When should I see a prosthodontist rather than my regular dentist? Do I need a referral?

It depends on the experience and training of your general dentist as well as your goals and expectations as a patient. Generally, referrals are not needed, but can be helpful in determining the etiology and history of a problem.

Today, the dental school curriculum is very complex; over time it has been compromised to the point such that the amount of prosthodontics taught has been gradually diluted. Prosthodontists have three years of education and training in addition to their four-year dental program.

What is the value or importance of a custom fitted mouthguard?

It is important that the muscles of mastication be supported at precisely the correct length for maximum effectiveness with regard to muscle resting length, muscle tone, and function. The fit must be exacting to prevent tooth movement, and provide the consistent support needed to stabilize the neuromuscular system.

What types of jaw and joint noise and movement problems are normal and resolve themselves in time?

Usually, minor trauma in an otherwise normal individual without a history of TMJ problems or clenching will resolve over time. Normally, jaw clicking, or popping sensations that do not persist and have no ongoing associated pain should not be cause for treatment or concern. However, locking of your jaw is cause for concern and should be treated.

Are clenching and grinding during sleep caused by stress?

Not necessarily. It can also be an attempt by the brain to resolve occlusal discrepancies or neuromuscular problems; that is, your brain unconsciously or subconsciously will attempt to correct or repair a misaligned bite or resolve neuromuscular problems just as it normally repairs and refreshes all other aspects of the body during sleep.

Stress is similar to throwing gasoline on a smoldering fire in that it exacerbates an existing dental problem. Resolving the problem or putting out the fire minimizes the effect of stress on clenching or grinding. Everybody normally clenches and grinds their teeth to a certain degree. It's only when symptoms occur such as jaw pain, headaches, wearing down of teeth, and neck pain that treatment is indicated.

Clenching while awake is a classically conditioned psychological and neuromuscular response to any number of learned stressors. For example, suppose a stressful relationship in which seeing or talking to a person causes clenching: later just thinking about that person causes clenching.

Is loud snoring always indicative of some kind of sleep problem?

Yes. Snoring is usually a sign or symptom of a more complex problem, such as obstructive sleep apnea, especially when combined with a weight problem and high blood pressure. However, even thin people with normal blood pressure can have oral anatomical discrepancies that are subtle, and over time, can lead to these serious health complications.

How serious is sleep apnea or other sleep disorders?

These conditions are very serious, and likely to account for a greater number of people "dying in their sleep" than is currently recognized. Unfortunately, there is little pathological evidence of such events, and therefore awareness of this problem is not as great as it might be.