A wake-up call for dental professionals

An everyday nightmare

Patients with obstructive sleep apnoea (OSA) may experience episodes of partial or complete obstruction of the respiratory passages during sleep.[i] This can have a variety of impacts on a patient’s general and oral health, and overall day-to-day life. It is somewhat common, too, with estimates suggesting between 9% and 38% of the general adult population is living with OSA – however, it is disproportionately more common in men.ⁱ An extreme cause for concern is that more than an estimated 80% of patients with OSA are not yet diagnosed.[ii]

OSA is caused by a narrowing of the airway during sleep, and this may be a result of other pre-existing factors in a patient’s life. There are links made between the condition and obesity, ageing, alcohol use and smoking, enlarged tonsils, and even having a bigger neck.[iii] However, it’s important and entirely possible to detect the condition early. One sign could just be habitual snoring.[iv]

Dental professionals hold an integral role in the screening of OSA risk factors, referral of patients when appropriate and provision of oral appliance therapy, where recommended.[v] Routine dental examinations provide the opportunity to recognise a small upper airway, amongst other anatomic risk factors, as well as the chance to ask simple screening questions.[vi] Tell-tale symptoms may be picked up on in a routine assessment too.

Oral health risks

A direct clinical relationship has been displayed between OSA and periodontitis,[vii] and it is especially pronounced in younger adults.[viii] There are a variety of mechanisms that explain this connection. Firstly, the disruption of regular breathing in sleep may lead to intermittent periods of hypoxia which, in turn, create conditions for oxidative stress and systemic inflammation, exacerbating periodontal diseases.^vii Mouth breathing is also a common result of OSA, often leaving patients with a sensation of a dry mouth when they awake.[ix] This can be extremely uncomfortable in itself, but more seriously can prevent the self-cleaning of the oral cavity, leading to periodontitis progression.^vii

Gum disease is not exclusive to sleep apnoea, of course, but its presence alongside other oral health concerns, such as dry mouth, may begin to indicate there are greater issues at play. Another coinciding symptom of OSA that a practitioner may notice during a routine clinical check-up is bruxism.[x] Studies have shown that it is especially prevalent in cases of mild and moderate OSA, however the correlation wanes when considering those with more severe forms of the condition.[xi]

Sleep bruxism, in particular, may be interpreted as a subconscious coping mechanism. The activity of grinding teeth encourages the mandible to protrude, restoring airway patency. This may not be sufficient when the condition is severe, and in turn, patients may experience excessive respiratory rate and effort to compensate instead.^xi

Taking action

The impact on a patient’s dentition can be so varied that, whilst other intraoral signs such as redness of the soft palate and uvula area can suggest OSA is present, dental professionals should take further steps to detect the problem before referral.

In an age of digital solutions, CBCT scanners may be an effective solution. When properly equipped, they can be used to identify a narrow upper airway, which would suggest problems occur in sleep.[xii] Utilising radiographic imaging in this manner allows clinicians to delve further into the anatomical root cause of the issue, better informing the necessary course of treatment going forward. When clinically necessary, the use of this tool can aid diagnosis at the appropriate time.

Employing a versatile CBCT system in the practice could make the difference when helping patients get the treatments they need, and improving their overall day-to-day life. Consider the CS 8200 3D Neo Edition from Carestream Dental, an unbelievably precise system that provides outstanding 2D and 3D images for a variety of clinical needs. Taking on the CS Airway Module, the CS 8200 3D creates colourised 3D renderings that allow for simple analysis, all whilst improving patient understanding and communication. Plus, take advantage of the all-new extended warranty, which can maintain the CS 8200 3D as an excellent system in your practice for many years to come.

Obstructive sleep apnoea is an underdiagnosed issue that can severely impact day-to-day life. Understanding the connection to oral health, and employing ways to detect it early, allows clinicians to take action, and give patients a good night’s sleep.

For more information on Carestream Dental and our new extended warranties visit www.carestreamdental.co.uk

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Nimisha Nariapara

Bio

Nimisha is the Trade Marketing Manager at Carestream Dental covering the UK, Middle East, Nordics, South Africa, Russia and CIS regions. She has worked at Carestream Dental for the past 7 years, where she has developed her marketing skills and industry knowledge to bring the core values and philosophy of the company to the market.

[i] Senaratna, C. V., Perret, J. L., Lodge, C. J., Lowe, A. J., Campbell, B. E., Matheson, M. C., … & Dharmage, S. C. (2017). Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep medicine reviews, 34, 70-81.

[ii] Lobbezoo, F., De Vries, N., de Lange, J., & Aarab, G. (2020). A further introduction to dental sleep medicine. Nature and science of sleep, 1173-1179.

[iii] NHS, (2022). Sleep apnoea. (Online) Available at: https://www.nhs.uk/conditions/sleep-apnoea/ [Accessed October 2023]

[iv] Sowho, M., Sgambati, F., Guzman, M., Schneider, H., & Schwartz, A. (2020). Snoring: a source of noise pollution and sleep apnea predictor. Sleep, 43(6), zsz305.

[v] Herrero Babiloni, A., Beetz, G., Dal Fabbro, C., Martel, M. O., Huynh, N., Masse, J. F., … & Lavigne, G. J. (2020). Dental sleep medicine: Time to incorporate sleep apnoea education in the dental curriculum. European Journal of Dental Education, 24(3), 605-610.

[vi] Quan, S. F., & Schmidt-Nowara, W. (2017). The role of dentists in the diagnosis and treatment of obstructive sleep apnea: consensus and controversy. Journal of Clinical Sleep Medicine, 13(10), 1117-1119.

[vii] Khodadadi, N., Khodadadi, M., & Zamani, M. (2022). Is periodontitis associated with obstructive sleep apnea? A systematic review and meta-analysis. Journal of Clinical and Experimental Dentistry, 14(4), e359.

[viii] Billings, M. E. (2015). Putting some teeth into it: connecting periodontitis with sleep apnea. Sleep, 38(8), 1153-1154.

[ix] Su, V. Y. F., Chou, K. T., Tseng, C. H., Kuo, C. Y., Su, K. C., Perng, D. W., … & Chang, S. C. (2023). Mouth opening/breathing is common in sleep apnea and linked to more nocturnal water loss. biomedical journal, 46(3), 100536.

[x] Berggren, K., Broström, A., Firestone, A., Wright, B., Josefsson, E., & Lindmark, U. (2022). Oral health problems linked to obstructive sleep apnea are not always recognized within dental care—As described by dental professionals. Clinical and Experimental Dental Research, 8(1), 84-95.

[xi] Martynowicz, H., Gac, P., Brzecka, A., Poreba, R., Wojakowska, A., Mazur, G., … & Wieckiewicz, M. (2019). The relationship between sleep bruxism and obstructive sleep apnea based on polysomnographic findings. Journal of clinical medicine, 8(10), 1653.

[xii] Enciso, R., Nguyen, M., Shigeta, Y., Ogawa, T., & Clark, G. T. (2010). Comparison of cone-beam CT parameters and sleep questionnaires in sleep apnea patients and control subjects. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 109(2), 285-293.