Undiagnosed sleep apnoea patients are seen in dental practices across the UK. Dentists are well positioned to screen those patients to ensure they receive the information and care required, says Dr Aoife Brid Stack.
Dental sleep medicine and airway is an area of dentistry gaining traction and interest. It is the discipline concerned with the study of oral and maxillofacial causes and consequences of sleep-related problems. Sleep is considered an essential part of health and dentists are ideally positioned to screen and treat sleep breathing disorders. Sleep disorders and poor sleep are considered to be part of modern disease. Patients and medical colleagues will need trained dentists to screen, detect, refer and treat sleep-disordered breathing. This opinion piece looks at the market of sleep dentistry, the reasons why dentists should be part of the team, and presents hypotheses for the future of dental sleep medicine in the UK.
Dental sleep medicine is an emerging and fast-developing field of dentistry. Dental sleep medicine is the discipline concerned with the study of oral and maxillofacial causes and consequences of sleep-related problems.1 There are few opportunities in dentistry to change the life of our patients. Alleviation of pain, delivery of a new smile and detection of oral cancers have all been the proudest moments for clinicians, the sort of dentistry that has patients coming back to the surgery with flowers, cakes, chocolates and cards. Dental sleep medicine can find itself a place in this list. Dentists are perfectly placed to screen patients and direct them to the right care and in many cases provide treatment to improve patients' health and lifespan.
Sleep is now hailed as a pillar of health, right beside healthy eating and exercise. Gym memberships exploded in the 2000s; healthy eating and the vegan movement in the 2010s; and now in the 2020s, hot trends and hashtags are focused on sleep and mindfulness.
Research articles are coming through in the thousands by the month. In 2019, the global sleep economy was valued at about 432 billion US dollars.2 The cost to the UK economy of sleep disruption is estimated to be $50 billion (£39.8 billion) or 1.86% of GDP.2
Dental sleep medicine is more complex than one may imagine at first glance, while highly rewarding...
Poor sleep is linked to many modern diseases. Poor sleep affects both physical and mental health. It affects family life too, ask any new parent! Poor sleep can increase inflammation, blood pressure, insulin resistance, cortisol, weight gain and cardiovascular disease, as well as decrease blood sugar regulation. Lack of deep sleep is linked with poor cognition and memory. Sleep disorders are directly linked with road traffic accidents. In the US in 2017, The National Highway Traffic Safety Administration estimates that drowsy driving was responsible for 91,000 crashes - resulting in 50,000 injuries and nearly 800 deaths.3 Sleep disorders range from narcolepsy, insomnia, sleep-disordered breathing (SDB), parasomnias and restless leg syndrome.
As dentists, we are perfectly positioned to screen patients for SDB. We can from our history taking and exam determine which patients may be at risk. The global prevalence of obstructive sleep apnoea (OSA) is estimated at 1 billion people.4 These patients come in and out of dental practices across the country every day. Undiagnosed sleep apnoea rates are an unthinkable 93% for women and 82% in men.5 Patients may not be seeing their medical doctor, but do visit the dentist regularly. We are the perfectly positioned health professionals to screen these patients alongside their dental and hygiene checks. The American Dental Association policy statement from 2017 states that the dentist's role includes assessing patients risk for SDB.6
The British Society of Dental Sleep Medicine (BSDSM) are pushing towards introducing a similar position in the UK, working with indemnity providers and the dental schools.
Medical history forms are a great place to start. It has been suggested that screening for OSA is an essential element of hypertension treatment.7 SDB is common in diabetics as OSA alters glucose metabolism. ADHD is commonly linked with SDB in children.8
Examination of patients reveal inflammatory markers within the periodontium. Tooth loss is significantly associated with deficient sleep, particularly the loss of the posterior teeth.9 These factors should be considered in prosthodontic treatment planning.
Gastroesophageal reflux disease (GERD) is intimately connected to OSA and snoring, due to the increases in intra-abdominal pressures, which overcomes the lower oesophageal sphincter. A high prevalence of sleep bruxism patients have OSA (33.3-53.7%).10 When we as dentists are looking to make protective night guards, it is imperative that the airway is properly assessed. There are reports of night guards increasing the Apnoea Hypopnea Index (AHI), so we implore diagnosis before treatment.11
The NICE guidelines, published in August 2021,12 have now set a framework within the NHS for funding to become available for treatment of OSA with customised and semi-customised mandibular advancement devices (MADs). The primary purpose of MAD is to move the mandible forwards relative to the maxilla in order to widen the airway and prevent closure.13 Medical and sleep colleagues are becoming aware of MAD as a treatment option for SDB. Patients will want and need this option. It is in the training of dental professionals that makes the difference in whether treatment is successful or not.
Dental sleep medicine is more complex than one may imagine at first glance, while highly rewarding when treatment success can be achieved.14
The British Society of Dental Sleep Medicine, which is joined with the British Sleep Society, runs introductory and advanced courses in Dental Sleep Medicine. Members of the society enjoy yearly members' days along with updates, case discussions and opportunities for research. More information on courses can be found at: https://bsdsm.org.uk/.
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Stack, A. Why now is the time to get involved in dental sleep medicine. Br Dent J 233, 258–259 (2022). https://doi.org/10.1038/s41415-022-4944-9
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DOI: https://doi.org/10.1038/s41415-022-4944-9