Too Much Coffee Can Cause Tooth Sensitivity and Tooth Wear By Dr. Jeff Shnall
Coffee is one of the most popular beverages around and a great many people do not feel right until they have had their morning cup. While coffee has been touted to have many positive health effects, if consumed in excess and/or over long periods of time throughout the day, coffee can cause tooth sensitivity, tooth wear and tooth erosion.
In this article I will discuss when coffee consumption can lead to tooth sensitivity, what kind of damage coffee can inflict on our teeth and how you can still enjoy your morning cup without having to worry about coffee harming your teeth.
Drinking a cup or two of coffee a day has been found to have some positive effects. For example, research has shown that having a cup of caffeinated coffee 30 minutes before a workout will boost exercise performance by ten percent.
The caffeine boost from a cup of coffee can help kick start our day and some people rely on coffee to help them get through their work day, giving them a wake-me-up when their energy is low.
When can coffee consumption lead to dental problems?
As the old saying goes, everything in moderation. I have met patients whose excessive coffee drinking has caused tooth sensitivity and tooth wear.
One cause of tooth sensitivity is frequent and /or prolonged exposure of our teeth to acid.
The source of this acid will either be found in the food or drink we consume or from strong acids that rise up from our stomach back into our mouth in conditions such as acid reflux or bulimia.
The acidity of food or drink is rated by its pH score. Tap water is neutral and has a pH of 7. If food or drink has a pH below 7 it is acidic.
Enamel is the hardest mineral in our body but it will start to dissolve if exposed to liquids with a pH of 5.5 or lower.
So if acidic food or drink is taken in amounts that is too excessive or too frequent our teeth can demineralize or dissolve. And once you start to lose tooth structure through dissolution or erosion you cannot grow it back.
If you are prone to enamel wear due to an overly acidic diet your enamel can wear and become thin. A tooth that is undergoing acid erosion can become more fragile, may chip more easily and can also become more sensitive.
Tooth sensitivity is far more common in people with gum recession Gum recession is a fairly common condition in which our gums shrink away from their original position on the tooth leaving an exposed root.
The roots of our teeth are not covered by enamel. Rather they are covered by a material called cementum. Cementum is softer than enamel and can be easily worn away by using a hard toothbrush and/or by brushing the roots of the teeth too aggressively.
Underneath enamel and cementum is a layer of dentin. Dentin is also softer than enamel and more easily eroded by acid.
Dentin and cementum can start to wear if it is exposed to food or drink with a pH of 6.7 or lower. But the most damage to exposed roots will be seen in people who either have dry mouth, who have a diet high in acidic food/drink or who have acid reflux issues.
When the exposed roots of our teeth are exposed to an excessive amount of acid the root surface softens.
For example, if you have gum recession and you drink a lot of acidic beverages (citrus fruit juices, sports drinks, coffee or pop/soda/soft drinks ) or have acid reflux the root surface will soften and erode. This can lead to deep defects in the side of the root and can also cause tooth sensitivity.
Is coffee acidic acidic enough to damage or teeth?
That will depend on the type of coffee you drink.
In an article titled “Low Acid Coffees,” author Kenneth Davids states “Most high grown, medium roasted coffees ….tend to register a pH of around 4.9 to 4.5.” (Source: The website “ Coffee Reviews”).
So if you regularly drink medium roast coffees you are exposing your teeth to an acidic drink.
Here are some other key points from his interesting article:
Acidity can boost the flavour of coffee
The organic acids in coffee are what gives coffee its health positive antioxidant effects.
Acidic coffees can stimulate and worsen acid reflux in people with this condition.
There are coffee companies that make low acid coffees and market them as such. These companies achieve low acidity by either slow roasting their coffee beans or by steaming the waxy outer layer off the green coffee bean before roasting it. These companies also purchase their coffee beans from certain regions of Brazil that grow coffee beans with naturally less acidity.
Other ways of finding a lower acidity coffee are by looking at brands that are dark roasted or very dark roasted, both which will result in lower acidity.
Three low acid brands that the author gave good taste reviews are “Tully’s French Roast” and “Peet’s Sumatra Blue Batak.” These brands were not advertised by their manufacturer as low acid brands but were found to be low in acidity as they are dark roasted.
The author of the article did not like the taste of some low acid coffees so you may want to do some research before you buy a brand just because it is advertised as a low acid coffee. The taste could disappoint you.
Two low acid brands that did get good taste review in the article were were the “Simpatico Nice Coffee” and “Simpatico Espresso Roast.”
The author also states that “ almost any Brazil or Sumatra and many Mexicos, Perus, Guatemala Antiguas and Nicaragua's brought to a darker roast should display relatively low acidity.”
What is the ph of low acid coffee?
I was not able to get good data on this. One brand of low acid coffee called "Trucup" states the following on their website:
"According to our test results, Trücup Born To Be Mild (Light Roast) clocked in at an impressive 5.74 pH level – making it 1.7 to 4.6 times less acidic than light roasts from some of the leading national coffee brands."
I have never tasted Trucup coffee. It does come in at a pH higher than 5.5 so that it means that it will not erode enamel and could be kinder to sensitive stomachs but a pH of 5.74 means that it still acidic enough to potentially cause root sensitivity if you have gum recession and drink it in excess.
When can coffee consumption cause sensitivity and tooth wear?
This depends on your consumption pattern: How much coffee do you drink? How many cups a day? How long does it take you to have your cup of coffee?
It takes me about 15 minutes to drink my morning coffee. I drink my cup of coffee at lunchtime in about 10 minutes or less. Drinking one or two cups of coffee a day in mere minutes does not bathe my teeth in an acidic liquid long enough to cause any tooth sensitivity or enamel wear, especially since I am also eating food as well with the coffee.
Having the coffee at a meal time boosts my saliva flow and means the acid of the coffee will be washed off my teeth at a faster rate. The bicarbonate, found inmy (and your) saliva will also buffer the acid found in the coffee further lessening the chance of damage to the enamel or dentin of my teeth.
However, I have patients who do have tooth sensitivity and do show signs of tooth erosion and it is likely coming at least in part from the coffee they drink.
What do these patients have in common?
They have longer periods of coffee exposure to their teeth.
They can take 45 mins to an hour to have a single cup of coffee, taking small sips.
They often have several cups of coffee a day
I have patients who tell me they have 3 cups of coffee per day, taking one hour to drink each cup.
Another patient recently told me she drinks 6 cups of coffee per day, taking an hour to drink each cup.
These patients are exposing their teeth to potentially acidic brands of coffee for 3 to 6 hours per day respectively (practically all day long at work).
It is no surprise that these patients complain of tooth sensitivity and show signs of enamel wear.
Tips to reduce tooth sensitivity and wear from excess coffee consumption
1. Limit the amount of coffee you you drink each day. Can you get by with 1 to 2 cups instead of 3 or more?
2. Limit the time it takes you to drink a cup of coffee. 10 to 15 minutes per cup is better than an hour per cup and and will expose your teeth to less acid.
3. Substitute coffee with tap water or milk if you feel you need to drink in between meals during the day. These latte two beverages are non-acidic, however do not sip on milk for long periods of time as milk does contain lactose, a natural sugar that can cause cavities if milk is sipped at for hours on end.
4. Try chewing sugarless gum to keep your mouth moist and occupied to help wean you off of an excessive coffee consumption.
5. Have coffee with a meal rather than as a stand alone beverage.
6. Get enough sleep at night! If you can get 8 hours of sleep each night you may not need as much caffeine to get you through the day.
7. Do some research on low acid coffees or check out some brands of dark roast coffees and see if there is available information on the pH / acidity of the brand. Searching the brand online is a way to start.
8. Some habits are hard to break. Some patients who do drink /sip on high amounts of coffee that I have in my practice can find it hard to cut back on their coffee consumption even if they know it is not a healthy habit.
How toothpastes for sensitive teeth work: (A) shows a magnified view of small openings on the side of the tooth root (brown dots) The openings are caused by acid stripping away the protective coating of the root. If cold water or sweets contact these opened tubules on the root, pain in the tooth can result. (B) If you brush with a desensitizing toothpaste i.e. Sensodyne chemicals such as potassium nitrate shown as yellow dots can plug up the microscopic openings on the root. (C) The root openings are plugged up, eliminating the root sensitivity.
For these patients a desensitizing toothpaste like Sensodyne, Colgate Pro Relief or others can seal up roots exposed by excess coffee consumption and give some relief from tooth sensitivity.
Another Low Acid Coffee Option:
By using a technique called Cold water brewing one can also lower the acidity of coffee.
Cold brew coffee is made by letting medium to coarse ground coffee sit (steep) in cold or room temperature water for 12 to 24 hours. Hot water is not used in the process. After at least 12 hours, the grounds are filtered out of the water leaving the finished cold brew coffee. You could filter the grounds out by pouring the coffee through a coffee filter or you could use a French press for the entire steeping and filtering process.
During the steeping process the oils,caffeine and sugars of the coffee are released out of the coffee grounds and into the water. The result is smooth, rich coffee that is of less acidity than regularly brewed or iced coffee.
Cold brew coffee is different from iced coffee, the latter being hot coffee that has been allowed to cool and then poured over ice. Iced coffee has the same acidity (pH) of hot coffee. (Source: .What is the Difference Between Cold-Brewed Coffee and Iced Coffee? By Amy Sowder | Published on Thursday, September 29, 2016 on the website Chowhound)
I am not about to give up drinking coffee and I am not suggesting you do either. However due to its acidic nature it should be consumed in reasonable amounts and is best not sipped over long periods on a daily basis. When our teeth are sensitive they may be are telling us that they are being exposed to too much acid.
Excess coffee drinking can cause severe tooth sensitivity. A patient of mine recently told me that she has been drinking many cups of coffee throughout the day for several years. Her teeth were so sensitive that she would require freezing of all of her teeth before they could be cleaned by a hygienist.
After explaining the acidity of coffee consumption she agreed to cut back on her consumption and also started to use a toothpaste for sensitive teeth. Her tooth sensitivity decreased significantly and she was able to have her teeth cleaned without local anaesthetic, although we did use a little nitrous oxide sedation. She felt it was a definite improvement though compared to previous cleanings.
Questions? Comments? Feel free to contact our office :) Jeff Shnall May 2018
What you need to know about tooth erosion to prevent premature wear or loss of your teeth.
By Dr. Jeff Shnall
The following article and diagrams cannot be reproduced without written consent.
Most everyone knows that if you eat too much sugar you risk getting a cavity. However, cavities or tooth decay are not the only way that our teeth can deteriorate. Tooth erosion is a very common yet underappreciated cause of tooth wear.
In this series of articles I will discuss what tooth erosion is, how it is different from tooth decay and how erosion can be prevented.
First let’s discuss what a cavity is and how it starts by way of some pictures.
Fig 1 Tooth anatomy
Figure 1 shows a typical tooth, covered by a layer of enamel. Enamel is the hardest tissue in the human body, harder than bone. Under the enamel layer is a softer layer of tissue called dentin. Once you get below the gum line the tooth is covered by a layer of cementum, which is similar to dentin in strength, both being softer and more porous than enamel.
Fig 2a Enamel rods
Figure 2a shows that the enamel layer of our tooth is made up of rods that run from the outer surface of the tooth to the inner dentin layer. These rods in turn are made up of minerals: mainly calcium and phosphate (I only illustrated rods on one half of the tooth).
Enamel rods can be visualized like the metal rods in fig 2b. Enamel rods run alongside each other but there are gaps between each rod.
Figure 3 Plaque (shown in yellow) clinging to the tooth
Figure 3 shows a layer of plaque is sitting on the surface of the enamel. Plaque is actually made up of clumps of bacteria that live on the surface of our teeth.
Figure 4 Plaque on the tooth
Fig 4 shows a white coating of plaque at the gum line of the teeth.
Figure 5 Acid produced by plaque travels in between enamel rods beneath the enamel surface
Figure 5 shows how when we eat or drink sugary food, the bacteria ( plaque) turns this sugar into acid. The acid and bacteria then travels down crevices between the enamel rods into the undersurface of the enamel. Interestingly, the acid being produced by the bacteria does not damage the outer surface of the enamel.
Figure 6 Inner enamel has broken down (decalcified area shown in blue)
In Fig 6 acid and bacteria has penetrated the inner part of the enamel layer, causing the inner enamel to break down.
The enamel is decalcifying, that is, the calcium and phosphate in the enamel is breaking down.
Fig 7 The outer enamel is still left intact. The bacteria in the plaque produce acids that travel through small microchannels in the enamel, which starts the next step: the destruction or demineralization of the inner enamel.
Fig 8 Rebuilding or remineralization of the tooth.
When a Cavity Starts Can it be Reversed?
Under the right conditions, the process described above can be reversed.
Figure 8 shows that if a tooth is exposed to phosphate, calcium or fluoride these minerals can travel down the same microchannels that the acid and bacteria travelled, into the inner surface of the enamel and remineralize or reharden the broken down enamel. The fact that these minerals travel down microchannels is important. They don’t rebuild the surface of the tooth. They rebuild the inner tooth.
In Fig 9 The inner enamel has remineralized and the tooth surface is left intact.
Special repairative toothpastes and creams containing calcium, phosphate and fluoride can deliver these minerals into the tooth and repair the demineralized enamel.
Another key point is that in the early decay process, the enamel rods are not completely destroyed. They can serve as a scaffold to rebuild the enamel.
As well, this reversal of decay can only occur if the bacteria has not reached the inner dentin layer. If that has occurred the tooth will not remineralize and the decay will go on to infect the entire tooth unless the decay is removed and a filling is placed.
Now that you are an expert in how cavities start, let's compare this to another type of damage we see in teeth, as mentioned early, tooth erosion and we will discuss how it is different from tooth decay.
Tooth erosion is the dissolving or breakdown of tooth structure (enamel and sometimes dentin) caused by exposure of the teeth to acid either from the diet (extrinsic erosion) or from our own stomach acids (intrinsic erosion).
The acid that causes tooth erosion is not produced by the bacterial plaque on our teeth. Instead it is caused by the acid found in soft drinks/pop, many kinds of fruit juices,some sports drinks and citrus fruits. In fact, many people who people whose teeth wear down due to acid erosion often keep their teeth very clean so it is not a plaque related issue.
Figure 10 Enamel and Dentin
Figure 10 shows the appearance of a normal tooth. It has a hard enamel outer coating and softer dentin inner layer.
Fig 11 Tooth exposed to acid. If a tooth is exposed to a strong enough acid the outer enamel layer can breakdown or dissolve.
Fig 11 shows this same tooth exposed to acid. If a tooth is exposed to a strong enough acid the outer enamel layer can breakdown or dissolve.
Although enamel is the hardest tissue in our body, food or drink that has a pH below 5.5 can dissolve enamel.
Almost every brand of pop/soft drink contains acid. Citrus juices are acidic as are most sports drinks. Lemons and other citrus fruits and even some brands of coffee and tea are acidic, below the critical ph of 5.5. If our teeth are exposed to large volumes of acidic food/drink or exposed to small amounts but over long duration erosion or breakdown of the enamel and other tooth structure can occur.
Some people develop tooth erosion due to stomach acids entering the mouth in conditions such as acid reflux or in eating disorders such as bulimia. The mineral that composes our teeth will also erode and dissolve due to the strong acidity of stomach acids.
Key differences between tooth erosion and tooth decay (cavity formation)
Above we discussed how in cavity formation, the outer enamel of the tooth is left intact while the inner enamel layer breaks down or demineralizes (see figures 6 and 7).
Figure 12 Tooth erosion
Fig. 12 In tooth erosion, the loss of tooth structure occurs at the surface of the tooth and works its way down into deeper areas of the tooth.
When a tooth is exposed to acid a certain amount of tooth material dissolves into the saliva.
Our saliva contains the buffering agent bicarbonate which can reduce the acidity at the tooth surface and limit erosion. The saliva also contains calcium and phosphate which if it is high enough amounts can limit the amount of calcium and phosphate that dissolves from the surface of the tooth. This is all happening on a microscopic level.
However if the amount of acid the tooth exposed to overwhelms the buffering and rebuilding ability of the saliva them loss of tooth material (erosion) will occur and once surface enamel or dentin is lost through erosion it cannot be regrown,, no matter how much you bathe the tooth in saliva, calcium, phosphate or fluoride. This is why it is important to avoid the loss of enamel and other tooth material from erosion in the first place. This means managing diet and treating underlying conditions that lead to tooth erosion before erosion occurs.
Why can’t you rebuild loss enamel and dentin through tooth erosion while a tooth developing an early cavity can reharden or remineralize? Let me explain.
Fig 13 shows a tooth that has just been brushed. It has a clean surface. All of the plaque/bacteria has been removed.
ig 14 shows this same tooth a few seconds after it has been brushed. After we brush our teeth, within seconds a thin film of called the dental pellicle forms on the tooth, shown as a blue thin coating in figure 15). The pellicle is thinner than the diameter of a human hair and is formed when proteins found in saliva coat the tooth.
The pellicle layer acts as a barrier to calcium, phosphate and fluoride and preevents these materials from binding or attaching to damaged enamel or dentin. So if your tooth loses enamel after drinking 2 cans of cola you cannot rebuild the lost enamel by applying a medicated calcium phosphate toothpaste. The pellicle coating prevents the tooth surface from rebuilding.
If it were not for the pellicle layer our teeth would continue to add layers of calcium phosphate from our saliva to our enamel and our teeth would become thickened.
This is also a reminder of how once our tooth surface is eroded the damaged tooth surface can not be regrown (although it can be filled or replaced with dental materials as needed).
It is the pellicle layer attracts bacteria/plaque to the surface of our teeth. In the situation where a tooth is developing a cavity, the pellicle layer does allow calcium, phosphate and fluoride to enter the dental plaque and these minerals can still heal or remineralize inner layers of demineralized enamel as we had discussed above. The pellicle does not play a disturbing factor in the repair of a tooth developing a cavity.
So it is important to know the causes of tooth erosion, namely the teeth being exposed to either dietary acids and/or stomach acids on an ongoing basis. Drinking one can of pop is not going to cause permanent loss of enamel, however if you sip on a can of cola each day for an hour or two while at work or while watching tv you almost assuredly will lose a noticeable amount of tooth enamel and or dentin, which will have consequences.
In my next article I will discuss other types of tooth wear related to erosion and also how to prevent and manage tooth erosion.
Do you or does someone you sleep with snore? Snoring is a common problem affecting about 40% of men and 20 % of women in Canada. Snoring can be a nuisance to others within earshot but it also can be a sign that you may have a condition known as Obstructive Sleep Apnea, a health condition that can have serious consequences if untreated.
The reason why as a dentist I am writing this article is that a device that you can get through your dentist can be an effective treatment for snoring and OSA.
In this article I will discuss causes of snoring, indications when snoring could be a sign of obstructive sleep apnea and solutions for both.
What is snoring?
When we inhale, air passes in through our mouth and/or nose, into the back of our throat and down into our lungs. If anywhere along this path the airway becomes partially closed the air will vibrate through the narrowed space and the resulting noise is what we call snoring.
Causes of snoring:
If the strip of tissue hanging down at the back of your throat (called the uvula) is longer than normal this can vibrate and cause snoring.
If you are overweight or obese, fat can be deposited in your airway, narrowing it, and snoring results.
In many people snoring is caused by the tongue falling to the back of the throat during sleep.
The tongue can block the airway for a variety of reasons:
When we sleep our muscles relax, and the tongue being a muscle is no different. If you have a large, broad tongue it is more likely to cause blockage of the airway than a smaller tongue would.
If the roof of your mouth is narrow and high, your tongue may have nowhere else to go during sleep other than the back of the throat so this type of anatomy can make you more prone to snoring.
If you have a receded lower jaw or if your upper jaw is small in size your tongue may crowd the back of your throat as it has nowhere else to go while you sleep, again leading to snoring.
Alcohol use before bedtime or sedatives (ie sleeping pills) can make the tissues that line our airway relax more than they otherwise would during sleep causing them to collapse, narrowing the airway and leading to snoring.
Tobacco/smoking can cause inflammation of tissue in the airway which can also lead to airway narrowing, hence snoring.
Sleeping on your back can make you more likely to snore, with gravity causing the tongue and other tissues in the airway to sag and partial closure of the airway.
When is snoring a sign of a more serious sleep disorder: Obstructive Sleep Apnea?
In people who snore, we already know that there is partial airway closure. However in some cases, the closure can become temporarily great enough that the airway is significantly or completely closed.
If you are already prone to airway closure, due any of the reasons listed above that cause snoring, as you inhale during sleep, the pressure from your lungs trying to bring in air can draw loose tissues that line the airway together and create a stop at the top of your airway. It’s like putting a cork in the top of a bottle.
If the airway closes, your chest is attempting to breath air in but nothing is getting through into the lungs.
If this blockage continues for 10 seconds or longer it is called an apnea.
If the airway is not completely closed and some air is getting into the lungs but only 20 - 50 % of the normal amount, and this lasts 10 seconds or longer it is called a hypopnea.
In our lungs blood picks up oxygen which then gets pumped throughout our body.
If there is a complete or partial blockage of air entering our lungs the amount of oxygen in our bloodstream will decrease. Our brain eventually senses the lowered amount of oxygen in our bloodstream and awakens us from a deeper level of sleep to a lighter level of sleep so that we can take a breath.
As we take in air we may snort, gasp or appear to be choking, all which can be alarming if witnessed by a sleeping partner. We don’t remember these partial awakenings as we are still in a light state of sleep when they occur, however if they occur many times our sleep is said to be “fragmented,” and we will not be spending enough time in restful deeper stages of sleep.
Some people who snore do not suffer from airway blockage great enough to reduce their blood oxygen levels, that is, they do not experience apneas or hypopneas. But for people who do, the number of times they may have reduced airflows and awakenings can number from just a few times and hour to over 30 times an hour.
If you count the number of apneas and hypopneas that occur each hour during sleep you arrive at a score which is also called the Apnea Hypopnea Index (AHI).
If you have 5 or fewer sleep interruptions per hour this is considered insignificant, however if you have 5 or more you are considered to have Obstructive Sleep Apnea (OSA)
Note: A sleep event is a partial or complete airway obstruction lasting 10 seconds or longer followed by a partial awakening to take a breath.
Obstructive Sleep Apnea is categorized the following way:
sleep events per hour 0-4.......................................... snoring only 5-14 ........................................ mild obstructive sleep apnea 15-29 ...................................... moderate obstructive sleep apnea 30 or more ........................... severe obstructive sleep apnea
Symptoms of OSA
People who have many episodes of airway closures and awakenings during a night of sleep may wake up feeling tired, feel sleepy during the day, can be at greater risk for car and work related accidents, have morning headaches, have trouble concentrating and also can be irritable and depressed.
Who is Prone to OSA?
If you have the following physical features you may be more prone to developing OSA:
If your neck circumference measures more than 40cm (15.75 in)
This is an indication that you may have excess fat in your neck and likely also lining your airway.
2. If your lower jaw is receded.
3. If you are obese.
4. If you are a man.
5. As well, many of the items listed in causes of snoring above can make you more prone to OSA, such as alcohol use before bed, taking sleeping pills, or having anatomy such as a broad flat tongue or high narrow palate (roof of your mouth).
How does Obstructive Sleep Apnea affect your health?
OSA affects the health of your heart and other parts of your cardiovascular system.
If you have OSA, your breathing is interrupted during sleep and your blood oxygen levels drop. Each time this occurs this stresses your body and as a result your body releases adrenaline. If this occurs many times throughout the night, the high levels of adrenaline in your body can lead to high blood pressure.
Low blood oxygen levels caused by OSA during sleep stresses your body and heart. People with untreated OSA are more likely to have heart failure, atrial fibrillation, heart attack and stroke.
According to Harvard Health Publishing (Harvard Medical School) OSA is found in 47 to 83 % of people with cardiovascular disease, 35 % of people with high blood pressure, 12 to 53 % of people with who have had heart failure, atrial fibrillation and stroke. If you have untreated OSA, your risk of dying from heart disease increases by five times.
How do you know if you have OSA?
There are two simple questionnaires that can be taken to help answer this question.
1. The STOP-BANG questionnaire and
2. The Epworth Sleepiness Scale.
THE STOP-BANG QUESTIONNAIRE :
(developed by Dr. Francis Chung, University of Toronto, 2008)
Answer "Yes" or "No" to the following questions. A total of "yes" to 3 or more items on this questionnaire is considered high risk for OSA.
S Do you Snore loudly? T Do you often feel Tired, fatigued or sleepy during the daytime? O Has anyone Observed you stop breathing during your sleep? P Do you have high blood Pressure?
B Is your Body Mass Index (BMI) above 30? (Are you obese)? A Age: are you over 50? N Neck circumference over40 centimetres? G Is your Gender Male?
(developed by Dr. Murray John of Epworth Hospital, Melbourne , Australia, 1991) A score of 10 or more is considered sleepy. If you score 10 or more on this test, you may not be obtaining adequate sleep. These issues should be discussed with your physician.
Use the following scale to choose the most appropriate number for each situation:
0 = would never doze or sleep 1 = slight chance of dozing or sleeping 2 = moderate chance of dozing or sleeping 3 = high chance of dozing or sleeping
Situation Chance of chance of dozing or sleeping
Sitting and reading............................................................................... ___ (0,1,2 or 3?) Watching TV........................................................................................... ___ (0,1,2 or 3?) Sitting inactive in a public place........................................................ ___ Being a passenger in a motor vehicle for an hour or more....... ___ Lying down in the afternoon ............................................................ ___ Sitting and talking to someone ...................................................... ___ Sitting quietly after lunch (no alcohol)........................................... ___ Stopped for a few minutes in traffic while driving...................... ___
TOTAL SCORE.. (add up all your answers) ____
(lowest score = 0, highest score = 24)
Depending on your score to each test you may be more or less likely to have OSA.
The way to properly diagnose whether you simply snore or indeed have OSA is to see your family doctor and discuss snoring or daytime sleepiness issues you may have. Your family physician may refer you to a sleep clinic that will often conduct a sleep study. That often involves having you attend the sleep clinic for one night while they can observe you while you sleep. They will measure your breathing, blood pressure and determine whether your sleep is interrupted by airway closure and if so, for how long, how many times an hour ands so on. They will also determine if breathing interruptions occur while you sleep on your side or only when you sleep on your back.
If you do have OSA they will let you know whether it is mild, moderate or severe, as discussed above.
The CPAP Machine with full face mask.
Treatment of Snoring and OSA
If you have been diagnosed with mild, moderate or severe OSA one treatment that is usually very effective is use of a CPAP machine.
CPAP stands for Continuous Positive Airway Pressure. The machine blows air through a mask that you wear on either your nose only, or nose and mouth together.
The pressure of the air flowing down your airway opens up collapsed tissues in the airway allowing air to pass into your lungs.
This eliminates snoring and also the other symptoms of OSA such as daytime sleepiness and as well lowers blood pressure and improves the health of your heart.
There are some problems that patients new to using a CPAP experience such as: finding the mask uncomfortable, feeling claustrophobic with the mask on, difficulty falling asleep with CPAP machine on, noise from the machine, dry mouth, removing the mask during sleep, finding the machine cumbersome to travel with or just not wanting to be connected to a machine during sleep.
There are usually solutions for all of these problems if you work with your CPAP provider, however despite this, 30 to 50% of patients that are prescribed CPAP quit using it.
The SUAD Appliance: One of many types of dental sleep appliances that bring the lower jaw forward to open up the airway.
Another treatment that can be used for people who snore or for those with mild to moderate OSA is a dental sleep appliance.
I mentioned earlier that one cause of snoring and OSA is the closure of the airway by the tongue as it falls to the back of the throat when we fall asleep.
Dental appliances are a recognized treatment for both snoring and mild to moderate obstructive sleep apnea, according to the American Academy of Sleep Medicine.
The most studied and accepted type of dental appliance used to treat these conditions is one that is worn in the mouth, bringing the lower jaw into a more forward position.
A technical name for this type of appliance is a “mandibular advancement appliance,” as “mandible” is the anatomical name for the lower jaw.
Professionally made dental sleep appliances work on the principle that if your lower jaw is brought forward, the base of your tongue (where your tongue attaches to your lower jaw) will also be brought forward, opening your airway during sleep and eliminating or reducing snoring and lessening or eliminating obstructive sleep apnea.
Dental sleep appliances can be very effective eliminating or reducing snoring and in the treatment of mild to moderate obstructive sleep apnea. There are several different designs of sleep appliances available to patients, and are made by dentists trained in delivering this form of treatment. One such appliance pictured here is the SUAD appliance, a popular sleep appliance I make for my patients.
Research has shown that the most effective dental sleep appliances have the following characteristics:
1. Those that are custom made by a dentist.
Custom made dental appliances are found to be better tolerated and more effective in reducing snoring and obstructive sleep apnea symptoms than simple appliances you can buy over the counter. Unfortunately you get what you pay for in this case.
2. Are adjustable: ie ideally the the distance that the lower jaw is brought forward can be increased or decreased in adjustable appliance.
Some patients can tolerate their jaw being brought more forward than others and it is nice to have the ability and flexibility to fine tune the distance rather than being confined to one setting.
3. Are composed of a separate upper and lower piece that fits over the teeth
4. The appliance opens the mouth minimally (you can open and close your mouth while wearing the appliance but the upper and lower piece will be closed together when your mouth is at rest.
The appliance design I favour has a soft inner material that contacts your teeth and a harder outer surface for durability.
Side effects of Dental Sleep Appliances for Snoring and/or OSA
Dental sleep appliances have very few side effects. They have been shown to be safe and effective and have been used for many years for patients who either snore or have OSA.
They do bring the lower jaw forward during sleep so in the morning your bite may feel different as your jaw settles back into its normal position over several minutes after waking.
Dental sleep appliances have been found to be safe for the jaw joint (TMJ) and have not been shown to causes changes in the joint.
Who is not a good candidate for a dental sleep appliance?
Research has shown that patients who snore or who have mild to moderate obstructive sleep apnea can be considered for these appliances.
If you have been diagnosed with severe OSA research has shown that CPAP is the most effective treatment, however if you can not tolerate CPAP, wearing a dental sleep appliance (MAP) in some cases is better than no treatment at all.
If your teeth and gums are not in good health this will ideally need to be addressed prior to making a dental sleep appliance, as the dental sleep appliance needs firm support from the teeth and or gums. Loose teeth and a dental sleep appliance are not a good mix.
Patients who are missing all of their teeth in one or both jaws can still be candidates for these appliances but may have to consider dental implants to help hold the appliance in place if they are missing all of their lower teeth.
If a person is are morbidly obese, dental sleep appliances have been found to be ineffective, as the airway cannot be sufficiently reopened merely by repositioning the tongue, as there is too much excess tissue in the collapsed airway during sleep.
Should I try a CPAP or Dental Sleep Appliance ?
If you snore but do not have OSA you may wish to try a dental sleep appliance. It is portable (fits in your pocket) and is not as cumbersome as CPAP. Dental sleep appliances can eliminate snoring or at least reduce the amount or volume of snoring.
If you have mild or moderate OSA, research has shown that patients do better overall if they are given a choice as to what type of treatment they prefer. Once they have been given all the pros and cons of CPAP and dental sleep appliances and they make an informed decision they are more likely to continue with the treatment ie they are more likely not to give up on CPAP if that is their preferred choice versus a patient who is only given the choice of using CPAP or no treatment at all, which does occur at some sleep clinics.
Although CPAP has been shown to be the most effective way to treat OSA studies have shown that it has to be worn at least 4 hours a night to be more effective than a dental sleep appliance.
Research has shown that many patients with CPAP do not wear it through the entire night whereas patients with dental sleep appliances are more likely to.
So even though CPAP is more effective while it is worn, the fact that patients who use dental sleep appliances get about the same amount of improvement in their symptoms of mild to moderate OSA ie they wake up as rested as the average CPAP user, have the same cardiac and health benefits and also rate their overall quality of life the same as patients who use CPAP.
Some CPAP users do not bring their CPAP machines while they travel as they find the machine too large to lug around or they may be somewhere without a reliable power supply (ie when camping or on an overnight flight). Research has shown that if a regular CPAP user has a dental sleep appliance as a backup for times they can’t wear their CPAP, they good relief of their apnea symptoms especially as compared to if they wore no appliance at all.
Research has also shown that sleep partners prefer dental appliances rather than CPAP for their sleep mates who snore or who have mild to moderate sleep apnea . However I don’t think this should be the overriding reason why someone should choose one mode of treatment over the other.
In a separate article I will discuss other ways that some people who have OSA or who snore can be further helped through surgery and also by using devices that prevent you from sleeping on your back, which in some people worsens snoring and apneas. If you would like further information on the dental sleep appliances or if you would like to book a consultation with me you can call our office at 416-691-2886 or email our office at BeechDental@gmail.com
No one should have to live with a snoring sleep partner or obstructive sleep apnea. You owe it to yourself, your sleep partner and your family to get treatment, whether it is a CPAP or dental appliance.