Exploring the link between sleep quality and oral health

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sleep quality and oral health
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Poor sleep and poor oral health often go hand in hand. Here, two dentists share how addressing sleep problems helps them better meet their patients’ needs. By Trudie McConnochie

Constant yawning, forgetfulness and under-eye bags—the effects of poor sleep are usually easy to spot among your family and friends. When it comes to your patients, however, the evidence of inadequate sleep is often right there in their mouths. Patients aren’t thinking about sleep health when they come to a dental appointment, but if you can spot the signs of inadequate slumber, you can make a big difference to their lives. 

Dr Cherie Yam from Brisbane practice Dentists in Yamanto feels that by talking to patients about their sleep patterns, she has positively impacted both their oral health and overall wellbeing. 

“Dentists should be looking out for this a lot more because we are the people who can actually see the signs quite easily,” she says.

A 2020 US study of more than 10,000 people found those who experienced inadequate sleep (defined as less than seven hours) had a 36 per cent higher prevalence of periodontitis compared to those with adequate sleep patterns (seven to eight hours). The researchers speculated the link could be explained by inadequate sleep causing inflammation or disruption to the immune system, but noted periodontitis could also be a cause (as well as a consequence) of sleep problems. 

Dr Yam describes poor sleep and poor oral health as a “chicken and egg” situation. 

“If someone’s got poor oral health and has decay, gum disease, any kind of inflammation, this discomfort can make it really difficult to fall asleep, or it can cause you to wake up quite a bit. On the flip side, if you do have sleep apnoea or night grinding, that can also exacerbate dental issues, so it’s almost like this constant cycle.”

Dr Maliha Siddiqui from Smile Solutions in Melbourne points to dry mouth from snoring or sleep apnoea—which affects around five per cent of Australians—as a major connection between poor sleep and increased risk of decay and gum disease. On the other hand, she notes, “poor sleep can lead to increased consumption of comfort or sugary foods and beverages, which can contribute to tooth decay”.

Spotting the signs

Dry mouth is one of Dr Siddiqui’s top five signs of potential sleep problems in patients, along with tooth decay, oral infections, bruxism and TMJ disorders.  

Dental anxiety can cause people to experience heightened stress and discomfort, which may lead to difficulty sleeping. Additionally, anxiety in general can negatively impact sleep quality by causing racing thoughts, restlessness and difficulty falling or staying asleep.

Dr Maliha Siddiqui, Smile Solutions

Another flag is dental anxiety. According to the Sleep Health Foundation, anxiety and poor sleep often go hand in hand. 

“Dental anxiety can cause people to experience heightened stress and discomfort, which may lead to difficulty sleeping,” Dr Siddiqui says. “Additionally, anxiety in general can negatively impact sleep quality by causing racing thoughts, restlessness and difficulty falling or staying asleep.”

In recent years Dr Yam has noticed an increase in children at her practice showing signs of sleep problems and advanced gum disease.

“Usually, when I see these kids come in, they’re not able to close their lips [due to crowding], but also they look tired, and they have trouble concentrating. I had a couple of kids once where I diagnosed them with an airway issue. They went to an ENT and got it treated, and they actually got their ADHD diagnoses reversed. So, the connection goes quite deep.”

A slightly hunched-over posture could indicate upper airway problems (including adenoid or tonsil issues) that would likely affect sleep quality and quantity.

“The most telling sign is usually when I have a kid in the chair and lay them back and they’re spluttering and coughing—and it’s not because they’re being difficult; it’s because they’re struggling to breathe,” says Dr Yam. 

She adds, “The question I’ll always ask parents is: ‘Are they up all the time and wandering around the house?’ And usually they’re like: ‘Yes, they’re up three or four times.’ And I explain that’s because they’re waking themselves up.”

Schooling the patient

If you’ve spotted the signs of potential sleep issues with a patient, it’s important to broach the conversation gently. Dr Siddiqui says it starts with creating a comfortable, non-judgemental environment, and asking open-ended questions about sleep quality without making assumptions.

If someone’s got poor oral health and has decay, gum disease, any kind of inflammation, this discomfort can make it really difficult to fall asleep, or it can cause you to wake up quite a bit. On the flip side, if you do have sleep apnoea or night grinding, that can also exacerbate dental issues, so it’s almost like this constant cycle.

Dr Cherie Yam, Dentists in Yamanto

“Educate patients on the importance of maintaining a consistent sleep schedule, creating a relaxing bedtime routine and creating a comfortable sleep environment,” she advises. “Encourage patients to adopt healthy habits such as regular exercise, maintaining a healthy weight, and avoiding caffeine and alcohol close to bedtime.”

Addressing underlying stress and anxiety is key, she adds. She recommends her patients try strategies such as relaxation exercises, mindfulness meditations or talk therapies such as counselling.  

If she suspects sleep apnoea, Dr Siddiqui refers the patient to sleep specialists for further evaluation. 

Oral appliances can also have significant benefits. Recently Dr Yam saw an adult who had been averaging one hour of sleep for the past 10 years due to “a mixture of mental health and medication” but a sleep apnoea device to reposition his lower jaw got him up to four hours of sleep a night. While this is still short of the recommended seven to nine hours of sleep for adults, it’s a vast improvement.  

“He was a patient who was pretty much at the end of all treatment,” she says. “He’d tried everything and had all the surgeries possible, and this was the last-ditch effort. And sometimes as dentists, we are kind of that last-ditch effort, especially when it comes to sleep.”

For sleep problems in children, you need to tread carefully with parents, she warns.

“Parents can sometimes be not very accepting because they’re just like ‘Oh, you’re a dentist, what do you know about airways?’” she says. “But usually when you bring it back to, ‘Hey, this might help your child in their everyday behaviour or concentration, even schooling,’ they’re usually a bit more accepting.”  

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