DR SCURR: How to cease enamel grinding… with out carrying a mouth guard

My dentist says I grind my teeth. I’ve tried mouth guards but tend to gag on them. Is there anything else that might help and does it cause long-term problems?

Michael Lister, Burnley.

The condition you describe is sleep-related bruxism, the repetitive grinding or clenching of teeth during the night.

It’s most common in childhood — affecting more than 20 per cent of children — but tends to decline as we get older. Most people are diagnosed through symptoms described by their partner and not, as in your case, through tooth damage.

For adults, common triggers include smoking, excess caffeine or alcohol intake and obstructive sleep apnoea, the snoring-related condition where breathing is interrupted every few minutes during sleep as the airways close up. It can also be linked to certain medications, including antidepressants and antipsychotics.

Sleep-related bruxism, the repetitive grinding or clenching of teeth during the night, is most common in childhood – affecting more than 20 per cent of children

What connects many of these triggers is that they cause very short periods of waking: studies show that bruxism occurs sporadically, during moments of ‘micro arousal’ from sleep, lasting 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 of the joint that connects the jaw to the skull.

Mouth guards don’t stop bruxism, but instead protect the teeth. The search for effective drugs for bruxism has proved disappointing. 

Best results are usually seen with clonazepam, a tranquilliser, although it generally only reduces the frequency of bruxism episodes by about 30 per cent. It’s thought to calm overactive circuits in the brain linked to tooth grinding.

You might consider asking your GP to prescribe clonazepam (1mg at night) to see if it helps you.

A better alternative might be an injection of botulinum toxin type A (Botox) into two of the muscles — the temporalis and masseter muscles — involved in chewing.

The injections must be carried out by a trained movement disorder specialist and repeated every six months, as the effect wears off. Speak to your GP, or even your dentist, about a possible referral to a specialist.

I’m 76 and have been diagnosed with heart failure after a heart attack a year ago. I suffer severe breathlessness. Yet my blood oxygen levels are fine. I’m also a lifelong asthma sufferer, could that be to blame instead?

Roger Bell, Dorchester.

The challenge here is to understand to what extent your breathlessness is due to poor heart function, and how much it relates to your asthma.

A heart attack occurs when the blood supply to part of your heart is cut off, usually by a clot in an artery, which causes tissue damage. You say in your longer letter you had a stent (a tiny metal tube) inserted to re-open the artery. But as this wasn’t done until 36 hours after you fell ill, your heart was permanently damaged.

It’s now less able to pump oxygen-rich blood around the body when you move or exercise.

Your oxygen saturation levels — a measure of how much oxygen is in your blood — at 98 per cent, are healthy (anything between 95 and 100 per cent is considered normal). But your heart is unable to pump enough to supply your muscles, leaving you breathless.

Clearly your asthma has worsened, as you say your GP increased the dose of your asthma inhaler.

I think it would be useful to try a peak-flow gauge, a hand-held device that measures the speed at which you can force air out of your lungs. (These are available on prescription, or over-the-counter from most pharmacies for £10 to £15.) 

This should be over 200 litres a minute, and preferably close to 500 litres. If not, your asthma treatment may be inadequate and you need to be referred to a respiratory specialist.

I’d also suggest asking your GP to refer you back to the specialist who inserted your stent. At 76, you shouldn’t be struggling in this way and specialist care may offer 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 [email protected] — include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health worries

In my view… Blood pressure alert for big arms

Measuring blood pressure became much easier with simple automatic blood pressure monitors.

But the cuff size matters: a patient came to see me last week about travel immunisation’s and, noting that he was considerably overweight, I took the opportunity to measure his blood pressure.

Yet his arm was so big it was impossible to place the cuff correctly.

When measuring blood pressure, the cuff size matters and you should use a large-sized cuff with overweight or obese patients

This reminded me that when using a standard-sized blood pressure cuff on a large arm, the reading may be falsely high — the 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 you must use a large-sized cuff with overweight or obese patients. But how many people — even nurses and doctors — are aware of this and how often is a large-sized cuff available?

If you have a large upper arm and the standard cuff hardly fits, insist on a larger cuff — or you may be wrongly diagnosed with high blood pressure, and given wrong advice and medication.