Sleep Disordered Breathing - The Missing Puzzle Piece

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Something isn’t right. You have done everything your education (which is vast) has taught you, added that to your years of experience, and then supplemented the results with compassion and resolve. Although Amber has a beautiful smile, built to a neuromuscular position to resolve her temporomandibular pathology and erase her pain, she remains uncharacteristically ambivalent.

Amber is having a difficult time losing weight, can’t wean herself from her Zoloft, and snaps at your assistant for leaning the chair too far back. Shouldn’t she be cheery and full of appreciation?   Perhaps another demon is at play. She may not be sleeping well, and the effects may not allow that raving fan you had envisioned to answer the bell.

According to the National Sleep Foundation, over 40 million people in the U.S. suffer from sleep disorders. It is believed that as the U.S. population continues to age, sleep disorders will increase in numbers, and it is estimated that by 2050 over 100 million people will suffer from some form of sleep dysfunction. Insomnia is currently the leading sleep disorder, but obstructive sleep apnea (OSA) is closing fast.

“Sleep disordered breathing in its various manifestations is arguably the number one health problem in the U.S., and probably throughout the world.”  This is a quote by the “Father of Sleep”, William C Dement. Dr. Dement has been working in the field of sleep for more than a half-century, and he is more worried now than ever before. 

If you have not been screening for this in your own patient population, you are missing an opportunity to improve the quality of life for about one third of your patients - and perhaps save many lives. The vast majority of patients with sleep disordered breathing, (more than 90%), are currently unaware of the diagnosis, and as a primary care health practitioner, you are ideally suited to alert them to the dangers.

In a recent course on sleep breathing disorders at LVI, I had the dentists go to their hotels with a home sleep monitor on the first night. When reading the studies the next day, most of the attendees had little idea of the amplitude with which their sleep was being fractured.  One showed severe symptoms, desaturating to 70% with more than 40 respiratory events every hour.  He is now seeing a sleep physician, and is starting a new life with more energy.

OSA has some devastating effects on homeostasis. Sequelae include insults to the cardiovascular, cerebrovascular, and reproductive systems - and OSA is included as a precursor to diabetes, depression, enuresis, and GERD. It agitates one’s sleep architecture to such a degree that fatigue and sleepiness have become a drain on the economy, and are the cause of many fatal auto accidents.

As a dentist, not only can you be an effective messenger and educator, but you can also treat a large number of those with OSA through mandibular advancement devices (MADs). The American Academy of Sleep Medicine, whose membership is almost exclusively made up of physicians, recognized our ability to treat these patients in February of 2006 through a change to their Practice Parameters.  The new wording now reads: “Although not as efficacious as CPAP,  oral appliances are indicated for use in patients with mild to moderate OSA who prefer OAs to CPAP, or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or positional change.”

If you still want to know why you should care as a dentist, a 2007 study released by the American Academy of Periodontology showed that lack of sleep ranked just under smoking as the number two lifestyle factor impacting oral health. Once you know the signs and symptoms, you can effectively improve the sleep of your patients.

Start screening your patients tomorrow. Ask them if they snore, or if someone has accused them of this affliction. You will be surprised at the stories, but more importantly, you can alert them to the potentially harmful effects that sleep disordered breathing can have on their health.

It is extremely satisfying to create an artistic smile for Amber using skills you have learned and the talent with which you have been blessed. It can be even more rewarding to help her live a healthier and more productive life through something as simple as an undisturbed breath.

Kent Smith is the course director/instructor for Sleep Breathing Disorders at LVI Global, is the co-founder and co-director of the Dental Organization for Sleep Apnea, and is on the Medical Advisory Board of Sleep Healers®. He can be reached (and solicits your questions) at