Patient FAQs Palo Alto

• Sleep Disordered Breathing (which includes Sleep Apnea or Upper Airway Resistance
  Syndrome) is a serious sleep disorder that impairs your breathing while asleep.
  Anyone can have Sleep Disordered Breathing, even children.
• Symptoms of Sleep Disordered Breathing may include:
  • Headaches
  • Lack of energy
  • Daytime sleepiness
  • Snoring
  • Difficulty falling asleep and staying asleep
  • Difficulty breathing while asleep

• Snoring and Sleep Apnea occur when the soft tissue structures of the upper airway collapse, resulting in a narrowed airway opening. The snoring sound is caused by the vibration of these tissues. Complete closure of the airway is an “apnea event,” which means that no air is getting into the lungs.
• The causal factors may include:
  • Structural – narrow jaw, large tongue, enlarged tonsils, enlarged adenoids, thick soft palate, small nasal valve, or deviated septum
  • Other factors – allergies, over consumption of alcohol, sedatives, smoking, disruption of normal sleep patterns or decreased lung capacity (often caused by obesity)

• Poor performance at work or school
• Forgetfulness
• Irritability
• Anxiety
• Depression
• High blood pressure
• Diabetes
• Stroke
• Heart attack and heart failure

• A useful screening tool to help determine if you have, or are at risk for, Sleep Disordered Breathing is the Epworth Sleepiness Scale (See Below).
• In order to fully diagnose Sleep Disordered Breathing, you must participate in a Sleep Study that monitors your sleeping overnight. Your medical or dental professional can help direct you to this service.

Once it has been confirmed you have Sleep Disordered Breathing, a physician will determine treatment which may include:

• CPAP (positive airway pressure)
• Surgery
• Sleep Appliance Therapy

A Sleep Appliance, or “Nightguard,” is a removable device worn in the mouth during sleep that helps control sleep apnea and snoring, thus improving sleep quality. The appliance gently positions the lower jaw and tongue slightly forward. This opens space in the back of the throat and reduces tissue obstruction to help keep your airway open and clear during sleep.

Sleep Apnea may pose serious health risks since it disrupts normal sleep patterns and can reduce normal blood oxygen levels. This can result in problems such as daytime sleepiness, driving and work related accidents, irregular heartbeats, high blood pressure, heart disease, stroke, obesity, and memory and learning problems. By wearing an oral appliance during sleep, your body may be able to maintain higher blood oxygen levels and decrease the severity of problems associated with Sleep Disordered Breathing.

Short term side effects may include excessive salivation, difficulty swallowing with appliance in place, sore jaw, sore teeth, jaw joint pain, dry mouth and short term bite changes. Most of these side effects are minor and resolve quickly on their own.

Long term complications may include permanent and significant bite changes as a result of wearing a Sleep Appliance. Follow-up visits with the provider of your Sleep Appliance are needed to ensure proper fit and effectiveness.

Other accepted treatments for Sleep Disordered Breathing may include behavioral modifications, positive airway pressure (C-PAP) and various surgeries.

Follow-up visits with your provider are mandatory to ensure a proper fit and to examine your mouth to assure a healthy condition. Alert your provider if you experience any changes. After fitting your Sleep Appliance, a Sleep Study is necessary to objectively assure effective treatment.

The following materials and techniques may be used in your non-surgical
periodontal therapy:

• Hand held instruments known as scalers and ultrasonics to clean
  the teeth.
• Local anaesthetic (numbing) to control sensitivity.
• Diabetes
• Anti-bacterial rinses to help decrease plaque and calculus.
• Antibiotic and antiviral pills to help kill bacteria and viruses and reduce
  the destructive response some people have to periodontal infections.
• Laser treatment to control bacterial levels around affected areas.

Some potential benefi ts of non-surgical periodontal therapy include:

• Eliminating the infection present
• Controlling further infections and bone loss
• Reducing swollen and bleeding gums
• Reducing bad breath
• Avoiding tooth loss
• Decreasing the risk for diseases associated with periodontal disease
  such as cardiovascular disease, diabetes and rheumatoid arthritis
• Decreasing the risk in pregnant women of low preterm low birth weight
  babies

Some potential risks following treatment may include:

• Tenderness of the gums for a period of time
• Open spaces developing between the teeth at the gum line due to
  shrinkage of previous swollen gums; these spaces may trap food and
  cause increased temperature sensitivity of the teeth for a period of time.
• Temporary tooth staining from certain anti-bacterial rinses

The alternatives to non-surgical periodontal therapy are:

• Surgical periodontal therapy
• No treatment

It is important to understand that periodontal disease is not curable.
In the early stages it may not even be noticeable to you. If you do not
manage your disease by performing excellent home care, attending
recommended cleaning intervals at your dental offi ce and adopting
appropriate periodontal therapies, you must recognize the risk of further
periodontal infection and ultimately tooth loss.

Gingivitis occurs when plaque is allowed to build up around a tooth and create

a sticky layer which causes a gum infection. If you look in your mouth you will see

redness, swelling and bleeding of the gum around your tooth.

Periodontitis occurs in susceptible patients when a long-term gum

infection is not treated. Infection and resultant inflammation lead to loss

of ligament and bone around the root of your tooth.

Factors which significantly increase the risk of developing periodontitis

include:

• Genetics
• Smoking
• Diabetes
• Medications (certain anti-seizure, blood pressure, and immunosuppressant medications)
• Stress
• Poor Oral Hygiene

To minimize your risk of future periodontal disease, you must be mindful of the risk
factors stated above. Gingivitis is usually well managed by adopting excellent
oral hygiene practices. Periodontitis is more difficult to manage.
Protocols recommended by your dentist may include:
Non-Surgical Periodontal Therapy

• root cleaning (scaling and root planning) at the appropriate interval
  to manage your risk for bone loss
• anti-bacterial mouth rinses
• oral antibiotics
• customized home care instruction
• smoking cessation counselling Surgical Periodontal Therapy
• recontouring of gum and bone around affected teeth to allow better
  access for professional root cleaning and daily home care

Surgical Periodontal Therapy

• recontouring of gum and bone around affected teeth to allow better
  access for professional root cleaning and daily home care

Bite problems on periodontally affected teeth can lead to accelerated
periodontal disease and loosening of the teeth.
If signs of a bite problem are present, the following may be considered to
balance your bite and relieve excess pressure on periodontally involved
teeth:

• bite therapies including deprogramming and equilibration
• orthodontic repositioning of teeth
• replacement of worn or damaged teeth
• replacement of worn or damaged fillings
• replacement of missing teeth
• use of a custom-fitted bite guard to protect from grinding or clenching forces

As uncontrolled periodontitis is progressive in nature, it will lead to increased bone loss and eventual tooth loss;
ultimately affecting your ability to eat and speak. There are also connections between periodontal disease and
other chronic diseases of the body such as cardiovascular disease, diabetes and rheumatoid arthritis. In pregnant
women, periodontal disease is strongly linked to preterm, low birth weight.

Most commonly, your own gum tissue is used for a gum graft. It is taken from an area in your mouth where it is abundant and transferred to the needed area. Sometimes a commercial material made from natural tissue is substituted to build up the gum around teeth and implants.

Gum grafts stop the continued recession of your gums away from your teeth. They may help decrease painful root sensitivity by covering up the exposed root surface. Grafts also protect the exposted root surfaces from excessive wear and notching. Gum grafts greatly improve the looks of the affected teeth and implants. Food accumulation around the teeth may be reduced after grafting.

The biggest risk to gum grafts is that they may not heal properly. They also may not integrate with the surrounding gum or may shrink while healing resulting in less coverage than anticipated. A gum graft may need to be repeated to get the desired result. Graft surgery can be painful for several weeks after the procedure, particularly when tissue is taken from the roof of your mouth.

The alternative is to do nothing and risk continued progression of the recession around the affected teeth or implants.

Abnormal tooth alignment and biting pressure are both important causes of gum deformities. Teeth that are tilted, crowded or rotated increase the risk for bone and gum defects. In order for a gum graft to be successful, tooth positioning issues and bite problems may need to be managed before performing the surgery.

After gum graft surgery, you should not use a hard toothbrush or dental hygiene aids that may irritate the new gum. Use of these products may cause the new gum to recede. Once the gum graft has fully healed you should be able to clean the area as normal.

A tooth colored filling is a mixture of a tooth colored resin with clear glass particles that give it strength.

Tooth colored fillings come in many shades so they very closely match the color of natural teeth. They are bonded into place and require less removal of healthy tooth structure than silver fillings.

As with any filling, having a tooth colored filling involves some inherent risks both to the remaining tooth structure and to the tooth colored filling itself:

• Tooth colored fillings are limited because they seal a tooth but do not prevent it from breaking.
• Tooth colored fillings may fracture; the larger the tooth colored fillings, the greater the risk of fracture.
• Tooth colored fillings may decay around the edge of the filling if your dentist is unable to keep the tooth clean and dry while placing the Tooth colored filling.
• Preparing for and placing a tooth colored filling can irritate the tooth and cause “post-operative” sensitivity
  which may last for up to 3 months.
• Teeth which have had tooth colored fillings may need a root canal treatment less than 1% of the time during the lifetime of the tooth.

The alternatives to having a tooth colored filling are:

• Having a silver filling or “amalgam” placed.
• Having a gold or porcelain inlay/onlay restoration placed.

Bite problems may lead to the tooth colored filling or tooth breaking or loosening.

• A Tooth colored filling may have a good color match with
  your natural tooth when it is placed but less of a match as
  your natural tooth ages.
• Tooth colored fillings can collect stain over time from foods
  such as black tea, coffee and wine.
• Tooth colored fillings may chip or break if used for abnormal
  activities (e.g. biting fishing line, sewing thread or finger nails,
  opening bottles).

Crowns are made of three types of materials:

1. Porcelain – most like a natural tooth in color
2. Gold Alloy – strongest and most conservative in its preparation
3. Porcelain fused to an inner core of gold alloy (Porcelain Fused to Metal or “PFM”) – combines strength and aesthetics

Crowns restore a tooth to its natural size, shape and – if using porcelain – color. They improve the strength, function and appearance of a broken down tooth that may otherwise be lost. They may also be designed to decrease the risk of root decay.

In having a crown, some inherent risks exist both to the tooth and to the
crown itself. The risks to the tooth are:

• Preparation for a crown weakens tooth structure and permanently
  alters the tooth underneath the crown.
• Preparing for and placing a crown can irritate the tooth and
  cause “post-operative” sensitivity, which may last up to 3 months.
• The tooth underneath the crown may need root canal treatment
  about 6% of the time during the lifetime of the tooth.
• If the cement seal at the edge of the crown is lost, decay may
  form at the juncture of the crown and tooth.
• Porcelain may chip and metal may wear over time.
• If the tooth needs a root canal after the crown is permanently cemented,
  the procedure may fracture the crown and the crown
  may need to be replaced.

Alternatives to crowns are fillings, such as composite or silver amalgam.
These restorations remove decay and may restore teeth to
their original form, but are limited because they do not improve the
strength of broken down teeth. They also do not decrease the risk of
root decay or improve the long term function and aesthetics of broken
down teeth or crowns.

• Excessive bite forces may lead to the tooth under the crown breaking or loosening.
• Excessive bite forces may lead to the crown chipping, breaking or loosening.

• Porcelain on a crown may have a good color match with adjacent
  natural teeth when the crown is placed, but less of a match as your
  natural teeth age.
• Gum recession may lead to unsightly dark roots or crown margins
  becoming visible.
• A crown may chip or break if used for abnormal activities (e.g. biting
  fishing line, sewing thread or finger nails, opening bottles).

Sometimes a tooth breaks upon impact such as accidentally chewing a pit or being hit in the face usually a small fracture begins at the edge of the tooth then deepens over time as you clench, grind or chew.

Some people are more susceptible than others to having a cracked tooth. Factors that are more likely to lead to a cracked tooth are:

• Deep fillings that leave thin amounts of tooth structure
• Sports such as hockey, football and boxing that have a high risk of facial trauma
• People who grind their teeth or have strong chewing muscles
• People with destructive habits like chewing ice or opening things with their teeth

Your dentist will make recommendations to minimize your risk of a
cracked tooth.
Here are some things that may be recommended:

• Have crowns placed to cover weak cusps of teeth
• Have your bite adjusted by your dentist
• Have old silver fillings replaced
• Do not chew ice or use teeth to open things
• Wear a night time grinding appliance
• Wear a sports guard

It is likely that the crack will continue to deepen and eventually the tooth may become painful to chewing or pieces may break off it. Sometimes the tooth may crack completely in half, at which point it must be extracted. Other times the crack goes into the nerve and a root canal treatment may be necessary to save the tooth.

A build-up is made of:

• A Tooth Colored “composite” filling material
• A silver “amalgam” filling material.

A build-up restores a broken down or decayed tooth to the ideal shape needed to accommodate a crown, bridge, inlay, onlay or veneer.

• Preparing for and placing a build-up can irritate the tooth and cause “post-operative” sensitivity which may last for up to 3 months.
• Teeth which have had build-ups may need a root canal treatment about 6% of the time during the lifetime of the tooth. 4.

No treatment alternatives exist besides a build-up for broken down or decayed teeth which require a crown, bridge, inlay, onlay or veneer.

• Excessive biting forces or untreated bite problems may lead to the build-up breaking or loosening.
• Excessive biting forces or untreated bite problems may lead to the tooth in which the build-up has been placed breaking.

A build-up may break or loosen if chewing very hard or sticky foods.