In this eighth posting from a 10-art series, exploring
Secrets Your Dentist Doesn’t Want You to Know, published August 27,
2009, Daily Finance. We’ll take a look at why your dentist might not
want you asking these questions – and why it’s critical that you should.
Secret #8 – Your dentist may not know enough about sleep apnea was published as follows:
The most common form of sleep apnea is caused by a blockage of the airway during sleep. It is a pretty scary condition. The patient can stop breathing hundreds of times during the night.
A common treatment for sleep apnea is Continuous Positive Airway Pressure (CPAP). CPAP involves blowing pressurized room air though the airway at high enough pressure to keep the airway open. Many Patients find it difficult to adjust to this device and want to avoid surgery, which is another treatment option. As an alternative, your dentist, working with your physician, can custom make a device that guides the lower jaw forward, called a mandibular advancement device or MAD. MAD devices are more comfortable to wear and the compliance rates are much higher than using CPAP.
If you have (or suspect you have) sleep apnea, here are some questions to ask your dentist: Are you a member of the American Academy of Dental Sleep Medicine? Do you regularly attend the annual meeting of the Academy? Do you work with Ear, Norse and Throat physicians and sleep physicians, where appropriate? You can also call sleep centers and ask them what dentist they refer to in your area.
Sleep Apnea is potentially a very serious medical condition. It is important to do careful due diligence before you select a dentist to treat it.
My Response …
I am a member of the American Academy of Sleep Dentistry and am certified with Priority Health to provide OMAD devices for their patients. We have been comparing four different devices for advancing the mandible. For those interested, the SUAD and the Somnodent devices have been excellent in comfort, adjustability and durability, but are too expensive for most insurance coverages. EMA’s are inexpensive and easy to fit but are not very adjustable and especially not as durable, not suitable for people who grinds at night. The TAP III is presently our “go to” appliance as it is midrange in cost, very adjustable and has been tolerated well by all patients so far.
In this seventh posting from a 10-part series, we’ll explore Secrets Your Dentist Doesn’t Want You to Know, published August 27th, 2009, Daily Finance.
Secret #7 – Bad dental advice about dentures can be fatal – was published as follows: Dentures are no joke to the millions of senior citizens who use them. While patients often pride themselves on keeping the same dentures for many years, this can be a big mistake. Your dentist should examine your dentures for evidence of wear. Wearing down the teeth on your dentures can result in distorted facial characteristics, collapse of the bite and closure of the airway. Dentures need to be replaced at least once every seven years. Poor fit or worn dentures can cause sleep apnea, stroke or even death. Yearly cancer screening exams of denture users are extremely important. Contrary to common perception, dentures should be worn at night in order to insure that the airway passage is kept open. Your dentist should instruct you on proper denture cleansing and should check you regularly for signs of infection.
In response …
The idea that dentures should be replaced “at least” once every seven years is absurd. The rationale for this philosophy is that when teeth are lost the bone tends to atrophy or shrink. For the same reason that patients who stop exercising or are in a coma loose muscle and bone mass, the jaw bone tends to disappear with the loss of stimulation from the roots. However, no two patients are alike and the rate of bone loss from patient-to-patient can vary significantly. Claiming that all dentures should be replaced “at least” every seven years is comparable to saying everyone should get new tires on their vehicles after a specific number of years. Like drivers, every patient is different. I think whoever gave the author this advice REALLY likes to do dentures.
I had two patients come to me a few years ago that illustrate the difference we see between patients. The first patient had only worn dentures for 8 years and had constant trouble. During the exam, the problem became obvious. Her lower jaw had already atrophied (shrunk) to the thickness of a pencil. She was close to a spontaneous fracture of her jaw from just normal chewing. We referred her to the University of Michigan where her hip and rib bones were grafted with moderate success. Her bars unfortunately were like sand, very soft.
The next patient, even though he was not having any problems with the fit of his denture, thought it was time to get a reline, a procedure to refit the inside of the denture to compensate for the usual loss of bone. After verifying that, in fact, his denture still fit quite well, I asked him how long it had been since his last denture reline. He shocked me by saying, “Twenty-one years ago.” I then found out this denture, which was still functioning well, was 40 years old! This patient’s bars were like concrete.
No two patients are alike.
A recent survey was published exploring the link between dental X-rays and a specific benign tumor, a meningioma (a growth that arises from the membranes that surround your brain and spinal cord.) This has obviously stirred up a lot of attention in the dental/medical world. The American Academy of Maxillofacial and Oral Radiology has criticized the survey for its methods of data collection and potential inconsistencies in its findings. I agree with their stance, some information can get twisted and sensationalized by the media. I will also admit that X-rays are not good for you. Excess radiation in any form is not good for you. I don’t think anyone is surprised to hear excessive radiation can cause tumors to grow. What exactly qualifies as “excess”?
There is more radiation in the world than many people are aware of. Cosmic radiation (from the sky) and terrestrial radiation (from the earth) account for twice the radiation per week as one digital bitewing. In fact the total average radiation dose for an average American per year is 310 times the amount from a checkup set of films (4 bitewings).
None of these numbers matter if we are taking X-rays without a benefit. We use X-rays to diagnose and treat many dental conditions. Our office has upgraded to a digital system that uses a fraction of the dose of a traditional film. Many other dental offices have done the same. As a profession, make every attempt to limit radiation exposure. We use a collimator, a way to focus the beam so it only hits the sensor, as well as lead shielding.
Overall I am pleased to see the medical community continuing to evolve toward safety. By exploring issues like amalgam, fluoride, and X-ray exposure, we can reassure our patients that we are confident about their well being, and continue to provide excellent care. I am very disappointed that the article was released before further studies could be preformed to confirm or debunk the claims. The survey has a very limited sample size, has not established a cause and effect relationship (like it implied), and was based solely on subjects recollection. I would like to see a study designed to confirm a direct cause and effect relationship, not just a correlation. The ADA states that 60% of the U.S. population sees a dentist every year, and I would assume most have had X-rays. Using these numbers, 188,056,360 people in the united states that have been exposed. That would mean (using current incidence of the tumor, 2 cases per 100,000) that .0003% of exposed people develop a meningioma. It seems very unlikely that, with so many people exposed to dental X-rays, and theorizing that X-rays are a direct cause, the incidence of meningioma is so low. The numbers don’t seem to support the claim.
We will look forward to further research that may prove or disprove this relationship.