Dental Sleep Medicine is NOT the Answer

The thought that sleep and airway dentistry is the answer lacks some understanding of what the question was. As a service to promote integrative solutions to common problems plaguing the population, perhaps it may be the answer. But as a sole resolution to sleep-related breathing disorders, it is not.

Let's step backwards momentarily. In recent years, the field of dental sleep and airway medicine has garnered significant attention, with the American Dental Association recommending that all dentists screen for sleep-related breathing disorders as part of comprehensive medical and dental histories. However, amidst the push for dentists to adopt sleep and airway dental services, one critical aspect often gets overlooked—the role of soft tissue dysfunction in contributing to these disorders.

The CDC and WHO have both declared sleep deprivation as national and global epidemics, respectively. Yet, the roots of these epidemics run deep, influenced by a complex interplay of factors including genetics, environment, habits, and nutrition. Anthropological studies, alongside the pioneering work of dentists like Weston A. Price and Alfred Rogers, have shed light on how poor craniofacial development and orofacial muscular dysfunction contribute to sleep-related breathing disorders.

Unfortunately, in the promotion or education of sleep and airway dentistry, soft tissue dysfunction is often sidelined or dismissed in favor of orthodontic or oral appliances. This oversimplification neglects the holistic approach that dentistry has long upheld, where multiple factors are considered in addressing oral health issues. Just as we educate our patients to remediate various factors contributing to caries and periodontal disease, such as diet and oral hygiene, we should adopt a similar approach to sleep-related breathing disorders.

Myofunctional therapy, a century-old modality that addresses soft tissue dysfunction contributing to sleep-disordered breathing, is the primary method of which this can be done. By remedying the underlying issues, myofunctional therapy not only improves breathing patterns but also reduces the risk of associated cardiac, neurological, and gastrointestinal events. While also serving as a method of assisting in patient comfort in wearing dental sleep oral appliances or aiding in the orthodontic retention of airway focused appliances. Integrating myofunctional therapy into sleep and airway education for dental clinicians elevates patient care to the high standards expected in dentistry.

To make the integration of myofunctional therapy a reality, three key considerations must be addressed:

1. Educational Integration: Educational institutions must incorporate knowledge about epigenetics and soft tissue dysfunction into their introductory curriculum for dental students. Moreover, assessment of soft tissue dysfunction should be included in the standard screening protocol for sleep-related breathing disorders. By equipping future dental professionals with this foundational knowledge, they will be better prepared to identify and address oral muscular dysfunction effectively.
2. Professional Recognition: The American Dental Association should recognize myofunctional therapy as a dentistry-founded modality and specialty. This acknowledgment would elevate awareness of the field among dental clinicians who may have previously been taught sleep or airway dentistry without a comprehensive understanding of oral muscular dysfunctional remediation. By integrating myofunctional therapy into the dental profession, clinicians can enhance patient care and outcomes.
3. Collaborative Care Approach: Myofunctional therapists should advocate for a collaborative approach to patient care. While many therapists already adopt a team-focused method to achieve patient goals, there is often a primary focus on airway dentistry. Dental sleep medicine is sometimes neglected as a collaborative treatment method. By fostering mutual recognition and collaboration between myofunctional therapists and dental sleep medicine practitioners, patients can benefit from improved access to comprehensive care and enhanced treatment outcomes.

Dental sleep medicine and airway dentistry alone are not the answer to a very complex question. Both highly valued and impactful as a part of the greater cog in the gears of resolution for sleep related breathing disorders, they need supplementation with soft tissue dysfunctional remediation, nutritional guidance, manual therapy, sleep hygiene instructions, and physician collaboration. As a part of the dental focused implementation, myofunctional therapy should be considered a standard component of introductory sleep and airway education for dental clinicians. By embracing this holistic approach, we can revolutionize the dental sleep and airway industry and enhance patient outcomes, aligning with the principles of high-quality care that dental patients deserve.