In this report, Dr. Ron Goldstein, a dentist in Mississauga (greater Toronto), Canada with Dr. Ron Goldstein and Associates, discusses the diagnosis and treatment of sleep apnea by dentists.
One thing that a dentist can do to initiate a discussion of a patients sleep is to look down the side of the tongue for indentations, referred to as scalloped tongue. The presence of this condition is 70% predictive of sleep apnea. If Dr. Epstein sees this condition in a patient, he discusses their sleep with them, asking if they feel they are getting proper rest.
There are other diagnostic steps that can be undertaken that don’t involve having a patient go to a lab that, in Dr. Epstein’s opinion, gives a more realistic result. Dentists in Canada may not make a diagnosis themselves, but they can send the results of the testing to a site where a sleep doctor will read the results and send back a medical interpretation.
As to treatment, a dentist can make an oral appliance for the patient. This is a highly accepted form of treatment. The effect of such an appliance is to hold the jaw forward, effectively “taking the plug out of somebody’s throat.” Patients breathe more easily, don’t snore, and awaken better rested. This may be an alternative to machines that supply continuous positive airway pressure (CPAP).
Whether a patient goes directly to the oral appliance depends on a clinic’s diagnosis whether a patient has mild, moderate, or severe sleep apnea. That determination is based on how many times per hour a patient has breathing problem episodes. There are three forms of treatment that will then be discussed: surgery (which one might want to avoid), oral appliances, or CPAP. A clinic may direct a patient directly to CPAP, even in a case of only mild or moderate apnea.
The American Academy of Sleep Medicine, an organization that sets many of the standards in this field, has for the last six years recommended oral appliances in cases of mild to moderate sleep apnea as the first line of treatment. Follow-up testing will be required to diagnose effectiveness. However, if the patient wakes up feeling rested and a bed partner comments that there was no snoring overnight, that is a 95% indicator that the problem has been successfully treated. The appliances can be adjusted by a dentist until a perfect result is achieved.
Dr. Ron Goldstein graduated in 1971 from the University of Toronto with B.Sc. and D.D.S. degrees. He is an expert in sleep apnea issues and treatment, and he spoke with Sleep Better TV, providing online sleep breathing disorder video news content. Sleep Better TV is a featured network of Sequence Media Group.