By Gordon Christensen – Clinicians Report

Snoring causes sleep disruption, psychological damage, and marital challenges. Should dentists be one of the primary practitioners treating snoring?

Although the topic is getting more attention in the lay press, many people do not know that there is professional help for snoring. Sleep apnea or pauses in breathing while sleeping in both adults and children ranges from 5 to 100 times per hour and causes daytime fatigue, slow reaction time, and an increased risk of heart attack and stroke. It has been estimated that 1 in every 15 Americans is affected by at least moderate sleep apnea which can cause serious physical challenges.

Snoring is a social problem and sleep apnea creates a significant health risk; therefore, they may require different therapies.

In this report, CR staff, scientists, and Evaluators provide a practitioner survey, a discussion of snoring treatment concepts, information on dealing with sleep apnoea, and clinical tips to motivate dentists to consider treating these conditions.

Gordon’s Clinical Bottom Line: About 30–50% of adults snore while sleeping. Snoring increases with age and is more prevalent in men. Its treatment has long been associated with dentistry, since reduction or elimination of snoring is produced when the mandible is moved forward or the tongue is depressed by an anti-snoring appliance. Sleep apnoea, or abnormal pauses in breathing or abnormally low breathing during sleep, can be life threatening. CR scientists and clinicians have compiled information about the various anti-snore concepts and devices and suggest what to do with patients who have sleep apnoea.

Snoring causes sleep disruption, psychological damage, and marital challenges. Should dentists be one of the primary practitioners treating snoring? Although the topic is getting more attention in the lay press, many people do not know that there is professional help for snoring.

Sleep apnoea or pauses in breathing while sleeping in both adults and children ranges from 5 to 100 times per hour and causes daytime fatigue, slow reaction time, and an increased risk  of heart attack and stroke. It has been estimated that 1 in every 15 Americans is affected by at least moderate sleep apnoea which can cause serious physical challenges.

Snoring is a social problem and sleep apnoea creates a significant health risk; therefore, they may require different therapies.

In this report, CR staff, scientists, and evaluators provide a practitioner survey, a discussion of snoring treatment concepts, information on dealing with sleep apnoea, and clinical tips to motivate dentists to
consider treating these conditions.

Diagnosis and treatment of snoring and sleep apnoea
A rational approach for dentists interested in these two conditions is to become educated in snoring and sleep apnoea; partner with recognized physicians and sleep centers; and treat these conditions.

Diagnosis of snoring is not a challenge.

  • Manifests itself by numerous types of objectionable sounds.
  • Caution: Patients who appear to have simple snoring may also have sleep apnoea and diagnosis of sleep apnoea should be assessed by a sleep medicine physician and analyzed by a sleep study.

 

Diagnosis of sleep apnoea requires a sleep study (a polysomnogram), usually done at a sleep study center or at home with a home sleep study system.

  • Discussion with a practitioner specializing in sleep disorders will help to determine which is indicated.

 

Snoring is caused by:

  • Soft-tissues at the back of the throat vibrating against one another
  • An obstruction in the nasal airway
  • Weak throat muscles, causing the throat to relax and get narrower during sleep
  • Skeletal Class II malocclusion
  • Muscle relaxants such as alcohol or sedative hypnotics (Benzodiazepines: Xanax, etc.)
  • Sleeping on one’s back causes the tongue to drop back into the airway

 

Treatment for snoring relates to opening the narrowed breathing passage. Snoring is usually treated by dentists, since oral appliances are commonly used. However, many treatments are available:

  • Anti-snoring oral appliances
  • Palatal surgery
  • Pillar procedure
  • Medications (Protriptyline)
  • Losing weight
  • Stop smoking
  • Sleep on their side not their back
  • Over the counter nasal sprays
  • Nasal strips or nose clips
  • Positional devices (anti-snore pillows or clothing to prevent sleeping on the back)

 

Treatment of sleep apnoea ranges through the following:

  • Lose weight and quit smoking
  • Oral appliances
  • PAP treatments, with CPAP being the most common
  • Positional devices to prevent sleeping on the back
  • Surgery of several types, including maxillo-mandibular advancement

 

Examples of Successful Anti-Snore/Sleep Apnoea Devices:

  • Adjustable PM Positioner
  • Aveo TSD Anti-Snoring Device
  • Dorsal fin devices
  • EMA (Elastic Mandibular Advancement)
  • Full Breath Solution
  • Herbst device
  • Klearway
  • The Moses
  • Silent Nite sl
  • SomnoDent
  • TAP (Thornton Adjustable Positioner)
  • Therasnore

 

Clinical Tips

  • Educate patients about how dentists can provide anti-snore devices that are usually effective. Place posters in your office, webpage information, office newsletters, newspapers, etc.
  • Associate with other practitioners providing treatment of sleep apnoea. Sleep medicine specialists usually include pulmonologists, otolaryngologists, neurologists, and psychiatrists. Other providers who are an important part of the team include primary care physicians, internists, general dentists, and dental specialists including oral maxillofacial surgeons. Seek out appropriate practitioners in your area.
  • Develop a relationship with a dental lab experienced in making anti-snore appliances and sleep apnoea devices.
  • Reducing snoring using oral appliances may increase sleep apnoea. Practitioners are advised to send snoring patients to sleep testing centers to ensure that they do not have sleep apnoea or other sleep disorders or to be treated for these conditions.
  • Many medical insurance plans, including Medicare, provide benefits for sleep apnoea appliances. You may find information on this subject by contacting the American Academy of Dental Sleep Medicine at www.aadsm.org
  • Many traffic fatalities relate to falling asleep while driving. Warn your patients about this possibility.
  • Caution: Patients using benzodiazepines can lose their airway rapidly.

 

CR Conclusions:
Treatment of snoring and obstructive sleep apnoea is well within the realm of dental practice for those dentists who are interested and who acquire adequate education.

Oral appliances used for snoring are very effective, but they may increase sleep apnoea if not diagnosed correctly.

Differential diagnosis of the reasons for sleep apnoea should be accomplished by a recognized sleep apnoea specialist, usually a physician. Snoring and obstructive sleep apnoea are closely related, and those treating either condition must have appropriate education and work with knowledgeable practitioners and sleep centers.

Yes, interested dentists can become skilled in screening and the treatment of snoring and sleep apnoea working together with recognized sleep medicine physicians who diagnose the condition.

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