact us or schedule an appointment for a consultation.

Myths about tooth decay

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Myths often start with a grain of truth, and that’s the case for many of the dental misconceptions most people have absorbed over the years. No matter how educated a person perceives they are concerning dental health, it’s possible a few false impressions have taken root.

Such as…

  • Cavities are a fact of life.
    It’s common knowledge that there are very real, clinically-evidenced explanations for dental health issues, so why is it that many times you cross your fingers and hope luck is on your side when it’s time to take the kids to the dentist? Recent advancements in research have focused a lot of attention on early intervention methods. So with proper education, fluoride, increased access to dental care, and ongoing research, children in this day and age may not need to worry about cavity development. No four-leaf clovers necessary.
  • Sweets are always the culprit
    Ok, ok, you’re aware that eating sweets isn’t doing anything good for our teeth, but focusing too specifically on that one source of sugar just isn’t wise. Here’s why: fighting cavities is essentially about keeping the proper pH balance in your mouth. Maintaining this balance requires adequate saliva flow, a balanced, varied diet, and a sensible daily oral hygiene regimen. Prolonged and frequent exposure to sugar can lower pH levels often enough to seriously impact your dental health, but it’s not just sweets that’s to blame. Fruit and fruit juices, soft drinks, and cooked starches also create that acidic environment which leads to tooth decay.
  • A cavity starts on the inside of your tooth
    This one is several hundred years old, and probably doesn’t affect your concept of tooth decay today. But it’s interesting to think that in the 18th century people believed that “tooth worms” formed within a tooth and ate their way out to the surface. Now we know that dental decay starts from the outside and works its way in, not the other way around!