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What is a Sleep Dentist?

The term "Sleep Dentistry" is used in two main contexts:

Sleep and/or Sedation Dentistry

Sleep/sedation dentistry is used to provide a relaxing and anxiety-free experience for receiving dental treatment. It enables individuals who are often afraid to go to the dentist to receive the dental care they need while avoiding the common apprehension known as dental phobia. According to the Dental Organization for Conscious Sedation, a professional dental organization dedicated to ensuring that patients receive safe, comfortable, and anxiety-free dental care, 30% of the population avoid the dentist due to fear. This all-too-common "dental phobia" prevents people from receiving necessary routine dental care, potentially compromising the health of their mouth and smile.

Sedation is a process used to establish a relaxed, calm state through the use of sedatives. Sedative drugs (tranquillizers, depressants, anti-anxiety medications, nitrous oxide, etc.) can be administered in a variety of ways. In the past, intravenous (IV) sedation - sedatives delivered via injection into the blood vessels of the hand or arm - was predominantly used to sedate a dental patient.

IV sedation is both safe and effective when administered by a trained professional. Today, however, sedation dentistry has evolved to be even more conducive to a relaxing experience. Patients have alternatives to the traditional modalities of inhalation (nitrous oxide or "laughing gas") and IVs, such as those offering a "no needle" (meaning, no injection) approach that many people find more appealing.

Oral sedation dentistry is now the most common technique used in the United States and Canada to quell patient fears. The technique is easy and requires no needles. Best of all, the medications create such a comfortable experience that most patients do not remember the visit; it is as if they "slept" through the treatment. In reality, oral sedation dentistry maintains a level of consciousness in the patient for safety and cooperation. Note that sedation is different from anesthetic injections. Although some forms of sedation, such as nitrous oxide gas, may raise your threshold for pain, most dental treatments still require a local anesthetic injected in the mouth even when sedation dentistry techniques are performed.

Dental Sleep Medicine

The second type of "sleep dentist" applies to dental practices that focus on the management of sleep-related breathing disorders, including snoring and obstructive sleep apnea (OSA), and who use oral appliance therapy (OAT) and perform upper airway surgery when required.

Sleep apnea is a potentially life-threatening medical disorder that causes your body to stop breathing during sleep. The muscles in your throat relax and the tongue may fall back and block the airway as you sleep, reducing the amount of oxygen delivered to all of your organs including your heart and brain. People with sleep apnea may snore loudly and stop breathing for short periods of time. The breathing pauses from sleep cause your body to briefly wake while you remain unaware. This can happen hundreds of times per night, and you may wake up feeling unrefreshed.

In addition to snoring and excessive daytime sleepiness, sleep apnea can cause memory loss, morning headaches, irritability, depression, decreased sex drive and impaired concentration. When left untreated, sleep apnea can lead to hypertension, stroke, heart attack and sudden death while asleep.

Sleep apnea patient are often older, obese and have thick necks, but men and women of any age or body type can have sleep apnea. The sleep disorder progressively worsens with age and weight gain.

The vast major of sleep related breathing cases go undiagnosed and untreated. An Institute of Medicine report found that an estimated 50-70 million Americans suffer from chronic sleep disorders, including sleep apnea. Excessive daytime sleepiness alone costs the economy $150 billion in lost productivity and workplace accidents another $48 billion in medical expenses related to auto accidents involving drowsy driving. Nearly 1 in 5 car accidents causing serious injury are associated with excessive daytime sleepiness.

Dentists, together with sleep physicians, are challenged to respond to the health risks and economic impact of untreated sleep apnea and excessive daytime sleepiness.

Dentists have pioneered the use of oral appliance therapy for the treatment of sleep apnea and sleep related breathing disorders. An oral appliance is a device worn in the mouth only during sleep. The device fits like a sports mouth guard or orthodontic retainer and prevents the airway from collapsing by either holding the tongue or supporting the jaw in a forward position. With an oral appliance, dentists can minimize or eliminate the symptoms of sleep apnea in mild to moderate cases.

Dentists with training in oral appliance therapy work closely with sleep physicians in the diagnosis, treatment and ongoing care for sleep related breathing disorders. The American Academy of Dental Sleep Medicine and the American Academy of Sleep Medicine recommend that a physician must diagnose sleep disorders including sleep apnea. Sleep physicians at AASM accredited sleep centers use an overnight sleep study to detect and diagnose sleep apnea.

Once a patient is diagnosed with sleep apnea or a sleep related breathing disorder, dentists may provide treatment. Dentists assist patients in the selection and fitting of an oral appliance and provide long-term follow-up care.