The undiagnosed may fit into these categories:
1. Patients have no idea that such a thing as Sleep Apnea exists.
2. They know about, but have no idea that they suffer from, Sleep Apnea .
3. They know they have the symptoms of Sleep Apnea but are in denial.
4. They know they have problems but refuse to do anything about it.
It is very difficult to get these people to want to be screened and diagnosed by just telling them that something is wrong. It is necessary for them to “see” it for themselves and for them to adopt a top down approach – of their own volition.The best way to do this is to educate them in the most simple, effective, non intimidating and cost effective way – we can show them films of OSA victims having sleep events. We must find a way to get them diagnosed and filmed and then show them their results. This is an massive education deficit issue.
American Sleep Apnea Association http://www.sleepapnea.org/i-am-a-health-care-professional.html
Indy Star, Lauran Neergaard, http://www.indystar.com/articles/9/186972-5719-052.html
Detroit Free Press, Bill Dow, http://www.freep.com/news/health/sleep2e_20041102.htm
- Helps these people discover their underlying causes of sleep dysfunction.
- Spreads a huge awareness of the dangers of Obstructive Sleep Apnea
- Creates recognition that he is a generous, caring healthcare professional
- Builds a Dental Sleep Medicine practice
Roseville, CA California Dentist, Dr. Thuy Nga Le Vu and staff were recently trained in identifying, diagnosing (with physicians) and offering treatment for patients with the deadly disorder, Obstructive Sleep Apnea. Trained by Sleep Group Solutions, Galleria Smile Designs, and all three of their locations, will bring their turnkey protocol to three different health fairs to spread the awareness of sleep apnea and ways to treat it. Galleria Smile Design will also provide Sleep Apnea screening and treatment in-office, by appointment.
Upcoming health fairs are open to employees and some public members, at the California Correctional Health Care Service on August 26, The Department of State Hospitals Health and Wellness on September 8th, and the UPS Health and Safety BBQ on September 11th. Dr. Vu and staff are looking forward to raising awareness, as well as offering a solution. “We are honored to help spread awareness that this treatment can save lives, not only for themselves but others around them that may be affected.” says Dr. Vu. “It affects everyone around us, even when sharing the same road with someone falling asleep at the wheel due to OSA, they may not even be aware of it.” Dr. Vu’s staff will do an initial patient screener with the Epworth Sleepiness Scale, and schedule appointments for any sleep apnea red flags.
“We find an enormous amount of patients and employees who suffer with high blood pressure, obesity, gerd, and scalloped tongue. These are all implications that OSA may be present.” says Dr. Vu. Snoring, along with many of the symptoms Dr. Vu’s practice is suffering with are commonly connected with OSA. “Many of my patients are currently on CPAP, but are non compliant, so we are happy to offer a solution.” Oral Appliance Therapy is an effective way to treat mild to moderate OSA, and are saving lives with non compliant CPAP users.
For patients who suffer with snoring, high blood pressure, daytime fatigue, morning headaches, and even Type 2 Diabetes, relief may come from Oral Appliance Therapy. Sacramento area patients can reach Dr. Vu’s friendly and knowledgeable staff at 916-787-1232 or online at Galleria Smile Designs.
“Doctor, I always thought these notches are from brushing too hard. They are painful and I have them on my teeth on both sides. What causes them?”
Here is a simplified explanation:
An abfraction occurs on the lower part of the crown of a tooth, near the gum line.
The enamel covering the crown tapers down to its thinnest there. When the occlusion (bite) is not balanced, there will be uneven pressures on the biting surfaces of teeth. Those pressures cause a torque on the tooth which produces a slight bend at the center where the crown meets the root. As the tooth keeps bending, the thin enamel at the bottom of the crown, near the gum line, chips away. The sensitive “dentin” surface inside the enamel is now exposed. Vigorous, improper teeth brushing will then wear away the unprotected dentin and the notches will grow deeper and larger.
The dentin also becomes vulnerable to acid erosion from foods such as citrus.
The uneven bite pressures also cause a loss of gum and bone attachment around the roots so the roots become progressively exposed adding to the acute sensitivity to touch and cold. Advanced effects can be fracture of the tooth at the crown-root junction, tooth mobility and serious gum disease.
Abfractions can resemble other conditions like decay or toothbrush abrasion, but the treatment is more specific. The treatment, after diagnosing the cause as a bite dysfunction, consists of balancing the bite to equally and properly distribute the pressures and then to restore the lost tooth structure. An occlusal guard may be required. About 25% of the population clench or grind their teeth at night (and are completely unaware of it!). Obviously, the earlier this condition is discovered, the less damage to the teeth and bone will have occurred. In advanced cases crowns may need to be placed to protect the weakened teeth. There are some cases where orthodontic treatment may be necessary.
Abfractions are non-carious cervical lesions (NCCL) caused by flexural forces, usually from cyclic loading; the enamel, especially at the cementoenamel junction (CEJ), undergoes this pattern of destruction by separating the enamel rods. Studies show that within the same patient, teeth with abfractions presented more gingival attachment loss than those without abfractions. However, associations were not demonstrated between premature contacts in centric relation (PCCR) and the presence of abfractions or increased attachment loss.
Abfractions are common in patients with Obstructive Sleep Apnea. Nocturnal bruxism plays a major role.
- Abfractions are usually caused by improper teeth brushing. (F)
- Abfractions are a specific type of dental decay. (F)
- Correction of an abfraction requires more than just a cervical filling. (T)
- Nutrition plays a role in worsening abfractions. (T)
Which are correct?
- .Abfractions occur primarily on the facial surfaces of teeth.
- A porcelain veneer can have an abfraction.
- Abfractions occur only on maxillary teeth.
- An abfraction may be able to cause a separation fracture of a tooth crown.
- All the above.
The treatment options include all except one of the following:
- Nutritional adjustments
- Occlusal adjustment
- Periodontal Therapy
- Cervical restorations
Obstructive Sleep Apnea Does Not Discriminate Against Sex or Age.In the European Respiratory Journal, Swedish scientists reported that OSA is common in both sexes, a disorder that was thought to mainly affect men.Dr. Karl Franklin and his team set out to find out how prevalent sleep apnea is among women and how often symptoms occur. Out of a population-based random sample of 10,000 women between the ages of 20 and 70 years, they gathered data on 400 of them. The test group were given questionnaires which included several questions regarding their sleeping habits and sleep quality. They also underwent overnight polysomnography.The authors concluded:
“Obstructive sleep apnea occurs in 50% of females aged 20-70 years. 20% of females have moderate, and 6% severe sleep apnea. Sleep apnoea in females is related to age, obesity and hypertension but not to daytime sleepiness. When searching for sleep apnea in females, females with hypertension or obesity should be investigated.”
- A apnea-hypopnea index of 30 or more (severe symptoms) affected 14% of the participants aged 55 or more
- 31% of the women who were obese and at least 50 years of age had severe sleep apnea
And let’s not forget our children. More reports to follow which will show corelations of OSA with children.
During the cessations of breathing the body will increase its efforts to take in air.
Abdominal contractions are exaggerated and increase until breathing resumes.
The contractions squeeze the stomach and force acid up the esophagus.
The efforts to breathe also increase a negative pressure in the esophagus which also pull up acid.
Become a Sleep Medicine Dentist and help your patients that have these Sleep Apnea connected comorbidities and symptoms-
Diabetes, High Blood Pressure GERD, headaches, nocturnal bruxism.
Explanations like this are presented in the upcoming Sleep Apnea seminars:
Oklahoma City Dr.Damian Blum
Atlanta Dr. Marty Lipsey
Hollywood, FL Dr. Dan Tache’
Boston Dr Barry Freydberg
Indianapolis Dr. George Jones
Orlando Dr Anjoo Ely
Miami Dr Barry Freydberg
Houston Dr.Damian Blum
Scottsdale Dr. Marty Lipsey
You can view the dates and course outlines and register here:
Sleep soundly this fall- don’t sleep with sound.
Snoring is disturbing and is a major cause of spousal alienation. Who can sleep with the sounds of a freight train two feet away from their ear? Spouses of snorers often have to move into separate bed rooms and sales are up of homes with two Master bed rooms.Snoring is, however, the most attention demanding WARNING SIGN of serious sleep dysfunction.
It is the common denominator in the Sleep Apnea equation. Snoring, like pain, should sound an alert to us that there is something more serious to look for under the surface.
We continue to learn about more illnesses connected to Sleep Apnea–
Researchers suggested a correlation between sleep apnea and increased cancer risk of any kind. A Cancer study of 1,240 participants who underwent colonoscopies found that those who slept fewer than six hours a night had a 50 percent spike in risk of colorectal adenomas, which can turn malignant over time. Another 2012 study identified a possible link between sleep and aggressive breast cancers. Ref: 2010 American Cancer Society Other serious ailments known to be tied to Sleep Apnea are:
Obesity, Dementia, Depression, Diabetes Mellitus, High Blood Pressure, Chronic Daytime Fatigue, Motor Vehicle Accidents
With an assortment of health threats like these, all Sleep Apnea related, we need to show more respect to snoring.