After your son or daughter's dental exam, you expect to hear about cavities, poor bites or other dental problems. But your dentist might suggest a different kind of problem you didn't expect—an eating disorder.

It's not a fluke occurrence—a dental exam is a common way bulimia nervosa or anorexia nervosa come to light. That's because the teeth are often damaged by the behaviors of a patient with an eating disorder.

Most of this damage occurs because of purging, the practice of induced vomiting after eating. During vomiting stomach acid can enter the mouth and "wash" against the back of the teeth. After repeated episodes, the acid dissolves the mineral content of tooth enamel and causes it to erode. There's also a tell-tale pattern with eating disorders: because the tongue partially shields the back of the lower teeth while purging, the lower teeth may show less enamel erosion than the upper.

Hygiene practices, both negligent and too aggressive, can accelerate erosion. Anorexics often neglect basic grooming and hygiene like brushing and flossing, which increases the likelihood of dental disease. Bulimia patients, on the other hand, can be fastidious about their hygiene. They're more likely to brush immediately after purging, which can cause tiny bits of the enamel immediately softened by the acid wash to slough off.

In dealing with a family member's eating disorder, you should consider both a short and long-term approach to protect their dental health. In the sort-term the goal is to treat the current damage and minimize the extent of any future harm. In that regard, encourage them to rinse with water (mixed optionally with baking soda to help neutralize acid) after purging, and wait an hour before brushing. This will give saliva in the mouth a chance to fully neutralize any remaining acid. Your dentist may also recommend a sodium fluoride mouth rinse to help strengthen their tooth enamel.

For the long-term, your goal should be to help your loved one overcome this potentially life-threatening condition through counseling and therapy. To find out more about treatment resources near you, visit the National Eating Disorders Association website at nationaleatingdisorders.org. Taking steps to treat an eating disorder could save not only your loved one's dental health, but also their life.

If you would like more information on eating disorders and dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”

The month of March brings the first day of spring, when nature seems to wake up after a restful winter slumber. It also brings Sleep Awareness Week, which leads us to ask: How's your sleep? For around one of every three people, the answer seems to be: Not so good! In fact, it's estimated that some 50-70 million people in the U.S. alone have sleep problems, including sleep-related breathing disorders like obstructive sleep apnea (OSA).

People who suffer from this condition seem to sleep fitfully and snore loudly—and they may actually wake up dozens of times every night without even knowing it. These "micro-arousals" make it impossible to get restful sleep, which can lead to fatigue, trouble concentrating, and behavioral issues. Children with sleep disorders like OSA are sometimes diagnosed with attention deficit/hyperactivity disorders because the symptoms are very similar.

If you suspect that you (or someone you care about) may have a serious sleep disorder, it's a good idea to get an examination from a medical professional who specializes in this area. If the diagnosis is OSA, there are a number of treatments that can be effective—one of which is an oral appliance that's available from the dental office.

Dentists are quite familiar with the anatomical structure of the mouth, which is sometimes the root cause of OSA. In many individuals, the soft tissue structures in the back of the oral cavity (including the tonsils, tongue and soft palate) can shift position when muscles relax during sleep and block the flow of air through the windpipe. The lack of sufficient air may cause a person to awaken briefly, gasp for breath, and then relax their muscles—over and over again, all night long.

After a complete exam, we can have an appliance custom-made for you that has proven successful in managing mild to moderate cases of OSA. Shaped a little like a retainer, it is worn in your mouth at night and taken out in the daytime. The appliance helps maintain an open airway by re-positioning the jaw and/or keeping the tongue out of the way.

Oral appliance therapy is one of the most conservative options available for treating OSA: It requires no major equipment or irreversible medical procedures. However, there are a number of other options, including machines that supply pressurized air through a face mask and even oral surgery. It's important to consult with a specialist in sleep disorders when you're facing this issue. If the diagnosis is OSA or a similar sleep problem, remember that help may be available here at the dental office.

If you have questions about sleep-related breathing disorders, please contact us or schedule an appointment for a consultation. You can read more in the Dear Doctor magazine articles “Oral Appliances For Sleep Apnea” and “Sleep Disorders & Dentistry.”

If you suffer from a temporomandibular (“jaw joint”) pain disorder (TMD), you know any activity involving jaw movement can be uncomfortable. That includes eating.

But avoiding eating isn’t an option—which means you may be attempting to minimize discomfort during flare-ups by choosing soft, processed foods that don’t require a lot of jaw force. While this may certainly ease your TMD symptoms, you might also be cheating your health by eating foods not optimally nutritious.

It doesn’t have to be a trade-off: with a few simple techniques you can still eat whole, natural foods while minimizing jaw joint pain. Here are 3 tips for making mealtime less stressful during TMD flare-ups.

Cut food into manageable bite sizes. Preparing your food beforehand will make a big difference in how much effort your jaws exert as you eat. Make sure all your food portions of vegetables, fruits or meats are cut or prepared into small, manageable bite sizes. It also helps to remove the tough outer skin of some fruits and vegetables or to mash other foods like potatoes or beans.

Use cooking liquids to soften food. For foods that aren’t naturally moist, you can add liquids to soften them and make them easier to chew. Incorporate gravies, sauces or marinating liquids into your meal preparation to help soften tougher foods like poultry, meats or some vegetables.

Go easy with your chewing and biting motion. The strategy here is to minimize jaw movement and force as much as possible. While preparing your food as mentioned before will help a lot, how you bite and chew will also make a big difference. Limit your jaw opening to a comfortable degree, take small bites and chew slowly.

Managing a jaw joint disorder is an ongoing process. When practiced together with other treatments like therapy or medication, eating deliberately can help make life with TMD easier.

If you would like more information on coping with jaw joint disorder, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “What to Eat When TMJ Pain Flares Up.”

If you think gum disease only happens to the other guy (or gal), think again. If you’re over 30 you have a 50-50 chance for an infection. After 65 the risk climbs to 70 percent.

Fortunately, we can effectively treat most cases of gum disease. But depending on its severity, treatment can involve numerous intensive sessions and possible surgery to bring the disease under control. So, why not prevent gum disease before it happens?

First, though, let’s look at how gum disease most often begins—with dental plaque, a thin film of bacteria and food particles built up on teeth and gum surfaces. If plaque isn’t consistently removed through daily brushing and flossing, it doesn’t take long—just a few days—for the bacteria to infect the gums.

While it’s not always easy to detect gum disease early on, there are signs to look for like red, swollen and tender gums that bleed easily when you brush or floss, and bad breath or taste. The infection is usually more advanced if you notice pus-filled areas around your gums or loose teeth. If you see any of these (especially advanced signs like loose teeth) you should contact us as soon as possible.

Obviously, the name of the game with prevention is stopping plaque buildup, mainly through daily brushing and flossing. Technique is the key to effectiveness, especially with brushing: you should gently but thoroughly scrub all tooth surfaces and around the gum line, coupled with flossing between teeth.

To find out how well you’re doing, you can rub your tongue along your teeth after you brush and floss—you should feel a smooth, almost squeaky sensation. You can also use plaque-disclosing agents that dye bacterial plaque a particular color so you can easily see surface areas you’ve missed. You can also ask us for a “report card” on how well you’re doing during your next dental visit.

Dental visits, of course, are the other essential part of gum disease prevention—at least every six months (or more, if we recommend) for cleaning and checkups. Not only will we be able to remove hard-to-reach plaque and tartar, we’ll also give your gums a thorough assessment. By following this prevention regimen you’ll increase your chances of not becoming a gum disease statistic.

If you would like more information on recognizing and treating gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “How Gum Disease Gets Started.”

“To gain something, sometimes you have to give up something else.”

No, that isn't the latest viral meme on the Internet. It's actually a practical consideration that could arise in orthodontics.

In this case, the “something” to gain is a straighter, more attractive smile; the “something” you may have to part with is a few teeth. This may be necessary if there are too many teeth on a dental arch for its capacity, a situation called crowding. A lack of space is the main reason teeth come in misaligned.

Before we can correct this, we'll need to free up space to allow for tooth movement by removing one or more of the existing teeth. The ideal candidates are those that are near to the teeth we wish to move but not highly visible. The first bicuspids are the most frequent choices for removal: they're located behind the cuspids or eyeteeth (the pointed teeth right under the eyes).

Ideally, we'll remove the target teeth some time before we apply braces to give the gums a chance to heal. At the same time we want to preserve the bone that once supported the teeth we've extracted. This is because when we chew the forces generated by the teeth stimulates bone replacement growth. When a tooth is no longer there the supporting bone doesn't receive this stimulation and may ultimately reduce in volume.

We may try to prevent this by placing a bone graft in the empty socket immediately after removing the tooth. The graft serves as a scaffold to encourage new bone to grow. Hopefully when we're ready to apply braces, the bone will be strong and healthy to handle the movement of the teeth.

As the teeth move under the influence of braces, they'll begin to fill up the space created by tooth removal. Once it's completed, the extracted teeth won't be missed — the other teeth now straightened will completely fill out the smile.

The different steps in this process must be carefully planned and executed precisely, and it will take months or even years to complete. In the end, though, this complicated bite problem can be corrected and replaced with an attractive, straight smile.

If you would like more information on correcting a poor bite, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Removal for Orthodontic Reasons.”