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Interviewer: You've been told by your dentist that you have impacted wisdom teeth and they need to come out. Is that the case and is there a way that it could be a little easier? We'll talk about that next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: I think my guests would agree that nobody looks forward to having their wisdom teeth pulled. But there could be an easier way than what you're aware of. We're with Dr. Bryce Williams. He's an oral surgeon in the Ear, Nose and Throat department at the University of Utah Health Care. Boy that's a tough thing isn't it? Is there anything more painful than having your wisdom teeth pulled?

Dr. Williams: It's certainly not the most exciting thing to have to look forward to. But it is kind of a rite of passage into adulthood.

Interviewer: Yes, so let's talk about why somebody should and the importance of it. And then we're going to talk about what you can do to make the experience a little bit better. So first of all, wisdom teeth. Why would somebody want to have them pulled? And is it important?

Dr. Williams: Wisdom teeth in the majority of people cause a problem because there's not enough room in the mouth for them to come in. So removing them early on in life is important because taking them out as you're older is more difficult; the bone is harder, you may have other health problems as you get older, and the roots are longer.

Interviewer: So get them out while you're young and healthy. Is this a preventative thing? This is before you see any evidence of impacted teeth?

Dr. Williams: Right. There's a lot of evidence to show that having the wisdom teeth taken out before the age of 25, you get a better outcome and you avoid long term complications.

Interviewer: And is that something everybody should do?

Dr. Williams: It's not for everybody. But the vast majority of people should at least get a dental x-ray to check out and see where those teeth are and to see if they're going to cause a problem.

Interviewer: And the dentist could figure that out for them?

Dr. Williams: Absolutely.

Interviewer: Okay, and then at that point the dentist says okay, you probably should have these pulled out. What then?

Dr. Williams: Yes a general dentist is able to remove your wisdom teeth. The difference between a general dentist and an oral surgeon is the oral surgeon is trained to remove the wisdom teeth using IV sedation.

Interviewer: Okay. And a dentist can't?

Dr. Williams: Oral surgeons typically do a deeper level of sedation and know how to do it safely. That way you can go completely to sleep and not remember any of the procedure, wake up when it's all done, and go home and have a somewhat good memory of the event.

Interviewer: As opposed to being awake the whole time and watching the thing.

Dr. Williams: Right. Exactly.

Interviewer: So only oral surgeons can do IV sedation which sounds like a huge benefit. What are some of the other benefits of having perhaps an oral surgeon do it over a general dentist?

Dr. Williams: So the core of an oral surgeon's training is four to six years after dental school. And the core of that is in removal of wisdom teeth. So we see a lot more cases, we do a lot more difficult cases, we're trained to do them with IV sedation. As a general dentist's bread and butter is fillings and crowns, an oral surgeon's core is the removal of wisdom teeth. So we feel very comfortable with it.

Interviewer: Yes, so that's what you do. You see a lot of it. You do a lot of them.

Dr. Williams: Exactly. And I think that helps translate into a quicker recovery for the patient, kind of a smoother procedure, and all of that.

Interviewer: Yes, and plus you don't have to be awake for it.

Dr. Williams: Exactly.

Interviewer: If somebody has any questions what can they do?

Dr. Williams: You can search for me on the university website, Bryce Williams, DDS. You can find more information about wisdom tooth removal and IV sedation, and my contact information is on there as well.

Interviewer: Final thoughts?

Dr. Williams: You should go to your dentist every six months for routine checkups and cleanings. Your dentist can take x-rays and diagnose you with impacted wisdom teeth. If you do need to have your wisdom teeth removed keep in mind that there is a nicer way to do it with IV sedation.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: November 7, 2018
originally published: August 8, 2014

Interviewer: If you've been diagnosed with sleep apnea there is an alternative to that mask and tank thing. We'll talk about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happy and healthier life. You're listening to The Scope.

Interviewer: Sleep apnea can be miserable and for people that have it, they're looking for a way to cure themselves, but sometimes they don't want to wear the mask to bed that's hooked to the air tank, or maybe it just doesn't work for them, but there is an alternative. We're with Dr. Bryce Williams; he's an oral surgeon in the Ear, Nose, and Throat department at University of Utah Health Care. Let's talk about this alternative to what they call a CPAP, which is basically that mask and tank. That's the first thing that people usually are given when diagnosed with sleep apnea.

Dr. Williams: Yes, that's right, and you know, it is a cure for sleep apnea, but unfortunately about 30 to 40 percent of patients that use it, they can't tolerate it for whatever reason, either they don't like wearing the mask, or they can't find a good fit, or their bed partner doesn't like all of the noise that it makes.

Interviewer: Sleeping with Darth Vader.

Dr. Williams: Exactly, yeah.

Interviewer: It's probably not that loud, I probably am being a little silly there.

Dr. Williams: It can be, you know, it can definitely disrupt sleep for sure.

Interviewer: So for a lot of people that's just not really an option; it's not going to work out for them, but what's your alternative that you have?

Dr. Williams: So another alternative that is successful in treating sleep apnea in some patients is a jaw re-positioning device. So it's basically a custom made splint that fits in the mouth that brings the jaw forward, which in turn brings the tongue forward, which in turn opens up the airway just like the CPAP machine does.

Interviewer: Okay, so is this like a mouthpiece type of a thing?

Dr. Williams: Exactly, you have to have dental impressions made, and those are sent to a lab, and you know, a week later you get the device back, and it's kind of adjusted to fit the desired amount or distance to advance your jaw in order to open up your airway.

Interviewer: So is part of the problem that some people might be having sleep apnea is because their jaw is not formed quite right, so they're not getting the air, and this fixes it, or does this? Do you get what I'm trying to ask?

Dr. Williams: Yes, yeah, you're right. Some patients have a small lower jaw, and that in turn doesn't give enough room for the tongue to sit in the mouth, so when they go to sleep the tongue relaxes, and falls back in the airway. With this device it brings the jaw and the tongue forward, opening up the airway, so that you know, you can breathe at night, get a sound sleep.

Interviewer: So this isn't for everybody.

Dr. Williams: It's not for everybody, patients with really large tongues, or very thick necks can get a little better with it, but it doesn't tend to offer them the same cure that CPAP does.

Interviewer: All right, and this is something that somebody like you can help them figure out.

Dr. Williams: Absolutely.

Interviewer: All right, and what kind of success do people have with this device? It sounds almost too simple to work well you know?

Dr. Williams: Exactly, well depending on if the correct patient is chosen you know, success can be up to 90% of a cure rate, and a lot of those patients can get off their CPAP machine. It all takes a meeting with the doctor, and then figuring out if you're the right patient for the appliance.

Interviewer: And what about cost on something like this?

Dr. Williams: Typically medical insurance will cover it, so the cost is usually nominal.

Interviewer: Okay. And tell me the kind of the difference it would make in somebody's life. Do you have any stories from patients?

Dr. Williams: Sure, yeah. I've had patients that snore very loud at night, or end up choking, and then their bed partner can't tolerate it, and they kick them out and make them sleep on the sofa. It's always nice to sleep in your own bed.

Interviewer: So it cures that snoring thing, and then also does sleep apnea, you're waking up numerous times, this will help prevent that as well.

Dr. Williams: Absolutely, yeah that, and you feel more rested during the day, and be able to function like a normal human being I guess.

Interviewer: And a lot of times this works better than the mask and the tank.

Dr. Williams: For sure, for those of you who like Star Wars, and sounding like Darth Vader it's a great thing, but most people don't prefer that I suppose.

Interviewer: All right, any final thoughts on this device?

Dr. Williams: I think it's important to explore different options when it comes to sleep apnea, and not give up. A lot of patients with sleep apnea get tired of looking for different things that can make them feel better, but there's certainly things out there, and this jaw re- positioning device is certainly one of them.

Interviewer: If somebody listening to this has any questions, what would you recommend that they do?

Dr. Williams: They can get on the internet and search out my name, Brice Williams, I'm on the University of Utah website. And you can find some additional information about sleep apnea there, and also my contact information. I'd be happy to answer any questions.

Announcer: We're your daily dose of science, conversation, medicine, this is "The Scope" University of Utah health sciences radio.

Interviewer: Do mouth guards really make a difference for your kids teeth? We'll find out next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: We're with Dr. Bryce Williams he's an oral surgeon in the Ear, Nose and Throat Department of the University Utah Hospital. Mouth guards and kids, let's talk about that for a second, do you recommend kids wear them, I think I know the answer it seems like an obvious one to me.

Dr. Bryce Williams: If you ask any dentist, oral surgeon they'll say yes. Not wearing a mouth guard you're at twice the risk for an injury to a tooth or to your jaw and then someone who's wearing a mouth guard.

Interviewer: Two times? And those types of injuries, give me how significant that is, what I mean is at the end of the day.

Dr. Bryce Williams: Well it could range all the way from breaking off a small part of usually it's a front tooth which for most people that's pretty significant, as far as cosmetically, to actually a fracture of the upper and lower jaws which can require some kind of major surgery.

Interviewer: Really, wow. So mouth guards what types of sports should the kids be wearing them in?

Dr. Bryce Williams: Really any sport, where any kind of contact sport are in any sport where there's a risk of falling. So football, hockey, certainly skiing, playing tackle football.

Interviewer: Skiing really? Interesting. Tackle football keep going with your list.

Dr. Bryce Williams: Tackle football

Interviewer: I'd imagine soccer

Dr. Bryce Williams: Soccer for sure.

Dr. Bryce Williams: A ball in the face, that's no fun.

Interviewer: Is there a sport in particular that's really notorious for injuries?

Dr. Bryce Williams: I think in football is pretty well guarded even in the full face mask on but I think that - and even baseball as well. I've seen several injuries from a ball or from a bat in people playing baseball.

Interviewer: So I understand how the mouth guard might protect my teeth but how's it is protecting my jaw?

Dr. Bryce Williams: It protects your jaw by allowing the teeth to come together when you get hit. And having the teeth together when you get hit, protects the jaw as well.

Interviewer: Alright. What about you see the helmets with the jaw guard on them?

Dr. Bryce Williams: Yeah I see more and more of those when I go up skiing and I don't think there's any literature as far as those are concerned at this point but I think it's probably good idea especially people that are skiing very fast and doing very tricky maneuvers. Certainly it can help to protect your lower jaw.

Interviewer: Do you ever find yourself in a situation where you just want to scream? You just want to say put a mouth guard in.

Dr. Bryce Williams: You always see a teen age kid with perfectly white teeth come in and they been playing tackle football in the park with their friends and they've broken two of their front teeth and they're very distressed and in those situations I just want to take them by the shoulders and say wear a mouth guard next time. Especially, after you get fixed.

Interviewer: What age should kids start wearing mouth guards?

Dr. Bryce Williams: Most dramatic event start to happen when kids are playing sports. So typically between ages 8 and 10 years old. Sometimes it's difficult for a general dentist to make a mouth guard fit a patient choose teeth are erupting and changing all the time. In those cases, it's fine to go to the store and buy a store-bought mouth guard to wearing and change every so often when the mouse grows or changes or a new tooth comes in.

Interviewer: So is one type of mouth guard better than another type of mouth guard?

Dr. Bryce Williams: I think with mouth guards there's several different types, you can buy the kind at the store that you can boiling water and adapt to your teeth. I think those are very good but the best kind of mouth guard you can get is one that's custom- made by your dentist and the reason those are better is they adapt to your teeth. They're fit to the relationships of your jaw and they're less likely come out while you're playing sports or other activities.

Interviewer: What's one of those cost, roughly?

Dr. Bryce Williams: It depends on the dentist but sometimes it's covered by insurance.

Interviewer: Oh really?

Dr. Bryce Williams: So sometimes you don't have to pay very much at all.

Interviewer: No excuses.

Dr. Bryce Williams: No excuses.

Interviewer: No excuses to mess up those teeth.

Dr. Bryce Williams: Absolutely.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.

Announcer: Medical news and research from University of Utah physician and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Bryce Williams is an oral surgeon at the University of Utah Hospital but he's in the Ear, Nose and Throat Department. I don't see teeth in there anywhere so I was curious how exactly do oral surgeons and ENTs, how are they related to each other?

Dr. Williams: That's a good question. We work together in a lot of different areas. One particular area is sleep apnea. Otolaryngologists offer surgeries that are based mostly on the soft tissues, the tongue, the soft palate. Oral surgeons can offer changes to the upper and lower jaws through surgery, which can help to open to your airway, and so a lot of times it's beneficial for the patient for the ear, nose and throat surgeons and oral surgeons to work together. We also do facial trauma together. Facial trauma's closely tied to the teeth and so getting the teeth in the right spot helps get the bones in the correct position and so ear, nose and throat and the oral surgeons kind of come together on facial traumas as well.

Interviewer: So for sleep apnea, teeth are an important part, it sounds like. What about other breathing like athletics or stuff like that?

Dr. Williams: As far as breathing in patients that play sports or if they're having difficulty breathing while they're playing, the otolaryngologist can offer nasal surgery to those patients to help open up the nose and sometimes in those patients oral surgeons can offer procedure, a simple procedure done to the chin to help kind of pull the tongue forward, if the tongue appears to be an area that's closing off the airway.

Interviewer: Wow. What other ways do the oral surgeons work with ENTs?

Dr. Williams: A lot of times, we're dealing with cancer patients so sometimes oral surgeons will get together and remove teeth prior to radiation therapy for oral cancer. Oftentimes ...

Interviewer: ... you'll have to remove teeth.

Dr. Williams: Yeah, sometimes leaving bad teeth in the area where a jaw is being radiated for cancer, it can cause death of the jawbone if there's some bad teeth in there.

Interviewer: Is this the type of cancer caused by smoking and chewing tobacco products, that sort of thing?

Dr. Williams: Absolutely.

Interviewer: That can really mess up your mouth, can't it?

Dr. Williams: It's no fun.

Interviewer: Yeah. What other ways are you working with ear, nose and throat specialists?

Dr. Williams: Another way we work together is benign tumors of the jaw. Oftentimes ear, nose and throat surgeons will need intra-oral access or incisions inside the mouth rather than going through the skin to get to those lesions and oftentimes I can help out with exposing those lesions through the mouth.

Interviewer: So are there times where in the operating room, you'll go in and do some preliminary work and then somebody else will come in and do the rest of it?
Dr. Williams: Oh, yeah, every week.

Interviewer: Really.

Dr. Williams: Yeah.

Interviewer: So not just one guy doing it all.

Dr. Williams: No, I think collaborating gets different minds together, thinks of different options for the patient. I think it's overall better for the patient. Interviewer: Yeah, so there are options in a lot of these cases and you can bring a perspective that maybe they might not have.

Dr. Williams: Absolutely.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to the Scope.

Interviewer: Dr. Bryce Williams is an oral surgeon at the University of Utah Hospital. As an oral surgeon, tell me about the effects of smoking and chewing tobacco on the teeth.

Dr. Bryce Williams: That's a good question. Smoking for the oral cavity causes a lot of different changes. Primarily, it causes a dry mouth. Not having that saliva in there to protect your teeth and your gums will cause a plaque build-up on the teeth and then slowly over time you can get cavities in your teeth that cause infection and need to be removed. The other obvious changes that happen with smoking in particular are the risks of getting oral cancer. Sometimes it doesn't always show up in the obvious place. It can kind of hide behind the tongue or further down the throat. It can make it very tricky for the otolaryngologist or the oral surgeon to find those areas of concern. With chewing tobacco, there's not necessarily a higher risk of oral cancer with chewing tobacco. That's never been proven. However, chewing tobacco does damage the gums around the teeth. It can cause recession of the gums and damage to the roots of the teeth, which require removal. Sometimes that's very difficult to repair so the teeth have to be removed.

Interviewer: Out of all the things that we're putting in our mouth and that we're doing to ourselves, would you say smoking and chewing tobacco are a couple of the worst things you can do for your teeth?

Dr. Bryce Williams: I think smoking and chewing tobacco are definitely terrible for the world cavity. Something else that's not typically thought of as been awful for the mouth are sweets and those kinds of things. Especially suckers and lozenges that have sugar in them. Those can have similar effects to chewing tobacco, causing recession of the gums and cavities in the teeth. Those work kind of slower over time but they can have a devastating effect on the teeth and gums.

Interviewer: Interesting. What about chewing ice? Is that bad for me?

Dr. Bryce Williams: Chewing ice can be bad for you as well, especially if you have a lot of fillings in your mouth. The fillings tend to weaken the teeth. If you take a nice crunch down on a piece of that ice, it can fracture that tooth and then you need some expensive dental work.

Interviewer: What about opening things with your mouth? You know, clamping down on a package of whatever and opening it up. Is that bad? I've heard it is.

Dr. Bryce Williams: It's always impressive to see someone open a bottle with their teeth.

Interviewer: Have you actually seen that?

Dr. Bryce Williams: Many times. I've never seen a tooth actually break.

Interviewer: That doesn't sound smart.

Dr. Bryce Williams: It does not sound smart, no. I'm sure the day will come when I will see someone and I'll give them a talking to.

Interviewer: What about other packaging, like, plastic bags of candy or whatever?

Dr. Bryce Williams: I'd say save your teeth for the food so you'll have your teeth long-termed to chew the food with.

Announcer: We're your daily dose of science, conversation, medicine. This is the Scope. The University of Utah Health Science's Radio.