What is Obstructive sleep apnoea (OSA)?
One issue that can have dental roots is obstructive sleep apnoea (OSA), a condition affecting 1.5 million people in the UK, where the walls of the throat relax and narrow, interrupting breathing and sleep.
OSA is common among people who grind their teeth at night. Despite being linked with serious conditions such as high blood pressure, diabetes, stroke and heart disease, up to 85 per cent of OSA patients are undiagnosed, as symptoms can be hard to spot and access to hospital sleep services is limited.
Up to 40% of adults with OSA grind their teeth. We used to think that teeth grinding at night was caused by stress, but a new theory is that, in some, it’s the result of not being able to breathe efficiently while sleeping. The grinding may be a way of trying to open the airway.
By spotting sleep grinding — signs are worn or damaged teeth — then looking for signs of OSA, such as a scalloped or large tongue, a dropped soft palate (soft tissue at the back of the mouth) and restricted airway, and checking for risk factors including snoring, dentists can diagnose OSA.
Treatment of OSA
If the condition is severe and they have other health problems, patients will need to be seen by a specialist and continuous positive airway pressure (CPAP) treatment — which uses mild air pressure to keep the airway open — may be prescribed.
In milder cases, the condition can be treated by a dentist using a mandibular repositioning device (MRD), a mouth guard which is worn when sleeping and works by holding the lower jaw and tongue forward at night, opening the airway.
For more information on OSA, watch this short video (2 mins)
Headaches first thing in the morning can be caused by teeth grinding at night, which affects up to a third of people. As the jaw grinds the teeth together, it not only ruins the teeth but causes injury to the temporomandibular joint (connecting the jawbone to the skull). This can result in temporomandibular joint dysfunction (TMD) - pain, inflammation and stiffness in the jaw joint and the surrounding muscles. Overusing these muscles by teeth grinding can also irritate and activate the trigeminal nerve (responsible for sensation in the face, biting and chewing) which can trigger headaches. Between 30-50% of adults who grind their teeth complain of a headache in the morning or during the day. Exactly the same mechanism can also result in ear pain, ringing in the ears or a feeling of fullness in the ear.
Managing the grinding — using mouth guards and muscle relaxants to take pressure off the teeth and jaw — along with the nerve pain it can cause, can get rid of these headaches.
These patients typically go to a GP for the headaches and try a series of medications. When they fail, other causes should be explored. We find them further down the line when they are eventually referred to the dentist and diagnosed with TMD.
Many doctors don’t consider the jaw as the source of the problem because this area of medicine is not part of their training, so they don’t know what to look for.
The British Dental Association (BDA), which represents 35,000 dentists, says it is already on the frontline for identifying conditions such as oral cancer, checking for signs of the disease as a routine part of dental appointments.
However, the BDA would welcome a more ‘joined-up system’ with doctors. Dentists see their patients twice a year — more frequently than many GPs. We are making progress but there is a lot more to be done to ensure patients get the treatment that they need.