What’s the role for dentists in managing sleep problems?
There are actually a number of links between your teeth and sleep. Grinding of the teeth or jaw clenching (bruxism) 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, and dental appliances are effective treatments for both snoring and sleep apnea. Managing these sleep disorders using dental treatments is 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 apnoea in adults. Particularly in non-obese adults a lot of obstruction occurs at the level of the tongue base. As the tongue anchors into the base of the lower jaw (mandible), moving the lower jaw forward holds the tongue base away from the back of the airway creating more space and reducing airway narrowing. This in turn reduces both snoring and sleep apnoea.
Devices to hold the mandible forward during sleep are called mandibular advancement splints and are the most common type of oral appliance used in treating snoring and sleep apnoea. The types of splints that work best are customised, adjustable splints that are made and fitted by a dentist experienced in the use of these devices. It does take 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.
Teeth clenching & grinding (bruxism)
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 apnoea, 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 apnoea 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. One of the strategies to manage the effect of bruxism on your teeth is use of an oral appliance to protect your teeth. In some cases botulinum toxin (Botox) can be used to reduce muscle tension, and exercises can also help.
For more information on bruxism and some exercises that can be done to help relax the jaw see this interview with Dr Harry Ball.
What should I do?
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.
Related posts & links:
- Treating snoring and sleep apnea with oral appliances – video
- Bruxism – video
- SleepWise Clinic – specialists in dental sleep medicine
- Dental Sleep Institute – courses for dentists
- Snoring treatments – blog post
Need more information about how you can sleep better?
At Sleephub we understand the struggle people endure with sleeping problems which is why we have created a comprehensive FAQs page with information for those seeking information about sleep disorders and potential solutions.