More Than Teeth Podcast | Top Sleep Disorder Questions Every Dentist Should Ask Patients

Top Sleep Disorder Questions Every Dentist Should Ask Patients

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Hey everyone, this is Dr. Michael Bennett with Cathy.

Hello everyone. So last time we talked about why are we still fixing teeth and, you know, can the hygiene visit really be one of the most important medical, dental visits of the year—of your life potentially—and we talked about some important reasons for that.

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Importance of Sleep Screening

Today we're gonna talk about what's keeping your patients up at night. You don't have to be a sleep doctor to ask great questions. So we will, we will talk about some of those things. You're, you're not diagnosing when you screen your patients for sleep disorder, like blood pressure checks and oral cancer checks. This is an airway check or a check for sleep apnea. So routine questions should be a part of our care every time we, we get together with a patient.

And then curiosity opens the door. A simple ‘how's your sleep?’ can reveal red flags. You know, you don’t need a lab coat to ask that. That seems pretty easy and not a very aggressive question to ask all of your patients while they're there getting their cleaning.

They just say, the hygienist says, “How’s your sleep?”, “Working well for you? Do you feel refreshed in the morning?” You know.

Something so simple. And really if you withhold treatment or withhold information that could really benefit somebody, I would—I dare, dare ask the question—is that an ethical issue?

That if we understand that sleep is so important and we don't screen for sleep disorder, perhaps we should feel a little twinge of guilt. I encourage everybody to feel just a tiny bit of guilt. Not too much, but just some—realizing that you could make a huge impact on that person's overall health and their oral health as well if you just took the time to screen.

So it's important again, that it affects healing, mood, immunity, and survival. The survival of the mouth, but more importantly, survival of the whole overall body if they were not sleeping well. So we should be screened.

And the American Dental Association even has made it part of their protocol to screen for sleep because they understand. And more studies come out every year of how screening for sleep is tied to overall health and wellness of the entire body. And dentists are the frontline advocates for that.

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Screening Techniques and Indicators

So don't ignore these different orofacial indicators. Look for a scalloped tongue. Look for those teeth imprints on the tongue. Look inside the mouth. If they can't fit their tongue on the roof of their mouth, that's called a high vaulted palate.

That's another risk factor because the palate is the floor of the nose. So you know that if it's narrow up in the palate, then it's narrow through the nasal passages.

Yeah. What is that Cottle test that you do?

Yeah, do the Cottle test. That's a great way to check your nasal valves. And so that's just pulling your nose, kind of flaring your nose with your fingers, right?
One finger on each side of the nose and pulling it apart to see if you can breathe better. Yep. Just those index fingers right on your cheeks, and then pulling your nostrils out and see how you breathe. If it's improved breathing, that's called a positive Cottle test, so that's one of the easiest things to help a person breathe—doing Breathe Right strips or Mute or other magnetic nasal strips.

Retrognathia—any underdeveloped jaw. So if you don't have your wisdom teeth, guess what? You don't have a full complement of room for your tongue. That tongue is supposed to fit within the space of 32 teeth. So if you don't have wisdom teeth, you're already underdeveloped.

That's crazy.

But years ago, they used to see those skeletal figures that had all 32 teeth.

And they had the broadest, most beautiful smiles. And now you hardly see anyone with a full set of teeth.

Yeah, and spaces between those big beautiful 32 teeth.

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Behavioral and Physical Signs of Sleep Disorders

And then look for behavioral cues, especially in children. But daytime fatigue is often related—for children, it's ADD and ADHD—very much related. The studies support that it's really impossible to tell the difference between a child with a sleep disorder and a child that has literal ADD and ADHD.

Just because they're one and the same, essentially. I've known several little kids that are so hyper because they know if they sit still for very long at all, they will fall right to sleep. They're so tired.

Yeah. And forgetfulness. You ever walk into a room and don’t remember what you went in there for?

That happens to me all the time.

Could be that REM sleep is being deprived. And then anxiety, poor school performance, and bedwetting in kids.

And there's not really much bedwetting in adults. It's more—adults know that they feel the urge, and they get up and go to the restroom. A lot. That’s how it manifests in adults.

Yeah. So I love those cases where you've helped little kids and they immediately stop wetting the bed and they feel so much better. 'Cause it's embarrassing. It's hard when they're older and they're still wetting the bed.

Oh. The parents are just worn out from changing sheets and then the poor kid gets bullied at school because they smell like urine.

That's so sad.

Yeah. And they don’t want to do sleepovers with friends or anything.

That’s right.

Because they’re very scared about wetting the bed.

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Screening Tools and Questionnaires

So then your screening tools—let's talk about those. Your basics are the STOP-BANG questionnaire and the Epworth Sleepiness Scale, but for pediatrics, for kids, it's the BEARS questionnaire.

And so the STOP-BANG, for example, gives you eight questions that you can easily ask adults—or they can fill it out on the form. Same with the Epworth Sleepiness Score. It helps to quantify their daytime sleepiness.

And it’s also great once you've done treatment that they fill out the form again and they're able to compare the before and after.

Yeah. And it is impactful.

Yeah. It's subjective, but it's really a value builder. That they spent this money to do this, they've been treated, and—hey—I’m actually feeling a little better and I can see that.

And then pediatric clues—often a child, you’ll see them watching a movie and their mouth is open, they’re mouth breathing, or they’re on Adderall.

They've got dark circles under their eyes, and you go into the room while they’re sleeping and they’re still—and they’re snoring.

Yeah, little children—some snore.

And I’ve heard you say to the parents, you think that’s kind of just a cute little thing, but that can indicate that there is a problem—an airway problem.

A hundred percent red flag. Snoring is not good. Normal breathing should be completely quiet.

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Reframing the Screening Conversation

All right, so let's talk about a few tie-ins and how if we reframe screening for sleep problems as a prevention—not a diagnosis—sometimes that is better for the doctor to feel more confident in actually screening.

Because dentists do feel nervous about screening for sleep because they feel like it's not in their lane. They feel like it's out of their scope of practice.

Correct, correct.

So that's one of the barriers. And so, you know, I think that’s good that you studied that as part of your PhD—you interviewed many dentists across the country and asked them why. What is the barrier? Why are you not screening? Or why are you screening?

Yeah.

And they often said that patients and/or their team made them feel like they were just trying to make more money—trying to create a profit center by screening those patients for sleep disorders. And they didn’t want to be construed as somebody that's money-hungry by their patients.

So framing it—really—by saying, “This might be an airway issue worth exploring with your doctor,” that often feels less risky than, “You have sleep apnea,” which a dentist should never do.

Mm-hmm. Yeah.

But often people are already diagnosed, and they'll come in and they'll have signed off on their health history saying that they have sleep apnea and, “I just can’t tolerate CPAP, and so I'm not doing anything about it.”

And so if that’s the case, it’s pretty easy to go in and say, “Well, we know you have the diagnosis—let's explore some alternative treatments.”

Yeah.

Then for that—and that’s where the dentist can really become part of the collaborative team.

Well, and I think too, if they see it as preventative—that screening is just like flossing. You know, hygienists are taught in school—and dentists probably too—to instruct their patients to floss and brush their teeth.

Correct.

So that they—that's a preventative measure to have healthy teeth. So this is just a preventative measure. You know, asking, “Hey, how’s your sleep? Do you feel refreshed when you wake up in the morning?”

And if they say no, then you say, “Well, let me take a look in your mouth and let’s see if we can see some signs that might indicate that there’s a problem.”

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Nutritional Impact on Sleep

You know, I know that nutrition has a lot to do with also how people sleep. I know for us, we try to eat an early enough dinner so that we can give our digestion system time to rest and digest—right?—and not have a gurgly stomach when you go to bed because it’s trying to digest that food.

So a really important part for nutrition is to avoid inflammatory foods near bedtime, especially sugar and dairy and gluten and processed snacks that increase airway swelling.

You know, there are so many preservatives and additives in our food nowadays. So many people—all of us—eat ultra-processed foods. And you know, a little bit maybe your body can handle, but a lot of that really causes negative reactions in our body. Our body was not meant to process things that are not actually food.

And there are a lot of foods nowadays on our shelves that actually could not be classified as food. So our body has a hard time, and it becomes inflamed because of the food that we’re eating.

Also, magnesium and omega-3 rich foods can support better rest and airway tone. That’s so important—to get those good rich oils from avocados and healthy nuts and those things that help our brain.

We love pumpkin seeds, and those have so much magnesium and zinc in them. Throwing that on a salad or in a protein yogurt—any of those kinds of things are very good to help with magnesium.

And also so important to have hydration and gut health. You know that’s all over social media now, but they play such an important part in our immunity and in airway inflammation at night. So those are great things to keep in mind when you're going to bed and trying to have a restful night's sleep.

Fantastic points.

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Personal Experience and Final Thoughts

One thing that hits home to me is—I often would, well before we got on this path, eat late and I'd eat too much. And I’ve learned that if I feel fullness in my belly—and if there’s an excessive amount, like even a puffiness up against the ribcage—I know now that the pressure of that food, those contents in your stomach, can actually cause kind of a push or an extrusion through the sphincter and back into the esophagus.

And so you're laying down and you’ve got food pressure and gastric juices pushing back up into your esophagus—that acid just burns all the way up.

Yes.

Into the mouth and nose area as well. And so that creates a lot of that inflammation. And many people will attest—they eat that big steak and potato late at night, they're gonna have a long night of snoring and waking unrefreshed in the morning.

So a lot of things you learn as you go—eat early, and eat only until you just start to feel a little bit of pressure. No pressure at all—that would be ideal.

So just imparting: ask some questions to your patients. “Do you feel refreshed when you wake up?” “Has anybody ever told you you snore or stop breathing?”

That’s a big one, because I’ve talked to a lot of ladies, especially, that say, “Yeah, I get so nervous sleeping next to my husband because he’s snoring.”
But what’s even worse than his snoring is when I hear him stop breathing, and I start to count in my mind how long he’s not breathing, and then I get nervous and I wake him up and shake him because he’s stopped breathing for so long.

So that’s a real thing—and a very scary thing.

Are you talking from experience?

No, not anymore.
You treated yourself, and now you’re a very good quiet sleeper.

Thank goodness.

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Conclusion and Next Episode Preview

All right, well, we're excited to continue this conversation in future episodes. We’ll go even deeper into how airway health impacts not just sleep, but emotional wellness, cognitive function, and long-term disease prevention.

If you're a dentist, hygienist, or health professional, remember that you're in a powerful position to make a lasting difference just by asking the right questions—especially during hygiene visits.

Start the dialogue. Empower your patients. And most importantly, treat airway and sleep health not as an afterthought, but as foundational to everything else we do in dentistry and wellness.

Yes—and if you're a parent, this matters for your kids too. Their behavior, learning, and even self-confidence can all be affected by undiagnosed sleep and breathing issues.

We’ll talk more about that next time—especially about tools like CBCT scans, myofunctional therapy, and collaborative care with pediatricians and ENTs. Stay tuned, and thanks for being part of this journey toward healthier living through better breathing and sleep.

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