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Medical Edge Newspaper Column from Mayo Clinic

OFF-THE-SHELF MOUTH GUARDS MAY CAUSE PROBLEMS

DEAR MAYO CLINIC: My dentist told me that I need a night guard because my teeth are showing signs of wear-and-tear from clenching. The price tag will be about $600. But I noticed that pharmacies and discount stores sell night guards for $20 to $30. Are these cheaper versions as safe and effective as the deluxe models? — Rochester, Minn.

ANSWER: Tooth wear because of clenching or grinding is not uncommon. The medical term for clenching, grinding or gnashing of teeth is bruxism. Sometimes only teeth show the ill effects. At other times both the teeth and the muscles can suffer. Bruxism can lead to damaged teeth, jaw disorders, headaches and other problems.

Night-guard devices often are recommended as part of the treatment plan. You’re correct that there is a big price difference in what your dentist offers and what’s available at the drugstore.

The difference isn’t just in price. Your dentist would create a custom guard that fits your mouth. In addition, the dentist monitors your care to ensure the device is improving your condition.

Using off-the-shelf mouth guards or mouth-guard kits will not likely result in a guard that fits as well, or be as durable. Most such devices are intended mainly for protection against tooth injury. If they are not fitted correctly, problems can result, including tooth soreness, gum irritation or even tooth movement if all teeth are not correctly covered.

I suggest that you work closely with your dentist to determine what’s contributing to your bruxism. In addition to the night guard, stress management could help. If clenching occurs during the day, you may be able to change the behavior by practicing proper mouth positioning. Limiting or eliminating the use of alcohol, tobacco and caffeine can also help. All three seem to make bruxism worse.

— Alan B. Carr, D.M.D., Dental Specialties, Mayo Clinic, Rochester, Minn.

Additional Resources:
Mouth Guards
Appointment Information
Information on Bruxism

DEAR MAYO CLINIC: I have had a bad rash on my groin for about six years. A biopsy showed it’s intertrigo. I have seen several doctors, and no one seems to know of a cure. I’ve tried over 30 remedies and nothing has helped. Is there no help for this dreadful thing? — Janesville, Wis.

ANSWER: I am sorry to hear you have had this rash for so long. A groin rash due to intertrigo usually responds well to simple treatment. It’s surprising yours has persisted even though you’ve seen multiple doctors and received so many treatments.

Intertrigo is a common skin infection and inflammation that results when two surfaces of skin rub against each other in a warm, moist atmosphere. The chafing traps moisture between the surfaces, causing the skin to become red, itchy and sore. The excess moisture causes tiny breaks in the skin and encourages the growth of fungi and bacteria.

Intertrigo most commonly occurs underneath breasts, in the groin area, underneath the armpits, in the space between the toes and underneath abdominal skin folds of people who are overweight.

Intertrigo is unlikely to go away by itself. The key to effective treatment is to get rid of the infection and to keep the affected area clean and dry. Here are several treatments commonly prescribed for intertrigo:

— Antifungal or antibacterial creams: These creams help destroy the germs infecting the skin.

— Vinegar soaks: Treatment with a very diluted vinegar solution helps kill the germs that cause fungal infections and dry out the affected skin.

— Mild hydrocortisone cream: This cream helps reduce inflammation of the skin.

— Drying agents: Use a fan or hair dryer on a cool setting to dry the skin completely before you put on clean, dry clothing. Then, use talcum powder or an absorbent powder to act as a buffer against wetness.
The bottom line is that, to effectively treat intertrigo and prevent it from coming back, the problem area must stay dry.

If you have already tried the measures outlined above without any relief, see your dermatologist. Sometimes more serious diseases can look like intertrigo. It might be time for another biopsy to confirm your diagnosis.

— Mark Davis, M.D, Dermatology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Intertrigo
Appointment Information
More Information on Intertrigo
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.