By Charles Kravitz, DDS

We know that men are more at risk of developing sleep apnea. But for women who suffer from OSA the risk of developing cancer is more than your male counterparts, says a recent research published in the European Respiratory Journal. The scientists collected data of 20,000 patients with OSA. It was found that a large percent of these patients were later diagnosed with cancer.


The studies show that people suffering from sleep-disordered breathing have an increased risk of developing cancer and are up to five times more likely to die from the disease.
Once again the culprit is HYPOXIA. The lack of oxygen (hypoxia) caused by untreated Obstructive Sleep Apnea (OSA) can be a catalyst for a process called neovascularization (the creation of new blood vessels), giving a blood supply that can encourage tumor growth.
 Two of the key hormones that fall out of balance—cortisol and melatonin—are critical for maintaining a healthy immune system (cortisol) and for regulating the body’s circadian system (melatonin). In addition, this neurochemical balance can lead to body-wide (systemic) inflammation.

How does this relate to cancer?
Without a healthy immune system, the body can struggle to fight off the aggressive cellular behaviors that can lead to tumors. 
With an imbalance in circadian rhythms as the result of decreased melatonin, the body produces higher amounts of other substances that are risk factors for cancer (for women, higher estrogen can lead to breast cancer, and for men, higher estrogen can lead to prostate, bowel, lung, and bladder cancer). 

Systemic inflammation causes oxidative stress to the organs. Oxidation is a breakdown of tissues that is the consequence of long-term inflammation; oxidative stress refers to the damage that results from unchecked systemic inflammation, which makes it easier for cancer—an opportunistic disease—to establish itself wherever the body is most vulnerable.
Cancer cells thrive in a low oxygen environment. Hospitals will put a patient on oxygen if their O2 levels drop below 92. Untreated OSA can cause oxygen levels to drop anywhere from the 90’s, 80’s and even in the 50’s.

Sleep apnea causes sustained low blood oxygen.

One of the biggest problems with sleep apnea is the way in which it deprives the body of necessary oxygen. Frequent apneas (pauses in breathing that last at least 10 seconds, but often last much longer) lead to nocturnal intermittent hypoxia. Dentists perform exams of  patient’s mouth, neck, and airway on a regular basis while screening for oral cancer. These health screenings are important, lifesaving moments in a patient’s health journey– we can do that with a similarly deadly condition like untreated sleep apnea.

Detecting OSA and leading the way for treatment can add YEARS to a  patient’s lifespan while significantly improving quality of life. Both cancer and OSA have symptoms that can be easily recognized in the chair during a regular checkup. While checking the mouth for masses and swelling, you can also check on the Mallampati score  and be alert to possible concerns you may have. 
Sources: American Sleep Apnea Association, Centers for Disease Control, Mayo Clinic, National Institutes of Health, National Sleep Foundation, The New York Times, Wisconsin Cohort Study, World Health Organization



Think about this-

A Sleep Coordinator in a dental practice asked me, “How do I find sleep apnea patients that I can treat?“

Here’s how I answered her, “They will find you.“
If you saw the award winning movie “Field of Dreams” you will remember Ray Kinsella (Kevin Costner) being told, “Build a field and they will come.”   He did build a baseball field in a Kansas corn field and sure enough the great legends of the game came to play there.
After you have been trained and become confident in your screening and treatment skills you’ll be pleasantly surprised at the vast number of sleep apnea patient resources.  Build your field and they will come.
These are just a few of the sources available to you:
  • word gets around that you can help them and new patients will seek you out
  • your patient base will produce enough candidates to keep your schedule filled  
  • you will be developing a network of healthcare professionals that will send you patients
  • patients you have treated will be referring their family and friends
Success in Dental Sleep Medicine, unlike in other ventures, does not have to be long and drawn out. If you focus on all the “little things“ and stay dedicated you will reach your objective in a few months.
Studies reveal OSA is prevalent. 
-A  study in Switzerland reported 50% of men and 23% of women had at least moderate OSA.1
-In 2002, the Sleep Heart Health study found that 24% of men and 9% of women have at least mild OSA.2

-In the Wisconsin Sleep Study Cohort, it was reported that 10% of men and 3% of women age 30 to 49 have at least moderate OSA, while 17% of men and 9% of women age 50 to 70 have at least moderate OSA.

-Over 50% of children diagnosed with ADHD suffer from sleep apnea
-According to a Harvard health report there are 18.9 million undiagnosed cases of obstructive sleep apnea and 40% (1.3 million) of CPAP users are non-compliant. So that alone conservatively projects 20.2 million victims of obstructive sleep apnea who may be helped by a dentist trained in Oral Appliance Therapy (OAT). 
-OSA is highly underrecognized, and it is estimated that 82% of men and 93% of women in the United States with OSA are undiagnosed.4
Is there any better opportunity today in dentistry?
Are you ready to build your field of dreams? 
Write me with any questions at cskdoc@aol.com.
  1. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-318.
  2. Young T, Shahar E, Nieto FJ, et al; for the Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults. Arch Intern Med. 2002;162(8):893-900.
  3. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014.
  4. Young T, Evans L, Finn L, Palta M. Estimation of clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705-706


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.

New Tag

Acid reflux


Study Club and Dental Society Members:

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.
 Hands-on training
4-20-13 GELB 3
 Presentation Outline
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 <cskdoc@aol.com> to find an available date for a presentation to your study club or dental society meeting.

The Medical Role of Hygienists in Dental Sleep Medicine

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.  
Take action! 
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.  



The TMJ- Sleep Apnea Connection

Charles Kravitz DDS
Patients have asked me,”I snore and grind my teeth at night and my jaw clicks,  Do you think I have Sleep Apnea?”


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.”


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) .

TMJ    2-2-15 TMJ.cropt


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.



Henry Thompson works 10 hours a day and gets 6 hours of sleep each night. He would like to reverse that and work 6 hours and sleep 10. But he is providing for his three children and wife. The oldest child is graduating high school next month and hoping to get admitted to college. 
Henry has high blood pressure and he snores loudly all night long. He suspects he has sleep apnea and he is beginning to worry about it. His friend Tony told him about the sleep clinic in the hospital. Tony explained the routine-  Finding time to get to a sleep center to meet with a doctor for evaluation, schedule a sleep study, take a night out of the house to sleep in the lab, then meet again with the doctor to discuss prognosis and treatment options . The hospital is a 1 1/2 hour drive for Henry. Henry felt that he just could not take off work that much, even for something as important as his health.                                                                                                                                                                                        
And then he heard “home sleep tests” could be ordered by dentists.     
 He found a dentist, near his home, who had been trained in dental sleep medicine by  Sleep Group Solutions. He made an appointment with that dentist, had an overnight sleep test in the comfort of his own bed, was treated by that dentist, and Henry’s story had a happy ending. Henry slept happily and healthy ever after.


Home sleep studies, like those offered by InterpStudies, a division of Sleep Group Solutions, sends a report by a board certified Sleep Medicine Physician within five business days to a sleep trained dentist.
According to the Mayo Clinic, “These tests usually involve measuring your heart rate, blood oxygen level, airflow and breathing patterns. If you have sleep apnea, the test results will show drops in your oxygen level during apneas and subsequent rises with awakenings.”  The information the HST collects may also include snoring sounds and head and neck movements.                                                                                                                                                                                                                                                 
The American Academy of Sleep Medicine (AASM) approves the use of home sleep tests.   The following criteria must be met:
  • You are between 18 and 65 years of age.
  • You have a high risk of moderate-to-severe sleep apnea. 
  • You have no other major medical problems.
  • You have no other sleep disorders.
You also may be eligible for a home sleep test if health or safety concerns prevent you from being able to leave home for a night. A home sleep test also may be used to evaluate your response to some sleep apnea treatments, including oral appliances, surgery, and weight loss.

But what if the nearest sleep center is hours away or booked up for months? Or what if a disability, or dependents, or a job makes a night in a lab too difficult? In cases such as these, a sleep dentist might prescribe a home-testing kit.                                                                                                                                                                                        

USA TODAY Reports:
 Home sleep studies use a less-expensive test that’s gaining ground across the nation, thanks largely to a push by insurance companies and mounting evidence of its effectiveness.
“You get to sleep in your own bed with your own pillow,” said Dr. Laddie Tackett, medical director for Anthem Blue Cross and Blue Shield in Kentucky. “It makes testing more accessible. It makes it more affordable. It makes it more convenient.”  They are less than half the price — up to $400 for a home test, compared with as much as $1,300 in a hospital.
The advantages of a Home Sleep Study are many: 
comfort, convenience, time. travel and cost.  





Legendary Dolphins coach Don Shula was hospitalized and treated because of sleep apnea and fluid retention, said his wife Mary Anne Shula.

Shula is the winningest coach in NFL history (with 347 regular-season and playoff victories) and a Pro Football Hall of Famer. He is also the owner of a successful chain of steakhouses throughout the country.

The 86-year-old was treated and released Tuesday from the Aventura Hospital and Medical Center. Dr. Barry Freydberg, a Dental Sleep Medicine expert and lecturer for Sleep Group Solutions, who screens and treats patients for snoring and sleep apnea says, “I am glad to hear his sleep apnea was treated. Nearly 18 million people remain undiagnosed with sleep apnea.”

Sleep apnea contributed to the premature death of star Green Bay Packers defensive end Reggie White in 2004.


5-20-12 HUMAN PYR

Here is how you can gain respect as a thought leader, generate New Patients, and provide a great public service.

Select a topic that will draw an audience. The “hottest” topic today is Sleep Apnea. Just google into the internet and you will see the widespread interest in Obstructive Sleep Apnea. People are becoming very aware of the dangers caused by the stoppage of breathing while they are asleep. They are looking for answers and very few Dentists are prepared to help them. Take a training course or a seminar, become knowledgeable in the signs and symptoms, the risk factors, and in the various treatment options. Sharpen your expertise.
6-2-12 BRAIN
Here’s how you do it:
Present a free seminar in your Reception Room. Select a date at least one month out so you and your invitees will be able to get it into your schedules.
How to Announce and Promote it:
  • Have a “sign-up sheet in your office
  • Send out email announcements to patients of record; ask them to assure their place by return email.
  • Let each invitee know they may invite two friends or relatives.
  • Place a large colorful poster in your Reception Room.
  • Distribute flyers to local businesses and professional offices.
  • Place a small display ad in your local newspaper.


Some Tips for your Seminar
  • Present it in the largest room in your office- usually the Reception Room
  • Prevent any interruptions – turn off phone ringers, etc.
  • Have a “Welcome Table” with some juices and other beverages (sugarless, of course).
  • Have your flyers, brochures, and business cards on the “Welcome Table”.
  • Prepare a power point presentation with video.
  • Subjects like Sleep Apnea are serious, but to keep the audience entertained, infuse some humor.
  • Encourage interactive participation. Invite questions from the audience.
  • Prepare some hand-outs for the participants to take home.
  • These are just a few ideas. I am sure you will think of a lot more.

Objectives and Outcomes

You will be respected as a Leader and Educator.

You will generate New Patient leads.

You will provide a needed and valuable public service.

If you want some help with any of this you may email me: cskdoc@ aol.com



“I’m thinking of doing it…..”
How many great ideas have you had in your life that were exciting… seemed like “sure things”… that had to be done… that could improve the world….that could improve YOUR world?  You thought about it, talked to a confidant about it, and then, fssst! Gone! Forgotten, or worse, watched someone else do it and get the credit for it. You’re in good company; we are all procrastinators to some degree.  Me, too.
When there’s a good idea, it’s in “the air”. A lot of people will think of it at the same time; but the person that takes action will be called the genius.
 “Action speaks louder than words but not nearly as often.”
Mark Twain
What have YOU been “thinking” of doing? Find a piece of paper right now and make the list. Were you “thinking” of getting that laser… registering for Dental Sleep Medicine training… writing an Office Manual… going to Italy for two weeks? Make the list and put in target dates for completion.  Then get it done! You’ll feel so good about your self.
Procrastination is the bad habit of putting off until the day after tomorrow what should have been done the day before yesterday.”
Napoleon Hill