Blog - Page 10 of 10 - Donald R. Tanenbaum DDS

Ringing in the ears, or tinnitus, is a symptom often described as a ringing noise heard in one or both ears, that can be present continually at the same level or vary in intensity. The presence of ringing in the ears during the course of a day is based on jaw movements, head positions and tongue activity. In addition to ringing, some people describe sounds such as hissing, buzzing, humming, clicking, whistling or roaring. Along with these perceived sounds individuals often report hearing loss.

Tinnitus can have its origin from a wide number of possible causes. For some tinnitus is short-lived while for others it is ongoing and disruptive to everyday life.

Subjective tinnitus, that which is described by a patient but not heard or detected by an examining physician, is often prompted by factors like exposure to abnormally loud sounds (one bad exposure or of long duration), chronic ear infections, ear pain, trauma to the inner ear, hearing loss, Menieire’s disease, Acoustic neuromas, chronic use of medications like aspirin, antibiotics or antiviral drugs, and neurologic diseases amongst others.

At times it has been suggested that temporomandibular disorders can be responsible for the onset of tinnitus. Though symptoms such as ear pain are commonly associated with TMJ disorders it is my opinion that no greater than 10-15% of all those patients that we see with TMJ problems report the symptom of tinnitus.

Since the histories and examinations of these patients are no different than those without tinnitus, the reason why they are suffering with ringing in the ears remains unclear. It has been proposed that overuse of the TM joints during gum chewing, tooth grinding, or nail biting for instance can sometimes cause tinnitus but this remains more opinion than fact. If, however, the ringing in your ears increases or changes with opening or closing of your mouth, or forward and side-to-side shifts of your jaw, there is a chance that a relationship exists between the tinnitus and your jaw. In addition, if you are a heavy nighttime tooth grinder or clencher and wake up with tinnitus it would be wise to investigate whether there are treatment options available to address this distressing and often disabling symptom.

The final word is that the symptom of tinnitus often cannot be attributed to any one or specific medical disorder or physical cause. As a result patients are often left to wonder whether relief will ever be found! If your tinnitus symptoms seemingly have any relationship to jaw function an investigation with a properly trained dentist would certainly be advised.

Oral Appliance Saves Marriage

August 24, 2011 — by Dr. Donald Tanenbaum

Recently, a 52 year old female patient told me about her experience with CPAP. She has a history of loud and disruptive snoring, which ultimately caused her husband to sleep in a separate bedroom.

After being evaluated at a sleep lab, she was diagnosed with mild to moderate Obstructive Sleep Apnea (OSA) and was prescribed a CPAP device. Thanks to the CPAP, her snoring was gone, but her husband still slept in the next room–he refused to get into bed with Darth Vadar. Now it was the cumbersome CPAP mask was causing her love life to suffer.

We made her an oral appliance to use nightly as an alternative to the CPAP. Presently, husband and wife are happy again.

Dr. Donald Tanenbaum has been practicing in New York City and Long Island for over 20 years. He is uniquely qualified to diagnose and treat Sleep Apnea, facial pain, TMJ and TMD problems, muscle pain disorders, nerve pain disorders, tension headaches, and snoring. Learn more here

What is CPAP?

August 22, 2011 — by Dr. Donald Tanenbaum

CPAP, or Continuous Positive Airway Pressure, is the primary therapy used to manage a condition called Obstructive Sleep Apnea (OSA). As the airway narrows during sleep in individuals with OSA, the CPAP device is designed to provide a constant flow of compressed air under pressure to keep the airway open.

Often called the most effective nonsurgical treatment for obstructive sleep apnea, wearing a CPAP mask at night can improve the quality of sleep. Nightly use of the CPAP machine can also reduce high blood pressure, daytime sleepiness and snoring.

Though the CPAP machine can provide great results, it is NOT the right solution for everyone. As a matter of fact, many people find CPAP to be uncomfortable, preventing them from falling or staying asleep. As a result, according to the American Sleep Apnea Association, 60% of CPAP users discontinue use within one year because of discomfort or side effects.

Drawbacks of CPAP include:

• Can cause excessive dreaming and nightmares
• The mask often causes skin irritation
• The mask or nasal attachments often slip out of position while sleeping, diminishing the effectiveness of the device
• The airway hoses can wrap themselves around the wearers head
• The mask creates a sense of claustrophobia
• The machine is loud and can disrupt you or your sleep partner

Alternative to CPAP

An alternative to a CPAP machine is a custom fitted oral appliance which can be used to prevent snoring and to treat mild to moderate sleep apnea. Scientific studies have shown that properly constructed and adjusted oral appliances have the capacity to consistently facilitate nighttime air flow into the lungs thereby reducing the risk of stroke and high blood pressure developing in individuals with this medical condition.

An oral appliance works one of two ways. The first and most commonly utilized type of oral appliance repositions the jaw forward, carrying the tongue out of the airway . This type of appliance attaches directly to the teeth of the upper and lower dental arches. With the tongue forward the patency of the airway increases. The second type which is infrequently used is called a tongue retaining device. This appliance attaches only to the tongue and via a suction mechanism, the tongue is pulled forward out of the mouth. The end result is typically a sore tongue and a restless nights sleep.

The Perfect Marriage

As any one treatment over the course of many years can become monotonous we continue to advocate the use of both oral appliances and CPAP in patients that seek our advice. Whether a fixed schedule of alternating between the oral appliance and the CPAP is established or whether the oral appliance is just worn when traveling for work or on vacation, many of our patients have benefitted from this scenario. As over the long term oral appliances have been shown to have a better than 70% compliance they have therefore become an important component of managing OSA and socially disruptive snoring.

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Jaw Problems Can Be Caused By Overuse

August 11, 2011 — by Dr. Donald Tanenbaum

Recently, while walking through a residential neighborhood in NYC I wandered into a food market to pick up some essentials for the week. As I approached the checkout counter I happened to notice a display for something called JawliPop.

I stopped dead in my tracks.

JawliPops are the biggest jawbreaker candies that I have ever seen–the size of a small softball but as hard as a chunk of concrete! I couldn’t imagine who would find this hunk of sugar appealing, but according to the gal behind the register they are big sellers.

Intrigued as to how someone would negotiate this rock solid mass, I bought one (figuring if it was inedible it could be used to have a catch with my youngest daughter!).

Once unwrapped, it was clear that no human could either put the entire thing in their mouth or bite through the hard outer shell. The only option would be to lick the surface like a lollipop until one day, likely months later, it would be reduced to a manageable size jawbreaker. Made of pure, unadulterated sugar, this new candy was destined to be a dentist’s dream (amongst other favorites like Sugar Daddy’s and Tootsie Rolls).

Beyond the destruction to the teeth, the JawliPop is likely to be a major menace to the health and comfort of the jaw muscles and temporomandibular joints. Considering that the overuse of gum often leads to painful and fatigued jaw muscles, you can be sure the effort required to conquer this sugary orb is not worth it.

If you never thought overusing your tongue muscle would create jaw pain, try sticking your tongue out for a few minutes while moving it to the right and left in a circular motion. Imagine doing that daily for as long as it takes to get through the JawliPop. Still up for this giant sugary challenge?

Many jaw related problems are caused by overuse activities. Whether the overuse is chewing gum, biting pens, pencils, nails, or cuticles, singing, clenching or grinding of the teeth or playing musical instruments, these repetitive motions can injure the muscles, ligaments and tendons of your jaw. Once injured, the potential for pain and/or functional problems arises and can become persistent—something I doubt the makers of JawliPop had in mind.

For those of you who may have purchased the JawliPop, I suggest an alternate use for this grandest of all jawbreakers! Anyone up for a game of catch??

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Beware! The Snore Patrol Has Arrived at Your Hotel

July 28, 2011 — by Dr. Donald Tanenbaum

Recently, I read in the news that a large hotel chain is making a focused effort to identify which of their nightly guests’ snoring is disrupting the sleep of others. Corridor monitors are instructed to identify the sources of snores and to knock on the doors, waking the inhabitants from their sound, but disruptive, sleep. Once identified, these sound offenders will be asked to relocate to a different part of the hotel if they are planning to stay several days. The hotel is also installing soundproof walls and purchasing soundproof headboards to silence the symphony of snores.

To those of us involved in the world of sleep, snoring has been of long concern. Not only has snoring been cited as a top reason why partners sleep apart, but the disruptive character of snoring actually diminishes the quality and quantity of your partner’s sleep. Imagine sleeping next to someone who continued to talk all night long as you attempted to fall or stay asleep. Impossible? In fact, many snorers snore at a decibel level of normal conversation, while the snoring of some has been rated to be as loud as a jackhammer!

A Simple Oral Appliance May be the Solution to Your Snoring Problem

Fortunately, there is a great solution to snoring both at home and when traveling. Though being available for years, oral appliances have only just begun to get the attention they deserve. These devices, when made by a dentist, have been shown to stop or reduce snoring on a predictable basis and are extremely comfortable to wear. As approximately 30-50% of snorers have a condition called Obstructive Sleep Apnea, oral devices are often used to treat this serious medical problem. In many cases, oral appliances can be used instead of a facemask at night and offer a portable alternative to the facemask apparatus at home while traveling.

Oral appliances that stop snoring will allow you to once again sleep with your partner…and to help you avoid the embarrassment of being awakened by hotel Snore Police.

You can read the article I referred to above here.

Snoring and Sleep Apnea Treatment

July 13, 2011 — by Dr. Donald Tanenbaum

While enjoying the July 4^th fireworks last week, I overheard a young girl observe:

“That sounds like Grandpa’s snoring when he lies on the couch after our Thanksgiving meal!”

This comment certainly raised a lot of laughter, but snoring is actually no laughing matter.

As the average weight of Americans continues to rise, and childhood obesity reaches crisis levels, snoring which is often a sign of a more serious condition, Obstructive Sleep Apnea, will have to be taken very seriously. Obstructive Sleep Apnea (OSA) can be responsible for problems like high blood pressure, stroke, atherosclerosis, diabetes, ADHD, and personality changes associated with anxiety and depression. OSA affects the quality of sleep and causes sufferers to feel tired and unproductive throughout the day.

Snoring is often the first sign of obstructions in the airway during sleep. The obstructions can be in the nose, oral cavity and/or in the pharynx (throat). As airflow is restricted, turbulence occurs and causes snoring. With time, snoring actually damages the airway’s soft tissues and the nerve endings that maintain muscle tone. As muscles become weak and/or damaged it leads to more snoring and more obstruction, resulting in a restless night’s sleep and daytime exhaustion.

Fortunately, there are a number of treatments available for Sleep Apnea today. Here is a list of the most effective treatments that I use for my patients, depending on the severity of their symptoms.

Treatment for Obstructive Sleep Apnea

Weight Loss: Maybe not the easiest solution, but certainly worth the effort
Oral appliances such as bite plates (see examples here)
A face mask worn during sleep that provides oxygen flow (called CPAP)
Surgery: Depending on the location of the airway obstruction surgery may be considered to address the nasal passages, the size or shape of the soft palate, uvula and pharynx walls and or the position of the lower jaw

Snoring should not be taken lightly as it may be the first sign of a more serious problem—especially if the snoring reaches fireworks volume! If you are feeling unfocused and tired during the day, OSA may be the cause.

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When a Painful Toothache Won’t Go Away

June 30, 2011 — by Dr. Donald Tanenbaum

I recently treated a 35 year old woman who was referred to my practice because she had a persistent toothache that continued though she already had a new filling placed, had her bite adjusted, and was constantly taking Advil and Tylenol. Based on how she described her tooth pain symptoms (variable in terms of the severity, frequency, and not related to eating or hot or cold fluids), I suspected that her pain was coming from somewhere, but not from her tooth!

You may ask how this that possible? To have a toothache that is not caused by a tooth? To begin to understand how you can experience pain in one area that is being caused by a problem somewhere else, it is important to become familiar with the concept of referred pain.

Referred pain is best understood when you consider the most common symptom reported by patients that are about to have or are in the midst of having a heart attack: pain in the left arm, the left side of the jaw, and under the chin. All caused by signals being sent by the heart muscle. You can only imagine that 100 years ago, before this connection was understood, doctors and community healers probably went to great lengths to sooth these left sided symptoms only to often fail with dire consequences.

The knowledge we have gained about referred pain through medical research not only has helped us recognize the signs of a heart attack, but have enabled us to also understand puzzling toothaches, face pains, ear symptoms, and other problems that often elude quick solutions. Getting back to the young woman with toothache: my evaluation uncovered that her symptoms were due to referred pain from the muscles of her upper neck! My patient was dumbfounded. How could the source of her painful toothache be her neck? But soon after her care began, her symptoms diminished and she is now happily toothache-free.

The care I applied was a combination of:

• Changing learned behaviors (posture, especially)

• Home exercises

• Physiotherapy

• Injections

It is routine to be asked by one of our patients, “Why does my ear, tooth, face, and eye hurt when I have been told by my physician and dentist that there is nothing wrong and they don’t see anything?” If this describes you, I assure you, you’re not “crazy.” Referred pain is real.

Muscle referred pain is just one of many topics I will be sharing on this blog. It is my hopes that these discussions will provide the insight and knowledge that you need to get proper care and guidance as you seek information to address your pain or that of other people in your life.

Drawbacks of CPAP include:

Alternative to CPAP

The Perfect Marriage

A Simple Oral Appliance May be the Solution to Your Snoring Problem

Treatment for Obstructive Sleep Apnea

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