Some people consider getting their 3rd molars or better known as wisdom teeth out as a right of passage going into adulthood.  Today we are finding out that may not always be the case and a multitude of factors go into a dentist and patient deciding to get their wisdom teeth removed.  A lot of us wonder why do people have so many problems with their wisdom teeth?  What other body part is routinely removed?  Maybe tonsils and the appendix but those are  not our specialty.

As a dentist I have been practicing for quite some time and I have had the opportunity to talk with patients and the staff about the frustrations dealing with and understanding dental Insurance.

     By improving our sleep we allow our body to heal itself..  When we get proper sleep, our bodies produce more hormones, like growth hormone.  It also allows us to repair our bodies.  This can improve our overall healing, headaches, heart health, immune system deficiencies and other illnesses.  

     What is happening when our body doesn’t get proper sleep?  We get sick when our body sleep gets interrupted.  Proper sleep gets us feeling better.  When we are born we are all dealt a genetic deck that we have to make the best of.  While we sleep we strengthen every one of our genetic weaknesses. When we do not sleep properly the diseases we are susceptible to manifest themselves.  Medical Doctors have done studies that show when we get proper sleep there are drastic improvements in many of the patients illnesses resulting in less need for headache, heart and diabetic medicines.      

     What causes sleep to go bad?  One thing is lack of vitamin D3.  Vitamin  D is actually a hormone made when sunlight on your skin converts cholesterol to vitamin D.  Have you ever noticed the big push in the last decade or so of people getting diagnosed with sleep apnea?   Some theorize the invention of Air conditioning and people staying inside on a hot summer day when we were getting the proper exposure to summer UVB rays necessary.  We substitute this by getting vitamin D milk and taking vitamins with the recommended 1000 I.U. Vitamin D is also needed to use Vitamin B12.  

     What is obstructive sleep apnea (OSA) and what causes it?  Obstructive sleep apnea is a partial or complete collapse of the upper airway that causes muscles controlling the soft palate and tongue to relax.  When this happens a person experiences apneas, hypopneas and flow limitation.  Apnea is a stop of the airflow for more than 10 seconds.  Hypopnea is a decrease in airflow lasting more than 10 seconds with a 30% oxygen reduction in airflow and at least a 4% oxygen desaturation from baseline.  Flow limitation is a narrowing of the upper airway and an indication of an impending upper airway closure.  When the airway is totally blocked snoring is the obvious symptom.

     Signs and symptoms of sleep apnea include a lack of energy, high blood pressure, frequent nocturnal urination, depression, obesity, excessive daytime sleepiness, gastro esophageal reflux and snoring to name a few. Increased risk factors are but not limited to being male, obesity, diagnosed with high blood pressure, excessive use of alcohol or sedatives, smoking, family history of OSA, large neck circumference and endocrine or metabolic disorders.  Studies have shown that sleep apnea is a independent risk factor hypertension.  43% of patients with mild OSA and 69% of patients with severe OSA have hypertension. 65% of stroke patients have some form of sleep disordered breathing.  

    How can we treat OSA?  The gold standard is to treat it with CPAP therapy.  This stands for continuous positive airway pressure therapy.  A physician diagnoses OSA by having a sleep study done and prescribing a CPAP machine.  Not everyone can tolerate the mask, the noise it creates and how it limits your flexibility sleeping.  This bring us to what a dentist can do.  We as dentists can treat OSA with a mandibular repositioning device (MRD).   It is a custom made, adjustable oral appliance that maintains the lower jaw in a forward position during sleep.  This mechanical protrusion widens the space behind the tongue and reduces the vibration and physical obstruction to breathing and the tendency to snore.

   MRDs have many benefits in mild to moderate cases equal to a CPAP machine.  MRDs offer significant improvement of sleep apnea symptoms including daytime sleepiness, quality of life, blood pressure and cognitive performance.  Although CPAP remains the most efficacious treatment option, dentist today are offering effective oral appliance therapy for thousands of patients that often have a better adherence rate that CPAP.  If you don’t wear the CPAP it can’t help you.  Oral appliances have a better track record for long term use helping thousands of patients that can’t tolerate the CPAP.

     The recommendation I can make to you is if you have some of the signs and symptoms we discussed get checked out by your physician and if needed have a sleep study done.  If you are diagnosed with sleep apnea try the CPAP machine and make sure you are getting enough Vitamin D.  If you can’t tolerate the machine please try an oral appliance that is usually better tolerated and sometimes can be equally effective.  If you have any questions give us a call, I would love to discuss this further.

I was taught in dental school to only prescribe opioids for short term pain relief.  Also, I recommend non-steroidal anti-inflammatories such as ibuprofen and Aleve as a first line of defense for pain.  Starting right away before the numbness wears off and taking the pain medicine before leaving the office. I tell people that most of your pain and swelling does not occur right away but 36 to 48 hours after the procedure.  So start taking the first line pain medicines for the first two days before you get the pain.  This will hopefully prevent inflammation and swelling so you may not even need something stronger like Vicodin. We were also taught in dental school to only prescribe medications such as Vicodin for 3 days duration or less because if you still have pain for more than 3 days something else is probably going on and you need to see us and be reevaluated for example you may have a dry socket or a boney spicule that needs removal following an extraction.  We can always prescribe you another three days worth of pain medicine.

The government is trying to help all providers identify patients that may be abusers.  Each state have set up their own prescription drug monitoring program that all providers and pharmacies have access to help identify potential abusers.

Another recent change that helps providers is making certain prescription only in written form.  We can no longer phone in Vicodin.  You have to be seen in the office and get a written prescription.  This has helped many dentists sleep better at night if nothing else, since we don’t get calls in the middle of the night requesting pain meds until they can be seen the next day and then they somtimes don’t show up questioning if they had legitimate pain!

 I hope you gained some insight into how we treat patients for pain.  Remember prevention beats a pound of cure!  Hopefully Nonsteroidals like ibuprofen, ice therapy and rest can help keep our dependence on opioid meds to a minimum in the dental office.