What's the role for dentists in managing sleep problems?
There are actually a number of links between your teeth and sleep. Bruxism (grinding of the teeth or jaw clenching) commonly occurs during sleep and can cause pain and damage to teeth. In addition, the shape of the jaws and arrangement of teeth, which are often reasons to seek dental or orthodontic treatment, can also predict the risk of sleep apnea and snoring. Dental appliances are effective treatments for both snoring and sleep apnea. Managing bruxism, snoring and sleep apnea using dental treatments are in the realm of dental sleep medicine. So when your dentist asks you about your sleep or whether you snore, there is a reason behind it.
Treating obstructive sleep apnea with oral appliances
Dentists have a significant role to play in the treatment of snoring and obstructive sleep apnea in adults. Particularly in non-obese adults, where a lot of obstruction occurs at the level of the tongue base. As the tongue attaches into the base of the lower jaw (mandible), moving the lower jaw forward can hold the tongue away from the back of the airway creating more space and reducing airway narrowing. This in turn reduces snoring and sleep apnea.
Devices to hold the mandible forward during sleep are called mandibular advancement splints (MAS) and are the most common type of oral appliance used in treating snoring and sleep apnea. Mandibular advancement splints have been shown to reduce snoring and be effective treatments for mild to moderate obstructive sleep apnea. The types of MAS that work best are customised, adjustable splints that are made and fitted by a dentist experienced in the use of these devices. It takes a lot of experience to get these devices working optimally as there is often some troubleshooting involved to minimise the risk of temporomandibular joint pain which can occur if the devices are advanced too quickly.
Oral appliances such as mandibular advancement splints used over years may result in minor changes to the alignment of the teeth, so for people using these devices it is important to make sure that they follow up with their dentists on a regular basis, at least once per year, to keep an eye on their teeth and bite.
For more information on the use of oral appliances as treatments for snoring and sleep apnea see this video.
Bruxism (teeth clenching & grinding)
Teeth clenching or grinding during sleep, called bruxism, is very common and has a range of causes. Whilst it can be exacerbated or precipitated by stress and/or anxiety, a number of people have bruxism in the absence of stress or anxiety. Bruxism can also be triggered by other conditions such as sleep apnea, where muscle activation occurs as part of opening up the airway to relieve snoring or airway narrowing. However, it's important to note that treating sleep apnea will not necessarily cure bruxism, which may still need treatment even once sleep apnea is managed.
Bruxism can present with symptoms such as teeth and/or jaw pain and headache. As bruxing can cause damage to the teeth it is important to have this looked at, particularly if your dentist is concerned about wear on the teeth. Some of the strategies used to manage bruxism on your teeth are use of an oral appliance to protect your teeth, sedative medications such as clonazepam, and in severe cases botulinum toxin (Botox) can be used to reduce muscle tension. In milder cases, exercises can also help.
For more information on bruxism and some exercises that can be done to help relax the jaw see this video.
What should I do if I snore or have sleep apnea or bruxism?
If you think that you may have snoring, sleep apnea, bruxism or factors about your teeth that may be part of a sleep problem talk to your dentist. Dentists working in the area of dental sleep medicine usually have a good working relationship with local sleep physicians who can assist your dentist with investigating and managing sleep disorders if needed.
The American Academy of Dental Sleep Medicine maintains a list of dentists with a particular interest in dental sleep medicine that you can search to find a dentist in your local area.