40% of the population grind and clench their teeth. For many, it is a nagging problem or a cosmetic concern. No one wants to have their teeth wear out like the tread of a tire, do they? Unlike tires, worn teeth look bad and old. 50% of cosmetic dental problems are related to uneven teeth wear and tear problems. But what can be done and why do people clench their teeth and wear them out?
Options for the Treatment of TMJ Pain Video
Bite Guards or Splint for Teeth Grinding
So called “splint therapy” has been the gold standard treatment for teeth clenching and non-surgical temporomandibular joint dysfunction. A bite splint manages teeth wear, but does not correct the cause of the problem.
Orthodontic Expanders can Cure Night Time Teeth Clenching
Most people who grind their teeth at night have undiagnosed sleep problems including sleep apnea. The DNA corrects the underlying cause of the problems by balancing the bite and increasing the size of the mouth and other upper airway spaces. Research and clinical practice has shown that bruxism and tooth clenching are really just symptoms of upper airway restriction syndrome and sleep apnea.
Corrective therapy such as the DNA is preferable to splint therapy, but there are some situations where conventional splint treatment may be more practical and appropriate.
A patient who has large numbers of implants vs natural teeth. And when a lot of teeth are missing.
There are lots of bridged or connected teeth in general
when there is a lot of TMJ joint soreness and muscle tension that has been around for a long time. In this case, the splint treatment should precede any definitive DNA therapy.
photo credits to Lab Tech
DNA Appliance is the best treatment
in most other situations except when there are many missing teeth. Improving the size and shape of the jaws and balancing the bite is stimulated by putting small amounts or pressure on teeth and the jaw bones. Without teeth, it becomes very difficult to put pressure on teeth to grow bone. Other appliances do exist such as the ALF appliance and the Homeoblock appliance (both examples of dental orthopedic appliances).
Facial and jaw bone growth during DNA appliance therapy is grown at the connections between the right and left palatal bones. If bridges span around the front teeth, it is impossible to put pressure in the right direction to get the jaws to grow properly. It cases were there are bridged teeth, sometimes the bridges can be sectioned and later re-done or replaced with implants when corrective temporomandibular treatment is complete.
Splint therapy is TMJ disorder treatment:
When there is a lot of longstanding pain in the TMJ, jaws and the all the facial muscles, it is not a great idea to start changing the bite and bone structure right away. It is better to try a new bite position and put the jaw muscles into a more relaxed state prior to changing any structures. Putting the jaws into a more favorable position where the muscles can get much needed rest is much of the goal of splint therapy. Splint therapy can be definitive and final treatment if:
The splint appliance is worn as directed and indefinitely at night time, forever.
If the goal is to stay out of pain, manage tmj symptoms, and not necessarily correct the underlying cause of the problem.
Night Guards only act as a Barrier against Teeth Wear
Night Guards are the least expensive treatment but only prevent wear by placing a protective plastic barrier to reduce direct wear on the teeth during clenching episodes during sleep. There are many different kinds of tooth wear but most of the time, the primary cause is bruxism during sleep caused by UARS or upper airway restriction syndrome.
PRF is an extract of patients blood. It is made by spinning samples of blood in a centrifuge. PRF is used for dental implants, bone grafting, gum grafting and treating infections in bone. These rich platelet techniques are very useful as a stand alone treatment or in conjunction with other bone graft products. Sticky bone is a graft therapy consisting of L-PRF, allograft bone and I-PRF. Since PRF comes from the patient, there is a 0% chance of rejection when using it as the only bone graft material. PRF is the grafting material of choice in patients with lots of allergies, sensitivities and biocompatibility issues. Platelet rich fibrin improves the success rates of full mouth implant cases and snap on implant dentures.
L-PRF vs I-PRF how are these Platelet Rich Fibrin treatments different?
PRF has a synergistic effect with allograft off-the-shelf graft products. PRF contains BMP or bone morphogenic protein. Through biological pathways BMP stimulates the bone cells to naturally grow more bone rapidly. Off the shelf products will slowly over time be converted to host bone. The two treatments together create a “biological bone graft” in that the allograft shows the bone cells where to grow bone. And the PRF stimulates the bodies bone cells to rapidly grow bone.
L-PRF is the most widely used for bone grafting, socket preservation and gum grafting. Basically blood samples are spun in a centrifuge at 2700 – 3000 RPMs for 10 – 15 minutes. The result is a thick clotted yellow jello like substance called “PRF.” When the reference to “PRF” is made, most of the time the reference is to L-PRF. PRF is invaluable in helping infected root canal removal sites.
What is I-PRF?
I-PRF is so called “injectable PRF.” It is so called because it is a thinner mixture of unclotted product containing all the same blood products listed above 1-5. I-PRF can be injected because it is not a clotted and is not thick but rather a injectable liquid. I-PRF has an unlimited number of applications including injections into areas where bone grafts have been placed. It can be injected into areas of previous infection, dental implant surgery sites, infected root canal sites. Injectable PRF improves success rates for metal free zirconia implants by using it to wet the implant surface prior to placement into the jaw.
Small jaws and spaces in the mouth and nasal passageways leads to sleep and breathing problems. It only makes sense that teeth will be crowded if mouth and jaw structure are small too. Breathing is one of the most basic functions of life. Breathing occurs through the mouth and nasal passageways. If the mouth and nasal passageways are small, of course breathing air through these spaces will be more difficult. So of course there is a link between crowded teeth, small mouth and upper airway restriction syndrome. But what about TMJ problems? Research shows that 77% of people with sleep apnea clench their teeth.
Palatal Expanders Can Cure Sleep Apnea
Corrective treatments for obstructive sleep apnea that do not involve surgery or a CPAP device do exist. Two such examples are the Homeoblock appliance and Vivos DNA appliance therapy. Adult anterior growth appliances can promote new bone growth in the mouth and nasal passageways. These appliances are called expanders because of their ability to increase the size and space in the jaws. The upper jaw bone is the base of the nasal passageways. The expansion decreases airway resistance and improves breathing while sleeping. The DNA (day time, night time appliance) works for adults by expanding the palate and surrounding jaw structure.
Expanders and growth appliances will cure pediatric sleep apnea with proper attention to other conditions such as tongue tie and lip frenums. Appliances for children include Schwarz, ALF and Crozat. No one appliance is the “best” appliance. It depends on the growth needs of the child. What the child can tolerate and what appliance the dentist knows how to use are considerations too.
Aligning Teeth is More than Cosmetic
Healthy natural teeth are essential for providing beauty to your smiles. Straight and well aligned teeth are not only necessary for proper chewing, biting and eating food but these teeth enhance self-esteem and confidence at work and during presentations in the universities. Crooked and poorly aligned teeth due to crowding of teeth result in compromised smiles and loss of confidence. In addition to cosmetic concerns, crowding of teeth allow accumulation of food debris and bacteria in areas between your teeth. Crowded teeth do not allow thorough cleaning of teeth through tooth brushing and mouth rinsing. These teeth provide a nidus for bacterial growth and impaction of food particles from your diet. The DNA dental appliance is also great for straightening teeth since is creates more space in the mouth for teeth to fit. Other appliances do exist such as the ALF appliance vs the DNA appliance.
What causes Crooked-Crowded Teeth?
Frequent and consistent use of pacifiers and feeding bottles during infancy and early childhood especially in children above 3 years of age
Tongue tie and poor tongue function
Cleft lip and cleft palate patients,
Thumb sucking habit in infants, toddlers and children,
Can crowded teeth cause bruxism, sleep apnea and UARS?
Jaw problems and poorly aligned teeth can be extremely problematic. Disproportioned teeth lead to disturbed bite and lead to night time grinding of teeth, increased stress, breathing difficulties and TMJ disorder. Treatments related to crowded teeth such as braces can also lead to sleep deprivation, stress accumulation and respiratory restriction. A popular treatment for crowded teeth in kids is natural orthodontics. Natural orthodontics is the assistance of natural forces such as tongue and chewing forces in aligning teeth.
What is sleep apnea?
Continuous and repetitive blockage of your airway passages during sleep hours can cause discontinued or no breathing at night. This obstruction of the breathing passages reduces the amount of fresh oxygen within your lungs. The end result is usually the production of loud and audible snoring sounds depicting choked airways. These loud snores can be heard due to forced breathing and are indicative of a serious disorder known as sleep apnea most commonly obstructive sleep apnea.
Snoring sounds are usually considered a normal phenomenon during sleep and ignored by majority of us. Even we do not know if we have ourselves developed snoring at night unless our roommates or spouses tell us about this finding. Sleep apnea is an extremely common and potentially fatal abnormality. Serious consideration and immediate consultation with your local dentist is strongly advised to avoid serious complications in future.
What happens during sleep apnea?
During sleep apnea, your breathing process gets disrupted or stops and then re-starts. The whole process is repeated again and again during sleeping hours. Snoring may or may not occur in conjunction with sleep apnea. Shallow Breathing is interrupted at frequent intervals during sleep. Multiple breathing pauses measured around 10-20 seconds occur during this time for over 100 times adversely affecting the sleep cycle.
Deep and uninterrupted sleep is required for regaining energy. Energy is not regained and re-filled when sufficient rest is not achieved. Light and interrupted sleep does not fulfill the requirements of human body.
How does sleep apnea develop during sleep?
Continuous and recurrent narrowing down and collapsed pharyngeal airway passages result in forced breathing and labored breathing efforts by the affected person in order to provide oxygen to the human body for survival. This phenomenon leads to disturbed and fragmented sleeping, loud snoring sounds and abnormal required gas exchange within the blood.
Sleep apnea episodes cause reduced oxygen levels in the bloodstream resulting in the loss of much needed oxygen supply to the brain tissues. This creates an emergency state and brain death can occur if it lasts for long time span. Body survival system immediately takes action and sleep interruption occurs triggering forced breathing for oxygen supply to the brain. Loud Snoring sound are produced in response to this reflex which mimics choking noises.
What are various types of sleep apnea?
Obstructive sleep apnea is the most common type characterized by loud snoring sounds.
Central sleep apnea is less frequent type in which snoring occurs rarely.
Complex sleep apnea is usually the combination of the above two types.
What are the consequences of sleep apnea?
Sleep apnea causes interrupted breathing resulting in lethargy, tiredness and slowness of reflexes during whole day at work. Breathing pauses of about 10-20 seconds occur between sleep ranging in frequently from a few to more than 100 times per night. Freshness of mind and energy regain is not achieved which is the basic purpose of sleep. Sleep deprivation results in,
Slow reflexes,
Lethargic attitude,
Dizziness,
Loss of concentration at work,
Inability to drive properly,
Accidents,
Increased anxiety, depression, stress,
High blood pressure and frequent episodes of headache,
Weight gain.
Which signs and symptoms are associated with sleep apnea?
Loud snoring occurs during sleep apnea especially during obstructive type,
Daytime sleepiness occurs irrespective of long stay in bed at night,
Laziness,
Lack of concentration,
Long pauses and stops during breathing,
Increased stress, tension and anxiety,
Dryness of mouth can occur,
Throat and neck infections,
Increased nocturnal urination occurrences,
Disturbed growth and development in infants and small children,
Mouth breathing habit.
What is teeth grinding and UARS?
Breathing related sleep problems occur in majority of people suffering from teeth grinding habits. Teeth grinding which may occur during night or daytime, usually affects 8-31% of the population. Treatments for teeth and jaw clenching do exist. The breathing related issues associated with teeth grinding habit are somewhat different in some people when compared with obstructive sleep apnea patients. The syndrome with distinctive features in such cases is termed as upper airway resistance or restriction syndrome abbreviated as UARS. The syndrome is characterized by clenching of the teeth when the airway becomes obstructed by the tongue or other soft tissue.
Various features which can characterize people with teeth grinding habits and development of this airway breathing problem are,
Majority will be females,
Persons with short and thin neck,
Small jaws,
Limited mouth opening,
Crowded and mal-aligned teeth,
Females undergoing braces treatment for crooked teeth,
Deep bite problems,
People with digestive problems,
People with disturbed chewing, biting and eating,
People suffering from depression, anxiety and stress,
Lethargic persons,
Daytime dizziness and drowsiness,
People with habit of sleeping on their stomach with face down on the pillows,
People who are unable to sleep on their back,
Tiny mouth,
People with low blood pressure,
People who often faint or suffer from light headedness,
People affected with deviated nasal septum,
People who are suffering from Temporomandibular pain dysfunction syndrome,
Chronic stuffed nose,
Infected sinuses,
Pain and discomfort in sinuses,
Migraine symptoms,
Digestive disorders such as crohn’s disease, irritable bowel syndrome, bloating, flatulence, constipation, diarrhea,
Cold and clammy skin, hands and feet,
Brain fog,
Skin allergy,
Skin rashes,
Non-cardiac chest pain and discomfort.
How can UARS be diagnosed?
Diagnosis and differentiation of UARS from OSA is quite difficult. However, few tests and clinical features may be helpful in this regard.
Sleep tests i.e. polysomnography PSG,
Apnea Hypnea Index (AHI),
Sleep pauses,
Chronic pain in the pelvic region,
Non-cardiac chest pain,
Fibromyalgia,
Tension headache hyperventilation syndrome,
Chronic fatigue syndrome,
Teeth grinding and clenching,
Frequent respiratory effort related arousals,
Lack of deep REM sleep,
Loose fatty tissues of the throat collapsing back into the airway,
Position of the tongue (falling back) during sleep,
In obstructive sleep apnea (OSA), airway obstruction develops then apnea occurs followed by arousal. UARS is different and is characterized by airway obstruction followed by arousal or RERA (respiratory effort related arousals). No apnea occurs in UARS,
No pauses of breathing occur in UARS characterized by AHI value 0.
Why breathing pauses do not occur in UARS?
Activation of sympathetic stress system occurs due to respiratory effort related arousals which are seen in UARS. Opening of the airway passages occurs resulting in forwarding of lower jaw or mandible. These forward jaw movements lead to unintentional teeth grinding and clenching. Efforts caused for respiratory purpose result in disruption of sleep. Incomplete sleep due to brain’s fight or flight mode does not allow the body to re-energize. Release of stress hormones and airway constriction continues throughout sleep hours.
How does teeth crowding contribute to UARS?
Size of airway passages decreases owing to relaxation of throat, tongue and face muscles during sleep at night. An additive problem occurs in small jawed individuals further limiting the air way entrance. Teeth crowding leads to incorrect tongue positioning as well as mouth breathing. Poor airway muscle tone and limited airway entrance add ups and breathing pauses develop. However, breathing does not stop in UARS owing to respiratory effort related arousal (RERA) which is its differentiating feature as compared to sleep apnea.
What are the various consequences of UARS?
Frequent night time arousals or nocturnal awakenings,
Dentists are in a unique position to diagnose and treat sleep apnea. While dentists cannot technically diagnose sleep apnea as sleep doctors do. Sleep apnea dentists do look in a lot of mouths and airways and the writing is on the wall. Or should I say, in the mouth. Novel dental orthopedic treatments capable of stimulating airway growth (even in adults) are available. The sleep apnea dental treatments permanently enlarge the airway and can cure some sleep apnea conditions.
One treatment offered by Dr. Adams is DNA appliance therapy. The DNA sleep apnea dental treatment results in a larger upper airway at the end of a treatment that lasts 6 – 18 months. Very few dentists offer this treatment yet due to the complexity of treatment. In the US fewer than 1% of dentists are certified DNA appliance providers. Hopefully more dentists will be trained as the demand for sleep apnea dental treatment increases.
Sleep apnea causes, risk and diagnosis
Deep, relaxed and adequate sleep, like adequate nutrition and adequate exercise, is essential for maintenance of healthy human body. Inadequate, disturbed and interrupted sleeping hours produce daytime sleepiness, tiredness and lethargy which will deteriorate general body health with the passage of time. inadequate breathing during sleep can be due to stress, anxiety, nocturnal teeth clenching, respiratory effort related sleep arousals or sleep-induced collapse of the upper airway passages. Your dental health care professional can help you in diagnosing the exact cause of your insomnia and breathing difficulties during sleeping.
What is getting in the way of your airway or causing “obstruction?”
Small mouth or a large tongue? What came first the chicken or the egg? When jaw a facial development is not sufficiently large, we see crowding of the tongue and teeth. In the picture to the right, you can see crowded teeth and tongue spaces. Unfortunately in the “after” picture, there is still crowding of the tongue. This tongue is in a posterior position and will certainly end up in the airway at night.
Extra soft tissue in the throat gets i the way of the airway. including the uvula, tonsils, adenoids and extra posterior palatal tissue. You can also notice the squished posterior position of the tongue. In this picture the tongue is further back in the mouth and literally on top of the airway. No surprise that all this stuff can get in the way of night time breathing. Who is in a better position to notice this stuff better than a well trained sleep apnea dentist?
What is sleep apnea? Is it related to snoring during sleep hours?
Repetitive and routine blockage of airway passages during sleeping may result in breathing cessation or interruptions at night. This obstruction of the normal breathing pattern limits the amount of much needed fresh air replenishing the lungs. Airway blockage results in the production of loudly audible snoring and choking sounds. Snoring sounds are usually considered normal and people do not even consult their family physicians or dentists in this regard unless problems in normal breathing are detected.
Most of the population does not even know about this snoring habit until their spouses or roommates feel disturbed and mention it at last. Frequent and loud snoring noises can be an indication and symptom of a frequent and potentially dangerous breathing illness known as sleep apnea. During sleep apnea, normal breathing activity stops and then re-starts again. The whole repetitive process involuntarily continues for hours at night during sleeping. Snoring may not occur in conjunction with sleep apnea state in many individuals and this further makes sleep apnea diagnosis difficult. Breathing is interrupted continuously and becomes shallow during sleep. 10-20 second duration pauses are usually recorded between normal breathing with a frequency of more than 100 times adversely affecting the sleep cycle.
What is the prevalence of sleep apnea?
The overall prevalence of sleep apnea is high and still progressively growing. 20-40 million individuals in the U.S. are suffering from this dangerous breathing problem and the alarming aspect is that approximately 90% of the patients remain undiagnosed for many years.
What are the various causes and common risk factors associated with sleep apnea?
Overweight and obese individuals are always at higher risk for sleep apnea occurrence. Obesity can cause the tongue to fall back and block air passages hampering the normal flow of air towards lungs,
Males are at higher risk as compared to females,
Genetic predisposition has been observed in sleep apnea. If one family member has developed sleep apnea, others should consult their dentist and family physician for early diagnosis and management,
Old age i.e. above 60 years is an important risk factor for sleep apnea,
Small-sized, deformed and abnormally developed thin airways in the nose, mouth and throat area,
Tobacco Smoking increases the chances for sleep apnea occurrence,
Strong evidence for racial predilection,
Inflamed or enlarged tonsils in tonsillitis in children are risk factor for sleep apnea,
Thick neck tissues,
Unhealthy and unhygienic lifestyle,
Excessive consumption of alcohol,
Misuse of sedatives and hypnotic drugs,
Nasal septum deviation can cause blockage of pharyngeal airways during sleep.
What are the different types of sleep apnea?
Sleep Apnea Can Be Classified Into 3 Different Types
Obstructive sleep apnea is the most commonly occurring type characterized by loud snoring sounds.
Central sleep apnea occurs less frequently as compared to obstructive type. Snoring occurs rarely in this condition.
Complex sleep apnea is characterized by intermediate features of the above two types.
What are the different signs and symptoms which point towards the development of sleep apnea?
Clinical features which can be seen in sleep apnea patients are,
Loud snoring sounds can be heard especially in obstructive sleep apnea,
Daytime sleepiness and dizziness occurs irrespective of long stay in bed during night,
Laziness and lethargic attitude,
Loss of concentration and focus at work is common in affected individuals,
Long pauses during normal breathing,
Cessation of breathing may occur,
TMJ pain. Tooth clenching is reported by nearly 80% of people with OSA
Severe headache especially during morning time after waking up from sleep,
Increased tension, stress and anxiety is common,
Night time teeth grinding and clenching,
Dryness of mouth (xerostomia) is common,
Head, neck and throat infections occur often,
Increased episodes of nocturnal urination,
Disturbances in normal growth and development in infants and small children,
Mouth breathing habit due to breathing difficulties,
What are the risks or adverse consequences associated with sleep apnea?
These can be,
Alarmingly Slowed down or reduced reflexes,
Daytime dizziness,
An urge to sleep during daytime,
Loss of concentration during work,
Loss of focus during studies,
Increased occurrence of road side traffic accidents (RTAs),
Increased occurrence of health issues such as development of diabetes mellitus, blood pressure disturbances, brain illness and heart disorders,
Increased weight gain,
Drowsiness and lethargy,
Inability to remember events (Memory loss),
3-5 times increased risk for accidents,
Greatly reduced productivity in life,
Increased risk of fatal diseases (Myocardial infarction, CHF, CVA)
3 to 2.5 times more chances of hypertension,
2 times increased risk of nocturnal cardiac arrhythmia,
9 times more likely to have congestive heart failure,
6 times increased chance of cerebro-vascular stroke,
4 to 2.3 times greater risk of myocardial infarction,
40% increased risk of depression and anxiety.
What are the various methods for diagnosis sleep apnea?
Early screening is of vital importance. Diagnosis can be done through,
Complete patient history,
Spouse history for snoring,
Comprehensive clinical examination,
Thorough dental check up,
TMJ examination,
Psychiatric evaluation,
In-laboratory polysomnography,
At-home polysomnography,
An FDA-approved limited channel ambulatory testing device which ensures chain of custody.
What is proper management of sleep apnea?
Sleep apnea can be managed with good outcomes and people can get their life back to normal in quick time. Patient compliance and cooperation is necessary for successful management. Different medical treatment options and special dental devices fabricated to treat this disease are helpful. Different interventions are,
Positional therapy focusing upon sleeping on your side,
Avoidance of lying down on the back during sleeping,
Sewing a tennis ball on the back side of the shirt or trouser’s top pocket is helpful,
Weight loss is important,
Use of a specially designed cervical pillow,
Elevation of bed head for a few inches to provide ease,
Maintenance of a sleep diary for recording sleep interruptions and awakening episodes during night,
Use a nasal dilator,
Get treatment of any systemic heart or brain disease causing/associated with sleep apnea,
Maintenance of continuous positive airway pressure (CPAP) is very helpful in treating sleep apnea. CPAP is generally maintained by a mask-like device which provides streamlined air flow for keeping breathing passageways open and dilated.
CPAP devices without mask for nasal hood phobic people,
Snap on dentures and All on 4 dental implants are both great options to replace a full set of teeth. All on 4 is also called full mouth permanent implants. In this article we discuss the pros and cons of both of these options including differences in the teeth and the procedure costs.
Implant dentures are also called snap on dentures. It is basically a traditional denture with additional snaps that connect the teeth to the implants. The snappy attachments are made by a company called Zest Anchors. The snap-in system has a male part connected to the the implants and a female part that is inserted into the under-side of the implant teeth. Snap-on teeth need to be taken in and out of the mouth for cleaning and maintenance. If the denture is made properly, it will not dislodge or rock during eating hard foods or talking. Implant dentures do not require any adhesive such as Fixodent.
The biggest difference between All on 4 full mouth implants and snap-on teeth is that snap on teeth are removable and All on 4 stay permanently in the mouth. Secondly, all on 4 teeth are usually made of zirconia which is much more durable and feel thinner, smoother and more natural feeling material.
What is Snap On Dentures Video?
Permanent All on 4 Implant Teeth
Permanent implants is a much different full mouth implant option. The biggest difference is snap-on dentures are removable and need to be taken out for proper maintenance and hygiene. All on 4 teeth are permanently installed into the mouth and are completely supported by implants. All on four is not removable and never comes out of the mouth during eating, teeth cleaning or ever unless the dentist uninstalls them.
The other very obvious difference is snap on teeth are made of acrylic and all on 4 is made out of zirconia. Zirconia is basically a high grade porcelain. Zirconia is a lot like ceramic and is very smooth, strong, thin and does not stain or break. Zirconia implant teeth last a lot longer than acrylic because they do not wear, break or absorb plaques and smells.
A much cheaper version of all on 4 teeth are made out of acrylic. Acrylic is basically a high grade plastic. Clear Choice for example offers acrylic as the standard teeth and the zirconia teeth are an upgrade for a higher price. Acrylic teeth are also called “hyrbid dentures.”
What is All on 4 Full Mouth Implants Video
Dr. Adams operates the dental implant implant center at Maryland Holistic Dentist in Spencerville, MD. He has successfully finished over 500 sets of implant teeth. Dr. Adams is dual licensed as a dentist and in IV dental anesthesia.
There are 2 clear advantages of snap-in teeth vs traditional dentures. First, the snap in system helps the teeth stay in the mouth and remain stable even while eating hard foods and talking. Secondly, snap-in dentures do not cover the palate with plastic. The biggest problem with standard dentures (other than they are unstable) is it changes speech and alters taste by covering up the palate.
All on 4 implants need more implants than Snap-in
Implant supported dentures need only two to four implants for support as the denture flanges provide additional support. On the other hand, all on 4 bridges need at least 4-6 dental implants when a complete arch of teeth is being replaced. To summarize 10-12 implants are needed for all on 4, but only 6-8 for snap-on teeth.
What is all-on-4 dental implants?
The all-on-4 concept for replacing missing natural teeth is basically a technique to replace all missing teeth in an arch with only 4 dental implants. All on 4 can support approximately 12-14 teeth. Temporary teeth are provided on the same day of surgery so the patient is not toothless. The All-on-4 concept is most frequently used for people who prefer teeth that stay in the mouth permanently.
All on 4 Treatment Process
The whole procedure involves two main stages. The surgical phase involves radiographic assessment with the help of x-rays and a cone beam CT scan. Thorough assessment of bone quality and volume is important. These 4 dental implants are placed in each arch by skilled dental professionals under profound local anesthesia for minimizing pain and discomfort. The patient can also choose to be put to sleep for the procedure.
On the day of surgery, all the remaining teeth are removed. Then the sites are cleaned and bone grafting is performed. Implants are put into the jaw. Special care must be taken for accurate positioning, alignment, parallelism, angulations and inclination of dental implants for achieving best outcomes. Temporary teeth are delivered immediately after the surgery and always on the same day. You will be called after a week for routine checkup and assessment.
All on 4 complete dental implants
Acrylic or Zirconia All on 4 Teeth Materials?
The zirconia teeth are more expensive but they may last a lifetime and feel and function better. The acrylic teeth need to be replaced every 3-10 years depending. With the following in mind a decision must be made about the final teeth material:
Appearance,
Durability,
Longevity,
Fit and function of framework,
Acrylic teeth used to be the Gold Standard before Zirconia
Can get discolored,
Color match is not exact,
Does not withstand chewing and biting forces,
Can fracture easily,
Can transfer stresses to implant causing implant fracture.
Solid printed zirconia teeth are stronger and more cosmetic
Much stronger and durable,
Best color match,
Lifelike and natural looking,
Do not get stained and discolored due to non-porous nature,
Resistant against plaque formation and bacterial accumulation,
Does not gets chipped off or cracked like acrylic,
Permanent solution,
Fabricated with CAD/CAM technology.
All on 4 vs Snap On Denture Cost
An entire mouth of All on 4 usually costs around 50K all-in. Snap on teeth cost roughly 30K for an entire set of teeth. The prices include sedation, removing all remaining teeth, bone grafting and temporary teeth. Removable teeth are always cheaper compared to permanent teeth. Zirconia all on four teeth and implants are expensive and their cost becomes almost double when compared with Snap-on teeth. Implant dentures requires half as may implants and the acrylic teeth are a fraction of the price of zirconia. In the long run, all on 4 are more cost effective because the teeth last a lot longer and the maintenance costs are much less over time.
Should Teeth be Removed and Replaced with Implants?
One thing to consider is whether or not you should replace all your teeth with implants or save your teeth? Sometimes replacing teeth can save considerable future dental spending in root canals, fillings and crowns. Implants do not rot ever need fillings or root canals. In fact, they can last a lifetime. Consider this carefully and look at reviews about all on 4 dental implant teeth. There are many different ways to replace teeth with implants. Consider all the different ways to replace teeth with implants. And if it is right for you, then you should go for it.
Is All on 4 or Snap-on teeth a better investment?
Removable dentures are most commonly provided to those patients who have lost multiple or all teeth and cannot afford dental implants. These dentures can be easily removed and cleaned at home. You will need to place these dentures in a bowl containing clean water outside the mouth during sleep. Conventional removable partial and complete dentures are considered to be optimum replacement restorations for your missing or lost natural teeth. These dentures are,
Relatively economical and cheap,
Serve well for a limited period of time,
Can restore chewing and eating on interim basis.
However conventional removable dentures have many limitations which make them unsuitable for permanent restoration of structure and function of lost natural teeth.
How to Take care of Snap on Dentures
Removed regularly at night before going to sleep,
Placed in a water jar otherwise permanent size changes can occur,
Removed before sleeping in order to avoid the disaster of accidental swallowing,
Conventional dentures are prone to cause continuous bone loss resulting in change of facial dimensions, loosening of dentures with time and compromised appearance.
Mobility can occur in lower dentures,
Dentures may come out of mouth during speaking and laughing if become loose with time,
Can cause irritation and discomfort in soft tissues and gums.
Fixed prosthetics aims at providing dental bridges or dental implants which do not need to be removed at night. Fixed restorations provide a feeling of completeness and people regain their lost confidence. However, when dental bridges are the fixed option.
What about Natural Teeth Bridges
These require removal of sound tooth structure from adjacent teeth for support,
There may be need to perform root canals of teeth acting as support,
Expensive as compared to removable dentures.
Dental Implants
Dental implants do not need removal of healthy tooth structure or the involvement of adjacent teeth. Dental implants act as replacement of natural tooth’s roots and make a strong connection with socket bone. When we compare all above options, these have their own benefits and drawbacks. When old age, bone loss and economical conditions are considered, you may opt for removable prosthetics. However, affordability, young age, healthy bone and better oral hygiene maintenance will always vote in favor of fixed restorative options in the form of dental implants or dental bridges.
Removable Dentures are Supported by Gum Tissue
Conventional complete dentures are the tissue supported dentures which are fabricated when people lose all teeth and need replacement for restoration of structure and function. Keeping in view various limitations and drawbacks of conventional removable dentures, advanced dentistry offers dental implants incorporated within the design of dentures for increased retention, support and stability purpose. These are known as implant supported dentures or locator dentures or implant over-dentures.
An implant retained or implant supported denture is basically a partial or complete denture attached or connected to an Osseo-integrated dental implant. Also called implant denture or dentures with implants. This dental implant is placed within the socket bone and gums similarly as the root of a natural tooth does. Implant supported dentures,
Provides a stable, fixed and retentive foundation to the denture attached over it containing artificial teeth,
Ensured stability when you speak, eat, chew, laugh, drink and yawn,
Enhances your self-esteem and confidence in daily life activities,
Providing comfort and ease,
Gives you a life-like feeling.
Limitations of Implant supported dentures
Dental implants are considered to be the best fixed prosthesis for all age groups. However, certain factors which may dictate the feasibility of placing this prosthesis in your mouth should be kept in mind.
Patients should not be suffering from any systemic illness such as uncontrolled diabetes, hypertension or immunosuppressive disorder,
Another major requirement for dental implants placement is the amount, width and height of healthy alveolar bone. If you have sufficient alveolar bone, you are a good candidate for implant supported dentures,
When replacement of missing teeth in upper arch is considered, your implant dentist will also evaluate position and distance of sinus before placing dental implant in this area.
However, modern dental procedures have developed for bone grafting in areas with compromised socket bone. You can benefit from latest artificial bone grafting methods before placement of dental implants in your mouth.
Research has proven that tooth clenching and grinding at night is one of the leading causes of damage to teeth. The extreme pressure and stress placed on teeth is what causes gum recession, periodontal disease and tooth loss. Excessive pressure on the gums during clenching causes the connection between the gums and the teeth to be torn and recede during episodes of teeth clenching.
Key points in this article will discuss:
How teeth clenching causes damage to teeth, gums and periodontal tissues
How expensive crowns, fillings, implants are secondary to bruxism (clenching)
Teeth clenching can cause TMJ pain and damage to the bite
What is the root cause of teeth clenching
How to stop teeth clenching
Teeth Clenching causes people to need more fillings and crowns
The need for dental work such as fillings, crowns, root canals and dental implants can be caused by teeth clenching. Excessive pressure on teeth causes surface cracks and damage to teeth enamel. Bacteria gets into the cracks and causes cavities and decay. Often the cracks get down to the nerves of the tooth and root canals, extractions and dental implants become necessary.
Tooth clenching and grinding is also one of the leading causes of gum disease. The gums support the teeth and cover and protect the roots of the teeth. When clenching occurs, the fibers that attach the gums to the roots of the teeth are torn loose and the gums recede leaving the roots of teeth exposed to the mouth. Loss of gum tissue is termed gum recession. The pressure from clenching also causes inflammation between the jaw bone and periodontal ligament. Long term inflammation in gum tissues results in bone loss. Deterioration of the gums leads to root cavities, fillings by the gum line, food trapping in between teeth and ultimately tooth loss. Teeth lost from gum disease can be replaced with implants.
The Root Cause of Teeth Clenching
Teeth clenching is caused by not having enough room and balance in the jaw spaces. Lack of space causes teeth crowding and an uncomfortable and dysfunctional bite. Healthy jaw and teeth alignment provides a position where muscles in the face, jaws, head and neck can rest. We call this a neutral bite. When the bite is crowded and the jaw alignment is poor, people will clench their teeth because the jaw muscles cannot find a comfortable place to rest. It is like trying to get comfortable in a bed or chair that is not ergonomic.
The root cause of teeth clenching during sleep is lack of space in the mouth for the tongue and other muscles to fit and function comfortably. Crowding of the tongue, tonsils and tissues in the throat will block the airway during sleep. Airway/throat blockage will cause poor breathing, oxygenation and sleep disturbances. Sometimes there will be dry-mouth, gasping and even choking. People will respond to this problem by teeth clenching and sleeping on their side. Often times people will not know they are clenching at night because they are asleep.
Sometimes people will have marks on the sides of their tongue called tongue scalloping. The scalloping comes from the tongue between squished up against the teeth. The sleep disturbances can sometimes be as bad as obstructive sleep apnea and airway resistance syndrome.
Teeth Clenching causes TMJ Symptoms
Overactive chewing muscles and pressure on the teeth, gums and TMJ can cause soreness and pain. Pain and soreness can be present in the gums, teeth, jaw muscles, neck muscles, trap muscles and lower and upper back. Other symptoms such as teeth sensitivity, poor sleep and brain fog are common.
Root Cause and Treatments for Teeth Clenching Video:
Stop Teeth Clenching and Save on Expensive Dental Work
Treatments such as the DNA appliance and Homeoblock device can prevent gum recession and teeth clenching. Eliminating teeth clenching is very important in lower dental care expenses and reducing recurring fillings, crowns and root canals. People who stop clenching save money and spend a lot less time in the dental chair. How to stop clenching and grinding?
What causes teeth clenching?
The two leading causes of tooth clenching and bruxism are night time airway issues such as upper airway restriction syndrome/obstructive sleep apnea and bite misalignments. Past orthodontics can also play a role in bruxism. Especially in cases where so called extraction-retraction braces have been done. Tooth clenching seems to be related to cases where orthodontics was done for long periods of time and where treatment outcomes were not good. Especially in cases where braces and extractions and retraction were used. If you you clench your teeth, you should be evaluated. There is a strong link between sleep apnea TMJ and a tied tongue.
Lack of Prevention of Teeth Clenching in Dentistry
Most dentists are not trained in diagnosing clenching problems from the standpoint of correcting it. A qualified TMJ expert will diagnose the problems and treat the condition so the teeth grinding habits cease and do not occur anymore. Novel treatments correct the underlying cause of the TMJ problem and do not involve wearing a night guard or other dental TMJ appliance forever. In short, a cure for TMD is possible in many cases and lifetime night guards and clenching should not be accepted.
Sleep Apnea and TMJ Link Video:
How Common is Teeth grinding in US?
40% of the population reports some awareness of clenching their teeth. Experienced dentists say most of their patients are unaware that they clench their teeth during sleep. Recent research shows that clenching and grinding is caused by two things: 1) upper airway restriction syndrome and obstructive sleep apnea 2) a bad misaligned bite.
Teeth Clenching Releases Mercury in Amalgam Fillings
How to Remove Mercury Safely in the Dental Office Video
How do dentists diagnose Teeth Grinding?
Your dental health care provider will thoroughly examine your teeth, gums and tongue after taking complete history of stress and anxiety. Following conditions in your mouth will point out towards the diagnosis of teeth grinding and clenching habit.
Worn teeth with flat grinding surfaces,
Yellowness of grinding teeth surfaces due to enamel loss and exposure of underlying dentin,
Sensitivity of teeth to hot and cold on applying air or water jet during examination,
Fractured or chipped teeth cusps,
White line can be seen where teeth meet inner side of your cheeks,
Marks of teeth on the side of tongue sometimes,
Scalloping of the tongue
History of braces and tooth removal
Symptoms associated with teeth grinding and clenching
TMJ pain and discomfort,
Severe headache and dizziness,
Pain in the ear and temples,
Muscular pain and tenderness in the head and neck area,
Locking of jaws especially during early morning soon after waking up from sleep.
Why teeth grinding or bruxism is damaging to teeth and TMJ?
Bruxism or teeth clenching is an alarming condition and needs to be managed as soon as diagnosed.
Unchecked grinding of teeth can cause wearing of tooth enamel of all teeth exposing sensitive dentin,
Pain and discomfort occurs in the start which may goes off when damage becomes extensive as the living pulp is exposed to the environment,
If no definitive management is performed, eventually teeth will be removed and dental implants will remain the only option for restoration of lost structure and function of your mouth..
Is it safe to place porcelain crowns over damaged teeth during Bruxism?
Metal free and tooth colored cosmetic restorations are popular these days. Advanced dentistry provides pleasing, functional and long lasting porcelain crowns for boosting your smiles and confidence at work. However, these porcelain crowns have the side effect of wearing natural tooth enamel when teeth grinding occurs. Porcelain or ceramic crowns must be avoided if you are suffering from Bruxism or teeth clenching. Zirconia is a much better material choice.
Proper evaluation of oral health conditions involving your TMJ and tooth contacts during function and rest is essential before including these restorations in the treatment. Consult a specialist TMJ dentist in this regard. Furthermore, continuous contact and grinding can result in chipping off and breakage of ceramic crowns due to their brittleness.
Can TMJ disorder develop the habit of teeth grinding?
Yes. Mal-alignment in teeth which develops TMJ pain and discomfort can result in the occurrence of teeth grinding or bruxism.
Management of bruxism involves,
Treatment of the root cause i.e. stress, anxiety or mal-aligned teeth,
Custom made and fit night guard fitting your teeth must be worn during sleep hours,
Is wisdom teeth removal necessary or do I have other options? Oral health care standards for the prevention of dental diseases have improved in the recent past due to increased awareness of the people and better treatment options at the dental clinics. People follow preventive advice before the occurrence of dental problems. They maintain their oral hygiene with the help of regular tooth brushing, use of dental floss and mouth rinsing. Infants,
toddlers and small children are brought to the dental offices for consultation visits as soon as milk teeth appear in their mouth. However, lifestyle modifications and improved dietary habits are needed. These days, Children do not like to eat hard foods. Increased intake of fast foods, soft diet and cola drinks causes decreased stimulation of jaw bone growth during early life when jaw development is underway. Restricted jaw growth is the major reason for impacted third molars/wisdom molars
What are third molars? Why these third molars are known as wisdom teeth?
Third molars or wisdom molars usually remain hidden within the gums or socket bone due to limited space or hindrance in their path of eruption. These are most commonly impacted teeth followed by second premolars and upper lateral incisors. Wisdom teeth are usually absent in a large number of individuals. Sometimes, wisdom teeth make their path within the small sized jaw bones or limited which results in their tilting, drifting, rotation. These tilted, drifted and rotated wisdom teeth badly affect adjacent teeth, jaw bone and nerves crossing near their roots and crowns. Furthermore, these can act as spaces accumulation of food debris which can result in infections, gum diseases and tooth decay in the future. Is wisdom teeth removal necessary always? No.
These teeth normally erupt around 17-25 years of age (late teenage years and early twenties). This age range is associated with the development of intelligence and learning in young ones. This is the reason why these third molars are called wisdom teeth.
Why third molars erupt late in the mouth/become impacted?
When jaw bone growth becomes restricted, it results in late eruption of teeth and this decreased size of jaws cannot accommodate all teeth within the mouth. Third molar teeth are located in the end of your mouth do not find enough space to erupt and remain within the gums and jaw bones. Little or no space does not allow these relatively large sized teeth to erupt through the jaw bone and gums. The diet has softened and people do not eat foods that are as hard. As a result Jaws are smaller and teeth do not have as much room to fit.
Why is it necessary to remove wisdom teeth from the mouth in majority of cases?
Abnormally tilted, drifted and rotated wisdom teeth become the reason for the occurrence of food impaction, infection and swelling of gum tissues surrounding and covering these teeth. Food particles cannot be easily cleaned from these narrow spaces and pockets around the wisdom molars leading to development of reddish, swollen and infected soft tissues which become extremely painful especially when patient tries to open wide. Normal tooth brushing and mouth rinsing becomes less beneficial when the problem becomes severe.
Severe pain, infection, fevers and reduced mouth opening develops in severe cases. You will be unable to eat, talk and perform your daily activities. Do all wisdom teeth need to be removed? Not always.
Novel treatments such as PRF wisdom teeth surgery, help accelerate bone healing and reduce swelling and pain after wisdom teeth removal.
Removal of these affected teeth becomes essential for the prevention of infection spread. Exposure and removal of surrounding jaw bone and gums may be needed. American Dental Association recommends complete and comprehensive consultation regarding the status of wisdom teeth buds in infants or around 16-19 years of age. Their early removal following preventive approach can save future complications.
Can I keep my wisdom teeth if these are harmless?
Yes. If your wisdom teeth have erupted normally and your jaw bones have enough space, you do not need removal of these teeth. Another condition which does not necessitate removal of wisdom teeth is when these teeth are buried deep down within the bone and their removal can result in loss of too much healthy bone causing weakening and danger of jaw bone fracture. Bottom line is, if you can keep the wisdom teeth clean. If the teeth fit in your mouth and if wisdom teeth are not causing bite problems and TMJ…You can keep your wisdom teeth.
Complications of Retained Impacted Wisdom Teeth?
Pain, discomfort and swelling in gums around wisdom teeth,
Limited/reduced mouth opening.
Repeated infection of area behind wisdom molars,
Formation of cysts around wisdom molars,
Tumors,
Pericoronitis (soft tissue infection around wisdom teeth),
Tilted wisdom teeth can damage adjacent teeth causing decay (most commonly second molars),
Stiffness around the impacted tooth,
Cheek bite may occur when upper wisdom teeth are tilted towards cheeks,
Crowding and malocclusion of other teeth,
Bone loss,
Inflamed gums,
Sinus problems,
Jaw damage.
Is Removing Wisdom Teeth Safe?
Wisdom tooth removal surgery required the services of an expert oral surgeon. Surgery should be performed after complete evaluation and comprehensive examination with the help of X rays, CT scan and CBCT scan for ensuring least trauma, damage and injury. Normal recovery time after wisdom tooth removal is around 7-10 days. It usually depends upon the degree of severity of tooth impaction, portion of tooth within jaw bone and closeness with adjacent tooth.
Can I do a surgery to keep my wisdom teeth? Do I have to remove my wisdom teeth? It depends, but rarely is it advisable to do surgery to keep wisdom teeth.
What complications can occur after wisdom tooth removal surgery?
Pain and discomfort,
Post-operative swelling,
Fever,
Restricted mouth opening,
Prolonged bleeding,
Delayed healing,
Nausea and vomiting,
Nerve damage leading of loss of sensations and numbness of associated area.
What should be done to promote speedy recovery after wisdom tooth surgery?
Homeoblock Appliance is an alternative to jaw surgery
99% of the time surgery is not necessary to correct orthodontic or tmj problems. There are many treatments to consider that correct TMJ and bad bites that do not involve surgery. If you are being told by an orthodontist that you need surgery, you should get another opinion, because there are appliances that can correct underbites, crossbites, deep bites and joint pain. Often times orthodontists are not aware of some of the available adult appliances and how to use them. The Vivos DNA and homeoblock appliances are examples of effective non surgical treatment alternatives to jaw surgery. The Vivos and Homeoblock are adult facial growth appliances. These appliances change the size a shape of the jaw bone and are a lot different than orthodontics that usually changes teeth positions only.
Vivos MRNA Photo
Reasons not to get Jaw surgery:
better non surgical treatment options exist that have better outcomes than surgery, cost less money and non surgical complications
it will be all over when you wake up and you may not like it
long recovery time. Your jaw will be wired for weeks
lots of pain and swelling
Jaw surgeries do not have a high success rate. You could actually get worse
It costs a lot of money
You will need months if not years of treatment with braces afterwards.
Non-surgical Treatment Options for TMJ and Jaw Pain
TMJ problems can cause severe pain
TMJ pain is among the most serious conditions affecting your face, jaws and muscles involved in chewing and biting food. Early diagnosis and management is essential for avoiding progression of the disorder and development of complications. Complete history and thorough check of TMJ and surrounding area is necessary before planning treatment of the problem.
Diagnosis and Preventative Treatment for Children:
Palatal Expanders and other growth appliances exist for children. Many kids suffer from under development of the jaw and facial bone. Diagnosis and treatment from a qualified professional can prevent the need for future jaw surgery. Signs of problems to come are crooked teeth, poor sleep and even pediatric sleep apnea.
TMJ pain disorder is the condition in which your face and mouth suffers from pain and discomfort during talking, laughing, eating, drinking, chewing, biting, yawning and all activities involving muscles of the face and mouth. Temporomandibular joint is the joint which connects the jaw bones to skull. If you are having symptoms, you should consult with a qualified professional.
What Are TMJ Symptoms?
TMJ disorder symptoms usually presents as pain and discomfort in the affected area of your face and mouth. In addition to feeling of pain, majority of TMJ cases are presented with popping and clicking noises when you open or close your mouth during talking, eating or chewing food. Clicks may occur during both opening and closing your mouth.
Difficulty in opening your mouth in the morning when you wake up from sleep,
Previous history of multiple dental treatments i.e. root canal treatments, dental implants, teeth whitening, dental fillings, dental bridges and crowns,
Severe pain within and around your ears (earache),
Severe pain and discomfort in your temple area, behind eyes and back of the head,
Temporary loss of vision due to stress,
Flu and sinus irritation,
Chipping and cracking of teeth,
Pain and discomfort in shoulders, neck, head and back,
Problems in bite between upper and lower teeth,
Loss of appetite.
When is Jaw Surgery Necessary?
It is not always necessary to opt for surgical jaw treatments in TMJ pain and orthodontic cases. Many non-surgical TMJ treatments are available and work. Surgical intervention is usually avoided at all costs as conservative and symptomatic treatments usually suffice and give excellent outcomes. In fact, majority of cases require conservative and non-invasive treatment planning. However, when your TMJ specialist has tried all non-surgical option or thinks severity of the disease required surgical procedures, these should be performed. Whenever surgical treatment is deemed necessary by the TMJ expert, it is usually performed in the least invasive manner possible.
What are the Non-surgical Treatments for TMJ?
Majority of TMJ pain cases are treated with the help of self-management exercises at home and conservative treatments by the TMJ specialists. The course of treatment is usually guided by the cause of problem. Your TMJ specialist will evaluate the condition before planning treatment for you. The two treatments that can correct TMJ without surgery:
Stretching exercises for increasing limited mouth opening,
Co-ordination and mobilization exercises for achieving controlled jaw movements,
Physiotherapy should be started as soon as possible. It will provide best results in early course of treatment,
Use of soft stabilization splints,
Rest,
Ultrasound,
Trans-electric nerve stimulation (TENS) jaw muscles relaxation and reducing pain/discomfort,
Correction of disturbed jaw bite with the help of braces,
Botox injections,
Various medications for reducing pain, discomfort and anxiety which will help in the treatment of TMJ pain i.e. Non steroidal anti-inflammatory drugs (NSAIDs), Tri-cyclic anti-depressants (TCAs), anxiolytics, anti-epileptics and cortico-steroids,
Lifestyle changes can help in the management of TMJ pain?
Your lifestyle and daily habits can be crucial in avoiding TMJ pain and discomfort. Your mouth functions throughout the day and needs rest as well. Following are very important for the prevention and management of TMJ pain.
Refrain from biting hard nuts and crunchy foods when you have TMJ discomfort,
Avoid taking sticky foods in this condition,
Taking soft diet will help in easing and relieving your TMJ pain,
Reduce stress and anxiety,
Avoid gum chewing,
Avoid sleeping on the affected side,
Avoid putting telephone cradle on the affected side,
Avoid wide yawning.
Surgical treatment options
Surgery is advised by the TMJ specialists as a last resort when all non-invasive procedures fail and do not provide the anticipated results. However, least invasive surgery will be opted first and more invasive procedures will only be performed when all other options become irrelevant. Surgical procedures which can benefit for the treatment of TMJ pain disorder are,
Arthrocentesis is the least invasive surgery and you can go home on the same day following this treatment,
Modified condylotomy,
Disc re-positioning,
Discectomy,
Joint replacement.
Jaw Surgery Complications
We aim to perform safe surgical procedures. You must go for an expert TMJ surgeon whenever it is planned to opt for surgical treatment. However, complications which can occur during surgery are,
During the night, the brain cycles through lighter and deeper stages of sleep. As the brain approaches deep sleep, all the muscles in the body have to fully let go and relax. This can cause trouble for the airway as the tongue and muscles in the throat and airway relax. The jaw is heavy and can easily reverse and block the main airway along with the tongue. The tongue, when fully relaxed can be displaced towards the throat and block the airway also. All these conditions can restrict air flow during breathing during sleep. This is called UARS or upper airway resistance syndrome. During UARS people will clench their teeth as a reflex. It is a defense mechanism to arouse someone from deep sleep to restore normal breathing patterns by opening and clearing the airway.
Options for treating TMJ pain and teeth clenching video
Teeth Clenching re-opens the airway during collapse
Researchers studied brain scans of people with airway resistance problems and what they noticed is that it was grinding (also called bruxism) that reopened the airway and got the study participants breathing again. As soon as they were given something to keep their airway open all night long like a CPAP machine or a dental appliance, the grinding stopped and so did the “sleep apnea” events.
Orthodontic Expanders can cure upper airway resistance
The DNA appliance therapy is a novel treatment that cures TMJ, sleep apnea and all the reasons why people grind their teeth at night time. The DNA or another adult orthodontic expander call the Homeoblock appliance is the best way to stop clenching and correct airway collapse?
Teeth clenching can cause a lot of damage
If grinding is what saves us, then what’s wrong with it? While grinding is effective at saving us at night, there are consequences to having interrupted sleep every night. You’re not sleeping well if you grind your teeth. Even with slight sleep apnea, you’re waking up in a damaged state. Tensing up the muscles to grind bounces the body out of deep sleep, and all the health benefits of sleep you read about come from deep sleep. This is where human growth hormone (HGH) is released, reversing the aging process, tightening skin, improving memory, burning fat, and building muscle, and potentially warding off diseases like Alzheimer’s. Untreated sleep apnea can have serious and life-shortening consequences like high blood pressure, heart disease, stroke, automobile accidents, diabetes, depression, anxiety, and weight gain. Don’t fall into the eight hour trap — just because you’re unconscious for eight hours, doesn’t mean it’s quality sleep.
Clenching causes cavities and teeth cracks
Teeth grinding causes people to need more dental work including fillings, dental implants, and crowns. The dental work just repairs wear and tear caused by clenching and not the cause of clenching. Later the dental work fails from more clenching and grinding and needs to be redone. Years of grinding and clenching can damage your teeth, cause tooth decay and tooth sensitivity, and lead to permanent jaw pain and damage to the TMJ.
Can night guards prevent clenching?
A mouth guard often makes things worse. A mouth guard is put in place to protect the teeth from grinding, but since it can reposition the jaw, it can actually make the obstruction of the airway worse.
Teeth clenching is a symptom of sleep apnea
If you grind your teeth, the new standard of care is that you get a sleep study because you are likely having episodes of interrupted breathing during the night and missing out on all the health benefits of deep stage sleep. Even if you’re otherwise healthy, sleep apnea is known to significantly increase your risk of high blood pressure, stroke, cancer, diabetes, depression, and obesity.
A Swedish study estimated that as many as half of women aged 20 to 70 suffer from some degree of sleep apnea which ranged from mild to severe. The old idea of an obese, middle-aged man who snores is no longer what we should think of when it comes to sleep apnea.
To treat grinding, you have to treat the source of what’s causing it, and that’s a small airway. If you grind your teeth, you might have been told that you need to sleep with a mouthguard to protect your teeth from wear and tear and that’s based on the old standard of care. Neglecting teeth grinding can lead to excessive wear and tear on teeth, leading to tooth decay, periodontal tissue damage, jaw pain, and headaches. The new understanding is that, in order to treat teeth grinding, you have to treat the root cause that is causing you to grind your teeth. And that’s the obstruction of the airway.
If you grind your teeth, it should be considered first due to its seriousness that you likely have a small airway and the reason you’re grinding is to open your collapsed airway while you’re sleeping.
In fact, wearing a mouth guard to protect your teeth from grinding may even make you grind more, since a mouth guard repositions the jaw in such a way that the airway could be getting blocked more than it would be without the mouth guard.
Mouth Guard can cause more harm than good
But how do you know if you grind your teeth if you’re asleep when you’re doing it? Most people don’t know that they grind their teeth until their dentist tells them. Unless the clenching is so frequent that TMJ pain commences.
A jaw joint that clicks when opening and closing your mouth
What to Do If You Grind Your Teeth
Talk to your dentist. Your dentist can’t make the diagnosis — she or he will leave that to the sleep medicine MD, but your dentist can screen you for teeth grinding and examine the beginning of your airway as you lie flat in the chair at your next appointment. There is an oral appliance your dentist can make for you that keeps the airway open while you sleep, which can work great in conjunction with a CPAP machine or even by itself in mild cases.
Get a Sleep Study Done
Find out if you grind your teeth. The telltale signs of a grinder are flat, worn teeth, jaw clicking, or jaw pain. Ask your dentist to be sure. Talk to your doctor about getting a sleep study. Ultimately, you will need a sleep study to get a diagnosis for sleep apnea from a sleep specialist.
TMJ disorder is definitely treatable if not completely curable. Management of TMJ disease lessens pain and discomfort and prevents it from progressing to the worse condition. DNA appliance therapy is one example of treatment that can cure TMD by treating underlying cause of the problem. TMJ symptoms are most often caused by a condition caused by small jaw structure and night time airway issues. How to stop teeth clenching and grinding?
Watch this video to learn more:
Small jaw structure has all kinds of negative consequences:
Less space in the mouth and inadequate room for tongue function and proper breathing patterns.
Less space for teeth to fit. There is teeth crowding and bad bites. Often people with small jaw structure have been treated with braces and other treatments that can make TMJ problems worse.
small jaw structure does not allow a balanced bite. The biomechanics of the bite are worse in these cases.
Management of TMJ disorder usually depends upon the cause of its occurrence. Treatment options for TMJ disease are diverse as there are so many causes of TMJ pain. These involve from self management procedures ranging from surgery to various TMJ and orthodontic expander appliances.
Various treatments are:
Counseling and education of patients (cognitive behavioral therapy) which usually involves reassurance of the condition and telling them about the cause behind it. Your TMJ dentist will tell you about it in detail and will guide you towards the anticipated outcomes as well. Your confidence in treatment will be established based on reality,
Habits which can damage TMJ and aggravate the disorder will be reversed and proper use of jaws during chewing, biting and eating will be guided and encouraged for future benefit,
Moist heat pads and cold packs can be applied on painful muscles as part of thermotherapy,
Massaging painful muscles of face which are used in chewing and biting food,
Reduced mouth opening will be increased through stretching exercises through the use of multiple tongue depressors and sticks placed between teeth several times daily,
Co-ordination and mobilization exercises will be taught to you by the TMJ specialist which will help in achieved controlled jaw movements,
Physiotherapy should be started as soon as possible. It will provide best results in early course of treatment,
Soft stabilization splints are provided for use within the mouth,
Trans-electric nerve stimulation (TENS) relaxes jaw muscles and reduces pain through the use of electric current,
Bite correction,
Botox injections can be helpful in some cases of TMJ pain,
Different types of stress reducing drugs help in treating TMJ pain such as Non steroidal anti-inflammatory drugs (NSAIDs), Tri-cyclic anti-depressants (TCAs), anxiolytics, anti-epileptics and cortico-steroids, muscle relaxants,
Surgical intervention is usually avoided at all costs as conservative and symptomatic treatments usually suffice and gives excellent results,
Whenever surgical treatment is deemed necessary by the TMJ expert, it is usually performed in the least invasive manner in the form of arthrocentesis and arthroscopy.
Which lifestyle changes and precautions would the TMJ specialist advises for prevention of TMJ pain?
Avoid biting hard nuts and crunchy foods,
Sticky foods can aggravate TMJ pain,
Take soft diet,
Reducing stress in daily life,
Avoid gum chewing,
Avoid sleeping on the side with TMJ pain,
Avoid listening to phone with the cradle put on ear on the affected side,
Eat food in smaller pieces,
Refrain from yawning with wide open mouth.
Relaxation exercises help in the management of TMJ pain?
Provide strength to muscles of jaws,
Stretch jaw muscles for providing maximum relief and benefit,
Increased mobility of jaws,
Relaxed jaw muscles,
Reduction in clicking of jaws,
Increased opening of locked jaws,
Help in achieving quick healing of affected jaws.
Is it possible that TMJ pain can go away on its own?
TMJ pain is among the common problems faced by students going for university and college examinations. Anticipated stress at work can cause throbbing pain and discomfort in your jaws and will result in sleepless nights. People lose confidence at work and are unable to perform their duties. It may result in grinding of teeth and sore face muscles. Simple painkillers and muscle relaxants can relieve the symptoms for sometime but the pain and discomfort comes back in no time. It is essential to consult your TMJ specialist for early diagnosis and complete management of TMJ pain disorders.
Previous history of multiple dental treatments such as root canal treatments, dental implants, dental fillings, dental bridges and crowns,
Receding gums,
Loss of bone around teeth,
Difficulty of breathing during night as the tongue falls back and blocks airway (sleep apnea),
Pain and discomfort on chewing and biting food,
Severe pain within and around your ears (earache),
Severe pain and discomfort in your temple area, behind eyes and back of head,
Temporary loss of vision due to stress,
Flu and sinus irritation,
Chipping and cracking of teeth,
Pain and discomfort in shoulders, neck, head and back,
Problems in bite between upper and lower teeth,
Loss of appetite.
TMJ pain can go away on its own and is of temporary nature if its due to a specific stimulus. It occurs during examinations and relieves soon after. However, TMJ pain is of recurring nature. However, TMJ discomfort due to injuries or some other permanent cause does not go away and needs complete treatment as advised by the TMJ specialist.
Can Acupuncture be used for treating TMJ disorder?
Yes. It may be of benefit to TMJ diseases associated with facial pain but the evidence related to this therapy is not conclusive yet. It may become established in future.
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