The relationship between sleep apnea and dentistry

By Michelle Kratt

I recently attended a course by Sleep Group Solutions and was amazed at some of the information they shared about sleep apnea and dentistry. Sleep apnea, also known as obstructive sleep apnea (OSA), is a common disorder that affects more than 18 million people in the United States alone. Out of all these people, less than 10% of OSA sufferers have been diagnosed. People with sleep apnea literally stop breathing repeatedly during their sleep, often for a minute or longer. If left untreated, OSA can take eight to 10 years off someone’s life.

Editor's Note: To see more information on OSA, please click here.

If not treated, OSA can also cause driving and work-related accidents, depression, memory loss, impaired concentration, high blood pressure, heart disease, and stroke. More studies are showing a correlation between sleep apnea and attention deficit disorder (ADD). Some experts believe that most people who suffer from sleep apnea also exhibit ADD, but the actual cause is still unknown. Children who are sleep deprived are often misdiagnosed as having ADD since these deficits can lead to behavioral problems and lowered daytime performance, accompanied by mood disorders.

So, how does this relate to us in the dental profession? Most people see their dentist or dental hygienist more often than they see their primary care physician, so we have a better chance of diagnosing something like this.

When you review patients’ medical history, check if patients have any of these — enlarged tongue, high blood pressure, stroke, diabetes, enlarged tonsils, obesity, or GERD. If so, you should ask if they snore, if they’ve been told they snore, if they wake up with headaches, or if they feel sleepy throughout the day.

What do you do if you have a patient who snores and has some of these other medical conditions or symptoms? Dentists are not permitted to diagnose sleep apnea. Diagnosis should be done at an accredited sleep center, but that doesn’t mean the dentist can’t do some screening and provide treatment for sleep apnea.

The standard treatment right now is CPAP (Continuous Positive Airway Pressure), but 25% to 50% of sleep apnea patients do not comply with or tolerate CPAP. That’s where we as dental professionals come in. Oral appliances are used to reposition the tongue and lower jaw forward during sleep to maintain the open airway. Usually, oral appliances are recommended for mild to moderate OSA patients, but can be used in severe OSA patients who cannot tolerate CPAP. Some recent studies show oral appliances to be the most effective in treating snoring and mild to moderate obstructive sleep apnea.

So the least we can do for our patients is ask a few questions and refer them to a physician. But think of how appreciative they will be when they start getting a good night’s sleep and their family stops waking them in the middle of the night because they’re snoring too loud.

As someone who was diagnosed with OSA and has a CPAP machine that is collecting dust, I’m anxious to have an oral appliance made.

With almost 20 years of dental experience, Michelle Kratt is currently working on dual Fellowships with the Association of Dental Implant Auxiliaries and the American Association of Dental Office Managers (AADOM). Michelle is also the President of NEDAT Study Club for dental administrative team members, and was recently recognized by AADOM for her efforts. She can be reached at [email protected].