One of the most difficult stumbling blocks in implementing OSA screenings in the dental office is educating the team to create conversations with patients. Most patients have no idea they have a sleep disorder so opening a dialog is crucial. With a few questions and a visual inspection, it can help gauge if further testing is needed and helps to have more information to use when treatment planning implants.  Assessing for sleep disorders whether you treat them within your practice or refer to a sleep physician creates even more opportunities to change the paradigm in our profession.   

Medical History

• Gender
• Smoking and alcohol use
• Presence of Hypertension
• Gastroesophageal reflux disease
• Menopause
• Thyroid problems

 Questions 

• Grind at night
• Morning headaches
• Problems sleeping
• Family history of OSA
• Sleeping supine
• Feeling irritable or depressed
• Waking up often in the night
• Inability to concentrate
• Forgetfulness
• Nasal Congestion
• Wakes up with a dry mouth
• Irritable Bowel Disease
• Dry skin, dry eyes
• Diabetes
• Erectile dysfunction

Bedpartner Questions

• Excessive Movement
• Do they snore or gasp for air?

Written Questionnaire

• Epworth Sleepiness Scale
• STOP BANG

 Diagnostic tools:  

EXTRAORAL

• Neck measurement > 15 female > 17 men
• BMI > 28
• Position of hyoid bone (lateral cephalometric or CBCT)
• Retrognathic upper and lower jaw
• Forward head posture-muscles in the head and neck will be tender on palpation .
• Venous Pooling
• Limited Range of TMY motion

INTRAORAL

• Narrow Palate
• Long soft palate
• Linea Alba
• Scalloped tongue – over 70% of sleep apnea patients
• Tongue tied
• Wear facets, abfractions, tori, calcified stylohyoid ligament
• Check the oropharyngeal airway space visually
• Uvula enlarged or red or battered
• Acid erosion of teeth
• Tonsil Grade Score of 3 or 4

• Mallampati Score of 3 or 4

Other assessments

Pulse oximeter

If daytime blood oxygen level is less than 90% when they are resting you can bet they are dropping during the night. They could have sleep apnea or other respiratory disorders like UARS.

SnoreLab app for iOS and Android

It will give measurements of snoring intensity and duration. When data has been  assessed about 75% of snorers have sleep apnea.

Dentistry cannot diagnose sleep apnea. We can assess, refer for sleep studies or incorporate home sleep apnea testing (HSAT) into your practice. Dentists should always check state licensure and third-party agreements regarding the prescribing of HSAT. Dentists and sleep physicians can work together in harmony to help improve the quality of patient’s lives.