The best way to learn is to ask better questions.

The Socratic Principle

Why sleep? Biological reasons include cell repair, hormone release, immune function strengthening, energy conservation, and body regulation. In brief, sleep makes for a more efficient organism.

Sleep is far more than the absence of wakefulness. It’s usually a complex physiologic, psychological, and behavioral condition coordinated by neurons and neurotransmitters in the brain. We spend 25 to 33% of our lives sleeping, or wishing we were. A restful night sleep can be described as three or four cycles of NREM (non-REM) sleep during which physiological functions are restored and REM (rapid eye movement) sleep during which mental functions are restored. NREM sleep is light and characterized by slow brain waves while REM sleep is deep and characterized by an increased heart rate, respiration, and brain activity, rapid eye movements and a decrease in muscle activity. REM sleep is the time when most dreaming occurs, when healing takes place, and when nerve energy is recharged.

 

Sleep is also occlusion repair time

Dentists have been applying splint therapy for almost a century, yet the practice of sleep-airway splint therapy only dates back a decade. Dentists around the world are asking their patients to sleep in a variety of orthotics to gather diagnostic information, develop treatment protocols, enforce active and passive muscle control, heal TM joints, or to prevent pathology related to clenching, bracing, gnashing, and grinding.

Throughout the years, and through trial and error, dentists have learned that they can increase the comfort of their patients, as well as increase their oxygen intake and their blood circulation by altering the position of their mandible during sleep. Sleep-disordered breathing or obstructive sleep apnea is often caused by small or retruded jaws and/or by airway obstruction which respond well to oral appliance therapy.

Dentistry could be sleep medicine’s strongest ally in curbing the current sleep-disorder epidemic for the following reasons:

  1. Dentists look into the oral cavity on a regular basis.
  2. Many dentists see kids, teenagers, and adults of all ages.
  3. Dentists, as opposed to physicians, generally see healthy patients. Dentists and orthodontists can identify distressed airways in growth, intervene, and prevent inevitable outcomes.
  4. Orthotic sleep devices, from simple splints to mandible repositioning appliances, work to provide comfort, increased ventilation, and reduction in snoring and in apneic events.

Sleep splint therapy will change the practice of dentistry as it becomes an adjunct to sleep medicine. It is entirely possible to foresee a time when certain dental (oral?) procedures will be covered by medical health plans.

Identify at-risk children

Incorrect growth of the nasomaxillary complex often results in early airway obstruction and impaired dentofacial development. A child with upper airway allergy and a long face syndrome is particularly at risk for sleep-disordered breathing. Allergic hypertrophy of the tonsils, adenoidal pad and inferior turbinates, when combined with neuromuscular dysfunction and a genetic predisposition for the dolichocephalic face, place the child in the high-risk group for airway obstruction growth patterns. Robert Jankelson, DDS, advises us to be on the lookout for the following when examining a patient:

Symptoms

  • Mouth breathing
  • Dry mouth
  • Snoring
  • Tired on awakening
  • Chronic allergies
  • Cervicalgia
  • Vertigo
  • Tinnitus
  • Earache without infection
  • Fullness in ears

 

Extraoral signs

  • Rolled lower lip
  • Facial asymmetry
  • Dry lips
  • Deep mentalis crease
  • Lips apart (chronic)
  • Deviated septum
  • Allergic gape
  • Dark circles under eyes

 

Intraoral signs

  • Scalloped tongue
  • High, V-shaped vault
  • Narrow maxillary arch
  • Narrow mandibular arch
  • Tongue thrust
  • Depressed curve of Spee
  • Crowded anterior teeth
  • Anterior open bite
  • Hypertrophied tonsils
  • Hypertrophied adenoids
  • Hypertrophied turbinates

Getting to know how and why stressed growth patterns develop is the first step in preventing and controlling airway obstruction. Early referral to an orthodontist who enjoys treating small children and understands the airway-swallow connection is life changing.

Dentistry knows the symptoms and is working on the solutions. However, dentists still wait until individuals develop chronic conditions before intervening when in fact they can offer early treatment options—most notably splint therapy—to the growing number of patients who are aware of, or diagnosed with, sleep-related breathing, swallowing, and snoring problem.

Advancing the treatment of growth parafunction may be dentistry’s greatest contribution in the arena of sleep and occlusion. Sleep and occlusion is still a concept that is not well understood. There are still more questions than there are solutions:

  • When does oral parafunction in sleep start?
  • What is bruxism?
  • Why do people squeeze their teeth at night?
  • Is parafunction physiologic or pathologic?
  • When does sleep apnea start and why?

The best offense is often a good defense. In other words, preventing or slowing the rate of parafunctional destruction is often the best form of treatment we can offer until we find satisfactory answers to the above-mentioned questions.