Dr. Tanya Al-Talib advocates for dentists becoming the first line of defense against sleep breathing issues.

UNLV School of Dental Medicine orthodontist Tanya Al-Talib considers good oral health integral to maintaining good overall health, and encourages her dental students to treat patient visits as opportunities for identifying other possible ailments during their earliest stages.

There’s one ailment she’s passionate about detecting—sleep breathing issues such as obstructive sleep apnea (OSA).

“People who snore usually know they do thanks to a bed partner, but those who may be susceptible to, or have the more serious sleep apnea may not,” said Dr. Al-Talib. “And unless a person expresses concern, a medical professional won’t automatically check for signs of the disorder.

“Since most comprehensive dental exam check vitals, height and weight, and head and neck pathology, I saw an opportunity to look for potential indicators of sleep breathing issues that could lead to earlier diagnoses before serious medical issues manifest.”

Dr. Al-Talib implemented questionnaires that, paired with anatomical criteria, evaluate the risk levels for sleep apnea and other sleep breathing issues among children and adults.

She used the Epworth Sleepiness Scale to calculate a person’s excessive daytime sleepiness, “STOP BANG” for OSA and Cone Beam Computed Tomography (CBCT), which is used to identify different skeletal and dental issues for orthodontic patients, to determine airway volume.

“I also collect data on height, weight, neck circumference, alignment, and skeletal make-up, and then combined it with data from the Epworth survey, airway measurements, and jaw discrepancy. So far, we have found an interaction between daytime sleepiness and skeletal make-up.”

The tools
The questionnaires for adult and pediatric patients are completed during the comprehensive dental exams.

Adult patients complete two questionnaires. One targets excessive daytime sleepiness and features questions such as “How likely are you to nod or fall asleep during the following situations: 1. Sitting and Reading 2. Watching TV, (etc.)?”

The STOP BANG questionnaire focuses on risks for obstructive sleep apnea and includes questions about a patient’s loud snoring, high blood pressure during sleep, or witnessed apnea, which occurs when a person stops breathing while asleep.

The pediatric sleep questionnaire addresses a child’s snoring and breathing during sleep, a child’s level of sleepiness during the day, and the child’s overall behavior.

While examining patients, dental students in the general clinics calculate a numeric score. Questionnaires with higher scores indicate greater risks for sleep disordered breathing, which prompts students to request a consult with Dr. Al-Talib.

The school started using the adult questionnaires during summer 2018 and has screened nearly 8,600 adults with possible sleep breathing issues. Dr. Al-Talib evaluated those with high questionnaire scores and referred them accordingly to local sleep labs for evaluation. The pediatric questionnaires have been implemented and are being used more recently.

Dentists and sleep apnea
Dr. Al-Talib is clear the questionnaires are not diagnostic—they are only screening tools.

“Diagnosing sleep apnea and other sleep disorders require specialized exams and the expertise of trained professionals,” she said. “Additionally, an overnight sleep test in a certified sleep lab, which is the gold standard for diagnosis, is critical for accurate diagnoses.”

Dr. Al-Talib said local dental offices should become more involved with treatment options for those with sleep apnea or other sleep breathing disorders, including snoring.

“The standard of care for sleep apnea patients is the Continuous Positive Airway Pressure (CPAP) mask. For those patients who have mild sleep apnea or cannot tolerate the CPAP, an oral appliance made by a trained dentist could be a successful treatment option provided it is prescribed by a sleep physician. The appliance, which is similar to a retainer, employs an advancing mechanism that moves the lower jaw forward and helps open the airway during sleep. This appliance can also aid those who snore.”

If you snore, experience daytime sleepiness, or are concerned about yourself or someone else’s sleep or sleep breathing problems, remember to speak with your primary care provider, and your dentist.

Photo: Dr. Tanya Al-Talib. Courtesy of UNLV School of Dental Medicine.