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Posted: November 19, 2018
Dental disease fits in one of three categories:
Each of them can be treated by standard or traditional dental care and treated completely incorrectly. On the other hand, in a dental office with the right training, the comprehensive plan can be completed relatively quickly and with long-lasting benefits! The key is to invest in the treatment options that get you to your goals quickest and will have the most predictable longevity afterward.
In this blog, we will outline bite disease and consequences and the best ways to keep your teeth for a lifetime!
For years dentists and orthodontists have said the same basic thing to our patients. Wait until you lose all your baby teeth and then go see the orthodontist and they can make them straight and pretty. And parents would wait. And kids would continue with the same basic problems that will one day need braces, but no one paid attention to the price that is being paid all along! It seems a little funny to hear an Aesthetic dentist say that straight and pretty isn’t the point, but it isn’t. Yes, it matters that your kiddos have straight and healthy teeth, but it is about so much more than just pretty! The reality is that it is all about life-long health and function and that it guides growth and development of not just the mouth, but also the body and brain and behavior and scholastic performance and athletic abilities and every single aspect of their lives!
What we had always said was something along the lines of ‘you have too many teeth for your mouth and we need to take out these teeth and then we can straighten the rest’ but what we should have realized is that is almost never the case! The reality is the mouth hasn’t grown large enough to hold the teeth in the proper arrangement and we should be looking at options to expand and develop your upper and lower jaws to allow room for your teeth. The teeth were right all along, but it’s the mouth that didn’t grow correctly and the sooner that gets addressed, the better off the kids are in every aspect of their lives! Additionally, the dentist looks at the maxilla as the upper jaw because we look from the mouth. If we looked at that same structure from above, we see it is the floor of the nose. Flip sides of the same coin, the roof of the mouth quite literally is the floor of the nose! If you have a problem with your mouth being too small to hold your teeth, you also have a problem with the floor of your nose being the wrong shape for proper breathing!
So much of health care is about managing the symptoms and it has created a massive problem because that’s the least effective, least efficient, and most expensive way to approach it! If you have a broken arm, it’s different. That’s a real problem with an obvious solution. It seems like decay and cavities or gum disease would be the same, but they aren’t. They are the result of a bacterial overload because the system is broken. Fortunately, we know a lot more about that system and have some amazing tools to address it as a profession. On the other hand, dentists are trained to think about the bite and jaw function in a way that quite simply isn’t accurate.
The consequence is the entire realm of bite and jaw function seems to be about popping and clicking and where the jaw bones and the little disc is, but the problem is much more pervasive and sinister and, oddly, nearly unrelated to the precise position of the pieces! The focus should always have been on the system. How the teeth relate to the bones, how the teeth and bones relate to the supporting muscles, and this complex governs the resulting airway. When it is viewed from this perspective, we routinely find solutions to “migraine pain” or chronic head and neck pain. From this more global perspective, we see patients sleep soundly through the night and wake up feeling amazing again. Snoring stops (more about that in an upcoming blog) and not only does the patient get a better night of sleep, so does their spouse!! That 3:00 wall where all the sudden you run out of gas ends up disappearing. You don’t find yourself asleep on the couch at night or worse, asleep at the wheel at a stoplight!
If we were to put it in a fortune cookie, the message would be to “Treat your bite right and it will treat your life right!”
If we are looking for the root cause of the problems, it is almost always related to the way our body responds to the environmental allergens. If your kids (or you when you were a kid) responded to these allergens with a chronic inflammatory response or growth of the adenoidal tissues, that will impact the room for and function of the tongue. For instance, if the adenoids block the nasal airway or the tongue has to move around the tonsils for you to get air, it will change the position you have to hold your mouth to be able to breathe. Typically your mouth ends up staying open and that is the start of massive consequences! By design, we are nasal breathers and if you or your kids sit and walk and sleep with your mouth open, there is almost certainly an issue that, if addressed, would improve both your health and also the quality of your life. Nasal breathing is essential for long-term health!
With your mouth open, among the many problems are two huge drivers for bite disease and airway problems later in life. One is the tongue isn’t helping to push your teeth into position and your nose isn’t breathing properly helping to pull your upper arch into the proper growth patterns. This one-two punch means you end up dealing with misaligned teeth and a lack of space – but again, the real solution isn’t taking out teeth, but rather growing the jaw. The other issue is the tongue can’t learn to function properly to reinforce long-term stability in the teeth. In fact, a LOT of babies who are ‘fussy’ or ‘won’t latch’ when breastfeeding are dealing with a tongue tie and quite simply, they can’t comfortably breathe or eat! It is incredibly important to correct tongue and lip ties as young as possible and should be screened for from birth!
An important thing to always keep in mind is the incredible rate of growth of kids! For sure you have noticed that the kids in Peanuts are all head and there’s a reason for it! With regard to head size;
By age 4 it’s 50% developed
By age 7 it’s 70% developed
By age 12 it’s 90% developed
Everything that can be done to encourage proper growth and development as early as possible is essential to ensure healthy development of physical attributes as well as cognitive ones!
I don’t know what happens with your kids, but I know what happened to mine and I feel bad for what I did to my parents! At my grandparent’s house, our snack was often a slice of white bread with butter and sugar and some Kool-Aid or colored sugar water! Ice cream was always around and we added sugar to everything from grapefruit to Rice Krispies or, on the best mornings, monkey bread (that buttery, cinnamony sugary mound of bread balls that starts with just a bite and doesn’t stop ‘til it’s all gone!). Sleep happens all too late and mornings come all too early the kids are given back tired and wired. Interestingly, kids who are dealing with ADD and ADHD act a lot like we did when we came back from the grandparents!
If you have children or know someone who does, this video is well worth the few minutes it takes to watch! Seriously, it is incredibly powerful and may mean the world to someone in your life! Click the link and scroll down to the video…
As we wax and wane through trends in medicine and are guided by non-health influences like insurance companies, we make a lot of mistakes. Today we are seeing more tonsils and adenoids removed but for a lot of years, it was simply ignored. The pediatrician had other things they were more concerned with and downplayed the importance. The amount of time spent with patients was pinched by ever-diminishing insurance reimbursement and the days of a physician actually taking time to talk for more than 3-7 minutes faded away. In those few minutes, vaccines and growth charts and allergies and a host of other concerns took over and we sort of missed the underlying problem. The airway and our ability to breath is critically important and generally overlooked! We all know that we can live weeks without food and days without water, but only a few minutes without air, but somehow we have forgotten it! Or, perhaps, breathing is so ubiquitous that we take it for granted assuming since you are alive, you must be breathing well. Interesting, there is an entire science of breathing that has spring up and it seems we aren’t really doing such a great job there after all!
At any rate, we have also seen the insurance reimbursement for tonsil and adenoid removal drop to next to nothing and given the time the surgery takes and the relatively frequent number of follow up visits or calls post-surgically, it simply isn’t worth the physician’s time to see the need. Human nature dictates that if it isn’t rewarding or immediately impactful, eventually we stop seeing the problem. So our kids have adenoids or tonsils that alter the mouth and prevents nasal breathing and forces mouth breathing. This creates growth and development problems and airway challenges and increases allergic responses and asthma and sleep disturbances. The consequence is a decrease in oxygenation to the body and that causes a buildup of lactic acids and other metabolic byproducts. These byproducts cause headache and chronic pain and/or an alteration in posture. This imbalance often causes numb fingertips or chronic neck and back pain or a disruption in the sleep cascade. The poor sleep often leads to a deterioration in the healing found in sleep, which in turn causes a downward trend toward heart disease and stroke and/or GERD and/or diabetes and/or chronic fatigue syndrome and/or migraine and/or erectile dysfunction and/or a whole host of other major problems! Today, questions are being asked about the impact of chronic hypoxia from a poor bite and the impact on dementia, aggravated dementia, and Alzheimer’s! It is a long list indeed!
It has often been said that the quality of your answers depends on the quality of your questions. Perhaps it’s time we ask different questions!
If we don’t have a well-developed and stable bite, our body may do just fine. A lot of people do. On the other hand, a lot of problems that are can be seen but not recognized for what they really are. Some by the patient, which are called symptoms, and are usually things like chronic headache or dizziness or difficulty swallowing or some other complaint they are looking for a solution to. Other issues are things a trained eye can see, but that may not be overtly impacting the life in a way that the patient is aware. That might be a short lower third of the face or a deep crease between the lower lip and chin, or something like crooked shoulders or forward head posture. It may not be overtly impacting the person’s life, but is a massive warning sign all the same.
Often the most logical place to seek help for bite problems seems like someone other than the dentist. Not surprising as most dentists don’t even recognize the cascade of events or appreciate what these signs really mean. It seems silly to ask the dentist about migraine type pain, chronic headache, neck ache, poor sleep, or numb fingertips, but the dentist may be the ideal person to help you resolve these issues!
Signs of potentially serious bite problems that are easy to miss:
Chin and nose are too close together
Significant wear on the teeth
Notches at the neck of the teeth
Forward head posture
Eyes aren’t level
Ears aren’t level
Pant legs/ shirt-sleeves need to be different lengths
There are lots of different dental schools but they all teach pretty much the same thing. Dental school training is designed to teach the fundamentals and to prepare the graduating students to take the clinical board exam. The entire focus of this exam is to be able to place a reasonably good filling, clean teeth reasonably well, do a decent root canal, and identify some basics in denture fabrication. It isn’t that the exam is elementary, but rather that it is designed to prove a baseline of skills. Unfortunately, that means it is also elementary. It is designed to address the bare minimal skills necessary to be a dentist, and that has nothing to do with the complicated and multifaceted issues of TMD issues or protecting a patent airway.
In fact, most dental schools are still teaching compartmentalized approaches to learning the basics of the bite and taught from the baseline that there is a particular bone relationship that will make the patient healthy. The lesson is that with the bone braced in this position, the problems go away. The reality is that this would be the only bone-to-bone joint in the entire body that in order to correct problems, we compress the bones together. Every other joint is managed by first decompressing the joints to allow more space and spur healing. Dental schools are taught from a premise that originated from clinical studies of skulls in the late 1800s and all of these insights were designed to make the dentures easier to build for people who had lost all their teeth.
When the goals of the questions are wrong, the answers tend to be wrong too! If we were to start asking questions about how the mouth works today instead of the 1800s, we would also have the benefit of EMG readings and live x-ray and MRI and CT scans and a whole host of other incredible tools to see a better picture of the issues. If we were to start to look today, we would arrive at better questions and then better solutions. If we were to start today, we would see the value of an optimized airway and comfortable maw and neck musculature and a stable bite. We didn’t start today, so the foundation of the science is based on things we thought we knew before the automobile was invented. Fortunately, there are people looking at how the teeth and the bones and the muscles and the airway all interrelates and they are finding out some amazing things!
While a lot of the things we deal with are straightforward cause and effect, there are also a lot of issues that the treatment is simply symptom management. These tend to be the ones that we are either blaming on stress or are labeled as idiopathic. The term idiopathic actually means ‘we don’t know’ which also means that we should look a little deeper! When patients report pain in various areas, health care is left looking for an answer as well as a way to help with the pain. All too often we resort to medication to manage the pain and while it makes a lot of sense to not hurt, there is no way that people are born short of Imitrex and that’s why they have migraines. There must be something else going on, but the doctors simply don’t have the perspective so understand or see it. In fact, that’s exactly what happens when people are dealing with chronic head and neck pain. As much as 90% of the pain in the body is muscular in origin and the muscles in the head and neck are all related to the bite and breathing.
On the team of people who you consult to manage chronic head and neck pain, it is important that at least one of them understands the impact of the bite and airway relative to the muscles in the head and neck. It happens that the temporal migraine pain is in the area of the muscles that control the lower jaw and the bite. It also happens that the muscles in the back of the neck and on the back of the head that are ones that control your head posture and those are stressed from forward head posture when your body is fighting to maintain an open airway. Things like TMD and OSA and Trigeminal Neuralgia and Migraine and Meniere’s Disease and a whole host of others are related to problems with the bite and airway, and a dentist who understands the impact of muscle physiology or what has been called Physiologic or Neuromuscular Dentistry can provide some incredible relief!
At Aesthetic Dentistry of Georgetown, we have built the practice on a few basic tenets. We firstly a relationship-centered practice, meaning that we aren’t going to run as many people through as possible. We will take the time to work with the individual people to help them to discover what their options really are. All too often the dentist comes in and takes a quick peek at the x-rays and mouth and ducks back out again and no one really knows the best options available. All too often the patient invests in a lot of restorative work and builds the mouth to a bite that isn’t right in the first place and the restorations end up failing way too soon. All too often the dentist doesn’t even recognize that the airway is compromised or the bite is pathologic and causing chronic pain like migraine or neck and shoulder pain.
We have made the commitment to make sure that you have the option to consider dentistry that recreates a bite that is built on a harmonious balance between the teeth, bones, and muscles and optimizes your airway. When this happens, the issues with migraine-type headaches disappear and sleep gets better and the grinding stops and life becomes much more fun to live because people aren’t dealing with chronic pain anymore!
There are a couple things we commonly hear from people as they start to work with us. For people dealing with chronic pain, they have often been to a number of physicians and chiropractors and other health care professionals and they have often tried a lot of things before they end up talking to a dentist about the pain they are dealing with. It isn’t uncommon that they have already been referred to a psychiatrist or psychologist or have been told that it’s all stress related and all in their heads. Unfortunately, this puts the weight of the problem back on the patient and they end up believing it’s all made up or they are somehow at fault. They hesitate to even mention the problems they are having because too often they have seen the look in the nurse’s eyes that makes them feel like they are making this all up or there’s a mental eye roll from whomever they are talking to.
We know this can be a massive issue. We know that some people have been in the fetal position in the closet hiding from the sun. We know some people have thrown up from the intense pain there are dealing with. We know some people have ended up on a morphine drip and in an ice bath in the hospital from the unrelenting pain. We know this because we have helped these people to end that pain cycle. Knowing it is real is the first step, and so we listen. As we help them to heal, they will talk about the experience and say things like “They actually took me seriously” or “For the first time, I had real hope!” This is an amazing thing to be able to do with and for patients. Amazing for us because we can really make a difference. Amazing for them because they are finally able to live their lives free of chronic pain!
We see ourselves as a resource for you. In this story, you are the hero and we are simply the guides. It’s our job to know the latest information in dentistry and to offer you the best options available. If you wanted to know dentistry at that level, you would have been a dentist! While some of our patients are dentists, most really don’t care about it that much and we get it! We will always offer you the best options available and always support whatever plan you decide is right for you. Quite often that won’t line up with the goals of dental insurance companies as their goals aren’t health care, but rather keeping your monthly premiums. In fact, insurance companies have developed lots of ways to deny and delay your payment and not help with your care! We will always work to maximize whatever help you can get from them.
Together with you, we develop a plan for your mouth to achieve your long-term goals. These plans will generally fit into some insurance code and we will fight with you to be sure you get whatever rebate is due to you according to the particular plan you have purchased or have through work. Proper care is sometimes a little bigger investment on the front end, but it saves you a lot more over the long term… it saves you not only money but in the long run, it saves your teeth!
At Aesthetic Dentistry of Georgetown, your entire team is an incredible blend of care and compassion with the latest clinical training and systems. Each of them is committed to ensuring a simple and comfortable experience whether it is a routine exam and cleaning, incredible professional whitening, chronic pain help, solutions to snoring and sleep apnea issues, or restorative care that spans the range of a single metal-free filling all the way to full mouth reconstructions supported with dental implants, and everything in between. Quite simply, we are a full-service practice that focuses on high-quality options across the complete range of dental care.
With years of experience, world-class training, and team approach to being a resource for you ensures that whatever your needs are, one of our team is always ready to help you to regain or protect the health of your mouth! Teeth were meant to last a lifetime, and with the unique education and experience of your dental family, you can expect us to help you to make that a reality!
If you are new to the practice, the best step to long-term health is a New Patient Experience where all aspects of the health of your mouth will be evaluated and a customized care plan will be developed with you to achieve your goals. If you aren’t new to the practice, you already know how amazing your team is and know they are in your corner for optimal oral health!