NMDA Journal Summer 2019

18 New Mexico Dental Journal, Summer 2019 of these people have been diagnosed. It is very important to un- derstand that this is a condition of both adults and children. Even though it is a growing topic with more and more research and treat- ments, OSA is fairly well documented in adults. But the even bigger issue may be the prevalence of undiagnosed and overlooked OSA in children. Many “behavioral” issues with children that have been routinely and casually treated with prescription medications have been linked to sleep disordered breathing. If you have any patients or know children diagnosed with ADD, ADHD, or depression at least entertain this idea as a possible underlying root of their problems and maybe give them a solution, rather than a prescription, and a whole new life. So, with the greater knowledge of these conditions hopefully we can better serve our children. As mentioned previously, it is believed that about 90% of Americans with sleep apnea have been undiagnosed, so there are millions of people who are going untreated night after night letting the effects of sleep apnea build and build. I will touch briefly on some sequelae of untreated sleep apnea because going into depth of all of them would take too long. Overall, it has been shown that untreated OSA will take 12–15 years off of one’s life on average and increases the risk of death by 46%. The biggest consequence is hypertension, and OSA increases hypertension risk by 45%. Going hand in hand with hypertension is the risk of a heart attack, which OSA gives individuals a 23x times higher chance of a heart attack than a healthy individual. For compari- son, hypertension alone increases chances by 7.8 and smoking only increases chances by 11 times (Hung, et.al http://www.ncbi.nim.nih.gov/ pubmed/1973968). So, OSA is over double the multiplying risk factor than hypertension and smoking. The large co-morbidities to be con- cerned with here are hypertension, diabetes, and cancer as it has been shown to worsen the effects of these conditions significantly. Other problems that commonly occur with untreated OSA are type II dia- betes, nocturia, erectile dysfunction, dementia. And let us not forget the very simple but very common reality of daytime sleepiness! It may help Starbucks and all the coffee companies out there, but daytime sleepiness plays a huge role in many people lives and careers. Many people are miserable at work because of it. There are millions of people who are going untreated night after night letting the effects of sleep apnea build and build. Identifying the Signs and Symptoms As oral health professionals, we already are always looking at more than just our patients’ teeth. We already look for signs of cancer and systemic diseases that can manifest themselves via signs in the oral cavity. Sleep apnea is no different and should be on every dentist and hygienist’s list of what they are looking for when they examine a patient. Additionally, most of the signs that patients with obstructive sleep apnea present with, we already have been making note of for years. It is only recently that we have connected the dots between these very common oral signs and their relationship and correla- tion to obstructive sleep apnea. Some of these findings are simply anatomical in nature, which leads to the patient’s airway being very narrow or susceptible to being blocked in passive, relaxed states like sleeping. These signs include retrognathia, high vaulted palate, malampati classification of the oropharynx, and hyperglossia. Other findings are present as the result of obstructed breathing during sleep. These include lingually tipped molars, lingual tori, cervical abfractions, acid erosion, GERD, headaches, serrated tongue, and kids with sunken eye sockets w/ dark circles under eyes. As with most things, all of these signs are not purely causative or resultative of sleep apnea alone and are usually multifactorial, but they should definitely trigger red flags for the provider when they are spotted, especially when a patient has several of them. Especially if our pa- tient has these signs along with other health co-morbidities like hy- pertension and diabetes, then we need to start connecting the dots and start asking these patients how they sleep at night, if they have been told they snore, etc. Since this is a condition of both adults and children, we need to look for it in both adults and children. In the case for kids, we should look at this with a positive note because we have an oppor- tunity to address the kid’s issue by correcting their occlusion and skeletal anatomy while harnessing their natural growth in order to prevent this from being a lifelong condition that they would have to deal with. From the perspective of one of our local orthodontists, Dr. Drew McDonald: Recognition of Obstructive Airway issues in patients is key to success, and early recognition is key to prevent growth and development abnormalities. The signs and symptoms can be visualized in the routine radiographs we take as dentists and orthodontist (pano, lateral ceph, AP ceph, CBCT). Obstructive airway issues are often the underlying reason patients are in my orthodontic chair. Clinical Signs: • Dental/skeletal malocclusion (why they are at the orthodontist) • NarrowMaxilla and/or Mandible • Venous pooling under eyes (dark circles) • Chronic gingival inflammation/enlargement • Low tongue posture • Anterior tongue thrust swallow pattern • Tongue tie reverse swallow pattern • Scalloping of lateral borders of tongue • Venous pooling at palatal vault • Mouth-breathing/snoring at night • Open mouth posture • Long lower face height • Severely worn teeth from grinding • Enlarged tonsils (visualized at exam) • Small oropharyngeal opening (visualized at exam) • Recessed maxillary or mandibular growth  continued from page 17