Sleep Dentistry

What’s this all about?

Many people who clench or grind their teeth also snore and also have OSA (Obstructive Sleep Apnea).
Obstructive: to block (in this case, the airway), Sleep Apnea: to cease breathing whilst sleeping. Untreated SA is a problem. There is a direct correlation between it and high blood pressure, increased risk for strokes, uncontrolled diabetes, motor vehicle accidents due to falling asleep at the wheel, and more. Why do I care? You WILL destroy your teeth and all the lovely dental work that I can do for you, not to mention decrease the quality and quantity of your life.

First is the screening:

I always inquire about clenching, grinding, and snoring, among many other things. Do you, or have you been told, that you do any or all of these? Are your teeth sensitive to cold and/or biting pressure? At times do you catch yourself with your jaws clamped tightly together? Do you awaken with your jaw muscles feeling tight and tired as if you have been working out and exercising those muscles? Are your teeth worn down? Have you broken any or many teeth? Do you have a lot of fillings and/or crowns b/c you have chipped or broken teeth?

I stick my head in their mouth and look around. Are there any or many areas of wear on the teeth (wear facets). Are there large “bumps” in the roof of the mouth and/or on the insides of the lower jaw (one torus, multiple tori, as they are called). I look at the relative size of their tongue. Big or not so big. I ask them to say “ahhh”. I am looking to see if I can see behind their tongue into their oropharynx. This is the Mallampati score. The more the oropharynx is blocked, the less that can be visualized, the higher the Mallampati number. What is the shape of the palate (the roof of the mouth)? Is it narrow and constricted or is it nice and high and wide? Are there tonsils present? If so, are they large or not? What is the person’s body-build like? Is that person a big person with a large neck or are they thin? All of this can be examined and discussed relatively quickly and easily at periodic hygiene or new patient appointments. There’s more, too.

Interpretation:

When you unwind and become sleepy, the muscles in your tongue, your neck, and your jaws (among other places) relax. This may allow your tongue to drop toward the back of your throat. As you inhale, you create a suction which may suck the tongue closer to the back of your throat. The air movement may cause vibration in the structures in your throat which may be loud. Think SNORING. It is entirely possible that the suction causes your tongue to block the airway. Obstructive. You stop breathing. Apnea. Your blood pressure begins to go up. This upsets your body. It doesn’t like this. You get fidgety, begin to move around, and then may snort loudly as the airway reopens. You calm down. Your blood pressure goes back down. Soon, the process begins again. This may happen 10, 20, 80, or more times each night.

The body is a marvelous thing. It tries to protect itself. It is not happy when you stop breathing, even for a few seconds. Many times your body will tighten the jaw muscles or cause you to grind your teeth. This is to prevent the jaw muscles from relaxing and allowing the tongue and jaw to drop back in your mouth and block your airway. So, when I see evidence of bruxing (grinding your teeth) or clenching, I am wondering about other things. Sore teeth and tight, sore jaw muscles may be associated with clenching and grinding. A history of broken teeth? Same thing. Those tori take up room for your tongue and your airway as do large tonsils. A high, narrow palate is also associated with OSA. A large tongue and a high Mallampati score, are also correlated with OSA. A big person with a large neck? Same thing.

What do I do about all of this?

Wouldn’t a bite guard help with the clenching and grinding? Yes, it would. It would protect the teeth and relax the jaw muscles. Relax the jaw muscles? Might this be the opposite of what we want? Wouldn’t this possibly make OSA worse? Yes, this might help with a dental problem but possibly make a medical problem worse.

We would need to rule out OSA, a medical problem before we would do much dental treatment. Many times we would refer you to a physician for you to undergo a sleep study. They would monitor many things while you sleep and determine the nature of your condition. Many times we could conduct a home sleep study and have it interpreted by a physician. The end result is a diagnosis of Obstructive Sleep Apnea, or not.

The gold standard for treatment for OSA is the CPAP device. Constant Positive Air Pressure. A mask and hose would be affixed to your face to pump air into your lungs at night to prevent you from stopping breathing. These can be very successful. They also can be a pita as you have this noisy machine and mask and hose with you all night, every night.

Another option is a dental device. This would fit over your upper and lower teeth and prevent your jaws from dropping to the back of your mouth. This can be titrated, adjusted, to slightly pull your lower jaw and tongue forward to increase the airway volume. No mask, hoses, or machine to deal with.

What if I do nothing?

As was previously discussed, there is a definite relationship between sleep apnea and heart disease, increased risk for strokes, worsening of diabetes, and more. Dentally, you are at a much greater risk for wearing down your teeth. This can lead to breaking teeth and your dental work. This can change your bite and create or worsen jaw problems. You decide what you want to do. These are your teeth, not mine.