Recognition of the problem
Dentists who are not interested in treating patients who snore or have obstructive sleep apnea can best serve their patients by including a few questions on the medical history form that will suggest the likelihood of sleep-disordered breathing:
- Do you snore?
- Are you tired or sleepy during the day?
- Has anyone ever mentioned that you stop breathing at night?
- Do you have high blood pressure?
In addition, a neck circumference of >17 inches in men and >16 inches in women is a risk factor for sleep-disordered breathing, as is obesity. High blood pressure is also frequently associated with snoring and obstructive sleep apnea. In children, enlarged tonsils and adenoids are quite often a cause of sleep-disordered breathing.
The clinical dental exam should strive to focus on the oropharynx where an enlarged tongue, enlarged tonsils, a large uvula, a drooping soft palate, medially displaced tonsillar pillars or retrognathia can predispose to upper airway obstruction during sleep.