Dental sleep medicine focuses on identifying adults and children who exhibit signs and symptoms of sleep breathing disorders; screening them in collaboration with a sleep physician specialist; and, when indicated, providing proven and effective oral appliances to treat the disorder. When the problem is severe, treatments may include oral or upper airway surgery.
Dental sleep medicine represents an amazing opportunity for properly trained dentists to provide potentially life-saving care while simultaneously increasing their revenue potential. Because dentists see many patients every 6 to 12 months, they may be the first to suspect that an adult or child has a sleep breathing disorder. Often undiagnosed in as many as 12 million Americans, sleep breathing disorders are potentially dangerous and life threatening if not treated properly.
Snoring and obstructive sleep apnea are the most common sleep breathing disorders. Snoring is the sound created when a person breathes during sleep; the soft tissues in the mouth and throat relax, causing the airway to narrow and become smaller—or partially obstructed. Snoring is a strong indication that an individual has a more serious sleep breathing disorder, such as sleep apnea.
Sleep apnea is the cessation of breathing during sleep. Obstructive sleep apnea is caused by an airway blockage from excessive tissue at the back of the tongue, throat or nose. Untreated sleep apnea affects an individual’s well-being and may cause high blood pressure, cardiovascular disease, and memory and concentration loss. Additionally, because sleep apnea reduces sleep quality and leads to daytime sleepiness, driving or operating machinery become dangerous.
During a patient’s regular appointment, it’s possible for dentists and team members to find tell-tale signs of potential sleep breathing disorders when visually examining the mouth, tongue, and throat. These signs may include a severely enlarged tongue, a narrow lower jaw, enlarged tonsils, and large uvula. Other indicators might be identified when examining radiographs, such as a disproportionate amount of space between the tongue and soft palate, or CBCT scans, such illustrate the areas and extent of airway obstructions.
When a sleep breathing disorder is suspected, it’s important for dentists and/or team members to further screen patients by asking specific questions, such as those listed below, to determine if further diagnostic testing and referral to a sleep physician specialist is necessary. If a patient answers “yes” to two or more of these questions, they could be potentially at risk for a sleep breathing disorder.
- Do you feel tired, fatigued, or sleepy during the day?
- Has anyone seen you stop breathing while you sleep?
- Do you have, or are you being treated for, high blood pressure?
- What is your body mass index? Are you 30 pounds or more overweight?
- Are you older than 50 years of age?
- Is your neck circumference greater than 15 ¾ inches?
- Are you male?
However, the only ways to diagnose moderate-to-severe sleep breathing disorders are an overnight sleep study at a healthcare facility, or using a home sleep test. In either case, only a sleep physician can render the diagnosis. Therefore, it’s essential for dentists and their teams to establish mutually respectful collaborative relationships with sleep physician specialists.
Then, depending on the diagnosis, dentists can work with their DSG laboratory to provide patients with a custom, state-of-the-art, and scientifically proven oral appliance. Oral appliances have been cleared by the FDA to treat snoring and mild-to-moderate sleep apnea, but they can only be prescribed after a sleep breathing disorder diagnosis has been rendered.