23 June 2024

Dentists can help with OSA too


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By: Assoc Prof Dr Daniel Lim Khim Hock, Dr Goh Yet Ching, Dr Tan Chuey Chuan

Sleep is vital for our overall health and well-being, yet millions of people worldwide struggle with obstructive sleep apnea (OSA), a condition that disrupts breathing during sleep and leads to various health complications. OSA refers to repetitive obstruction of upper airway and constitutes 90-95% of sleep apnea cases.

OSA occurs more commonly in men and the occurrence increases with age, significantly in older adults. The frequently associated signs and symptoms are loud snoring, restless sleep, and daytime sleepiness. It is noteworthy to highlight that not all snorers have OSA but it can be a key sign of OSA.

Before delving into the roles of dentists and oral and maxillofacial surgeons in managing OSA, it is essential to have a basic understanding of the condition itself. OSA occurs when the muscles in the throat relax excessively during sleep, causing the airway to narrow or collapse intermittently. This results in periods of reduced airflow (hypopnea) or complete cessation of breathing (apnea), often accompanied by snoring and choking sensations. OSA not only disrupts sleep patterns but also leads to daytime fatigue, cognitive impairment, cardiovascular complications, and other serious health issues if left untreated. Individuals with small jaws are at higher risk to develop OSA.

Many are unaware of the significant roles that dentists and oral and maxillofacial surgeons play in managing this disorder. Their expertise in oral anatomy, physiology, and treatment modalities positions them as one of the key players in providing comprehensive care for patients suffering from this disorder. Dentists play a crucial role in the screening, diagnosis, and treatment of OSA, primarily through the use of oral appliance therapy (OAT).

These custom-fitted oral devices, often referred to as mandibular advancement devices (MADs) or mandibular repositioning appliances (MRAs), are designed to reposition the lower jaw and tongue to maintain an open airway during sleep. Dentists with specialized training in dental sleep medicine are experienced at evaluating patients for OSA risk factors, conducting thorough examinations of the oral cavity and airway, and fabricating personalized oral appliances tailored to each patient’s unique anatomy and needs.

Moreover, dentists collaborate closely with sleep physicians and other healthcare providers to ensure comprehensive care for OSA patients. They monitor treatment progress, adjust oral appliances as necessary, and provide ongoing support and education to optimize treatment outcomes. Dentists also play a vital role in educating patients about lifestyle modifications, such as weight management and positional therapy, which can complement OAT and improve overall sleep quality.

In cases where OAT alone may not adequately address the severity of OSA or when patients present with anatomical abnormalities requiring surgical intervention, oral and maxillofacial surgeons play a critical role. Surgical procedures aimed at expanding the airway and correcting structural abnormalities can complement or serve as alternatives to non-surgical therapies, particularly for patients with moderate to severe OSA.

Common surgical interventions performed by oral and maxillofacial surgeons for OSA are maxillomandibular advancement (MMA) and genioplasty, which aim to move the jaws forward to enlarge the airway and reduce airway collapsibility during sleep. Oral and maxillofacial surgeons work closely with dentists, sleep physicians, and other healthcare professionals such otorhinolaryngologists (Ear, Nose and Throat specialists) to assess the appropriateness of surgical intervention, select the most suitable surgical approach, and provide comprehensive pre-operative and post-operative care.

In conjunction with the Global Day of Parents observed annually on 1 June, let’s all agree that OSA is a serious health condition that requires prompt diagnosis and appropriate management to prevent complications and improve quality of life, especially so if it involves our beloved parents. And understand that dentists and oral and maxillofacial surgeons play indispensable roles in the comprehensive management of OSA, by offering non-invasive treatments such as oral appliance therapy and surgical interventions when necessary.

By working collaboratively with other healthcare professionals and empowering patients to take an active role in their sleep health, dentists and oral surgeons contribute to better sleep quality, enhanced overall health, and improved well-being for individuals affected by OSA.

So, talk to your dentist today if you think you are suffering from OSA, ya?

The authors are from the Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya.