Patients with obstructive sleep apnea (OSA) are at risk of serious health problems including heart disease, memory loss, diabetes, stroke, impotence, and depression. Yet many of them remain undiagnosed. Dentists, however, can play a key role in identifying them and getting them the treatment they need.
“Dentists already have the patient relationships and tools to really make a difference in the lives of the millions of people who don’t know that they are suffering from sleep apnea,” said Kathleen Bennett, DDS, president of the American Academy of Dental Sleep Medicine (AADSM).
“Dentists routinely see patients every 6 to 12 months, which gives us regular opportunities to perform an intraoral and upper airway examination while also asking sleep-related questions to help assess their risk for obstructive sleep apnea,” said Bennett.
Characterized by loud snoring, sleep apnea occurs when the tongue and soft palate collapse onto the back of the throat, blocking the upper airway and obstructing breathing up to hundreds of times a night. Dentists can increase awareness of OSA and help patients pursue diagnosis by identifying at-risk patients and treating diagnosed patients with oral appliance therapy.
By combining a traditional intraoral exam with an upper airway evaluation, dentists can identify key physical attributes that correlate with sleep-disordered breathing, such as a large tongue or a long soft palate. Dentists also can ask simple questions about snoring or daytime sleepiness or use a validated questionnaire such as the University of Toronto’s STOP-Bang to identify patients with a high risk of OSA.
The AADSM offers courses and resources for dentists and others who need a basic understanding of OSA and its symptoms. For example, its 40-minute, Web-based “Introduction to Sleep and Sleep Disordered Breathing” learning module provides an overview of the nature and physiology of sleep as well as the causes, risk factors, and consequences of OSA.
“With so many untreated sleep apnea sufferers at risk of serious comorbidities, we need to learn how to recognize the warning signs for the disorder,” said Bennett. “Dentists can increase sleep apnea awareness by identifying at-risk patients and referring those with symptoms to a sleep physician for diagnosis.”
By referring patients to an accredited sleep disorders center, dentists can put patients on a path to improved sleep and health. Paying attention to sleep-disordered breathing also helps dentists strengthen patient relationships by demonstrating that they care about their patients’ general well being.
Patients with OSA often are prescribed continuous positive airway pressure (CPAP), though the AADSM says that only about half of these patients adhere to it. Oral appliances that are custom-fit by the dentist, the AADSM says, can be effective alternatives.
Oral appliances prevent the airway from collapsing by supporting the jaw in a forward position. More than 100 oral appliances cleared by the Food and Drug Administration are now available. Also, many insurances including Medicare cover oral appliance therapy, which can be comfortable, quiet, portable, and easy to maintain.
Qualified dentists can treat patients who have been diagnosed with OSA and prescribed oral appliance therapy. These dentists evaluate the patient’s teeth, jaw, and airway. Then, they determine the protrusive range with a measuring device and select the appropriate oral appliance to increase treatment success.
“Treating sleep apnea patients is rewarding, and I often hear from patients that my help improved their sleep and turned their lives around, lifting their mood and energizing their body,” said Bennett. “By providing dental sleep medicine services, dentists can benefit patients who are unable to tolerate CPAP and may otherwise go untreated.”
The AADSM offers its “Essentials of Dental Sleep Medicine” several times a year in multiple major cities in the United States. Designed for dentists who are new to dental sleep medicine, the in-person course reviews OSA and treatment options with a focus on appliance therapy while explaining how to get started in the field.