Everyday clinical encounters see dental professionals come across issues such as tooth decay, bruxism, dry mouth and jaw pain all the time. However, if patients show signs of tiredness, complain of headaches and seem distracted overall, there may be a greater cause for concern.
Each of these symptoms may be caused by one overarching issue that a patient might not notice. After all, it’s a struggle to pinpoint the problem if they’re doing it in their sleep.
An everyday nightmare
Patients with obstructive sleep apnoea (OSA) may experience episodes of partial or complete obstruction of the respiratory passages during sleep. 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 nine per cent and 38 per cent of the general adult population is living with OSA – however, it is disproportionately more common in men. An extreme cause for concern is that more than an estimated 80 per cent of patients with OSA are not yet diagnosed.
Obstructive sleep apnoea 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. However, it’s important and entirely possible to detect the condition early. One sign could just be habitual snoring.
Dental professionals hold an integral role in screening OSA risk factors. Where appropriate, patients can be referred for oral appliance therapy. 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. 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, and it is especially pronounced in younger adults. 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. Mouth breathing is also a common result of OSA, often leaving patients with a dry mouth sensation when awake. This can be extremely uncomfortable, but more seriously, it can prevent the self-cleaning of the oral cavity, leading to periodontitis progression.
Gum disease is not exclusive to sleep apnoea, of course, but its presence alongside other oral health concerns, such as dry mouth, may indicate greater issues at play. Another coinciding symptom of OSA that a practitioner may notice during a routine clinical check-up is bruxism. 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.
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.
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 effective. When properly equipped, they can be used to identify a narrow upper airway, which would suggest problems occur in sleep. 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 a difference when helping patients get the treatments they need and improving their overall day-to-day life. For example, the CS 8200 3D Neo Edition from Carestream Dental 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.
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.