Getting Rest, For The Rest Of Your Life

How your mouth tells a story about your sleep

By Kathleen Duff for Aging at Altitude

Your mouth speaks volumes when it comes to understanding how you’re sleeping at night. “The teeth, the mouth, the tongue, the skeleton all give us clues as to what’s going on,” said Dr. Andrew Kelson of Dental Horizons in Longmont. Kelson said a strong connection exists between the mouth and sleep health, particularly when it comes to obstructive sleep apnea.

The condition occurs when a person repeatedly stops and starts breathing through the night, sometimes several times an hour. Those with sleep apnea often snore and snort, awakening themselves. It can lead to daytime sleepiness, headaches, high blood pressure, acid reflux and a greater risk of cardiac death, among other health concerns.

Kelson said plenty of signs point to sleep disorders. For example, a person’s airway can be restricted for anatomical reasons. Perhaps a person has a large mouth or a large tongue or an elongated uvula. Or, patients may have small windpipes or a very vaulted palate. Even those with tongue-tie may have difficulty breathing. “These are all things we see when a person comes in for a dental exam,” he said. “For much of my career, I just looked at crowded teeth just as crowded teeth. But for a sleep standpoint, it may mean their airway is narrower and their tongue may fall back, creating an atmosphere in which it is difficult to breathe.”

Mouth breathing is another manifestation of sleep apnea. Patients who breathe through their mouths can create an environment for bacteria to thrive, and a higher risk of periodontal disease and tooth decay. There also is a higher risk for tonsils and adenoids to be larger. Those who don’t breathe through their nose lose the body’s best air filter and the ability to generate nitric oxide, which relaxes the body’s vascular system. He explained, “We pay attention to how we eat, how we exercise, but we don’t pay attention to how we breathe. But how we breathe affects our circulatory system and our digestive system. Patients are not breathing at night and they don’t even know it. The teeth just scream that I’m not breathing.”

Kelson said some research is showing that children are occasionally being misdiagnosed with Attention Deficit Hyperactive Disorder when they may really have a sleep disorder. While Kelson cannot diagnose sleep disorders, he can and does ask his patients questions about their sleep habits as he examines them. If he gathers enough evidence, he may refer them to a physician for a sleep study to determine their condition.

But dentists also are doing more than asking questions. Kelson said (day and night) dental appliances can be used to remodel the jaw, with more emphasis now being placed on expanding the upper jaw to increase the airway. The devices, which can be worn 12-24 months, may reduce the need for CPAP machines, often recommended for those with sleep apnea. “We can certainly help adults, but with kids, it’s even more exciting. There are dental appliances they can wear at night that can stimulate and encourage growth and development of the skeleton, so there aren’t problems in the future. It can address the need or extent of the need to straighten teeth.”

Kelson said of the broader approach to dentistry, “It’s extremely rewarding to help someone breathe better, and the cascade of benefits that come from breathing better certainly affect the teeth. When they use that dental appliance … they are excited because it’s changing their life. They are waking up and feeling rested for the first time in their lives. Anxiety and stress are reduced. … It changes their motivation and their ability to heal in general.”