The Connection Between Sleep Apnea & Your Mouth

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The Connection Between Sleep Apnea & Your MouthClinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. What Is Sleep Apnea?
  2. Is It Related to Oral Health?
  3. Sleep Bruxism & Sleep Apnea
  4. Orthodontic Problems & Sleep Apnea
  5. Getting Sleep Apnea from Misalignment
  6. Orthodontic Treatment Options
  7. Mouth Taping
  8. References

Sleep apnea is a common sleep disorder that is tied to other health conditions, including heart disease and diabetes.

Medical professionals know that there are several chronic health conditions that increase the risk of developing sleep apnea, including obesity. However, misaligned teeth and poor oral health can also increase your risk of developing sleep apnea. This, in turn, increases your risk of heart disease, diabetes, and other health problems.

A dentist can diagnose sleep apnea if you have poor oral health, including dental misalignments. They can then develop a treatment plan to align your smile.

What Is Sleep Apnea?

Sleep apnea is one of the most common sleep disorders in the United States, with about 22 million American adults suffering from this condition.

Many people do not know that they struggle with a form of sleep apnea, although they may experience daytime sleepiness, consistent stress, headaches, or neck and back pain. They may also have partners who complain that they snore or grind their teeth in their sleep.

About 80 percent of diagnosable sleep apnea cases are obstructive sleep apnea, in which the airway becomes partially blocked due to weak muscles and the tongue. Other types of sleep apnea include central sleep apnea, in which the brain does not send signals to the lungs to breathe, and mixed sleep apnea, which may be caused both by nervous system problems and airway obstruction.

Sleep Bruxism & Sleep Apnea

These are the most common risk factors for sleep apnea:

  • Being older
  • Being male
  • Family history and genetics
  • Obesity
  • Unhealthy lifestyle factors, such as drinking alcohol, smoking cigarettes, or not getting enough exercise

Studies have found that dental problems, particularly grinding or clenching your teeth during sleep (sleep bruxism) can make sleep apnea worse.

About 31 percent of adults in the US are affected by tooth grinding or sleep bruxism, and a quarter of those people also have sleep apnea.
Several medical studies have found a high correlation between people who have sleep bruxism and people with obstructive sleep apnea (OSA). Many people with OSA, for example, are more prone to grinding and clenching their teeth, as they also gasp for breath or temporarily stop breathing in their sleep. While these studies show a high correlation, medical professionals suggest two possible links:
OSA Causes Bruxism

The muscle movements in the jaw causing teeth to clench and grind against each other may begin in response to pauses in breathing associated with sleep apnea. While these movements are associated with chewing, they may also help to reopen the mouth and throat, and move the tongue, so obstructions to the airway are released.

It is also possible that bruxism helps to lubricate the back of the throat, which might dry out due to snoring associated with extended sleep apnea sessions. This suggests that sleep bruxism is an attempt by the central nervous system to protect the body from obstructive sleep apnea.

Your mouth's saliva plays an important role in cleaning away food remnants and fighting against cavities. Regular dry mouth increases your risk for tooth decay. However, grinding your teeth together also increases the risk of tooth decay due to cracked and damaged enamel.

Bruxism Causes OSA

Fewer dentists and doctors believe in this causal pattern, but it is also possible that sleep bruxism causes OSA. Signals from the brain that might trigger grinding or clenching are also associated with increased tension in other muscles that might cause congestion or airway restriction. This can, in turn, lead to disordered breathing.

These signals may also affect heart rate, which could explain some of the overlap between OSA and heart disease.

Orthodontic Problems & Sleep Apnea

While sleep bruxism and obstructive sleep apnea are closely linked, there are some underlying causes for bruxism that may also be linked to higher risk of OSA.

Problems with alignment of your teeth can increase grinding, both during the day and at night, because the teeth and jaw do not fit together properly.

Overbites, crowded teeth, and crooked teeth can all increase the risk of both daytime and sleep bruxism because these issues mean that the teeth and jaw do not fit together when the mouth is closed. You might not notice that you grind your teeth, but you might notice an increase in jaw pain, dental problems, including cracked or chipped teeth, or more shifts in your teeth as they move further out of alignment.

These problems also contribute to the increased risk of mouth breathing, both during the day and at night. Mouth breathing is directly correlated with increased dental misalignment and oral disfigurement. The tongue, as it juts out, puts pressure on the teeth, which can move them.

If mouth breathing is a habit during the day, it can become a subconscious habit at night. This might appear not only as physical pain, but also as an increased overjet or even an open bite due to tongue pressure on the teeth.

When the front teeth do not fit together due to an overjet or open bite, you are even more likely to grind your teeth, struggle with tongue thrusting, or keep your mouth open while you breathe. This creates a circle of problems that feed into each other.

Getting Sleep Apnea from Misalignment Diagnosed

Your general practitioner may not notice that some of your physical health issues are related to sleep apnea since this condition is typically associated with chronic health issues like diabetes, heart disease, and obesity. If you do not have these conditions, your physician might not look for them, but your dentist can.

These are signs your dentist might look for that indicate potential sleep apnea problems:

  • Redness at the back of the throat
  • Dry mouth
  • Consistent headaches and jaw pain
  • A clicking sound in the jaw

According to the American Dental Association (ADA), other potential links between OSA and your mouth include the following:

  • Retrognathia, or overbite
  • Micrognathia, or a lower jaw that is too small
  • A large tongue
  • Large tonsils
  • A large neck circumference, which is also indicative of being overweight
  • A partner reporting gasping, grinding sounds, pauses in breathing, or snoring
  • Damage to tooth enamel or the jaw

Your dentist will look at your overall oral health, but particularly at your teeth, to determine if misalignments lead to sleep apnea. Once they have diagnosed sleep apnea, they can create a treatment plan that will improve the alignment of your teeth. The goal is for your teeth to fit together to reduce strain, and reduce grinding, clenching, and sleep apnea.

Treating Bruxism & Sleep Apnea with Orthodontics

Once you are diagnosed with sleep apnea related to dental alignment, your dentist or aligner treatment company can develop a treatment plan primarily focused on orthodontia to improve your bite alignment. There are some other steps you can take in the meantime to reduce grinding, clenching, and sleep apnea.

  • Breathe through your nose with mindfulness techniques. This can help you relax and reduce your risk of mouth breathing, which could shift your teeth more.
  • Your dentist may recommend a mouth guard to protect your teeth while you sleep, which reduces damage to tooth enamel from grinding.
  • A sleep specialist can help with other treatments, including lifestyle adjustments, sleep positioning to reduce pressure, and some devices like CPAP machines.

Oral appliance therapy may be prescribed after orthodontic treatment to manage shifted or misaligned teeth. Your retainer might also be part of easing sleep bruxism and OSA, similarly to how a mouthguard reduces pressure on tooth enamel.

The above recommendations are all important, but if dental misalignment is causing sleep apnea, getting orthodontic treatment is your best way to end this problem. Your dentist can recommend a type of orthodontic treatment that will best suit your needs. Fortunately, many people with dental-related sleep apnea are great candidates for treatment with clear aligners.

Mouth Taping: An Ineffective Sleep Apnea Strategy

Mouth taping experienced brief popularity for a few years, as a way to stop someone from snoring or grinding their teeth in their sleep. This inexpensive solution was not only popular with the average person, but it was also recommended by physicians or dentists. However, there is little science to support mouth taping as a solution for sleep apnea because apnea is a chronic condition that requires more extensive medical treatment.

The practice of mouth taping is exactly what it sounds like — using sticky tape, applied to your cheeks and mouth, to keep your mouth closed as you sleep. Since the only required device is tape, this process seems like the least expensive way to deal with sleep apnea, snoring, and bruxism.

The theory behind mouth taping was that, if you could forcibly shut a person’s mouth while they slept, they would breathe through their nose instead. This is the airway you should breathe through when you sleep while your mouth remains closed.

Some people reported, anecdotally, that mouth taping worked for them. They got better sleep, they had less jaw pain, and they had fewer self-reported symptoms associated with sleep apnea.

However, scientific studies around mouth taping conflict. A small study in 2015 found that mouth taping reduced symptoms of sleep apnea, while an earlier study in 2009 reported no benefit to mouth taping.

There are also downsides to mouth taping, like these:

  • Irritation around the lips and face due to the tape
  • Pain when pulling the tape off
  • Sticky residue from where the tape was placed on the skin
  • Further disrupted sleep from irritation related to tape
  • Trouble breathing from continued throat or nasal malformations that are not addressed by shutting the mouth
  • Ongoing jaw pain from clenching or grinding the jaw, with no relief due to the tape

If your sleep bruxism or apnea is caused by misaligned teeth, simply taping your mouth shut will not address this underlying health condition. Tongue thrusting, jaw clenching, and teeth grinding can still occur when there is a piece of tape over your mouth or keeping your jaw shut. For some people, taping can make these issues worse, as your body subconsciously tries to remove the tape and breathe naturally.

There is no cheap or free solution to overcoming sleep apnea. You simply have to get a diagnosis and treatment plan from a medical professional.

If your dentist notices signs of sleep bruxism or sleep apnea, work with them to alleviate this condition. When sleep apnea is properly treated, you will experience less stress and daytime tiredness, which can improve your health.

References

Combat Dental Problems by Treating Sleep Apnea Patients. (January 2021). Dentistry Today. Date fetched: May 29, 2021.

Sleep Apnea (Obstructive). (March 2020). American Dental Association (ADA). Date fetched: May 29, 2021.

Sleep Apnea. National Heart, Lung, and Blood Institute (NHLBI). Date fetched: May 29, 2021.

The Link Between Sleep Apnea and Teeth Grinding. (August 2020). Sleep Foundation. Date fetched: May 29, 2021.

How Are Crooked Teeth and Sleep Apnea Related? (November 2015). Patch. Date fetched: May 29, 2021.

Oral Appliance Therapy. (June 2020). American Academy of Dental Sleep Medicine (AADSM).

Retrognathia. (April 2021). Stat Pearls.

Keep Your Mouth Shut, but Should You Tape It? (October 2019). Forbes.

Mouth Taping for Sleep. (October 2021). Sleep Foundation.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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