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Diagnostic, Evaluation, and Treatment Approaches Used in Dental Sleep Medicine
Stephen Poss, DDS
While some causes or symptoms of sleep-disordered breathing can be identified visually upon oral examination or by observing radiographic images, establishing a diagnosis of this disorder and determining its severity requires the use of specific diagnostic testing. This article reviews diagnostic and evaluation technologies, as well as surgical and nonsurgical treatments, currently available for dentists collaborating in the treatment of patients with sleep breathing disorders, including snoring and obstructive sleep apnea.
Sleep-disordered breathing (eg, snoring, obstructive sleep apnea) affects an estimated 24% or more of adults and contributes to such life-threatening conditions as hypertension and high blood pressure, heart failure, diabetes, stroke, depression, and obesity.1,2 It is also associated with serious motor vehicle, work-related, and at-home accidents.3 Characterized by recurring cessations or reductions in breathing during sleep, sleep-disordered breathing involves loss of the normal “awake” or “upright” tone and position of the oral cavity and oropharyngeal musculature. In some instances, the tongue falls back into the oropharynx, or the airway narrows, collapses, or otherwise becomes obstructed. Sleep-disordered breathing results from obstructions and/or upper airway collapse, some of the causes or symptoms of which can be identified visually upon oral examination and others by examining radiographic images.4,5
Among the anatomical characteristics that may contribute to sleep-disordered breathing that could be observed during a dental examination are macroglosia, narrow mandibular arch, high palatal vault, large uvula, and enlarged tonsils. Considering that dentists see most of their patients every 6 to 12 months, they may be the first healthcare professionals to suspect a patient is suffering from sleep-disordered breathing. Other contributing anatomical characteristics that can be observed radiographically include a larger distance between the mandibular plane and hyoid bone,6 posterior displacement of the symphysis,7 and other disproportionate relationships between the tongue base, soft palate, cranial base, pterygoid processes, cervical spine, and others.8
Visual examination and radiographic approaches are helpful for identifying the signs of, and anatomical characteristics potentially contributing to, sleep-disordered breathing. However, establishing a diagnosis of sleep-disordered breathing and determining the severity of the disorder (ie, snoring, obstructive sleep apnea, mild-moderate-severe) require the use of specific diagnostic testing (eg, polysomnography, portable home sleep study). Depending upon the state in which dentists practice, they may be limited to screening for the condition or administering a sleep apnea test, and prohibited from rendering a diagnosis or prescribing a specific treatment because the tests must be interpreted—and a correct diagnosis rendered—by a physician.9,10
Fortunately, since dental sleep medicine began gaining greater attention more than 20 years ago, dentists and sleep physicians are increasingly collaborating to enhance the timeliness of sleep-disordered breathing diagnoses and appropriateness of treatment. Further, a variety of diagnostic/evaluation technologies and treatment approaches have been studied and reviewed in recent years to enable dentists and their sleep physician colleagues to determine the most appropriate treatment options for individual patients, based on the cause of their sleep-disordered breathing and the extent of the problem. This article briefly reviews diagnostic and evaluation technologies and surgical and nonsurgical treatments currently available for dentists collaborating in the treatment of patients with sleep breathing disorders.