My dentist says I grind my teeth. I’ve tried mouth guards, but I tend to choke on them. Is there anything else that can help? Does it cause long-term problems?
Burnley player Michael Lister is on the pitch.
The condition you describe is sleep-related bruxism, the repeated grinding or clenching of your teeth during the night.
It is most common in childhood (affecting more than 20 percent of children), but tends to decrease as we age. Most people are diagnosed through the symptoms their partner describes and not, as in your case, through damage to the teeth.
For adults, the most common triggers are smoking, excessive caffeine or alcohol consumption, and obstructive sleep apnea, a snoring-related condition in which breathing stops every few minutes during sleep as the airway closes. It can also be linked to certain medications, including antidepressants and antipsychotics.
Sleep-related bruxism, the repeated grinding or clenching of teeth during the night, is most common in childhood, affecting more than 20 percent of children.
What connects many of these triggers is that they cause very short periods of wakefulness: Studies show that bruxism occurs sporadically, during moments of “micro-awakening” from sleep, and lasts between five and 20 seconds.
Treatment is not always essential unless your teeth are damaged or if there are symptoms such as morning headaches, jaw pain or clicking in the joint that connects the jaw to the skull.
Mouth guards do not stop bruxism, but they do protect the teeth. The search for effective medications for bruxism has been disappointing.
The best results are usually obtained with clonazepam, a tranquilizer, although it usually only reduces the frequency of bruxing episodes by 30 percent. It is thought to calm the overactive circuits in the brain related to teeth grinding.
You might consider asking your GP to prescribe clonazepam (1mg at night) to see if that helps.
A better alternative might be an injection of botulinum toxin type A (Botox) into two of the muscles (the temporalis and masseter) involved in chewing.
Injections should be performed by a trained movement disorders specialist and repeated every six months as the effect wears off. Talk to your GP, or even your dentist, about a possible referral to a specialist.
I am 76 years old and was diagnosed with heart failure after having a heart attack a year ago. I suffer from severe shortness of breath but my blood oxygen levels are fine. I also have lifelong asthma, could that be the cause?
Roger Bell, Dorchester.
The challenge here is to understand to what extent your shortness of breath is due to a malfunctioning heart and to what extent it is related to your asthma.
A heart attack occurs when the blood supply to part of the heart is cut off, usually by a clot in an artery, causing tissue damage. In your longer letter, you say that you had a stent (a small metal tube) inserted to reopen the artery, but because this was not done until 36 hours after you became ill, your heart was permanently damaged.
It now has less ability to pump oxygen-rich blood throughout your body when you move or exercise.
Your oxygen saturation levels (a measure of how much oxygen is in your blood) are healthy (anything between 95 and 100 percent is considered normal), but your heart can’t pump hard enough to supply your muscles, leaving you short of breath.
It is clear that her asthma has worsened as she says her GP increased the dosage of her asthma inhaler.
I think it would be helpful to try a peak flow meter, a hand-held device that measures the speed at which air can be expelled from the lungs. (These are available on prescription or over the counter in most pharmacies for £10-£15.)
This flow rate should be greater than 200 liters per minute and preferably close to 500 liters. Otherwise, your asthma treatment may not be adequate and you should consult a pulmonologist.
I would also recommend that you ask your GP to refer you to the specialist who placed the stent. At 76, you should not have to go through this and specialist care can offer you a better quality of life.
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Write to Dr. Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email drmartin@dailymail.co.uk — Please include your contact information. Dr. Scurr can’t get into personal matters Correspondence. Answers must be taken in a general context and always consult your own GP with any health concerns
In my opinion… Blood pressure alert for big arms
Measuring blood pressure has become much easier thanks to simple, automatic blood pressure monitors.
But cuff size matters: A patient came to see me last week for some travel vaccinations, and noticing that he was considerably overweight, I took the opportunity to measure his blood pressure.
But his arm was so big that it was impossible to put the bracelet on correctly.
When measuring blood pressure, cuff size is important and a large cuff size should be used in overweight or obese patients.
This reminded me that when you wear a standard-sized blood pressure cuff on a large arm, the reading can be falsely high: fat has a cushioning effect, so the cuff won’t fully compress the underlying artery, which is how blood pressure is measured.
The advice is that a large cuff size should be used in overweight or obese patients. But how many people (even nurses and doctors) are aware of this and how often is a large cuff size available?
If you have a large arm and the standard cuff doesn’t fit properly, insist on a larger cuff; otherwise, you may be misdiagnosed with high blood pressure and given the wrong advice and medication.