Friday, January 29, 2010

Gum Disease & Periodontitis

I often ask people how their mouth is feeling when they are in my office. Hardly anyone ever says - wait, I've never heard anyone say - "Doc, I think I have gum disease occurring and progressing." Why's that?

Gum disease is a tricky disease. It's unlike a toothache. If you have a toothache, it will hurt and you will know something is wrong. Gum disease (be it a reversible state called gingivitis or one with irreversible and progressive bone loss called periodontitis), typically won't hurt even if it progresses from the reversible to irreversible state. It's been said that hypertension (high blood pressure) is the silent killer because you won't feel it if you have high blood pressure; high blood pressure needs to be detected and diagnosed by measuring it. Same thing with gum disease -- you need to have x-rays to evaluate bone levels and routine periodontal charting (gum level measurements) to detect gum disease. Well actually, you can detect gum disease on your own. But that's when it's much too late and your teeth are wiggly or you notice a lot of spacing between your teeth, etc. So whenever I get a patient that says that they haven't been to the dentist in many years and everything feels fine, 9/10+ times I know there is periodontitis occurring.

If you have any questions for Dr. Tuan Pham, please give us - your South Austin Dental team - a call or email us!

Tuesday, January 26, 2010

Sleep Apnea!

So I decided to finally start blogging about dentistry...things and subjects that I find pretty exciting.

So I have sleep apnea. I didn't realize it for a very long time....I just knew I was tired all the time and naps were my favorite things in the world. I knew I snored, but I figured so what, many people snore. Then one day, I started to notice myself waking up and gasping for air. Finally one day I just decided that I'm just tired of being tired. So I made an appointment with an ENT.

ENT's suggestion was to first get a PSG (polysomnogram) to diagnose and confirm if I do have sleep apnea. But from my symptoms and Epworth sleep scale (used to give doctors an idea of how likely you have sleep disorder), it was already likely that I had it. So technicians came to my house and hooked up wires to me and off to bed I went. Sleep study w/o a doubt confirmed that I had moderate sleep apnea. BTW, sleep apnea is classified by AHI which is apnea hypopnea index. It consists of instances of not breathing greater than 10 seconds divided by hours slept. Try holding your breath for 10, 20 or more seconds. That's super hard to do. Some people with apnea, do this hundreds of times a night. Some people have oxygen saturation levels that drop to 80 percent or even lower. You can't even do that by holding your breath!

So back to the ENT I went. ENTs are very familar with 2 modalities of treatment typically: cpap and surgery. CPAP can be great for many people with apnea, particularly people with severe apnea. Biggest disadvantage is obviously a large machine and mask (although newer machines are much smaller and more comfortable now). Surgery can also be very good especially when other modalities of treatment have been tried and don't work. Down side is obviously it's an irreversible surgical procedure and healing times are often not pleasant.

I personally decided after looking at CPAP machines on line that there is absolutely no way I could sleep with one. I'm single and I don't want anyone seeing that machine in my bedroom. I also decided that while surgical options are always an option, I do not want to try something irreversible at this point and I just couldn't take off time from work for 2+ weeks to recover. So time to research 3rd option which are Mandibular Advancement Devices (MAD) aka Oral Appliance Therapy (OAT).

The premise of these devices are that if you advance your jaw forward, your airway opens and you breathe much better. MRI studies confirm this. The main advantage, besides being non-surgical, is that it is a very conservative approach. Nothing is done to the tooth structure. These devices consist of taking an impression of your jaw, recording a position of advancement, delivering it and titrating it until you don't snore and feel better. Down sides include possible bite changes and TMJ pain. I've had mine for months now and do not notice any of these side effects.

After doing research on this, I visited Dr. Kent Smith in Dallas and had a device made myself. He's one of the top instructors on sleep apnea for dentists. I eventually had a sleep study done again to confirm the effectiveness and indeed my AHI index has dropped to mild/no-apnea state. I sleep better and no longer snore (previoulsy it was up to 60-70 dB which is REALLY LOUD). Since I realized how well it works, I decided that I must offer this great service to patients especially since I realized a couple things:

1. sleep apnea increases risk of cardiac infarction (heart attack) by 22.3x. obesity is 7x, hypertension is 7.8x and smoking is 11x.
2. apnea is also highly correlated with behavioral issues in kids like ADHD.
3. apnea is more prevalent than diabetes!!

In any case, my office is now starting to treat sleep apnea. If you are CPAP intolerant or are interested in trying a different treatment option, consider dental oral devices. We would need to diagnose and evaluate your condition, but they may work great for you!

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