Is Sleeping Killing You?

Is Sleeping Killing You?


Maybe.  You may not even know it.  But if you have a bed partner, for sure he or she knows it.


OK.  Millions of people snore.  It's annoying.  It drives those you share a bed with crazy.


But it won't kill you if that's all it is.  


But for many snorers, the situation is way more serious.  


Because what they have is called Obstructive Sleep Apnea (OSA for short).


OSA is a killer.  Let me tell you a little about it.  And then let me tell you how a dental office can help you.


Obstructive sleep apnea is a common disorder that affects more than 18 million people in the United States. In many of these people, the condition is undiagnosed. People with OSA literally stop breathing repeatedly during their sleep, often for a minute or longer and as many as hundreds of times during a single night.

Sleep apnea can be caused by either complete obstruction of the airway (obstructive apnea) or partial obstruction, both of which can wake one up. OSA occurs in approximately 2 percent of women and 4 percent of men over the age of 35.

It is important to emphasize that, often, the person who has obstructive sleep apnea does not remember the episodes of apnea during the night.

The main symptoms are usually associated with excessive daytime sleepiness due to poor sleep during the night. Often, family members, especially spouses, witness the periods of no breathing.

A person with obstructive sleep apnea usually snores heavily soon after falling asleep. The snoring continues at a regular pace for a period of time, often becoming louder, but is then interrupted by a long silent period during which there is no breathing. This is followed by a loud snort and gasp, and the snoring returns. This pattern repeats frequently throughout the night.

During the nonbreathing episodes, blood oxygen levels fall. Persistent low levels of oxygen may cause many of the daytime symptoms. If the condition is severe enough, pulmonary hypertension may develop, leading to right sided heart failure.

Symptoms that may be observed include:

Abnormal daytime sleepiness, including falling asleep at inappropriate times. Awakening unrefreshed in the morning.  Depression (possibly).  Episodes of no breathing (apnea).  Lethargy.  Loud snoring.  Memory difficulties.  Morning headaches.  Personality changes.  Poor concentration.  Restless sleep.  Abnormal heart rhythm (arrhythmia).  Excessive carbon dioxide levels in the blood.  High Blood Pressure.  Heart disease.  Sleep deprivation. Stroke.

So why is a dentist talking to you about this? Because specially trained dentists (that's us) can be terrifically helpful with mild to moderate OSA.

Dentists with a special interest in this issue know how to make an oral appliance that advances the jaw in sleep and keeps the airway open. Sometimes this is all that is needed to stop the problem.

These appliances are easy to wear in sleep and the improvment in sleep quality, to say nothing about the improvement of the sleep for the partner, can be remarkable.

The alternatives are for the OSA person to use CPAP (continuous positive airway pressure) devices, which involve a mask that fits over the face and a machine that pumps air under pressure to force breathing. And there are surgical procedures that may be able to help.

I personally favor the oral appliance called Somnodent, and my patients have found it to be comfortable and effective.  The SomnoDent is a custom-made device, which improves the effectiveness and comfort level of treatment, as the jaw is moved only as far as is required to alleviate the condition.

The SomnoDent is a clinically proven treatment of snoring and mild to moderate OSA.   96% of patients with proven OSA stated they would like to continue to use the SomnoDent.  91% of patients reported substantial improvement in sleep quality with the SomnoDent. 

The SomnoDent works by moving the lower jaw forward slightly, which tightens the muscles in the upper airway preventing them from collapsing and vibrating at night. 

If you are told you snore loudly or stop breathing in sleep, or if your partner does this, please seek help. The diagnosis is usually made by having a sleep study at a sleep center.

But here is some terrific great news: 

Our office can now arrange for you to have a sleep study done right in your own home, in your own bed.  It's so comfortable to be in familiar surroundings without the cameras and observers in a sleep center.

And the cost of a home sleep study is only about $350 instead of the $2000 to $3000 for a sleep center study.

Don't neglect OSA. It can kill you.

If you even suspect you might have OSA, or even if you simply want to stop or reduce your snoring, call us. We can and will help you.  Do it now.

Dental Pain Truths - What You Need To Know

Dental Pain. It's the worst!

But dental pain comes in many different forms. Let's go through some of the common types and put them in some perspective.  Smart Patients know stuff and they keep their teeth.

Brief, sharp momentary pain to something cold.

Goes away as soon as the cold is removed.  Teeth are normally a little sensitive when exposed to real cold.  No problem.  

But: if the cold sensitivity happens when the food or drink is only slightly cold, then it can be from a gap in a filling, actual decay, an exposed root surface (happens if the gum is receded) or if there is a crack in the tooth.  Call us. 845-297-6206.

Or: If the pain lasts for more than a few seconds or a minute, that can mean that the pulp (the living tissue inside the tooth) is stressed or deteriorating.  Call us. 845-297-6206

Deeper, more aching pain pain, especially if heat makes it worse.

More serious.  This indicates that the pulp of the tooth is badly inflamed and is on the way to becoming necrotic.  Call us promptly.  This is going to get worse.  845-297-6206.

A real long lasting, steady, throbbing toothache that is agonizingly painful and is worse if you bite on the tooth or press it with your tongue or finger.

This is an emergency.  It means you have an abscess (infection) and it must be treated quickly.  It can become a deep space infection and can become dangerous.

I have a broken tooth or a hole in my tooth but I have no dental pain.  Nothing hurts.  Am I OK?  Can I wait to take care of this?

No.  Any opening in a tooth beyond the enamel is a wound.  It gets infected.  Bacteria enter the microscopic tubules in the dentin and travel to the pulp and then you are on the way to a dead pulp and a toothache.  Many times the reason the tooth doesn't hurt is because the nerve endings in the pulp are already dead.  Call us. 845-297-6206.

I had a toothache but it went away.  Did it heal?

No.  The pulp of the tooth probably died, so the nerve tissue is no longer able to transmit the pain impulses.  Dead pulps need to be treated.  The body does not like dead tissue and it will create problems if it is left.  Call us. 845-297-6206.

I bit on something hard and it hurt, but the pain went away quickly and the tooth isn't sore.  What should I do?

If the tooth stays comfortable, just don't bite hard on it for a day or two.  

But: If the tooth starts to ache or gets tender to temperatures or pressure, call us. 845-297-6206

My teeth are just sort of sore a lot, especially when I wake up in the morning.  What's happening?

You are probably clenching or grinding your teeth in sleep. Some people do this in the daytime too. This is not good for teeth, or for your jaw joints or the chewing muscles in your face.  You need help.  Call us. 845-297-6206.

The bottom line is this: Call and get advice when you are not sure.  We are glad to advise you.

Check out our web site.  It has a ton of information.  We're here for you.

So Glad To Be Here

Today I want to share a communication I got from one of my colleagues on the Academy of Comprehensive Esthetics forum.  June is not a dentist.  She is a Ph.D. who focuses on development and performance.  She's very smart.

So here's a Guest Blog from June Darling.

And as always, you can read my blog at our website.

Enjoy!

-----------------------------------------------------------

So Glad to Be Here

Perched in her high chair, the toddler seemed extremely thoughtful. She must have something big on her mind. As a matter of fact she did, because when her mother asked her what she was thinking about, she said, "I'm thinking about my pancakes."

That thought seemed all too appropriate, perfectly sensible, and somehow funny since she was at that very moment eating her pancakes. Why did it seem so humorous?

Quite often we aren’t thinking about what we’re actually experiencing. The toddler was thoughtfully focused on her pancakes, being right here, right now, in the present – a sound, practical, and unusual way for many people between the ages of four and ninety-four to live (The young and the old are often the best practitioners of what some call “being present.”)

Many of us spend much of our time hovering around somewhere outside our present experience. We may be worrying about something bad which could happen in the future or feeling depressed about something that’s already happened. We are quite unaware of what is actually happening now.

We are often so unaware of what is going on with us and around us at this particular moment that we live our present on auto-pilot. That happens to me.

A number of years ago I was on my way to work. I parked my car. When I started to get out, I realized I was not in the parking lot of my present workplace, but rather in place I had worked previously.

Test yourself. How many of these “unpresent” situations or similar ones are happening to you?

I experience some emotion and may not be conscious of it until some time later.

I break or spill things because of carelessness, not paying attention, or thinking of something else.

I tend to walk quickly to get where I’m going without paying attention to what I experience along the way.

I forget a person’s name almost as soon as I’ve been told it for the first time.

I get so focused on the goal I want to achieve that I lose touch with what I am doing right now to get there.

I find myself listening to someone with one ear, doing something else at the same time.

I snack without being aware that I’m eating.

If you’re like I am. A good dose (or two) of “being fully present” would be useful.

According to psychologists, in addition to helping us get where we want to go, being present helps us feel healthy, happy, and aware. It's an antidote for stress and worry (and can also improve our relationships and help us perform better).

I'm not suggesting that we live every moment in the present (though some people do recommend that), but for most of us a bit more thinking about our pancakes, when we are in fact eating our pancakes, could make for more enjoyment of our pancakes – that is… our lives.

This month let’s use the toddlers' and old folks' cure for anxiety, depression, and unhappiness (which I am personally calling “thinking about my pancakes”) by being more present - right here, right now. We won’t be upset if we notice that our attention has skittered off. We won’t beat ourselves up if we find ourselves in the past, the future, or our old parking lots. We’ll just smile and gently bring ourselves home.

Our life is an experience we don’t want to miss.

How might being “more present” help you move up To The Good Life?

June Darling, Ph.D.
President of Summit Group Resources, An Executive and Personal Coaching Company specializing in organizational and personal development, peak performance, and happiness.

Follow June on Twitter

Migraines and the NTI

Is this you?

We can help.

Over 29 million Americans suffer from migraines. And some dentists are trained to deal with them

We are one of them.

We can design and create an amazing little piece of plastic that fits between your front teeth that can dramatically reduce or even eliminate your migraine symptoms.

It's called the NTI-tss.  The NTI-tss is an FDA approved migraine prevention option. It is a small nightguard that comfortably fits over your four front teeth. It's patented design keeps your canine and back teeth apart. This separation minimizes the intensity of your nighttime clenching forces.

Check it for yourself

To demonstrate how the NTI-tss works, simply hold the muscles of your temples (like the woman in the photo) while biting down on a pencil with only the back teeth. The temporal muscles will bulge and intensely contract. But  when you bite down on a pencil with only the front teeth, the temporal muscles remain relaxed.  There is a reflex (it is actually called the "Nociceptive Trigeminal Inhibition" reflex) that prevents hard contraction of the biting muscles when only the front teeth touch.

Thank you, Dr. Boyd

The NTI-tss therapeutic protocol was developed by a California dentist, James Boyd, DDS. Having suffered chronic, daily headaches and frequent migraine attacks for 12 years, Dr. Boyd developed the protocol to rid him of pain. He is now an associate with The Headache Center Neurology clinic in Encinitas, CA. He is something of a genius.

There's a neat website about this at www.TheHeadacheRemedy.com.  And you can check out our website page on this at http://www.drsteveross.com/migraine-tmj-facial-pain.html.

Don't live with pain. Call (845-297-62063) or send e-mail (DrSteveRoss@aol.com) and we will be glad to evaluate you.  We can help! 

Fixing Cavities - The Old Way and the New Way

One of the most common questions asked in our practice concerns our choice of the material that we use to repair cavities in teeth.

Amalgam: The old stuff (we don't use this)

Silver-mercury (amalgam) fillings were introduced to dentistry over 100 years ago. At the time, this mixture of silver and mercury was considered a miracle material (of course, at that time, so was indoor plumbing).

Is it safe?

Today, amalgam fillings are made of a mixture of silver/zinc/tin/copper alloy and mercury. And as of today the American Dental Association believes that amalgam is a safe and effective material for use in the human mouth. They are entitled to their opinion. Here is my personal opinion about amalgam:

It is possible that the mercury in amalgam is not harmful to us. However, mercury is a toxic substance and according to the EPA, must be disposed of in a Toxic Waste Disposal Site. In my opinion, anything that must be disposed of in a Toxic Waste Disposal Site should maybe not be placed in our mouths. 

But this may simply be an over-cautious position on my part. I do not actually know what the long term outcome of on-going research will be. I do know that some European countries and a couple of states in the U.S. have regulated amalgam use, mostly because of environmental contamination reasons. Some European countries have banned the use of amalgam in pregnant women and young children.

I want to be clear on this. I have not used amalgam since April of 1982. And I'm not going to use it again. And the reason has nothing to do with its safety or non-safety. The jury may still be out on that.

So what do I like?

The reason I do not use amalgam is that, in my opinion, it is a poor restorative material compared to newer materials we have now. Like everything else, improvements have been constant over the last 100 years. It took science until the 70’s to develop an alternative to amalgam, and into the 2000s to improve it to its current excellent level.

The material I favor and use as my first choice is bonded composite resin. This material is extremely biocompatible and flexes and wears like natural teeth. A silver-mercury restoration has no bond to tooth structure. Expansion and contraction of amalgam over the years causes cracks in teeth and eventually, many teeth will fracture. You may have had this happen to you, even when you were eating something soft. Amalgam tends to leak after five or ten years, causing recurrent decay. Amalgam corrodes and turns black.


M.I.D.
Another reason I like to use bonded resin is because I am a strong proponent of what dentists call Minimally Invasive Dentistry.  Those of us who have this philosophy believe that as much natural tooth structure as possible should be preserved when restoring teeth to good form and function.  You would think that every dentist would believe this, but they don't.  It is easier to drill away teeth and make crowns than to artfully sculpt and bond modern resins onto the natural tooth. It takes time, skill and care.  But it's better for the tooth and that's what matters to me.  Crowns are very appropriate in many situations, but not as often as many dentists use them. I prefer to preserve if possible. The easy way is not always the best way.

I also restore teeth with various types of wonderful ceramic materials (usually called porcelain) and the always terrific old standby, gold.  You can use these in minimally invasive ways also.

When aging amalgam restorations are replaced by bonded composite resin or ceramic restorations, the strength of the tooth is improved and underlying tooth structure is sealed.

Plus, of course, composite resin and ceramic restorations are tooth colored and are so much more attractive and natural looking than metal fillings.

Let's talk about cost

Now let me talk with you about the economics of composite resin. Composite resin and ceramic restorations are more technique sensitive and are more time consuming to place. Special care must be exercised to operate in a controlled environment that can be moist when desired and dry when desired. These bonded restorations are more sensitive to moisture control procedures than amalgam. When placing these fillings, we use bonding agents to seal the dentin against bacterial infiltration and protect the dental pulp from irritation. As a result of this necessary expertise and the increased time associated with composite and ceramic placement, the cost of restoring teeth is a little higher than with amalgam.

Cost is not the same as value

Teeth matter.  They deserve the best chance for lifetime function, comfort and good appearance.  Replacing teeth is much more costly than preserving them. We opt for the best value for our patients.

You have insurance?  That's good!  But...

Insurance companies are slow to embrace newer techniques, especially when it could cost them money to provide state-of-the-art care to their insured. Many insurance companies will only cover the cheapest material to restore teeth. Yup, that’s amalgam, and many will pay their amalgam benefit even when composite resin or ceramic materials are used. Yes, they are allowed to do that. That should irritate you, in my opinion.

My patients have mostly learned about the ways insurance carriers pay benefits. For example, they have learned not to be fooled by the “usual and customary fee” jive. They know that this is bogus and is intended to drive a wedge between patient and doctor. If you are concerned about anything you read in an Explanation of Benefits you receive, just call us. We’ll explain it with straight, honest talk. You don't have to be my patient to get advice; we'll be glad to help anyone.

The bottom line

Composite resin, porcelain and gold are wonderful, modern, state-of-the-art beautiful materials we use to help you have the strong, functional teeth and great smile you have always wanted.

Lose Your Teeth, Lose Your Mind

Ever have a senior moment? Then you might be missing some teeth, too.

I'm sharing today a remarkable piece of research published by Boston University Henry M. Goldman School of Dental Medicine just a few days ago (yes, I actually do read this stuff).

We know that the connection between dental disease and system diseases are becoming better understood every day. We now know that there is a correlation between periodontal disease and heart disease, pancreatic and maybe other cancers, low birth weight babies and a bunch of other problems.

But this one is really startling. Read the article for yourself. Let me know what you think about this. If it makes you worry, that's not a bad thing, really. Worry is sometimes the first step to doing something important for yourself. I'd love to help you with that. All it takes is a phone call or e-mail.

Here's the article. It will also be available on our website at Dr.SteveRoss.com (click on the section called Blog):

April 30, 2010

Researchers at Boston University Henry M. Goldman School of Dental Medicine (GSDM) link tooth loss and periodontal disease to cognitive decline in one of the largest and longest prospective studies on the topic to date, released in this month’s issue of the Journal of the American Geriatrics Society.

Dr. Elizabeth Krall Kaye looked for patterns in dental records from 1970 to 1973 to determine if periodontal disease and tooth loss predicted whether people did well or poorly on cognitive tests. She found that for each tooth lost per decade, the risk of doing poorly increased approximately eight to 10 percent.

More cavities usually meant lower cognition too. People with no tooth loss tended to do better on the tests.

Dr. Kaye says inflammation is a possible cause, noting that other studies found higher levels of inflammation markers in people with Alzheimer’s. “Periodontal disease and caries are infectious diseases that introduce inflammatory proteins into the blood,” she says. “There’s a lot of circumstantial evidence that inflammation raises your risk of cognitive decline and it could be that gum inflammation is one of the sources.”

The men studied—veterans living in the Boston metropolitan area—enrolled in the VA Dental Longitudinal Study in the late 1960s and early 70s and came back for medical, dental, and cognitive exams, which started in 1993, every three years.

Participants took two cognitive tests. The first, the Mini-Mental State Examination, tests orientation, attention, calculation, recall, language, and motor skills. The second, a spatial copying test, asks participants to copy nine geometric designs ranging from easy to complex.

“The ability to copy is one of the things people lose as they lose cognitive ability,” Dr. Kaye says.

Physicians might want to think about the dental health of their patients who test poorly, according to Dr. Kaye. “The findings should also give dentists yet another reason to prevent tooth loss and periodontal disease and encourage patients to do as much as they can to prevent dental disease,” she says.

Dental School faculty Drs. Kaye, Raul I. Garcia, Avron Spiro, III, and Thomas Dietrich; dental student Aileen Valencia, and Boston University School of Medicine nutrition student Nivine Baba worked on the study, which is a group effort among GSDM, the Veterans Affairs Boston Healthcare System, Boston University School of Public Health, and the University of Birmingham School of Dentistry in the United Kingdom.

What You Can Learn From An Injury

I found out recently that a skill I believed I had mastered still had a ways to go. I mean walking. After all, how hard is it? I have been doing it since very early childhood.

Still, with all that practice, on March 9th I tripped and fell and broke my shoulder!

I don't recommend it.

But now that I'm healing and getting able to do more and more regular activities every day, I did my usual thing – I've been thinking about what can be learned from this miserable experience.

Here are some observations I want to share with you:

It is a truly wonderful idea to be married to a smart, good looking nurse.

The people who work in the emergency room are very overworked, very dedicated and very good at their jobs. They took good care of me. However, the emergency room is not a fun place to have to spend time. Everything takes forever, you better have all your information available because they are gonna ask you for it (maybe more than once), you have a hard time finding out what's going on, privacy is minimal, and, of course, they don't actually fix you. That comes later, somewhere else. But it's a good place to start because they are very good at, well, emergencies.

Dr. Lawrence Kusior of Orthopedic Associates of Dutchess County is an excellent doctor in an excellent group of doctors. He is warm, caring, efficient and direct. He shared information with me freely. I felt he was involved. I did not feel rushed with him even though I know that physicians today have killer schedules.

Physical therapy, which is what I'm doing now, is hard and uncomfortable. A lot of the time it just hurts. But it is the key to success. It's not my first time with P.T., and I didn't like it any better the other times, either. Heather Kelly, my therapist at Orthopedic Associates, is terrific. She motivates and pushes me even when I tell her, "That's enough." Because it isn't.

Good health insurance and good access to health care is a must and the fact that our country lags behind most western nations in providing it for all their people is shameful.

My colleagues reacted to the news of my injury with empathy and offers of help. Every one of them whom I asked stepped up to the plate for me.

My patients have been fabulous. They waited patiently while I got able to resume their care and they have been so concerned. I appreciate them so much. They are the best!

My Assistant Jennifer and Care Coordinator Joan have been unbelievably effective. I could not asked for more or better. And their patience with me in my irritable times (pain can shorten your fuse) tells of their maturity, devotion and focus. I am lucky to have them with me.

A famous physician-teacher once said that every doctor should have to undergo a sickness or injury and be in the health care system before being allowed to care for patients. This is a terrific idea. There is a good movie called The Doctor, starring William Hurt, that tells this very well. I recommend it to all who care for others.

It's important to look for the gift in any experience. Sometimes it's hard to see it while you're in the middle of the crisis. But it's there.

And finally: Life goes on. The crisis passes. You get stronger if you learn something.

I would like it if you would share this blog with others. Maybe someone you know might be helped by something in it.

"TMJ" - Initials That Stand For Lots Of Unpleasant Things

OK, let's talk about pain. Wait! Don't run – stay with me a minute. I'm not talking about toothache pain. I'm talking about something more subtle. Tons of people live with this kind of pain most days or even every day and can't figure out why. Their doctors tell them different things depending on the doctor's specialty (when you are a hammer everything looks like a nail).

The chronic discomfort makes people depressed and sometimes a little desperate. Patients sometimes tell me they feel as if they are going crazy. They change they way they eat and they avoid foods that make them hurt. Sometimes they take medications, often strong medications, to get some relief.

A surprising percentage of the time, the problem turns out to be what dentists who know about this call "TMJ" (it has other names like "TMD" and "Myofascial Pain Dysfunction syndrome"). They are all pretty much the same thing and the name doesn’t matter if you have it.

Do you have any of these symptoms?

• Frequent headaches, including what has been diagnosed as "migraine".
  
• Clicking or pain in the jaw joints.
  
• Pain or difficulty when opening or closing the mouth.
  
• Pain, ringing, or fullness in the ears.
  
• Neck, shoulder, and/or facial pain.
  
• Eye pain or visual disturbances.

Some things that can cause this are:

• Trauma to the jaw.
• Teeth clenching or grinding (bruxism), especially in sleep.
• Improper bite alignment.
• Overactivity of the motor and sensory nerves that connect to the muscles of your face, which sets off spasms in those muscles.

Sound familiar? If it does, you may have TMJ.

You'd be amazed how many people have this. It shouldn't be ignored, because it gets worse over time.

Call our office. Send e-mail. We'll take you seriously. We'll review your history, conduct a gentle thorough examination, and discuss our findings. If you do have TMJ problems, we'll help get you feeling better again.

We have a special interest and special training in the the treatment of these special problems. You can feel comfortable again. Don’t live with chronic pain or dysfunction any longer. Relief could be just a few visits away.

Hushing Up Your Lizard Brain

We say we want one thing, then we do another. We say we want a great smile, but we say no when the dentist tells us how to have one. We say we want to replace some missing teeth, but we hesitate when the dentists tells us how.

Why is it so difficult to do what we say we want?

The lizard brain.

The lizard is a physical part of your brain, the pre-historic lump near the brain stem that is responsible for fear and rage and reproductive drive. Its actual name is the amygdala.

One writer described it as the resistance. The resistance is the voice in the back of our head telling us to back off, be careful, go slow, wait, compromise. The resistance is about putting things off because we aren't absolutely dead perfect sure about something.

The resistance grows in strength as we get closer to deciding to act.

That's because the lizard brain hates change and achievement and risk.

Want to know why so many companies can't keep up with Apple? It's because most companies compromise, have meetings, fear critics and generally work to appease the CEO's lizard. Having lots of meetings is just one symptom of an organization run by the lizard brain. Late lunches, middle of the road products and the excuses that go with them are others.

Dental patients are like that sometimes. They say that they will talk it over with someone, or do it next year, or they really aren't that eager to have it, they are worried about money, or the treatment, they are busy right now, and on and on.

So time passes and they get older and older and they never pull the trigger and say "YES". And they don't experience that wonderful feeling of making a decision and getting something they want. And the lizard wins.

So sad.

The amygdala isn't going away. Your lizard brain is here to stay, and your job is to figure out how to quiet it and ignore it. This is so important, and that's why I decided to blog it.

Now you've seen the lizard and you know its name. What are you going to do about it?

We can help. All you have to do is call and say, "I want (whatever) but I'm having a problem with the lizard." We'll focus in with you on your lizard's fears and help you tell the lizard to shut up. We are very good at that; it's why we are successful.

It's easy. 845-297-6206. DrSteveRoss@aol.com. You can dial or use a keyboard, can't you? After all, it's only a little lizard stopping you.