Gastro esophageal reflux disease, GERD, a.k.a. acid reflux is one of the most common comorbidities of sleep apnea. Although very common in senior adults it still occurs frequently in younger people.Poor little GERD was so under-appreciated in our poll.
How it happens: During the nocturnal cessations of breathing the body will increase its efforts to take in air. Abdominal contractions are exaggerated and increase until breathing resumes. The contractions squeeze the stomach and force acid up the esophagus. The efforts to breathe also increase a negative pressure in the esophagus which also pull up acid.
It’s November and you probably have your CE credits locked in for this year.
Here’s how to get fast and easy CE credits for next year and score even greater benefits:
Have your Dental Study Club or local Dental Association schedule a speaker for a Dental Sleep Medicine presentation. We will provide a nationally known DSM speaker, all materials, CE credits and most importantly, a valuable introduction to Dental Sleep Medicine.
These DSM presentations include:
analysis of patients’ symptoms and how to screen for them
scripts for an effective patient interview
how to motivate the Dental team to commit their patients
how to get your patients to “own” their disease
the morphology of the airway
comorbidities to look out for
the effects on the systemic organs
the reimbursement strategy and insurance billing using dental and medical coding.
Dentists who attended our DSM presentations have gone on to secure huge rewards for their patients and their practices. Email me at <firstname.lastname@example.org> to find an available date for a presentation to your study club or dental society meeting.
Is there anyone in a better position than the Hygienist to discover the signs and symptoms of Obstructive Sleep Apnea? Your field of operations is right there at the opening of the airway.
You can’t miss the signs. You can see if a large tongue is blocking the passageway to the pharynx. You can see if the sides of the tongue show a scalloping which is indicative of a forceful gasping for precious air. Is the airway blocked laterally by large fauces or tonsils? You can’t miss the patient’s Mallampati score.
Do the occlusal surfaces of the posterior teeth show evidence of bruxism? Are the incisal edges of the anterior teeth worn down? Does your patient have acid reflux? TMJ pain? A severely receded (retrognathic) chin?
And in your interview with your patient do you learn that your patient has daytime sleepiness, often dozes off while watching TV or at the movies, and even worse, feels sleepy while driving?
Were you informed that the patient’s spouse complains about loud snoring?
Do you see an overweight patient with a large diameter neck?
Listen to the alert! These are some of the more common signs and symptoms of obstructive sleep apnea. They are so easy to see. These warning signs are sitting right there in the hygienist’s field of operations and they are screaming out, “Notice us. We are here to destroy your patient”. “We can cancel out all the good that you do for this patient.”
For a diligent Hygienist to miss these warnings would be to surrender a great opportunity to help patients enjoy a better quality of life and, in fact, to save lives. The rewards to you, your practice, and your patients are considerable- both emotionally and financially.
Become a member of the LinkedIn discussion group RDH SLEEP SOLUTIONS and enter the discussion to learn to incorporate Dental Sleep Medicine into your practice.
A Hygienist/Staffing Specialist in Cleveland/Akron, Ohio posed this question on LinkedIn to the American Dental Education Association: “…why are schools graduating so many Dental Hygienists in a field that is very saturated, with little chance of job opportunities for these new Dental Hygiene grads? “
I am also interested in hearing the answer. Here in south Florida there is a plethora of well trained, dedicated Hygienists who are working part-time for Staffing Agencies, or as clinical assistants, and in other industries, because there are not enough opportunities in dental offices. My colleagues in Philadelphia and southern California tell me the situation is similar there.
Do you find this to be the case in YOUR area?
From The Bureau of Labor Statistics:
Job prospects are expected to be favorable in most areas, but will vary by geographical location. Because graduates are permitted to practice only in the State in which they are licensed, hygienists wishing to practice in areas that have an abundance of dental hygiene programs may experience strong competition for jobs.
Projection data from the National Employment Matrix Occupation:
237,000 2018 36% increase
Do you feel that expanding the legal functions of Hygienists, and relaxing their areas of “direct supervision” will alleviate this problem?
Are you a smoker? If so, the chances are that you have obstructive sleep apnea. Smokers are three times more likely to have obstructive sleep apnea (OSA) than are people who have never smoked.
Smoking may irritate the tissues in your nose and throat and cause inflammation and fluid retention in your upper airway. This swelling causes a blockage which restricts air flow.
Both smoking and OSA are deadly conditions that, in combination, will wreak havoc to your quality of life and can severely shorten your life span.
Smokingand Sleep Apnea: 1+1 = 1000
Both sleep apnea and smoking can cause all sorts of cardiovascular and respiratory health problems. OSA can lead to stroke and heart disease while smoking increases one’s chance of contracting mouth, throat and lung cancer. Studies have even shown that sleep apnea victims who smoke, generally have heightened triglyceride levels and lowered HDL levels.
The average person loses 1.2 minutes of sleep for every cigarette they smoke, due to nicotine’s stimulating and subsequent withdrawal effects, according to a University of Floridastudyin 2011.
Men’s Health reported, “People who smoke within two hours of bedtime struggle to fall asleep because the nicotine disrupts their natural sleep-wake cycle, and withdrawal symptoms set in before the morning alarm goes off, often leaving smokers feeling even more restless and agitated.”
Patients who suffer from untreated sleep apnea are rarely able to reach the cycles of deep sleep where dreaming occurs. With treatment, patients begin to dream again and it takes time to get used to it. Vivid dreaming is a common occurrence in those who are in the process of quitting smoking and have begun sleep apnea treatment.
A 20012 report in Chin Med concludes: “Smoking may act as a risk factor for OSA and join with OSA in a common pathway to increase the risk of systematic injury. OSA, in turn, may be a predisposing factor for smoking. Thus, smoking cessation is recommended when considering treatment for OSA, and treating OSA may be a necessary precondition for successful smoking cessation.”
American Journal of Respiratory and Critical Care Medicine.
Dr. George Jones will explain theWHYand theHOWof theseObstructive Sleep Apnea connections:
WHYis High Blood Pressure a symptom of SA?
WHYis Acid Reflux (GERD) a symptom of SA?
WHYis Diabetes a symptom of SA?
Learn therisk factorsandHOWthey contribute to OSA:
Excess weight.Fat deposits around your upper airway may obstruct your breathing. However, not everyone who has sleep apnea is overweight. Thin people develop OSA, too.
A narrowed airway.You may have inherited a naturally narrow throat. Or, your tonsils or adenoids may become enlarged, which can block your airway.An enlarged or inflamed uvula will block the airway. Being male.Men are twice as likely to have sleep apnea. However, women increase their risk if they’re overweight, and their risk also appears to rise after menopause.
Age.Sleep apnea occurs much more often in adults over60.
Family history.If you have family members with sleep apnea, you may be at increased risk.
Race.In people under 35 years old, blacks are more likely to have obstructive sleep apnea.
Use of alcohol, sedatives or tranquilizers.These substances relax the muscles in your throat.
Smoking.Smokers arethree timesmore likely to have obstructive sleep apnea than are people who’ve never smoked. Smoking may increase the amount of inflammation and fluid retention in the upper airway. This risk likely drops after you quit smoking.
Nasal congestion.If you have difficulty breathing through your nose — whether it’s from an anatomical problem or allergies — you’re more likely to develop obstructive sleep apnea.
Neck circumference.People with a thicker neck may have a narrower airway.
Earn 16 CE credits and become The Sleep Dentist.
Brand yourself as a Doctor who understands, discovers, treats sleep problems.
Dr. George Jones is a native of Wheeling, WV and earned his BS in Chemistry from Wheeling Jesuit University. He received his Dental Degree from the University Of Florida College Of Dentistry, and relocated to coastal North Carolina in 2003. Over the years, Dr. Jones has served as a consultant and evaluator for several dental manufacturers and maintains a private practice in Sunset Beach, NC. .
Patients have asked me,”I snore and grind my teeth at night and my jaw clicks, Do you think I have Sleep Apnea?”
THE SYMPTOMS OF TMD AND OSA
Headaches, clicking jaw, malocclusion (misalignment of teeth), and mandibular (lower jaw) displacement are all associated with temporomandibular joint disorder (TMD). However, these symptoms often occur in patients with Obstructive Sleep Apnea (OSA) as well. Research in The Journal of Sleep determined in 1993 that nocturnal headaches may be caused by temporomandibular joint disorder or triggered by Sleep Disordered Breathing—“ with very similar clinical manifestations but very different therapeutic implications.”
CAUSES OF THE SYMPTOMS
The temporal muscles of the forehead play an important part in the positioning and closing of the jaw. If your occlusion (bite) is not correct, it can lead to abnormal tension in these muscles – and cause tension type headaches, toothaches, and Temporomandibular Joint Disorder (TMD) .
TMD: “THE GREAT IMPOSTOR”
TMD is called “The Great Impostor.” The symptoms can both overlap and mimic those of Obstructive Sleep Apnea. Some dentists believe that TMD is partly the existence of a TMJ problem and partly the manifestation of a Sleep Disordered Breathing problem, such as Sleep Apnea. The simplest way to understand the connection: the bruxism (teeth grinding) or jaw shifting associated with Sleep Disordered Breathing occurs when sleeping patients are trying unconsciously to find the best possible positioning of their airway. These motions may inflame the temporomandibular joint or exacerbate a problem with the joint that was pre-existing.
If you believe you have Temporomandibular Joint Disorder, I suggest you find a dentist to screen you for Obstructive Sleep Apnea. Find one who has taken dental CE courses and is trained in Dental Sleep Medicine. Don’t let “the Great Impostor” trick you into believing that your problem is solely a TMD one. It may not be.
“Oral Appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures.”– American Academy of Sleep Medicine.