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Dentist’s role in managing sleep apnea: What you need to know

InnoHEALTH magazine digital team — Thu, 19 Oct 2023 10:56:18 +0000

The daytime sleepiness linked to sleep apnea heightens the likelihood of accidents.

Sleep apnea, a frequently unacknowledged condition, possesses the potential to significantly impact one’s well-being and daily routines. This comprehensive article delves into the intriguing intersection of sleep apnea and dentistry, elucidating the role dental professionals can play in enhancing their patients’ sleep health.

Understanding Sleep Apnea:

Sleep apnea stands as a sleep disorder marked by recurrent interruptions in breath during slumber. These interruptions stem from a transient collapse or partial obstruction of the upper air passages, impeding the flow of air into the lungs. These episodes, referred to as apneas, can result in decreased oxygen levels in the blood and the disturbance of the typical sleep cycle. There are essentially two primary types of sleep apnea:

Obstructive Sleep Apnea (OSA): This represents the most prevalent form of sleep apnea. It materializes when the muscles at the rear of the throat excessively relax during sleep, culminating in a partial or complete blockage of the air passage. Consequently, individuals with OSA often exhibit loud snoring and encounter recurrent instances of breathing cessation, typically followed by a sudden gasp or snort as they briefly awaken to restore their airway. OSA can profoundly disrupt sleep, giving rise to daytime fatigue and a range of other health complications.

Central Sleep Apnea (CSA): CSA, less common than OSA, transpires when the brain fails to transmit the appropriate signals to the respiratory muscles. In contrast to OSA, CSA does not entail a physical obstruction of the airway. CSA is frequently linked to specific medical conditions such as heart failure or stroke.

The Impact on Health

Sleep apnea is a serious condition that can have significant health consequences if left untreated.

Daytime fatigue: Among the most prevalent and noticeable consequences of sleep apnea is an overwhelming sense of daytime drowsiness. Sleep disruptions caused by apneas can hinder individuals from attaining restorative sleep, resulting in persistent exhaustion and a reduced capacity to focus, execute daily responsibilities, and remain vigilant.

Increased risk of accidents: The daytime sleepiness linked to sleep apnea heightens the likelihood of accidents, encompassing motor vehicle crashes and workplace mishaps.

Reduced productivity: Unattended sleep apnea can lead to decreased productivity at work or in educational settings due to daytime sleepiness and cognitive impairments.

Cardiovascular health: Sleep apnea is correlated with an escalated risk of cardiovascular complications, encompassing hypertension, heart ailments, strokes, and irregular heart rhythms. The recurring oxygen level drops and stress imposed on the cardiovascular system during apneas can contribute to these health issues.

Metabolic health: Sleep apnea has been associated with disruptions in metabolism, including insulin resistance and type 2 diabetes. Disrupted sleep patterns and hormonal fluctuations associated with sleep apnea can lead to impaired glucose regulation.

Weight gain: While obesity is a significant sleep apnea risk factor, the condition can also foster weight gain. Subpar sleep can upset the equilibrium of appetite-regulating hormones, prompting increased hunger and cravings for unhealthy foods.

Mental health: Sleep apnea has been linked to mood disorders such as depression and anxiety. The chronic strain on the body and brain from frequent nighttime awakenings can contribute to emotional and psychological disturbances.

Cognitive function: Cognitive impairments, encompassing memory lapses, concentration difficulties, and compromised decision-making abilities, are commonplace among individuals with untreated sleep apnea. Over time, these cognitive deficits can impair overall cognitive functioning.

Quality of life:Sleep apnea can adversely affect an individual’s overall quality of life. The amalgamation of daytime fatigue, health concerns, and impaired daily functioning can result in diminished well-being and a lower quality of life.

These episodes, referred to as apneas, can result in decreased oxygen levels in the blood and the disturbance of the typical sleep cycle.

Sleep apnea and the role of dentists

A. Patient Assessment

Dentists can assess patients for signs and symptoms of sleep apnea during routine dental examinations. These include:

1. High Mallampati score (It’s an assessment done to describe the relative size of the base of the tongue compared to the oropharyngeal opening)
2. Enlarged tonsils
3. Bruxism (teeth grinding): The grinding of teeth is linked to sleep apnea and may indicate the presence of the condition.
4. Jaw structure: A misaligned jaw can contribute to airway constriction during sleep.
5. Oral tissues: The size and condition of oral tissues, including the soft palate and uvula, can contribute to sleep apnea.

A. Diagnosist

The process of diagnosing sleep apnea often involves a sleep study (polysomnography) conducted in a sleep clinic or at-home sleep apnea testing (HSAT). Based on the symptoms, clinical examination & tests, sleep apnea can be classified as obstructive sleep apnea (OSA), central sleep apnea (CSA), or complex sleep apnea syndrome (also known as treatment-emergent central sleep apnea).

B. Oral Appliance Therapy

One of the key ways dentists contribute to the management of sleep apnea is through oral appliance therapy. These custom-fitted devices, known as mandibular advancement devices (MADs) or tongue-retaining devices (TRDs), are designed to:

– Reposition the lower jaw and tongue to prevent airway collapse during sleep.
– Keep the airway open, reducing the frequency and severity of apneas.

These devices are effective for many patients, especially those with mild to moderate OSA. They are comfortable, non-invasive alternatives to continuous positive airway pressure (CPAP) machines and are often more tolerable for patients.

C. Collaborative Care:

Dentists work in collaboration with sleep medicine specialists to provide comprehensive care for sleep apnea patients. This multidisciplinary approach ensures that individuals receive personalized treatment plans that address both dental and medical aspects of the condition.

This multidisciplinary approach ensures that individuals receive personalized treatment plans that address both dental and medical aspects of the condition.

D. Patient Education
Patient education on sleep apnea is a crucial aspect of its management from a doctor’s perspective

1. Symptoms and Risks: Outline the common symptoms of sleep apnea, such as loud snoring, choking or gasping during sleep, excessive daytime sleepiness, and mood disturbances. Emphasize the potential health risks associated with untreated sleep apnea, including cardiovascular problems, metabolic disorders, and reduced quality of life.

2. Lifestyle modifications: Encourage patients to make positive lifestyle changes to reduce the severity of sleep apnea. This may include weight loss, regular exercise, smoking cessation, and reducing alcohol and sedative use.
3. Sleep hygiene: Educate patients about good sleep hygiene practices, which can help improve sleep quality regardless of the treatment chosen. This includes maintaining a consistent sleep schedule, creating a comfortable sleep environment, and avoiding stimulants before bedtime.
4. Patient Engagement: Empower patients to take an active role in managing their sleep apnea. Encourage them to track their symptoms, adhere to treatment plans, and communicate openly with their healthcare team.

Educating patients about sleep apnea helps them understand the condition, its potential consequences, and the importance of seeking diagnosis and treatment. Remember that patient education is an ongoing process. Patients may require reinforcement of information and support over time. Empowering patients with knowledge about sleep apnea and its management can lead to better compliance with treatment and improved long-term outcomes.

Sleep apnea is a serious condition that affects millions of people worldwide. Dentistry’s role in early detection, customized oral appliances, and collaborative care cannot be overstated. By recognizing the critical connection between sleep apnea and dentistry, patients can benefit from more accessible, comfortable, and effective treatment options, ultimately improving their quality of life and overall health. Regular dental check-ups might just be the first step in a journey towards better sleep and well-being.Remember, the path to better sleep and improved health begins with understanding and action.

Sweet dreams await!

“Composed by: Dr. Pratyusha, is a dental professional who keeps herself abreast with the latest developments in her field and she contributes her knowledge and insights to the dental community through her writings.”

The post Dentist’s role in managing sleep apnea: What you need to know appeared first on InnoHEALTH magazine.

Health and Oral Health Diseases

InnoHEALTH Magazine — Thu, 14 Nov 2019 11:06:01 +0000

Well, many of them must be wondering how that can be possible. But if we look over the past 2-3 decades, the mortality rate has increased to its next level, obesity being one of the rising causes. In 1990, the World Health Organization considered obesity as a global epidemic. And guess who made it go globally that vast? We humans did. Irregular eating habits, irregular sleep patterns, stressful life and not maintaining overall health is leading to an unsatisfactory life.

Talking about obesity, what is more important for the body? Nutritionist are vital to human development and maintaining health. 7 essential nutrients a body needs are water, carbohydrates, proteins, amino acids, fats, vitamins, minerals and omega-3 fatty acids.

Also Read: Super Foods For Your Diet This Winter

What exactly is obesity and why is it an important topic that everyone should be aware of? In simple terms, it means abnormal or excessive fat accumulation that may impair health. And it is an important concept in our day-to-day lives because of health consequences. Thus, in today’s generation an individual’s life is more interconnected to one’s personality, lifestyle, socioeconomic status, and social interactions.

Recently heard of benign obesity? It is a term sometimes used to describe a condition in which an individual is overweight or obese but does not suffer from any co-morbidities, such as diabetes, hypertension etc. Our daily lifestyle choices have a direct connection to whether or not a person is prone to facing obesity.

Also Read: Cover Your Ears on Public Transport

Asking about if obesity is hereditary? Then, genes aren’t the most worrisome risk of obesity. An individual’s upbringing can be, the way the family raises, the daily food intake, importance placed on physical activity and how a person would take their behaviour model, are the bigger influences on likelihood of obesity than genes. Health is not valued till sickness comes, true isn’t? Obesity is not because it runs in the family!! It is because no one runs in the family!!!

Today, more than 95% of all chronic diseases is caused by food choice. Yes,being overweight is linked to a number of health and oral health diseases, including: heart disease, high blood pressure, diabetes, cancer, gallbladder and gallstones, breathing problems, such as sleep apnea (when a person stops breathing for a short time during sleep) and asthma, oral health problems such as caries, halitosis, poor oral hygiene, periodontal disease. Symptoms for obesity include breathlessness, Increased sweating, snoring, inability to cope with sudden physical activity, feeling tired, back and joint pain, low confidence and self-esteem, and feeling isolated.

Also Read: Exclusive interview with Minister Dr Harsh Vardhan

After being aware of the risks, proper health and oral hygiene should be maintained. And why is maintaining diet an important factor? Because a poor diet may result in lack of essential nutrients and vitamins thus potentially making it more difficult for your body to fight off an infection. A diet high in fat and calories, including large quantities of processed foods or sugar, and lack of physicalactivity, leads to obesity. Those same foods can cause oral health problems including gum disease, premature tooth loss and bad breath Our body craves for what is in our bloodstream. Wheat, sugar, alcohol, coffee and de-vitalized foods are designed to be addictive. Sugar being addictive – agreed. But how does sugar affect an individual’s health and oral health? Well, consuming sugar is bad for an individual, but consuming too much has become a norm and that can cause health issues. The only type of sugar the body needs is glucose, which it can make by breaking down carbohydrates, proteins and fats. When ingested, simple sugars are converted into plaque if not removed immediately. As plaque begins to accumulate on our teeth and gums, the risk of varying forms of gum diseases such a gingivitis and periodontitis, as well as tooth decay, may become inevitable.

In 2018, a study revealed that 170 children and young people have rotten teeth removed every day, undergoing general anaesthesia. That’s an unpleasant operation that is completely avoidable; we have got a lot of evidence to show that the main cause is excessive sugar. There are also links with type 2 diabetes, usually chronic disease seen in adults, but we are seeing more and more under the age of 25 these days.

Also Read: A Right Gesture Saves Life

So, what an oral health care professional should be aware of? Dentists must be aware of how nutrition impacts general and oral health, and how dental treatment can impact patient’s nutritional status. Oral health is strongly influenced by the daily intake of food; on the other hand, oral health can also play a significant role in nutritional intake and general health status. The dental caries is also a chronic disease and may be depend on oral hygiene, high intake of sugar added to food, lifestyle factor, and host factors (salivary flow, buffer capacity and buccal microflora). Relationship between obesity and gum disease – we actually don’t know if this is a one-way or a two-way street. For example, conditions like diabetes, the relationship is bilateral. Periodontal disease will affect diabetes and diabetes will worsen periodontal disease, so that could be a possibility here. What are the other reasons of obesity affecting gums and what would be its risk factors? Because of various dietary habits and improper maintenance of oral hygiene, chronic periodontal infection is an inflammatory state that is described by a deviation in microbial environment and composition of subgingival plaque bio films and accelerated destruction of tooth supporting structures. Thus, low glycaemic diet may be beneficial to our oral health. Periodontal diseases are also influenced by various risk factors including aging, smoking, oral hygiene, socio-economic status, psycho social stress, osteopenia, osteoporosis and various systemic diseases, which signifies that periodontitis does not merely occur as a consequence of plaque deposition but is also coupled with various other host factors. Also, on examination, obese adolescents exhibited multiple carious teeth, higher plaque index, gingival inflammation, bleeding on probing and probing depth compared to normal weight subjects of similar age.

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An obese patient, whose lungs are often not large enough to lift heavy chest walls, can have trouble during breathing, especially when active. Also, during sleep the person might breathe through his/her mouth instead of nose, thus jaw is forced into an unnatural position for a longer period of time. This can lead to teeth grinding and development of an overbite, over jet or spacing between the anterior teeth.How can we, as dentists, help the obese patients? Dentists should include the evaluation of BMI in routine patient examination and eventually refer obese periodontal adolescents for weight reduction interventions like diet therapy, behavioural therapy, pharmacotherapy, so that they can have better control over periodontal inflammation.What are the practical considerations in dentistry? It can be difficult carrying out dental care for an obese patient: the maximum lifting weight for modern dental chair is approximately 140kg (23 stones). The position of anatomical landmarks may be less obvious if surrounded by fatty tissue, the landmarks for placement of an inferior alveolar nerve block can be impossible to palpate through excess soft tissue. It may be impossible to palpate cervical lymph nodes in a large neck. Also due to constant secretion of saliva, the mouth and teeth are rinsed and kept free off food debris and foreign particles, thus excess of buccal pad of fat hinders with self-cleansing action in the mouth. Because of lack of saliva present in the mouth, it can lead to dry mouth. Sip water frequently throughout the day and use alcohol-free antiseptic mouthwash daily for cure. A normal sized mirror is unsafe for retraction of soft tissues: a ‘lax’ tongue retractor can be useful.What is the alternative to conventional dental chair? Refer the patient to the hospital environment where the patient may be treated on an operating table or trolley. Another possible solution for obese patients is a custom-made chair such as DIACO dental chair. What is the difficulty faced during conscious sedation? When thinking about conscious sedation for obese patients, the potential difficulties in airway management and intravenous cannulation should be considered. The provision of inhalation sedation with nitrous oxide during which oxygen levels are maintained at or above 30% may be more appropriate. If intravenous sedation with midazolam is proposed, the overall benefit to the patient must be carefully weighed up against the increased likelihood of significant respiratory depression and the difficulties in managing a respiratory complication. New research suggests that the health of your mouth mirrors the condition of your body as a whole. A healthy smile can surely transform our visual appearance and the positivity of our mind-set.

‘Eat every two hours, sleep eight hours, have plenty of water and pray to keep calm. Most importantly, carry a smile on your face.’

About the author

Dr. Vishaj S. Maru is a dental surgeon. She studied dentistry at the D.Y. Patil School of Dentistry. She does clinical practice in Mumbai with a keen interest in academia and clinical dentistry.

The post Health and Oral Health Diseases appeared first on InnoHEALTH magazine.