Dentaltown September 2022 - 57

The dental team is on the front lines
of intervention for sleep- and airwayrelated
problems because dentists and
hygienists can look for signs and ask
about symptoms and risk factors each
time they look in a patient's mouth.
A patient who experiences more than one
of these symptoms more than once a week and
checks " yes " to such questions on their health history
would likely benefit from a referral. The same
is true if you note any of the anatomic/pathology
presentations below, which are often correlated
with an unhealthy airway and sleep disorders.
* Lingual scalloping.
* Frequent or chronic fractured restorations.
* Coated tongue.
* Uncontrolled periodontitis.
* Red or inflamed oropharyngeal
walls and uvula.
* Linea alba.
* Little to no space between the tongue and
oropharyngeal walls and soft palate.
* Narrow or vaulted palate.
* Retronagthic mandible/significant overbite.
* Relapsed orthodontia.
* Open bites.
* Tight and restrictive frenulum attachments.
* Chronically dry and cracked lips.
* Chronically enlarged tonsils.
* Chronic, or a history of, temporomandibular
joint disorders.
Chronic, nonrestorative sleep can manifest
into behavioral and health concerns for children
and adults. Fragmented sleep prevents the body
from fully repairing itself and cleaning the brain of
plaques,2
which can lead to dementia3
mer's disease.4
and AlzheiIt
also can interfere with our ability
to focus, pay attention and process our emotions.5
The specialists
Once a positive history has been established,
it is helpful to have guidance in the referral process.
Typically, it's best to refer out to an orofacial
myofunctional therapist initially. Orofacial myofunctional
therapists can be viewed as the " quarterbacks "
of the care team, because they'll have a
group of providers within their referral network for
the patient's needs.
Alternately, if the patient has had chronic inflamed
tonsils noted at each recall/exam, it would
warrant a referral directly to an ear, nose and throat
specialist (ENT).
Sleep specialist. First, identify a nearby sleep
specialist you feel comfortable referring to who
can analyze the patient's sleep quality and make
recommendations. At-home sleep testing options
also are available.
ENT or allergist. If tonsils are blocking the
airway, send the patient to an ENT. Doing this
doesn't necessarily mean surgery will be required;
there could be options for management and establishing
a baseline. If pathology or anatomical
structures impede the patency of the airway, this
should be addressed first.
Orofacial myofunctional
therapist. Neuromuscular
reeducation is an adjunctive therapy,
individualized to the patient's needs, that can
help address the root cause of some symptoms of
sleep-disordered breathing.6
Orofacial myofunctional
therapists, who have postgraduate education
and training in this arena, are licensed dental
hygienists, speech language pathologists or occupational
therapists who've trained to screen and
assess for barriers to optimal function-tongue
and lip ties, mouth breathing, oral habits, etc.-
and recommend a therapy plan to manage them.
Dentaltown September 2022

Table of Contents for the Digital Edition of Dentaltown September 2022
