MAYO CLINIC HEALTH LETTER

R E L I A B L E I N F O R M A T I O N F O R A H E A L T H I E R L I F E
VOLUME 23 NUMBER 9 SEPTEMBER 2005

stroke. These effects may mean that

Inside this issue
HEALTH TIPS . . . . . . . . . . . . . 3
Curbing your appetite.
NEWS AND OUR VIEWS . . . . 4
Annual flu vaccination improves
odds for older adults. Rethinking
early bone loss treatment.
JOINT INFECTIONS . . . . . . . 4
Early and aggressive treatment is
vital.
SLEEP AND AGING . . . . . . . . 6
Getting the rest you need.
BRUXISM . . . . . . . . . . . . . . . . 7
Breaking the teeth-grinding habit.
SECOND OPINION . . . . . . . . 8
Can I take my thyroid medication
at the same time that I take my cal-
cium supplement? What’s the dif-
ference between seborrhea and
psoriasis?
Stroke
rehabilitation
Helping achieve
independence
Your sister had a stroke a few days
ago. Her doctors say that it may be
several days before they know the full
extent of her impairment. But even
so, they’ve already begun planning
a rehabilitation program for her.
Stroke is the third-leading cause
of death and the leading cause of
long-term disability in the United
States. Approximately 4 million Amer-
icans are living with the effects of
you must change, relearn or redefine
how you live.
The goals of rehabilitation are to
build strength, capability and confi-
dence so that you can continue your
daily activities despite possible im-
pairments. New discoveries and tech-
nologies may enhance the recovery
process. In the future, these advances
may even allow for the repair or
replacement of damaged brain cells.
In the brain
Stroke occurs when the supply of
blood that normally nourishes the
brain is reduced. It can happen in
two ways — when blood flow to
brain tissue is blocked, or if blood

Coming in October

OVARIAN CANCER
Recognize the early warning signs.

BEANS
Make them diet regulars.

ADULT ACNE
Troublesome, but treatable.

ERYTHROPOIETIN
Treating severe anemia.

Stroke occurs when the supply of blood that normally nourishes the brain is reduced. Stroke
affects brain cells that send signals controlling almost every function in the body, including
those listed in this illustration. In addition, stroke on the right side of the brain often affects
functions on the left side of the body, while a stroke on the left side of the brain often affects
functions on the right side of the body.
2 M AYO C L I N I C H E A LT H L E T T E R
leaks into the brain or into tissues
surrounding the brain.
Stroke affects brain cells that
send signals controlling almost every
function in the body. When brain
tissue is damaged, it can have far-
ranging effects, including:
■ Physical — Paralysis, stiffness,
weakness, a loss of feeling or lack
of coordination may affect your face,
an arm or a leg, or an entire side
of your body. You also may have bal-
ance problems, visual problems,
including partial blindness in one
or both eyes, or trouble speaking or
swallowing.
■ Cognitive — The way in which
you think, remember, interact with
others or perceive the world around
you may be affected. Perceptual
changes may make it hard for you
to understand what you feel, see or
hear. You may also have difficulty
The road to recovery after stroke
The outlook for stroke reha-
bilitation is better today than
ever before. After a stroke,
some people experience a
complete or nearly complete
recovery. Still, approximately
half of stroke survivors will be
left with some kind of perma-
nent disability.
The success of rehabilitation
depends on many factors,
including:
■ Its timing — The earlier
rehabilitation begins, the more
likely you are to regain lost
abilities and skills.
■ The extent of brain injury
— People with milder injuries
are likely to benefit the most.
But even with slight improve-
ment, rehabilitation can mean
the difference between return-
ing to your home or staying in a
care facility.
SEPTEMBER 2005
understanding what you read or
what people say.
■ Psychological — Stroke can
affect you by damaging an area of
your brain that’s involved in pro-
ducing emotions. You may feel help-
less, frustrated and uninterested in
activities you once enjoyed. You may
cry or laugh more easily or have
sudden mood swings for no appar-
ent reason. Depression, grief, irri-
tability and fatigue sometimes occur.
What’s involved
The purpose of rehabilitation is
to reach the highest possible level
of independence. What you do in
rehabilitation depends on what skills
you need to become independent.
A major part of rehabilitation is often
physical training and therapy. This
may involve training with mobility
skills, such as relearning to walk or
■ Its intensity and frequen-
cy — Studies suggest that
greater intensity and frequency
of therapy improves functional
outcomes. Even if rehabilitation
sessions are scheduled only a
few times a week, therapeutic
exercises should be done on a
daily basis.
■ Your outlook and attitude
— Motivation and a positive
attitude are key to obtaining an
optimal level of recovery. Reha-
bilitation requires a willingness
to work hard.
■ The cooperation of
friends and family — Com-
panionship and emotional
support are essential to reha-
bilitation. Caregivers also play
an important role in assisting
with rehabilitation exercises
and therapies and helping you
maintain improvement.
learning to self-propel a wheelchair,
balance skills, and maximizing the
range of motion in your joints.
Rehabilitation may also involve
relearning self-care skills — includ-
ing eating, grooming, bathing and
dressing — or learning to adapt how
you perform these tasks to com-
pensate for disability. Addressing
cognitive skills, including memory
and problem solving, and commu-
nication and social skills also are
important parts of rehabilitation (see
“Speech therapy” in our July 2004
issue). You may also learn how to
reorganize your living space to make
it safer and more accessible.
Because numerous impairments
may be involved, rehabilitation is
facilitated by a diverse team, which
may include doctors specializing in
MAYO CLINIC HEALTH LETTER
Managing Editor Medical Editor
Aleta Capelle Robert Sheeler, M.D.
Associate Editors Associate Medical Editor
Carol Gunderson David Williams, M.D.
Jennifer Jacobson
Editorial Research
Joey Keillor
Deirdre Herman
Medical Illustration Shelly Hewlett
Michael King
Proofreading
Customer Service Miranda Attlesey
Manager Donna Hanson
Ann Allen
Administrative Assistant
Jill Thompson-Riese
EDITORIAL BOARD
Shreyasee Amin, M.D., Rheumatology; Amindra
Arora, M.D., Gastroenterology and Hepatology; Brent
Bauer, M.D., Internal Medicine; Julie Bjoraker, M.D.,
Internal Medicine; Diane Dahm, M.D., Orthopedics;
Timothy Daley, M.D., Internal Medicine; Mark Davis,
M.D., Dermatology; Bobbie Gostout, M.D., Gyneco-
logic Surgery; Timothy Hobday, M.D., Oncology;
Todd Johnson, Pharm.D., Pharmacy; Frank Kennedy,
M.D., Endocrinology and Metabolism; Suzanne
Norby, M.D., Nephrology; Steve Ommen, M.D.,
Cardiology; Robert Sheeler, M.D., Family Medicine;
Phillip Sheridan, D.D.S., Periodontics; Peter Southorn,
M.D., Anesthesiology; David Williams, M.D.,
Pulmonary and Critical Care Medicine; Mark
Williams, M.D., Psychiatry; Aleta Capelle, Health
Information. Ex-officio: Carol Gunderson, Jennifer
Jacobson and Joey Keillor.
Mayo Clinic Health Letter (ISSN 0741-6245) is published
monthly by Mayo Foundation for Medical Education and
Research, a subsidiary of Mayo Foundation, 200 First St.
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 M AYO C L I N I C H E A LT H L E T T E R
physical medicine and rehabilita-
tion (physiatrists), rehabilitation nurs-
es, physical therapists, occupation-
al therapists, recreation therapists,
speech-language pathologists, social
workers, psychologists and chap-
lains. Although each team member
lends particular expertise, the team
works together to help recovery.
Advances
The brain was once thought to
be a static organ — brain cells could
die, but not be repaired or regained.
In recent years, due to research stud-
ies and advances in brain-imaging
techniques, doctors and researchers
are gaining a new understanding of
how brain systems adapt after stroke
to regain function (brain plasticity).
After injury, efforts are geared
toward maximizing function in spite
of the damaged brain. In some
research models, scientists observed
that brain cells surrounding a dam-
aged area undergo changes in func-
tion and shape that allow them to
take on the functions of the dam-
aged cells. Results indicate that sim-
ilar changes occur in human brains
after stroke and other trauma.
Researchers have hypothesized
that stem cells one day may enable
damaged brain areas to recover their
function. Other therapies to encour-
age the regeneration of damaged
brain cells are also being explored.
Many other recent advances
may play a role in retraining injured
areas of the brain and helping to
stimulate use of paralyzed or weak-
ened areas of the body.
Other advances include:
■ Constraint-induced therapy
— This therapy involves restricting
the use of an unaffected or less-
affected limb while intensively train-
ing the more-affected limb. This
helps improve limb function.
■ Forced-use therapy — With
conventional forced-use therapy,
SEPTEMBER 2005
therapists or caregivers manually
assist with thousands of movement
repetitions to help the injured brain
relearn how to accomplish tasks
with an impaired limb. Researchers
are exploring the use of robots to
assist with these movements.
■ Electrical stimulation and bio-
feedback — Functional electrical
stimulation involves the use of elec-
tricity to stimulate muscles weak-
ened or paralyzed by stroke to cause
them to contract. In biofeedback, a
sensor is placed over a target mus-
cle, and when that muscle is suc-
cessfully moved, the electrical activ-
ity generated by that muscle is
picked up by the sensor and used to
provide feedback to the individual.
The goal is to help a stroke survivor
become more aware of the means
to move the target muscle and
achieve this movement more easi-
ly. Some rehabilitation facilities
combine these two methods to
speed muscle and nerve retraining.
■ Cortical stimulation — With
this technique, an electrical current
is used to stimulate the motor cor-
tex in the brain. Studies have shown
that it improves the performance of
a paralyzed limb. However, it has-
n’t yet been approved for clinical
use in the United States.
In addition to these therapies,
pioneering work is being done in
the area of virtual reality. These sim-
ulations and training methods en-
courage the brain to reorganize to
compensate for damage. They’re
designed to improve range of mo-
tion, balance, stepping and other
measures of motor function.
However, none of these treat-
ment methods has been shown to
be significantly better than willful,
task-specific practice of a motor
behavior. A willingness to work
toward improvement is one of the
most important ingredients of suc-
cessful treatment. ❒
3
Health tips
Curbing your appetite
You know you should cut back
on the amount you eat to shed
a few extra pounds, but some-
times it’s just so hard.
Here are a few tips that
may help you curb your appe-
tite and avoid overeating.
■ Don’t skip breakfast —
If you make breakfast a high-
fiber cereal, whole-grain bread
or fresh fruit, you’ll be less like-
ly to overeat at lunch.
■ Eat slowly — Savor each
flavor and texture and remem-
ber it takes about 20 minutes
for your brain to receive the
signal that you’re full.
■ Think small — If you
always eat everything that’s on
your plate, start with half the
amount of food you usually
eat. And, to make less food
seem like more, have your
main course on a salad or
dessert plate.
■ Eat only when you’re
hungry — Stop and ask your-
self whether you’re stressed or
bored — or just hungry. Then
act accordingly.
■ Ride out the urge —
Cravings generally pass with-
in seconds or minutes. Engage
in an activity unrelated to food
until the desire to eat passes.
Exercise is an especially good
— and healthy — distraction.
■ Allow an occasional
splurge — If you’re really com-
mitted to eating less, an occa-
sional lapse is fine. In the long
run, it will have little impact
on your lifetime plan for con-
trolling your appetite. ❒
4 M AYO C L I N I C H E A LT H L E T T E R
SEPTEMBER 2005

Joint infections
News and our views
Early and aggressive
Annual flu vaccination improves odds for older adults treatment is vital
Receiving a flu vaccination can significantly reduce hospitaliza-
tions and deaths among high-risk older adults. However, the pro- You’ve never experienced pain like
tection provided by a flu vaccine is good for only a year due to chang- this before. Over the course of an
ing influenza strains. An annual revaccination is crucial in order to hour — and for no apparent reason
continue receiving these benefits. — the slightest movement of your
A study in the Nov. 3, 2004, Journal of the American Medical knee causes excruciating pain. The
Association looked at the effects of flu vaccination among older adults. skin looks red and is warm to the
Researchers found that the first flu vaccination reduced the risk of touch. Your doctor says it looks like
death in men and women age 65 and older by 10 percent. Those who an acute infection has settled in your
were revaccinated in following years reduced their risk of death by knee joint.
an additional 15 percent to 28 percent. Those whose vaccine series As surprising as it may seem,
was interrupted experienced a strong increase in mortality risk. joints are subject to infection. Prompt
However, restarting vaccination after an interruption led to a risk treatment for bacterial infections of
reduction similar to that found following revaccination. Overall, one a joint typically involves surgery and
death was prevented for every 302 vaccinations. Other studies have antibiotics. This is done in an effort
found an average of 50 percent reduction in deaths among older adults to stop the infection before it severe-
who receive a flu vaccine. ly damages the affected joint. Joint
Mayo Clinic doctors recommend an annual flu shot for all adults infections from other types of germs
over 50, for those with medical conditions such as heart disease may require antibiotics alone or —
and diabetes, and for all others at high risk of complications. ❒ in the case of some viruses — treat-
ment may not be required.
Rethinking early bone-loss treatment
A medication typically used to treat osteoporosis in postmenopausal Behind the infection
women may also help prevent fractures of the spine (vertebral frac- The cause of infections in joints
tures) in women with early bone loss (osteopenia). can be bacteria, viruses, fungi and
Osteopenia is a condition in which your bone density lies some- other germs. These organisms can
where between normal levels and levels that indicate the presence of reach a joint in a couple of ways.
the bone-thinning disease osteoporosis, but you haven’t yet experi- One way occurs when infection
enced complications such as fractures. Unlike osteoporosis, first-line located elsewhere in your body —
therapy for osteopenia typically hasn’t included the use of prescrip- such as pneumonia in your lungs or
tion medications that prevent bone loss. a urinary tract infection —is trans-
But a review of data from a multicenter study done in the 1990s ported through your blood and set-
found that postmenopausal women with osteopenia who took the bis- tles in a joint. Another means of
phosphonate drug alendronate (Fosamax) experienced a 60 percent introducing infection to a joint is
reduction in vertebral fractures. The findings, published in the March through a direct injury.
2005 issue of Mayo Clinic Proceedings, also showed that alendronate’s A joint infection — referred to
benefit was measurable early on in the three years of treatment. as septic or infectious arthritis —
Mayo Clinic doctors say the findings suggest an expanded role for is most commonly caused by the
oral bisphosphonate drugs — such as alendronate — which prevent staphylococcus bacterium often car-
bone loss (resorption). Another drug in this class of medications — ried on the skin. Joint infections can
risedronate (Actonel) — has also proved helpful in managing early also be caused by other germs, such
bone loss. Mayo doctors say it’s too soon to conclude that all women as tuberculosis, the sexually trans-
with osteopenia should take bisphosphonate drugs. However, in all mitted bacterium gonorrhea and the
likelihood, it will be women with osteopenia who also have addi- germ that causes Lyme disease.
tional risk factors for bone loss that may benefit the most. ❒ Various factors may put you at
greater risk of developing a joint
 M AYO C L I N I C H E A LT H L E T T E R
infection due to bacteria. Older
adults are more susceptible. The
same is true of people who are
chronically ill or have weakened
immune systems.
If you have osteoarthritis, rheu-
matoid arthritis or other joint dis-
eases, you’re also at increased risk
of joint infections. Some other fac-
tors that may increase risk include
having diabetes or having a foreign
material — such as artificial joints,
plates or screws — in your body.
Spotting the problem
Some joints — particularly the
knee, hip and shoulder joints — are
more likely than are others to be-
come infected. Signs and symptoms
of infectious arthritis vary, depend-
ing on where the infection occurs,
its cause and how far along it is. You
may experience:
■ Sudden, often intense joint
pain, especially pain that occurs
when the area is touched or the joint
is bent
■ Diminished range of motion
in a joint
■ Red, warm, tender skin over
the affected area
■ Fever or chills
■ Overall weakness
Immediate medical care for joint
infection is critical due to the risk of
joint destruction and the possibili-
ty of septic shock, which is a poten-
tially fatal condition. Several tests
are typically done to help determine
the extent of the infection and what’s
causing it. These may include:
■ Arthrocentesis (ahr-thro-sen-
TE-sis) — This involves withdraw-
ing joint fluid (synovial fluid) with
a needle. The synovial fluid is then
analyzed and cultures are done in
a laboratory to confirm and help
identify the cause.
■ Blood tests — These may be
done in addition to arthrocentesis
to check for an elevated white blood
SEPTEMBER 2005
One factor that may increase your risk of
joint infection is having foreign material,
such as an artificial joint, in your body.
cell count or elevated markers of
inflammation, which are indicators
of infection.
■ Diagnostic imaging — Imag-
ing techniques such as computer-
ized tomography (CT), magnetic res-
onance imaging (MRI), bone scan
and ultrasound may be used to bet-
ter image the joint structures, to
locate anything that may suggest
infection and to determine the
extent of any damage.
Surgery is likely
Typically, surgery is needed to
treat joint infection due to bacteria.
A surgeon may open the joint to
remove infected and damaged tis-
sues. This can sometimes be done
through several small incisions using
an arthroscope.
If the infection is bacterial, intra-
venous antibiotics generally are pre-
scribed according to the type of bac-
teria and where the infection is
located. These can often be given
outside the hospital. Oral antibiotics
may also be given. It may also be
necessary to immobilize the joint
with a splint while it recuperates
from infection.
Outcomes following joint infec-
tion vary. Physical therapy may be
helpful in regaining muscle strength
and mobility in the joint. Unfor-
tunately, joint infection may also
5
Joint replacements
and infections
Joint infection is an especial-
ly serious concern in an
artificial (prosthetic) joint.
Bacteria can adhere to and
multiply on the surfaces of a
prosthetic joint. Infections in
artificial joints may occur
shortly after joint replace-
ment or may crop up
months, or even years, later.
In some circumstances
after joint replacement sur-
gery, it may be important to
take antibiotics when you
have a procedure that could
result in bacteria entering the
bloodstream. Such proce-
dures may include dental
work and minor surgery.
Infections that occur in
artificial hip or knee joints
within the first weeks after
replacement may respond to
antibiotic treatment along
with surgery to clean the
joint area and the surfaces of
the joint replacement.
Later infections in re-
placed joints tend to be
chronic and may require
two-stage surgery along with
weeks of intravenous antibi-
otics. The first stage involves
cleaning the area and remov-
ing the implanted prosthesis.
Weeks later, the joint area is
opened again, cleaned and a
second prosthetic joint is
installed. Success rates are
about 90 percent for two-
stage reimplantations of knee
and hip joints.
result in permanent joint changes,
including osteoarthritis in the joint.
In severe cases, joint replacement
surgery may be an option. ❒
6 M AYO C L I N I C H E A LT H L E T T E R
Sleep
and aging
Getting the rest you need
You’ve always been a bit of an early
bird, but lately, “early” has been
taken to a new extreme. No mat-
ter what time you go to bed, you
wake up well before the sun rises.
Is this your body’s way of saying you
don’t need as much sleep as you
used to?
With age, changes in your sleep
patterns, health and lifestyle may
contribute to sleep difficulties. Even
so, you still require about the same
amount of sleep as you did in the
past. Identifying and treating the
causes of your sleepless or restless
nights may help you get the amount
and quality of sleep that you need.
The amount of sleep needed
each night varies from person to per-
son. Between seven and eight hours
of sleep is about average. Some
need more, while others do fine with
less. The most important measure is
how you feel during the day. If
you’re alert, functioning well and
don’t feel tired, you’re probably get-
ting enough. However, if you’re
fatigued or struggling with concen-
tration and your daily tasks, it’s time
to take action to reclaim a good
night’s sleep.
Changes with age
As you get older, three types of
changes often occur that may affect
your sleep. These include:
■ Normal changes in sleep pat-
terns — As you age, you spend more
time in lighter sleep stages and less
time in deep sleep. In addition, the
clock in your brain speeds up, cre-
ating the desire to go to bed earli-
er and earlier. Consequently, you
may wake up earlier, as well. Try to
SEPTEMBER 2005
Sleep solutions
In some cases, simple
changes in your daily and
nightly habits may result in
better sleep. This may mean
finding ways to unwind and
relax, limiting the time you
spend in bed to when you
are sleeping, and avoiding or
limiting caffeine, nicotine
and alcohol. Regular exer-
cise enhances sleep, but
avoid exercising too close to
bedtime. Also try to avoid
naps or limit them to less
than 30 minutes. Long naps
may make it harder to fall
asleep at night.
Your doctor can help you
overcome the obstacles
keeping you from getting
enough sleep. This may
involve getting treatment for
sleep disorders and other
conditions.
resist the temptation to go to sleep
earlier by going outside in the
evening. The bright light you absorb
in the evening helps you to main-
tain your clock.
■ Changes in activity — De-
creases in your physical or social
activity may play a role in your sleep
patterns, since activity helps pro-
mote a good night’s sleep.
■ Changes in health — Chronic
pain associated with conditions such
as arthritis or back problems can
interfere with sleep. So can depres-
sion, anxiety and ongoing stress.
Older men often develop noncan-
cerous enlargement of the prostate
gland (benign prostatic hyperplasia,
or BPH). This may be associated
with the need to urinate more fre-
quently during the night. In women,
hot flashes associated with meno-
pause can be disruptive to sleep.
Sleep-related disorders, such as
sleep apnea and restless legs syn-
drome, also become more common
with age. There’s also evidence that
some breathing problems can dis-
rupt sleep. Certain medications are
also a cause of insomnia, and nico-
tine and alcohol can disrupt sleep.
Why it’s important
Lost sleep may sap your moti-
vation and make it difficult to con-
centrate. Long-term deprivation can
affect both your physical and men-
tal health. Sleep helps bolster your
immune system. And, people with
chronic insomnia have an increased
risk of subsequent depression com-
pared with those who get adequate
sleep. However, it’s not clear if in-
somnia is a cause of depression, or
if treating insomnia reduces the inci-
dence of depression.
A recent study linked sleep dep-
rivation to obesity. People who are
sleep deprived experience hormonal
disruptions that result in increased
hunger and appetite.
How much is too much?
Needing too much sleep can be
a problem, too. In recent years, stud-
ies have found that the optimal
amount of sleep for most people is
seven hours. Compared with those
who sleep this amount, people who
sleep eight hours or more a night
have been shown to have a higher
mortality rate. Many experts believe
that needing excessive amounts of
sleep is likely a sign of underlying
health problems. People who regu-
larly sleep less than seven hours a
night also have a higher than nor-
mal mortality rate.
Remember, the most important
gauge of how much sleep you need
is how you feel during the day. Once
you’ve determined that, you can
either sleep easy or take steps to get
a better night’s sleep. ❒
 M AYO C L I N I C H E A LT H L E T T E R
Bruxism
Breaking the
teeth-grinding habit
Since your last dental check you’ve
developed cracks in three different
teeth. Judging by the wear on your
teeth, your dentist suspects the
cracks may be the result of clench-
ing or grinding your teeth.
The medical term for grinding,
gnashing or clenching your teeth
is bruxism. For most people, brux-
ism is only a mild, occasional prob-
lem of little consequence. But for
some, it can be a real problem.
Behind the grind
Some people grind their teeth at
night, others do so during the day.
There are others who grind during
the day and the night.
The causes of bruxism aren’t
completely understood. In the past,
it was thought that abnormal align-
ment (malocclusion) of the upper
and lower teeth contributed to the
problem. But studies have clearly
demonstrated that isn’t the case.
The tendency to clench or grind
your teeth during the daytime is
increasingly being viewed as a hab-
it, nothing more. It’s also a com-
monly held belief that bruxism may
be related to — but not necessari-
ly caused by — stress and anxiety.
During episodes of stress, peo-
ple commonly clench or grind their
teeth without being aware they are
doing so. On the other hand, early
morning jaw pain — including tem-
poromandibular joint pain — may
be related to bruxism that occurs
during the night. Evidence suggests
there may be a relationship between
bruxism and ongoing jaw muscle
pain or temporomandibular joint
pain — temporomandibular joint
(TMJ) disorders. Painful jaw muscles
SEPTEMBER 2005
Finding the neutral
mouth position
Whenever you find yourself
clenching or grinding your
teeth during the day, stop for
a moment and make these
simple adjustments to relax
your jaw:
■ Note the placement of
your tongue when you say
the letter “n”
■ Lightly place your
tongue in that position just
behind your upper front
teeth
■ Separate your teeth just
slightly
Repeatedly relaxing your
jaw in this manner can help
break the bruxism habit.
also may be a symptom of certain
inflammatory conditions of the
blood vessels.
Bruxism may also be an uncom-
mon side effect of some antide-
pressant medications, particularly
the selective serotonin reuptake
inhibitors (SSRIs). Some of these
include citalopram (Celexa), esci-
talopram (Lexapro), fluoxetine (Pro-
zac), paroxetine (Paxil) and sertra-
line (Zoloft). In addition, any sort of
stimulant — such as caffeine — may
contribute to bruxism.
Telltale signs
Aside from actual clenching or
grinding that may occur in the night
or during the day, there are other
signs and symptoms of bruxism.
These may include:
■ Flattened, chipped or worn
teeth — although it’s normal to have
some age-related tooth wear
■ Unusual sensitivity of teeth
■ Dull, aching jaw pain
■ Chewed tissue on the inside
of your cheek in your mouth
7
Once you recognize bruxism
may be the reason for mouth-relat-
ed discomfort or tooth damage,
there are steps you can take to inter-
fere with or even stop this habit.
These include:
■ Use of a splint or mouth guard
— These dental prostheses can be
worn on the upper or lower teeth,
usually on an ongoing basis. You
may opt to have your dentist make
a custom-fitted splint for your teeth.
Another option is to purchase a
mouth guard from a sporting goods
store. These are less expensive, but
they also may not be as comfortable
as a splint that is made specifically
for your teeth.
■ Behavior modification — There
are steps you can take to change
your behavior and break the day-
time habit of bruxism. Practice put-
ting your mouth in a neutral posi-
tion. (See “Finding the neutral mouth
position.”) Use stickers or visual cues
in your home, place of work or car
to remind you to relax your jaw.
Over time, being attentive to these
visual cues and repeatedly placing
your mouth in a neutral position will
help discourage habitual clenching
and grinding during the day.
■ Medication — If you wake up
with pain from clenching or grind-
ing, certain drugs can be effective
in managing sleep-related bruxism.
These include the benzodiazepine
drug clonazepam (Klonopin, others)
and tricyclic antidepressants, such
as nortriptyline (Aventyl, Pamelor,
others). If you take an SSRI, your
doctor may suggest decreasing the
SSRI dosage or possibly taking the
anti-anxiety drug buspirone (BuSpar,
others) in addition to your SSRI.
In some instances, it may be
determined that bruxism is strong-
ly related to psychological stressors.
If that’s considered the case, focused
cognitive behavior therapy may help
reverse a bruxism habit. ❒
8 M AYO C L I N I C H E A LT H L E T T E R
Second opinion
Questions and our answers
Q: I have an underactive thyroid
and take the thyroid drug levothy-
roxine. I also take a calcium sup-
plement to help prevent osteo-
porosis. I’ve heard that I should take
these two at different times of the
day. Is this true?
A: Yes it is.
In some people, taking a calci-
um supplement has been shown to
interfere with the body’s ability to
absorb levothyroxine (Levothroid,
Levoxyl, Synthroid), thus reducing
thyroid levels to below what the
body requires. However, this effect
appears to occur only when the
medication and supplement are
taken at the same time.
If you take a calcium supple-
ment — as many people do for gen-
eral osteoporosis prevention — Mayo
Clinic doctors say that the thyroid
drug and the supplement should be
taken at least four hours apart so that
your body can properly absorb your
thyroid medication. It’s also best to
take thyroid medications each morn-
ing before eating. ❒
Q: Please explain the difference
between seborrhea and psoriasis.
A: Seborrhea, also called seborrheic
dermatitis, is a common, generally
mild skin disorder. It’s characterized
by greasy scaling, itchiness and a
somewhat reddened appearance of
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Seborrhea most commonly affects the scalp,
nose, eyebrows, area behind the ears and
the chest.
Psoriasis usually affects the elbows, knees,
trunk and scalp.
the skin. It most commonly affects
the scalp, nose, eyebrows, area be-
hind the ears and the chest.
Seborrhea tends to run in fami-
lies. In the scalp, it causes dandruff,
which can be associated with an
itchy scalp. In infants, it may appear
as crusty, scaly skin on the scalp
called cradle cap.
Treatment for seborrhea gener-
ally can help keep it under control.
If dandruff is the problem, daily
shampooing and careful rinsing may
help. Your doctor may recommend
using a nonprescription medicat-
ed shampoo containing ketocona-
zole, tar, zinc pyrithione, selenium
sulfide or salicylic acid. Creams or
solutions containing hydrocortisone
or ketoconazole cream may help
treat other affected areas.
Psoriasis is also a common skin
disorder but ranges from being a
mild nuisance for some to being
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totally disabling for others. Psoriasis
affects the life cycle of skin cells,
resulting in the rapid accumulation
of cells that form dry, red patches of
skin covered with silvery scales. The
inflammation usually affects the el-
bows, knees, trunk and scalp. Psor-
iasis tends to flare periodically and
then subside for a time, but it almost
always returns. Scalp psoriasis and
scalp seborrhea can be hard to dif-
ferentiate. Sometimes the diseases
overlap. Fortunately, treatments for
both are similar.
Like seborrhea, psoriasis is be-
lieved to be an inherited disorder.
Although psoriasis can’t be cured,
treatments are usually effective but
must be tailored to each person,
especially in more severe cases. In
mild cases, nonprescription soaps,
shampoos or ointments may suffice.
Otherwise, prescription ointments,
prescription oral medications or
phototherapy may be necessary. ❒
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