Pay attention to dental side effects during long-term oral appliance therapy

We understand how successful treatment of obstructive sleep apnea (OSA) can be. However, we need to pay attention to the potential side effects from long-term oral appliance use. If we are aware of these side effects, we can help educate our patients and prevent them from occurring and interrupting care.

What do we do as dentists to help?

I have read several studies that looked at the predictors of dental changes associated with long-term treatment with oral appliances in patients with OSA. From these studies I have found that yes, long-term use can lead to dental complications if we do not educate our patients.

Before you fit your patient for an oral appliance, ask them if they are willing to take at least two-minutes out of their morning to perform exercises. That’s all it takes. Just two minutes (maybe even less) a day to prevent further complications. And, of course, if they do notice any shifts in their teeth, it is important for them to keep you up-to-date. You can provide an adjustment to their treatment or offer other solutions to improve this change.

When you are fitting your patients for their oral appliance, let them know that it is important to perform daily exercises after removal of the device. By performing jaw exercises, it can help prevent the patient’s mouth from becoming stiff or sore. It can also help to prevent lock-jaw and other complications.

It is our duty as dentists to take care of our patients and that means proper education for daily exercises after removing the oral appliance each morning.

What are you doing to help your patients through the oral appliance process? Are you having them perform exercises? If so, what kind? I am interested in learning what everyone is doing to help their patients each step of this journey.

Risk factors for sleep apnea during pregnancy

If you are pregnant, snoring, older age and obesity can put you at risk for sleep apnea, according to the National Institutes of Health (NIH). They completed a study that appeared in the American Journal of Obstetrics and Gynecology to look further into this connection and how risky it is for sleep apnea and pregnant women.

What are the risk factors?

An earlier study of first-time pregnancies found that sleep apnea increases a woman’s risk for hypertension and gestational diabetes. However, there are currently no medical guidelines or treatment recommendations available for sleep apnea during pregnancy. NIH’s current study, though, supports a look at treatment options for pregnancy-related sleep apnea. And, based on these results, they are planning a larger study to look deeper into this subject.

Researchers found that almost four percent of more than 3,000 women in early pregnancy and more than eight percent of over 2,500 women in mid-pregnancy had sleep apnea. The risk factors for having this condition included frequent snoring, older maternal age and being overweight as determined by body mass index (BMI).

Each woman’s risk will vary depending on their individual characteristics. However, the researchers in this study created a calculator using maternal age, BMI and snoring frequency to arrive at the woman’s probability of sleep apnea in early and mid-pregnancy.

Treating sleep apnea during pregnancy

Of course one option  available is the use of CPAP therapy. However, it is not currently known if this type of treatment during pregnancy will prevent hypertension, diabetes or other complications of sleep apnea. We can also turn to oral appliance therapy to help improve sleep apnea symptoms and potentially improve the woman’s health and well-being during pregnancy.

What is the role of sleep apnea in COPD?

Chronic obstructive pulmonary disease ( COPD ) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Obstructive sleep apnea (OSA) is a known common comorbidity of COPD. However, the relationship of the combination of OSA and COPD on mortality is not clear. It has been found that OSA occurs in about 10 to 15 percent of patients with COPD. This is often referred to as the overlap syndrome.

What is the connection?

According to the COPD Foundation, sleep-related disorders are most prevalent in adults and are associated with increased mortality and morbidity from obesity, cardiovascular diseases, diabetes and depression. As a result, so many people experience a reduced quality of life and increased health care costs.

Patients with severe COPD commonly exhibit abnormal sleep like insomnia that can contribute to daytime sleepiness and fatigue. Additionally, medications that have been used to treat COPD may affect the patient’s quality of sleep. Due to a nighttime reduction of oxygen levels that are commonly seen in patients with COPD, it can have a profound effect and lead to long-term sequelae, which can produce arrhythmias, myocardial stress and even lower survival rates.

Oral appliances for treatment

Individuals with both conditions have an increased risk of death and more hospitalizations without CPAP treatment, or in our case, oral appliance therapy. Without treatment, it can negatively impact their overall well-being. The use of oral appliance therapy helps to improve breathing for patients.

For patients with COPD, there is a very poor quality of sleep involved. And if they suffer from OSA as well, it can have profound effects. By looking further into OSA among patients with diagnosed COPD, it can potentially help improve treatment and their outlook on life. Recommend a sleep evaluation for patients diagnosed with COPD and try asking questions about daytime sleepiness, snoring, etc.

We owe it to our patients to remain up-to-date on the latest health connections with sleep apnea for improved care.

The link between sleep apnea and other health conditions

About one in five Americans suffer from sleep apnea, which is a number that is far too high. And with that comes untreated sleep apnea, which can lead to further complications in a person’s health. Of those that suffer from this condition, most don’t even realize it. This can be a deadly mistake.

Whether our patients are falling asleep watching TV, sitting in the car or even at their desk, it is important that we educate our patients on the negative effects of sleep apnea before it’s too late.

What are the complications?

Many patients state that they are always tired, have memory loss and high blood pressure–all signs that they might suffer from sleep apnea. After undergoing a sleep study, it can uncover obstructive sleep apnea (OSA). Interrupted sleep can lead to an array of health problems including severe daytime fatigue, heart and liver ailments, sexual dysfunction and sleep-deprived partners.

Those that suffer from sleep apnea can also pose as public safety risks. For example, engineers in two New York City commuter train crashes had sleep apnea. These crashes injured hundreds and even killed one person. After an investigation, the U.S. National Transportation Safety Board found that both engineers suffered from severe sleep apnea–neither had been tested before the crashes. And 4 years before that, a train derailed in New York City (again). This time it killed four people. According to the NTSB, the driver had an undiagnosed sleep disorder.

What can be done?

While CPAP therapy is the most widely used and accepted forms of treatment for sleep apnea, dentists can offer an alternative: oral appliance therapy. These devices can adjust the position of the jaw and tongue to improve breathing throughout the night. By advancing your knowledge of sleep apnea, you can provide advanced options for your patients to help in treatment and to prevent further complications.  

Anyone can suffer from sleep apnea, but certain factors increase a patient’s risk for the sleep disorder, such as excess weight, thicker necks, a narrowed airway, being male or older, family history, use of alcohol, sedatives, smoking and nasal congestion. Stay ahead of the game and complete continuing education to ensure you know what to look out for and what to recommend to help your patients remain healthy.