HJAR Jul/Aug 2022

50 JUL / AUG 2022 I  HEALTHCARE JOURNAL OF ARKANSAS ORAL HEALTH DIALOGUE COLUMN ORAL HEALTH THERE is science-based evidence that im- proper rest can promote risks of infectious disease, progression of cardiovascular dis- ease, cancer, and incidence of depression. 1 The National Highway Traffic Safety Administration estimates nearly 800 fatalities and 50,000 injuries are the result of car crashes that are due to falling asleep at the wheel. 2 Why are we so sleepy? There are a multitude of answers, and sleep apnea is among the culprits. Sleep apnea is a common sleep disorder, which entails repeated breathing interruptions occurring during sleep cycles. 3 Multiple stop and start breathing cycles cause a person to literally gasp for air in an attempt for each breath. The blaring sound of snoring is often ignored in a person’s nocturnal fight for breaths, and many go undiagnosed for years. In the case of sleep apnea, this disorder doesn’t just interrupt sleep but is a significant risk factor for stroke and death. 4 This occurs due to oxygen levels decreasing and blood pressure increasing, which places increased strain on the heart muscle. There are three types of sleep apnea, which include obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed sleep apnea, a combination of OSAand CSA. OSA, the most common of the three, is caused by the throat muscles intermittently relaxing, which blocks the airway during sleep. 5 The upper airway becomes obstructed due to inadequate muscle tone of the tongue and/ or the dilator muscles. OSA is a breathing disorder that has far- reaching implications beyond disturbed sleep. It has been identified as a risk factor in ad- verse health conditions such as cardiac, neu- rologic, and metabolic disorders, as well as depression and cancer. Health consequences associated with untreated OSA include day- time sleepiness, decreased concentration, fatigue, memory loss, and increased risk of motor vehicle accidents. 6 Unfortunately, this disorder continues to go undiagnosed in a significant portion of the population. 7 Some common denominators of OSA include being overweight, being older than 40 years of age, and having some type of nasal obstruction due to a deviated septum, allergies, or sinus problems. Although OSA can occur at any age, it seems to get worse at the sixth to seventh decade but then appears to plateau. OSA is approximately two to three times more common in men than women, and risk increases in postmenopausal women. 8 OSA is diagnosed and treated collaboratively by the physician and dentist. The physician diagnoses the disorder and may refer the patient to the dentist for fabrication of an oral appliance. Conversely, the dentist may actually determine possible signs/symptoms of OSA in their patient and refer to the physician for diagnosis of suspected OSA. Due to the presentation and intraoral anatomy, the dentist may identify clinical signs in a patient suffering from this disorder. Common traits associated with OSA are an enlarged tongue, gingival inflammation, xerostomia, gingival recession, attrition, abfraction, a long slopping soft palate, enlarged or elongated uvula, and an obstructed view of the oropharynx. The Mallampati index score is an assess- ment of observing the position of the tongue and the view it allows at rest, indicating the risk of OSA. Anesthesiologists utilize this quite frequently to assess the ease of intu- bation for surgery. Scores range from I-IV, indicating the risk. Ascore of I visualizes the soft palate, uvula, tonsils, and the oropharynx. This is in contrast to a score of IV, where the soft palate cannot be seen, nor any struc- tures beyond the hard palate. Those with a Mallampati index of III-IV are at risk of OSA. [see fig. 1, Mallampati Classification] Extraorally, chapped lips, angular cheilitis, retrognathic mandible, long face, enlarged masseter muscle, and forward head posture are all common features of the OSA patient. The dentist must rule out other dental-related disorders before determining the patient may have OSA. These include caries, temporo- mandibular dysfunction, bruxism, orofacial pain, and headaches, which may be linked to temporomandibular dysfunction. 9 Whether the dentist recognizes possible signs and symptoms of OSA and refers to the physician, or the physician refers the patient to the dentist for construction of an oral appliance, the definitive diagnosis of OSA Dental Sleep Medicine: A Collaborative Approach of Medical and Dental Disciplines Getting enough sleep is essential in allowing the body and mind to recharge and function to the highest potential.