Screening for Sleep Apnea in the Dental Practice

Learning how to identify patients in your dental office that have sleep apnea or are at risk, is a key part of an effective sleep apnea program. Dentists and staff members often mistakenly believe that, "they just don't see sleep apnea patients" in their office. What is much more likely is that they don't understand what to look for, and do not have systems or protocols in place that make it possible to connect with these patients. Statistically, it is very likely dentists see patients regularly that have already been diagnosed with sleep apnea and have a CPAP machine at home in the closet. These are ideal candidates for oral appliance therapy. There are simple and powerful tools available that can be utilized in any dental office to make it easier to identify these patients.

The S.T.O.P. questionnaire consists of 4 simple yes or no questions that take a patient one to two minutes to complete. A "yes" response to two or more of the four questions, indicates a 90% likelihood of sleep apnea. The questionnaire was developed by anesthesiologists and published in 2008; today it is routinely used as a sleep apnea screening tool in acute care settings.

The four questions are:

1. Snoring

Do you snore loudly (louder than talking or loud enough to be heard through a closed door)? YES NO

2. Tired

Do you often feel tired, fatigued or sleepy during the day? YES NO

3. Observed

Has anyone observed you stop breathing during your sleep? YES NO

4. Blood Pressure

Do you have or are you being treated for high blood pressure? YES NO

Dental offices can incorporate these questions into their new patient intake forms. An even more effective approach is to give the questionnaire to every patient while in the waiting room. Dentists, staff members and hygienists should all be comfortable talking with patients about the questionnaire, the dangers of undiagnosed sleep apnea and the benefits of treatment. During the conversation, some patients will acknowledge that they have previously been diagnosed with sleep apnea. Others who answer yes to two or more questions but have never had a sleep test may benefit from a diagnostic sleep study.

Other screening techniques involve observing patients and looking for key signs of sleep apnea. One of the most common is daytime sleepiness. Did the patient fall asleep in the waiting room? It may be due to lack of sleep last night, or it may be a pattern for that patient. Are they sleepy most days in the morning or afternoon? Other dental indications of sleep apnea risk include: a narrow or crowded upper airway; scalloped tongue; acid wear on teeth and bruxism. High blood pressure and obesity are linked to sleep apnea. While it is not uncommon for a patient to exhibit any of these symptoms, the presence of more that one significantly increases the likelihood that underlying sleep apnea may be present.

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