Anorexia Nervosa (Eating Disorders)

Introduction

It has been estimated that more than 10 million Americans currently are affected by serious eating disorders such as anorexia, bulimia and binge eating. While anyone can suffer from an eating disorder, they are most common in teen and young adult women. Eating disorders can have a large negative impact on an individual’s quality of life. Self-image, relationships with families and friends as well as performance in school or on the job can be damaged. It is critical for anyone with symptoms of an eating disorder to seek professional help since an individual can die from the medical complications these disorders can cause.

Types of Eating Disorders

Anorexia typically involves an extreme fear of gaining weight or a dread of becoming fat. Even though these individuals may be very thin or even extremely underweight, they see themselves as “fat.” They may attempt to reach or maintain what they think is their perfect body weight by literally starving themselves. They may also exercise excessively. Others may eat excessive amounts of food in one sitting and then attempt to get rid of the food and calories from their bodies by forcing themselves to “throw up” or by the misuse of laxatives or enemas.

Bulimia also includes the fears of being overweight. But it also includes hidden periods of overeating (binge eating) which may occur several times a week or even several times a day. While overeating, individuals may feel completely out of control. They may gulp down thousands of calories often high in carbohydrates and fat – in amounts of food that would be greater than what an average person would eat at one sitting. After they overeat, the individuals try to “undo” the fact that they ate too much as quickly as possible by forcing themselves to “throw up” or by the misuse of laxatives or enemas. This is often referred to as “bingeing and purging.”

Binge Eating or Compulsive Overeating may affect almost as many men as women. In the past, these individuals were sometimes described as “food addicts.” They overeat (binge eat) as noted in bulimia above, but do not regularly try to get rid of the food immediately by throwing up or by misusing laxatives or enemas. Feelings of guilt may make it easier for the person to overeat again.

Symptoms

Each of these eating disorders can rob the body of adequate minerals, vitamins, proteins and other nutrients needed for good health. Individuals with eating disorders can display a number of symptoms including dramatic loss of weight, secretive eating patterns, hair loss, feeling cold, constipation and, for women, the loss of their monthly menstrual period. Eating disorders may also cause numerous other physical health complications, such as heart conditions or kidney failure, which can lead to death.

Eating disorders can also affect oral health. Without the proper nutrition, gums and other soft tissue inside your mouth may bleed easily. The glands that produce saliva may swell. Individuals may experience chronic dry mouth. Throwing up frequently can affect teeth, too. When strong stomach acid repeatedly flows over teeth, the tooth’s outer covering (enamel) can be lost to the point that the teeth change in color, shape and length. The edges of teeth become thin and break off easily. Eating hot or cold food or drink may become uncomfortable.

Photographs

Prevention

Eating disorders arise from a variety of physical, emotional and social issues all of which need to be addressed to help prevent and treat these disorders. Family and friends can help by setting good examples about eating and offering positive comments about healthy eating practices. While eating disorders appear to focus on body image, food and weight, they are often related to many other issues. Referral to health professionals and encouragement to seek treatment is critical as early diagnosis and intervention greatly improve the opportunities for recovery.

Treatment of Oral Health Consequences of Eating Disorders

·         Maintain meticulous oral health care related to toothbrushing and flossing.

·         Immediately after throwing up, do NOT brush but rinse with baking soda to help neutralize the effects of the stomach acid.

·         Consult with your dentist about your specific treatment needs.

·         See your dentist regularly.

DENTAL X-RAYS

Study Links Dental X-rays to Risk of Brain Tumors

A new study published in the American Cancer Society peer-reviewed journal Cancer finds people diagnosed with the most commonly diagnosed primary brain tumor in the United States reported twice as frequent dental x-rays in the past. Led by Elizabeth Claus, MD, PhD, of the Yale University School of Medicine in New Haven and Brigham and Women's Hospital in Boston, researchers studied information from 1,433 patients who were diagnosed with the disease between the ages of ages 20 and 79 years between 2006 and 2011. The investigators compared answers to a health survey to answers given by a control group of 1,350 individuals who had similar characteristics but who had not been diagnosed with a meningioma. They found patients with meningioma were more than twice as likely as controls to report having ever had a bitewing exam, which uses an x-ray film held in place by a tab between the teeth, or panorex exams, which are taken outside of the mouth and show all of the teeth on one film, taken at a young age or on a yearly or more frequent basis. Below are comments from Otis W. Brawley, M.D., chief medical officer for the American Cancer Society, regarding the study. "It's important to recognize that this is what is called a case control study, which by its very nature is limited in the conclusion one can draw from it. You cannot conclude based on this study that people who got more dental x-rays were at higher risk of brain tumors. All that we can reasonably conclude from this study is that it suggests that there may be a link between dental x-rays and brain tumors, and that further research into the issue is justified. What the study actually found was that people with these tumors, when asked in a survey, reported having more x-rays in the decades before. That could mean one of two things: that x-rays may increase the risk, or that people who have been treated for these brain tumors remembered and reported having more dental x-rays than healthy people. That's called recall bias and is a common problem with these studies. "We need more data before we can even begin to state there is a relationship between dental x-rays and these tumors. Until that research is done, the best advice we can give people is to get dental x-rays when they are necessary and only when they are necessary. The dose of radiation given in a bitewing or panoramic x-ray is lower today than it was two decades ago. Nonetheless, x-rays should be done only when necessary. This is true of all x-ray technology, and it's the same advice experts would have given without this study. Even the American Dental Association says that although radiation doses in dental radiography are low, exposure to radiation should be minimized where practicable, and that dentists should weigh the benefits of dental radiographs against the consequences of increasing a patient’s exposure to radiation, the effects of which accumulate from multiple sources over time."

Jaw Pain

Overview

Many adults suffer from chronic facial pain. Some common symptoms include pain in or around the ear, tenderness of the jaw, clicking or popping noises when opening the mouth, or headaches and neck pain.

Two joints and several jaw muscles make it possible to open and close the mouth. They work together when you chew, speak or swallow. They include muscles and ligaments, as well as the jaw bone--the mandible (lower jaw) with two joints called the temporomandibular joints or “TMJ.”

The TM joints are among the most complex joints in the body. Located on each side of the head, they work together to make many different movements, including a combination of rotating and gliding actions used when chewing and speaking.

Several muscles also help open and close the mouth. They control the lower jaw (mandible) as it moves forward, backward, and side-to-side. Both TM joints are involved in these movements.     

Each TM joint has a disc between the ball and socket (see diagram). The disc cushions the load while enabling the jaw to open widely and rotate or glide. Any problem that prevents this complex system of muscles, ligaments, discs and bones from working properly may result in a painful TMJ disorder.

Diagnosis & Treatment

A dentist can help identify the source of the pain with a thorough exam and appropriate x-rays. Often, the pain may be from a sinus problem, a toothache or an early stage of periodontal disease. But for some types of pain, the cause is not easily diagnosed. The pain may be related to the facial muscles, the jaw or the TM joint.

Some TM problems result from arthritis, dislocation or injury. All of these conditions can cause pain and dysfunction. Muscles that move the joints are also subject to injury and disease. Injuries to the jaw, head or neck, and diseases such as arthritis, might cause some TM problems. Other factors relating to the way the upper and lower teeth fit together (the bite) may cause some types of TM disorders. Stress and teeth grinding are also considered as possible factors.

Diagnosis is an important step before treatment. Part of the dental examination includes checking the joints and muscles for tenderness, clicking, popping or difficulty moving. Your complete medical history may be reviewed, so it’s important to keep your dental office records up-to-date. Your dentist may take x-rays and may make a "cast" of your teeth to see how the upper and lower teeth fit together. Your dentist may also request specialized x-rays for the TM joints. Depending on the diagnosis, the dentist may refer you to a physician or another dentist.

There are several treatments for TMJ disorders. They may include stress-reducing exercises, wearing a mouth protector to prevent teeth grinding, orthodontic treatment, medication or surgery. Treatment may involve a series of steps beginning with the most conservative options. In many cases, only minor, relatively non-invasive treatment may be needed to help reduce the pain.

Dental Implants

Dental Implants

Did you know that dental implants are frequently the best treatment option for replacing missing teeth? Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone.

A Solution of Choice for Replacing Missing Teeth

Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.

Twenty years ago, these patients would have had no alternative but to employ a fixed bridge or removable denture to restore their ability to eat, speak clearly and smile. Fixed bridges and removable dentures, however, are not the perfect solution and often bring with them a number of other problems. Removable dentures may slip or cause embarrassing clicking sounds while eating or speaking. Of even greater concern, fixed bridges often affect adjacent healthy teeth, and removable dentures may lead to bone loss in the area where the tooth or teeth are missing. Recurrent decay, periodontal (gum) disease and other factors often doom fixed bridgework to early failure. For these reasons, fixed bridges and removable dentures usually need to be replaced every seven to 15 years.

Today there is another option for patients who are missing permanent teeth. Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone. Composed of titanium metal that "fuses" with the jawbone through a process called "osseointegration," dental implants never slip or make embarrassing noises that advertise the fact that you have "false teeth," and never decay like teeth anchoring fixed bridges. Because dental implants fuse with the jawbone, bone loss is generally not a problem.

After more than 20 years of service, the vast majority of dental implants first placed by oral and maxillofacial surgeons in the United States continue to still function at peak performance. More importantly, the recipients of those early dental implants are still satisfied they made the right choice. If properly cared for, dental implants can last a lifetime. 

Anatomy of a Dental Implant

A dental implant designed to replace a single tooth is composed of three parts: the titanium implant that fuses with the jawbone; the abutment, which fits over the portion of the implant that protrudes from the gum line; and the crown, which is created by a prosthodontist or restorative dentist and fitted onto the abutment for a natural appearance.

Many people who are missing a single tooth opt for a fixed bridge; but a bridge may require the cutting down of healthy, adjacent teeth that may or may not need to be restored in the future. Then there is the additional cost of possibly having to replace the bridge once, twice or more over the course of a lifetime. Similarly, a removable partial denture may contribute to the loss of adjacent teeth. Studies show that within five to seven years there is a failure rate of up to 30% in teeth located next to a fixed bridge or removable partial denture.

 

Further, conventional dentures may contribute to the loss of bone in the area where teeth are missing. As illustration (a) indicates, the presence of natural teeth preserves the jawbone. When a tooth is missing, as in illustration (b), the bone may erode and weaken until it may be necessary for your oral and maxillofacial surgeon to graft bone to the area to strengthen it for placement of a dental implant. When a missing tooth is replaced by a dental implant, the fusion, or osseointegration, of the implant and bone provides stability, just as the natural tooth did.

If you are missing several teeth in the same area of your mouth, you may still enjoy the confidence and lifestyle benefits that come with dental implants. Your oral and maxillofacial surgeon will place two or more dental implants, depending on the number of teeth that are missing. Your replacement teeth will be attached to the implants to allow excellent function and prevent bone loss. The implants will serve as a stable support that tightly locks into your replacement teeth and dentures to prevent slipping and bone loss.

With an overall success rate of about 95% and almost 50 years of clinical research to back them up, dental implants are frequently the best treatment option for replacing missing teeth.

Dental Implants vs. Conventional Dentures

Many patients who have selected dental implants describe a quality of life that is much more comfortable and secure than the lifestyle endured by those with fixed bridges or removable dentures. Dentures often make a person feel and look older than they are, cause embarrassment in social situations when they slip and click, and restrict the everyday pleasure of eating comfortably.

When they count the benefits they enjoy as a result of their dental implants, patients say their implants eliminate the day-to-day frustrations and discomfort of ill-fitting dentures. They allow people to enjoy a healthy and varied diet without the restrictions many denture wearers face. With a sense of renewed self-confidence, many people rediscover the excitement of an active lifestyle shared with family and friends and the chance to speak clearly and comfortably with co-workers. For all these reasons, people with dental implants often say they feel better... they look better... they live better.

Dental Implants are a Team Effort

Dental implants combine the best of modern science and technology, including a team approach spanning several disciplines.

A successful implant requires that all parties involved — the patient; the restorative dentist, who makes the crown for the implant; and the oral and maxillofacial surgeon, who surgically places the implant, follow a careful plan of treatment. All members of the implant team stay in close contact with each other to make sure everyone clearly understands what needs to be done to meet the patient's expectations.

The team is organized as soon as the decision for placing a dental implant is reached. Following an evaluation that includes a comprehensive examination, x-rays and a consultation with the patient and members of the implant team, the oral and maxillofacial surgeon surgically places the posts, or implants, in the patient's jaw.

When the implants have stabilized in the jaw, the restorative dentist prepares an impression of the upper and lower jaws. This impression is used to make the model from which the dentures or crowns are created.

The teamwork continues long after the implant and crown have been placed. Follow-up examinations with the oral and maxillofacial surgeon and restorative dentist are critical, and progress is carefully charted. Both the oral and maxillofacial surgeon and the restorative dentist continue to work together to provide the highest level of aftercare.

Are You a Candidate for Dental Implants?

Whether you are a young, middle-aged or older adult; whether you need to replace one tooth, several teeth, or all your teeth, there is a dental implant solution for you. With the exception of growing children, dental implants are the solution of choice for people of all ages, even those with the following health concerns:

Existing Medical Conditions. If you can have routine dental treatment, you can generally have an implant placed. While precautions are advisable for certain conditions, patients with such chronic diseases as high blood pressure and diabetes are usually successful candidates for dental implant treatment.

Gum Disease or Problem Teeth. Almost all implants placed in patients who have lost their teeth to periodontal disease or decay have been successful.

Currently Wearing Partials or Dentures. Implants can replace removable bridges or dentures, or they can be used to stabilize and secure the denture, making it much more comfortable.

Smokers. Although smoking lowers the success rate of implants, it doesn't eliminate the possibility of getting them.

Bone Loss. Bone loss is not uncommon for people who have lost teeth or had periodontal disease. Oral and maxillofacial surgeons are trained and experienced in grafting bone to safely and permanently secure the implant.

Our staff is eager to help you achieve a healthy smile. “Let’s talk about your smile!” Please call our office at (305) 534-2002 to schedule an appointment or visit our website at http://www.4everteeth.com.

4everteeth Dental Center -Miami Beach

Dr. Arnold Rothman

(305) 534-2002

939 Arthur Godfrey Rd.

Miami Beach, Fl 33140

Snoring and Sleep Apnea

Snoring and Sleep Apnea

People who snore loudly are often the target of bad jokes and middle of the night elbow thrusts; but snoring is no laughing matter. While loud disruptive snoring is at best a social problem that may strain relationships, for many men, women and even children, loud habitual snoring may signal a potentially life threatening disorder: obstructive sleep apnea, or OSA.

Snoring Is Not Necessarily Sleep Apnea

It is important to distinguish between snoring and OSA. Many people snore. It's estimated that approximately 30% to 50% of the US population snore at one time or another, some significantly. Everyone has heard stories of men and women whose snoring can be heard rooms away from where they are sleeping.

Snoring of this magnitude can cause several problems, including marital discord, sleep disturbances and waking episodes sometimes caused by one's own snoring. But, snoring does not always equal OSA; sometimes it is only a social inconvenience. Still, even a social inconvenience can require treatment, and there are several options available to chronic snorers.

Some non-medical treatments that may alleviate snoring include:

Weight loss — as little as 10 pounds may be enough to make a difference.

Change of sleeping position — Because you tend to snore more when sleeping on your back, sleeping on your side may be helpful.

Avoid alcohol, caffeine and heavy meals — especially within two hours of bedtime.

Avoid sedatives — which can relax your throat muscles and increase the tendency for airway obstruction related to snoring.

Your doctor has other treatment options, including the following:

Radio Frequency (RF) of the Soft Palate uses radio waves to shrink the tissue in the throat or tongue, thereby increasing the space in the throat and making airway obstruction less likely. Over the course of several treatments the inner tissue shrinks while the outer tissue remains unharmed. Several treatments may be required, but the long-term success of this procedure has not as yet been determined.

Laser-Assisted Uvuloplasty (LAUP) is a surgical procedure that removes the uvula and surrounding tissue to open the airway behind the palate. This procedure is generally used to relieve snoring and can be performed in the Oral and Maxillofacial Surgeon's office with local or general anesthesia.

Identifying and Treating OSA

Unlike simple snoring, obstructive sleep apnea is a potentially life-threatening condition that requires medical attention. The risks of undiagnosed OSA include heart attack, stroke, irregular heartbeat, high blood pressure, heart disease and decreased libido. In addition, OSA causes daytime drowsiness that can result in accidents, lost productivity and interpersonal relationship problems. The symptoms may be mild, moderate or severe.

Sleep apnea is fairly common. One in five adults has at least mild sleep apnea and one in 15 adults has at least moderate sleep apnea. OSA also affects 1% to 3% of children. During sleep, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. Also contributing to the problem may be the airway muscles, which relax and collapse during sleep, nasal passages, and the position of the jaw.

The cessation of breathing, or "apnea," brought about by these factors initiates impulses from the brain to awaken the person just enough to restart the breathing process.This cycle repeats itself many times during the night and may result in sleep deprivation and a number of health-related problems. Sleep apnea is generally defined as the presence of more than 30 apneas during a seven hour sleep. In severe cases, periods of not breathing may last for as long as 60 to 90 seconds and may recur up to 500 times a night.

Symptoms of Sleep Apnea

Those who have OSA are often unaware of their condition and think they sleep well. The symptoms that usually cause these individuals to seek help are daytime drowsiness or complaints of snoring and breathing cessations observed by a bed partner. Other symptoms may include:

·         Snoring with pauses in breathing (apnea)

·         Excessive daytime drowsiness

·         Gasping or choking during sleep

·         Restless sleep

·         Problem with mental function

·         Poor judgment/can't focus

·         Memory loss

·         Quick to anger

·         High blood pressure

·         Nighttime chest pain

·         Depression

·         Problem with excess weight

·         Large neck (>17" around in men, >16" around in women)

·         Airway crowding

·         Morning headaches

·         Reduced libido

·         Frequent trips to the bathroom at night

Diagnosing Sleep Disorders

If you exhibit several OSA symptoms, it's important you visit your Oral and Maxillofacial Surgeon for a complete examination and an accurate diagnosis.

At your first visit, your doctor will take a medical history and perform a head and neck examination looking for problems that might contribute to sleep-related breathing problems. An interview with your bed partner or other household members about your sleeping and waking behavior may be in order. If the doctor suspects a sleep disorder, you will be referred to a sleep clinic, which will monitor your nighttime sleep patterns through a special test called polysomnography.

Polysomnography will require you to sleep at the clinic overnight while a video camera monitors your sleep pattern and gathers data about the number and length of each breathing cessation or other problems that disturb your sleep. Often a "split night" study is done during which a C-PAP (continuous positive airway pressure) device is used. During polysomnography, every effort is made to limit disturbances to your sleep.

Treating Sleep Apnea

Obstructive sleep apnea can be effectively treated. Depending on whether your OSA is mild, moderate or severe, your doctor will select the treatment that is best for you.

Behavior Modification - If you are diagnosed with mild sleep apnea, your doctor may suggest you employ the non-medical treatments recommended to reduce snoring: weight loss; avoiding alcohol, caffeine and heavy meals within two hours of bedtime; no sedatives; and a change of sleeping positions. In mild cases, these practical interventions may improve or even cure snoring and sleep apnea.

Oral Appliances - If you have mild to moderate sleep apnea, or are unable to use C-PAP, recent studies have shown that an oral appliance can be an effective first-line therapy. The oral appliance is a molded device that is placed in the mouth at night to hold the lower jaw and bring the tongue forward. By bringing the jaw forward, the appliance elevates the soft palate or retains the tongue to keep it from falling back in the airway and blocking breathing. Although not as effective as the continuous positive airway pressure (C-PAP) systems, oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances, who do not respond to C-PAP, are not appropriate candidates for C-PAP, or who fail treatment attempts with C-PAP or behavioral changes.

Patients using an oral appliance should have regular follow-up office visits with their Oral and Maxillofacial Surgeon to monitor compliance, to ensure the appliance is functioning correctly and to make sure their symptoms are not worsening.

C-PAP (Continuous Positive Airway Pressure) and Bi-PAP (Bi-Level) - A C-PAP device is an effective treatment for patients with moderate OSA and the first-line treatment for those diagnosed with severe sleep apnea.Through a specially fitted mask that fits over the patient's nose, the C-PAP's constant, prescribed flow of pressured air prevents the airway or throat from collapsing. In some cases a Bi-PAP device, which blows air at two different pressures, may be used.

While C-PAP and Bi-PAP devices keep the throat open and prevent snoring and interruptions in breathing, they only treat your condition and do not cure it. If you stop using the C-PAP or Bi-PAP, your symptoms will return. Although C-PAP and Bi-PAP are often the first treatments of choice, they may be difficult for some patients to accept and use. If you find you are unable to use these devices, do not discontinue their use without talking to your doctor.Your Oral and Maxillofacial Surgeon can suggest other effective treatments.

Surgery for Sleep Apnea

Surgical intervention may be a viable alternative for some OSA patients; however, it is important to keep in mind that no surgical procedure is universally successful. Every patient has a different shaped nose and throat, so before surgery is considered your Oral and Maxillofacial Surgeon will measure the airway at several points and check for any abnormal flow of air from the nose to lungs. Be assured, your doctor has considerable experience and the necessary training and skill to perform the following surgical procedures:

Uvulopalatopharyngoplasty (UPPP) - If the airway collapses at the soft palate, a UPPP may be helpful. UPPP is usually performed on patients who are unable to tolerate the C-PAP. The UPPP procedure shortens and stiffens the soft palate by partially removing the uvula and reducing the edge of the soft palate.

Hyoid Suspension - If collapse occurs at the tongue base, a hyoid suspension may be indicated. The hyoid bone is a U-shaped bone in the neck located above the level of the thyroid cartilage (Adam's apple) that has attachments to the muscles of the tongue as well as other muscles and soft tissues around the throat.The procedure secures the hyoid bone to the thyroid cartilage and helps to stabilize this region of the airway.

Genioglossus Advancement (GGA) - GGA was developed specifically to treat obstructive sleep apnea, and is designed to open the upper breathing passage. The procedure tightens the front tongue tendon; thereby, reducing the degree of tongue displacement into the throat. This operation is often performed in tandem with at least one other procedure such as the UPPP or hyoid suspension.

Maxillomandibular Advancement (MMA) - MMA is a procedure that surgically moves the upper and lower jaws forward. As the bones are surgically advanced, the soft tissues of the tongue and palate are also moved forward, again opening the upper airway. For some individuals, the MMA is the only technique that can create the necessary air passageway to resolve their OSA condition.

Talk With Your Doctor

Sleep apnea is a serious condition and individuals with OSA may not be aware they have a problem. If someone close to you has spoken of your loud snoring and has noticed that you often wake up abruptly, gasping for air, you should consult your Oral and Maxillofacial Surgeon.