January 2, 2014
There’s no doubt about the benefits of breastfeeding, but most of the benefits that are written about in medical journals is related to the nutritional and immunologic benefits of human breast milk. Here’s one more of many articles touting the developmental benefits of breastfeeding over bottle-feeding. Most of the studies compare breast milk (including pumped milk) to formula, but this study specifically states that children who where specifically breast-fed had significantly higher scores in cognitive development, receptive communication, expressive communication, and fine motor development. Children who were breastfed for more than 6 months had the highest scores compared with children that were never breastfed.
There’s a general consensus within the dental community that bottle-feeding can potentially promote dental crowding. The physical act of swallowing is very different when sucking from an artificial nipple vs. suckling from a mother’s breast. Dr. Brian Palmer has an excellent explanation on his website.
In the original study, nowhere is where any mention of the biomechanics differences with breast-feeding versus sucking from an artificial nipple from a bottle. Poor swallowing mechanics leads to improper tongue motion, which can cause malocclusion (dental crowding), which in turn can increase your chance of narrowed airways and sleep-related breathing disorders (such as obstructive sleep apnea). This is also why using a pacifier or even thumb sucking has similar, detrimental effects.
What are your experiences with breast or bottle feeding and dental crowding issues in your children?
December 30, 2013
It’s been a while since my last post. With all the holiday season activities it’s been quite busy. But the main reason I haven’t written is that I just underwent minor surgery. Not just any surgery, but something that I do on a routine basis—a lingual frenulectomy. In other words, I just had my tongue tie cut and released.
The medical term for tongue tie is ankyloglossia. Many people have a band of tissue that tethers the bottom of the tongue to the floor of the mouth in the midline. This prevents proper tongue movement and normal resting posture in the mouth. My condition was mild to moderate in degree and I had no significant effects that I knew of, but since my son was scheduled to undergo this procedure, I decided to have it done as well, just to show him my support.
The procedure was performed by an oral surgeon DDS and MD, in his office. After a topical anesthetic was applied, Novocaine (an anesthetic) was injected. Getting the numbing medication was the most uncomfortable part. Afterwards, he used a CO2 laser to make the cut and remove the thin band of tissue.
Is was a bit rough for the first few days, but by day 5 to 6, I was able to eat normal foods. It’s been about one week since the surgery, and I’m slowly beginning to feel better and better. My speech is still a bit affected, but I can talk relatively normally. I’m now feeling things in my mouth that I could never feel before.
Newborn infants came to me in years past with severe tongue tie, which prevented them from latching on to their mother’s breast. After a simple cut in the office, infants are usually able to latch on and start feeding immediately. It’s a wonderful feeling to see this. Since the tongue is your most important orthodontic appliance, it’ important to have good tongue mobility. Having underdeveloped jaws can lead to dental crowding and sleep-related breathing disorders such as obstructive sleep apnea.
Not all cases of tongue tie should to cut, but if there’s any significant tethering, it’s something to bring up with your doctor. Oftentimes, the younger you are, the easier the recovery. This ended up being the case for my son—he’s healing much faster. Having undergone even this minor procedure is a great reminder for me what my own patients must experience, especially with much more aggressive procedures. Sometimes, a doctor needs a taste of his or her own medicine once in a while.
For a great resource on tongue tie, take a look at this article on Dr. Brian Palmer’s website.
December 9, 2013
The number of children with attention deficit hyperactivity disorder (ADHD) has risen 42% in the past 10 years. These findings were reported online in the Journal of the American Academy of Child and Adolescent Psychiatry. Currently, 11% of children in the United states have a diagnosis of ADHD. In addition, 6% of all 4 to 17 year olds (3.5 million children) in this country are reported by their parents to be taking medication for ADHD, which is a 28% increase from 2008 to 2012.
What’s more frightening than these statistics is that the real incidence of hyperactively and behavior problems probably goes underreported and under-diagnosed. What frustrates me every time I hear or read about this epidemic is that sleep is almost never mentioned as a major possible cause of this condition. Sometimes, good sleep hygiene is mentioned, but only rarely is the possibility of an underlying sleep-related breathing disorder ever addressed.
In a past study, 28% of children scheduled to undergo routine tonsillectomy were found to have ADHD. After tonsillectomy, 50% were cured of their ADHD diagnosis.
ADHD has many different causes and it’s likely that there are multiple factors that add up to produce symptoms in a child, but poor sleep due to any reason can definitely affect memory, focus and attention. Not breathing well during sleep with lack of oxygen to the brain can make things even worse.
It’s also not too coincidental that the estimated rate of snoring for children in this country is about 10%. Another study showed that the presence of snoring in young children predicted behavior problems in later school years. We know that a significant number of people who snore have undiagnosed obstructive sleep apnea. We also know that snoring without obstructive sleep apnea can still significantly affect sleep, with increased risk of attention problems, car accidents, and even stroke in adults.
Given all the evidence, it’s important to at least screen for obstructive sleep apnea in any child with a new diagnosis of ADHD.
November 21, 2013
With all the talk about sleep apnea and its’ association with high blood pressure and diabetes, little has been mentioned about how obstructive sleep apnea can affect your cholesterol and other lipid levels. We already know that OSA is linked with fatty liver syndrome. It’s not surprising that treating obstructive sleep apnea with CPAP has been shown to raise your HDL levels (the good kind of cholesterol).
Have your cholesterol or other lipid levels changed after using CPAP?
November 18, 2013
Types of OTC oral appliances for snoring
There are literally dozens of over-the-counter (OTC) mandibular advancement devices (MAD) available, which means that making a decision can be anything but easy. One should consider several factors before making such an important decision. After all, an oral appliance is a medical device that is used to treat conditions such as snoring and sleep apnea; so naturally you should desire what is best for your health.
Over-the-counter mouthpieces are available in a variety of designs from the simple boil and bite units to more complex models which allow you to create an impression using dental clay and then have a custom piece created at a lab. Then there are Tongue Stabilizing devices (TSD) which attach to the end of your tongue, preventing it from falling into the back of your throat. Finally, there are more complex devices which use both mandibular advancement and a tongue stabilizing device. Such mouthpieces have proven to be effective in many cases of snoring and sleep apnea. Here is a bit more information on each of these devices and a few reasons why you may want to choose them.
Boil and bite mouthpieces
By far, boil and bite mandibular advancement devices have dominated the market over the years. They are constructed from a unique type of thermoplastic material that becomes moldable when heated in hot or boiling hot water. This type of device typically comes pre-shaped to fit closely around your teeth. Once exposed to hot water for the specified amount of time, the user inserts the device into their mouth and bites down while moving their lower jaw forward. This position is held for up to one minute before the unit is removed and cooled, typically using a bowl of iced water.
Thermoplastic devices are often criticized due to their bulky nature. Some models are intrusive and uncomfortable while others are bearable and can be tolerated by the user. They are often almost twice the thickness of the more expensive OTC devices and can cause excessive drooling and dry mouth in some cases. Some have issues with these types of mouthpieces while others do not.
Some OTC oral appliances come with holes which allow for breathing while others do not. Breathing holes are generally considered a good feature to have while some prefer to have no holes due to issues dry throat issues. This sometimes occurs because a concentrated stream of air that constantly enters and exits your airway and dries out the saliva in the mouth.
One desirable feature that is not so commonly found is the ability to make advancement adjustments. Being able to adjust the jaw position forward 1 mm at a time enables one to find a desirable position which is comfortable yet still effective. With most devices, once the molding process has been completed, making adjustments can be difficult if not impossible. This means that one must locate the ideal position during the first fitting or they will end up with a piece that is unusable.
Boil and bite devices are typically the least expensive type of OTC mandibular advancement devices available, costing anywhere from $35 to $60 including shipping. The length of time that they last depends on how they were manufactured. In general, most last between 6 months and 24 months. Boil and bite devices are often used by those who are interested in testing the waters to see if a MAD will be an effective solution. If proven successful, many eventually choose to move up into a better constructed and more expensive unit.
If you are considering purchasing a boil and bite mouthpiece, be sure to carefully examine the manufactures sales page for these potential pitfalls before making a product selection.
Laboratory created OTC oral appliances
Some find that a better solution is the lab created OTC mouthpiece. These types of devices are typically more expensive than their boil and bite counterparts with an average selling price of $120 to $200.
While they still work exactly the same as the boil and bite types, a custom created mold allows them to fit much better in the mouth. When ordered, a custom impression kit is sent to your home which contains 2 dental trays and impression clay among other items. The impression clay is loaded into the trays and then inserted into the mouth where the person gently bites down and releases. After creating the impression, the tray is removed from the mouth and then placed into a shipping container where it is then sent off to a laboratory where it will be created. Within a couple weeks it is returned to your home and should be ready to use.
Perhaps the greatest advantage of this type of oral appliance is a closer, less intrusive fit. In comparison to the standard boil and bite model, these take up much less room in the mouth and overall are not nearly as bulky.
In some cases they can be adjusted while in other cases they remain in a fixed position.
Tongue stabilizing devices
A newer type of mouthpiece that is gaining momentum is the tongue stabilizing device (TSD). While far less popular than the mandibular advancement device, the TSD is making big strides and gaining market share.
Technically speaking, the TSD is not a mouthpiece in a traditional sense. It resembles a pacifier and actually attaches to the end of your tongue using the power of suction and rests between the lips and outer teeth. This device works by holding your tongue forward as you sleep to prevent the tongue from falling to the back of the throat and causing an obstruction in the airway.
Good Morning Snore Solution currently markets and sells an OTC version of this mouthpiece which can be purchased for around $120 including shipping.
Hybrid mouth guard
Recently, Zyppah has created a unique hybrid B&B device that also contains a tongue stabilizing strap which stretches from one side of the tongue to the other and is used to hold the tongue in place. These types of MADs provide both jaw advancement and tongue stabilization.
It works like any other MAD by holding the lower jaw in the forward position in order to prevent tissues form obstructing the airway. The stabilizing strap is an additional measure that is used to keep the tongue from relaxing and migrating towards the back of the throat.
Which type is most effective?
When it comes to snoring prevention, all four types of mouthpieces have been proven to be effective. While choosing a snoring treatment, consider which type will be the most comfortable for you and weight this against the total price of each device. Boil and bite devices are the most affordable yet some find them to be uncomfortable. Laboratory molded devices along with TSDs offer a more comfortable solution yet can cost more than twice as much as other alternatives.
OTC mouth guards can be a less costly alternative when compared to more expensive devices that are custom made by your dentist. As always, please speak with your doctor before using any oral appliance to treat snoring.
Robert Thomas is an expert writer and reviewer for http://www.snoringmouthpieceguide.com. He writes on topics such as snoring, sleep apnea, CPAP treatment, Mandibular Advancement Devices, and natural snoring therapy.
November 12, 2013
You may think that stroke is something you only see in older people, but strokes can also be seen in younger adults and even in children. A recent study published in The Lancet revealed that from 1990 to 2010, rates of new onset stroke, stroke survivors, and deaths from stroke increased 68%, 84%, and 26%, respectively. There were bigger increases in low and middle-income countries, and in people younger than 75.
There are lots of different reasons for stroke, including your genes, lifestyle habits, diet and exercise, but I wonder how much of an underlying sleep-breathing condition may be contributing, as more countries adopt Western style foods and habits. It’s remarkable how our younger generations have more dental crowding and smaller jaws, which lead to more narrow upper airways.
October 30, 2013
Here’s one of many recent studies showing low lack of good quality sleep can cause memory problems, dementia, and even Alzheimer’s disease. In this Johns Hopkins study, researchers found that people who slept less of had trouble sleeping had higher levels of beta amyloid plaques in their brain. Having plaques alone doesn’t mean you’ll develop Alzheimer’s disease, but what this study showed was that sleep may play an important role in how your brain rids itself of beta amyloid plaques, which are one of the hallmarks of dementia.
October 22, 2013
Guest post by Lisa Hunter
Many people, whether they are healthy eaters or not, find that during the evening they crave food to snack on, particularly salty, starchy or sweet choices. This generally happens a couple of hours before bedtime. Standard health advice is that we shouldn’t eat at this time of the evening, as our bodies don’t burn off fat and we simply store it, thus leading to weight problems. For sleep apnea sufferers, snacking before bedtime is particularly ill advised as it exacerbates this condition; however when you are not sleeping well, you crave snacks to boost energy levels in your body.
There are foods recommended for those tempted by snacking each evening, such as low glycemic choices and meals containing roughage. These will fill you up for longer and stop those nighttime cravings, leading to a better diet and healthier lifestyle.
Breaking the Pattern
People snack in the evening for different reasons. Sometimes it is because there is no structure, after a busy day, or we might snack as we’re cooking dinner, or end meals with a treat. Patterns are formed easily, such as craving cookies at nighttime, and a study in Obesity Journal shows that it is our internal clock that makes us reach for treats at around 8pm. It made sense for our ancestors who genuinely needed to store fat in order to survive, but today we do not need to replicate this pattern. Obesity is a debilitating disease and affects a significant number of people in the U.S today.
According to researchers at Oregon Health and Science University, our internal clock, known as the circadian system, intensifies our hunger at night and leads to obesity. Sugar tolerance is impaired in the evening and because we do not burn off energy at this time we simply store calories. Dr Shea, key author of the obesity study, explained that staying up later and storing energy leads to poor sleep, and these factors contribute to putting on weight. He recommends eating higher calorie meals earlier in the day, choosing lower calorie food for the evening meal and getting enough sleep to achieve weight loss.
Meals that fill you up for longer can break the pattern of snacking in the evening. You should also try to change your routine, to avoid munching on snacks in the kitchen or reaching for the calories during commercial breaks. Occupy yourself in other tasks instead so that you break the connection between activities and eating before you go to bed.
Foods to Fill You Up
Researchers have discovered that foods with a low glycemic content can help fill you up at mealtimes whilst keeping your weight down. The glycemic index was developed by researchers at the University of Sydney and relates to foods containing carbohydrates and how effectively they are converted into glucose within your body. If a food scores lower than 55, it is seen as low GL and is beneficial because it will allow glucose to reach your body in a steady stream, keeping you feeling fuller for longer.
Vegetables contain low glycemic levels and are high in fiber, minerals and vitamins. Peppers, broccoli, asparagus, cucumbers, eggplant, green beans and leafy greens are all low GL and can be served in a mixed salad or stir fried, tossed in chilli, served with rice or burritos for healthy meals that will satisfy you for longer.
Potatoes score surprisingly highly on the GL index, at 93, and therefore you need to cut down your consumption of baked potatoes and fries at evening meal times as they will make you crave snacks later on.
Dairy products such as skimmed milk are good for you, as its GL is just 32, but be careful of fatty dairy produce that contains lactose and try to stick to low fat choices.
Blueberry pancakes make a nourishing, tasty snack at mealtimes and there are many other low GL recipes to follow for your healthy diet. Try tomato and red kidney bean soup, bangers and mash or carrot and walnut cake. Opt for a tuna stir fry, skinny rice pudding or Thai green papaya salad. Hot smoked salmon with mango salsa makes a delicious meal and will fill you up and help you avoid those cravings for carbs.
Organic foods are considered to be healthier for you because of the lack of chemicals and additives within them. This means that they are ‘higher in beneficial vitamins, minerals and anti-oxidants’ and therefore your body is receiving more nutrients than it would with processed food, explains Licensed Prescriptions. With organic food, your body is getting the roughage it needs in a more natural way, and you have the peace of mind of knowing that your vegetables, fruit and meats are prepared and delivered within a short space of time, fresh and ready for the table. Fresh organic foods are perfect for mealtimes and will taste delicious in any recipe. They also break the connection you may have with processed, pre-packaged food that have a high GL content and lead to cravings after dinner. Low GL recipes, made with organic, natural ingredients, will give you a greater sense of satisfaction and help stop snacking.
By breaking evening habits and discovering low GL recipes for making meals that have a far greater satiety, you can eat healthier and stay fuller for longer.
October 15, 2013
Obstructive sleep apnea (OSA) is a common condition among Americans. This is well evident as one in 15 Americans suffers from this condition these days. A new study states that women who have OSA are highly prone to high risk health conditions during pregnancy, which is fatal to their babies and the mothers. The study said that those babies that were born to women with OSA condition are more likely to be admitted to the neonatal intensive care unit than those babies that are delivered by healthy mothers.
Details of the study
The study was conducted on obese women who were pregnant. The study revealed that the women with Sleep Apnea were more prone to develop preeclampsia, which is a serious condition of high blood pressure during pregnancy, where an emergency caesarean section may be required. The complications during pregnancy of obese women were also linked to high blood pressure and gestational diabetes. These two medical conditions are always understudied and under-diagnosed in women who are pregnant, according to the researchers. The study researcher and Assistant Professor of Obstetrics and Gynecology at the University of South Florida, Dr. Judette Louis, said that there is a need for better methods to test for and treat sleep apnea among women during their pregnancy.
Nature of Sleep Apnea
Usually, people who experience this condition gasp for air while sleeping. Women who are overweight face a higher risk of experiencing this condition, as fat in the throat can narrow the airway and can cause difficulty breathing at night.
Findings of the study
In this new study, researchers analyzed the condition of over 175 obese women who were pregnant and were screened for OSA in their homes by offering them a small portable device. About 15% of participants were found to have OSA. These participants were a bit heavier and had higher blood pressure levels than those who did not have OSA. Among those pregnant women who had OSA, about 65% needed a caesarean section while 33% of those without this condition needed a C-section to deliver their baby.
In addition, the study revealed that 42% of those with sleep apnea had preeclampsia when compared to 17% of those who did not have this condition. However, the premature birth rate was similar between the groups involved in the study. The percentage of newborn babies that required admission to NICU was 46% of the mothers who had OSA. This is much higher when compared to the 18% of those mothers who did not have sleep apnea. Researchers feel this might be because of the high rate of the caesarean births among the group of women who have sleep apnea. However, it is not clear on the effects of sleep apnea among women who are not obese as this study focuses on obese women.
Rania Paula, Author of this article writes for http://www.sleepwellblog.com. A weblog providing information about various sleep disorders such as insomnia, sleep apnea, restless leg syndrome, sleep deprivation, etc and there by helping you to have good night sleep.
October 10, 2013
In my last post, I described a Swedish study which explained how low testosterone could be caused by obstructive sleep apnea. In another Swedish study, midlife stress was shown to be associated with significantly higher levels of dementia and Alzheimer’s disease. These stresses included workplace problems, serious illness, divorce, and widowhood. Alzheimer’s developed in 21% of women who were followed for an average of 38 years.
We know from another study that 60% of Swedish women over aged 60 has obstructive sleep apnea. Obstructive sleep apnea is known to cause major brain damage, which can lead to dementia and Alzheimer’s disease. Is it possible that underlying untreated obstructive sleep apnea could have aggravated some of these midlife stresses (and illnesses), as well to cause later development of dementia?
There are lots of studies that show a strong link between brain damage and untreated obstructive sleep apnea. However, there has yet to be a study published showing that treating obstructive sleep apnea can prevent or delay dementia or Alzheimer’s disease. That study will deserve the Nobel Prize.