Snoring – a problem? Ask around! It might be a problem for you, but ask the people around you when you sleep. They will be the people to tell you if it’s a problem – for them! Truth be told? It’s a problem for a lot of people. Since about half of all adults snore at least some of the time, we are all likely to get to deal with this “annoyance”.

Most of us know what snoring sounds like, but what causes it? Snoring occurs when breathing pulls air past the relaxed tissues in the back of the throat and causes the tissue there to vibrate. For many it is simply annoying, but for others, it may indicate a serious health concern.  

There are many things that may contribute to or cause snoring: The anatomy of the mouth and sinuses, including the nose; a cold or allergies may cause the tissue in those areas of your body to swell up and narrow the passage for the air flow; alcohol consumption may  lead to greater relaxation of those tissues; being overweight is a significant contributor since our bellies aren’t the only thing that expands when we are too heavy! And lastly, being a male raises your odds of snoring.

One of the most common areas involved in snoring is the uvula. That’s the triangular or oval shaped piece of fleshy tissue that hangs down in the back of  your mouth. The larger that is, the more the airway is restricted and the more it is present in the path of your airflow to vibrate.

Snoring may be a much bigger concern than simply being a nuisance. Snoring may also be a sign of a serious medical condition called obstructive sleep apnea. Apnea is characterized by periods where a person completely stops breathing while asleep. When that happens, once their body sends out a desperate signal that it needs air, they wake up enough to tighten up tissues to allow the air to pass. For some people this happens many times per hour and can lead to exhaustion. And that exhaustion can lead to falling asleep when the person should be alert, such as when driving — a major potential problem! It can also lead to high blood pressure, heart conditions, and possible strokes.  

A medical evaluation is indicated when you becomes aware of your snoring. The prime purpose of that evaluation is to determine if you are “simply” snoring or if you have sleep apnea or any other medical condition that the snoring is either causing or contributing to. Your medical doctor will want to know when you snore most, how often it occurs, and whether you are aware of ever stopping breathing. There is also an easy screening test that may also be used to provide some information for you and your doctor about your level of alertness or exhaustion.  

If the medical evaluation rules out problems other than snoring, then that snoring can either be ignored (if it is not causing problems for you or others in your life) or treated in a variety of ways.  

Here are some ideas to try for  “self-help” approaches:

• Try changing your sleep position.  
• Avoid consuming alcohol for several hours before going to bed.  
• Weight loss may eliminate the problem.

If those don’t work or aren’t an option, there are treatment approaches with which either your medical doctor or dentist can help you.

• Several surgical approaches are available. In most cases, in my opinion, they are often more involved and carry greater risks than make sense, but there are exceptions to that.
• Treating your allergies may help eliminate the snoring.
• A (CPAP) device (continuous positive airway pressure). This forces air past the soft tissue obstructions, maintaining an open airway and thus eliminating most snoring. This works well, but is usually used for treating obstructive sleep apnea.  It tends to be a fairly costly alternative and many people find it cumbersome or a nuisance.
• Oral appliances are a highly effective alternative. These work by holding a person’s mouth part way open, and thus opening the air passage. These appliances are far less costly than a CPAP.

Snoring is a condition that CAN be successfully treated and doesn’t have to become a life-long annoyance. If you are someone who snores or are the one listening to someone snore, seek help. Rest in peace!

This article originally appeared in Dubuque 365ink magazine. It is republished with permission from the publication.

STRESS! You see it, you feel it, everyone seems to have it – some days more than others, right? That tension you experience finds its way to so many parts of your body, sometimes without your awareness, and sometimes it’s screaming at you. The tightness! The aches! The pains! For many, the discomfort lands in the head, neck, shoulders, jaws, -- and a place that is often overlooked -- the teeth.

Dr. Matthew Messina, a consumer adviser for the American Dental Association, says, “Stress, whether it’s real or perceived, causes flight-or-flight hormones to release in the body. Those released stress hormones mobilize energy, causing isometric activity, which is muscle movement, because that built-up energy has to be released in some way.” That energy may be exhibited in tooth clenching or grinding.

We often see the results of tension and stress as wear on teeth due to clenching and grinding. When we suggest that to people almost everyone tells us they don’t do it, or aren’t aware that they do it. So we suggest that they might notice how their mouth feels when they wake up in the morning; do they feel any tightness or soreness around their temples, jaws, or muscles in their face? Or when they are concentrating at the computer do they notice holding their teeth tightly together? What about the next time they are feeling angry? What’s happening with their jaw? Are they athletes? What about when they are weight lifting for strength training, or on that uphill climb on their bikes? Yep! The next time those folks are reporting, “you know, I catch myself holding a lot tension in my mouth; I find that my teeth are clenched tightly together.” Or “when I wake up in the morning, before I open my eyes, I checked and my jaws were feeling tight and sore – I must be doing that in my sleep!”

So then we need to consider the damage that this stress causes in the mouth, on the teeth, jaws, and muscles of the head and neck. We see this leading to major tooth wear and damage, or causing very sore muscles. Over time it can even lead to wear and damage to the temporomandibular joints (the TMJs), the jaw joints that are located in front of your ears.

Consider this: Dr. Robert Rawdin, a Manhattan prosthodontist, notes that when we chew we “normally exert about 20 to 30 pounds per square inch on our back molars.” As if that isn’t enough force on our teeth, he adds, “teeth grinders, especially at night without restraint, can exert up to as much as 200 pounds per square inch on their teeth.” Just think about how much damage that amount of force can create! For some people the damage is localized to extensive wear or broken or chipped teeth. For others, the muscles or jaw joints take the damage.

While the damage and wear that grinding creates can often be repaired, a far better approach is to prevent it from occurring in the first place. Most grinding and clenching creates some warning signs before the damage is extensive. Regular dental check-ups allow your dentist to monitor those signs to determine if problems are occurring before major damage is the result. And if your dentist determines that there may be a concern, it’s time for you to take steps to prevent further problems.

The first step is often to listen to your body. By choosing to integrate and practice things such as mindfulness, meditation, relaxation and yoga, people can first realize where the tension in their bodies is building up and then learn techniques to eliminate it. Some signs that you may be clenching or grinding your teeth are headaches, over-sensitive teeth, sore facial muscles, jaw pain, flat or sharp teeth, and/or damage or soreness on the inside of your cheeks.

By becoming aware of your patterns and learning to relax your jaw and those muscles, you can prevent problems before they become severe enough to require extensive dental treatment. It’s true: prevention, like honesty, IS the best policy!

This article originally appeared in the January issue of 365ink magazine.

We have always paid a great deal of attention to issues that affect what is now becoming a much more publicized and researched issue, namely the oral-systemic link as it relates to your health.  We’ve always known that there is a huge connection between the health of your mouth and your general health.  In the last few years, research is confirming that connection.  One impact on both is the use of bisphosphonate drugs, such as Fosamax, Zometa, Reclast, Boniva, etc. They have a potentially significant impact on both oral and systemic health.

There has been a great deal written about the benefits and risks of bisphosphonate therapy to treat or prevent osteoporosis, especially in the last ten years.  Many of you, primarily women, have asked me my opinion since there has been a legitimate concern about oral problems in people who have taken one of the bisphosphonate drugs.

The main concern has been a fear of osteonecrosis of the jaw (ONJ) which has been reported as occurring in people taking the bisphosphonate drugs in a far higher than normal rate of occurrence.  Today, the discussion truly needs to be broadened beyond the bisphosphonate drugs to include other, newer medications, that function in similar ways, i.e., they prevent the resorption of bone that occurs in osteopenia and osteoporosis. 

So if I’m saying there is a fear of osteonecrosis of the jaw, what IS it?  Osteonecrosis of the jaw is a severe bone disease that can affect either the upper or lower jaw.  It causes destruction of the bone and can be progressive.  It can be extremely painful, but there is not always pain present.  The most effective treatment for it is to remove the damaged bone surgically, but that sometimes leads to further development of the disease on adjacent bone. 

Some of the initial research was reporting extremely high rates of ONJ in people taking bisphosphonates – some in the 10% range.  While ONJ was reportedly occurring primarily in women who were taking high doses of bisphosphonate therapy to treat breast cancer that had spread to their bones, it was also occurring in people taking much smaller doses to treat osteoporosis and osteopenia.  That was forcing many people, primarily women, to make a choice between avoiding possible ONJ and avoiding possible hip or spinal fractures due to osteoporosis. 

The Journal of the American Dental Association, in its November issue, (JADA 2011; 142(11):1243-1251) published an updated report based on a review of research and other literature that has been published since its previous advisory statement that was released in 2008.  This statement is much more positive than the last one.  The report indicates that the highest reliable estimate of antiresorptive agent-induced osteonecrosis of the jaw (ARONJ) is approximately 0.10%.  That translates to an incidence of 1 per 1,000 people taking any of these drugs.  (This study broadened the focus beyond bisphosphonates to include other related drugs used to treat similar diseases and lumped them all into the category of “antiresorptive agents”, thus the new abbreviation of ARONJ.)

The incidence of severe problems related to osteoporosis is far higher than the percentage of risk for ARONJ, so the recommendation is becoming more clear: if your medical doctor recommends that you take one of the anti-resorptive drugs to treat osteoporosis or other medical conditions, strongly consider taking his/her advice. 

Combining the already low risk of developing ARONJ with meticulous oral hygiene will certainly lower your risk even further.  That’s true because one of the precipitating factors to developing ARONJ is having a tooth extracted or requiring other bone surgery in your jaw.  If you are keeping your mouth in excellent health, your risk of needing any oral surgery is greatly reduced, thus also reducing your risk of developing ARONJ.

I’m delighted to be able to share this with all of you, since I know many of you have anguished over the decision about whether or not to take one of these drugs.  This will significantly reduce your risk of one of the major side effects. 

Please remember that getting an adequate amount of calcium and vitamin D on a daily basis along with performing regular weight bearing exercise will also help control or prevent osteoporosis.  Remember also, the healthier your bones are, the healthier your whole body, including your mouth, will be.

As always, our goal is to help you stay healthy.  Sometimes we can accomplish that through treatment, sometimes by coaching, and sometimes by keeping you well informed about how you can best stay healthy or improve your health.  All of which is our way of “helping you with healthy habits”, a cornerstone of the Kuttler Dental Team’s approach to your care.  Certainly helping you maintain good dental health means we need to pay attention to your total health—and the opposite is just as true.  The healthier we can help you keep your mouth, the healthier the rest of you is likely to be!

--Bill Kuttler, D.D.S.

Recently I was introduced to a magazine called The Sun by a good friend of ours.  I loved it!  She loaned us her January issue, and it contained a variety of articles related to health—a topic of great interest to all of us at Kuttler Dental.  I appreciated the excerpted portion from Normal Cousins’ book entitled Anatomy of an Illness.  Although I’ve read the book before, it was a refreshing reminder of the patient’s perspective, and I appreciated the reminder.

However, the article that I want to highlight was an interview with Dr. Andrew Weil titled “Vital Signs; Dr. Andrew Weil Diagnoses Western Medicine”. Although western medicine was the subject, much of the article could have just as easily been focused on dentistry.  Both medical doctors and dentists are all trained to treat disease far more than we are to prevent it—although I’m happy to say that I believe dentistry has always been in the forefront of prevention and has emphasized it for many years.

Dr. Weil speaks of integrative medicine which he defines as “first and foremost focusing on the body’s natural healing potential, which has been ignored in conventional medical education and training.”He further explains the concept:

• Integrative medicine looks at the whole person, because patients are more than physical bodies. To understand health and illness you’ve got to look at the mental and emotional and spiritual dimensions, not to mention the person’s involvement in a community. If you pay attention only to the physical body, you limit your interventions to those that are often the most expensive and the most potentially harmful.

• Integrative medicine focuses on preventing disease and promoting health. Conventional medicine has failed us here, and that is one cause of the healthcare crisis. We are too occupied with managing cases of established diseases, most of which are lifestyle related and preventable. The essence of prevention is not colonoscopies and mammograms; it is understanding how our life choices reduce or increase the risk of disease. As a society we need to be helping people make better choices.

• Integrative medicine emphasizes the doctor-patient relationship, which was once a major reward of practicing medicine. In the era of for-profit medicine, that relationship has been sabotaged. If you work in a corporate practice that requires you to spend only five to seven minutes with each patient, you can’t form the kinds of relationships that foster healing and provide emotional satisfaction.

• Finally, integrative medicine embraces all therapeutic options that may be of value. That includes many that aren’t even on the radar of conventional medicine — simple, low-cost interventions like breath work and laughter therapy. The preference is for more-natural, less-invasive, less-expensive options whenever possible.

When I read Dr. Weil’s words, one of the big things I take away from them is that he is talking about the importance of first treating the patient and then that person’s disease.  That feels very different to me than treating the disease that happens to be occupying someone’s body.  I remember years ago hearing someone talk about the difference between saying someone is a diabetic versus saying someone has diabetes.  That has stayed with me ever since, and we’ve tried very hard to integrate that approach into our practice.  We try to care for our clients as people who may have dental problems and who almost certainly would like to prevent those problems from re-occurring in the future.

I also read Dr. Weil emphasizing the importance of forming a partnership between the physician ( I read “dentist” ) and the patient.  That resonates with me so very much, because I believe there is little we can do to effectively treat dental disease that doesn’t need to involve the person who has it.  While I can restore decayed or broken teeth, if we don’t change the environment of that person’s mouth, the problems will only re-occur.  And I don’t believe that helps anyone.

Lastly, I appreciate how Dr. Weil stresses the importance of treating the body, mind, and spirit.  While that may seem far out to some folks, especially as it relates to dentistry, I don’t agree.  In dentistry we are trying to prevent, and are treating, “life-style diseases”.  True preventive dentistry is far more than teaching someone to floss.  It is working with people to identify some of the causes of their dental problems—whether those might be cavities, gum disease, teeth-grinding, or others.  I believe those issues are significantly impacted by daily choices—their life’s style.  Whenever we are paying attention to someone’s lifestyle, I believe we are involving the entire person—truly their body, mind and spirit. 

Yes, we fix and clean teeth in our office, but we really want to help people require our services less in the future because they are healthier.  Helping people develop healthy habits is the most valuable service we offer at Kuttler Dental!

-- Bill Kuttler, D.D.S.