What is the dentist’s role in sleep disordered breathing: A review – 4

Additional findings within studies about SDB:

The severity of OSA is classified as mild (5-14 AHI); moderate (15-30 AHI), and severe (+30 AHI). However, for children the threshold is lower: mild (1-5 AHI), moderate (5-10 AHI), and severe (+10 AHI).

This infers that 0-5 is insignificant in an adult, yet not a child, we have no evidence (except anecdotal) for this and low levels of AHI may be associated with snoring which when heavy and chronic has shown itself a significant co-factor in stroke.

Usually, the reduction in the AHI, respiratory dis­turbance index, and respiratory event index must be less than 5 and greater than 50% reduction in these indexes to be classified as successful in the management of the disease, but again must be reviewed in light of the individual.

What would you do for someone who had severe OSA with an AHI of 60, when they either cannot or will not wear CPAP? They subsequently find OAT successful in that they wear it happily and long-term and find improvements in may symptoms.

Measurement shows significant improvement in measurements including a reduction of AHI down to (only) 16. Is that a success?

Snoring patients without features of OSA should undergo treatment to reduce snoring to a subjective reason­able level. With little mention in the study, there is widespread belief that snoring, even heavy, is OK except for domestic disharmony. This is not what investigation shows.

Age 12 years is the cutoff point for childhood SDB. This is completely arbitrary and added as an after thought. The adult ranges have already changed once so this must still be seen as a practical work in progress.


A definition given by the AADSM in 2008 states that the dentists’ role in dental sleep medicine “focuses on the management of sleep-related breathing disorders (SDB), which includes snoring and obstructive sleep apnea (OSA), with oral appliance therapy (OAT) and upper airway sur­gery.”

With a broader definition, it has been pro­posed “Dental Sleep Medicine is the discipline con­cerned with the study of the oral and maxillofacial causes and consequences of sleep-related problems.” 

This study reports that from this perspective, the role of dentists would go farther, including the management of orofacial pain, oral moistening disor­ders (including oral dryness and hypersalivation), gas­tro-esophageal reflux disorder (GERD), SDB (including snoring and OSA), and mandibular movement disorders (including dyskinesia, dystonia, and sleep bruxism).

According to the studies included in this systematic review, screening SDB, OA treatment, and follow-up are the major roles for dentists working in dental sleep medicine.

In future posts we can deal with the other aspects of this review, namely, screening, treatment and follow up. This is far from the only study but was chosen as it covered the aspects adequately.

Incidentally, as obstructive sleep apnea (OSA) is an increasing problem worldwide a large number of patients may remain undiagnosed.

Dentists could suspect OSA, but little is known about their knowledge and attitudes towards the topic. An email questionnaire was sent to dentists working in Helsinki Health Centre, Helsinki, Finland. It consisted of demographic data, items on dentists’ overall knowledge of OSA and factors associated with it, and their possibilities and willingness to take part in the recognition and treatment of OSA patients.

The study found that dentists could play an important role in suspecting OSA, but they may need more education to cope with that.

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