At your next dental appointment, don’t be surprised if the dentist asks about your sleep health. Dentists are now on the front lines of screening – and treating – health conditions that may prevent a good night’s sleep.
One sleep disorder, obstructive sleep apnea (OSA), can linger undiagnosed in children and adults. Those with OSA may experience disrupted sleep and serious health risks, like heart disease and diabetes, from an upper airway obstruction that causes frequent and significant pauses in breathing during sleep. Snoring is often a telltale sign.
“The dentist can be proactive in screening individuals because we sometimes see patients on a more regular basis than physicians do,” says Dr. Maria Therese Galang-Boquiren, an assistant professor of orthodontics at the University of Illinois at Chicago College of Dentistry.
Dr. Galang-Boquiren, also a sleep health researcher, says it’s becoming more common for dentists to screen patients for sleep health issues, either through patient questionnaires or interviewing patients. Some dentists may even measure patient neck circumference, which is correlated to Body Mass Index (BMI). A higher BMI is a risk factor for obstructive sleep apnea.
Dentists also notice the size of your tongue and tonsils. A March 2016 study led by the University at Buffalo and published in the Saudi Medical Journal found that oversized tonsils and tongue indentations (teeth imprints along the tongue which show it’s too large for the mouth) put people at high risk for OSA.
Dentists can’t make an official diagnosis of OSA. If a dentist suspects a sleep health issue, they refer the patient to a sleep physician.
The gold standard treatment for OSA is a continuous positive airway pressure machine (CPAP), worn at night. CPAPs have been shown to be more than 90 percent effective. Because of CPAP’s cumbersome nature, tolerance and adherence remain an issue for many patients, says Dr. Galang-Boquiren. Here, too, dentists have become part of the solution.
The Food and Drug Administration has approved oral appliances, custom-made mouthpieces worn at night, to treat mild to moderate sleep apnea. While their efficacy ranges around 40 to 60 percent, research has shown they have a higher adherence rate, making them comparable to CPAP in practicality, says Dr. Galang-Boquiren. Mandibular advancement splints, which advance the lower jaw to open obstructed airways, are the most commonly used oral appliances. The American Academy of Dental Sleep Medicine maintains a directory of dentists who are expert at treating OSA with oral appliance therapy.
“Dentists work in collaboration with the sleep physician,” says Dr. Galang-Boquiren. “Dental devices are offered as an alternative, and that expands the treatment options for this population of diseased individuals. In severe cases, an oral surgeon may be involved in advancing both upper and lower jaws.”
Oral health issues may also prevent you from getting a good night’s sleep. Sleep bruxism, also known as teeth grinding, is actually considered a sleep-related movement disorder. Sleep disordered breathing, such as OSA, is a clinical risk factor for sleep bruxism, though not a direct cause.
Dentists can tell if patients have sleep bruxism by looking at the condition of their teeth, particularly the molars. If allowed to progress, teeth grinding damages the occlusal surfaces of the teeth – the chewing and biting surfaces that come into contact with teeth in the opposing jaw. It can also lead to headaches, muscle pain in the face and jaw, and temporomandibular joint syndrome (TMJ). Dentists treat teeth grinding and clenching by fitting the patient with a specially made mouth guard.
Sleep bruxism is common in children, with a prevalence of over 49 percent in first graders and decreasing with age, according to a review published in the Dental Press Journal of Orthodontics. For young adults ages 18 to 29, the prevalence is 13 percent.
If your dentist suspects sleep bruxism is related to sleep disordered breathing, he or she may recommend seeing a sleep medicine specialist.
The main issue with children, that dentists are often first to notice, which may affect nighttime breathing and sleep health, says Dr. Galang-Boquiren, is enlarged tonsils. “In kids, if warranted, the first line of treatment is tonsil and adenoid removal. An ENT [ear, nose and throat specialist] referral is commonplace.”
Dr. Galang-Boquiren stresses that research is still lacking in the dental sleep medicine field. “Long term, well-controlled studies of all dental treatment alternatives for sleep health issues are definitely needed,” she says.
To find out how you can get a better night’s sleep, watch this Sleep Number® video of Sleep Geek Pete.