Devices Reduce Blood Pressure in Sleep Apnea

January 5, 2016 — Both continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) reduce blood pressure in patients with obstructive sleep apnea, according to a new study in the Journal of the American Medical Association.

The meta-analysis found no significant difference between the blood pressure outcomes associated with the two therapies, but CPAP had a considerably higher probability of reducing systolic blood pressure, concluded lead study author Daniel Bratton, PhD, and colleagues (JAMA, December 1, 2015, Vol. 314:21, pp. 2280-2293).

Obstructive sleep apnea occurs in about 2% to 4% of the population in Western countries according to a 2002 study in the American Journal of Respiratory and Critical Care Medicine (May 2002, Vol. 165:9, pp. 1217-1239); however, the study authors noted that the prevalence of the condition is on the rise because of increasing obesity in these populations. The condition is associated with oxygen loss and wakefulness from sleep, which can lead to increases in blood pressure and the risk of cardiovascular disease, according to a 2010 study in Nature Reviews Cardiology(December 2010, Vol. 7:12, pp. 677-685).

CPAP versus MADs

Continuous positive airway pressure devices have been shown to be an effective treatment for improving symptoms of obstructive sleep apnea, such as daytime sleepiness. The authors of the current study cited multiple studies that show the device also lowers blood pressure. For patients who are unable to tolerate CPAP, an alternative treatment often used is the mandibular advancement device, which works by protruding the mandible and tongue to keep the airway open during sleep.

In this study, the researchers from the University of Zurich in Switzerland compared CPAP and MAD to see what changes the devices had in the blood pressure of patients with obstructive sleep apnea. The meta-analysis included 51 studies from the databases of Medline, Embase, and the Cochrane Library to the end of August 2015 and included 4,888 patients with obstructive sleep apnea.

The researchers found that both CPAP and MADs were associated with similar reductions in systolic and diastolic blood pressure compared with an inactive treatment.

Survey: Many pregnant women don’t visit the dentist

Theresa Pablos assistant editor

More than 75% of pregnant women experience an oral health problem, according to a new Cigna survey of pregnant women and new mothers. The survey also found that almost half of the surveyed women did not visit the dentist during pregnancy despite having dental problems.

The researchers cited cost as one of the main reasons why pregnant women do not visit the dentist, and they found that women without insurance were twice as likely as those with insurance to not visit the dentist during pregnancy. However, healthcare professionals may be able to increase the amount of women who prioritize oral health by simply talking to women about the importance of visiting the dentist.

“The dental professional community should continue to advise and emphasize to expectant mothers the importance of practicing good oral hygiene habits at home before and during pregnancy and the need for regular dental checkups,” stated Miles Hall, DDS, Cigna’s chief clinical dental director, in an email interview with

Pregnant women aren’t told the importance of oral health

It is important for pregnant women to visit the dentist because all infections, including ones in the oral cavity, may impact the health of their baby. In addition, according to the Cigna study, hormonal changes throughout pregnancy can increase the risk for periodontal disease.

“The dental professional community should continue to advise and emphasize to expectant mothers the importance of practicing good oral hygiene habits.”
— Miles Hall, DDS, Cigna’s chief clinical dental director

The American College of Obstetricians and Gynecologists recommends that all women, including pregnant women, should be counseled about the importance of oral health.

To see if pregnant women and new mothers knew about the importance of oral health during pregnancy and if they followed through with visiting a dentist, Cigna conducted a survey through M/A/R/C Research. The online survey went out to pregnant women and also women who had babies within the past 12 months.

All the women included in the survey were between the ages of 21 and 45. A total of 801 women were surveyed:

  • 200 pregnant women with dental insurance
  • 200 pregnant women without dental insurance
  • 201 new mothers with dental insurance
  • 200 new mothers without dental insurance.

The survey found that although 76% of pregnant women reported having an oral health problem, including bleeding gums, toothache, and increased tooth sensitivity, only 57% actually visited a dentist during their pregnancy. To help remedy this, the survey authors recommended that healthcare providers, including dentists and hygienists, explain how pregnancy can affect the oral cavity.

oral health survey

Data courtesy of the 2015 Cigna survey “Health Smiles For Mom And Baby.”

“Explain the connection between oral health and overall wellness before, during, and after pregnancy,” the survey authors wrote. “For pregnant women, any infection, including tooth decay and gum disease, has the added possibility of affecting the baby’s health.”

The study also found that pregnant women who did not have dental insurance were twice as likely to not visit the dentists as those with dental insurance, and 33% of the women skipped a dental visit during pregnancy because of the cost.

“It is important to acknowledge the frequent reasons for avoiding the dentist and offer insight into overcoming potential barriers — such as providing details about what services are covered under a preventive visit and upfront communications about treatment costs for restorative services,” Dr. Hall said. “Help patients determine whether their dental plan has a special program with extra covered services for pregnant women, like additional exams or cleanings.”

same day crowns

The Greenwich Dental Group now offers E4D same day dentistry!

Using E4D Same-day Dentistry technology, Dr. Altman was able to do two same-day crowns. The patient did not have to come back for a second appointment, get a second injection or wear temporary crowns for 2 weeks.

What is E4D Same-day Dentistry technology?

E4D is a new CAD/CAM technology that takes images of your teeth and allows us to design your crown, filling or veneer while you wait.

Does that mean you won’t have to have a temporary?

That’s right. No temporary. You’ll go home with your permanent ceramic restoration the same-day.

How does it work?

Your dentist determines that your dental condition is right for a digital restoration; we take a series of digital images of your teeth while you watch the process chairside. In the past, we’d have to take impressions and send them out to a laboratory, and they’d make your restoration while you had a temporary in place. With this new technology, you’re in and out on the same-day with your permanent restoration seated in place.

How will you know if I can have this same day treatment?

We will perform a thorough examination before recommending any dental treatment. If you’re experiencing any dental problems or want to learn if E4D is right for you, let’s schedule you for an appointment.

Drinking Alcohol May Worsen Periodontal Disease


The more alcohol people drink, the worse their periodontal condition may be, according to a new study in the Journal of Periodontology. The findings show that men and women who consume at least four alcoholic drinks per week have worse periodontal status than those who drink less than that amount monthly, or who do not drink alcohol at all.

The Brazilian researchers wanted to find out how alcohol usage affected the severity of periodontitis. After dividing patients into groups based on their alcohol consumption, they found that those who were alcohol-dependent had more plaque and higher clinical attachment levels than patients who drank less frequently.

“A higher severity of periodontitis has been reported among alcohol users with incremental odds for occurrence of the disease proportional to the frequency of alcohol consumption, as well as a higher need for periodontal treatment,” the authors wrote (J Periodontol, June 11, 2015). “Therefore, it is important to highlight that in the present study, alcohol-dependent users presented a higher plaque index and a higher severity of periodontitis.”

Link between alcohol and periodontitis

While many studies have linked alcohol consumption to other diseases, few have looked at its effects on periodontal disease. Since excessive alcohol intake can contribute to faster biofilm formation and alcohol users are more likely to have poor oral hygiene, the researchers wanted to see if alcohol consumption was associated with periodontitis.

“Alcohol-dependent users presented a higher plaque index and a higher severity of periodontitis.”

Alcohol-consumption questionnaires were given to men and women on the waiting list for medical and dental treatment from three health centers in Brazil. The patients were divided into four categories based on how much alcohol they consumed. Patients who consumed alcohol at least four times per week were categorized as alcohol-dependent, while those who did not use alcohol or used it less than monthly were deemed as nonusers or occasional alcohol users.

In the end, the researchers looked at 88 patients ages 35 to 55. The sample was divided into four groups of 22 people each based on their periodontal status and alcohol consumption levels:

  • ADP: alcohol-dependent with periodontitis
  • ADNP: alcohol-dependent without periodontitis
  • NAP: nonusers or occasional alcohol users with periodontitis
  • NANP: nonusers or occasional alcohol users without periodontitis

Despite the four groups having homogenous smoking status, educational levels, and body mass index, the alcohol-dependent groups tended to have worse periodontal status than the nonusers or occasional alcohol users.

“In the present study, the ADP group presented worse periodontal status and higher frequency of some periodontal pathogens,” the authors wrote. “The microbial analysis revealed significant differences in bacterial counts among the four groups, demonstrating higher counts associated with periodontitis and alcohol dependence.”


Periodontal condition by alcohol consumption and periodontal status
Plaque index 1.5 1.2 1.3 0.9
Site percentage PD 4-6 mm 15.3% 6.5% 0.31% 0.22%
Site percentage PD ≥ 7 mm 3.7% 2.3% N/A N/A
Site percentage CAL ≥ 4mm 16.4% 7.2% 5.4% 2.9%

PD = probing depth; CAL = clinical attachment level. Data from “Alcohol Consumption and Periodontitis: Quantification of Periodontal Pathogens and Cytokines,” Journal of Periodontology, June 11, 2015.


“Individuals without periodontitis showed significantly lower bacterial levels when compared to those with periodontitis, although with no significant difference in relation to alcohol consumption was observed,” the authors noted.

Alcohol users without periodontitis also had more plaque than their nondrinking counterparts. Alcohol’s drying effect on the mouth may contribute to plaque formation, triggering an inflammatory response in the gums, the researchers explained.

Encourage patients to be honest

While the study did present some significant findings, it consisted of a relatively small sample size, and the authors called for other researchers to look at larger samples and different populations. They also note that finding alcohol-dependent patients may be difficult.

“Although the topic of alcohol use and its effect on periodontal health requires further research, this report offers valuable insight on why our patients should care for their gums and teeth, especially if they enjoy the occasional drink,” stated Joan Otomo-Corgel, DDS, MPH, president of the American Academy of Periodontology, in a press release. “For patients who are diagnosed with periodontal disease, it’s imperative that they are encouraged to be completely honest about their drinking habits. This information can guide in determining appropriate treatment and next steps.”


Study: Half of oral cancer deaths due to cigarettes


June 15, 2015 — Almost half of the deaths caused by cancers of the oral cavity and pharynx in U.S. adults 35 and older in 2011 were attributable to cigarette smoking, according to a multi-institution research letter published in JAMA Internal Medicine

Overall, almost 346,000 people died of one of 11 cancers in 2011 in the U.S. (see list below), including about 150,000 women and more than 197,000 men. Of these deaths, 48.5% were attributable to cigarette smoking.
“Cigarette smoking continues to cause numerous deaths from multiple cancers despite a half century of decreasing prevalence,” the authors noted (JAMA Intern Med, June 15, 2015).
There were more than 8,500 deaths in the U.S. from cancers of the oral cavity and pharynx in 2011. Researchers attributed 47% of these deaths to cigarette smoking. In comparison, more than 80% of deaths from lung, bronchial, and tracheal cancers and more than 76% of deaths from cancer of the larynx were attributed to smoking in the research letter (see chart below). Source: JAMA Intern Med (June 15, 2015).


By gender, these deaths from oral and pharynx cancers broke down to more than 6,000 men and slightly more than 2,500 women. Just under half of these deaths (2,955) in men were attributed to smoking. In women, 43% (1,077) of deaths from cancers of the oral cavity and pharynx were attributed to smoking.

The authors noted that the 2014 U.S. surgeon general’s report provided an estimation of the annual number of smoke-attributable deaths from 2005 to 2009 from cancer overall and from lung cancer, but not from the 11 other cancers found to be caused by smoking.

“Updated estimates are needed because smoking patterns and the magnitude of the association between smoking and cancer death have changed in the past decade,” they noted.
The researchers, from the American Cancer Society, Harvard Medical School, the National Cancer Institute, and the Fred Hutchison Cancer Research Center, reported that while smoking prevalence dropped more than 5% (23.2% to 18.1%) from 2000 to 2012, the “risk of cancer death” among smokers increased over the same period.

The researchers noted one limitation of their study was the cohort populations, which were “less racially diverse” and “more educated” than the U.S. population in general. Also, exposure to secondhand smoke was not included in their analysis. Exposure to secondhand smoke is estimated to cause an additional 5% of lung cancer deaths, according to the 2014 U.S. surgeon general’s report.

The cancers in the study included colorectal; esophageal; kidney and renal pelvis; larynx; liver and intrahepatic bile duct; lung, bronchial, and tracheal; myeloid leukemia; pancreal; stomach; urinary bladder; and uterine cervix; and cancers of the oral cavity and pharynx.

“Continued progress in reducing cancer mortality, as well as deaths from many other serious diseases, will require more comprehensive tobacco control, including targeted cessation support,” the authors concluded.


American Oral Health Could Use a Brush-up


New data on tooth decay and cavities among American adults reveal the sad state of our pearly whites. More than 25% of American adults ages 20 to 64 have untreated tooth decay, and 91% have one tooth — or more — that has been treated for tooth decay or needs to be.


or read the full study here.

Why Falling Asleep Without Brushing Your Teeth Is Actually Pretty Darn Gross


The question:
Just how gross is it really if I forget to brush my teeth before bed every once in a while?
The answer:
Bad news: It’s pretty gross.


You probably already know that the American Dental Association (ADA) recommends brushing those pearly whites twice a day. You also probably know that brushing your teeth is one of the easiest ways to avoid scaring off your date.
But brushing is important for reasons beyond fresh breath. Skip a session, and you’re on your way to encouraging the growth of bacterial buildup in the form of plaque, which can lead to cavities and gum disease.
“In the middle of the day, [run your tongue] across your teeth right around the gum line. You’ll find something sticky or fuzzy,” Deepinder “Ruchi” Sahota, DDS, a dentist in Fremont, California, and a spokesperson for the ADA, tells The Huffington Post. “That’s plaque.”

Brushing, thankfully, “disrupt[s] that bacteria so it doesn’t stay in place,” she says, because if left in place, it starts to attack your teeth. Plus, the longer that plaque sits in one place, the more likely it is to become tartar, “that hard, yellow, rough material you sometimes feel in between your teeth” that can cause inflammation and bleeding in the gums, she says. Leave that untreated for too long, and you could risk losing teeth.

While there’s not exactly a precise timeline of when plaque becomes risky, “you can start the process of a cavity by not brushing once, absolutely,” says Sahota, especially if your occasional forgetfulness is more frequent than you’d like to admit. (We won’t tell.)

However, doing a so-so job brushing can be just as bad, Sahota warns. That twice-a-day routine is no joke, preferably with fluoride toothpaste and a soft-bristled brush. Each brushing session should last about two minutes and cover all surfaces of the teeth, not just the parts we see when we smile, she says. The ADA also recommends flossing once a day and seeing a dentist regularly to take care of the rest (like that tartar, which only a dentist can truly clean, she says).

Also, no cheating: Gum, mints and mouthwash are no brushing replacements. All three can give your mouth a fresher feel, says Sahota, but “brushing and flossing are the only ways to effectively, physically remove the plaque.”

Case Study – Replacement of Old Silver Fillings (amalgams)


While the research is still inconclusive as to whether silver/mercury amalgams are harmful to your health (via mercury leeching, we often find the problems of cracks around and cavities under amalgams more of an immediate problem to take care of).

Old silver fillings are a factor in teeth cracking, a common occurrence in people in their 40’s and 50’s. Silver fillings do not strengthen teeth at all but transfer biting forces to the surrounding tooth structure, commonly resulting in cracks and chips. Forces on molar teeth can be up to eight times the forces on the incisor teeth, resulting in damage to the tooth structure. Larger fillings also contributed to the damage. This is just such a case.

Two upper molar teeth with old silver fillings, cracks, and cavities required immediate attention. Dr. Altman saved these teeth by doing 2 all porcelain crowns. Our patient was thrilled with the results and grateful for not losing these teeth.

Healthy Teeth for a Healthy Baby: Establishing the Link between Oral Health and a Healthy Pregnancy


It is now believed that infections account for 30% to 50% of all premature and low-birthweight deliveries.

Gum diseases are among the infections that can lead to these outcomes. However, gum disease can be easily treated and prevented – far more easily than the problems that can result in infancy when gum disease goes untreated in pregnant women.

If you are trying to get pregnant, see your dentist first so any existing dental problems can be addressed before you get pregnant. However, if you aren’t able to see your dentist before getting pregnant, it’s not too late to seek dental care.

  • As soon as you find out you are pregnant, see your dentist for a professional cleaning and an evaluation of your gums.
  • Brush at least twice a day, floss once a day and use an antimicrobial mouth rinse to prevent pregnancy gingivitis.
  • Avoid sugary foods and drinks.
  • Frequent cleanings during pregnancy will enable your dentist to monitor the health of your gums and address any problems that arise.
  • Pay careful attention to your teeth and gums during pregnancy and report any signs of gum disease to your dentist right away.
  • Continue to see your dentist after delivery, especially in the first three months, and remember to take your child for his/her first dental visit at the age of 12 months.

If you do experience gum disease during pregnancy, it should be treated as soon as possible. Gingivitis, the early stage of gum disease, can usually be eliminated with professional cleaning. During the cleaning (also referred to as scaling), plaque and tartar (plaque that has built up and hardened on the tooth surface) will be removed from above and below the gum line of the teeth. Root planing can also be performed to treat gum disease. During root planing, rough spots on the tooth root are smoothed, giving the gums a clean surface to attach to. Surgical procedures can be performed to treat more serious cases of gum disease. As you prepare for the arrival of your little one, take care to practice good oral hygiene and seek regular care from a dental professional. Not only will you preserve your dental health, you’ll be taking important steps to protect the health of your baby.

Find the full article on Ehealth!

What You need to Know to Keep Your Child’s Smile Healthy!


1. At Home Care

Brushing and flossing are at the core of great care. Adults as well as children should be brushing twice daily, along with developing proper daily flossing techniques. Having healthy eating habits also helps reduce risks, as frequent intake of carbohydrate— rich or sugary foods increase the chance of tooth decay.

2. Fluoride: Too Much or Too Little

The right amount of fluoride helps to prevent and control tooth decay in both children and in adults. How it does this is by both incorporating itself into the structure of developing teeth when it is ingested and protecting teeth once it comes in contact with the surface of the teeth. Today we obtain fluoride from a majority of toothpastes as well as from water. Fluoride is a natural occurring mineral and a majority of community water systems have also adjusted the naturally existing levels by adding the safe, optimum amount. This mineral, when combined with others such as calcium and phosphate, not only strengthens teeth, but can rebuild them as well.

3. Sealants

Although these are more often recommended for children and teenagers, dental sealants are also beneficial to adults. A thin, resin coating that is painted on the chewing surfaces of the back teeth, sealants serve as a protective shield and barrier for those hard to keep clean nooks and crannies. Many insurance companies cover sealant costs for children and it is an easy and painless process. Sealents can prevent tooth decay for up to 10 years, as long as the sealant remains intact. Your dentist will be able to evaluate your risk for decay and determine if sealants are the right treatment for you.

4. Making that Visit

As we work together to encourage dental visits for our children and youth, starting as soon as 6 months when the first tooth arrives, we should also be mindful of our own needs as adults. According to a Harris Poll survey collected in April 2014, approximately 22.9% of adults indicated they were not sure or were not planning on visiting a dentist within the next 12 months. Regular visits to the office are an important part of preventative healthcare, allowing you to become aware of developing risks and potential issues.

Encouraging our youth to practice great oral health habits serves to also remind you to be mindful of your own needs as well.The development of good practices is not solely for the young and sometimes it is easy to say that we do not have the time or the need to do so. Sitting in a chair twice a year for an hour or so for a check and cleaning is a lot better than a lifetime of easily prevented toothaches. We may not need the extra bubblegum flavoring, but that shouldn’t stop us all from making our health our first priority.

Besides, who doesn’t love that fresh tingling feeling you get when you crack that first smile? We sure do.

Not All Whitening Systems Are Created Equal


Most over-the-counter whitening systems are one-size-fits-all affairs. They have to be, to fit as many people as possible. Thankfully we have some of the best whitening products tailored to your needs, with custom-fitted trays for at-home treatments or just the right light intensity and duration in our office.

The system I’d like to focus on in this blog post is the family of Zoom! treatments. Over 10 million patients have had their smiles brightened by a Zoom treatment. We understand that patients have different needs when it comes to whitening—that’s why we offer three different Zoom products:

In-office Whitening

The quickest, easiest way to effectively whiten your teeth is our in-office treatment with Philips Zoom WhiteSpeed. Zoom WhiteSpeed is the only in-office system that has a variable intensity setting so each treatment can be customized to maximize patient comfort. The system also includes desensitizers to help minimize sensitivity and protect your enamel. This supervised, in-office procedure is safe, effective and clinically proven to whiten up to eight shades—for a brighter, whiter smile in just one office visit.

Whitening at Home

Philips Zoom DayWhite and NiteWhite offer superior at-home whitening for a visibly whiter smile in one day and your whitest healthiest smile in seven to fourteen days. They are the only at-home whitening products to contain amorphous calcium phosphate (ACP), which is clinically proven to reduce sensitivity, protect enamel and help improve the luster and smoothness of the teeth.
Zoom at-home whitening products are completely customizable. We’ll create a custom tray made just for you and can tailor the formula concentration and wear times to your sensitivity and lifestyle.

Whitening Maintenance

To ensure your smile stays bright and white between treatments, we offer the Zoom Whitening Pen. With only two applications per day, this proprietary formula will help you maintain your white smile.

For continued stain removal and your healthiest teeth and gums, look for a power toothbrush like Sonicare DiamondClean or HealthyWhite. They’re proven to whiten teeth and remove plaque better than manual brushes.

Even if you are familiar with whitening procedures, you still may have questions:

Is teeth whitening safe?

Yes. Clinical studies have shown that whitening your teeth with carbamide or hydrogen peroxide under the supervision of a dental professional is safe for teeth and gums.

What causes teeth to discolor?

There are many causes to tooth discoloration. Some of the most common include the consumption highly colored foods and drinks (berries, coffee, tea, red wine). Some medications, aging, smoking and trauma can also cause teeth discoloration.

How long does it take?

With Zoom, your teeth will be visibly whiter in one day. With Zoom in-office, you will achieve up to eight shades whiter in 45 minutes. With Zoom at-home, when used as instructed, you will achieve the same great results in one-two weeks, depending on concentration of formulation and wear time you select.

Are there any side effects?

The most common side effect is tooth and gum sensitivity. A dentist is your best resource to ensure that you are a good candidate for whitening and that you are using the right concentration of whitening formula.

How long will my Zoom whitening results last?

Whitening treatments help to reduce existing stains, but through consumption of coffee, soft drinks or just through natural aging, your teeth may eventually become discolored again. Maintenance whitening can help combat recurring discoloration. Only Zoom at-home whitening products include ACP, which has been shown to help reduce whitening fade-back.

Sleep Apnea

While many of us might not consider seeking out the advice of a dentist to achieve a better nights sleep, you should know that certain dentists are trained to provide solutions to those suffering from Sleep Apnea.

What is Sleep Apnea?

In simple terms Sleep Apnea is a chronic medical condition where the affected person repeatedly stops breathing during sleep. These episodes last 10 seconds or more and cause oxygen levels in the blood to drop. It can be caused by obstruction of the upper airway, resulting in obstructive sleep apnea, or by a failure of the brain to initiate a breath, called central sleep apnea. It can cause and worsen other medical conditions, including hypertension, heart failure, and diabetes.

What are common symptoms of Sleep Apnea? 

  • Waking up with a very sore or dry throat
  • Loud snoring
  • Occasionally waking up with a choking or gasping sensation
  • Sleepiness or lack of energy during the day
  • Sleepiness while driving
  • Morning headaches
  • Restless sleep
  • Forgetfulness, mood changes, and a decreased interest in sex
  • Recurrent awakenings or insomnia

How can a dentist help?

A dentist with specialized Sleep Apnea training is committed to your overall wellness, and works in conjunction with your medical doctor to determine the best course of treatment. Often, a person affected with this condition can benefit from the option of wearing a simple mouth appliance at rest that comfortably repositions the jaw and tongue to alleviate airway obstruction.

At Greenwich Dental Group, our team of Doctors are available to discuss your concerns and offer possible Sleep Apnea solutions that involve comfortable oral devices that keep the air way free of obstruction. Please feel free to schedule a complimentary Care to Share appointment.

We recommend you follow the link to learn more: