By Sophia Bennett
Sleep related breathing disorders (SRBDs) are coming up in private and public conversations more than ever. Part of the reason is that the incidence of these conditions (which can include snoring, obstructive sleep apnea and upper airway resistance syndrome) is on the rise. People who are obese are more likely to have sleep problems. As the rate of obesity among Americans increases, so does the rate of SRBDs.
However, the bigger reason for the bump in diagnoses has to do with growing awareness and education. As more people understand what SRBDs are, they’re asking their doctor about them. In turn, a growing number of doctors are on the lookout for them.
Besides GPs, dentists may be the non-specialists in the best position to spot SRBDs. The reason is that many signs and symptoms of the conditions present in the oral cavity. Dr. Michael Giesy with the TMJ and Sleep Therapy Centre of Washington in Tacoma, who has specialized in sleep dentistry for over a decade, explains how dentists can spot those signs and why they should take the treatment of SRBDs seriously.
Why every dentist should understand SRBDs
SRBDs can lead to a variety of serious cardiovascular, metabolic and respiratory diseases. “If you stop breathing at night, your body will do whatever it can to open up your airway,” says Giesy. “And it will literally starve certain cells and organs of oxygen at that moment in time to reroute blood to more essential organs, such as the heart, lungs and brain. Apnea puts your body in a fight or flight response. Taking that oxygen and blood flow away from your other organs repeatedly 10 to 100 times per night can lead to numerous chronic medical conditions.”
Although dentists can’t diagnose sleep apnea and similar conditions, they can treat them by crafting custom oral appliances that help keep the airway open while a person is sleeping. As more dentists move into this field, Giesy says it’s important that they receive the correct training and stay up to date on the current best practices in the field.
“A lot of dentists believe the only way to open the airway is to protrude the jaw forward with a mandibular advancement device,” he reports. “If you do this too far you will dislocate the jaw.” In addition, people with sleep apnea are three times more likely to develop TMJ. A mandibular advancement device can exacerbate that condition.
“Ultimately, as dentists, we want to establish credibility in the medical community,” Giesy says. “Sometimes dentists believe that because they can make a night guard they can make an oral appliance. But we are treating a medical condition. We can’t treat a serious medical condition the same way we’re taught in dental school to make night guards.”
There’s tremendous value in crafting proper oral appliances for SRBD sufferers. Many of them can’t or won’t use a CPAP machine, which is the most common treatment for sleep apnea. An oral appliances gives them a great alternative.
Recognize and refer
Although not every dentist will learn to design and fit oral appliances, they can all play a role in identifying potential SRBDs. The process can start at the very beginning of an appointment with intake paperwork. Adding a few questions about sleep quality can help indicate whether a problem exists.
“There are some common oral signs and symptoms a dentist might see in their examination,” says Giesy. “If the person’s tongue is large for their mouth—which means large for the space between their teeth—it’s possible it’s blocking their airway during sleep. If you see scalloping, it’s the indentation of the tongue pressing against the teeth. That in and of itself is 70 percent predictive of a sleep breathing disorder.”
When he sees any of these signs, Giesy will talk to the patient about how they sleep. “Do they fall asleep easily? Do they stay asleep through the night? And when they wake up in the morning, do they feel rested?”
If the answer to these questions is no, he refers the patient to a sleep doctor for evaluation. “Some insurance companies require a primary care doctor to make that referral, but many will allow a referral from a dentist,” says Giesy. If your community doesn’t have such a facility or you don’t know who to refer the patient to, contact their physician and ask for a recommendation.
Dentists interested in learning more about SRBDs or getting trained on oral appliance manufacturing should contact the following professional organizations:
American Academy of Dental Sleep Medicine, aadsm.org
American Board of Craniofacial Dental Sleep Medicine, abcdsm-us.org
American Sleep and Breathing Academy, americansleepandbreathingacademy.com
In 2017 the American Dental Association issued a policy statement that provided guidance on identifying and treating SRBDs. View it at ada.org/sleepapnea.