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Spotting OSA During Your Exam: 5 Signs Prosthodontists Shouldn't Miss

Did you know an estimated 85-90% of OSA cases go undiagnosed? As prosthodontists, we have the power to spot signs others might miss. Here's what to look for...


Your OSA Screening Checklist


  • Oropharyngeal Structures: High arched palate, enlarged tonsils, elongated uvula, large tongue. [1,2,3] Assess for tori mandibularis and a narrowed lateral pharyngeal wall. [4]

  • Mallampati Score: This classification of soft palate and uvula position predicts OSA severity. [4,5]

  • Maxillary Constriction: Look for a narrow maxilla with a deep palatal vault. [5]

  • Mandibular Position: Evaluate for retrognathia, a risk factor for OSA. [1]

  • Breathing Patterns: Note signs of mouth breathing, suggesting airway difficulties. [3]


Beyond the Obvious

  • Bruxism (teeth grinding): May be the body repositioning the jaw for better airflow.

  • Scalloped Tongue: Indentations suggest pressure due to constricted space.

  • TMJ Issues: Ask about pain, clicking, or limited jaw movement.


If You See This, Then...

  • If You See This: Scalloped tongue, retrognathia Then: Consider adding a validated OSA screening questionnaire (STOP-BANG, etc.) to your intake forms.

  • If You See This: Enlarged tonsils, high Mallampati score Then: Refer to a sleep physician for further evaluation.


Special Considerations for Children

Keep OSA in mind with pediatric patients too. Look for signs of mouth breathing, hyponasal speech, and craniofacial abnormalities constricting the upper airway. [6,8] Early intervention may be life-changing for these children. [7]



By incorporating these simple observations into your exams, you become a frontline defender against the hidden risks of OSA.


References

  1. Lavigne, G., Lavigne, G., Babiloni, A., Babiloni, A., Beetz, G., Fabbro, C., Sutherland, K., Huynh, N., & Cistulli, P. (2019). Critical Issues in Dental and Medical Management of Obstructive Sleep Apnea. Journal of Dental Research, 99, 26 - 35. https://doi.org/10.1177/0022034519885644.

  2. Schellenberg, J., Maislin, G., & Schwab, R. (2000). Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures.. American journal of respiratory and critical care medicine, 162 2 Pt 1, 740-8 . https://doi.org/10.1164/AJRCCM.162.2.9908123.

  3. Petrou-Amerikanou, C., Belazi, M., Daskalopoulou, E., Vlachoyiannis, E., Daniilidou, N., & Papanayiotou, P. (2005). Oral findings in patients with obstructive sleep apnea syndrome.. Quintessence international, 36 4, 293-8 .

  4. Ruangsri, S., Jorns, T., Puasiri, S., Luecha, T., Chaithap, C., & Sawanyawisuth, K. (2016). Which oropharyngeal factors are significant risk factors for obstructive sleep apnea? An age-matched study and dentist perspectives. Nature and Science of Sleep, 8, 215 - 219. https://doi.org/10.2147/NSS.S96450.

  5. Ashraf, A., Menon, I., Gupta, R., Arora, V., Ahsan, I., & Das, D. (2022). Oral findings as predictors of obstructive sleep apnea- A case-control study. Journal of Family Medicine and Primary Care, 11, 5263 - 5267. https://doi.org/10.4103/jfmpc.jfmpc_582_21.

  6. Drogomyretska, M., & Gergel, I. (2023). Results of dental examination of children with obstructive sleep apnea syndrome. SUCHASNA STOMATOLOHIYA. https://doi.org/10.33295/1992-576x-2023-4-54.

  7. Toshniwal, N., Mani, S., Mote, N., & Nalkar, A. (2021). Obstructive Sleep Apnoea in Orthodontics - A Review. Journal of Evolution of Medical and Dental Sciences. https://doi.org/10.14260/jemds/2021/620.

  8. Kawashima, S., Niikuni, N., Lo, C., Kohno, M., Nakajima, I., & Akasaka, M. (1999). Clinical findings in Japanese children with obstructive sleep apnea syndrome: focus on dental findings.. Journal of oral science, 41 3, 99-103 . https://doi.org/10.2334/JOSNUSD.41.99.

  9. Aurora, R., Casey, K., Kristo, D., Auerbach, S., Bista, S., Chowdhuri, S., Karippot, A., Karippot, A., Lamm, C., Ramar, K., Zak, R., Morgenthaler, T., & Tracy, S. (2010). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults.. Sleep, 33 10, 1408-13 . https://doi.org/10.1093/SLEEP/33.10.1408.

  10. Villa, M., Bernkopf, E., Pagani, J., Broia, V., Montesano, M., & Ronchetti, R. (2002). Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion.. American journal of respiratory and critical care medicine, 165 1, 123-7 . https://doi.org/10.1164/AJRCCM.165.1.2011031.

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