牙齒不整竟與鼻子過敏息息相關！ 隱適美快速擴弓牙套可以同時改善鼻塞與牙齒空間不足 ✋Hi，我是 DR. EMMA 蔡宜均醫師！台灣位處亞熱帶，氣候潮濕、悶熱，且空氣汙染嚴重，帶來的是台灣人罹患過敏性鼻炎比例居全球之冠！根據健保資料庫統計，約有 50% - 75% 的學齡兒童有過敏性鼻炎。雖說過敏體質與遺傳有關，但是環境因素才是造成過敏人數日漸增多的最大元兇。常見的過敏性鼻炎症狀有：打噴嚏、流鼻水或鼻塞。 但家長不知道的是，長期鼻子過敏對正在發育中的孩子健康危害影響相當深遠，除會導致一連串齒顎生長與臉型發育的惡性循環，如小下巴（下顎發育不良）、缺乏蘋果肌（中臉凹陷）、牙弓狹窄、鼻道狹窄與鼻中隔彎曲、牙齒凌亂、暴牙、深咬、彎腰駝背等；這樣狀況還會導致上呼吸道窄小，成年後不僅容易打呼，還可能變成睡眠呼吸中止症，開啟許多老年時慢性病的風險。 內容標題 牙齒不整齊與鼻子過敏有什麼直接關聯呢？ 口呼吸該如何解決呢？ 實際案例 牙齒不整齊與鼻子過敏有什麼關聯呢？ 鼻子過敏導致小朋友無法用鼻子好好地呼吸，便會被迫改用嘴巴呼吸，雖然鼻子過敏並不會直接的影響牙齒排列，但使用口呼吸時，舌頭的位置就不會維持頂著上顎的自然位置（下圖虛線）；而為了打開口腔氣道，舌頭變得會往下往後（如下圖紅色箭頭），這導致正在發育中的上顎骨缺少了舌頭的支撐力量而變得發育不良，並引發一連串畸形發展： 牙弓變狹窄→牙齒空間不足變得擁擠凌亂→前牙突出變暴牙。 牙弓變狹窄→上顎弓上拱→鼻腔通道變窄→惡性循環開始。 由於白努利原理，空氣流過狹窄的鼻道時速度會加快、壓力變大，導致鼻黏膜容易腫脹，又使得鼻呼吸的流量變少。鼻子在呼吸不到足夠的空氣情況下，更加重了兒童不自覺地對口呼吸的依賴。 口呼吸該如何解決呢？ 如果孩子年紀還小時已發現鼻子過敏，可以及早預防並且避免過敏原的刺激。下列提供一些平時需要注意的事項： 規律地清洗床單、被單、地墊，並且需要讓陽光曝曬。 避免家中使用太厚的地毯及窗簾，或是毛茸茸的玩具。 避免將陳舊的報紙、鞋子及衣服堆積在家中。 避免養狗、貓等容易掉毛的寵物，更不能讓寵物跑到床上。 避免在家裡抽菸或是噴香水…等會刺激鼻腔的動作。 時常使用除塵蟎吸塵器打掃家中環境，並定期更換濾心。 若是早期診斷出過敏性鼻炎，則需搭配藥物治療，例如：口服藥物，鼻噴劑，以及抗生素，和鼻沖洗液。 若是小朋友已經養成用嘴巴呼吸的習慣，則需盡早就診治療。 對於上顎牙弓窄小的患者，使用上顎快速擴張器，是非常有效的方式。雖然上顎擴張的過程會較為不舒服，但在年幼時介入治療，可以有效的將上顎骨均勻撐開，讓鼻腔通道加大，改善鼻塞及口呼吸(嘴巴呼吸)的症狀。 另外，目前隱適美的牙套結合了「牙弓擴張」的設計，以較為緩和的方式去讓牙弓慢慢撐開，雖然牙弓擴張的幅度有限，對於輕度牙弓窄小、怕痛的患者是非常理想的治療方案喔！ 實際案例： 就讀國三的王同學，從小有著鼻子過敏的困擾，常常嘴巴開開地呼吸，媽媽嘗試讓他改過來，但是因為長期習慣鼻子塞住的緣故，小朋友也無法正常運用鼻子呼吸。雖然先前已至耳鼻喉科就診，但因長期口呼吸的關係，臉型已造成改變：下巴變得短小，上唇前突，牙弓也變得狹長，牙齒看起來也看起來暴暴的。 這個Case是典型的「安格氏II級異常咬合1類」 (上顎前凸，牙齒往前暴)。對於這類型的病患，通常會使用上顎快速擴張裝置。但是隱適美隱形牙套目前也有上顎擴張的效果，尤其是對於學齡階段的小朋友效果更為顯著。 因此治療計畫採用隱適美的「擴弓設計」，以及下顎前導裝置。經過一年的努力，王同學的上顎擴張到理想的程度，下巴也漸漸地長出來，改善了口呼吸的習慣。牙齒及臉型也獲得了調整。小朋友本身也變得更有自信，歡喜迎接嶄新的高中生生涯。 因此，趕快把握矯正黃金期，讓孩子提早綻放開朗笑容！！ 矯正前： 矯正後： 延伸閱讀： 何時是兒童牙齒矯正的最佳時機？ 你知道口呼吸會影響孩子臉型發育與一生健康嗎？ 孩子注意力不集中是過動症？脾氣差、打呼？ MRC 口腔肌功能訓練是牙齒矯正嗎？ 【醫學證實】孩童睡眠呼吸中止造成神經認知退化與行為問題 "內文為專業醫師經驗談，因各人口腔狀況不同，成效因人而異，若有問題請跟從專業醫師評估指引" Last Updated: 2022-03-28 加入 DR.EMMA 蔡宜均醫師粉絲團，追蹤限時動態
How to Choose the Correct Mouthwash: A Dentist's Guide
Maintaining good oral hygiene is crucial for overall health. Brushing and flossing are essential for removing plaque and food particles, but using mouthwash can provide additional benefits. Mouthwash can help kill bacteria that cause bad breath, prevent cavities, and reduce the risk of periodontal disease. However, with so many different types of mouthwash available in the market, it can be challenging to choose the right one. In this guide, we will provide tips on how to choose the correct mouthwash to maintain optimal oral health. Periodontal Disease: The Link Between Oral Health and Systemic Conditions Periodontal disease is a type of infection that affects the teeth, and it is characterized by symptoms such as swollen and bleeding gums, an increased gap between teeth, and gum recession. If left untreated, it can even lead to tooth loss. The bacterial infection that causes periodontal disease triggers a mild inflammatory response in the body, contributing to the development of systemic diseases. Furthermore, without early treatment, the bacteria toxins can enter the bloodstream through everyday activities like eating or brushing teeth, leading to temporary bacteremia. This can stimulate the formation of blood clots in the blood vessels, which increases the risk of cardiovascular diseases such as heart attacks and strokes that are associated with arterial hardening. Image Source：iStock What Should an Ideal Mouthwash Contain? An ideal mouthwash should have the following properties: Antiseptic: It should effectively kill or inhibit the growth of bacteria and other microorganisms that can cause plaque, gingivitis, and bad breath. Disinfectant: It should be able to neutralize or destroy harmful pathogens and prevent cross-contamination. Correct concentration for gingivitis: The mouthwash should contain the right concentration of active ingredients to effectively combat gingivitis without causing unnecessary side effects. Pleasant taste: The mouthwash should have an appealing flavor to encourage consistent use and promote good oral hygiene habits. Safe for daily use: The mouthwash should be gentle enough for daily use without causing irritation, dryness, or other adverse effects. Patients often inquire about maintaining their dental hygiene after completing treatment. Along with teaching proper brushing and flossing techniques, I advise them on suitable mouthwash products to augment oral protection. The market provides numerous options for mouthwash, with different formulations emphasizing gum health, cavity prevention, fresh breath, and even ones specifically formulated for children and pregnant women. In Taiwan, the Food and Drug Administration categorizes mouthwash into two types: "medicated mouthwash" and "general mouthwash." Classification Ingredients Main Functions Medicated Mouthwash Chlorhexidine Gluconate (concentration ranging from 0.1% to 0.2%) Cetylpyridinium Chloride (concentration ranging from 0.045% to 0.1%) Antibacterial and disinfectant properties General Mouthwash Chlorhexidine Gluconate (concentration < 0.1%) Cetylpyridinium Chloride (concentration < 0.045%) Sodium Fluoride Essential oils Alcohol Antibacterial and disinfectant properties Cavity prevention Oral freshness Medicated mouthwashes have higher concentrations of antibacterial ingredients compared to general mouthwashes. However, prolonged use may cause tooth staining, so it's best to follow instructions from healthcare professionals. After rinsing with mouthwash, avoid rinsing with water and wait for 30 minutes before eating or drinking to maximize its effectiveness. If you have oral wounds or dry mouth, choose alcohol-free mouthwash to avoid irritating the oral mucosa and tongue. For periodontal disease, mouthwashes with Chlorhexidine Gluconate can combat plaque and inhibit periodontal disease when used twice a day for 30 seconds to one minute. What is Chlorhexidine and How Does it Work? Chlorhexidine is a widely used antiseptic and disinfectant in the field of dentistry. It is a bisbiguanide compound that was first developed in the 1940s and has been used as a general disinfectant ever since. In the 1970s, its antiplaque activity was discovered, leading to its introduction as a mouthwash. Mechanism of Action The mechanism of action of chlorhexidine involves its rapid attraction to negatively charged bacterial cell surfaces, which contain phosphates and sulfate groups. This cationic property allows it to bond strongly to these negatively charged sites within the biofilm, including bacteria and extracellular polysaccharides. This binding disrupts the bacterial cell wall, allowing chlorhexidine to penetrate and damage the cytoplasmic membrane, ultimately leading to the death of the bacterial cell. Pharmacological Effects Chlorhexidine has potent antimicrobial and antifungal properties, which make it effective against a wide range of oral pathogens, including Streptococcus mutans, a major contributor to dental caries. It is also effective against both gram-positive and gram-negative bacteria, as well as some fungi and viruses. Side Effects of Chlorhexidine Although chlorhexidine is generally considered safe and effective, it can cause some side effects, especially when used at higher concentrations or for extended periods. Some of the most common side effects include: Extrinsic tooth staining: Prolonged use of chlorhexidine mouthwash can lead to the staining of teeth, which is the most common reason for patients discontinuing its use. Altered taste sensation: Some users may experience a change in taste or a numb feeling in their mouth and tongue after using chlorhexidine mouthwash. Oral irritation and xerostomia: Some people may develop oral irritation, burning sensation, or dry mouth after using the mouthwash. Allergic reactions: Though rare, some users may experience allergic reactions to chlorhexidine, such as swelling of the parotid gland, oral paraesthesia, or glossodynia. Clinical Uses of Chlorhexidine Chlorhexidine has several clinical applications in dentistry, including: Gingivitis treatment: When used as an adjunct to mechanical plaque control, chlorhexidine mouthwash can help reduce gingivitis and improve overall oral health. Prophylactic use and post-oral surgery: Chlorhexidine mouthwash is commonly prescribed following periodontal and implant surgeries, as well as in situations where mechanical plaque control is difficult or impossible due to postoperative pain or discomfort. Periodontal disease management: Chlorhexidine mouthwash can be used as an adjunct to subgingival instrumentation in patients with periodontitis, helping to control inflammation and improve overall periodontal health. Can Mouthwash Replace Brushing? The short answer is no. While chlorhexidine mouthwash can be an effective adjunct to mechanical plaque control, it should not be considered a replacement for regular brushing and flossing. Proper mechanical cleaning of teeth, such as brushing and using interdental cleaning aids, is essential for removing plaque and maintaining good oral hygiene. Chlorhexidine mouthwash can help in reducing the bacterial load and inflammation, but it cannot remove plaque and food debris as effectively as mechanical methods. Conclusion In summary, chlorhexidine mouthwash is a valuable tool in promoting good oral hygiene and combating gingivitis when used as an adjunct to regular mechanical oral hygiene procedures. It is essential to choose a mouthwash with the correct concentration of chlorhexidine for your specific needs and to be aware of its mechanism of action, clinical uses, and potential side effects. While mouthwash can provide additional benefits in maintaining good oral health, it should not be considered a replacement for regular brushing and flossing. By incorporating an appropriate chlorhexidine mouthwash into your daily oral care routine, you can help maintain a healthy mouth and prevent common dental issues like gingivitis and plaque buildup. References： Chlorhexidine mouthrinse as an adjunctive treatment for gingival health Chlorhexidine in Dentistry: Pharmacology, Uses, and Adverse Effects
Can orthodontic treatment be performed on teeth with periodontal disease? Which is more suitable, Invisalign or traditional brackets?
Typically, people associate orthodontic treatment with young individuals who have healthy teeth. However, the reality is that a significant proportion of individuals requiring orthodontic treatment also suffer from varying degrees of periodontal disease. So, the question arises: Can teeth with periodontal disease undergo orthodontic treatment? If so, which option, traditional brackets or Invisalign, is more suitable? Let's delve further into the relationship between periodontal disease and orthodontic treatment. Understanding Periodontal Disease Periodontal disease is a chronic inflammatory condition caused by bacteria in the oral cavity, which affects the gums and supporting structures such as the alveolar bone. It starts with gingivitis, a mild gum disease characterized by redness, swelling, and easy bleeding of the gums. If left untreated, gingivitis can progress to periodontitis, a more severe form of gum disease where the surrounding bone is also affected and damaged. This bone loss can lead to tooth mobility and even tooth loss due to lack of support. Can Orthodontic Treatment and Periodontal Disease Coexist? Historically, the presence of periodontal disease has been considered a contraindication for orthodontic treatment, as moving teeth within inflamed periodontal tissues could exacerbate the inflammation and lead to further bone loss. However, recent studies have shown that orthodontic treatment can be safely performed before or during a well-controlled periodontal condition. Several research reports indicate that orthodontic treatment can improve periodontal health and address malocclusion issues. Additionally, it can reposition teeth that have shifted due to bone loss, contributing to periodontal control. Therefore, orthodontic treatment is viable when periodontal disease is well controlled. Invisalign and Traditional brackets: Which is More Suitable for Patients with Periodontal Disease? Regarding the treatment of patients with periodontal disease, recent research suggests that Invisalign may offer advantages over traditional brackets. Invisalign and Periodontal Health Invisalign's clear aligners can be removed, making it convenient for patients to maintain good oral hygiene during treatment. Many studies have found that patients using Invisalign show better results in terms of plaque index, probing pocket depth, and gingival index compared to those undergoing traditional brackets. Moreover, Invisalign carries a lower risk of periodontal bacterial growth and inflammation, further promoting periodontal health. These advantages make Invisalign an attractive option for patients with periodontal disease. Traditional brackets and Periodontal Health Traditional orthodontic brackets and archwires can make it difficult for patients to maintain oral hygiene. Research shows that patients with traditional brackets often have a higher plaque index and are more prone to gingival inflammation, which could exacerbate periodontal disease. However, it's important to note that maintaining good oral hygiene is still possible with traditional brackets, and many patients do not experience significant periodontal issues during treatment. Additionally, the use of low-profile brackets and improved oral hygiene aids can help minimize these risks. Long-Term Outcomes of Orthodontic Treatment in Patients with Periodontal Disease Multiple research studies have demonstrated that wearing Invisalign aligners may result in less gingival recession compared to traditional brackets. These findings suggest that Invisalign treatment may help reduce the risk of gingival recession. However, it's essential to recognize that each patient's case is unique, and treatment outcomes may vary. The occurrence of gingival recession is influenced by multiple factors, including individual oral hygiene habits, tooth position, and the specific treatment plan. Therefore, it is still recommended for patients to consult and assess with their dentist before undergoing orthodontic treatment, ensuring the most suitable treatment plan is chosen, and maintaining good oral hygiene practices to protect gingival health to the fullest extent. Case report The image shows a 70-year-old elderly woman in her seventies who has gradually improved the spacing between her upper and lower teeth through nearly ten months of Invisalign treatment. She is currently still undergoing treatment. In addition to the improvement in overjet, it can be observed from the photo that the patient's gum recession did not deteriorate, and the initial mild root exposure has not worsened. This case demonstrates the significant advantages of Invisalign treatment in preserving tooth structure and periodontal tissue. Even in the age group of seventy and above, the success of this patient highlights the potential of Invisalign treatment across different age groups. Results In the past, periodontal disease has been considered a contraindication for orthodontic treatment. However, recent research indicates that patients with periodontal disease can still safely undergo orthodontic treatment. Invisalign, with its removable and easy-to-clean features, may be a more suitable option for patients with periodontal disease. However, treatment choices should be based on the specific circumstances of the patient, including their periodontal health status, treatment needs, and personal preferences. For patients with periodontal disease, it is recommended to seek advice and evaluation from dental professionals before proceeding with orthodontic treatment. References： Assessment of the periodontal health status and gingival recession during orthodontic treatment with clear aligners and fixed appliances: A systematic review and meta-analysis Periodontal health status in patients treated with the Invisalign® system and fixed orthodontic appliances: A 3 months clinical and microbiological evaluation Effect of periodontal–orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis: A systematic review with meta‐analysis