
Don’t get mad at the patient; in this case he can’t bite on his back teeth. (The images are not underexposed; his teeth are really this dark). This is the result of long term snore guard appliance wear.
He has been in a snore appliance every night for five years. He noticed some changes in his bite almost immediately but was always able to get back on his back teeth. It slowly changed until he can no longer touch his back teeth.
This is a well-documented sequela of snore guard or forward-positioning appliances and should always be discussed with the patient before making the appliance. Most sleep physicians suggest a sleep study for patients whose snoring is a problem, and if therapy is indicated will prescribe CPAP before a snore guard.
If CPAP fails or the patient can’t tolerate the mask, then a forward-positioning appliance may be indicated. The consequences, of course, should always be discussed prior to beginning treatment.
Stay tuned for my next blog when we talk about treating this condition.

By now I’m sure you’ve heard about the technical glitch that occurred during the opening ceremonies of the Olympics here in Vancouver. After eight years of meticulous preparation and countless rehearsals, the show proceeded flawlessly for two hours—until the climactic moment when, with the world watching, one of the four hydraulic pillars that would form the centerpiece for the Olympic flame failed to emerge from the floor.
I’m back in my old hometown of Vancouver for the Olympics and what a phenomenal experience it is to come back to a place I know so well and see it so transformed. Everything I love about the city and its people—the deeply-rooted multiculturalism, the welcoming attitude, even the dazzling physical setting—are amplified and infused with new energy. Just walking the old familiar streets, now teeming with people and alive with an air of celebration, is electrifying.
See the little cupped out area in the mesiobuccal cusp of the molar? Until very recently, I didn’t know why it was there. As I write this I am sitting in the 




