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Thursday, June 30, 2016
Dentist with patient

Successful Sleep Dentistry Article #1 - Identifying Sleep Apnea in Your Dental Patients

The Rise of Need For Dentists to Treat Obstructive Sleep Apnea

The need for dentists to take a greater role in the identification and treatment of obstructive sleep apnea (OSA) has never been higher; according to a Harvard health report approximately 25 million adults in the U.S. suffer from the condition and almost 19 million of them are undiagnosed. OSA is a condition that affects the airway and since dentists and dental hygienists see the airway of their dental patients every day, they can potentially be the first line of defense in the identification of OSA, a condition that leaves sufferers excessively tired and increases the chance of suffering from cardiovascular problems.

 

Gary's Story

“Gary walked into the dental office, asked for Dianna, our hygienist, gave her a big hug and said, ‘You changed my life!’.

For many years, Gary would come in for a periodic dental prophylaxis, and as soon as the dental chair was reclined, he immediately fell asleep and started snoring. Dianna tried a few times to wake him, but she quickly realized it was useless. She continued to clean his teeth while he was sleeping.

Gary is 45 years old, in good health and in good shape. You would not expect him to be a severe sleep apnea patient, but he suffered from excessive daytime sleepiness. He felt he was sleeping his life away – not able to spend quality time with his family. His snoring had become so bad that he no longer slept in the bedroom with his wife.

Dianna showed Gary many of the anatomic indicators of sleep apnea while he was in the dental chair for his cleaning appointment. She reviewed his symptoms and saw that they were consistent with what she saw. Dianna informed Gary that he should see a sleep specialist and discuss if he is a candidate for a sleep test. He was tested with a sleep study and diagnosed with severe obstructive sleep apnea.

Gary was first recommended to use a CPAP machine but found he was not able to tolerate it. He was then referred for oral appliance therapy, which finally gave his energy and life back. The daytime sleepiness is gone, the snoring is gone and Gary is now back in the bedroom with his wife.

Recently our hygienists all took dental sleep medicine training and learned how to screen patients for the signs and symptoms of obstructive sleep apnea.  As a dental hygienist with the awareness and training for screening for sleep apnea, Dianna has truly changed the lives of her patients. Now she consistently gets big hugs.”

Dr. Barry Chase, an expert sleep dentist with over 10 years’ experience in the field, shares the above true story from his practice.

 

Dentist's Role in Treating OSA

There are over 100,000 dentists in the U.S., each seeing between eight and 15 patients per day. The American Dental Association states that 60% of the U.S. population sees a dentist every year, meaning that most dental practices will have several undiagnosed OSA sufferers walk through their doors on a daily basis. Dentists and dental hygienists are in a unique position to identify the intraoral indicators of OSA while assisting patients with other dental needs, and many already do in cases for oral cancer. The same can be applied for OSA. Even though the formal diagnosis of OSA should be made by sleep physicians, sleep dentists and hygienists can take the role of identifying, referring and, in many cases, treating OSA patients and help them get their lives – and health – back.

 

Identifying the Signs of OSA Among Your Patients

For dentists that are expanding into the field of sleep dentistry, step one to grow a sleep practice is to know how to detect the signs of OSA among the patients who come for dental treatment. In a normal intraoral cavity exam the dentist will need to keep an eye out for the following indicators: A large scalloped tongue[1]

  • Narrow maxillary and mandibular arches[2]
  • A narrow vaulted hard palate[3]
  • Class II retrognathic mandible[4]
  • Inability to see the posterior wall of the pharynx, and associated tissues[5]
  • A long soft palate hanging below the level of the posterior aspect of the tongue (Fig. 1 Mallampati score)[6]

 

 

Fig. 1  Mallampati Score

 

Additionally, dentists should look at other signs patients may exhibit as indicators of sleep apnea. Some of the other non-intraoral signs include:

  • Deviated septum[7]
  • Large neck circumference (greater than 15” in women; 17” in men)[8]
  • Obesity (BMI > 30)[9]
  • Head forward posture and open bites with mouth breathing[10]
     

OSA causes patients to experience a number of side effects. It is not uncommon for patients to normalize their symptoms, as they may consider several symptoms a day-to-day aspect of their lives. Patients may report the following symptoms, comorbidities and other indicators:

  • Excessive daytime sleepiness (EDS)[11]
  • Loud and persistent snoring[12]
  • Waking with headaches[13]
  • Fragmented sleep with frequent awakenings[14]
  • Moodiness and irritability from chronic OSA sleep deprivation[15]
  • Memory impairment[16]
  • Not feeling clear minded, having “foggy brain”[17]
  • Bed partner witnessing apneas (periods of not breathing)[18]
  • Waking choking or gasping for breadth[19]
  • High blood pressure[20]
  • Adult Type II diabetes[21]

 

Building a Sleep Dentistry Practice

The majority of patients coming through a dental practice will be largely ignorant of OSA, and even those that are familiar with the condition may not realize that it can be treated at their dentist’s office. This is why it’s important to begin raising awareness of your sleep practice and provide OSA education to your dental patients effectively. This can be accomplished by taking the following steps:

 

Marketing a Dental Sleep Practice

Dentists can show patients and their communities that they are an expert in the field of sleep dentistry and the go-to person with sleep apnea issues. This can be accomplished by organizing or participating in community events to educate the public on OSA and oral appliance therapy (OAT). Sending newsletters to your dental patients or local community and creating an informative section for OSA and OAT on their website is another effective way to market a sleep practice. Provide educational resources for OSA and OAT in the waiting room An effective approach is to educate patients in the waiting room or even chair-side. Placing posters and leaflets in the waiting rooms, as well as preparing apps or devices to test the oxygen level for visitors waiting for their treatment are very effective ways to build awareness of OAT in the practice itself.

 

Educate others within the dental practice

Building a sleep dentistry practice cannot be done if only the dentists are educated. Screening patients for sleep apnea is most effective when the entire practice is educated on sleep dentistry. A dentist should make his or her own dream team for sleep apnea treatment, including an administrator, hygienist and dental assistants, and educate them in the different aspects of sleep dentistry. There are some training courses available that focus not only on the dentist but the entire practice.

 

Finding a Trusted Partner

The medical device company Whole You collaborates with expert sleep dentists and provide effective oral appliances for OSA treatment. Whole You is also committed to support dentists who want to start practicing dental sleep medicine and further enhance the knowledge of the experienced sleep dentist practitioner. This series of articles, commissioned by Whole You, to provide practical tips and resources to new or experienced sleep dentists with expanding their practice will be posted on www.wholeyou.com every month so check back on a regular basis for more information.   

Whole You provides resources to help dentists grow their sleep dentistry practice, which are available at the Professional Resource section of the website.

If you are interested in oral appliance therapy to add as a treatment option for your patients please call the Whole You call center at 844-548-3385 (toll free) or visit www.wholeyou.com.

Whole You has recently released a new generation of Oral Appliances, Respire EF, with significantly more tongue space. To learn about Respire EF, visit https://www.wholeyou.com/medical-products/sleep-apnea-devices/sleep-ef for more information.

 

Further Reading

Successful Sleep Dentistry Article Series

#2 :The Do’s & Don'ts During Your Patients’ First Sleep Apnea Consultation

#3 :Five Steps For A Successful Relationship With A Sleep Physician

#4 :Check Points to Select the Oral Appliance That’s Right for Your Patient

#5 :A Sleep Dentist’s Guide to Begin Medical Insurance Billing

 

 

Other Sleep Apnea related articles

 



[1] “Scalloped Tongue Causes, Pictures, Hypothyroid, Diagnosis & Treatment.” Heal Cure http://www.healcure.org/tongue/tongue-problems/scalloped-tongue-causes-p.... 29 June 2016.

[2] Gungor, Ahmet Yalcin, and Hakan Turkkahraman. "Effects of Airway Problems on Maxillary Growth: A Review." European Journal of Dentistry 3.3 (2009): 250-54. Print.

[3] Gungor, Ahmet Yalcin, and Hakan Turkkahraman. "Effects of Airway Problems on Maxillary Growth: A Review." European Journal of Dentistry 3.3 (2009): 250-54. Print.

[4] Hamada, Takashi et al. "Mandibular Distraction Osteogenesis in a Skeletal Class II Patient with Obstructive Sleep Apnea." American Journal of Orthodontics and Dentofacial Orthopedics 131.3 (2007): 415-25. Print.

[5] Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of Sleep Apnea. Physiological Reviews 2010;90(1):47-112. doi:10.1152/physrev.00043.2008.

[6] G. Liistro, Ph. Rombaux, C. Belge, M. Dury, G. Aubert, D.O. Rodenstein. "High Mallampati Score and Nasal Obstruction Are Associated Risk Factors for Obstructive Sleep Apnoea." European Respiratory Journal 21.2 (2003): 248-52. Print.

[7] Georgalas C. "The role of the nose in snoring and obstructive sleep apnoea: an update." European Archives of Oto-Rhino-Laryngology 268.9 (2011):1365-73. doi:10.1007/s00405-010-1469-7.

[8] "Sleep Apnea." WebMED. http://www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea. Web. 29 June 2016.

[9] Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. “Interactions Between Obesity and Obstructive Sleep Apnea: Implications for Treatment.” Chest 137.3 (2010):711-19. doi:10.1378/chest.09-0360.

[10] VERON, Helenize Lopes et al. “Implications of mouth breathing on the pulmonary function and respiratory muscles.” Rev. CEFAC 18.1 (2016).

[11] Slater G, Steier J. “Excessive daytime sleepiness in sleep disorders.” Journal of Thoracic Disease 4.6 (2012): 608-16. doi:10.3978/j.issn.2072-1439.2012.10.07.

[12] “What is sleep apnea?” National heart, Lung, and Blood Institute http://www.healcure.org/tongue/tongue-problems/scalloped-tongue-causes-p.... 29 June 2016.

[13]Almoznino, Galit et al. “Sleep disorders and chronic craniofacial pain: Characteristics and management possibilities.” Sleep Medicine Reviews 0.0. http://dx.doi.org/10.1016/j.smrv.2016.04.005.

[14] “Obstructive Sleep Apnea, Daytime Sleepiness, and Type 2 Diabetes.” The Diabetes Educator 33 (2007): 475-82.

[15] “What Are the Signs and Symptoms of Sleep Apnea?” National heart, Lung, and Blood Institute https://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/signs. 29 June 2016.

[16] “What Are the Signs and Symptoms of Sleep Apnea?” National heart, Lung, and Blood Institute https://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/signs. 29 June 2016.

[17] "Sleep Apnea Symptoms." WebMED http://www.webmd.com/sleep-disorders/sleep-apnea/symptoms-of-sleep-apnea. Web. 29 June 2016.

[18] “What is sleep apnea?” National heart, Lung, and Blood Institute http://www.healcure.org/tongue/tongue-problems/scalloped-tongue-causes-p.... 29 June 2016.

[19] "Sleep Apnea Symptoms." WebMED http://www.webmd.com/sleep-disorders/sleep-apnea/symptoms-of-sleep-apnea. Web. 29 June 2016.

[20] “What is sleep apnea?” National heart, Lung, and Blood Institute http://www.healcure.org/tongue/tongue-problems/scalloped-tongue-causes-p.... 29 June 2016.

[21] “What is sleep apnea?” National heart, Lung, and Blood Institute http://www.healcure.org/tongue/tongue-problems/scalloped-tongue-causes-p.... 29 June 2016.