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The Role of Dentists in the Diagnosis and Management of Sleep Disorders
TAKE-HOME MESSAGE
- Sleep medicine is a highly multidisciplinary emergent field within which there is an increasing role for dentists in the prevention, assessment, and management of obstructive sleep apnea and sleep bruxism; assessment and management of snoring and sleep-related orofacial pain and oral dryness; and assessment of sleep-related gastroesophageal reflux disorder. The clinical role of dentists in sleep medicine must be based on the scope of practice of dentistry. There has been an upward trend in sleep medicine education over the last decade in dental schools in North America and Japan.
- Inadequate sleep is an upstream cause and downstream consequence of major chronic diseases. Collaboration between dentists and sleep physicians, neurologists, cardiologists, ENT surgeons, and psychiatrists, as well as other relevant specialties within medicine and dentistry, is crucial for the effective management of patients with sleep disorders.
abstract
This abstract is available on the publisher's site.
Access this abstract nowSleep Medicine has evolved into a highly multidisciplinary field over the last few decades, involving respiratory physicians, neurologists, cardiologists, ENT surgeons, psychiatrists and psychologists to name a few. It is within this highly multidisciplinary context that we have seen an increasing role for dentists in the recognition, diagnosis and management of select sleep disturbances and disorders. Over the last couple of decades, this growing role for dentists has seen the informal emergence of a new interdisciplinary field of Dental Sleep Medicine-a field that bridges medicine and dentistry as it pertains to the diagnosis and management of sleep disorders. This article describes this new field in terms of its history, the evolving scope of practice for dentists, the implications for education and training, and the importance of multidisciplinary care that optimises outcomes for patients.
Additional Info
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The interdisciplinary field of Sleep Medicine-time for dentists to sink their teeth into it!
Aust Dent J 2024 Oct 09;[EPub Ahead of Print], PA Cistulli, R BalasubramaniamFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The authors of this journal article make the clarion call for dentistry as a profession and on a global scale to become more involved in the screening and management of sleep-related disorders via the emerging interdisciplinary field of dental sleep medicine. The authors discuss the pervasive nature of sleep disorders in Australia, which demographically is a microcosm of the US, including the resultant multitude of dental and medical comorbidities.
In calling for a robust interdisciplinary collaboration for favorable clinical outcomes, the authors maintain a siloed and specialized collaboration such that there "should be no encroachment on the scope of other established healthcare disciplines within the field" they define. The authors suggest that, once an accurate medical diagnosis has been obtained, the dentist's capacity may include sleep hygiene advice, management of sleep bruxism, orofacial pain, and other dental conditions, as well as the delivery of dental devices under the guidance of a physician in fostering interdisciplinary collaboration.
With that said, this commentary finds the author's discussion on the dentist's role in collaborating with the physician limiting at the expense of the dentist's important role in preventing sleep disorders with all the previously mentioned comorbidities beyond merely managing an end-stage disease of obstructive sleep apnea syndrome as an adjunct to the physician.
Medicine must manage the disease once it is at this end stage, no question. However, most primary care physicians, perhaps until recently, rarely ask the patient about sleep disorders even when faced with chronic disease consequences such as metabolic disorders, cognitive correlates, and other functional somatic symptoms due to the siloed, specialized symptom-driven approach. There is now significant evidence that many sleep disorders are initiated early in life during the epoch when craniofacial growth and development are at a critical stage, resulting in conditions such as chronic snoring, mouth breathing, attention–deficit disorder or attention–deficit/hyperactivity disorder, metabolic dysregulation, recurrent otitis media, recurrent upper airway infections, tonsilitis, bed wetting, sleep bruxism, respiratory reflux, cognitive correlates, and so on.1-25
During this critical period of craniofacial growth and development, the dentist can play a critical lead role in fostering optimal craniofacial growth and development by identifying the functional and structural risk factors resulting in aberrant facial growth and many sleep breathing–related problems. Even if sleep apnea is identified early in growth, using the “gold standard” continuous positive airway pressure (CPAP) therapy is rarely the lifelong solution. Moreover, a recent randomized control study on the use of CPAP suggests that CPAP use carries a significant cardiovascular risk, calling the “gold standard” intervention into question.26
Dental interventions can prevent or reverse the above medical and dental comorbidities. It is time for dentistry and medicine to collaborate beyond a siloed disease management mindset where the dentist plays an adjunctive role in managing sleep disorders. Dentistry can play a much more critical role in preventing, reversing, and managing the high prevalence of sleep-breathing disorders to benefit public health beyond treating the teeth, gums, and temporomandibular joints. Physicians must manage end-stage sleep disorders to be clear, and dentists can prevent and reverse many sleep-breathing problems by optimizing craniofacial growth and development in the early stages. Lastly, there are many tools in the dental toolbox beyond using widgets such as sleep appliances. Let us all move to the future with copacetic collaboration to benefit public health.
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