Snoring More Than Usual? It Might Be More Than Just a Nuisance: The Importance of Dental Sleep Medicine Screening

Do you or your partner experience loud snoring, pauses in breathing during sleep, or daytime sleepiness? These could be signs of a sleep-related breathing disorder like obstructive sleep apnea (OSA). While often overlooked in a dental setting, dentists are increasingly playing a crucial role in identifying and managing these conditions through Dental Sleep Medicine (DSM).

Why involve your dentist in your sleep? Because dentists are experts in the oral and maxillofacial region, which directly impacts your airway. They are often the first healthcare professionals to notice potential signs of sleep-disordered breathing during routine check-ups.

Screening for Sleep-Disordered Breathing: What to Expect

Dental sleep medicine screening is a non-invasive process that can provide valuable insights. Your dentist might:

• Ask you questions: They'll inquire about your sleep habits, snoring patterns, daytime fatigue, and any diagnosed medical conditions. Be honest and thorough in your responses!

• Conduct a physical examination: This will involve assessing your airway, jaw position, tongue size, and bite. Certain oral features can be indicators of a higher risk for OSA.

• Utilize questionnaires: Standardized sleep questionnaires, like the Epworth Sleepiness Scale, can help quantify your daytime sleepiness and assess your risk level.

Tools Dentists May Use in DSM Screening:

While dentists don't typically perform full sleep studies (polysomnography), they may use or recommend tools to aid in the screening process:

• Home Sleep Apnea Tests (HSATs): Dentists can sometimes provide or recommend these convenient tests, which monitor your breathing patterns overnight in your own bed. The data is then analyzed by a sleep physician.

• Sleep Screening Devices: Some dental offices may utilize small, portable devices that record basic sleep parameters like oxygen saturation and heart rate overnight.

• Cone-Beam Computed Tomography (CBCT): In certain cases, a CBCT scan can provide a 3D image of your airway, helping to identify any structural issues that might contribute to breathing problems during sleep.

What Happens After Screening?

If your dental screening suggests a potential sleep-disordered breathing issue, your dentist will likely refer you to a sleep physician for a comprehensive diagnosis through a polysomnography. If diagnosed with mild to moderate OSA, or if CPAP therapy is not well-tolerated, your dentist, with specialized training in DSM, may be able to offer oral appliance therapy (OAT). These custom-fitted devices help keep your airway open during sleep, providing a comfortable and effective alternative for many patients.

Don't let snoring and daytime fatigue disrupt your life. Talk to your dentist about Dental Sleep Medicine screening – it could be the first step towards a better night's sleep and improved overall health!

Our STOP-Bang Questionnaire

--------------------------------------------------------------------------------------Please tick the boxes if the following is present -----------------------------------------------------------------------------

❒ Snoring?
Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?

❒ Tired?
Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving)?

❒ Observed?
Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?

❒ Pressure?
Do you have or are being treated for High Blood Pressure?

❒ Body Mass Index more than 35 kg/m2?

❒ Age older than 50 years old?

❒ Neck size large? (Measured around Adams apple) For male, is your shirt collar 17 inches/43 cm or larger? For female, is your shirt collar 16 inches/41 cm or larger?

❒ Gender = Male?

___________________________________________________________________________________________________________________________________________

Scoring Criteria (for general population)

• Low risk of obstructive sleep apnoea (OSA): Yes to 0-2 questions

• Intermediate risk of OSA: Yes to 3-4 questions

• High risk of OSA: Yes to 5-8 questions

  • or Yes to 2 or more of 4 STOP questions + male gender 2

  • or Yes to 2 or more of 4 STOP questions + BMI > 35 kg/m

  • or Yes to 2 or more of 4 STOP questions + neck circumference (17”/43cm in male, 16”/41cm in female)

All you need to know about Oral Appliance Therapy

Snoring and sleep apnea are common signs of disturbed sleep patterns. However, it can be difficult to talk to patients about snoring and sleep apnea treatment, particularly when patients see negative or humorous portrayals of continuous positive airway pressure (CPAP) on social media and elsewhere. Patients might assume CPAP is the only option and not realize that dental sleep apnea treatment is an effective alternative. Patients may also feel strange talking to a dentist about a medical condition that has no obvious connection to the teeth, jaws or gums.

While snoring, sleep apnea and CPAP can be characterized as humorous, sleep-disordered breathing may also be associated with conditions such as:

• Diabetes

• Heart disease

• Stroke

• High blood pressure

• Bed wetting

• Fragmented sleep patterns

• Concentration issues

• Mood changes

• Nighttime sweating

• Excessive daytime sleepiness

It is recommended that dentists speak with patients about sleep-disordered breathing during routine exams. If snoring and sleep apnea are disrupting sleep patterns, treatment may provide a significant improvement on the patient’s overall health and well-being. Here are top questions and answers that patients need to know to better understand dental sleep apnea treatment.

1. What Is the Dental Treatment for Snoring and Sleep Apnea?

Dental treatment for snoring and sleep apnea has been in the literature since the early 1900s, when Dr. Pierre Robin identified that the airway size corresponds to the position of the jaw. Dr. Robin developed a simple monobloc device that held the jaw in a protrusive position. This was the first documented use of an oral appliance for the treatment of snoring.

Modern oral appliance therapy incorporates titratable devices that allow the advancement of the mandible in increments of 1 mm or less. This gives a trained dentist the ability to move the mandible forward or backward depending on the patient’s response to this treatment.

Naturally, there is more than one way to get this kind of adjustment, and as the patient’s comfort is considered, there are different functional components that achieve the desired results.

2. Why Is Airway Size Important for Snoring and Sleep Apnea?

Snoring and its more serious comorbid condition sleep apnea are signs of a collapsing airway. In fact, snoring is the sound that a partially collapsed airway makes. When the patient falls asleep and the tissues of the airway relax, the jaw can fall back in the airway. As the base of the tongue approaches the wall of the hypopharynx, the rushing air vibrates soft tissue of the airway, creating the snoring sound.

When the airway completely collapses, the soft tissues can adhere to each other, creating an obstructive seal of the airway. The seal stops the patient from breathing entirely and can last for 10 seconds to more than a minute, despite the patient’s efforts to breathe. This is a serious medical condition.

If snoring is accompanied by any of the following issues, it may warrant consultation with a dentist or physician for sleep apnea evaluation:

• Witnessed breathing pauses during sleep

• Excessive daytime sleepiness

• Difficulty concentrating

• Morning headaches

• Dry mouth upon awakening

• Restless sleep

• Gasping or choking at night

• High blood pressure

• Chest pain at night

• Loud snoring that disrupts a partner’s sleep

3. How Do Oral Appliances Work?

Oral appliances for snoring and sleep apnea treatment have a very specific method of action. They are designed to cover and engage the upper and lower teeth, like a retainer or nightguard. These appliances all have some mechanism that joins the upper and lower splints, so that they are fixed together. This is how the lower jaw (mandible) is held in a position set by the dentist to apply tension to the muscles and ligaments of the upper airway and support the airway all night long.

As noted above, this position is an anterior or advanced jaw position, and it can be different for every patient. Modern oral appliances are all adjustable between 6 mm and 15 mm. This allows the dentist to adjust the lower jaw position after the appliance has been delivered, and the patient adapts to the initial jaw position.

Myofunctional Therapy: Restoring Natural Breathing & Oral Health

Nature designed us to breathe through our noses—yet for many, mouth breathing becomes an unconscious habit. When breathing is compromised, it can quietly undermine your oral health and overall wellbeing.

At Le Dentistry, we specialize in identifying and correcting the root causes of mouth breathing. Just as exercise strengthens and balances the body, myofunctional therapy retrains the tongue, lips, and facial muscles to restore ideal oral posture. This gentle, science-backed approach helps you relearn healthy patterns for breathing, chewing, and swallowing—naturally.

Safe, minimally invasive, and free of side effects, myofunctional therapy is a proactive step toward lifelong wellness—starting with the way you breathe.

Ready to breathe easy? Let’s talk.

Myofunctional therapy is a program of exercises designed to improve the function and coordination of muscles in the mouth and face, including the tongue, lips, and jaw. It focuses on retraining these muscles to promote proper eating, breathing, swallowing, and speech. This therapy can address issues like obstructive sleep apnea and TMJ disorders. 

Click on the following videos to learn more about myofunctional therapy and exercises.