Adjunctive Services
1. Whitening teeth.
Many products currently on the market promise whiter, brighter teeth. The American Dental Association (ADA) says that if you are a candidate for a whitening procedure, your dentist may suggest a procedure that can be done in a dental office. Other options include at-home products, which your doctor may give you or you can purchase over-the-counter. But, dental professionals, and the ADA, caution you about the improper use of such over-the-counter products. They are sometimes too abrasive and can damage the teeth with extended use.
The ADA describes “whitening” as any process that will make teeth appear whiter, using one of two ways. A product can bleach the tooth, therefore changing the natural tooth color. A bleach contains peroxide that helps remove deep and surface stains. However, a non-bleaching whitening product contains substances that help remove surface stains only.
Who may benefit from teeth whitening?
| Most beneficial | Moderately beneficial | Not recommended |
|---|---|---|
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What are some different teeth-whitening methods?
The dentist will prescribe either an in-office bleaching system while you are in the dental chair, or a dentist-supervised, at-home bleaching, which is more economical and, in many cases, gives the same results.
One option for at-home bleaching involves using a custom-made tray that can be worn comfortably while you are awake or sleeping. The tray is so thin that you should even be able to talk and work while wearing it. Some bleaching systems recommend bleaching your teeth from 2 to 4 hours a day. These usually take 3 to 6 weeks to complete and work best on people with sensitive teeth. Other systems recommend bleaching your teeth at night, while you sleep, which may take only 10 to 14 days to complete. Your dentist can recommend the best system for your needs, and instruct you on the correct usage.
Recently, more over-the-counter products are available that offer simple whitening solutions. However, they may not provide the dramatic improvement that a professional treatment option offers.
Side effects and health risks
The American Dental Association has granted its seal of approval on some teeth whitening products. Talk to your dentist about which products are most effective and safe to use.
Gum irritation and increased tooth sensitivity are the most common side effects of teeth bleaching with peroxide solutions.
Many products currently on the market promise whiter, brighter teeth. The American Dental Association (ADA) says that if you are a candidate for a whitening procedure, your dentist may suggest a procedure that can be done in a dental office. Other options include at-home products, which your doctor may give you or you can purchase over-the-counter. But, dental professionals, and the ADA, caution you about the improper use of such over-the-counter products. They are sometimes too abrasive and can damage the teeth with extended use.
The ADA describes “whitening” as any process that will make teeth appear whiter, using one of two ways. A product can bleach the tooth, therefore changing the natural tooth color. A bleach contains peroxide that helps remove deep and surface stains. However, a non-bleaching whitening product contains substances that help remove surface stains only.
Who may benefit from teeth whitening?
| Most beneficial | Moderately beneficial | Not recommended |
|---|---|---|
|
|
|
What are some different teeth-whitening methods?
The dentist will prescribe either an in-office bleaching system while you are in the dental chair, or a dentist-supervised, at-home bleaching, which is more economical and, in many cases, gives the same results.
One option for at-home bleaching involves using a custom-made tray that can be worn comfortably while you are awake or sleeping. The tray is so thin that you should even be able to talk and work while wearing it. Some bleaching systems recommend bleaching your teeth from 2 to 4 hours a day. These usually take 3 to 6 weeks to complete and work best on people with sensitive teeth. Other systems recommend bleaching your teeth at night, while you sleep, which may take only 10 to 14 days to complete. Your dentist can recommend the best system for your needs, and instruct you on the correct usage.
Recently, more over-the-counter products are available that offer simple whitening solutions. However, they may not provide the dramatic improvement that a professional treatment option offers.
Side effects and health risks
The American Dental Association has granted its seal of approval on some teeth whitening products. Talk to your dentist about which products are most effective and safe to use.
Gum irritation and increased tooth sensitivity are the most common side effects of teeth bleaching with peroxide solutions.
2. Occlusal Guard
The term “occlusal” refers to the surfaces of your teeth that are used for chewing. When you are damaging those surfaces by clenching or grinding your teeth, an occlusal guard may be recommended by your dentist.
Also referred to as a nightguard, bite guard, or bite splint, an occlusal guard is a removable appliance that fits over your upper or lower teeth. It helps prevent damage to your teeth that can be caused by grinding and clenching, a destructive oral habit also known as bruxism.1
While occlusal guards don’t necessarily stop you from grinding or clenching, they do help protect the tooth surfaces from damage caused by those actions. Occlusal guards can also help alleviate the symptoms associated with bruxism including jaw pain, head and neck muscle pain, tooth wear and fracture, tooth sensitivity, and headaches.
Occlusal guards are similar in appearance to sports mouthguards but are typically less bulky and are made of smoother, thinner plastic.2 They can be custom-made by your dentist to fit your mouth exactly, bought at a neighborhood drugstore ready-made (boil-and-bite or microwaveable), or purchased online.
Do you need an occlusal guard or nightguard?
You may be wondering if you’re in need of an occlusal guard or nightguard. While occasional teeth grinding or clenching should not be a major cause of concern, consistent, long-term bruxism can lead to pain, broken teeth, loss of tooth enamel, and in severe cases – loss of teeth themselves. For these individuals who experience moderate to severe bruxing, an occlusal guard could greatly benefit oral health.
Bruxism is a fairly common problem. It is estimated that about 10 percent of adults and as many as 15 percent of children are affected.3 This grinding and clenching typically occurs at night, but may also be a daytime habit, and most people are unaware they have the problem. Unless your sleep partner complains about the noise, your dentist is usually the first to recognize the damage to your teeth and raise concern.
Some symptoms that may indicate the need for an occlusal guard include: 4
o Teeth clenching and grinding
o Jaw pain or stiffness
o Fractured or worn-down teeth and dental restorations
o Loose teeth
o Temperature-sensitive teeth
o Headaches, earaches, toothaches in the morning
o Facial pain
o Disrupted sleep
o Sleep partner complains about the noise
Types of occlusal nightguards 5
There are three common types of occlusal guards used to limit the effects of bruxism. If you have any questions about which type is the best for you, then we recommend speaking with your dentist who will be able to advise.
1. Soft nightguard – Used to alleviate symptoms for mild cases of bruxism. They fit comfortably and are usually easy to get used to wearing.
2. Dual laminate nightguards – Designed for moderate to severe teeth grinders. They have a soft, comfortable, inner surface and a hard, durable outer surface.
3. Hard nightguards – Used for very severe cases of bruxism. They are made from acrylic, are extremely durable and long-lasting, and will need to be custom-fit by a dentist.
Other things to know about occlusal guards 6
Your occlusal guard is intended to make your mouth feel more comfortable. If it doesn’t, then you may not have the right fit. Your occlusal guard may need to be adjusted after placement, and, if it feels uncomfortable in any way or if you experience any pain, then it’s best to let your dentist know. They’ll be able to help.
Most occlusal guards are worn at night only, but those who grind or clench their teeth during the day may also benefit from daytime wear. If esthetics are a concern, your dentist can make a custom guard for daytime use that is significantly less visible from the front – but may also be less durable than those worn at night.
It is extremely important to clean your occlusal guard before and after each wear as they are prone to colonization by bacteria or other microorganisms7. Insufficient care can lead to greater oral health problems or the spread of other diseases.
Final thoughts
Occlusal guards won’t stop you from clenching or grinding, but they can be a very effective way to protect your teeth during the day or night if you suffer from those unconscious destructive oral habits. If you do decide to get an occlusal guard, the type you choose will depend on the severity of your individual condition, as well your comfort needs and financial limitations.
If you have any questions about whether you need an occlusal guard, we recommend seeing your dentist for an evaluation. He or she will be able to diagnose any bruxing damage and help guide you through treatment options.
3. Sleep Apnea Appliance
What is obstructive sleep apnea?
Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing many times during sleep, sometimes hundreds of times during the night.
There are three types of sleep apnea: obstructive, central and mixed. Obstructive sleep apnea (OSA) is the more common of the three. Obstructive sleep apnea occurs when the upper airway is blocked either partly or completely during sleep. During an apnea episode, the diaphragm and chest muscles work harder as the pressure increases to open the airway. Breathing usually resumes with a loud gasp or body jerk. These episodes can interfere with sound sleep, reduce the flow of oxygen to vital organs, and cause heart rhythm problems.
In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center. Central apnea is related to the function of the central nervous system and not treated by oral appliance therapy.
Mixed sleep apnea is a combination of both obstructive and central sleep apnea.
Who gets obstructive sleep apnea?
Obstructive sleep apnea occurs in about 25 percent of men and nearly 10 percent of women. Obstructive sleep apnea can affect people of all ages, including babies and children and particularly people over the age of forty and those who are overweight. Certain physical traits and clinical features are common in patients with obstructive sleep apnea. These include excessive weight, large neck, and structural abnormalities reducing the diameter of the upper airway, such as nasal obstruction, a low-hanging soft palate, enlarged tonsils, or a small jaw with an overbite.
What causes obstructive sleep apnea?
Obstructive sleep apnea is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses during sleep. Central sleep apnea is usually observed in patients with central nervous system dysfunction, such as those who have had a stroke or who have neuromuscular diseases. It is also common in patients with heart failure and other forms of cardiac and pulmonary disease.
What are the symptoms of obstructive sleep apnea?
Often the first signs of obstructive sleep apnea (OSA) are recognized not by the patient, but by the bed partner. Many of those affected have no sleep complaints. The most common symptoms of OSA include:
- Snoring
- Daytime sleepiness or fatigue
- Restlessness during sleep
- Sudden awakenings with a sensation of gasping or choking
- Dry mouth or sore throat upon awakening
- Intellectual impairment, such as trouble concentrating, forgetfulness, or irritability
- Night sweats
- Sexual dysfunction
- Headaches
Symptoms in children may not be as obvious and include:
- Poor school performance
- Sluggishness or sleepiness, often misinterpreted as laziness in the classroom
- Daytime mouth breathing and swallowing difficulty
- Inward movement of the ribcage when inhaling
- Unusual sleeping positions, such as sleeping on the hands and knees, or with the neck hyper-extended
- Excessive sweating at night
- Learning and behavioral disorders
- Bedwetting
What are the effects of obstructive sleep apnea (OSA)?
If left untreated, obstructive sleep apnea can result in a number of health problems including hypertension, stroke, arrhythmias, cardiomyopathy (enlargement of the muscle tissue of the heart), congestive heart failure, diabetes, and heart attacks. In addition, untreated sleep apnea may be responsible for job impairment, work-related accidents, and motor vehicle crashes as well as academic underachievement in children and adolescents.
What if I have been diagnosed with obstructive sleep apnea (OSA)?
If your doctor has found that you have OSA, you will be offered treatment options. Generally, the gold standard for treating OSA is a continuous positive airway pressure (CPAP) machine. For various reasons, CPAP may not work for you. Another option is oral appliance therapy which resembles a mouth guard used by athletes.
PROCEDURE DETAILS
How does oral appliance therapy work to treat obstructive sleep apnea (OSA)?
For patients with mild to moderate obstructive sleep apnea, dental appliances or oral mandibular advancement devices that prevent the tongue from blocking the throat and/or advance the lower jaw forward can be made. These devices help keep the airway open during sleep. A sleep specialist and dentist with expertise in oral appliances for this purpose should jointly determine if this treatment is best for you.
How do I order an oral appliance for obstructive sleep apnea (OSA)?
If you and your doctor decide that an oral device is a good option, you will need a referral to an appropriate dentist to have an evaluation. The dentist will decide if you are a candidate for this treatment and make an impression of your teeth. The dentist will make the device and call you back for a fitting. You will also be given a morning repositioner to realign your bite after the appliance is removed. He or she will also give you instructions on how to use and clean the appliance. You might also have to go back to the dentist for further custom adjustments to optimize care. Once care is completed, it is recommended that have another sleep test to see how the appliance is working for you. Further adjustments may be necessary.
RISKS / BENEFITS
What are the risks of oral appliance therapy for obstructive sleep apnea (OSA)?
The risks of oral appliance therapy include:
- Bite changes
- Pain in the jaw, teeth, and temporomandibular joint (TMJ) pain
- Loose teeth
- A need for dental work replacement
- Excessive drooling
- Mouth dryness
What are the benefits of oral appliance therapy for obstructive sleep apnea (OSA)?
Oral appliance therapy:
- Can improve symptoms of OSA, including daytime sleepiness, moodiness, concentration issues and reduce or eliminate snoring.
- Offers another option for people who cannot tolerate CPAP
- Is easier to take along when traveling
- Works without electricity
- Is quiet
WHEN TO CALL THE DOCTOR
What questions should I ask my doctor and dentist about an oral appliance to treat obstructive sleep apnea (OSA)?
- How much does oral appliance therapy cost?
- Will oral appliance therapy be covered by medical or dental insurance?
- What kinds of problems should I be looking for?
- How many visits will this require?
- How many sleep tests will I need to take?
- How long will the device last?
- Are there things that I should avoid doing or eating?