How knowledgeable are dentists about OSA?

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Based on recent research, an estimated 936 million people globally between the ages of 30 to 69 have mild to severe obstructive sleep apnea (OSA).1 Roughly 45% (425 million) of those affected have moderate to severe OSA.

In populations with greater rates of obesity, such as the United States, OSA can affect an even larger portion of the population, but despite its high prevalence, OSA remains underdiagnosed.2 Untreated, OSA poses a threat to public health, as the condition increases the risk of many long-term cardiovascular and metabolic diseases and places a significant financial burden on healthcare organizations and community resources.3

Alongside teams of other healthcare professionals, dentists can play a critical role in improving the rate of diagnosis, quality of treatment, and access to care for patients with OSA. But how knowledgeable are dentists about OSA? And how can dentists and dental sleep specialists better help patients facing an OSA diagnosis?

How OSA treatment and dentistry intersect

As defined by the American Dental Association, OSA is a chronic condition that is “characterized by recurrent narrowing or collapse of the upper airway during sleep, resulting in partial or complete cessation of airflow despite continued respiratory effort.”4 Like other sleep-related breathing disorders , OSA can have incredibly detrimental effects on patients’ long-term health outcomes.

Due to repeated interruptions in sleep, patients with OSA can experience significant impacts on their quality of life and overall health. Daytime sleepiness and cognitive impairment owed to poor sleep can put those with the condition at greater risk for accidents and worsen their performance in school or at work.5 Additionally, OSA increases patients’ risk of hypertension, cardiovascular disease, cancer, type 2 diabetes, dementia, and mood disorders.4 

Patients with OSA are most often prescribed continuous positive airway pressure (CPAP) machines to regulate their breathing during sleep.5 However, many patients find CPAP therapy ineffective or uncomfortable, leading to poor compliance and worsened treatment outcomes. Oral appliance therapy offers an alternative to treatment with CPAP machines for many patients.

Dental appliances or oral mandibular advancement devices can be used to keep patients’ airways open during sleep. However, effective oral appliance therapy requires cooperation between the prescribing sleep specialist or physician and dentists, who have the specialized knowledge to fit oral appliances to the mouth and teeth properly.6

OSA knowledge among dentists and physicians 

For OSA diagnosis and long-term treatment to improve OSA on a broader scale, both dentists and physicians need to recognize the symptoms and risk factors in potentially affected patients. While there are common risk factors that any health professional can and should note (such as obesity, gender, age, family history, and ethnicity), dentists, in particular, can play a key role in screening patients for OSA. 

Dentists have the knowledge and opportunity to assess patients effectively and consistently for specific risk factors, such as4:

  1. Oral or craniofacial abnormalities
  2. Enlarged tongues
  3. Enlarged neck circumference
  4. Retrognathia or micrognathia
  5. Narrowing in the soft tissue of the upper airway
  6. Enlarged tonsils or adenoids

A recent study published in the Journal of Dental Sleep Medicine surveyed dentists in California to assess how knowledgeable they were about OSA compared with physicians.2 Researchers surveyed 2 samples of dentists online and in-person over the course of 4 months, administering 18 knowledge items from the validated Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) Questionnaire.2 

Based on their survey answers, the dentists’ OSA knowledge scores, knowledge gaps, and competencies were compared with physicians’ results compiled from 12 studies conducted between 2003 and 2020.2 Within the physician group, some samples scored better than others. A group of Canadian otolaryngology residents had the highest OSA knowledge scores (75.6%), followed by all US physicians (75.6%), and then all other non-US physicians (62.3%).

Overall, the study revealed more knowledge gaps among surveyed physicians than among the California dentists.2 While physicians had a mean OSA knowledge score of 63.9%, surveyed dentists scored 73.6% on average. These results indicate that dentists can expand the availability of reliable diagnostic and treatment options for potential patients with OSA, but further training and specialization may be needed to provide the support that sleep specialists and their patients need.

How dentists can improve OSA diagnosis and treatment 

Dentists have the training, knowledge, and opportunity to play a key role in screening patients for OSA, as well as improving the quality and efficacy of their eventual treatment.2 While dentists have long contributed to OSA treatment plans,7 dental education, practices, and diagnostic approaches can be better adapted to help address this underdiagnosed condition.

Not only can dentists help fit oral appliances for patients, but they can also adapt their oral examinations to account for common OSA risk factors and symptoms. And for patients showing signs of OSA, new diagnostic tools, such as home sleep apnea tests (HSATs), can provide a convenient, cost-effective alternative to laboratory-based polysomnography (PSG) sleep studies.

Adopting these kinds of tools and approaches can allow dentists to better serve their patients, support and collaborate with physicians treating patients with OSA, and expand the scope of their practice and expertise.

References

  1. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687-698. doi:10.1016/S2213-2600(19)30198-5
  2. Simmons M, Sayre J, Schotland HM, Jeffe DB. Obstructive sleep apnea knowledge among dentists and physicians. J Dent Sleep Med. 2021;8(4). doi:10.15331/jdsm.7212
  3. Morsy NE, Farrag NS, Zaki NFW, et al. Obstructive sleep apnea: personal, societal, public health, and legal implications. Rev Environ Health. 2019;34(2):153-169. doi:10.1515/reveh-2018-0068
  4. Sleep apnea (obstructive). American Dental Association. March 10, 2020. Accessed December 5, 2021. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/sleep-apnea-obstructive
  5. Oral Appliance Therapy for Obstructive Sleep Apnea, Accessed December 5, 2021. https://my.clevelandclinic.org/health/treatments/21129-oral-appliance-therapy-for-sleep-apnea
  6. AASM and AADSM issue new joint clinical practice guideline for oral appliance therapy. American Academy of Sleep Medicine. Accessed December 7, 2021. https://aasm.org/aasm-and-aadsm-issue-new-joint-clinical-practice-guideline-for-oral-appliance-therapy/ Published October 5, 2017. 
  7. Quan SF, Schmidt-Nowara W. The role of dentists in the diagnosis and treatment of obstructive sleep apnea: consensus and controversy. J Clin Sleep Med. 2017;13(10):1117-1119. doi:10.5664/jcsm.6748