Force, the Other Dental Adversary

Besides bacterial decay, the other most common adversary to our teeth is force. In addition to the obvious dilemma of an accidental, traumatic blow to our teeth, the forces of clenching or grinding over time will eventually also cause damage. Bruxism is the term applied to the grinding or rubbing of teeth across one another. Bruxism always damages, only in different ways.

The high incidence and predictability of this self-imposed damage makes bruxism and clenching a high focus in our practice here at Austin Skyline Dental. A high percentage of those bruxing away, either during sleep or subconsciously while stressing through portions of the day, are unaware of the process until it is grossly evident. Our doctors and staff routinely screen our patients for early detection of this insidious process.

Some bruxers and clenchers develop muscle fatigue or stress headaches, while others break down in the temporomandibular joint (TMJ). This often manifests with clicking or popping at the hinge of the jaw. Not uncommon is the uneven wear on the anterior teeth, causing unsightly, shorter teeth. Too often the fracture of posterior teeth is also a result of bruxism. Lastly is breakdown of the supportive soft and hard tissue around the teeth. Gum recession and “V” shaped notches on the cheekward necks of the teeth termed abfractions result from the damaging horizontal forces from bruxism.

Since we can’t stop our patients from bruxing, distributing these otherwise harmful forces is the goal of treatment. Protective splints or “guards” are very conservative and cost effective. When indicated, an equilibration or reshaping of the bite to better distribute force is recommended. Know you will be evaluated for this aspect of risk when becoming a patient in this practice.

While You Were Sleeping?

The question mark is included due to the fact many of us do not enjoy all the rest and recuperation we should during our sleep time. Exhaustive studies from the medical community confirm the quality of sleep is greatly compromised by snoring and sleep apnea. Upper airway resistance is the cause of snoring and more threatingly, sleep apnea. Reduction of proper oxygen saturation of the blood is the problem and cause of the pathology caused by sleep apnea.

Sleep medicine, developed in the last 30 or 40 years, is the specialty appropriate to this dilemma. For optional results, planning should be directed by this type of physician, only then with our collaboration.  Current dental techniques and appliances are an alternative to the continuous positive air pressure, or CPAP, machines provided through the medical community. The objective of either approach is to keep the airway open, removing the constriction that causes both snoring and sleep apnea. Dental sleep disturbance appliances compare nicely for many patients to how much “is going on” with the CPAP machines.  Dental sleep disturbance appliances are more user friendly.

When we sleep, our tongue muscles relax, allowing the tongue to fall back into the oropharynx. This constricts the airway and is the most frequent cause of snoring and sleep apnea. The mechanics of our sleep disturbance appliances is to posture the mandible (lower jaw) in a slightly open and slightly forward position. This posturing draws the base of the tongue forward along with the jaw, maintaining an open airway.

In an equitable situation, most of us agree you should “get what you pay for.” Over the counter sleep disturbance appliances can be effective but pale in comparison to the comfort and quality of those provided by dental professionals and their supportive laboratory technicians. Let’s face it, wearing any appliance is a compromise to falling asleep naturally. We believe such an intervention to natural sleep should bring as few obstacles as possible.  Sleep disturbance appliances from dental professionals and certified dental labs result in a far lower “obstacle index” than either CPAPs or over the counter appliances.

Wearability of such a “thing” in your mouth goes up with the engineering and comfort built into state of the art appliances. There is a threshold to wearability when trying to fall asleep. Less expensive, unmonitored quick fixes from infomercials or the internet will more likely threaten this threshold.

Troubleshooting is integral to our continued care once appliance therapy begins. Close attention to avoid any problem with the temporomandibular joints (TMJ) or unplanned tooth movement, related to appliance therapy, is provided here. Instead of feeling loose or unstable on the teeth, our appliances fit so snugly we often have to make them more relaxed on the teeth. We do this in a conservative specific fashion. In the end, we have wearability!

Sleep partners are inevitably the informal sleep study. What does your sleep partner have to report?

Tooth Restoration

When it is too late for the prevention of decay, tooth wear or fracture, it is time to restore that tooth! The term restoration is carefully chosen. A good percentage of the time, a direct filling is the restoration of choice. Other times, a laboratory crown is required to restore the tooth. The most conservative, effective method to restore your damaged tooth is the goal of Austin Skyline Dental. Our doctors strive to closely evaluate the upside and downside of every close decision.

Fairly often, due to other life obligations such as running a household or raising a family, it is hard to immediately budget in the needed laboratory crown or definitive care. In these instances, when a laboratory restoration needs to be delayed, we innovate through developing a healthy holding pattern. In such an instance, teeth significantly damaged by decay or fracture receive a large filling called a “buildup.” This build up filling resolves decay, deferring the expenses of the crown yet stabilizing the tooth. Though this build up is not a restoration, it is the foundation for the restoration to be later provided. We are a health centered dental office and believe in such a case, we can best achieve eventual optimal health with the buildup.

Routinely we work our way toward health, clearing up both dental and periodontal disease.  Often, this is done before preparing our first laboratory crown. We term this phasing and feel we better serve many of our patients’ well being with this health first focus.  For others, the better service is to prepare the laboratory crown the same appointment as the buildup. Collaboration with informed patients on the risk and benefit of when to develop the laboratory crown is the style of decision making to which our doctors are committed.  Providing the formula that best serves each individual patient is the goal in this practice.  (See Phasing and Buildup)