Many people do not realize how sleep disorders affect their overall health. Sleep disorders, systemic and oral health are closely connected, and dental professionals play an important role in recognizing the signs and symptoms of many common conditions. Making the connection between oral signs and symptoms, and sleep problems, is key to helping your patients understand the long-term health consequences of their own sleep patterns.
Identifying Potential Sleep Disorders in Your Patients
One issue that dental hygienists may be able to identify is nighttime bruxism. Signs and symptoms often include the presence of worn or fractured teeth, tight jaw muscles and facial pain. Unless a partner has told them, patients with nighttime bruxism can be unaware of their habit of grinding until a dental professional recognizes potential signs and symptoms, and discusses these with them.
More debilitating sleep disorders often follow the same pattern in that a patient may not recognize they have a problem until a dental professional notices the warning signs. Here are some common sleep disorders that can affect your patient's oral health and the symptoms you should be aware of.
Obstructive Sleep Apnea (OSA)
According to DentistryIQ, this often undiagnosed disorder is characterized by pauses in breathing or shallow breathing during sleep. Patients with this condition tend to be overweight and have a larger neck circumference. Potential oral signs include a small or recessed chin, a scalloped tongue, a vaulted palate with decreased inter-molar distance, enlarged tonsils, eroded enamel and enamel wear from bruxism.
Sleepiness during the day can be a classic sign of OSA. If a patient exhibits the oral signs of sleep apnea, ask them to evaluate their daytime habits with the Epworth Sleepiness Scale. Keeping a close watch for these signs could help a patient toward vital treatment. DentistryIQ notes that OSA is associated with conditions such as heart disease, diabetes and depression.
Chronic Mouth Breathing
The Oral Health Group notes that normal, healthy breathing occurs mainly through the nose. Chronic mouth breathing during sleep can cause irregular breathing at night, interrupted sleep and daytime fatigue. While children generally do not experience sleep-disordered breathing, in children whose mouths are still growing, mouth breathing may be associated with Class II and III malocclusions or a vaulted palate. These skeletal changes increase the chances of a person developing a snoring problem or obstructive sleep apnea later in life.
In contrast to mouth breathing, with nasal breathing the inhaled air is filtered and the nitric oxide produced in the nasal passages is believed to help increase the ability of the lungs to absorb oxygen. Dry mouth may occur with persistent mouth breathing and, if it does, is usually associated with mouth breathing during sleep. The night-time discomfort associated with this can be alleviated by using a mucoadhesive saliva substitute at night.
Sleep-Related Gastroesophageal Reflux (GERD)
According to the National Sleep Foundation (NSF), GERD occurs when acid from the stomach backflows into the esophagus, resulting in frequent episodes of heartburn. Most people with GERD have more intense symptoms while lying down or trying to sleep. They may be awakened by coughing or choking if the acid reaches the throat and larynx. People who suffer from GERD also have an increased likelihood of reporting sleep-related issues like insomnia and sleep apnea.
The oropharyngeal signs of GERD include enamel erosion, gingival inflammation and bad breath. Over time this condition can sometimes cause more serious problems in the esophagus, such as ulcers or bleeding, or to Barrett's syndrome which can eventually result in cancer, writes the NSF.
How to Talk to Your Patients
Start any discussion of sleep disorders and oral health by explaining to your patient what you are seeing in their mouth.
Getting your patients the help they need is the crucial next step. For a patient with suspected OSA, a referral can be made to a sleep specialist who can test for sleep apnea and suggest lifestyle changes like weight loss or quitting smoking, and treatment with a continuous positive airway pressure (CPAP) machine or an oral appliance may be provided, according to the Mayo Clinic. Dentists frequently provide oral appliances for patients, as part of the overall care of their patients. A referral to an otolaryngologist or allergist can often help pinpoint the cause of mouth breathing. If GERD is a concern, urge your patient to see their physician. An essential component of working in dental hygiene is ensuring the patient's whole body wellness is addressed in connection with their oral health.
- Many patients are unaware that they may have a sleep disorder, or that one could affect their oral health.
- Refer your patient to the appropriate specialist to address sleep disorders.
- Not addressing sleep disorders over time can lead to serious health consequences.
Why It's Important
Spreading awareness of health risks is an important component of dentistry. When you explain to patients how sleep disorders can affect whole body health, you can give them advice and referrals when needed. By being an advocate for your patient, you can help them safeguard their oral and overall health.