Obstructive sleep apnea (OSA) is linked to many life-threatening conditions such as heart attacks, strokes, and cardiovascular or cerebrovascular disease. Obesity is an underlying cause of OSA, and therefore, these conditions are all interlinked. Dentistry has an important role to play in the treatment of OSA and the management of sleep and breathing disorders.

What Is OSA?

During sleep, the tongue may collapse over the back of the throat or pharynx and block the flow of air. This results in apnea or a temporary cessation of breathing, which causes a lowered oxygen concentration in the blood. When carbon dioxide levels rise, air hunger gets triggered to restore a normal breathing pattern again. This pattern is repeated throughout the night. The number of apnea episodes occurring every hour are measured by the apnea-hypopnea index (AHI). An AHI of more than 10 requires treatment. OSA interferes with the natural sleep rhythm of light and deep sleep with serious consequences. Obesity and a large neck circumference, as well as an abnormally large tongue and nasal allergies some risk factors for OSA.

OSA Diagnosis and Treatment:

For a definitive diagnosis of OSA, a test called a polysomnogram (PSG) must be performed. A patient is monitored overnight and sleep patterns, the number of episodes of apnea, blood pressure, eye movements, oxygen saturation, and breathing are recorded. The PSG can only be performed at a specialized sleep center and the overnight stay can be quite disruptive to a patient’s schedule. The treatment for OSA is also cumbersome and does not appeal to many patients. Successful treatment requires an interdisciplinary approach with an otolaryngologist (ENT), oral surgeon, and dentist working in tandem to manage the airflow by moving the jaw forward that sometimes may require surgery on the jaw.

OSA And Other Diseases:

The oxygen deprivation that occurs with OSA affects many metabolic processes in the body and consequently OSA is linked to serious health conditions such as coronary artery disease, hypertension, high cholesterol, and diabetes. Studies have shown a link between OSA and the resultant intermittent hypoxia with hyperlipidemia and high blood pressure. OSA is also associated with increased daytime somnolence and a higher risk of automobile accidents.

OSA And Dentistry:

Dental practitioners are in a unique position to identify the typical signs and symptoms of OSA. OSA is often associated with bruxism or grinding of teeth during sleep. A dentist can also question a patient about telltale symptoms and recognize other high-risk factors such as obesity in a patient. However, a dental practitioner cannot make a definitive diagnosis of OSA without the cooperation of other medical practitioners and definitive studies.

Treatment Of OSA:

An AHI value higher than 10 is the standard clinically significant cutoff point when treatment must be started. Weight management is the first line of treatment. Sleeping on the back is also recommended.

Continuous Positive Air Pressure (CPAP):

A CPAP device is the most common and effective treatment for OSA. It works by pushing pressurized air down the nasal passage to keep the tongue from collapsing on the pharynx. Treatment with CPAP almost always reduces the AHI. However, only about 30-40% of patients are able to tolerate CPAP and others find it too uncomfortable.

Oral Appliances:

These are easier to tolerate for most patients as they are adjustable. Oral appliances are also more affordable. These appliances work by either moving the mandible and tongue forward or by using a suction bulb to retain the tongue in the front of the mouth to prevent it from falling back onto the pharynx. While patients are more likely to tolerate oral appliances than CPAP, their effectiveness is not as great and their success rate in reducing AHI is much less than treatment with a CPAP device.


Surgery is a last resort treatment for OSA and is only recommended if weight loss, oral appliances, and CPAP have not been effective and candidacy is determined by the patient’s throat anatomy. A procedure called uvulopalatopharyngoplasty removal of some tissues to prevent blockage of the pharynx. The surgery is associated with many complications and its success rate is less than half. Some procedures involving the hyoid bone have shown improved success rates of up to 80%. Removal of tonsils in children may be a method to treat OSA.


Obstructive sleep apnea is a life-threatening condition with serious consequences of a person’s health. Dental health professionals play a vital role in raising awareness about the condition and in the diagnosis and treatment of OSA. It is important that dentists examine the throat anatomy and ask their patients questions about snoring, daytime sleepiness, bruxism, and other symptoms of OSA. The presence of one or more warning signs should trigger further investigation. Weight management, CPAP devices, and oral appliances are the treatments of choice, and dental professionals should work in collaboration with other medical professionals to identify and treat OSA.