Your teeth, gums and jaw line could be costing you sleep.
Just ask Dr. Stephanie Kinsey, a general dentist in St. Augustine, FL who has taken additional training during the last decade to help identify patients with sleep apnea who might be helped with dental work.
It’s a part of her practice that falls under neuromuscular dentistry.
“It’s an approach looking at a patient’s entire body,” she said. “We’re getting into the sleep issues in terms of how the teeth and the jaw relate to the rest of the body, to posture and how having the proper bite can affect a patient’s overall well-being.
“A lot of people come in and have no idea that what they’re dealing with may be related to how their jaw sits. Anything from headaches to neck pain to ear congestion, after we eliminate all the other causes, those can be handled through neuromuscular dentistry. So it’s creating harmony.”
How is sleep apnea connected to dentistry? How can a dentist help diagnose and treat it?
There are certain questions you can ask. You can look into a patient’s oral cavity. If there’s large tonsil tissue that you can see or there’s a restriction of their airway based on visual inspection, that would be a tip-off. There’s also some correlation with patients who are a little bit heavier, with a big neck. There’s a huge overlap with patients who have TMJ problems and sleep apnea. They’re both disorders of cranialfacial anatomy.
A lot of sleep breathing disorder stuff happens when they’re younger. If a child becomes more of a mouth breather and doesn’t breathe through their nose, that sets off certain physiologic and metabolic changes in the way their face develops and the way their teeth come in. That creates some of the airway restrictions and consequently we see those patients down the road with pink in their head and neck area. A lot of times we see those folks after they see the ear, nose and throat doctor, the neurologist for headaches and unexplained pain.
Are these the only symptoms of sleep apnea?
There’s a profile, but it’s not 100 percent. Your typical sleep apnea person is someone who’s a little overweight. Their neck is kind of thick. I can pick out people in the airport. There’s forward head posture – when you move your head forward, that’s your body helping your head breathe a little bit better. If you walk around with your head forward all day, you’ve got this bowling ball-shaped object that weighs 7 or 8 pounds, and after a while, you’re neck’s going to start bothering you. Oral cavity wise, we look for indentations on the tongue. That’d be a sign that someone is clenching or grinding the teeth. That goes hand-in-hand with sleep apnea, though it’s not always 100 percent. Your body, in order to lubricate your airway, clenches and grinds, and that stimulates saliva flow. Your body’s making some choices: do I stay alive and breathe or do I grind my teeth a little bit at night? Then that sets off some of the pain issues.
There’s a lot of research when it comes to sleep apnea with heart problems and diabetes. We’re looking at all of that.
How we usually handle who I suspect might be a sleep apnea patient is I go through our list. We’ll ask them, “Do you fall asleep easily?” “Do you feel tired during the day?” “If you’re a passenger in a car, do you want to nod off?” “If you’re watching television during the day, do you tend to fall asleep?” “Do you wake up tired?” A lot of those patients will say, “I sleep 8 hours a night, doc, and I’m still always tired.”
We have to refer them to a certified sleep physician to get that diagnosis. Dentists can’t technically make that diagnosis because sleep apnea is a medical problem in terms of hypertension, heart disease and stroke, so typically the physician will make a diagnosis.
If the patient cannot do a CPAP at all, then they get kicked into my corner and I work with the sleep physician to get an oral appliance that will help them.
There’s many out there. The one I like is something called the Somnodent. It’s made by a company called Somnomed. It’s a pretty neat device, pretty comfortable, pretty thin. It’s an upper and lower component and it places the jaw in a position … that maintains an open airway so you can breathe properly. It’s portable and there’s no mask.
But CPAP is the gold standard. Usually we have to get a letter of medical necessity from the physician and a letter that says the patient is CPAP intolerant to get insurance payment.
Would this be good for patients with mild to moderate sleep apnea?
Yes, especially with patients who would not use CPAP at all. Statistics show that people who have a CPAP machine generally only use it about 50 percent of the time. In the medical world, that’s a success when you have a 50 percent compliance rate or 50 percent decrease in symptoms. Dentistry treats things a little bit differently. We’re perfectionists and all trying to get to 95 percent or 100.
Also with patients with moderate to severe sleep apnea who just can’t tolerate the CPAP, the sleep appliance is the next best line of defense.
If you are wanting to learn more about your oral health, contact Sleep dentist Dr. Stephanie Kinsey by calling (904) 474-5444 and scheduling an appointment at her St. Augustine office today!