DR SCURR: How to Stop Grinding Your Teeth… Without Wearing a Mouthguard

My dentist says I grind my teeth. I have tried mouth guards but they make me gag a lot. Is there anything else that can help and will it cause long term problems?

Michael Lister, Burnley.

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

It is most common in childhood — it affects more than 20 percent of children — but decreases as we get older. Most people are diagnosed through symptoms described by their partner, not, as in your case, through damage to the teeth.

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

What many of these triggers have in common is that they cause very brief periods of wakefulness: studies show that bruxism occurs sporadically, during moments of “micro-arousal” from sleep, lasting between five and twenty seconds.

Treatment is not always necessary unless your teeth are damaged or if you have symptoms such as morning headaches, jaw pain, or clicking of the joint that connects the jaw to the skull.

Mouthguards do not stop bruxism, but they protect the teeth. The search for effective medicines for bruxism has been disappointing.

The best results are usually seen with clonazepam, a tranquilizer, although it generally reduces the frequency of bruxism episodes by only about 30 percent. It is thought to calm overactive circuits in the brain that are linked to teeth grinding.

You may consider having your GP prescribe clonazepam (1 mg in the evening) to see if this helps.

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

The injections should be administered by a trained movement disorder specialist and repeated every six months as the effect wears off. Talk to your family doctor, or even your dentist, about a possible referral to a specialist.

I am 76 and have been diagnosed with heart failure after a heart attack a year ago. I have severe shortness of breath. Yet my blood oxygen levels are fine. I have also had asthma my whole life, could that be the cause?

Roger Bell, Dorchester.

The challenge here is to understand to what extent your shortness of breath is due to poor heart function and to what extent it is related to your asthma.

A heart attack occurs when the blood supply to part of your heart is blocked, usually by a clot in an artery, causing tissue damage. You write in your longer letter that you were given a stent (a small metal tube) to reopen the artery. But because this was not done until 36 hours after you became ill, your heart is permanently damaged.

It is now less able to pump oxygen-rich blood through the body when you exercise or play sports.

Your oxygen saturation levels — a measure of how much oxygen is in your blood — are healthy at 98 percent (anything between 95 and 100 percent is considered normal). But your heart can’t pump enough to supply your muscles, leaving you out of breath.

It is clear that your asthma has worsened. As you say, your GP has increased the dosage of your asthma inhaler.

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

This should be more than 200 litres per minute, and preferably close to 500 litres. If it is not, your asthma treatment may not be adequate and you should be referred to a lung specialist.

I would also recommend asking your GP to refer you back to the specialist who placed your stent. At 76, you should not be struggling with this anymore 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 — Please provide your contact details. Dr. Scurr cannot provide personal information correspondence. Answers should be be taken in a general context and always consult your own General practitioner in case of any health problems

In my opinion… Blood pressure warning for big arms

Measuring blood pressure has become much easier thanks to simple automatic blood pressure monitors.

But the size of the cuff is important: last week a patient came to me for travel vaccinations. When I saw that he was considerably overweight, I immediately measured his blood pressure.

However, his arm was so big that it was impossible to put the cuff on properly.

When measuring blood pressure, the size of the cuff is important and in overweight or obese patients you should use a large cuff

This made me think that if you use a standard size blood pressure cuff on a large arm, you may get a false high reading. The fat has a cushioning effect, preventing the cuff from fully compressing the underlying artery, which is how blood pressure is measured.

The advice is that you should use a large cuff for overweight or obese patients. But how many people — even nurses and doctors — are aware of this and how often is a large cuff available?

If you have a large upper arm and the standard cuff barely fits, insist on getting a larger cuff. Otherwise, you may be misdiagnosed with high blood pressure and given the wrong advice and medications.