In this presentation, the speaker argues that dentistry should serve as the first line of defense against obstructive sleep apnea (OSA) because OSA is linked to a wide range of serious systemic conditions—including heart attack, stroke, Parkinson’s disease, dementia, diabetes, cancer, erectile dysfunction, and hypertension. Citing leading sleep‑medicine experts such as Dr. John Remmers, Dr. David Gozal, Dr. Steve Almos, Dr. Brendan Stack Jr., Dr. Brian Blevins, Dr. James O’Brien, Dr. Christian Guilleminault, and Dr. Ron Harper, the talk outlines alarming prevalence data (e.g., 17% of the U.S. population has OSA, 95% undiagnosed, 65‑80% of stroke patients have OSA) and highlights the profound health impacts of untreated OSA, including reduced IQ in children, increased risk of hypertension, brain cell loss, and a 20% reduction in life expectancy. The speaker emphasizes that many dental patients already exhibit signs of OSA (e.g., bruxism, snoring) and that dentists can identify these patients through targeted questioning. The presentation also discusses the role of orofacial growth and jaw positioning in airway patency, reviewing evidence that bimaxillary expansion can improve respiratory parameters in some children but may be ineffective for anterior‑posterior skeletal patterns. The overall message is a persuasive call to action for dentists and parents to screen for, recognize, and intervene early in sleep‑disordered breathing to mitigate severe health consequences.
Chapters
Welcome back. This segment is entitled Reasons to Be Concerned and Involved. I'd like to share with you my thoughts of the future of dentistry. I happen to believe that dentistry should be the first line of defense in heart attack, head and face pain, Parkinson's disease, stroke, dementia, diabetes, And even cancer, because all of these are related to sleep apnea. In order to get men's attention, we have to go to something more important than living or dying, and we have to tell them that even erectile dysfunction is associated with sleep apnea. Well, let's look at what the experts have to say. First, Harvard-trained physician, well known throughout the world of sleep, Dr. John Remmers, tells us that sleep apnea will be the most common chronic disease in all industrialized countries That 65 to 80% of stroke patients have sleep apnea. 17% of the US population suffers from sleep apnea, and 95% of us, of the sleep apnea patients, go undiagnosed. David Gozal, past president of the American Thoracic Society, from the University of Chicago, states that snoring is not normal and should never occur. He further states that 7 to 13% of all preschool children snore. He states that sleep apnea is present in 2 to 3% of all preschool children, and that sleep apnea may be responsible for a 10-point drop in IQ. He also says that if you don't address the sleep apnea problem in children, you may not be able to later reverse the cardiovascular problems which will occur. He also talks about a study of 297 poorly performing first graders in which the incidence of sleep apnea was 6 times more frequent than in a normal group. Steve Almos, well known in the world of sleep, states that 90% of OSA patients suffer from hypertension, and that 40% of adults over age 40 snore. Brendan Stack Jr., who is an ENT physician, states that 60 to 80% of snorers test positive for sleep apnea, and furthermore, he states that untreated sleep apnea results in a 20% reduction in life expectancy. Brian Blevins states that OSA sufferers are 6 times more likely to clench or grind than a normal group, which brings attention to those of us in dentistry to think about the patient with worn teeth as something more than— far more important than just someone who needs veneers to take care of their worn teeth. Finally, James O'Brien, Boston-trained sleep apnea specialist, states that everyone who snores will develop sleep apnea eventually if they live long enough. The important thing here is we must realize that all of us in dentistry have these patients in our practice all the time, whether we know it or not. We need to just be asking the right questions to find out who they are so that we can help them. Again, Remer states sleep apnea will be the most common chronic disease in all industrialized countries. He further states that it's due to a structural narrowing of the pharynx in most, if not all, cases. And he says that sleep apnea would not exist if the jaws were placed properly forward in the face. And this is terribly important for us to understand in dentistry. Also from the refereed literature, one of the best names— known names in sleep is Christian Guilleminault from Stanford University, who talks about Abnormal orofacial growth induced by dysfunction leads to development of a smaller than typical upper airway with increased risk of collapse during sleep. There is a progressive worsening of dysmorphia and a slow worsening of sleep disorder breathing over time. In sum, he states, the abnormal orofacial growth may have different genetically or environmentally induced etiologies, but recognition of the factors leading to orofacial dysfunctions and their treatments early in life may decrease the frequency of OSA, A syndrome that affects at least 7% of the pediatric population and spills over into adulthood. Also, from another article from Stanford University, from Christian Guilleminault, he talks about bimaxillary expansion can be a treatment option for improving respiratory parameters in children with sleep-disordered breathing. But he further states that retronathia in an anterior growth rotation pattern may not respond to efforts of bimaxillary expansion. The point being is that the knee-jerk reaction of dentistry is that we must expand to address sleep apnea. But in reality, it may be more of an anterior-posterior problem than a lateral problem. Finally, let's get down to some of the serious health consequences. Dr. Ron Harper, professor of neurobiology at UCLA, states that 5 hours of intermittent hypoxia can cause brain cell— brain damage, killing Purkinje cells, which are responsible for motor coordination. And the brain injury from sleep apnea results in a 3 to 4 times increased risk of hypertension. When you look at this, everyone who's a parent needs to be involved and concerned. The point is, every dentist has patients like this in their practice who need to be helped.
