My dentist told me I was grumpy. I have tried mouthguards but tend to gag on them. Is there anything else that can help and cause long term problems?
Michael Lister, Burnley.
The condition you describe is sleep-related bruxism, repetitive grinding or clenching of the teeth at night.
It is most common in childhood – affecting more than 20 per cent of children – but tends to decrease as we get older. Most people are diagnosed through symptoms described by their partner and not, as in your case, due to tooth damage.
For adults, common triggers include smoking, excessive caffeine or alcohol intake and obstructive sleep apnea, a snoring-related condition in which breathing is interrupted every few minutes during sleep when the airway is closed. It may also be linked to certain medications, including antidepressants and antipsychotics.
Sleep-related bruxism, repeated grinding or clenching of teeth at night, is most common in childhood – affecting more than 20 percent of children.
What connects many of these triggers is that they lead to very short periods of wakefulness: studies show that bruxism occurs sporadically, during periods of ‘micro-arousal’ from sleep, lasting between five and 20 seconds.
Treatment is not always necessary, unless the tooth is damaged, or if there are symptoms such as morning headaches, jaw pain or clicking in the joint that connects the jaw to the skull.
A mouthguard does not prevent bruxism, but it does protect the teeth. The search for effective drugs for bruxism has been disappointing.
The best results are usually seen with clonazepam, a tranquilliser, although it generally only reduces the frequency of bruxism episodes by about 30 percent. It is thought to create overactive circuits in the brain that are associated with tooth grinding.
You might consider asking your GP to prescribe clonazepam (1mg at night) to see if it helps you.
A better alternative is to inject botulinum toxin type A (Botox) into two muscles – the temporalis and masseter muscles – involved in chewing.
Injections must be administered by a trained movement disorder specialist and repeated every six months, as the effects wear off. Talk to your GP, or even your dentist, about possible referrals to specialists.
I am 76 and have been diagnosed with heart failure after a heart attack a year ago. I was breathing heavily. But the blood oxygen level improved. I’ve also had asthma all my life, could that be to blame?
Roger Bell, Dorchester.
The challenge here is to understand how shortness of breath is due to poor heart function, and how it relates to your asthma.
A heart attack occurs when the blood supply to a part of the heart is cut off, usually by a clot in an artery, causing tissue damage. You said in your letter again that you had a stent (small metal tube) inserted to reopen the artery. But because this doesn’t happen until 36 hours after you get sick, your heart is permanently damaged.
It is now less able to pump oxygen-rich blood around your body when you move or exercise.
Your oxygen saturation level — a measure of the amount of oxygen in your blood — is at 98 percent, healthy (anything between 95 and 100 percent is considered normal). But your heart can’t pump enough to supply your muscles, and you can’t breathe.
Clearly your asthma is getting worse, because you said your doctor increased the dose of your asthma inhaler.
I thought it would be helpful to try a peak flow meter, a hand-held device that measures how fast you can force air out of your lungs. (This is available on prescription, or over-the-counter from most pharmacies for £10 to £15.)
This should be more than 200 liters per minute, and preferably closer to 500 liters. If not, your asthma treatment may not be enough and you should be referred to a respiratory specialist.
I also recommend asking your doctor to go back to the specialist who placed the stent. At 76, you don’t have to struggle this way and specialist care can give you a better quality of life.
Write to Dr. Scurr
Write to Dr. Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email drmartin@dailymail.co.uk — including your contact details. Dr Scurr can’t log in to private correspondence. The answer is yes taken in a general context and always ask yourself GP with health concerns
In my view… Blood pressure sign for big hands
Measuring blood pressure just got easier with a simple automatic blood pressure monitor.
But cuff size is important: a patient came in last week about travel immunizations and, because he was overweight, I took the opportunity to measure his blood pressure.
But his arm was so big that he couldn’t put the cuffs on properly.
When measuring blood pressure, the size of the cuff is important and you should use a large cuff for overweight or obese patients.
This reminds me that when using a standard size blood pressure cuff on the big arm, the readings can be wrong – the fat has a cushioning effect, so the cuff will not compress the artery inside, which is the blood pressure. measured.
Your advice is to use the large size cuff with overweight or obese patients. But how many people – even nurses and doctors – know about it and how often are large size cuffs available?
If you have a large upper arm and the standard cuff hardly fits, insist on a larger cuff – or you may be misdiagnosed with high blood pressure, and given the wrong advice and medication.
