Sleep and Your Dental Health

In my 26 years as a dentist, I don't recall a single lecture in dental school on sleep, sleep disorders, or the connection to the mouth. It just wasn't part of the curriculum. Over the years, sleep dentistry has become a significant part of how we diagnose patients because it can affect where the teeth sit in the mouth and lead to severe wear and erosion that ends up requiring significant dental treatment. The literature on this has grown considerably over the years, and as a profession we're getting better at catching these issues earlier, in hopes of preventing long-term damage to teeth and to overall health.

To put this issue in context, a 2025 analysis estimated about 32% of US adults have OSA with 52% mild, 30% moderate, and 18% severe.

As dentists, we were not the ones who diagnose sleep problems, but we can screen and when highly suspected, refer patients to a physician for a proper diagnosis.  There are a handful of sleep related conditions to watch for. Obstructive sleep apnea, or OSA, involves repeated pauses in breathing during sleep caused by the airway collapsing or becoming blocked. This decreases the oxygen intake and adds extra stress on your heart which can become major problems over time. It affects both adults and children, though the underlying cause often differs by age. Snoring sits on the same spectrum. Not every snorer has sleep apnea, but snoring is often the first sign that the airway is struggling. Sleep bruxism, grinding and clenching the teeth at night, isn't a breathing disorder itself, but it shows up alongside sleep disordered breathing often enough that we take it seriously as a possible sign. In children, sleep disordered breathing tends to look different than it does in adults, often driven by enlarged tonsils or adenoids, a narrow palate, or chronic mouth breathing, and it can affect a child's growth and behavior.

Dentists see patients regularly, often more regularly than physicians do, and that puts us in a good position to notice warning signs. During a routine exam we look for worn or fractured teeth from nighttime grinding, scalloped edges on the tongue where it's been pressing against the teeth, a narrow palate, or a recessed lower jaw, enlarged tonsils at the back of the throat, and dry mouth or chronic gum inflammation from habitual mouth breathing. Patients will mention morning headaches, a sore jaw, or a partner who says they snore or gasp during sleep. On their own, none of these are a diagnosis. Together, they're often enough to start a conversation and send a patient for a proper sleep evaluation.

We don't diagnose sleep apnea ourselves as that requires a sleep study ordered by a physician. But we can help catch it early, and in many cases, we can treat it. The main dental treatment is oral sleep appliance which is a custom made appliance similar in some ways to a mouthguard, that repositions the lower jaw slightly forward to help keep the airway open during sleep. For the right patient it's a far simpler option than a CPAP machine. The American Academy of Sleep Medicine and the American Academy of Otolaryngology, Head and Neck Surgery, both physician-led organizations, recognize oral appliances as an appropriate first-line treatment for mild to moderate OSA, and as a reasonable option for many moderate to severe patients who can't tolerate CPAP. Moderate and severe cases are still generally best managed with CPAP or, in select cases, surgery but oral appliances have become much more common in recent years.

Children are handled differently. Surgical removal of the tonsils and adenoids is usually the first line of treatment for moderate to severe pediatric OSA. Dentists play more of a supporting role here, monitoring jaw and palate development and, in some cases, using palatal expansion to help create more room for the airway as a child grows.

If you snore, wake up with headaches, grind your teeth, or notice your child breathing through their mouth or snoring at night, mention it at your next dental or medical appointment to be screened and catch issues before they become problems.

Staying Healthy Article for the Capital Democrat Sept 2026 by Dr. Joiner