Treatment options for sleep apnea

What is sleep apnea?

Sleep apnea is a condition when your breathing stops during your sleep, sometimes occurring 20-30 times per hour. Each time you stop breathing, the lack of oxygen available to supply to the brain causes you to wake up to restart the breathing process. The continuous process of wake-sleep, wake-sleep cycles prevent you from achieving deep sleep and causes you to feel constant drowsiness and fatigue during the day.

What are the risk factors?

Sleep apnea can occur with any age and gender. However, it is more common in males over age 40. There is higher risk for individuals with obesity, smoking, drinking, and family history.

Should it be treated?

Sleep apnea should be treated immediately. If left untreated, it can lead to high blood pressure, risk of heart failure, and stroke. It interferes with sedation and surgical recovery. Due to unintentionally falling asleep during the day, it negatively affects work and school. It also leads to higher risk of injury while operating heavy machinery.

How is sleep apnea treated?

Treatment for sleep apnea depends on the severity and type of apnea. Basic treatments involve behavior management, such as instructing patients to lose weight, stop smoking, stop drinking, and sleep on their side instead of their back.

Intervention treatment may include an oxygen machine. A medical device called a CPAP machine (Continuous Positive Airway Pressure) is commonly used to treat moderate to severe sleep apnea. It delivers a continuous stream of oxygen to the patient, and has been proven to lower blood pressure and reduce heart problems [Source: WebMD].

Many people find that the machine works effectively at delivering air flow. However, the drawbacks include wearing a face mask that can be cumbersome and uncomfortable, and the mask can cause sore spots and irritation to the skin. The machine can be noisy, which can wake a person up at night. It is also an expensive machine. Some patients find themselves waking up at night to take the oxygen mask off.

An alternative treatment is oral appliance therapy. The oral device works best for mild and moderate cases of sleep apnea and avoids the drawbacks of an uncomfortable machine. The treatment involves fabricating and fitting a custom-made appliance to position the mouth open and unobstructed in order to maintain an open airway. This appliance is fabricated by an orthodontist and is used to prevent throat blockages. The oral appliance must fit comfortably so that it does not cause sore spots and the person can breathe comfortably.

In some severe cases, surgical treatment may be required to permanently change the position of the jaw. The mandible can be advanced to open the airway. The maxilla can be widened with a palatal expander in order to widen airway spaces.

If you or someone you love suffers from sleep apnea, talk to your physician to be referred to a sleep apnea specialist. The specialist may conduct a sleep study to diagnose the extent of the problem and recommend the appropriate treatment. If you are diagnosed with obstructive sleep apnea (OSA), you can schedule a consultation with an orthodontist to see if oral appliance therapy may be helpful to treat your sleep apnea. We can custom create an oral device for you to help open your airway and improve breathing.

If you find this blog helpful, let us know. Dr. Nancy Phan and the team at Care Orthodontics want you to have a beautiful and healthy smile. We create beautiful smiles with Care!

Sources and Citations:

1. http://www.progressivebraces.com/sleep-apnea-appliance-snore-appliance
2. http://www.dentistryiq.com/articles/2013/11/using-oral-and-dental-devices-to-treat-snoring-and-sleep-apnea.html
3. http://www.webmd.com/sleep-disorders/sleep-apnea/continuous-positive-airway-pressure-cpap-for-obstructive-sleep-apnea

What is the difference between snoring and sleep apnea?

What is snoring?

Snoring occurs when you make hoarse sounds during sleep. It is caused by the vibration of the soft palate. It presents due to narrowing and laxity of airway tissues. Snoring does not restrict the airway and it does not cause sleep disturbances.

Studies estimate that 30% to 50% of the U.S. population experience snoring. Light snoring can be a minor annoyance. Excessive, loud and habitual snoring can disturb your loved one. Snoring does not cause breathing or sleep disturbances. However, it can progress into upper airway resistance syndrome, which causes sleep disturbances and becomes sleep apnea. Snoring can be a sign of sleep apnea. Snoring can increase a person's risk for stroke. [Source: Lee et al.]

In summary, as long as there is no airway restriction, then the term “snoring” is used. It is important that you recognize the differences between snoring and sleep apnea.

What is sleep apnea?

Sleep apnea is a condition when your breathing stops during your sleep, sometimes occurring 20-30 times per hour. Each time you stop breathing, the lack of oxygen supply available to the brain causes you to wake up in order to restart the breathing process. The continuous process of wake-sleep, wake-sleep cycles prevent you from achieving deep sleep and causes you to feel constant drowsiness and fatigue during the day.

Sleep apnea is defined as restriction of the airway passage for a minimum time leading to oxygen saturation drop. Apnea is a complete or almost complete blockage of the airway for a certain time.

What are the signs of sleep apnea?

Snoring is one symptom of sleep apnea. However, snoring does not always indicate sleep apnea. It may be a social inconvenience but may not cause cessation of breathing, and may not require immediate treatment. Currently, 1.2 million Americans suffer from sleep apnea.

To diagnose sleep apnea, look for these symptoms:

• Choking or gasping that follows loud snores at night
• Breathing cessation episodes
• The need to wake up frequently with shortness of breath
• Sore throat and dry mouth after waking
• Insomnia or difficult sleeping
• Headaches, drowsiness, and irritability upon waking in the morning
• Falling asleep unintentionally during the day

What are the different types of sleep apnea?

The types of sleep apnea are usually diagnosed by a sleep apnea specialist in a sleep lab.

There are 3 types of sleep apnea:

1. Obstructive sleep apnea (OSA) is the common type. It occurs due to a physical blockage, typically caused by the tongue, uvula and soft palate, which collapse and block the airway in the back of the throat.
2. Central sleep apnea (CSA) is a less common type. It occurs due to lack of proper signals from the brain sent to the breathing muscles.
3. Complex sleep apnea is a less common type. It is a combination of obstructive and central sleep apnea. [Source: Dental IQ]

 

Medical and dental conditions associated with sleep apnea

• People who have high blood pressure, frequent heartburn and hypothyroidism have high associations with sleep apnea.
• People who have heavy clenching, grinding, bruxing, temporal mandibular joint symptoms and frequent headaches have high associations with sleep apnea. [Source: Health checklist]

If you have these conditions, along with disruptive sleep patterns, you should see your physician to get diagnosed with sleep study tests to rule out sleep apnea.

Should it be treated?

A light snoring can be a minor annoyance to your spouse or family member but may not need treatment. Severe snoring can be a sign of sleep apnea and should be diagnosed and treated. Sleep apnea should be treated immediately. If left untreated, sleep apnea can lead to high blood pressure, risk of heart failure, and stroke. It interferes with sedation and surgical recovery. Due to unintentionally falling asleep during the day, it negatively affects work and school. It also leads to a higher risk of injury while operating heavy machinery.

In the next post, Dr. Nancy Phan will discuss different treatment options for sleep apnea.

If you find this blog helpful, let us know. Dr. Nancy Phan and the team at Care Orthodontics want you to have a beautiful and healthy smile. We create beautiful smiles with Care!

1. http://www.dentistryiq.com/articles/2013/11/using-oral-and-dental-devices-to-treat-snoring-and-sleep-apnea.htm
2. Lee SA, Amis TC, Byth K, et al. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 2008, 31:1207-1213
3. Bruce, Dan. Health history checklist for sleep-related breathing disorders. Dental Economics 03 2015, 80-84

3 effective methods to clean your retainers and Invisalign aligners

If you are wearing removable retainers such as Hawley, or clear retainers or aligners, you may notice they get white build-up. At first, the build-up may be soft and sticky due to plaque build-up. With time, this sticky layer turns into crusty, white build-up that is difficult to brush away.

Just as calculus builds up on teeth, caused by minerals in saliva, calculus deposits can form on retainers. With time, it is very hard to remove. Aside from the unattractive look, dirty retainers also smell like rotten fruit. Thus, it is important to keep retainers and aligners clean.

Below are 3 methods of cleaning retainers: 

1. Brush your retainers manually
2. Soak your retainers in a sonic cleansing system
3. Soak your retainers in homemade solutions

 

1. Brush your retainers manually

This method is the cheapest, most reliable, and most effective way of cleaning retainers and aligners. Every morning, a minimum of once a day, manually brush your retainers with liquid hand soap and a toothbrush. Use a denture toothbrush that has stiff bristles to help get rid of the white plaque. Then rinse with warm water. Store retainers or aligners in a case with the lid open to air dry and eliminate any damp, salivary smell. Use soap that contains an antibacterial agent to clean plaque. It will also have a deodorizing agent to eliminate the smell.

Make sure to store retainers dry and only if they are clean and free of build-up. If they are dirty and you don't have time to brush them in the morning, then you should store the retainers in a cup of distilled water. Dirty retainers will dry out with a white biofilm and harden into crusty white calculus that is very difficult to clean and remove.

If you are concerned about avoiding chemicals, then use water only to clean the retainers. It may take a little longer to manually scrub the retainer.

You can use toothpaste instead of soap to brush the retainers. However, most toothpaste contains about 20% of abrasives, such as silica compounds, triclosan, polymers, and pyrophosphates. These ingredients are used to polish the teeth, prevent biofilm formation, prevent stains, and prevent tartar formation respectively. These ingredients can create micro scratches on your retainers or make retainers look more dull over time.

 

2. Soak your retainers in cleaning tablets and a sonic cleaner

This method uses a proprietary system of sonic cleaner and tablets. It is convenient and works effectively, however, it is more expensive. You can purchase a portable sonic cleaning kit and cleaning tablets at a drug store or over the internet from websites such as dentalkit.com or smileshop.com.

The sonic cleaners cost from $10 to $50 per unit depending on if they are battery operated or have a power plug with an auto shut-off option. These units basically vibrate to shake off calculus and plaque build-ups. The cleaning tablets cost about $5 per monthly supply. There are many brand names, such as Retainer Brite, SonicBrite, DentaSoak, Efferdent, and Polident. These tablets have antibacterial agents, cleaning agents and deodorizing agents to eliminate the smell and clean retainers. [Source: Wikihow]

 

3. Soak retainers in homemade cleaning solutions

With this method, you will need to create your own ingredient mix. The ingredients can be vinegar, baking soda or hydrogen peroxide.

You can use 5% distilled white vinegar, used for home cooking. Mix 1 part vinegar to 3 parts warm water. Soak your retainers or aligners for 20 minutes. Then clean off with water to dissolve white plaque. Use vinegar sparingly, as long term use can degrade the plastic and change the color of acrylic.

If you have not been cleaning your retainers and the build-up is old, chunky, and crusty, then use 1 part vinegar to 1 part water and soak overnight. Brush off with a stiff brush in the morning. Vinegar works as a dissolving and antibacterial agent. Most of the time, you can get rid of about 75% of crusty calculus. You still need mechanical brushing to scrape of the remaining tenacious hard calculus. By brushing your retainers daily, you prevent hard mineral build-ups as described here.

Baking soda or hydrogen peroxide can be used in substitution for vinegar, also with dilution in water. These ingredients work as an antibacterial agent to neutralize acidic bacteria and clean soft plaque. In general, vinegar still does a better job at removing hard calculus.

If you find this blog helpful, let us know. Dr. Nancy Phan and the team at Care Orthodontics want you to have a healthy and beautiful smile. We love to see you smile!

Am I too old for braces?

From time to time, we have grandparents who are interested in orthodontic treatment after having brought the grandkids into our office. We also have middle-aged adults who would like to get started with treatment or want re-treatment. Nowadays, there are more adults getting braces and Invisalign treatment than decades before. According the American Association of Orthodontists, currently 20% of orthodontic patients are adults, compared to less than 5% over 20 years ago. 

Reasons why it is easier for adults to wear braces these days:

• The metal brackets are thinner and smaller
• The clear, ceramic brackets are thinner, less brittle, less likely to cause stains
• Optional lingual braces are attached to the back of the teeth and are less noticeable
• Invisalign is a good alternative for adults who do not want to wear braces
• Socially, it is more acceptable to wear braces and more people are doing it than ever before

As more people are aware of the benefits of straight and healthy teeth, they are more motivated to obtain treatment. You don't have to live with negative consequences of physically limited oral health due to bad bite, uneven teeth, gingival recessed gum, or trapped plaque. You don't have to suffer the psychological setback of covering your unattractive teeth while smiling, and you don't have to fear that people will judge you negatively due to crooked teeth.

Here are the benefits of receiving orthodontic treatment:

• Less chance of food build-up, stain, and plaque accumulation with aligned teeth
• Less periodontal disease and gum recession when teeth are in proper occlusion
• Less trauma in occlusion when teeth are properly fitted
• It is much easier to brush and floss with straight teeth
• You chew food properly and avoid gastrointestinal problem with correction of improper bite
• You speak better and digest food better with correction of an open bite
• You show more self-confidence when you have a better smile
• When you smile more, you are more approachable to others, make more friends, attract the opposite sex, and perform better at job interviews.

Should you consider orthodontic treatment at your age?

You are never too old for orthodontic treatment. Even in your 70s or 80s, as long as there is normal bone metabolism and no periodontal disease, tooth movement can occur. However, here are some important differences to consider in adult orthodontics:

• By adulthood, bone growth has stopped. Therefore, there are no opportunities to manipulate jaw growth except for jaw surgery. With severe underbites, overbites, crossbites, or facial asymmetry, a combination of jaw surgery and orthodontic treatment may be necessary.
• Treatment may take longer in adults compared to adolescence. With age, teeth may move a little more slowly due to dense bone. With age, adults are more prone to root resorption and periodontal diseases. Thus, adults need to be more closely monitored and need more frequent cleanings. Adults need gum pockets checked every 4-6 months to ensure healthy periodontal structure.
• Adults often need more inter-discipline care and dental cosmetic treatments along with orthodontic treatment. Procedures such as veneers, porcelain crowns, teeth whitening, gum grafting, etc. are often indicated to restore size, shape, and function of teeth as a result of heavy grinding, bruxism, root-canal treatment, internal staining, or gum recession.

The outcomes are just as good for adults. Even though many adults worry about the age to pursue orthodontic treatment, the majority are satisfied with the end results. They are happy that they invested the time and money in their smile and they can keep their healthy smiles for many more years to come!

At Care Orthodontics, we are here to help. If you have any questions about your bite and would like to consider treatment options, you can schedule an appointment for complimentary consultation with Dr. Nancy Phan at 408-971-2885. You can also find other beneficial information on our website at www.CareOrthodontics.com.

Does my child need a palatal expander?

Some parents are concerned when seeing many crooked teeth in their child’s mouth, and often ask if a palatal expander would be beneficial. The answer is, it depends. A child should be seen by an orthodontist to evaluate the size, shape, and bite of the mouth to determine if an expander is indicated.

What is an expander? It is a custom-fitted dental device that is made by 2 metal halves joined together by a small screw. When turned, the screw opens slowly to widen the width of the upper jaw.

  

When is palatal expander used? A palatal expander can be used on a child or an adult to correct a bad bite, sometimes referred as a "cross-bite." It is also used to widen the maxilla. Anatomically, the upper jaw and roof of mouth are together know as a maxilla. In some individuals the maxilla is narrower than normal and causes the upper teeth to fit abnormally inside the lower teeth when biting down known as a "cross-bite." A cross-bite may restrict the amount of space available for the permanent teeth to erupt. A cross-bite can also cause the lower jaw to shift lopsided when biting down creating facial asymmetry.

In a child, there is a window of opportunity to correct a cross-bite non-surgically. Since the maxilla is made up by 2 pieces of bones connected in the middle by a seam of cartilage, this cartilage is soft and can be stretched by a palatal expander. Once puberty hits, on average round age 12-14; this cartilage hardens into bone. The 2 pieces of maxilla bones fuse together and cease to expand. Any expansion has to be done through surgery.

In adults, jaw expansion works through jaw surgery via a cut through the roof of the jaw, then a palatal expander separates the bones, bone fills in the expansion gap, and finally bone healing occurs 3-4 months later to stabilize the new jaw.

Why is palatal expander used? The expander is used to correct a one-side cross-bite or two-side cross-bites and to widen the roof of the jaw. In a child, the expander fixes the bad bite, prevents unsymmetrical facial growth, prevents uneven wearing of teeth, and gains space to allow ease of eruption of permanent teeth. In adults, using an expander establishes balanced occlusion, prevents uneven enamel wear, and corrects facial asymmetry.

Does it hurt to wear an expander? Insertion of an expander does not hurt except for turning the appliance. One can feel some tight pressure around the base of the nose and the roof of mouth a few minutes after the expander has been turned. An expander does alter speech and swallowing for 1-2 weeks until the tongue adjusts to the new device.

How long is the expander turned? In general the expander is turned for 1 to 2 weeks while being monitored by an orthodontist. After that, the expander is left in the mouth for an average period of 6 months for bones and tissues to adapt.

In summary, a palatal expander is beneficial when indicated. Although it is non-invasive to separate the maxilla bone with an expander, it must be done before puberty. Discovering this type of malocclusion early is one of the many reasons the American Association of Orthodontists recommends a child to see an orthodontist by the age of 7. It is much easier for parents to have a consultation with an orthodontist to survey their child's bite problem, discuss options, and plan the course of treatment early than dealing with complicated options which may require pain and surgical intervention later on.

At Care Orthodontics, we are here to help. Dr. Nancy Phan can provide a complimentary consultation to answer your questions at (408) 971-2885. You can also find other beneficial information on our website at www.CareOrthdontics.com.

10 Extra Tips for Wearing Invisalign

Wearing Invisalign aligners to straighten teeth is the easiest way to go through orthodontic treatment without the pain and embarrassment of wearing braces or the worry of food stuck between the brackets. 

Currently, there are 1.4 million people who have been treated with Invisalign world-wide. Since Invisalign aligners are removable, they can be removed quickly for eating, brushing, flossing, photo sessions, important presentations or special occasions, such as weddings, graduations and reunions. 

Below are 10 tips that can be beneficial to you while wearing your Invisalign aligners:

1. Brush your teeth often. Frequent brushing can help you remove most food and plaque to keep your teeth and gums feeling clean. Brushing can eliminate most external stains from food and drinks, such as tea, coffee, ketchup or food coloring that will lead to yellow teeth. Brushing often is the first step to having clean, white teeth.
2. Floss your teeth daily. With Invisalign, flossing is as routine and simple as not going through any orthodontic treatment. Daily flossing will cut down food build-up around the gum pockets to reduce the risk of gum inflammation or gingivitis.
3. Eliminate nail biting habits. Like Brittney Spears, a few of us may have this tenacious nail-biting habit that is hard to get rid of. Wearing aligners is the fastest way to help you kick the habit. You will notice that, with plastic around your teeth, you can hardly bite into your nails.
4. Insert new aligners at night. Studies show that patients report a feeling of tightness during the first day or two of wearing a new set of aligners. When you insert a new set of aligners at night, there are two benefits. First, you sleep through the discomfort of new pressure and feel less sensitivity. Second, after eight hours of sleep, your teeth already moved. By the morning, the aligners are easier to remove than when you first placed them in your mouth at night.
5. Take a pain reliever during the first two nights of wearing new aligners. Since most people feel slight pressure during the first two nights of new aligners, taking pain reliever medication, such as Ibuprofen or Tylenol, will eliminate any discomfort.
6. Remove aligners from back to front. It is easier to lift the aligners off on the back area of the mouth first, on both right and left sides. Then peel the front aligner off. If you do the opposite and try to push the front out first, it can be very tight since there is more retention on the front teeth.
7. Remove aligners when the mouth is warm. Invisalign aligners are made out of a special plastic material. Plastic is more pliable in warm temperatures. If you take a sip of warm water or just slightly open your mouth for a few minutes to breath warm air into your aligners, you can lift them off easily. This is especially helpful if you have very short nails or no nails at all. On the contrary, if you take a cold drink of water and try to take the aligners out, the aligner can be very stiff and it is harder to lift off.
8. Whiten your teeth while wearing Invisalign. One of the many benefits of wearing aligners is that you can use whitening gels, such as over-the counter products or from your general dentist's dispensary, to whiten your teeth. Although there are attachments bonded on your teeth while wearing Invisalign, most whitening gels can get beneath the attachments. If there are many large attachments, you may need an extra round of teeth whitening after the end of Invisalign treatment to lighten these spots. In general, whitening 1-2 times a year is generally safe with over-the-counter products. However, if your teeth feel sensitive to cold or heat, then you should consult with your dentist first.
9. Reduce teeth clenching at night. For those who tend to grind and clench your teeth a lot night, wearing Invisalign aligners will cut out enamel wear and reduce the soreness that your teeth feel in the morning after heavy grinding. Since you are changing to new aligners every two weeks, any scratches to your aligners are better than dealing with worn enamel. Aligners make an excellent alternative to a mouth guard.
10. Enjoy a night out. If you ever feel burned out from going through orthodontic treatment, you can remove the aligners for a few hours to enjoy a special night out. Overall, you need to wear your aligners an average of 22 hours a day for your treatment to be successful.

At Care Orthodontics, Dr. Nancy Phan and team hope that you find these tips helpful while wearing Invisalign. If you have any questions or need a complimentary consultation regard orthodontic treatment or Invisalign treatment, please give us a call at our San Jose office to schedule an appointment. 

8 Ways to Kick the Nail Biting Habit

Nail biting is a “nervous disorder” that is scientifically described as onychophagia. It is usually triggered by stress, excitement, boredom or nervousness. Between 30% to 65% of children and 15% of adults bite their nails at one time or another. More than 75% of these people stop the habit after age 35, except for a few with OCD (Obsessive Compulsive Disorder).

There are several reasons to stop biting your nails:

• It's unsanitary. Nails harbor bacteria below the nail beds and you swallow these bacteria while biting your nails. Bacteria and viruses passed from your fingers to your face and mouth can make you vulnerable to infection.
• It's unattractive and socially unacceptable. In addition to having a negative appearance, it causes damage to your health. Nail biting leads to ragged and unattractive nails. It also causes nail bleeding and damage to nail beds.
• It can cause stomach problems. When you bite your nails, you transfer bacteria between your mouth and your nails. Swallowing bacteria and broken nail bits can lead to stomach problems.
• It wears down teeth. Pressure from nail biting wears down your teeth over time. In addition, biting pressure leads to crooked teeth. It causes gum redness and irritation. Overall, nail biting can lead to permanent damage to your teeth, gums and nails.
• It can delay your orthodontic treatment and cost you money. Nail biting leads to frequent broken brackets or chipped teeth, which costs you more to fix the dental problem and delays orthodontic treatment.

Here are eight recommended ways to kick the nail biting habit:

1. Keep nails short so there is less nail to bite.
2. Coat your nail with bitter-tasting nail polish. Try fake nail products such as acrylics, wraps, gels and press-on nails.
3. Wear bandages on your nails or gloves on your hands. It may seem a bit awkward at first, but this can be an effective tool.
4. Wear a mouth guard, a clear retainer, or an Invisalign aligner to prevent you from biting your nails.
5. Wear a rubber band around your wrist and snap it every time you have an urge to gnaw on your nails.
6. Take up a new habit in order to kick old habits. Understanding when and why you bite your nails is the first step to making a conscious effort to kick the habit. Then find a way to distract yourself when you have an urge to bite your nails, such as humming, finger tapping, chewing gum, knitting, crocheting, nail care, decoration, doing art projects with clay or plaster, etc.   Outdoor activities such as running, playing basketball, tennis, etc. will also keep you occupied and distracted from the urge to gnaw on your nails.
7. Get support from those around you. Share the news with a friend or family member to encourage and remind you to stop.
8. If you can't find a suitable distraction or habit to help you stop biting your nails, you might try addressing the problem therapeutically. There are options such as behavior therapy or online support groups. You could also find a "quit buddy" to help you on your journey to a bite-free existence.

View How to Stop Biting Your Nails on Howcast

At Care Orthodontics, Dr. Nancy Phan and team care for your oral health as well as your overall health. We hope you find these tips helpful to kick any nail biting habits that you may have.

Sources and Citations:

1. http://www.webmd.com/healthy-beauty/stop-nail-biting-tips
2. http://www.psychologytoday.com/blog/making-habits-breaking-habits/201301/how-stop-biting-your-nails
3. http://www.rd.com/health/beauty/14-tips-for-strong-and-healthy-nails/
4. http://www.wikihow.com/Stop-Biting-Your-Nails