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The Dental Detective

Case 11 – Airway and Dentistry, is there a connection?

Sleep apnea diagnosis on a clipboard

A 62-year-old gentleman came in with the chief complaint of his upper front teeth breaking down. He blamed it on the lockdown in 2020 due to the Covid Pandemic; that perhaps his lack of regular dental visits had contributed to his upper front teeth crumbling? 

One look inside his mouth revealed that his upper and lower teeth were worn and lined up perfectly like a jigsaw puzzle when he brought his lower jaw forward and assumed an “edge to edge bite”. His back teeth had some old crowns on them with the ceramic chipped off.

Upon further prodding, the patient revealed that he suffers from sleep apnoea and wakes up at night gasping for air at times. “What has that to do with my front teeth crumbling doc? Can’t you do some sort of filling in my upper front teeth?” asked the patient.

Obstructive Sleep Apnoea is a condition where the person stops breathing due to an obstruction in their airway. During sleep, the muscles around the airway relax and cause a blockage which reduces and stops the airflow. This results in reduced oxygen saturation in the blood signaling the brain to acknowledge a problem. The person is awakened so that the muscles around the airway tighten and the lower jaw is driven forward to open the airway, to allow re-entry of air. This process continues in a cyclical manner while the patient is asleep.

Man using CPAP Machine and Sleeping Mask for Treatment of Sleep Apnea
Man using CPAP Machine and Sleeping Mask for Treatment of Sleep Apnea

The constant posturing of the lower jaw forward night after night makes the lower teeth hit against the upper front teeth causing wear of the back of the upper front teeth. Sometimes sleep apnoea is accompanied by acid reflux (GERD-Gastro Oesophageal Reflux disease) and this compounds the problem by increasing the wear of the upper front teeth due to acid erosion. The patient admitted to suffering from long-standing acid reflux at night. The enamel thins and this becomes a chronic disease. Biting on anything insignificant can cause the upper front teeth to chip as they have thinned down. It’s like the straw that broke the camel’s back!

Back to our patient. Rehabilitating the patient would mean correcting the bite to provide a long-lasting dentition. However, unless the underlying cause of the chipping teeth is taken care of, my beautiful ceramic restorations which are made of glass will also be destined to the same fate-chipped ceramic instead of chipped enamel!

A referral to a sleep medicine specialist and gastroenterologist was advised prior to undertaking any dental work. The patient realized the value of correcting his condition as sleep apnoea has detrimental effects not only on the teeth but on many organs of the human body.

His dental visit proved to be invaluable to him as the underlying condition for his deteriorating health was detected in time!

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