How do sleep disorders interact with oral diseases?
N.T. Huynh, E. Emami, J.I. Helman, R.D. Chervin
Dental sleep medicine is a rapidly growing field that is in close and direct interaction with sleep medicine and comprises many aspects of human health. As a result, dentists who encounter sleep health and sleep disorders may work with clinicians from many other disciplines and specialties.
The main sleep and oral health issues that are covered in this review are obstructive sleep apnea, chronic mouth breathing, sleep-related gastroesophageal reflux, and sleep bruxism. In addition, edentulism and its impact on sleep disorders are discussed. Improving sleep quality and sleep characteristics, oral health, and oral function involves both pathophysiology and disease management.
The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral healthrelated sleep disorders that are commonly seen in dental practice.
Purpose of the Review
The review highlights some key aspects of the interactions between oral health and sleep, sleep disorders, and related sleep-health management issues that are commonly seen in dental practice.
- The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral health-related sleep disorders.
- The team usually includes one or more sleep specialists and oral health specialists, such as a dentist, orthodontist, or oral and maxillofacial surgeon.
- The role of the dentist or orthodontist is to screen, assess, refer to a sleep specialist, and possibly refer to an otolaryngologist. The dentist or orthodontist also plays an important role in short- and long-term follow-up.
- Patients who report excessive daytime sleepiness (EDS), snoring, or witnessed apneas, often with concomitant risk factors such as obesity, large tonsils, or specific craniofacial morphologies (narrow jaw, deep palate, retrognathia, macroglossia), should be referred to a sleep medicine physician.
- Obstructive sleep apnea and sleep-related gastroesophageal reflux are medical diagnoses.
- General dentists and prosthodontists can provide obstructive sleep apnea therapy to suitable candidates, on the recommendation of the treating sleep physician, using various oral appliances such as a mandibular advancement device. Patients should be advised to maintain good oral health and healthy sleep hygiene.
- Maxillomandibular surgery by either an oral and maxillofacial surgeon or otolaryngologist to treat adult obstructive sleep apnea is usually preceded and followed by orthodontic treatment to help ensure successful and stable repositioning. Orthodontists can also treat and prevent exacerbation of obstructive sleep apnea in children through guided craniofacial growth, such as rapid maxillary expansion and mandibular advancement with a functional appliance.
- Successful management of obstructive sleep apnea can subsequently have positive consequences for many other sleep disorders, such as insomnia and parasomnias, which in some patients are secondary to the sleep apnea.
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