OSA, antioxidants and periodontal disease

Oftentimes, dentists and hygienists are under pressure to perform treatment, yet unless they have a full grip on the clinical diagnosis they can’t communicate, educate or perform what their patients really need and want.

What is the connection between inflammation and antioxidants

This is true of the understanding of inflammation and antioxidants. This balance can be disturbed by trauma, stress, exercise, nutrition, degenerative diseases, immune disturbances and hormonal imbalance; which can also accelerate the formation of free radicals. Free radicals are unstable compounds. Evidence indicates these contribute to ageing and disease, including periodontal disease (PD).

A connection between inflammation and periodontal disease

Periodontal disease (PD) is initiated by the colonization of gums by bacterial pathogens. This process results in the host tissue damage due to free radical production. Studies have reported a significant reduced total salivary antioxidant capacity in PD patients; hence damage is heightened in individuals with PD because of the lack of adequate antioxidant defense.

A connection between periodontal disease and obstructive sleep apnea (OSA)

Obstructive sleep apnea (OSA) tends to cause episodic blood deoxygenation, and numerous studies have reported that OSA is associated with increased free radical production and tissue reactive oxidative stress. OSA patients have also been found to demonstrate increased blood levels of ROS and  decreased blood and saliva antioxidants levels.

Imbalance between inflammation and antioxidants

An imbalance between antioxidants and pro-oxidants may result in cellular damage predisposing our patients with OSA to cardiovascular and a relationship between oxidative stress and oral/dental diseases, particularly PD. 

Link between periodontal disease and antioxidants

Nearly 20 years ago, it was reported that PD is associated with lower antioxidant capacity in whole saliva and lower antioxidant concentrations in the gingival crevicular fluid contributing to  increased damage to the gingival and surrounding structures by activated neutrophils.

Antioxidants, oxidative stress and oral cancer.

Oral cancer is the sixth commonest malignancy in the world. Free radicals such as ROS and reactive nitrogen species (RNS) that induce oxidative and nitrosative stress are main contributors to oral carcinogenesis. Oxidative stress plays an important role in the pathogenesis and complications of diabetes too. Oxidative stress is increasingly recognized as one of the major factors contributing to the chronic inflammatory process such as rheumatoid arthritis.

Removing oxidative stress in oral diseases

A relationship exists between OSA’s  oxidative stress and oral and dental diseases, particularly PD.  So how can dental hygienists help? Removing potential causes of oxidation and dietary supplementation with antioxidants are, I believe, a prudent way forward.


Antioxidants play a protective role in the inflammatory process.

We are all aware of the epidemic of sleep disordered breathing which includes, obstructive sleep apnea, snoring and upper airway resistance syndrome. We know that for many of our patients there may be a dental solution, but who are the candidates?

Managing obstructive sleep apnea (OSA) with oral appliances.

Oral appliance therapy to manage SDB is indicated in those patients with mild to moderate disease. Approximately 60% of those will do well, it will fail on the remainder. We need a way of increasing our ability to determine which of our patients will fare well, before we start, what if we could do this?

OSA testing in the dental office

Testing is now available in the dental office – whereby the patient can have an overnight home test and results provided at around 97% probability – removes the guesswork for most patients and is a test that can be fitted by the hygienist after physician prescription. Only a physician can diagnose OSA and prescribe management, but this technology expedites the necessary care and we all know that most of us want a solution yesterday!

Saliva testing in the dental office

Since saliva reflects general health status of the human organism and is easy to collect, it can be used as a non-invasive diagnostic tool of the markers that reflect oxidative attack. Already we are beginning to look at inflammatory markers in blood, but one wonders if salivary inflammatory biomarker (chemical mediators) screening may become an adjunct to the biomarkers (bacteria) some offices provide and opportunity to enhance dietary antioxidants.

The value of increasing uptake of antioxidants

The evaluation of oxidative stress status is proposed as an important factor in diagnosing the development and progress of such general diseases as periodontal disease, oral cancer, diabetes, rheumatoid arthritis, chronic renal failure, obstructive sleep apnea syndrome, and HIV. Measurement of oxidative stress in salivary fluid may provide a tool for diagnosing, monitoring and treatment of some systemic diseases as well as of local pathologic disturbances such as PD. Increasing uptake of antioxidants both in foodstuffs and supplements is to be encouraged as both prevention and treatment of OSA and PD tissue damage.

Dr. Stephen Bray 2020

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