From the Winter 2025 Journal of the Colorado Dental Association, By Becky O’Guin, CDA Communications Director
Dentistry’s role in sleep medicine continues to be defined as more dentists either add it to their existing practice or practice dental sleep medicine exclusively.
Dental sleep medicine uses oral appliances to treat sleep-related breathing issues, including snoring and obstructive sleep apnea (OSA). OSA is a sleep disorder that causes breathing to stop during sleep and affects 30 million to 54 million people in the U.S., many of them undiagnosed. Untreated, sleep apnea can increase the risk of developing a host of health complications including heart attack, stroke, dementia, etc.
CDA member Dr. Isabella Jasek has been practicing dental sleep medicine for several years now. A year ago, she decided to go exclusively into dental sleep medicine and has no regrets. “I really love dental sleep medicine, and it can be challenging to integrate it into a restorative practice. The opportunity to go exclusively with sleep medicine has allowed me to get to know my patients better and focus on education and how much treatment impacts the rest of their lives.” It is common for couples to sleep in different rooms because of the disruption of sleep apnea either because of snoring or the noise of a CPAP machine. With a mandibular advancement device, they can sleep in the same room again, Dr. Jasek said.
According to the Center for Disease Control and Prevention (CDC) the prevalence of sleep apnea increases with age and is higher among individuals aged 50-64 compared to other age groups. Studies also show a higher rate of diagnosed sleep apnea among men compared to women. However, children are also impacted by sleep disorders. Dr. Jasek said she has treated children as young as three and that sleep apnea is underdiagnosed in children. Some signs of disordered breathing in children are mouth breathing, bed wetting and teeth grinding.
What’s New in Dental Sleep Medicine
In November 2024, the American Academy of Dental Sleep Medicine (ADDSM) held a first-of-its-kind summit convening key dental organizations, including the ADA, the American Association of Orthodontists, and many other associations involved in dentistry. Dr. Kevin Postal, the AADSM president, said that the dentists who attended agreed that more dentists need to be made aware of dental sleep medicine. He said the public needs more awareness about OSA and how it is diagnosed and treated.
AADSM has approximately 2,200 AADSM qualified dentists and AADSM Diplomates who have received training in oral appliance therapy through the AADSM’s Mastery Program, an unbiased, comprehensive educational program about oral appliance therapy. There are approximately 40 members in Colorado.
Despite growing interest in dental sleep medicine, the number of sleep medicine physicians in the U.S. remains stagnant[i] and primary care physicians are overburdened. So, dentists can and do play a vital role in screening for sleep-related breathing disorders and the ADA recognized that by policy many years ago.
While the dentist cannot diagnose OSA, “they are well positioned to identify symptoms such as “daytime sleepiness, choking, snoring or witnessed apneas and an evaluation for risk factors such as obesity, retrognathia or hypertension, according to the ADA’s policy on sleep-related disorders.”[ii]
Dr. Postal said dentists usually see patients more often and spend more time with them than primary care providers, giving dentists another good reason to screen patients for these disorders.
The November summit elicited several key recommendations including working with the Commission on Dental Accreditation (CODA) to ensure that dental and dental hygiene students receive education on how to screen for obstructive sleep apnea and publicly promoting dentists as the provider who must evaluate the patient in person and provide oral appliance therapy. This last recommendation is key to promoting patient safety.
“Our organization reaches out to give continuing education to dental students every year,” Dr. Postal said. “It’s a struggle to get dental schools to provide this education because there are not enough educators to teach this in school.”
Education is one of the biggest hurdles for dentists wanting to get into sleep medicine, but not the only one. Insurance is also a hurdle, Dr. Postal said, because medical insurance is quite different than dental insurance and OSA is a medical condition.
“Our academy has really helped educate the dentists who really want to do this and to help navigate the insurance game to make this as easy as possible,” Dr. Postal said.
Dental sleep medicine is a field that continues to grow and encompasses more dental specialties including oral and maxillofacial surgeons, orthodontists, oral medicine, oral pathology and orofacial pain specialists.[iii]
“It’s really becoming more interdisciplinary. Having a team approach working with myofunctional therapists or ENTs, body work specialists is beneficial for patients in making sure that we are not only treating their sleep, but also their whole health because sleep really impacts every aspect of your health,” Dr. Jasek said.
Dr. Jasek said it can be overwhelming for dentists to get involved in dental sleep medicine because there are so many available oral appliances today and many educational courses but there are simple things dentists can do to help patients who struggle with sleep disorders as well. One action a dentist could implement is a simple screening protocol.
“It could be adding questions on a patient questionnaire,” Dr. Jasek said. “Hygienists are great assets to have for screening and to keep their eyes on different anatomical factors that they might notice could be a link to sleep apnea.”
[i] Collen JF, Wickwire EM, Capaldi V, Lettieri C. Losing sleep! Are we missing the future of sleep medicine? J Clin Sleep Med. 2020 Apr 15;16(4):473-474.
[ii] ADA Adopts Policy on Dentistry’s Role in Treating Obstructive Sleep Apnea, Similar Disorders. American Dental Association. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/the-role-of-dentistry-in-sleep-related-breathing-disorders.pdf. Accessed December 19, 2024.
[iii] Lobbezoo F, de Vries N, de Lange J, Aarab G. A Further Introduction to Dental Sleep Medicine. Nat Sci Sleep. 2020 Dec 14;12:1173-1179. doi: 10.2147/NSS.S276425. PMID: 33363423; PMCID: PMC7754253.
