sleep apnea and oral conditions

Getting some ZZZ’s: Beyond Teeth

I don’t snore… I just dream of being a motorcycle! Classic.

 

The more research that comes out, the more we are finding a link between sleep apnea and oral conditions. Basically, with a few simple questions and by looking in your mouth, I can screen you for sleep apnea!

We used to think that most Apnea patients are overweight middle age males that snore. We’re finding this is not the case. We see this a lot in kids (likely due to englarged tonsils) and females with perfectly healthy BMI’s! Consider Jenny, she is pretty much healthy and doesn’t snore, but she doesn’t feel like she sleeps particularly well, but doesn’t have time to be tired. She has her 2 cups of coffee in the morning and is always finding stuff to do and to work on. She’s stressed out because of how many things she has on her plate, but doesn’t want to stop them because otherwise she would finally realize how exhausted she really was if she wasn’t “kept busy”.

Consider Johnny, 8 year old kid with enlarged tonsils who also doesn’t sleep well. He snores, grinds his teeth at night, and sometimes gasps for air. He has night time urination, acts out in class, and his pediatrician thinks he should be on ADHD medicine because he can’t concentrate. Sound familiar?

 

I don’t have to tell you how big a deal sleep is! Yet we all take it for granted. If I told you that there was something you could change that would decrease your odds of a heart attack by 23:1 would you do it? Sleep apnea has a heart attack risk factor increase of exactly that much as compared to smoking which is only 11:1 or High Blood Pressure which is 8:1.

Additionally, there are some stats that say if you have uncontrolled high blood pressure even with medication, you have a 83% likelihood of having Sleep Apnea. The other big kicker is GERD, or gastric reflux. Having GERD means you a 60% likelihood of concurrently having Sleep Apnea.

How do we screen for sleep apnea? Well, for one there are some questions we can ask. Have you been told how much you snore? Are you often tired during the day? How likely are you to fall asleep while watching TV. Do you wake up tired? These can be flawed because watching golf will almost certainly put me to sleep =)

We then take a look at your airway to see how much constriction there is. The teeth can be very telling of apnea. The neat thing about our bodies is we are adaptable and of course we HAVE to breathe. So at the expense of our teeth and sleep, our body’s responses to apnea is a microarousal where we either move around during our sleep (causing fragmented or poor quality sleep) or we thrust our jaw in order to open the airway, this can cause a very particular pattern of wear on the teeth. We can also see changes to the tongue and the gums. Take for example, do you notice a difference between these two mouths?

 

With apnea the pressure in our abdomen changes which is why it increases our risk of having acid reflux and will secondarily cause frequent night time urination. Look at what reflux can do to our teeth!

If we see these risk factors, we will likely refer for a sleep study. An at home study can be prescribed as a further screening tool, but an in lab Polysomnograph is needed for a formal diagnosis. Once diagnosed there are a few things we can do to treat Apnea. One is a CPAP machine. These are very effective but some people aren’t able to tolerate them. Doesn’t this fella look comfortable?

Another is a mandibular advancement device. This is a mouth guard that holds the lower jaw forward. It can be much more comfortable and a great option for someone who can’t tolerate a CPAP. There are some drawbacks to this such as slight tooth movements and this device can worsen TMJ symptoms if you already have TMJ issues.

Lastly there are surgical interventions. If the apnea is being caused by deviated septum or in the nasal region that can be fixed by an ENT. If the obstruction is from the throat area, surgeries like a UPPP can be done.

The takeaway here is that Sleep Apnea can have some serious consequences but the good news is dentists are now screening for this and there is treatment out there! If you or someone you know has suspected sleep apnea, please have them contact their primary care physician or give us a call! Keep Smiling ! 🙂