Headaches and Sinus Rinsing

Spring Allergy season is here, and so are the associated headaches, itchy eyes and runny noses.  Did you know that sinus pain can manifest as upper tooth pain?  Did you know that Sinus pain can increase the severity of a TMJ headache that is caused by clenching and grinding of your teeth?

One simple, over-the-counter method for managing sinus pain is sinus rinsing.  This is a volume rinse of warm sterile saline which decreases the volume of irritants (and allergens) in the nose and sinuses, decreases the inflammation of the mucous membranes which line this respiratory region, and decreases the accumulation of mucus. Sinus rinsing can be performed daily, does not interact with any medications, and will clear the way for topical medications (like nasal steroids) to reach the inflamed surface.

The old fashioned method of sinus rinsing is with a Neti Pot, but this delivery method requires an abnormal tipping of the head which can irritate neck and jaw musculature.  The newer method, made by NeilMed, is a plastic bottle delivery system with a cone shaped cover which extends to a straw that inserts in the bottle.  Warm pre-boiled water is placed in the bottle up to the dotted line (8 ounces) and a buffered salt packet is added.  To rinse, lean forward over the sink, place the dome shaped cap in one nostril, and squeeze gently.  The water will go up one nostril, and if the path is clear, will descend the opposite nostril.  If the path is not clear, simply remove the bottle and let the saline drip out.  Blow your nose to remove the loosened mucus and rinse again until 4 ounces have been used for each side of your nose. (Do not squeeze the bottle hard. It will cause the salty water to go down your throat.)

It takes time for water to boil and cool to the correct temperature, so I have come up with a short cut.  I keep a tempered glass bottle (from marinara sauce) by my stove.  Every time I have boiled water for another use (like tea or coffee) I save the extra in this jar.  This way I have a store of room temperature pre-boiled water.  When I am ready to rinse my nose I put only 3 ounces of water up to boil. While it is cooking I get my NeilMed bottle and salt packet from the cabinet, pour 5 to 6 ounces of pre-boiled water into the bottle, and add the salt packet.  By then the new water has come to a boil, and I add the hot water until I reach the 8 ounce line.  I shake the contents, and check the temperature on my wrist before rinsing so that I know the saline will not be hot enough to burn before using it to rinse my nose.  I sinus rinse when coming in from time outdoors during seasonal allergy seasons, and after being in an area which is too fragranced (air fresheners and perfume) or too smoky (from smokers or fireplaces.) I also wash my face and hands, and if possible, shower and change into clothes that do not also smell from the allergen environment.  In this way I am not re-breathing the same irritants all night long. In addition to decreasing headache pain, sinus pressure and nasal stuffiness, post nasal drip and nasal congestion. Keeping the time of the allergen exposure short also decreases the severity of other allergy issues like asthma.

http://shop.neilmed.com/Products/Sinus-Rinse/Sinus-Rinse-Regular-Kit

At the high school reunion of the first 5 graduating classes of Blind Brook High School, last night we recognized the teachers who helped develop who we are and honored Bruno Ponterio, our elementary and middle school principal. While I am mourning the aging and loss of my parents’ generation and recognizing the one year anniversary of the death of my Uncle Jack Kabcenell, I am also feeling the loss of my own generation. Last night I heard of the recent death of Billy Russillo, and the not so recent death of Jeff Sollender. May they, as well as Seth Baygell, Roopi Sethi, Jennifer Johnson, Mitchell Quat and David and Melissa Heinsohn always be remembered.

Yesterday the topic of the ninth district dental society meeting was digital scanning and CAD/CAM technology. A digital scan in dentistry is the substitution of a digital 3D image for a dental impression.  It involves taking pictures with a mini- camera which uses either a blue LED ( light emitting diode) or laser light to make a three dimensional model of the teeth. This model can be used to make a digital restoration (like a crown, inlay, or onlay) which can be digitally printed for use in the mouth (i.e. CAD/CAM technology). This can replace, in some situations, the use of gooey impression material in a tray to make a negative image of the teeth. The “footprint” is either used to make a stone model of the teeth, or is scanned to make a digital model. Scanners have come a long way.  Intraoral scanners can very accurately reproduce the shape of one to three teeth in the arch to be able to make a single tooth restoration (crown, inlay or onlay), or even a three unit bridge.  The problem with intraoral scans is that they take tiny images which are “stitched together”.  If a larger area is scanned there is more distortion from the multiple sites of “stitching,” i.e. the bigger the scan, the greater the distortion.  The intra-oral scanning technology is not advanced enough to make a full mouth model which is as accurate as the model which can be made from a dental impression. If the scan is made outside the mouth, i.e. an impression is taken and then scanned, the model is very accurate and can be used to make a “printed” dental restoration which is bigger than three teeth, such as the framework for a partial denture. The technology is very expensive, and is outdated every three to four years.

What does this mean for the patient? If you want a crown made by your dentist and don’t like the feeling of gooey impression material in your mouth, you can find a dentist who has a digital scanner, and a digital printer to make the crown out of a block of “ceramic” material. If he has enough staff the can even prepare the tooth and restore it the same day.  If you want aligner treatment and can’t tolerate impression material in the tray, you can find a large, high volume, orthodontic practice which has a digital scanner, and they can take a digital scan of the full arch to send electronically to the aligner company.  There is enough flexibility of the aligner material to counteract the inaccuracies in the scan. If however, you like a small dental office with the personal touch, you may have to forgo the digital scan.  The technology is too expensive to be supported in a small, low volume, office, and also keep fees reasonable.

What does this mean for the dentist?  If you are competent in taking impressions it is fine to stick with taking impressions.  They are more accurate, and they can be scanned accurately by a digital lab.  There are dental labs that scan impressions, there are dental labs that print the models, and there are dental labs that print the restorations. Therefore your patients can still benefit from the accuracy of digital restorations.  If you are a new dentist who has not been trained in impressions taking because your school has “gone digital”, you are in trouble.  The scanning technology is great for single tooth restorations, but you still need impressions to make full arch restorations (crown and bridge or denture type restorations) accurately.

Bonded (Permanent) Retainers- Pros and Cons

I was asked to weigh in on a facebook discussion about bonded retainers.  The opinions ranged from “why would you want to attach something to your teeth forever,” “They are hard to clean because you have to floss under them (or waterpik around them), ” “they promote tooth decay and periodontal disease because of plaque build- up (i.e  it is difficult cleaning around them) “ to “at least you can’t lose them” and “they keep the front teeth looking straight so you haven’t thrown your money out for the braces when everything moves.”

I loved this opinion:

“If it helps to hear a positive old-school retainer story: my kids have managed to not only NOT lose, but use their retainers for five years now. They can keep track of keys and wallets too. It's not a bad skill to develop and less risky than the permanent option.”

I also enjoyed reading this one:

“I sometimes wonder when orthodontists recommendations cross the line between good dental health and strictly cosmetics reasons. I probably could have used a permanent retainer, but the slight crookedness of my lower teeth has never had a bad impact on my dental health. I would want a second opinion and a very detailed explanation why a permanent retainer was necessary.”

Here is how I responded:

Teeth will move your whole life- from any force that is put on them. This includes over-bulked fillings that make the contact too tight, mouth habits (such as pencil biting, improper tongue posture, clenching your teeth), and aging (which causes the lower jaw to rotate forward "throwing" the lower front teeth against the upper front teeth.) Some orthodontists choose to "guarantee" the lower front teeth stay straight with respect to "each other" by bonding them together. This does not stop them from moving as a unit! It can also have other undesirable side effects (such as creating space between the upper front teeth, or pushing the lower jaw backwards causing clicking in the temperomandibular joints) in patients who clench their teeth. It is necessary to floss or waterpik the bonded retainer daily to prevent gum problems, and to have it checked every year to make sure that it is still bonded securely- otherwise you can get decay under it.

 "Invisalign" or "Essex" vaccuum formed retainers stretch-out over time so that they become less effective, and they prevent posterior teeth from settling fully into occlusion (i.e. they prevent your bite from working properly) when used long term.

 I still prefer removable hawley style retainers (with a shelf on the front of the top one for vertical control)- worn full time when the braces come off, and then just “at night” after the first year- at least til the patient stops growing. (I switch to an occlusal guard if the patient is a clencher.) If the braces were worn as an adult it is likely retainers will be needed at night forever.

#braces, #orthodonticretainers, #hawley retainers, #bonded retainers, #permanent retainers, #invisalign retainers", #essix retainers

I can fix that!

Orthodontists have many skills which are useful to straighten teeth.  These skills can also be used outside the office.

Recently my bottom refrigerator shelf split from using it to support heavy pots.  It seemed ridiculous to replace the refrigerator when the motor still worked.  After staring at the broken shelf for months I said to myself, “I can fix that.”  Using the method which my grandfather, Dr. Joseph Okun, used to repair dentures, and which my father, Dr. Stanley Okun, adapted to repair retainers, I set out to repair my refrigerator shelf.  I drilled holes on both sides of the crack, and sewed .012 ligature-wire across the crack.  On the top side of the shelf I flowed Triad Gel over the “stitches” to create a smooth surface, and light cured the gel.  Then I used cold cure acrylic on the underside of the shelf, to add strength to the repair.  I restored the support leg with .045 retainer wire and cold cure acrylic, the same way that I used to transfer copings when I still did general dentistry. Now my refrigerator shelf is as good as new!

How handy is your orthodontist?

The Danger of Undiagnosed Sleep Apnea, and Dental Treatment for Sleep Apnea

Once again, undiagnosed sleep apnea is in the news, as the cause of the September 29, 2016 Hoboken Commuter train crash.  It was also the cause of a New York City commuter train crash in 2013 and of freight train crashes in 2011 in Iowa, and in 2013 in Missouri. According to a CBSnews.com report on 11/21/16), “Metro-North started testing for sleep apnea after the 2013 crash. Metro-North’s screening program has found sleep apnea in 51 of its 438 engineers and trainees, spokesman Aaron Donovan said. They are undergoing treatment, he said. Now Federal regulators are urging railroads across the country to test train operators for obstructive sleep apnea.”

“Sleep apnea is especially troubling for the transportation industry because sufferers are repeatedly awakened and robbed of rest as their airway closes and their breathing stops, leading to dangerous daytime drowsiness. Studies have long concluded that people with the disorder have diminished performance in multiple areas during the daytime.

“You end up with an engineer who is so fatigued they’re dosing off, they’re falling asleep in these micro bursts and they often have no memory of it, and they’re operating a locomotive at the time, so they’re putting hundreds of people in danger,” (Sarah)Feinberg (of the Federal Railroad Administration) said.

“Airplane pilots with sleep apnea aren’t allowed to fly unless they’ve been successfully treated. Regulators are also pushing for bus and truck drivers to get tested.”

Treatment for sleep apnea may include:

Sleep hygiene measures such as: going to sleep the same time every night and getting up at the same time every morning in order to train your body when it should be sleeping, sleeping in a dark room, using the bedroom only for sleeping, and avoiding blue light from televisions, tablets and smart phones before bedtime.

Sleeping with a Continuous Positive Airway Pressure (CPAP) mask over the mouth and nose.  The air which blows into the mouth and nose keeps the airway open so that it doesn’t collapse when the airway muscles collapse during sleep.

Sleeping with a dental appliance which positions the lower jaw forward, so that the jaw position holds the airway open despite the collapse of the airway muscles during sleep.

In extreme cases there are surgeries which either cut away soft tissue or reposition bones to change the anatomy of the face and jaws, so that the airway is not obstructed during sleep.

All of these treatment options have side effects, but the consequences of leaving sleep apnea untreated are far more severe.  If you, or someone you know, is interested in treating their sleep apnea with a dental appliance, schedule a consultation appointment with Dr. Judith Okun to discuss your options and questions.

Yes, "It is your fault."

“It ain’t my fault”

Yesterday I heard Zara Larson, a singer who was on TV singing "it ain't my fault", a song about how it isn’t her fault if she falls for a man and can’t control her actions.  Every day we hear from politicians that the status quo is not their fault; it was caused by their predecessor. (Unless it was favorable, then they claim it for themselves.) We seem to live in a society of people who don’t make an effort to take responsibility (or make an effort to not take responsibility.)

Orthodontic treatment requires responsibility and effort by both the doctor and the patient. The orthodontist sets up the system, and the patient “drives” it.  I explain it to patients as if it is a car.  You can spend a lot of money on a car, but if you don’t put gas into it, it won’t drive; You can spend a lot of money for braces, and if you don’t put in your effort (wear elastics, eat in ways that won’t break your braces, and keep regular

appointments) your treatment will not progress.  It’s like saying that it is a two hour trip from here to Philadelphia, but you never turn on the car.  Two hours later you won’t be in Philadelphia.  Your case may take two years to complete if you follow directions, but you won’t have a complete result in two years if you don’t put in your effort.  The patient has to take responsibility and put in the effort to get that satisfactory result! Yes, “it is your fault” if you don’t. All of us are much happier when the result is amazing, so please take responsibility, and help make your smile spectacular.

Dr. Okun supports "Officer Phil"

Dr. Okun is proud to be one of the sponsors of the Officer Phil safety programs through the Rye Brook Police Department and the Bruno M. Ponterio Ridge Street School.  This educational program not only enables students in grades 1 through 4 to interact in a comfortable environment with their local police department, but it also provides them with an activity book to take home and share with their parents, to teach age-appropriate safety measures at home. There is a different activity book for each grade. Dr. Okun has been a supporter of this program since its inception three years ago.