The recognition and management of sleep-breathing disorders: a mandate for dentistry

Abstract

Dentistry is unique among the health professions in that biannual re-examination visits are deeply ingrained in the American psyche. This and the close personal relationships that often develop between dentist and patient afford dentists the opportunity to closely monitor the medical health of their patients. But dentistry, in its zeal to avoid the constraints of dental insurance and to cater to the increasing demands for cosmetic enhancement by the public, has relinquished, in many cases, the responsibilities that the title of doctor has bestowed on the profession. Simply stated, dentistry, as a whole, is not doing enough to fulfill its public health responsibilities. Nowhere is this more evident than in the field of sleep-breathing disorders. Most dental school curricula (and, incidentally, most medical school curricula) do not provide any background in sleep medicine. Consequently, most practicing dentists do not even consider including sleep questions on their medical questionnaires or asking simple questions during initial or recall examinations or even before oral or IV sedation. 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, and death. 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. The need for publicizing dentistry’s involvement in sleep medicine is, however, the subject for a different article. While it is understandable that many in the dental profession do not want to assume the added responsibility of treating a medical problem with an oral appliance and cannot devote the time, resources, and effort it requires to become qualified to practice in this area, there are two simple things every dental practitioner can and must do. – STOP questionnaire – Measure neck size