The snoring-dentistry connection

Feb. 1, 2005
At press time, NFL Hall of Famer Reggie White died from sleep apnea at the age of 42.

Michael DiTolla, DDS, FAGD

At press time, NFL Hall of Famer Reggie White died from sleep apnea at the age of 42. While his untimely death is certainly tragic, perhaps it can serve to help educate the public about this disease, and the role the dentist can play in treating it.

A recent Consumer Reports article, “Snoring: Deadly Din?” reported that “roughly half of all adults snore, and the numbers are higher in men and in overweight or older people ... retrospective studies suggest that people with full-blown, sleep-apnea syndrome may face a doubled risk of hypertension, a tripled risk of coronary heart disease, and a quadrupled risk of stroke.” What was CR’s advice? Try self-help: Slim down, shun drugs and alcoholic drinks before bed, don’t smoke, sleep on your side, keep your neck straight. If self-help doesn’t work, CR suggests “your doctor may steer you to a dentist who can fit you with a device worn at night to reposition the lower jaw, tongue, or other parts of the upper airway. A prefabricated, non-adjustable device costs a few hundred dollars; a custom-made, adjustable appliance typically runs about $900 to $1,500, but may cost more.” CR says “as a last resort, you could consider surgery.”

New snoring and sleep-disorder research continues to attract public attention. ABC News reported a possible link between snoring and Alzheimer’s disease. The November 2002 FDA Consumer details the consequences of not getting enough sleep in a cover story entitled, “How Well Are You Sleeping?” For instance, “Research suggests [that] if sleep deprivation is long-term - whether because of lifestyle choices or sleep disorders - it may increase the severity of age-related chronic disorders such as diabetes and high blood pressure.”

According to “Snoring can kill you,” an August 1998 Reuters news release about the findings of a UCLA study, sleep apnea was linked to SIDS, attention deficit disorder, poor school grades, high blood pressure, strokes, and heart disease. A team of dental surgeons at UCLA’ s School of Dentistry found that snoring can cause damage to the walls of the carotid arteries and an increased stroke risk coming from the neck area (Journal of Oral and Maxillofacial Surgery, November 1998). “When persons with sleep apnea fall asleep, their tongue falls back into their throat, blocking their airway. As they struggle for breath, their blood pressure soars,” said Dr. Arthur Friedlander, an oral surgeon. “It’s like pressing a pillow over someone’s face.” The January 1999 ADA News reported some patients are at a high risk of stroke and blockage in the carotid artery, and that diagnosing the problem presents “an opportunity for dentists to practice true preventive health care.”

Snore remedies are varied, but mostly alike in that few work. Except for ear plugs, most remedies begin with the person who snores. Drug store remedies such as herbal pellets or wearing nasal strips are temptingly easy to try. Sewing a tennis ball in the back of a pajama top is a self-help solution that is tailor-made to help keep sleepers from snoring on their backs. One shocking approach is a device that administers small, electrical jolts to a person who snores. If a patient’s dentition and temporomandibular joints are healthy, beginning treatment with dentist-prescribed oral appliances may become a preferred approach. Oral appliances are easy to try, are effective for many at reducing symptoms, and are probably the best initial therapy.

So, who is a candidate for an oral appliance? A recent study of patients with sleep disorders found an ideal candidate is a patient “with mild-to-moderate sleep apnea ... who is not obese, who snores or has mild-to-moderate OSA, who has an adequate protrusive range of motion of the mandible and adequate dentition, [and] patients who cannot tolerate CPAP or with whom surgical intervention failed.” (Neda Mohsenin, et al., “The role of oral appliances in treating obstructive apnea,” JADA, Vol. 134, April 2003).

Dentist-prescribed oral devices show snoring prevention success rates of up to 85 percent. The Silent Nitedevice comfortably sets the mandible forward by means of special connectors attached to transparent upper and lower forms. Positioning the lower jaw forward advances the tongue and soft palate away from the back wall of the throat, thus increasing the three-dimensional space in the airway and reducing air velocity and soft tissue vibration. You can easily verify the efficacy of the mandibular repositioning principle: With your mouth closed, simply push the jaw forward, and you should notice a significant increase in the volume of air through the nose.

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Dr. Michael DiTolla is director of clinical research and education at Glidewell Labs in Newport Beach, Calif., where he also teaches over-the-shoulder courses on topics such as esthetic restorative dentistry. Dr. DiTolla also teaches a two-day, live-patient, hands-on laser-training course that emphasizes diode and erbium lasers. In addition, he teaches a two-day, hands-on digital photography course emphasizing intraoral and portrait photography, and image manipulation. More information on these and other courses can be found by email at [email protected] or by calling (888) 535-1289.