Well, maybe not always, but it can change how you feel. I recently stumbled across a Scientific American (Sept. 2009) article entitled; Smile! It Could Make You Happier. This article points out, as we all know, we smile because we are happy and we frown because we are sad. But, does the corollary hold true? A study by psychologists at the University of Cardiff in Wales found that when people whose ability to frown is compromised by cosmetic botox injections, they are happier, on average, than people who are able to frown. “It appears that the way we feel emotion isn’t just restricted to our brain – there are parts of our bodies that help and reinforce the feelings we’re having,” says Michael Lewis, a co-author of the study. “It is like a feedback loop.”

I have seen it time and again; we restore a person’s smile and they just seem happier. Not just when it is first completed, but years later. If a person is embarrassed by their smile or just not confident about it, do they smile less? Absolutely! Well, it appears that the lack of smiling may very well have an emotional effect as well. Whether we fix a small chip on a front tooth, a broken mis-matched crown or even whiten teeth, it can make a huge difference in a person’s appearance and their emotional well being. I’ve seen it happen and it is nice to see it verified by a scientific study. The emotional and restorative benefits of an attractive healthy smile can positively affect you in prominent ways.

The following photographs show the “Before” smile on the left and the “After” smile on the right.  These people are definitely smiling a whole lot more than they did in the past!

David Frayer, a client at the Gatti Studio is a paleoanthropologist at the University of Kansas whose research has long focused on the evolution of fossil Europeans.  Teeth have become an important part of his work and following is a link to an article written by him about an artistic view of teeth, which, of course, we find quite interesting and thought you might enjoy it too.  When you get to the article be certain to click on the slideshow to view some unique images.

http://www.scientificamerican.com/article.cfm?id=science-art-neandertal-teeth

Sleep Appliances and Jaw Exercises

In the December 2011 issue of Sleep and Breathing there is an article, “Mandibular Exercises Improve Mandibular Advancement Device Therapy For Obstructive Sleep Apnea”, which I think could be beneficial to many of our current Sleep and TMJ patients. I would like to briefly touch on the importance of the article and share a simple set of exercises with you that may be of great benefit.

Although the study was to evaluate the effect of exercising the mandible on Temporomandibular disorders (TMD) in patients wearing oral appliances for the treatment of snoring and obstructive apnea, I believe these exercises can benefit most everyone that suffers with TMD. These mandibular exercises were found to be effective in reducing pain and therefore increasing compliance of wearing the appliance.

Following are the exercises that were utilized:

This protocol consisted of coordinated exercises to stretch the mandibular muscles, and it was adopted to control pain in those individuals hampered by TMD pain.

For coordinated movements, patients were instructed to perform sequences of exercises by controlled mouth opening. This was achieved by maintaining the tongue in contact with the palate, followed by a sequence of lateral left-right movement of the mandible against light-hand resistance. This type of movement was used with the intent to exercise the lateral pterygoid muscles and the TMJ. For stretching, they used the movement of opening the mouth against light resistance of the hand, followed by a maximum opening of the mouth assisted by the fingers, with the intent of stretching the temporal and masseter muscles. Patients were instructed to exercise twice a day, in three sets of five repetitions of each movement.

These exercises have proven to be efficient and effective in the treatment of TMD in general and with mandibular advancement appliances (snore and OSA appliances) as well.

Concerned about overall health, oral health or just worried
about bad breath? Tongue cleaning on a daily basis is important for all of the aforementioned. The tongue collects an unbelievable number of living and rotting organisms as well as infected mucus, bacterial biofilm and food debris. Numerous studies indicate that up to 90% of halitosis comes from the mouth and about 80% of that comes from tongue debris.

It is important to utilize tongue scraping or tongue cleaning for more than bad breath. One of our biggest concerns is the prevention of dental decay and periodontal disease. Even though you may brush
and floss meticulously, if you don’t clean your tongue, guess where all that bacteria on your tongue goes? You guessed it – right back on your teeth and gums, thereby reinfecting those areas. For the best oral hygiene, tongue cleaning becomes essential. As you are most probably aware, the implications of dental disease go beyond the oral cavity and are a contributing factor to an entire host of systemic diseases. So, whatever you can do to keep your mouth healthy, directly contributes to your overall health.

Brushing your tongue with a standard toothbrush is really not adequate to thoroughly clean your tongue. There are a variety of tongue scrapers readily available on the market. They vary in width, shape, size and material. Some look like a rake, while others are more like a strap. I suppose it is a lot like a toothbrush in that much of the design you like is purely personal preference. My preference is a simple flexible plastic tongue scraper. The good thing is that they are all rather inexpensive and work for a long time.

Using a tongue scraper is very simple. After you floss and
brush, open your mouth wide and fully extend your tongue. Then place the scraper as far back on your tongue as is comfortable the first time and progressively go further during subsequent cleanings. Use gentle strokes. Do this repeatedly until you no longer are able to remove debris. I only take a few seconds. The next time you are at the Studio we will be happy to review the technique with you. Just realize that the significance of the debris on the tongue is enormous and can be very negative. It is easily removed with a tongue scraper and should be done so daily or as often as it accumulates.

AirFloss is a new piece of dental hygiene technology for cleaning between your teeth that has recently been introduced by Phillips, the maker of Sonicare. The device works by delivering a rapid burst of air and water droplets designed to disrupt the biofilm (June 26, 2011 blog  http://blog.gattidds.com/?s=biofilm ) between your teeth. The force behind the AirFloss is powerful enough to remove plaque while remaining gentle on your teeth and gums.

The AirFloss has a tip designed to guide it between your teeth. Once in place, click on it and a microburst occurs. This point-and-click is then repeated around the mouth. Typically this will take 60 seconds or less to complete the entire mouth.

This device usually costs between $80 and $90. It comes with a charging base or you can use your Sonicare recharging base if you already own a Sonicare brush. Typically the charge will last around two weeks.

The question that often arises is, “Is it better than flossing my teeth?” The short answer is NO. The AirFloss was developed to bridge the gap for those individuals that need to floss, but don’t. At the Studio we recommend the AirFloss for our clients that have found flossing to be unrealistic for a variety of reasons. So, if you floss your teeth daily, continue. If you can’t manage the floss or don’t want to, this may be a good option for you.

For individuals who wear a night time appliance for the prevention of snoring and/or obstructive sleep apnea one of my major concerns has always been change occurring to the bite. When the lower jaw is held in a forward position (as is done with appliance therapy) the lateral pterygoid muscle is shortened. If the muscle is not stretched back out to its full length every morning, changes to the bite will and do occur.

Patients often ask what I mean by change. The one that concerns me the most is an open posterior bite. In other words, the back teeth no longer come completely together when biting – they don’t touch. This can be rather insidious because a person can still function normally and may be unaware any change has occurred. One study showed that 70% of those people wearing mandibular advancement devices (the appliance we use to treat snoring and obstructive sleep apnea) for two years have changes in the bite of which they are unaware. An interesting aside is that there is now substantial evidence that CPAP (continuous positive airway pressure) devices are causing significant bite changes as well.

Initially we used bite tabs and jaw exercises to regain the normal bite each morning. For the past year I have been using a new adjunct device – the AM Aligner – with a great deal of success. This has proven to be the most effective, quickest and easiest way for a person to establish their normal bite each morning. Typically it takes about one minute each morning to use the AM Aligner.

I believe anyone wearing a mandibular advancement device for snoring and/or sleep apnea should have their occlusion or bite evaluated routinely to make sure no changes are occurring. To date, we have found the AM Aligner to be the best and easiest way to help prevent changes in the bite.

Lasers have been used in dentistry for decades. Many different types of lasers with various wavelengths have been adapted for oral use. Today dental lasers can be broadly divided into two groups; those for use on hard tissue (teeth and bone) and those for soft tissue (lips, tongue, gums and muscle).

Lasers for use in dentistry continue to evolve. A couple of years ago I decided that soft tissue lasers were now at a place that it would be useful to incorporate into our dental practice. At the studio I have been utilizing a soft tissue diode laser for the last year. I have found it to be advantageous in treating several specific situations. Some of these indications are as follows:

*  Removing gum tissue around deep dental decay. On occasion I run into a cavity that has gone well below the gum tissue. By utilizing the laser two issues can be addressed better than ever before. One is visualization. The laser allows me to remove the gum tissue that is blocking my view of the area of decay. Secondly, it can be done in such a way that all of the bleeding is eliminated – this is critical because blood will negatively affect the set, bond and strength of all dental fillig materials.

*  Removal of cysts, tumors and growths. With a soft tissue laser I am able to remove the lesion and cauterize the area in one step. The healing time is faster and there are not any stitches that will need to be removed. It is painless and there are no annoying stitches for your tongue to play with. Any tissue that is removed can and will still be sent in for a pathology report in order to confirm the diagnosis and rule out a cancerous lesion.

*  The elimination of a hemangioma or veneous pool. These lesions tpically appear on the lip as a purple spot. Often times they can be elevated. They are completely benign, however they can be very unsightly. In the past the problem was that if you tried to remove them they would bleed like crazy and it was sometimes difficult to eliminate the source. With the use of the laser they are easily eliminated in a painless fashion, without having to put stitches in the lip.

Over the last year I have found the soft tissue dental laser to be a real beneficial addition to our practice. I am better able to serve my patients and have found it absolutely invaluable in certain situations.

Last week I attended the 20^th anniversary meeting of the American Academy of Dental Sleep Medicine. The three day event was, as usual, filled with great interaction and presentations. I have to tell you that listening to scientific research is not my favorite thing in the world, but important. The topics varied from Effects of Mouthpiece Use on Gas Exchange Parameters during Steady State Runs in College Males and Females to TMD and
Nocturnal Bruxism to Pharmacology of Sleep Disorders Medications, to Risk Factors Associated with Sleep Related Breathing Disorders, to name just a few. Guess what, even the thought of Pharmacology makes my head hurt – thank goodness there are people who love this stuff.

Given all of the meetings and presentations, it is impossible to summarize all that was learned or even what I was left wondering about; however there were a couple of key items that made a strong impressionon me. First, it is not normal for a child to snore. If you have a child that snores, at minimum I would have an evaluation done by an ENT (ear, nose and throat physician.) Secondly, there is a growing amount of evidence that routine snoring is pathologic and progressive and should not be ignored. There was preliminary research presented that demonstrated physiologic changes that occur in the soft tissue of the throat that are destructive and possibly irreversible. Basically, if snoring vibrations cause local nervous lesions in the upper airway, this trauma repeated night after night, could explain the progressive nature of the disease. In essence, snoring may cause Obstructive Sleep Apnea. Thirdly, I have long known that snoring and sleep apnea appliances can cause bite changes, but now there is a growing amount of evidence that CPAP can also alter the bite.

The bottom line to all of this is that the more you know the more you realize that you don’t have all of the answers – nobody does. The treatment of snoring and sleep apnea is a rapidly growing area in dentistry. It is not nearly as simple as you might think and equally important is that it is not as simple as many dentists are led to believe by the marketing materials that every dentist receives on a weekly basis.

I have been in the private practice of general dentistry since 1983 and it is still amazing how much more there is to know. The old adage, “The more you know, the more you don’t know,” is so true. I guess the continual challenge is what keeps this fun and exciting.

If I can help you or someone you know with their snoring or untreated sleep apnea (a.k.a. my CPAP is in the closet and no way am I ever wearing it) please let me know.

Sincerely,

Joe Gatti, DDS

You have long heard, “Brush your teeth after every meal,” or “Brush your teeth twice a day.” Is any of this based on fact or is it just something your mother told you to do. Well, there are several answers to why you should brush your teeth multiple times per day and they range from removing stains and food debris, avoiding bad breath, preventing dental disease and other points as well. Ultimately, if prevention of dental disease is one of your primary objectives then brushing and flossing your teeth twice a day becomes very important.

Here is the reason this becomes important for dental health, systemic health and preservation of the great smile. What actually leads to disease in your mouth is Biofilm – the sequential build up of bacteria. This happens in a very predicable pattern. The first bacteria to collect on your teeth are not pathogenic – they do not cause dental disease. However, they do form a “sticky” lattice work for destructive bacteria to build upon. In a free floating state these bacteria cannot cause disease. It is when they become attached to the teeth and gums and are allowed to multiply that they cause destruction. If you are genetically susceptible to periodontal disease, it may then begin to develop.

So, when you put all of this together, the reason for brushing and flossing those areas that are not reachable by brushing is to disrupt the biofilm and prevent colonization of destructive bacteria. When this mechanical debridement is done it forces the biofilm to keep starting over again.

I’m sure you have read much over the last few years about the correlation between multiple systemic diseases and dental health. The inflammation in your mouth due to the development of biofilm is most likely what is contributing to the total inflammatory burden and therefore increases the risk for systemic disease.

I will go over the reason that brushing and flossing before bedtime is the most important time and what type of toothpaste you should use in a future blog. For now, just know that brushing your teeth multiple times per day for better health is not just an old wives tale.

For better health,

Joseph R. Gatti, D.D.S.  and the entire team