Advocate for OSA Awareness
Dental Hygienists Are in a Pivotal Position
Kent Smith, DDS, D-ABDSM, ASBA
With approximately 30 million Americans afflicted with sleep-disordered breathing1 and the prevalence of obstructive sleep apnea (OSA) continuing to grow,2 dental professionals are witnessing firsthand a public health issue with severe consequences for patients and public safety. However, despite years of advocating for increased OSA awareness (including a similar call to action in Registered Dental Hygienist Magazine in 2008), we're still lagging in our efforts to address the problem. As the estimated undiagnosed rate is up to 80 percent,1 we have considerable work to do to promote OSA screening and treatment in this country.
Over the next 40 years, the US population age 65 and older-a group at high risk for the condition-is projected to top 98 million.3 What's more, by 2030 about half of the US adult population will be obese4-a major risk factor for the development and progression of OSA. These two trends will undoubtedly contribute to an increase in OSA, resulting in a higher risk for vehicular crashes, work accidents, and serious medical conditions (including depression, high blood pressure, diabetes, and stroke).
As if the tolls on health and safety weren't enough, it also is estimated that untreated OSA adds approximately $3.4 billion annually to healthcare costs in the United States.5 Due to a lack of education about the condition, underappreciation of its seriousness, and a healthcare system hyperfocused on acute illness, undiagnosed and untreated OSA is costing billions of dollars, while millions of patients continue to suffer its chronic effects.6
The good news is that-as with many chronic conditions-early diagnosis and effective treatment of OSA reduces healthcare utilization, medical costs, unnecessary suffering, and even mortality. If we can create a system of care in which clinicians across healthcare disciplines-from the physician's office to the dental operatory-band together to educate patients about the condition's risk factors, signs, and symptoms, we can protect our patients from falling victim to this often debilitating disorder and its life-threatening comorbidities.
Forging a Partnership
The father of dental hygiene, Alfred C. Fones, DDS, was a true believer in preventive medicine, envisioning a world in which dental hygienists collaborated with other health and social service workers to provide preventive care for the benefit of patients' overall quality of life. Today, dental hygienists are in a pivotal position to realize Dr. Fones' vision through an interdisciplinary effort to screen patients for conditions such as OSA that, if present, could have a major impact on relationships, health, and safety.
Fifty-eight percent of Americans reportedly visit the dentist's office at least once per year7-arguably more often than they visit their primary care doctor. Although hygienists and dentists cannot diagnose OSA, we can (and should) play a key role in initiating the collaboration between the medical and dental fields with regards to the disorder.8 By including an OSA screening protocol into routine care procedures, we can increase the potential for patients to receive an accurate, early diagnosis and encourage them to seek treatment.8
There are two key ways in which practices and dental hygienists can take a more active role in OSA detection:
Screen for anatomical indicators during routine visits. Many patients with sleep-disordered breathing have craniofacial characteristics that are easily discernible during a routine dental visit:
• Large neck circumference
• Lack of cricomental space
• Small or recessed chin
• Pharyngeal grade over 2 or high Mallampati
• Enlarged tonsils
• Decreased intermolar distance & vaulted palate
Proactively discuss OSA risk factors with patients. Dental practices can implement, as part of their patient paperwork protocols, a screening tool that allows hygienists to engage patients in a proactive discussion about OSA risk factors. A few examples of established OSA questionnaires include the Epworth Sleepiness Scale; Apnea Risk Evaluation System Questionnaire; and STOP-BANG questionnaire.
Step Out of Your Lane
As dental health professionals, we know that oral health is more than just healthy teeth-and it's time we step up to serve as the first line of defense against OSA. Hygienists and dental staff can step out of their lanes and challenge the current status quo to forge greater collaboration between the dental and medical communities.
History has shown that dentists have an important role in the public health equation. When dental professionals joined in the fight to combat oral cancer through opportunistic screening that increased early detection, lives were saved. As with oral cancer, early detection of OSA has a profound effect on treatment and health outcomes. We can help patients improve their quality of life, reclaim physical and psychological health, and reduce the health consequences of OSA and its dangers to society.9
In short, we have the power to advocate for our patients. Now is the time to confidently take the initiative in the campaign against OSA.
About the Author
Kent Smith, DDS, D-ABDSM, ASBA
Founding Director, Sleep Dallas
Founder, 21st Century Sleep Seminars
1. Peppard PE, Young T, Barnet JH, et al. Increased Prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014.
2. Osman AM, Carter SG, Carberry JC, Eckert DJ. Obstructive sleep apnea: current perspectives. Nat Sci Sleep. 2018;10:21-24.
3. Mather M, Jacobsen LA, Pollard KM. Aging in the United States. Population Bulletin. 2015; 70(2):3.
4. Close to half of U.S. population projected to have obesity by 2030 [news release]. Boston, MA: Harvard T.H. Chan School of Public Health; December 18, 2019.
5. Motamedi KK, McClary AC, Amedee RG. Obstructive sleep apnea: a growing problem. Ochsner J. 2009;9(3):149-153.
6. Frost & Sullivan. Hidden Health Crisis Costing America Billions. American Academy of Sleep Medicine. 2016.
7. Survey: More Americans want to visit the dentist [news release]. Chicago, IL: American Dental Association; March 21, 2018.
8. Komegay EC, Brame JL. Obstructive Sleep Apnea and the Role of Dental Hygienists. J Dent Hyg.2015;89(5):286-292.
9. Understanding and treating obstructive sleep apnea. Impact of treatment. Harvard Medical School Division of Sleep Medicine Web site. https://healthysleep.med.harvard.edu/sleep-apnea/treating-osa/impact. February 2011. Accessed March 11, 2020.