Dentistry and Sleep-Breathing Disorders

It has been estimated that in the United States alone 18 million men, women and children suffer from sleep apnea. Millions more snore. Of these 18 million, approximately 85% are not aware of their problem despite the fact that the average life span of an untreated sleep apneic is years shorter than for the rest of the population. Both snoring and obstructive sleep apnea have been implicated causally and otherwise in cardiac disease, myocardial infarction, irregular heart beat, hypertension, diabetes, stroke, depression, and erectile dysfunction to say nothing about vehicular and occupational accidental injury, death and planetary pollution. At a time when, in the United States, presidential candidates and the public clamor for the adoption of universal health care, the increased medical costs associated with untreated sleep apnea are estimated to be in the billions a year.

Oral appliance therapy has been accepted as an alternative or supplement to CPAP in some instances and yet the public and many dentists remain unaware of the vital role of the dentist as part of the healthcare team for the recognition and management of snoring and obstructive sleep apnea.

Dentists who have chosen to become involved in the recognition and management of snoring and obstructive sleep apnea are exceptional in their viewpoint and in their dedication to learning. Those physicians who recognize the important contribution dentistry can make and have accepted these dedicated practitioners as part of the treatment team are to be applauded. Dental schools whose forward-looking faculties have chosen to include the study of sleep-breathing disorders are to be commended.

There is, however, more that needs to be done.

Dentistry must assume its full role as a healthcare profession in the 21st century. It is no longer enough to be consumed with only the appearance and health of the oral cavity. The ability to recognize potential stroke victims by panoramic radiograph and to recognize the relationship of periodontal disease to cardiac disease have already mandated a new vision for dentistry. To that mandate we must add, at the very least, the screening for obstructive sleep apnea.

In the May, 2008 issue of the journal Anesthesiology , Chung et al propose a series of 4 questions to be asked of every patient about to undergo surgery under general anesthesia. Dr. Chung and her team propose the STOP questionnaire:
S: Do you snore loudly?
T: Do you often feel tired, fatigued or sleepy?
O: Has anyone observed you stop breathing during sleep?
P: Do you have or are you being treated for high blood pressure?

If you answer "yes" to two or more questions, then you have a high probability of having obstructive sleep apnea. For a more in-depth assessment, please visit the Ares Screener at SnoringIsntSexy.com.

This questionnaire should be part of every practicing dentist's initial medical history and asked again at reevaluation appointments. It is essential that these questions also precede every administration of oral or IV sedation in-office.

If your dentist doesn't ask you these questions, point him or her to this site or to SnoringIsntSexy.com for more information on the way he or she can protect your health and the health of loved ones.