Typically, a person having trouble sleeping would not think to ask their dentist for help. Yet research has shown that the tongue and the structure of the jaw are vitally connected to Sleep Disordered Breathing (SBD), which can progress into Obstructive Sleep Apnea (OSA).
Since dentists inspect the tongue and jaw during routine dental exams, they can be the first line of defense in battling these diseases.
“In 2017 the American Dental Association released a statement on the dentist’s role in the treatment of sleep apnea and encouraged dentists to screen for signs of SDB,” said Jenna Schwibner, DMD, FAGD, owner of Dental Partners of Vero Beach. “Dentists have the advantage of seeing adult patients at least twice a year. With the proper training and a comprehensive evaluation, which includes a tongue inspection, we can identify signs and symptoms of deficient growth and development in children and adults and consider oral appliance therapy as an appropriate treatment.”
Turns out that the patient’s tongue position and shape have everything to do with a good night’s sleep and can be predictive of sleep disorders. A scalloped tongue is highly predictive of sleep pathology as it shows there is not enough room in the dental arches for the tongue to fit comfortably. When a tongue does not fit between the teeth correctly there is an increased chance that it will end up obstructing the airway while sleeping.
“In most cases, it’s not the tongue that is the problem, but that there is no room for the tongue,” Dr. Schwibner explained. “It’s the garage for the tongue, which happens to be our jaws and our palate. It’s about how much room there is for the tongue to function [as it should], so that when we are talking our tongue is pushing up against our palate and we can feel it against our teeth. If the tongue is in the front of the throat and doesn’t have room to go forward into the oral cavity, it’s going to only have one option, and that’s to go backwards and block the throat, which decreases our breathing.
“So, we focus on how we can make the home for the tongue bigger. A lot of times we accomplish it with orthodontics that move the teeth out to make more room for the tongue.
We also look to see if there are any tongue ties or restrictions that are holding the tongue down and back. Our goal is to bring it forward and out.”
According to Mayo Clinic, tongue-tie, or ankyloglossia, is when an unusually short, thick or tight band of tissue that tethers the bottom of the tongue’s tip to the floor of the mouth. The band of tissue is called the frenulum. The most common type of tongue-tie is visible near the front of the tongue, but posterior tongue-ties can occur further back, underneath the tongue.
While there is controversy about releasing a tongue tie in an adult, most professionals recognize the importance of releasing a tongue tie in infants. Babies with tongue-ties have difficulty breast or bottle feeding because they must be able to get the tongue to the roof of the mouth to squeeze the nipple and express the milk. If a tongue is limited in the range of motion, the child can’t create a good seal and is less effective expressing milk from the bottle or nipple and pushing it to the back of the mouth to initiate swallowing.
“A lot of conditions like colic and gas pains are misdiagnosed and treated with medications when they are really the result of a tongue tie which could be released with a laser,” Dr. Schwibner explained. “As the child gets older, he may have speech issues or become a picky eater because physically he has a hard time eating and is more prone to choking. If a child isn’t able to swallow properly there is decreased drainage of the ears resulting in more frequent ear infections. Tongue ties can hold back the development of the jaws resulting in narrow arches and crowded teeth, which once again makes for an underdeveloped airway and breathing issues.
“Some of these issues can be corrected by orthodontics. Orthodontists should take into consideration the shape and position of the tongue. They should first look for tongue ties and the tongue should be wide and pancake-like instead of being long and straight or short and held back. My partners and I do comprehensive orthodontics to develop the jaw so that all teeth fit in.
“For most adults, I use expanders that look like a kid’s retainer but with a little key in the middle that the patient turns to push on the palate and help it expand. We also use Invisalign clear aligners with an expansive technique to widen the arches and make more room for the teeth, tongue and breathing.
“It all depends on how much space they need and how symptomatic they are. We do not end treatment until the patient’s sleep study is negative for sleep apnea and upper airway resistance syndrome. If needed, after aligning their teeth and their jaws, a patient may need a customized oral appliance that holds the lower jaw forward to open the airway or CPAP therapy. Often, we need a team approach with our local ENT’s and Sleep Physicians.”
Treatment of SBD (Sleep Disordered Breathing) requires a team approach including collaboration with an Oral Myofunctional Therapist (OMT) who provides long-term dental stability and maxillofacial health for both adult and pediatric patients. OMT plays a positive role in the improvement of swallowing, proper tongue posture and position, and overall muscle function, and reduces relapse of previous and active orthodontic treatment. OMT treatments alone have been shown to significantly decrease sleep apnea in patients of all ages and make them more tolerant to the sleep apnea appliances the dentist fabricates.
Dentists have a unique role and ability to screen and identify risk factors for SDB and OSA, according to the American Dental Association. If you or someone you love is not feeling well-rested or complains of snoring, ask your dentist about the possibility of it being related to your jaw being underdeveloped and seek out a dentist trained in the latest airway health-focused techniques.
A native of Vero Beach, Dr. Jenna Schwibner is a graduate of Nova Southeastern University’s College of Dental Medicine with a Doctor of Dental Medicine degree. Dr. Schwibner’s postgraduate education included completing advanced training in Airway, Sleep Medicine and Laser Training. Her areas of expertise center around the relationship between oral and total-body health through Airway Health-Focused Dentistry. This forms the foundation of her general, cosmetic, implant and early-intervention orthodontic treatments. Dr. Schwibner provides sleep-disordered breathing management for patients of all ages, treating patients as young as 3 days old. Dental Partners of Vero Beach is located at 3790 7th Terrace, Suite 303, Vero Beach. Call 772.569.4118 for additional information or to schedule an appointment.
