Dentist’s Leadership
Role in Detection and
Treatment of
Sleep Apnea and
Snoring
Donald Warren, DDS
Role of the
dentist in sleep
medicine
Indirect Approach
• Recognize that a sleep
disorder may be present
• Educating the patient
and making the proper
referral
Direct Approach
• Involved with the direct
treatment of the patient to
aid with patient’s sleep
disorder
• Most of the time this
involves the use of an oral
appliance
What the dentist and
staff see every day that
are indicators of a
potential for having a
sleep disorder
• Bruxism/toothwear
• Scolloped tongue
• Cross bites
• Narrow maxilla/high plate
• Mouth breathing
• Tongue thrust
• Crowded dentition
• Loss of gag reflex
• Orofacial pain
• GERDS/coated tongue, red
splotching on posterior
pharyngeal wall
Our job is to
evaluate arch form,
tongue,
soft palate and
size of tonsils
Mallampatti
Friedman’s Tongue Position
Indications for Oral
Sleep/Snoring Appliances
• Primary snoring
• Mild to moderate
obstructive sleep apnea
• CPAP intolerant
• Surgical failures
• Substitutive therapy
Types of Oral Appliances
• Mandibular repositioners
• Tongue retaining devices
• Soft palate lifters
Pediactric
Symptoms
Associated
with SRBD
Nightime
• Snoring
• Bruxism
• Awakenings
• Mouth
breathing
• Nightmares
• Bed wetting
Daytime
• Neurocognitive
impairment
• ADD or ADHD
• Hyperactivitiy
• Irritable
• Tired
• Poor school
performance
Nasal or
Mouth
Breathers
(thumb suckers or bracers)
These kids are all
mouth breathing
because some part
of their airway is
obstructed
Posterior Crossbite
Anterior Open Bite
Pediactric Treatment
• Tonsil and adenoid removal
• Maxillary/palatal expansion
• CPAP
• Surgery
• Allergy treatment
Dentistry is in a great
position to be a leader
in detection of sleep
breathing disorders
and treatment of
apnea and snoring
For Dentists:
Are you going to
step up and be
one of the
leaders?
Direct or
indirect?
You choose.
Sleep Doctors
Are you going to
work with a trained
dentist or one with a
weekend course or
no training at all
Trained
or
Not trained
You choose