A sleep apnea is a disease that may cause the individual to not breath for several seconds and could wake up to breath again during his sleep. Its seen in patients who snore loudly during their sleep. By determining the cause of snoring, we can manage sleep apnea.
As a dentist, we are not authorized to diagnose sleep apnea since its a medical problem and thus require the examination by a physician particularly a medical sleep specialist or ENT (Ear, Nose, and Throat) specialists. You will have to consult their advice as they may require you to do a sleep study to determine the severity of the condition.
I would say its a serious problem on the long run since it has many risk factors for strokes, coronary artery disease, mood changes, hypertension, cardiac arrhythmia and insulin resistance. By getting yourself diagnosed, you will feel energetic and fresh once you wake up like you have never been previously before.
There are many signs that can suggest sleep apnea although snoring is the characteristic feature. All dentist should ask their patients, wives or parents if the individual is snoring at night.
- Signs of Hypoxic (Lack of Oxygen) Distress
- High blood pressure
- Poor concentration
- Bags under the eyes (See Figure 1)
- Signs of Airway Distress
- Vaulted arched palate (See Figure 2)
- Narrow arch (See Figure 2)
- Large neck
- Uvula engorgement (See Figure 3)
- Mouth breathing
- Signs of Dental Distress
- Turkey waddle
- Overbite (See Figure 4)
- Bruxism (See Figure 5)
- Erosion (See Figure 6)
- Scalloped tongue (See Figure 7)
Of course these are just signs that might predict sleep apnea, the actual diagnosis itself relies on the sleep study that will be done by the physician. He/she will explain to you the ways to diagnose the problem and how treatment will be done.
If the cause is not from the mouth, then we will rely on the physician to solve the problem. If however, the obstruction of airway is as a result of a mouth condition, then we as a dentist should fabricate the necessary appliances that will have to be wear during sleep, and treatment shall depend on the physician’s recommendations according to its causes.
The question here arises, what oral appliance can we do?
We should work on oral appliances that will protrude and stabilize the mandible to maintain a patent airway during sleep. A custom oral appliance can be made digitally or using the physical impression techniques. It should be made of biocompatible materials and engages both the maxillary (upper jaw) and mandibular (lower jaw) arches. The oral appliances should be titratable so that they can allow for varying amounts of mandibular protrusion according to their mechanism. The increasing protrusion of the mandible is considered analogues to the migration of continuous positive airway pressure. Non-titratable oral appliances hold the mandible in a single protrusive position, and no changes are possible over the course of treatment.
Now comes the guidelines, I will quote here what the updated 2015 American Academy of Dental Sleep Medicine Guidelines say.
- When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices.
- We suggest that qualified dentists provide oversight—rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence.
Another thing that might come on your mind, is that does this oral appliance have side effects?
The answer is yes, oral appliances may aggravate temporomandibular disorder (TMD) and may cause dental misalignment and discomfort. In addition, oral appliances can be rendered ineffective by patient alteration of the device. Specific side effects differ widely in types and severity, but most are of a dental nature: sore teeth, gum problems, sore jaw muscles, excessive salivation, difficulty chewing in the morning, dry mouth, and change in occlusion.
1- Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015 By The American Academy of Dental Sleep Medicine (AADSM).
2- Take The Time To Check For Sleep Apnea: By Erin E. Elliott, DDS in Dental Economics.
What do you think about this article and the science behind sleep medicine?
Let me know what you think in the comments.
Haider Maitham, DDS / Bondistry