Sleep apnea considerations for the restorative patient

March 11, 2014

The dental side effects of obstructive sleep apnea can be seen in many of the patients who may present for restorative treatment. In this article, Dr. Dan Bruce goes through a case study of a patient who presented for four esthetic anterior crowns. After this case, he makes sure to perform a pre-prosthetic clinical checklist and comprehensive health history update that includes sleep disturbance screening.

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The dental side effects of obstructive sleep apnea can be seen in many of the patients who may present for restorative treatment. Below is a case study of a patient who presented for four esthetic anterior crowns. Three of the teeth had been endodontically treated. I went through the full diagnostic process for creating esthetic crowns. The esthetic results are for a different discussion, but the patient was very pleased with the result. I was also satisfied with all aspects of the functional occlusion.

Over the next few weeks, though, I saw the patient for complaints of anterior tooth sensitivity. I saw the patient for several weeks of adjustments. Finally, I convinced the patient he must be clenching and made an occlusal guard for nighttime wear and occasional day use. He has a stressful job and thought that was causing the clenching. He tolerated the guard during the day, but never was able to sleep very well with the guard at night. He finally gave up using it, and we dealt with cold and biting sensitivity periodically.

ALSO BY DR. DAN BRUCE |Hidden dental dangers of undiagnosed obstructive sleep apnea

As my knowledge of sleep-related breathing disorders increased, I suspected he may have sleep apnea. Although he denied daytime fatigue, he reported loud and frequent snoring. He filled out a screening form for sleep-related breathing disorders and answered positive to some of the questions. He was sent to a sleep physician who performed an overnight polysomnogram (sleep study). The report from his sleep study showed severe sleep apnea. The patient is getting a continuous positive airway pressure (CPAP) machine.

After this case, I make sure to perform a pre-prosthetic clinical checklist and comprehensive health history update that includes sleep disturbance screening.

Dr. Dan Bruce, DDS, is a 2005 graduate of the University of Washington School of Dentistry. Dr. Bruce has been in private practice in Boise, ID since graduation. He maintains a general practice but devotes a significant and increasing proportion of his time to treatment of sleep apnea. Dr. Bruce has been invited to speak on sleep apnea treatment for SomnoMed, at local dental study clubs, along with local physician offices. For more information, please visit www.boisedentalsleeptherapy.com/educational-courses or contact Dr. Bruce with any questions at [email protected].