Straumann Group together with Laura Paini explained how it all originates from airway obstruction and unveiling conditions, symptoms and impact on health
MILAN – Sleeping 8 hours a night is a habit that has a positive effect on health: however, many struggle with difficulty falling asleep and early nocturnal awakenings. Not everyone knows that, at times, the quality of sleep can be linked to oral health: in Italy there are 7.5 million people who suffer from dental sleep disorders(1), sleep disorders that originate from the mouth and are tiring and disabling. On World Sleep Day (March 17), Straumann Group – a global leader in implantology and orthodontic solutions that restore smiles and confidence – and Dr. Laura Paini, specialist in odontostomatology and orthodontics, highlighted this often underestimated issue.
CONDITIONS, SYMPTOMS AND IMPACT ON HEALTH
First of all, it must be emphasized that the origin of everything is in the soft tissues and in the obstruction of the airways: a factor that determines the various sleep discomforts. Among the most common, there are obstructive sleep apneas, or moments of pause in breathing due to a closure of the airways: they usually occur from 5 to 15 episodes for each hour of sleep(2), they have as a symptom the sudden awakening, snoring, bruxism and can cause metabolic, cardiovascular and neurological complications, increasing the risk of stroke, arterial hypertension, coronary heart disease and arrhythmias, diabetes. “They are due to a reduction in the volume of the airways, which can occur due to malocclusion due to a narrow palate or mandibular retreat or due to relaxation of the soft tissues of the palate, typical, for example, in postmenopausal women – explains the Dr. Paini – This is why the orthodontist assumes a fundamental role as sentinel”. Furthermore, a study has shown that those who have few teeth in the back of the mouth risk suffering from it to a greater extent: this status can lead to a decrease in the volume in the retropharyngeal areas, obstructing the airways(3). This is why dental implantology and adequate implants can become essential for a better quality of life.
A further symptom is nocturnal bruxism, which consists of the involuntary grinding of the teeth and can lead to their chipping and fracture, with damage even from an articular point of view. Even macroglossia, or excessive swelling of the tongue, plays its part in disturbing our moments of rest: a voluminous tongue, in fact, can obstruct the airways and interrupt sleep.
Finally, there are some symptoms that can be indicators of a non-optimal quality of sleep derived from mouth problems, such as hypersalivation and xerostomia, or dryness of the oral cavity.
THE ROLE OF BREATHING AND SLEEPING POSITION
A red thread linking these conditions is mouth breathing. The confirmation comes from a study carried out on children aged 6 to 9 years: 59% of young patients tend to breathe with their mouths open and, among these, a high percentage of malocclusions, tooth decay, bruxism and obstructive sleep apnea was found ( 4). In fact, breathing with the mouth open and not through the nose can lead to various negative effects: “For example, a lowering of PH, which generates a greater incidence of caries”, confirms Dr. Paini. All people who suffer from sleep disorders and bruxism should avoid sleeping in the supine position: “Sleeping in this position could cause soft tissue to fall backwards, with airway obstruction, affecting rest – reveals the Dr. Paini – This is a precaution that people who snore should also consider, because snoring leads to a vibration of the soft tissues. It is therefore important to learn to sleep on your side to have better breathing”.
WEAPONS AGAINST DENTAL SLEEP DISORDERS
Managing and combating dental sleep disorders is possible. “In the case of obstructive apneas, for example, considering that the air does not pass and the blood is not oxygenated, it is good to bring oxygen back into the circulation through an expansion of the airways – explains Dr. Paini – To do this, there are various weapons available of dental professionals, such as therapeutic devices that can work on mandibular advancement, bites and transparent aligners that work on the function of the teeth by repositioning them in the correct way. The last way is to intervene surgically on the soft tissues, modifying the shape of the palate or tongue”.
PREVENTION AND ADVICE
As with many other areas of health, prevention plays a key role in avoiding the development of sleep disorders. “It would be good to work a lot on children, so as to prevent them from developing respiratory problems and, in the long term, sleep disorders – advises Dr. Paini – With them it is possible to intervene on the growth of the jaw bones, where necessary, while in adults we intervene from a therapeutic point of view, not preventive. For this reason it is important that the dentist reads the right signals in young patients”. Therefore, the intervention of professionals is fundamental: if a child sleeps with his mouth open, a visit to the orthodontist (but not only) could be the solution; adults, on the other hand, should be attentive to some signs such as snoring, dental abrasions, repeated awakenings and facial contractions and moments of great stress, reporting them to a trusted specialist.
GUIDE OF PROFESSIONALS TO CONTACT
Dental sleep disorders, therefore, concern different areas of health and, as such, need to be brought to the attention of the right professionals. According to Dr. Paini, the specialists to contact in case of similar symptoms and conditions and who should work with a multidisciplinary approach are:
The neurologist and the sleep centers for an initial check on a possible bad quality of sleep; The otorhinolaryngologist who intervenes especially in the diagnosis and treatment of obstructive sleep apnea; The dentist, who takes care of preventing, diagnosing and treating pathologies affecting the oral cavity and who can detect the first signs during visits with patients; The orthodontist, who deals specifically with malocclusions (among the first signs of dental sleep disorders) and can intervene with suitable therapeutic aids to solve the problem.
(1) Faber J. et alt., Obstructive sleep apnea in adults, Dental Press Journal of Orthodontics, 2019.
(2) Data from the Italian Association for Sleep Medicine (AIMS).
(3) Kondo Katsunori, Progress in Aging Epidemiology in Japan: The JAGES Project, J Epidemiol, 2016.
(4) Castilho R. et alt., The interface between dentistry and respiratory sleep disorders in children, Sleep Science, 2020.
