How Your Dentist Can Help You Look Better, Sleep Better And Be Healthier
If you have spent much time on this site, you know that I place the utmost importance on quality sleep. The average adult needs about 8 hours of sleep per night, but currently the American average is 6.8 hours of sleep per night. (1) Believe it or not, Americans slept on average 9 hours per night in 1910. (2) Many people believe that they can “get used to” less sleep, however, this is a false belief. The fact is that too little sleep can lead to high blood pressure, stroke, heart failure, irregular heartbeat and heart attack, diabetes, depression, and worsening of ADHD. (3) Another very common side effect of poor sleep is clenching and grinding. Once I find out that a patient grinds, I always follow up by asking about how they sleep. In almost 100% of the cases, the patient claims to be a poor sleeper. The truth is that your body does most of its repair while sleeping, so don’t skimp on it!
Most advice about sleeping better focuses on improving your habits. I have advice on “sleep Hygiene” here. There are other reasons for poor sleep. One of the main reasons is that people stop breathing during sleep which causes them to wake up each time it occurs. These are called apneas and are defined as temporary cessation of breathing of 10 seconds or more, while hypopneas are periods of shallow breathing that result in oxygen desaturation. Obstructive sleep apnea is defined as having five episodes per hour with symptoms, or fifteen without. (4) “Central Sleep Apnea” is caused by improper signals from the brain. The causes of this type of sleep apnea are things like strokes and brain tumors and are beyond the scope of this post. The second type is called “Peripheral Sleep Apnea” and will be my focus today. The causes of peripheral sleep apnea (which is a form of airway obstruction) are being over 40, being overweight, having large tonsils, having a large tongue, having small jaws, having a deviated septum, allergies or sinus problems. (3) As you can see, there are many causes of breathing problems and therefore there are many methods of treating them encompassing many health professions, dentistry being one of them.
If your dentist should asks you about your sleep and state of alertness, it is because they are being thourough. When I have a patient that is overweight, has high blood pressure and tooth wear, I become suspicious that one of their problems is poor sleep and possibly sleep apnea. The main symptom of poor breathing while sleeping is daytime drowsiness, but as I stated before, almost 100% of my patients who grind are not sleeping well. One of the main causes of breathing problems stems from small jaws. The position and size of one or both jaws, the size and position of your tongue, tongue movement habits are all involved in airway issues and should all be assessed by your dentist. The position and movement of the tongue is critical for normal facial and airway development. If a child has a tongue tie or is a mouth breather, these problems should be addressed as soon as possible for normal facial growth. It is critical for children to have an assessment done as early as possible. The best way to verify the airway is to use a CAT scan unit to measure it. I have one in my office (they are usually called CBCT units). You can read more about them in my previous post.
If caught early, things like improper tongue position and small jaws can be addressed with exercises and appliances which take advantage of natural growth to establish proper facial development and prevent airway obstruction. Two of the best airway dentists in the field that I know are Dr. Kevin Boyd in Chicago and Dr. Mike Mew in the UK. The photos to the left are non-surgical results using appliances and exercises with the jaw and tongue. The photo at age 11 shows the patient’s lower jaw too far back. notice the photo below showing that the lower teeth are almost not visible as they are too far behind the upper ones. At age 16 and 31 the bite and facial profile are perfect.
If caught later, improper jaw size and position will require full orthodontics and possibly jaw surgery. This is called orthognathic surgery. Notice on the x-rays to the left how the facial profile A has the chin and lower jaw too far back pinching off the airway (as indicated by the red arrows). The results of surgery can be dramatic as seen in image B. Notice how much more open the airway has become. I am partnered with all of the different types of specialists in my own practice and offer this in my practice. Many of my patients have opted for this route and none have been disappointed with the results, despite the six-week healing phase after surgery.
Many patients are daunted by the prospect of surgery. I can certainly understand this stance. Because most people reject the idea of surgery, CPAP machines have become the norm when treating obstructive sleep apnea. Research shows that these units are very effective. They are prescribed by sleep specialists after sleep studies are done. There is a problem with compliance, as the units are bulky and uncomfortable to many patients.
The second most effective remedy is provided by dentists. They are generally called sleep apnea appliances and there are many designs. Most of them advance the lower jaw to keep the tongue from falling back and occluding the airway. The better appliances are two-piece and adjustable. These appliances should only be done after a CPAP has been rejected by the patient, and only after a sleep study has been done. I won’t make one unless I have a referral from a sleep specialist and results from the sleep study. Even after I make an appliance, several follow-ups are required to assess the effectiveness of the appliance. I also recommend a follow-up with the sleep specialist after the patient has accommodated to the appliance where they often redo the sleep study to make sure that the appliance is effective. There are many studies proving that sleep appliances work well. One study showed that oral appliances improve quality of life measures and decrease excessive daytime sleepiness in adult patients with OSA and are nearly equivalent or equivalent to CPAP on both, respectively. (5)
If you suspect that you have issues with breathing and sleeping, the dental office is not the place to start. You should contact a sleep specialist. Click here for a guide to help you better understand sleep.
It is important that you discuss your issues with your dentist, as the cause of poor breathing is related to the oral cavity.