Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low breathing event is called ahypopnea. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or "sleep study".

There are three forms of sleep apnea: central (CSA), obstructive (OSA), and complex or mixed sleep apnea (i.e., a combination of central and obstructive) constituting 0.4%, 84% and 15% of cases respectively. In CSA, breathing is interrupted by a lack of respiratory effort; in OSA, breathing is interrupted by a physical block to airflow despite respiratory effort and snoring is common.

Regardless of type, an individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body . Symptoms may be present for years (or even decades) without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.

Diagnosis

The diagnosis of Sleep Apnea is based on the conjoint evaluation of clinical symptoms (e.g. excessive daytime sleepliness and fatigue) and of the results of a formal sleep study (polysomnography, or reduced channels home based test).Obstructive sleep apnea

Patient connected for a sleep study to determine degree of apnea. Sensors variously detect brain activity, nasal air flow, snoring sounds, etc.

Obstructive Sleep Apnea (OSA) is the most common category of sleep-disordered breathing. The muscle tone of the body ordinarily relaxes during sleep, and at the level of the throat the human airway is composed of collapsible walls of soft tissue which can obstruct breathing during sleep. Mild occasional sleep apnea, such as many people experience during an upper respiratory infection, may not be important, but chronic severe obstructive sleep apnea requires treatment to prevent low blood oxygen (hypoxemia), sleep deprivation, and other complications. The most serious complication is a severe form of congestive heart failure.

Individuals with low muscle tone and soft tissue around the airway (e.g., because of obesity) and structural features that give rise to a narrowed airway are at high risk for obstructive sleep apnea. The elderly are more likely to have OSA than young people. Men are more likely to suffer sleep apnea than women and children are, though it is not uncommon in the latter two population groups. The risk of OSA rises with increasing body weight, active smoking and age. In addition, patients with diabetes or "borderline" diabetes have up to three times the risk of having OSA.

Common symptoms include loud snoring, restless sleep, and sleepiness during the daytime. Diagnostic tests include home oximetry orpolysomnography in a sleep clinic.

Some treatments involve lifestyle changes, such as avoiding alcohol or muscle relaxants, losing weight, and quitting smoking. Many people benefit from sleeping at a 30-degree elevation of the upper body or higher, as if in a recliner. Doing so helps prevent the gravitational collapse of the airway. Lateral positions (sleeping on a side), as opposed to supine positions (sleeping on the back), are also recommended as a treatment for sleep apnea, largely because the gravitational component is smaller in the lateral position. Some people benefit from various kinds of oral appliances to keep the airway open during sleep. "Breathing machines" like the continuous positive airway pressure(CPAP) may help. There are also surgical procedures to remove and tighten tissue and widen the airway.

Some treatments involve lifestyle changes, such as avoiding alcohol or muscle relaxants, losing weight, and quitting smoking. Many people benefit from sleeping at a 30-degree elevation of the upper body or higher, as if in a recliner. Doing so helps prevent the gravitational collapse of the airway. Lateral positions (sleeping on a side), as opposed to supine positions (sleeping on the back), are also recommended as a treatment for sleep apnea, largely because the gravitational component is smaller in the lateral position. Some people benefit from various kinds of oral appliances to keep the airway open during sleep. "Breathing machines" like the continuous positive airway pressure(CPAP) may help. There are also surgical procedures to remove and tighten tissue and widen the airway.

At the gentle dentist we specialize in sleep disorders can prescribe Oral Appliance Therapy (OAT). The oral appliance is a custom-made mouthpiece that shifts the lower jaw forward, opening up the airway. OAT is usually successful in patients with mild to moderate obstructive sleep apnea. We have a high success rate in using OAT. We use brands such as SomnoMedÒ, silent night.

The purpose of cosmetic dentistry is to provide you with the means to achieve the most beautiful smile possible. Many children and adults alike encounter various kinds of teeth and gum problems throughout their life, whether it is caused by injury, mistreatment, or other factors, cosmetic dentistry provides the means to correct these flaws, achieving a beautiful teeth and smile we are confident and comfortable with.
Please look at how we can transform the smile of these lovely people below.

The means to achieve cosmetic dentistry includes :

• Veneers
• Teeth Whitening
• Teeth Straightening
• Implant
• Cosmetic Crown
• Tooth Colored Filling
• Bonding

Porcelain veneers, often termed dental veneers or dental porcelain laminates, are wafer-thin shells of porcelain which are bonded onto the front side of teeth to make a cosmetic improvement in their appearance. Porcelain veneers are routinely used to idealize teeth that are discolored, worn, chipped, or misaligned. Porcelain veneers are ideal because they provide natural looking teeth and resist staining quite well, giving a long lasting clean looking smile.

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Teeth whitening can be attained in several ways to remove unsightly stains. Some stains can easily be removed with simple bleaching, whereas porcelain veneers or bonding may be the alternative if extra structural rigidity in the tooth is required along with the whitening process. Whitening of teeth has become a very effective treatment modality for discolored teeth, where the aesthetic is our main concern. In the gentle dentist two treatment modalities are available for whitening of teeth.

Amalgam restorations are now being replaced with ‘white’ alternatives including materials called composite resin or ceramics that do not contain mercury and are tooth coloured. We can refill the tooth with either composite resin or a ceramic restoration from your old silver/black filling tooth to have a more natural looking and strong enough to form part of your tooth, this is a great way to get your new smile on the right track.

If you want more information about restoration, please refer to Inlays&Onlays and Bonding

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Porcelain inlays and onlays are utilised to restore strength, function and a natural appearance to the teeth. Only the minimum amount of tooth structure is removed during preparation, thereby preserving as much of the natural tooth as possible. Caring for your inlay or onlay is important. Plaque, tartar build-up and gum disease can be susceptible. Therefore cleaning appointments every six months will ensure your inlays and onlays last for many years.

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By permitting what is left of the natural tooth to remain intact, bonding has revolutionized the process of repairing broken teeth. In the past, chipping a tooth meant replacing it with a crown, unless the chip was small enough to cosmetically contour it out. Now a new tooth can be formed by simply applying moldable plastic to the remaining structure. This will build the tooth back to its original shape and can even be used to make it better than it was.

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What is a Immediate denture?

Immediate dentures are dentures that are placed in your mouth right after your teeth are extracted. The shape of your mouth will change quickly for about a month. As the healing process continues your gums which support the denture will shrink. During this time it is important that you keep your dental appointments for adjustments.

When the gums are inflamed, gum pockets become deeper, and they lose bone connections inside. The deeper the pockets are, the easier it is for them to trap plaque deposits and make the gums worse. The perio pockets require cleaning in order to stop further inflammation. Root planning is the process by which this buildup is cleaned. Sometimes local anesthesia is needed and depending on the degree of difficulties, root planning can take several visits.

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An orthodontist is a specialist in the diagnosis, prevention and treatment of dental and facial irregularities. Most common treatment as an orthodontist is the application of braces to align and untwist teeth. There are different kinds of orthodontic appliances and the gentle dentist provides this service with the latest transparent braces, which are barely visible.

If you want more information about orthodontics, please refer to Invisalign ® and Damon 3 System

Feeling self-conscious about the appearance of metal braces in social and professional situations caused many adults who desired a straight smile to be reluctant to undertake orthodontic therapy. Ease of use, comfortable fit as well as being virtually invisible has led to Invisalign® rapidly becoming the orthodontic treatment of choice with adults who wish to attain a straight smile.
Unlike fixed metal braces, Invisalign® aligners can be removed allowing you to eat, brush and floss normally without having to worry about cleaning around brackets and wires. You will need to visit the Gentle Dentist team approximately every 6 weeks so we can ensure your treatment is progressing as planned. Depending on the position of your teeth, treatment can vary between 9 – 15 months.

Advantage

The most obvious advantage of the treatment is cosmetic: the aligners are completely transparent, therefore far more difficult to detect than traditional wire and bracket braces. This makes the method particularly popular among adults who want to straighten their teeth without the look of traditional metal braces, which are commonly worn by children and adolescents. In addition, the aligners are markeed as being more comfortable than braces. Due to the removable nature of the device, food can be consumed without the encumbrance of metalic braces.

Clinically, aligners avoid many of the side effects of traditional fixed appliances, for example the effects on the gums and supporting tissues. Almost all other types of orthodontic treatment will cause the roots of teeth to shorten (root resorption) for most patients, and demineralisation or tooth decay occurs in up to 50% of patients because (unlike Invisalign) they cannot be removed for eating and cleaning, and because they prevent accurate x-rays from being taken. Patients "graduate" to a new set of aligners in their treatment series approximately every two weeks. The aligners give less force per week and less pain than do fixed appliances (traditional metal braces). Fixed appliances are adjusted approximately every six weeks and apply greater forces.

Aligners should be removed to eat, drink, to clean the teeth, or to have them checked by the clinician. Because you remove the aligners, you are not limited to what you eat. (It is acceptable to wear aligners while drinking water.) Computerized treatment planning is compulsory as part of the Invisalign protocol. As with other forms of orthodontic treatments that incorporate a computerized plan, this allows the prospective patient to review the projected smile design, learn how long the treatment is likely to take, compare different plans, and make a more educated decision about whether or not to use Invisalign.

Invisalign treatments have been claimed to be quicker than traditional orthodontics. A large-scale study of 408 patients with traditional appliances in Indiana took an average of 35.92 months with a maximum of 96 months, while Invisalign takes between 12–18 months. In a much smaller study Invisalign was shown to be faster and achieve straighter teeth than alternatives but relapsed to ultimately get similar results to the traditional appliances examined. The study was considered by the authors, however, to be too small for many conclusions to be statistically significant. Furthermore, this general concept that Invisalign is faster has been challenged by the Invisalign review which points out that there are other brace appliance systems that take half the time, for example by incorporating surgery or temporary implants that insert into the patient's bone, to accelerate the procedure.

For more information, please visit the invisalign® offical website

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An Orthodontics patient sharing her experience with her Invisalign treatment

We call them “invisible braces”, even if in the end Invisalign doesn’t rely on the regular braces system. There are no wires or ligatures in there, nothing metal, just some clear plastic and some attachments that have the same colour as your teeth have. Invisalign is one of the newest orthodontic treatments that’s got a lot of patients straightening their teeth without others noticing this.

Invisalign works simple: you wear some plastic aligners on your teeth and they do the job. Invisalign doesn’t rely on a fixed system (as the classical braces), but on mobile aligners. You take them out to eat and brush and then place them back.

How does this work?

At first you are given this choice if your orthodontist has a license to use this system and if your case is not that complex. In my case for instance, the teeth were too crooked at first, so I had to wear Damon braces for 7 months (on the lateral teeth, to solve some of the big problems) and afterwards I was able to get Invisalign.

Since I am a 30 year old woman and have also got my own web design firm, you can imagine I wasn’t too pleased to sport a “metal mouth”. The Damon system worked nicely and it didn’t show (since the front teeth weren’t braced) and now Invisalign will finish the job.

Only your orthodontist can know for sure. You can use another system and then Invisalign or just go for the invisible braces, if your doctor advises you to.

In order for your treatment to begin, your doctor will take moulds and these will be sent to Align Technologies. There, these will be used to prepare the treatment in a 3D computerized system and the aligners you’ll wear. Your orthodontist will show you the animation and you’ll be able to accept or decline the treatment. You’ll be able to see your teeth moving till the final step.

Here is a very interesting video I was able to find on youtube: The Invisalign process

After you have accepted the treatment, you’ll receive your first set of aligners. Your doctor will help you put them on your teeth and some attachments might be added. The attachments have the same colour as your teeth and are very discreet. Some orthodontists don’t use attachments, so it depends on your doctor.

You wear a set for 2 weeks. Then another one and another one. All aligners come packed with your name on the bag, the aligner number and the total number of aligners. From this total number you can know how long your orthodontic treatment will be: in my case I have 26 aligners for the upper teeth and 37 for the lower ones (this means 13 months for the upper teeth and 18 months and a half for the others).

You are advised to wear them for 20-22 hours a day. The more you respect this requirement, the better. Take out your Invisalign aligners for eating and oral hygene and then place them back. Some lisp is also possible in the first days, but it does get better.

As a Damon braces patient before I can tell you that Invisalign is a walk in the park compared with the metal braces. I did have some slight pain in the first 2 days, but nothing compared with not being able to eat anything than very soft food for 10 days. Some Invisalign patients consider the treatment to be hard, but I can tell you it’s one of the easiest.

Here are some things to consider:

• you might face problems with taking out the aligners at the first time. You might not be used to this. I find it easier to take the aligners from the laterals (molars) and then from the front teeth. The attachments might prove tricky: I just place my nail under the attachment (take care to not hurt your gums) and lift a bit till the aligner gets “freed” from the attachment. With some experience you’ll be able to take out the aligners fast
• don’t lose them. You have a nice box for the aligners. Try to not misplace them since it would be bad for your treatment. You’d have to wear the old ones and wait for the duplicates. DON’T LOSE THEM!
• you will brush like a maniac. Whenever I eat, I just take out my aligners, eat and then brush and then place back. Never had such clean teeth. Try to also clean the aligners, they’ll smell very bad otherwise.
• you might experience some slight pain. Some people complain about big tooth pains, it all depends on your body in the end. Just take some painkillers if you can’t cope with the pain. It will pass in few days.
• you’ll talk funny for some days. Even if so, you’ll still be able to discuss almost normally, so don’t expect to be too funny. I am a radio DJ and wore my aligners since day one. I did have some slight issues with my diction, but I am getting better.

What are the advantages?

• They are INVISIBLE. All my friends had to take a really good look at my mouth to spot them. If you don’t drink coffee or coke with them on, your aligners will remain clean and invisible for the 2 weeks you are supposed to wear them.
• easy to clean: I just use mouthwash and my toothpaste for them
• they don’t stain (unless you drink something that might do the trick)
• the mouth sores can happen, but we are talking less damage than from metal braces. I recall using dental wax for 3 weeks with the Damon braces, for Invisalign I just had something small, but after 2 days nothing was there.
• you can see how your teeth will look at the end.

The Damon System is an innovative combination of passive self-ligating brackets, high-tech archwires and minimally invasive treatment protocols that work together as a low-friction, low-force system. The end result is clinically proven performance that includes faster treatment time, fewer appointments, improved patient comfort, exceptional results and wider arch development with fewer extractions as well as less reliance on surgery.

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Wisdom Tooth Removal

Wisdom teeth usually emerge from the gums between the ages of 17 and 24. They are the last teeth to push through the gums, some people never develop wisdom teeth. Wisdom teeth don’t usually cause any trouble and don’t need to be removed, however if there isn’t enough space for them to grow up at the back of your mouth, they will become impacted, they also will cause severe pain swelling or infection. Impacted teeth need to be surgically removed in order to relieve the symptoms.

At The Gentle Dentist your dentist will advise you to rest until the effect of the anesthetic or sedation have passed. After local anesthetic it may take several hours before the feelings come back, you should take special care not to bump or knock the area, you will be able to go home when you feel ready, if you had a general anesthetic or sedation you will need to arrange someone to drive you home, at The Gentle Dentist we will provide you transport if necessary. You may be given painkillers, antibiotics and mouthwash solutions to take home.

What To Do After Surgery

The following tips will help you to speed up your recovery :
• After surgery bite gently on the gauze provided and change it every 30 minutes.
• Call your dentist if you still have bleeding 24 hours after your surgery.
• While your mouth is numb, be careful not to bite the inside of your check or lip, or your tongue.
• For 24 hours after surgery do not expose yourself to too much sun or do exercise, physical activity may increase bleeding.
• Try using an ice pack on the outside of your cheek for the first 24 hours for 2 or 3 days.

Inside your tooth's hard outer shell is a nourishing pulp of blood vessels, lymph vessels and nerves. The root's canal, allow these vessels and nerves to extend to connect to the rest of the body's systems. Deep tooth decay, or injury can cause serious damage and infection to the pulps nerves and vessels. The Gentle Dentist performs root canals to clean out the infected pulp chamber and canals and replaces the organic material with an inert filling called gutta-percha.

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What is a Temporomandibular Joint disorder?

The Temporomandibular Joint (TMJ) is comprised of muscles, blood vessels, nerves, and bones. You have two TMJs, one on each side of your jaw. Temporomandibular joint and muscle disorders (TMJ disorders) are problems or symptoms of the chewing muscles and joints that connect your lower jaw to your skull.

What causes TMJ pain?

The cause of pain in the TMJ include: -The result of displacement of the cartilage disc that causes pressure and stretching of the associated sensory nerves.

- A bad bite or orthodontic braces stress and tooth grinding.

What are the symptoms of TMJ?

Symptoms associated with TMJ disorders may be:

-Biting or chewing difficulty or discomfort

-Clicking, popping, or grating sound when opening or closing the mouth

-Dull, aching pain in the face

-Earache

-Headache

-Jaw pain or tenderness of the jaw -Reduced ability to open or close the mouth