Revisit dental sleep medicine for improved knowledge and care

So many of our patients are currently suffering from sleep apnea and they might not even be aware of it. When people wake up feeling even more tired than before, we should be available to help provide recommendations and solutions. To help patients get the care they need, dentists should provide dental sleep medicine (DSM) in their practices.

While you may already know a lot of information about dental sleep medicine, let’s revisit this topic.

What is Dental Sleep Medicine? DSM is an area of dentistry that focuses on the use of oral appliance therapy to manage sleep-disordered breathing–that includes snoring and obstructive sleep apnea (OSA). Oral appliance therapy allows for a more comfortable treatment option for many patients that might be CPAP inept. A custom-fit oral sleep appliance is an effective form of treatment for preventing the airway from collapsing by supporting the jaw in a forward position. Dentists will work together with sleep physicians to help identify the best treatment option for each patient.

What is Periodontology? It is a dental specialty that involves the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes. It is also the maintenance of the health, function and esthetics of these structures and tissues. In other words, a periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease, as well as the placement of dental implants.

What is the difference? While periodontology focuses on prevention, diagnosis and treatment, so does dental sleep medicine. However, dental sleep medicine dentists don’t do the diagnosing. Instead, dental sleep medicine dentists work with sleep physicians to gain a diagnosis after they might have noticed signs of sleep disordered breathing or a patient’s responses to a questionnaire showed a possibility of this condition. From a diagnosis through a sleep physician, dentists can plan for proper treatment with oral appliance therapy.

Dental sleep medicine is a team atmosphere in which we must work together to prevent, diagnose and treat our patients. Periodontology doesn’t require the same team alliance. That doesn’t mean it is any less important because it is extremely important for our patients. However, dental sleep medicine takes the treatment of our patients to a whole new level that works to improve their health and their overall well-being.

What is the connection? Periodontology and dental sleep medicine can go hand-in-hand. Periodontology has been shown to affect the cardiovascular system and untreated sleep apnea affects it as well. Research has shown that periodontal disease is associated with several other systemic diseases. For a long time, it was thought that bacteria was the factor linking periodontal disease to other diseases, but, more recently, research has shown that inflammation may be the culprit.

And, just like periodontology, sleep apnea also affects the body in the same way. By treating sleep apnea and periodontal disease, you can help your patients prevent further complications and systemic conditions.

Dental sleep medicine is in and now is the time to take advantage by attending upcoming lectures and seminars to get your education going in the right direction.

What are the ABCs of dental sleep medicine?

What do the airway, bruxism and craniofacial pain all have in common? It might seem like nothing, but there is a lot more than you might realize. And while we have discussed this previously, I think it is important to continue to revisit this area of dentistry to further help our patients.

A lot of dentists don’t know that much about these areas of the dental specialty, so you’re not alone. However, because of this, dentists are unable to recognize the risk of sleep apnea, let alone manage patients with oral appliances, which is the same for craniofacial pain and bruxism. Each of these conditions are often overlooked and our patients are suffering.

By taking the steps toward a better understanding of the unique connections between the airway, bruxism, craniofacial pain and other conditions, dentists can create endless opportunities for services in diagnosis and treatment options within their practice. To help, let’s examine the ABCs of advanced dental services.

Airway. This is commonly referred to in sleep disordered breathing disorders, such as obstructive sleep apnea (OSA). Dental practices are in a unique position to identify patients at risk for conditions involving the airway. Understanding the airway and how it can affect a patient’s sleeping patterns due to sleep apnea and other sleep disordered breathing conditions is vital in maintaining your patients’ health and improving service offerings. It can also help in treating other conditions when there is a clear link available.

Bruxism. This is the gnashing and grinding of teeth that occurs without a functional purpose. When a patient is suffering from bruxism, it can cause a lot of problems (as you know). Whether it is due to a nervous habit, stress or unknowingly grinding teeth at night, bruxism can cause damage to not only a patient’s teeth, but their overall health as well. Due to the breakage of dental restorations from bruxism, tooth damage, induction of temporal headaches and temporomandibular joint disorders (TMD) can occur.

Craniofacial Pain. We come full circle with craniofacial pain, as it covers a wide spectrum of symptoms exhibited in many areas of the head and neck. In particular, a majority of craniofacial pain complications can be associated with temporomandibular joint disorder (TMD). Can you see the pattern? Because of this, an essential part of routine dental examinations for all patients should include an evaluation for TMD, including a patient’s history, clinical examination, and imaging when appropriate.

What is the connection? While it might not be found in every patient, there are still some individuals that require further attention because there is an apparent connection. As a dentist, it is important to understand that clenching or grinding of one’s teeth can be a way for the brain to protect itself from suffocation during sleep–it connects the ABCs.

Educate yourself by completing continuing education courses and attending lectures or seminars. While it might not occur in every case, it is vital that we as dentists understand it for those certain individuals suffering from all three conditions.

Dental sleep medicine standards for sleep-related breathing

Sleep-related breathing disorders are one of six classifications of sleep disorders identified in the International Classification of Sleep Disorders – Third Edition, the American Academy of Sleep Medicine’s clinical text for the diagnosis of sleep disorders, according to a recent article in the Journal of Dental Sleep Medicine.

The article states that obstructive sleep apnea (OSA) has an estimated prevalence of 12 percent, which includes both diagnosed and undiagnosed. There is also a lot of literature out there to support the use of oral appliances as an effective treatment of OSA in adults. However, limited evidence exists to suggest that mandibular advancement and maxillary expansion is an effective treatment modality for the management of pediatric OSA.

The American Academy of Dental Sleep Medicine understands there is inconsistent information about sleep medicine in U.S. schools. For this reason, they are looking to offer additional educational opportunities. This is to help improve dentists’ knowledge and experience in treating and managing OSA patients. However, there is still a lack of uniform standards for the practice of dental sleep medicine.

Current standards available

The AASM and AADSM released a clinical practice guideline for the treatment of OSA with oral appliances. The guideline was created to provide dentists with qualifications required or needed in the treatment and management of OSA.

It states that a dentist should have at least one of the following to treat sleep apnea patients:

  • Diplomate certification in dental sleep medicine by a nonprofit organization.
  • Designation as the dental director of a dental sleep medicine facility accredited by a nonprofit organization.
  • Obtain the designation of “qualified dentist.”

While completing continuing education in dental sleep medicine, dentists must also seek diplomate and/or dental director status.  The AADSM also commissioned a task force of experts to create a document defining the scope of a DSM practice.

The paper goes into clear set guidelines and standards for dentists. To learn more, check out the AADSM’s paper that sets clear guidelines for dentists.

What is the prevalence of general dentists who screen for OSA?

Now this is an interesting study that I know many of you will want to learn more about. While I was searching the internet for new studies and information on sleep apnea I found this study in the Journal of Dental Sleep Medicine. The researchers were looking to determine the prevalence of general dentists screening for obstructive sleep apnea (OSA).

One thousand general dentists across the U.S. received a brief 12-item questionnaire consisting of a demographic section and questions about OSA screening methods, parameters and preferences. Here is what researchers found.

General dentists screen for OSA

Out of 1,000 general dentists who received the questionnaire from researchers, only 71 responded. However, based on demographic results, those who did respond represent a broad range of general dentists practicing in the U.S.

Dentists were asked to select which screening modalities they use and to supply specific information to provide validity to their responses. Researchers found that 76 percent of general dentists who responded, reported that they screen for sleep apnea.

Dentists use more than one modality

Most of these dentists also use more than one modality when screening for sleep apnea in their patients.  The questionnaire found that 60 percent do not routinely screen more than 70 percent of their patients. And a total of 37 percent ranked themselves a three or less on a scale of one to five regarding their confidence in screening for sleep apnea (one being uncomfortable and five being confident).

To screen for OSA, 72 percent of dentists reported using a patient interview, 52 percent identified anatomical parameters and 39 percent used patient questionnaires. Of the dentists who screen for OSA, 41 percent stated that they have their patients perform an at-home sleep test. There were also 87 percent of dentists suspecting OSA who referred their patients to physicians for further evaluation.

Additionally, dentists with fewer than 30 years of experience were significantly more likely to screen for OSA (87 percent) than those with more than 30 years of experience (63 percent).

A majority of general dentists do screen for OSA in their patients. However, most lack the confidence in performing accurate routine screenings. They do so in fewer than 70 percent of their patients. If you are a general dentist, reach out for help. By completing education courses and attending upcoming lectures, you can better prepare for screening for sleep apnea.