Excess weight is a well-established predictor of sleep-disordered breathing (SDB), which true across the world: US, Australia, Europe, and Asia
Dr. Liao, with patient’s permission, shares the experiences of other patients to assist those with similar symptoms. Below is a recent patient’s story: K.O., his patient, came to Dr. Liao and his team for her cleaning after a year’s absence. This is their ChairSide chat:
DFL: “How are your teeth doing?”
KO: “No big problems. All is under control.”
DFL: “Nice to hear, Next, how’s your health? Any problem you wish you did not have to live with day after day?”
KO: “I am 40 pounds overweight, and I feel like I am missing a battery. I am motivated to do everything, but can only do one thing! I wake up refreshed maybe once a week, and my son says “I snore” when we went on a trip together. I eat very little and still gain weight — “It’s not my diet. I wish I could go for a walk with my husband but I am so exhausted all the time, I just can’t.”
KO’s baseline history includes:
- Bleeding gums
- Food traps in ULQ
- Teeth Grinding – “Big Time”
- Poor digestion
- Sleeps poorly
- Wakes up tired
- Low thyroid properly supplemented
- History of amalgam revision 8 years ago with sauna and Vitamin C, which “helped make me felt better but still not feeling well.”
- History of Lyme Disease – now gone
- Teeth crowded again despite braces in high school
DFL: K.O. is clearly trying but frustrated with her outcome. Medically, she is well-managed for her thyroid and Lyme disease. Oral-Systemically, Dr. Liao can see the airway as her number one issue, and stress as number two.
Oral-Systemic Links (OSA)
”… caniofacial abnormalities play significant roles in the pathogenesis of OSA in Malay patients,” concludes a 2011 study published in European Journal of Orthodontics (1). It is found in the following OSA patients:
- Larger neck and Body Mass Index (BMI, an indicator of obesity if > 25 kg/m2)
- Thicker tongue and longer soft palate
- Narrower airway spaces
I find the same to be true in American patients in my office just about every day.
“Excess weight is a well-established predictor of sleep-disordered breathing (SDB), which true across the world: US, Australia, Europe, and Asia (2). Among its findings:
- As Body Mass Index (BMI) and neck size goes up, so does the prevalence of Sleep Disordered Breathing (SDB, defined as AHI > 5 from sleep test)
- 41% of adults with mild SBD have excess weight (BMI > 25)
- 58% of adults with moderate-severe SBD (AHI > 15) have excess weight (2)
There is a greater risk for Sleep-related Breathing Disorders coming from living and sleeping with excess weight. Later, a 2008 study confirms:
- Obesity is probably the most important risk factor for the development of OSA
- 60–90% of adults with OSA are overweight
- Relative risk of OSA in obesity (BMI >29 kg/m2) is ≥10 times
- “Thus, it appears that obesity and OSA form a vicious cycle where each results in worsening of the other.” (3)
Holistic Mouth Recommendations
- Epworth Sleepiness Scale to assess Excessive Daytime Sleepiness (EDS)
- CBCT Imaging to evaluate cranial-facial abnormalities
- Clinical photos of her oral-facial-postural status
- Cranial-Facial Analysis
- Sleep Test as needed
- Refer to own physician for thyroid evaluation
- Consultation on treatment options
- Begin exercise once oxygen debt is paid down sufficiently
- Tongue posture is a clinical indicator of OSA risk (4)
- Tooth prints on sides of tongue is 70% specific for one of the criteria for OSA and correlates with poorer sleep efficiency. (5)
- Tongue swelling may indicate thyroid disorder (6, 7)
- Tongue Tie contributes to the relapse of her orthodontic (braces) treatment.
My Points: These are based on my clinical experience from listening to patient feedback after carrying out Whole Health recommendations. My Points do not constitute proof that I am right, nor am I offering medical advice with them. They are offered for consideration by you, your dentists and doctors, and for future studies to prove them right or wrong.
- Apple-shaped belly is connected to Impaired Mouth through Sleep-related Breathing Disorder, not by diet alone.
- Retruded (opposite of protruded) spells airway troubles, as mentioned in Impaired Mouth Syndrome discussion.
- A common oral-facial sign of an Impaired Mouth is Lack of upper lip support in profile. Flat upper lip that drops straight down on side view, usually indicates a retruded upper jaw and teeth, which usually spells airway troubles.
- Have K.O.’s doctors picked up on her sleep related breathing disorder?
- ChairSide chats in a dental office are an effective place to screen for SBD and control OSA-Obesity vicious cycle early.
1. Albajanlan OA, et. al, Eur J Orthod (2011) 33 (5): 509-514.)
2. Young T, Peppard PE, Taheri S. Excess weight and sleep- disordered breathing. J. Appl. Physiol. 2005; 99: 1592–9.
3. Pillar G., et al, Diabetes Care February 2008 vol. 31 no. Supplement 2 S303-S309.
4. Barcelo X, et al, Oropharyngeal Examination To Predict Sleep Apnea Severity, Arch Otolaryngol Head Neck Surg. 2011;137(10):990-996.
5. Weiss et al, Archives of Otolaryngology, Head & Neck Surgery 2005:133(6)966-71
6. Shalu C & Manish B, Oral Manifestations of Thyroid Disorders and Its Management. Indian J Endocrinol Metab. Jul 2011; 15(Suppl2): S113–S116. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169868/
7. Huber MA, Terezhaimy GT, Risk Stratification and Dental Management of the Patient With Thyroid Dysfunction. Quintessence Int. 2008 Feb;39(2):139-50. http://www.ncbi.nlm.nih.gov/pubmed/18560652