Recently the American, Canadian, and Australian Dental Associations recommended that dentists routinely screen for sleep disorders, particularly sleep apnea. When your dentist screens for sleep disorders, you can expect a comprehensive evaluation of your oral and dental health as well as an assessment of your risk factors for sleep apnea. The goal of screening for sleep apnea in a dental setting is to identify those who may be at risk for the disorder and facilitate appropriate referrals and interventions to improve their sleep quality and overall health.
What sleep-related disorders can my dentist screen me for?
Obstructive sleep apnea and snoring:
Snoring is the sound made when air passes over soft tissue. It can be annoying but is not harmful. Obstructive sleep apnea is a medical condition in which the airway becomes blocked, triggering the brain to wake, just enough to breathe again and the cycle repeats. This disrupts sleep leaving a person feeling ‘foggy’ and ‘unrefreshed’ when they wake.
It’s not possible to distinguish between snoring or sleep apnea without a sleep study and interpretation by a board-certified sleep physician.
What will my dentist look for to determine if I have a sleep disorder?
Your dentist may conduct a physical examination of the oral cavity and throat. During the dental evaluation, they will look for signs of airway obstruction or other anatomical factors that could contribute to sleep apnea such as enlarged tonsils or a recessed jaw. Your dentist may measure your neck circumference, examine your teeth, and how your jaws align as certain dental issues such as a misalignment or a narrow palate can contribute to sleep apnea.
Your dentist will review your medical history and medications. This can provide valuable clues in revealing the bigger picture. For example, something as seemingly innocent as a chronic dry mouth in the morning, chronic indigestion, snoring, fatigue, or frequent nighttime waking may be signs of an untreated sleep disorder. Untreated obstructive sleep apnea has been linked to many medical conditions such as hypertension, type 2 diabetes, stroke, and abnormal heartbeat (AFIB).
Your dentist is an expert at noticing even slight signs of wear to your teeth. Sleep bruxism, or grinding your teeth at night, can lead to permanent loss of tooth structure and cause pain by overworking the muscles of the face.
As a patient, what should I ask my dentist?
Share your concerns and those of your bed partner regarding snoring, frequent night waking (even if it’s just to reposition or use the bathroom), daytime fatigue, and changes in your medical history. Let your dentist know if other blood relatives have a history of sleep disorders.
If a loved one believes you stopped breathing during your sleep notify your provider.
Can every dentist treat sleep disorders or only those who are specially trained?
Dentists have very specialized training. Some focus on oral surgery or orthodontics while others focus on root canals or cosmetic dentistry. Not every dentist chooses to train in the field of dental sleep medicine. Those who have completed advanced training in dental sleep medicine through the American Board of Dental Sleep Medicine (AADSM) can create custom-made oral appliances to manage obstructive sleep apnea and snoring. This happens after a diagnosis by a board-certified sleep physician who will interpret the findings of a sleep study. Your care is a collaboration between your providers to find the most appropriate treatment based on your specific needs. The treatment options include CPAP or BiPAP, custom-made oral appliances, and surgical intervention.
How do I find a dentist who can treat sleep disorders?
To find a dentist who has received advanced training and those who have completed the AADSM diplomate status in dental sleep medicine, please refer to www.aadsm.org Find-A-Dentist.
Michelle Cantwell, DMD, is a prosthodontist for the Pulmonary & Sleep Medicine Department of WellSpan Health. She is board-certified in dental sleep medicine, an instructor for the AADSM’s Mastery Program, and has been named as President-Elect of the AADSM.