Oral Health connected to sleep quality

Written by the Sutton Editor and medically reviewed by Dr. Joseph Salim DMD (a sleep apnea dentist in New York)

One of the hallmarks of obstructive sleep apnea (OSA), is that your sleep partner will migrate to a different room and have murderous thoughts. 😉

Well, now, on a more serious note, some common signs include:

  • chronic snoring
  • feeling drowsy during the day
  • waking up with a dry mouth or sore throat
  • morning headaches

Although this short acronym (OSA) looks simple, it conceals a frequently undiagnosed disease.

OSA affects the sleep of 22 million Americans[1]. Yes, nothing less than 22 million. Take a moment and let that sink in.

OSA results from the collapse of tissues in your upper airways, which obstruct your breathing. This occurs during your sleep since muscles relax as you doze off.

If you suffer from OSA, your sleep will look like a repetitive process of complete obstructions or partial decreases in airflow (hypopnea).

You will snore loudly and make choking sounds as you will gasp for air. Breathing pauses may last 10 to 30 seconds or more … even up to 1 minute.

A bit like a Freddie Krueger-type bogeyman, OSA comes during your sleep. But unlike the movie, it is after your breath and your health.

You will feel tired and sleepy most of the day. It will deprive you of vitality and mental performance. It will zap your daily energy and, it may eventually kill you if left untreated.

So, over time, you may suffer from all sorts of related health effects. These include:

  • depression,
  • hypertension,
  • irregularity of heartbeat,
  • mood disorders,
  • erectile dysfunction, etc.

Interestingly, there exists a link between OSA and some dental pathologies.

Let’s take a closer look.

Dry mouth

If you are an OSA sufferer, mouth breathing will increase, which will lead to a dry mouth.

Given that saliva production is lowest during sleep, OSA will make things even worse.

Now, a dry mouth is a sign of poor oral health, and saliva has a protective action.

Skeptical?

Well, dry mouth patients, either due to OSA or insufficient salivary function, show[2]:

  • more caries,
  • fewer teeth,
  • detrimental effects on denture wearers because saliva has a significant impact on their retention

Some evidence indicates that low saliva levels increase oral infections due to Candida Albicans (a fungus).[3]

Finally, low salivary flow rates may also lead to infections of the tissues supporting and surrounding your teeth (periodontal disease). Although this remains somewhat controversial.[4]

Teeth loss

Given the above, you will not be too surprised to hear that the chances of losing one or more of your teeth is linked to sleep apnea. A study showed that if you are edentulous (aka toothless), you will be more likely to suffer from this disease[5].

But it does not stop there.

In the same vein, another publication showed that if you are a patient aged 25-65, then each tooth counts. Your risk of suffering from OSA increases by 2% for every new tooth that is lost.

Chronic periodontitis

Another dental pathology in the list is chronic periodontitis. It is the inflammation of those tissues that cover and support your teeth.

As you may be surmising already, OSA also plays a role here[6]. A publication shows that this disease affects 62.3% of patients with sleep apnea[7].

Now, doctors frequently use oral appliances to treat sleep apnea. They protrude the lower jaw forward, pulling the tongue along and freeing your upper airways. But, if you suffer from periodontitis, their use is not indicated.

Why not?

Because they may pull out your teeth. Since your teeth are less firmly attached to the surrounding tissues, you are at risk of losing them.

Yet, another issue often related to OSA is teeth grinding and clenching. It is also known by a more obscure term: bruxism.

Let’s take a look.

Bruxism and cracked, or worn-down teeth.

It occurs mostly at night, and the quality of your sleep will suffer. Feeling unrefreshed and suffering from headaches, neckaches or jaw pain will be the new norm once you are awake.

Add to that a gradual erosion and destruction of your teeth and jaw popping, and things start to look direr. Cracked and worn-down teeth are a telltale sign of this issue.

Bruxism is not just an oral health disease. It is also a sleep-related movement disorder. This is due to the uncontrolled physical movements (of your jaw) it entails.

If you are sufferer, ensure that your dentist prescribes you a sleep study before a bite guard.

Why?

The rationale is that a sleep study will allow a sleep specialist to confirm or deny the diagnosis of OSA.

If you are an OSA sufferer, then curing it may very well resolve your bruxism.

Nope, it is not witchcraft.

The explanation is quite simple: your bruxism may result from the body’s instinct to try and keep your airways open.

So, treating your OSA will be like killing two birds with one stone, meaning that it will solve your bruxism as well. Your body will not have to start a back and forth motion associated with grinding, to increase the narrow diameter of your airways.

The addition of a nightguard to prevent erosion of your teeth due to grinding and clenching may instead make things worse.

Can you see the reason for this?

It will narrow your airways even more, and the quality of your sleep will plummet.

Now, though we stand by what you have read, note that the relationship between OSA and bruxism is complicated.

You may very well find yourself grinding your teeth away during the night, despite the presence of an effective dental appliance.

In that case, your dentist will advise using a reinforced adjustable mandibular device to manage your OSA. But he/she will have to treat your bruxism separately.

Let’s now briefly examine another dental health issue. Some people suffer from temporomandibular disorder (TMD).

Just scroll down to discover more.

TMD and OSA

A study[8] showed that “Men and women with two or more signs/symptoms of OSA had 73% greater incidence of first-onset TMD, than those with fewer signs/symptoms.” Now, these (signs/symptoms) included:

  • witnessed apnea,
  • trouble staying awake,
  • hypertension,
  • and/or loud snoring

The results were “independent “of age, gender, race/ethnicity, obesity, smoking history, and autonomic parameters.”

Also, those more likely to have sleep apnea were three times as likely to suffer from TMD.

But wait a minute! You may have forgotten what this health condition is about (or maybe it is new to you).

So, here is a brief refresher explanation: we all have two temporomandibular joints (TMJ), one on either side of our face. They connect our lower jaw to our cheekbones. Despite their short acronym, these hinges are complex for they allow:

  • vertical,
  • lateral
  • forward/backward

movements of the mandibles. And this not by chance for we need their full range of motion for eating and speaking.

When these (joints) do not function properly, you will suffer from several symptoms that may affect your sleep. These include:

  • dull headaches that begin at your temples
  • jaw pain and jaw joints’ tightness
  • problems when chewing
  • popping/clicking sounds, when you open your jaw; they can be loud enough to wake up your sleep partner
  • dizziness
  • swelling on the side of your face
  • the inability of opening or closing your jaws for some time (locked jaw)
  • tenderness or pain spreading behind your eyes to your ear, shoulders, face, neck, jaws, and head
  • struggling to open your mouth wide

Conclusions

To wrap it up, if you suffer from signs of sleep apnea, don’t put off an appointment with your dentist. Else you may have a negative surprise when discovering the state of your oral health.

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[1] https://www.sleepapnea.org/

[2] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1834-7819.2010.01229.x

[3] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1834-7819.2010.01229.x

[4] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1834-7819.2010.01229.x

[5] https://www.ncbi.nlm.nih.gov/pubmed/21209983

[6] https://www.ncbi.nlm.nih.gov/pubmed/19198909

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009157/

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706181/