How Undiagnosed Sleep Apnea Is Hiding in Your Dental Chair

How Undiagnosed Sleep Apnea Is Hiding in Your Dental Chair

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Hey everybody. This is Dr. Mike Bennett. I'm here with Cathy.

Hello everyone.

And we are starting a series of Airway and Wellness episodes. We'd like to dig into that deeper.

Yeah, those two really mesh well together. Oh, airway and wellness.

They do. They do.

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The Importance of Dental Visits for Health Screening

So ask this question to yourself: What if your hygiene exam was the most important health screening that you got all year? No matter, you know—just think about all the screenings you get. What if that was the most important?

Because consider this: dental visits are the most consistent point of healthcare access for adults. And nearly two-thirds of U.S. adults see a dentist annually—often more than their physician. In fact, it's interesting that dermatologists actually see more patients than dentists do. So it'd be nice if they did a screening for sleep.

Yeah. Every six months it’s recommended to…

Mm-hmm. Have a dental visit.

Yeah.

Yeah. So that’s right.

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Identifying Sleep-Related Breathing Disorders

And then dentists can observe early signs of sleep-related breathing disorders. That’s often something others miss—because we’re looking in the mouth and the throat area.

These often include tooth imprints on the tongue—called scalloped tongue, signs of bruxism where you have broken or cracked teeth or worn teeth, crowded teeth—anything that crowds the tongue, crowds the airway.

Even retrognathic profiles, which means a back-set jaw or receded chin—those are often associated. And then mouth breathing as well.

Yeah, that’s a big one. I think—yeah, sometimes people don’t realize how important our breathing is. But mouth breathing has kind of been on social media lately with different methods to close your mouth, such as taping your mouth when you sleep, those kinds of things.

So I think there is becoming an awareness out there of the importance of nasal breathing, but you still see it, especially in kids that are congested.

Oh, their mouth is open, so…

Mm-hmm. For sure. And what you don’t realize is the roof of your mouth creates a suction cup for your tongue. And so if you’re trying to breathe through there, then the tongue can’t suction—and it collapses—and you have apnea issues.

The American Dental Association identified that if you don’t sleep well, you’re more subjected to lots of risks—things like Alzheimer’s and cancer and cardiovascular disease. So they recommended that dentists screen all of their patients—not some—but all of their patients for sleep-related breathing disorders.

And then let ’em know, “Hey, you’ve been screened and you can do something about it.” And I do believe it’s going to become the standard of care eventually. I hope it does, at least.

Yeah. You see that because the American Dental Association—they just had their big annual symposium meeting, and it was all about sleep-disordered breathing and how that ties to overall wellness.

Yep, yep. I definitely attended that and realized more impactfully than ever that if your sleep isn’t working, your health declines—and you’re always gonna be behind the eight ball with your health.

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The Silent Epidemic of Undiagnosed Sleep Apnea

So let’s talk about the silent epidemic of undiagnosed sleep apnea. It’s very much underdiagnosed and widespread.

There’s research that estimates 38% of adults have risk factors for apnea—or they have apnea—and it’s not being treated. And realizing that untreated sleep apnea has comorbidities, which means side effects. If you are not breathing well, then you will have high risk for hypertension, stroke, diabetes, and cancers.

And when you think about family members and what they’ve passed away from—I think about my own family—and they’re on that list. They have those things.

You do hear about people that pass away in their sleep.

Mm-hmm. And it’s heartbreaking. And sometimes that can be related to sleep apnea.

Mm-hmm. Oftentimes it is.

Oh yeah. And I’ll never forget a patient that scheduled with me to be examined—and actually ended up not showing up that Tuesday morning—because he had passed away the night before. It was only a 51-year-old male.

Yeah. Heartbreaking.

Yeah. Just heartbreaking. So that’s why we’ve got to screen. Untreated sleep apnea contributes to poor healing.

So if you’re an athlete and you’ve just sprained your ankle, you’re gonna have a harder time healing—and even if it does heal, having a quality heal.

Your ligaments are going to be more stretched out if they don’t have enough growth hormone and prolactin to help create the healing process. But then you’re also going to be more subjected to chronic pain, depression, and immune dysfunction.

Athletes, post-op patients—anyone with systemic illness—is going to be more subjected to a magnified version of that condition if their sleep isn’t working.

I was just thinking about a person I saw not just recently—where I’m treating them for headaches, neck pain, jaw pain—and they got done telling me that they only sleep five hours a night.

Oh. And they sleep from 1:00 AM to 6:00 AM. We got into a discussion about, “Hey, you gotta sleep while the sun is down.” So then your body can really heal. People don’t realize that the radiation, the energy from the sun, actually activates our nervous system.

Yes.

And puts—and helps with circadian rhythm, right?

Yeah. Mm-hmm.

Yeah. And she said, “My husband has a graveyard shift too, and he’s wondering if he should quit that.” And I said, “My vote is yes.”

Yes.

Very hard. Very much so.

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Economic and Health Impacts of Sleep Disorders

But you also don’t realize that this silent epidemic is related to a huge economic burden—which is, by best estimate, $150 billion associated with the costs of accidents and comorbidities of sleep disorders.

Yes, it’s prevalent.

Yeah. And they say it’s even higher when you think about productivity at work—where employers will come in and their people just can’t think properly. They have to get up and stretch and move—and they’re just not getting work done.

And then not to mention the accidents that happen on the road.

Yes. Yeah. I think that’s very easy to see when you consider all of the drinks—the caffeinated drinks—that are consumed. Very sleep-deprived population.

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Barriers to Dental Screening for Sleep Disorders

Okay, now we’re gonna talk about dentistry being a frontline opportunity—and why we often miss it. This has a lot to do with what I researched in my dissertation.

So barriers include—and these are some of the things that the dentists told me and what I actually experienced personally firsthand…

You mean why dentists don’t screen their patients for sleep?

Yeah. Yeah. Why they don’t screen patients for sleep—because that’s not part of our wheelhouse. It’s not what we do on a regular basis. We don’t get paid for it.

But they said—and I agree—the barriers include that we just don’t have enough time, we lack the training, and we’re confused about what our role is. Do we diagnose it? Do we just screen it and refer? What exactly is going on?

And then they’re also unsure about their scope—being perceived as something outside of dentistry. Where a patient coming in wouldn’t ever think, “Well, I’m excited for my dentist to screen me for sleep.”

Yeah, that’s a new one. But it really is the new wave of dentistry.

So I think more people are becoming aware that the dentist is the best person—truly the best person—to screen for sleep.

Mm-hmm. But the word still is not out to everyone. And I’ve had people even ask me, “Why would a dentist screen for sleep? That seems so odd.”

And then after you explain that they are the expert in the head, the neck, the mouth—the whole face, all of those things—then they understand, “Oh, well, I guess he is the most qualified for that type of work.”

Well, and that’s why we often miss doing our responsibility—because we’re worried about that social pressure that we’ve gotta stay in our lane.

Don’t do anything outside, and then just kind of keep the status quo. But also, the staff resists that too. It’s difficult to get out of the routine of regular dentistry—to stop and screen someone and then talk to them about their sleep problems.

But there are ways to do it really efficiently. Those that were successful at it could get in and get out and not really mess up their schedule.

Wouldn’t you say the education and getting your team—your staff—on board was the number one thing?

Oh yeah.

In trying to get them…

Yeah, on board with you. Yeah. Certainly the dentist has to have the vision of, “Hey, this means something to me.”

Those dentists who had a family member who had problems with sleep apnea or passed away from it—and they felt like they could have done something earlier on to help prevent the disease—those are the ones especially on a mission to make sure that that doesn’t happen to their patients. Or at least give their patients the chance to recognize it and do something about it.

I love that. It truly is just watching out for your patients—not just trying to get money. It really is trying to help patients live a healthier life and a longer life—better quality of life.

A huge value add for that hygiene appointment.

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The Role of Dentists in Sleep Disorder Screening

Okay, so we wanna share some insights from the research that I conducted for my PhD. Most dentists know sleep matters, but don’t act—due to time pressure, lack of training, and role confusion.

And it’s interesting—there’s a theory of planned behavior that essentially has a few points: the dentist will ask themselves—Do my peers expect that I screen? Is there some kind of professional expectation that I should be screening?

And then—Do I really believe that I should be screening for sleep disorders? And if I do screen, what are the outcomes of that?

So if any of those answers are “No” or “I’m not sure,” then the behavior will be—I'm not going to screen. The intention may be high, like, “I understand it,” but they won’t do it because the expectation professionally isn’t there.

And it’s currently not there. I’m in a partnership, and my partners and I—we struggle. Even I sometimes will fall into old habits and not screen. So there’s definitely a perceived behavioral control and unclear roles that limit follow-through for screening.

But training and referral pathways change everything. When a dentist is educated about the workflow, they’re far more likely to screen.

If I have a good physician that I know I can screen my patient and refer them to, and then have a seamless transition—and then have communication back from the physician on the patient—then it’s much easier to build the value and send the patient.

And then the patient doesn’t get lost in the process.

Yeah. And you actually don’t make a diagnosis, is that…

Correct. Dentists don’t diagnose—but they can screen. And that’s a good point. Dentists will need to realize that they aren’t diagnosing when they screen. They’re simply identifying risk factors for sleep apnea and making a proper referral.

That makes it a lot less scary, I think, for the dentist—if they know that all they are doing is referring out and just explaining what they’re seeing, the risk factors that they’re seeing.

Yeah. Yeah. And I’ve also realized there are so many benefits for the dental team to do the screening from a dental standpoint.

Because we know from the research that a person has less periodontal disease and fewer cavities if their sleep apnea is treated.

Yes.

So all of our therapies that we’re working so hard to do will have better outcomes—if we also treat the sleep issues on top of that.

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Holistic Wellness and the Importance of Sleep

Well, and you know that sleep is one of the foundational pillars for overall health. I’m a health coach, and it is something I ask my clients every single week in their check-in:
“How was your sleep? Are you getting between seven to eight hours of sleep a night?”

And most people do not. Once they’re really cognizant of it and trying to do it, then it becomes better. It’s like anything else—if you’re tracking food, you’re more careful about what you’re eating. If you’re tracking sleep, or how much water you drink, or your exercise—all those things—when you become aware that it’s important and that you need to get a certain amount, then you’ll start paying more attention.

But sleep drives immune repair, tissue healing, and emotional regulation.

We all know that when you don’t get enough sleep, you kind of have brain fog—you’re just not as with it. You’re not as sharp mentally or physically.

So fragmented or hypoxic sleep—that disrupts healing at every level. If you are trying to lose weight, it makes it harder. If you’re trying to heal from a surgery or anything in your body, and you’re not getting sufficient quality sleep, it really manifests in your body’s overall health and wellness.

And I see that in my migraine and TMJ practice all the time.

You do?

Yes. We just don’t get more permanent stability and healing if the sleep’s not working. They have to wear their splints the rest of their lives.

Yes, because it’s kind of a Band-Aid. We haven’t really gotten to the root of the problem.

Yes. And that’s the whole thing about holistic wellness: we want to get to the root problem of these issues and fix it—not just put Band-Aid solutions on it.

So chronic mouth breathing is another thing that disrupts facial development and airway growth.

You talk about that so much with the kids you see in the dental office.

It sets the stage for lifelong disease and all sorts of problems.

People need to know how important it is to breathe through their nose. That’s the body part that filters, humidifies, and cleans all the air going into our lungs.

So if we’re breathing through our mouth, it’s going to affect us in a negative way.

Breathing—I’m also a breathing coach—and that’s something I talk to clients about all the time:
Keep your mouth closed and breathe through your nose.

And dentists are airway guardians. You know, with the right lens, they become wellness advocates—not just tooth mechanics.

It’s so much more than teeth, and that’s why we named this whole movement—this whole newsletter and podcast—More Than Teeth—because it truly is about overall health and wellness. The two really do work together synergistically.

Yeah, that’s wonderful.

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Conclusion: Implementing Sleep Screenings in Dental Practice

Okay, so in conclusion, we should talk about how we start our conversation with our team. Open, honest reflection about how we feel about sleep and what it does for us needs to happen in our office. That vision—from the leadership of the dental office—really is key.

So let’s ask: What’s holding us back? What are the barriers that we’re experiencing?

We mentioned it for you in this series.

And then once we’ve decided that we do want to screen, let’s use tools like STOP-BANG and the Epworth Sleepiness Scale. For example, STOP-BANG—if you get a “yes” on any of those, that’s a risk factor for having sleep apnea.

And then reframe—and I love this part—reframe your hygiene exam as a wellness screening or wellness exam.

Because if the upper airway is compromised in any way—that upper airway is also part of the digestive system. So you can have compromise on two major systems that keep the human body alive and flourishing—and you can identify those.

The dentist really is a gatekeeper to identify those problems—and it becomes about whole-body health.

It really does. The ADA also tied back systemic health—where cardiovascular and so many systems in your body depend on good oral health. And so that’s not just plaque—that’s talking about your heart, your lungs—all of those things.

So as we end this podcast, that really is what we want to leave you with:
Do you screen for sleep?

And if not, why not?

Maybe look at those barriers and start today—adding something simple, like working with your team and showing them how important it is for the health and wellness of your patients. You love them. You care about them.

That’s why—I see—I know Dr. Bennett went into dentistry because he loves, genuinely loves people and wants to help them. And I think that’s the biggest reason you do what you do. Right?

That’s right. It’s all worth it, for sure. Yeah. So screening is so important.

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Key Takeaways and Resources

• Dentists are uniquely positioned to screen for sleep-disordered breathing.
• Use tools like the STOP-BANG questionnaire and Epworth Sleepiness Scale.
• Reframe the dental hygiene exam as a total wellness visit.
• Address barriers such as time, training, and scope confusion through team education and clear referral pathways.
• Remember: Better sleep = better healing, mood, immunity, and longevity.

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