Why Your Dentist Might Ask About How You Sleep

Things have changed about the dentist's office over the past few years. In addition to asking whether we floss and if we have pain in our mouths, now there are questions about sleep. How well do you sleep? Do you snore? Does your partner say something? Wake up with headaches? Are you tired in the middle of the day even though you got eight hours last night?

Such questions are not casual small talk. Dentists are screening for sleep apnea, and doing so in a place most people wouldn't suspect. There's a significant connection between what occurs in your mouth and your ability to breathe at night, and dental professionals know how to look for the signs.

The Mouth-Sleep Connection No One Talks About

The reality is that the dentist is one of the only professionals who will see parts of you that a doctor likely never will. For example, the tongue, the soft palate, the back of the throat and the teeth/jaw's positioning all contribute to how air stays open or closed while sleeping. Usually, these elements are assessed during dental hygiene assessments.

Sleep apnea occurs when something obstructs the airway while sleeping, or reduces access to it. It could be something as benign as the tongue rolling back when unconscious; it could be excess tissue lining the back of the throat (think polyps) or the structural formation of the jaw; perhaps it's a teeth grinding scenario pushing everything backward further than it already goes. Or it's simply the physical position of a receding jaw, postured back mouth or smaller overall structure; it's things an oral professional can catch that are problems when it comes to nighttime breathing.

This is where a St. Louis sleep apnea dentist might notice something during examination that could signal issues for breathing down the line, or problems that would go unnoticed for significant time until more severe.

It's Preventative

The problem is that things present themselves in teeth as well as functional structuring of the jaw. For example, teeth excessively worn in certain places (most often on biting areas), where they're flat and yellowed, denote grinding, which comes with many people who have sleep apnea.

Teeth that are scalloped on their edges means that either someone has a big tongue, or that the tongue is so far positioned forward in an effort to keep the airway open that it gets manifest on the edges of teeth from clenching (since the tongue cannot hold itself up in the cavity).

An upper jaw that's overly narrow denotes excess tissue; a high palate or large tonsils note reduced space in the throat; a recessive lower jaw indicates a recessed chin, likely an airway that becomes smaller naturally. The lower the tongue and larger it appears, either it's pushed down further or it's bulkier in the form which makes it more difficult since falling back naturally prevents airway access.

Why It Matters

Sleep apnea is more than annoying snoring and feeling like you need three shots of espresso to wake yourself up. Sleep apnea occurring all night, even if it's for seconds at a time, stresses multiple physiological systems. The heart has to work harder; blood oxygen levels decrease; every time someone partially wakes up because they run out of breath, their sleep fails to get deeper/restorative.

Long-term complications associated with untreated sleep apnea include high blood pressure, heart disease, stroke, diabetes, cognition and concentration failure; sleep apnea coincides with increased accidents on the road because people are so tired during the day. The long-term implications are worse than any temporary daytime grogginess can fail to acknowledge.

But for most people with sleep apnea, of which 80% remain undiagnosed, they don't realize they have it. They know they snore; they know they're tired, but they don't recognize it's a diagnosable condition with life-or-death ramifications because it happens while they're asleep. They can't catch symptoms as most occur when they're unconscious. But if a dentist asks the right questions, he or she could be first to recommend assessment for a more significant diagnosis.

The Sleeping Screening Process

The dental screening for sleep apnea isn't so complicated. It involves a questionnaire-type assessment inquiring about nighttime quality, observed snoring, morning headaches, daytime fatigue, partner-reported breath holding and more (some offices use risk assessments based on criteria).

Then comes a physical assessment whereby a dentist looks for jaw structures, size and placement of the tongue/soft palate/tonsils and overall assessment of airway space (he or she might take measurements to see how far forward and backward any aspect should go).

Should screeners come back suggesting possible breath apnea issues, referral to a sleep specialist becomes the next step. Diagnosis comes through a sleep study assessment which can either happen at home (less accurate) or through an assigned device overnight at a lab (more accurate). A physician can officially diagnose sleep apnea but dentists can determine if someone warrants additional assessment.

The Treatment Options That Come From The Dentist

Most importantly, dentists can facilitate treatment, once someone has gone through testing with a diagnosis from a specialist. Oral appliance therapy involves therapeutic devices that look like mouthguards or orthodontic retainers. They position the jaw forward while sleeping to keep airways open.

Oral appliances work best for mild-to-moderate sleep apnea cases and many people find them easier to acclimate to than CPAP (the big mask and hose situation). They're portable, small, quiet and do not require access to batteries or outlets; many people who cannot tolerate CPAP often find success with oral appliances instead.

Note that the dentist needs to get an impression for an accurate mold; there's an adjustment period since someone must learn how to use it effectively while also keeping functioning open for airways. Follow-up appointments gauge effectiveness without excess discomfort/tooth wear.

When Jaw Position Is A Problem

Sometimes treatment relates specifically to jaw development formations, which occur earlier on in life or not at all for adults. A recessive lower jaw or narrow upper jaw limits nasal passageway from birth. Childhood development allows dentists/orthodontists to intervene with children so they grow properly.

Palate expanders widen nasal passages in the upper jaw which creates more space for tongues but also larger nasal passages; specific braces or expansion appliances help lower jaws grow more forward (an angled chin becomes naturally jutted after development). When these preventable developments occur during younger years, it's possible to prevent sleep apnea from happening in the first place.

However, when people become adults, this opportunity no longer exists since bone formations become cemented. This doesn't mean oral appliances won't work for functional positioning during sleeping; they absolutely change biomechanics for airflow, but they will not adjust physical growth after fact.

For severe conditions that warrant jaw surgery (much less likely), teeth need to be removed while jaws can shift into their respective positions, but this is a last resort if there's no other avenue which succeeded.

Why More Dentists Get Involved

Education behind dental understanding has added awareness concerning sleep disorders; many dentists seek special certification in dental sleep medicine specifically as studies show mouth structure health relevant connection with issues breathing-related.

There's also practicality, dentists see patients frequently every year (one or twice); it's better than seeing one's primary care physician one every 2-5 years and if any other preventative diagnostic possibilities can be noted within those frequent visits, all the better.

Insurance options have expanded coverage for dental interventions concerning sleep apnea as well (though plans vary and medical insurance will typically cover anything prescribed over dental work). Either way, oral appliances are covered by medical insurance due to diagnosis versus merely dental work after testing.

What To Do When A Dentist Brings It Up

If a dentist approaches concern over your quality of sleep potentially suggesting sleep apnea, it's important not to take offense, it's not unsubstantiated claims as they don't mean there's definitely something wrong; they just feel further investigation is warranted based upon what they've seen/explored.

Assessment/testing isn't complicated for sleep apnea; home testing has been much more prevalent as accurate overnight assessments where patients wear tiny home monitoring devices which track breath quality and oxygen count during slumber.

If someone does receive an assessment from testing showing sleep apnea, there are benefits associated with treatment which make life better, for people report feeling more rested, feeling lighter on their feet and thinking clearer, and general well-being increases beyond feeling better at night through optimistic health assessments.

So next time your dentist asks about how well you're sleeping they aren't trying to prompt small talk, they're considering anatomical presentations of components which likely will cause complications come nighttime. It's preventative, assessed from where it happens, and ideally caught by too many who go years without any diagnosis.