Saturday, February 25, 2012

Sleep Apnea ~Dental Professional Red Flags

Sleep Apnea  sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour.

Sleep Apnea Elevates Death by 46%

Sleep apnea is a condition that is overwhelmingly wide spread and common, yet seriously under diagnosed. If left untreated it can lead to hypertension, heart disease, and stroke. All health care professionals should be current with the information out there. Last year I attended a two day class that focused on identifying red flags during dental appointments. Day one back to the office and the knowledge was applicable, and continues to be on a weekly basis. I want to share this information with everyone in hopes that you too can help bring awareness to your patients.

The Vortex of Red flags
Seemingly simple signs to look for, that when observed can start the whirl of co-discovery 

  • Chipped Anterior Teeth ~ Specifically # 8, 9. We've all seen this scenario, 8 and/or 9 wearing down, where the canines are not affected. It's not the side to side grinding that catches the cuspid rise, but just straight anterior. Here is what's happening: as the airway is blocked, the patient juts his jaw forward in an attempt to gain airway and O2. 
  • Acidic Wear on Posterior Teeth ~ Acid Reflux. Ask about it, get your patients aware. Pitting on mandibular posterior teeth is usually caused by acid reflux that occurs during sleep. With or without the presence of sleep apnea, acid reflux is an important conversation to have. Another under diagnosed condition that can occur without conscious knowledge. In the case of sleep apnea, the pressure in the esophagus caused from the body trying to gain O2 results in the rise of stomach acids. 
  • Missing Four Premolars ~ Common practice of orthodontists to remove four premolars in an effort to accomplish a desired outcome. I strongly believe this is not a sound practice, but am not educated in orthodontics, so it is an opinion. Here's what I do know; instead of maximizing jaw growth by making more room for the crowded teeth, growth is stunted or hindered when the premolars are removed and anterior teeth retracted.  The mandible follows the growth of the maxilla, and an underdeveloped mandible leads to airway obstruction issues in adult hood. 
  • TMD ~ Temporal Mandibular Disorders. Clicking, popping, crepitus, pain, headaches. You may start to notice a correlation with the four missing premolars. Pretty consistent with misplaced occlusion and retracted mandible.
  • Snoring ~  If you are starting to recognize a couple of these red flags with a patient, go ahead and ask if they snore. It is most likely an issue that affects other areas of their lives, like relationships. Even without the presence of sleep apnea a discussion about snore relief could change lives. 
  • Sleep Patterns ~ It's not a common question to be asked at a dental visit, but get curious about how well your patients are sleeping. "How well do you sleep at night?" It can open the door for a wide range of conversations, encompassing health and lifestyle, but keeping in mind the red flags for sleep apnea; listen for answers like, "Not well at all, I'm up numerous times at night and I find myself tired during the day". Usually someone who is suffering from sleep apnea will wake often during the night due to the lack of O2.
     After starting to become familiar with these signs, you may be surprised how many people it is applicable to. Where do you go from here? 
Encourage your patients to follow up with a physician and possibly a sleep study. Be entirely clear how important it is for a full diagnosis with a doctor. The gold standard for treating sleep apnea is a CPAP ( continuous positive airway pressure) machine. Our role is to help bring conscious awareness to a serious and life threatening condition. 

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