Most people turn to their GP when they develop headaches or have trouble sleeping — but what they may need is a trip to the dentist.
Growing evidence shows dental and oral problems can cause a series of common health complaints. Yet awareness that dentists can help remains low.
‘There is a lack of awareness among both the public and the medical profession — even some dentists haven’t done extra training that would allow them to help resolve a number of health conditions, particularly breathing-related sleep disorders,’ explains Dr Aditi Desai, president of the British Society of Dental Sleep Medicine.
‘Most patients think of going to the dentist only when they need a check-up or have toothache. However, sleep problems, headaches and ear and jaw pain can all be caused by dental problems.
GP alternative: Dental and oral problems can cause a series of common health complaints
‘If your GP is not able to resolve these issues, you should consider going to your dentist.’
Mounting evidence linking sleep disorders with dental problems such as teeth grinding has given rise to a whole new branch of medicine, known as dental sleep medicine.
Next week Dr Desai, a dentist for more than 40 years and a specialist in sleep medicine for 15, will be among experts at a meeting at the Royal Society of Medicine in London, Sleep Disorders: Dental and Medical Approaches, to discuss the latest ways of treating sleep problems.
It will highlight the need for collaboration between medical specialists and suitably trained dentists.
One issue that can have dental roots is obstructive sleep apnoea (OSA), a condition affecting 1.5 million people in the UK, where the walls of the throat relax and narrow, interrupting breathing and sleep.
Dr Desai says OSA is common among people who grind their teeth at night. Despite being linked with serious conditions such as high blood pressure, diabetes, stroke and heart disease, up to 85 per cent of OSA patients are undiagnosed, as symptoms can be hard to spot and access to hospital sleep services is limited.
Did you know? Another area of sleep medicine where dentists may be able to help is snoring. In these cases a mouth guard my help
‘As many as 40 per cent of adults with OSA grind their teeth,’ says Dr Desai. ‘We used to think that teeth grinding at night was caused by stress, but a new theory is that, in some, it’s the result of not being able to breathe efficiently while sleeping. The grinding may be a way of trying to open the airway.’
By spotting sleep grinding — signs are worn or damaged teeth — then looking for signs of OSA, such as a scalloped (a sign the patient has bitten it to keep the airway open) or large tongue (the resulting lack of space in the mouth pushes it backwards, blocking the airway) a dropped soft palate (soft tissue at the back of the mouth) and restricted airway, and checking for risk factors including snoring, dentists can diagnose OSA.
‘If the condition is severe and they have other health problems, patients will need to be seen by a specialist and continuous positive airway pressure (CPAP) treatment — which uses mild air pressure to keep the airway open — may be prescribed,’ says Dr Desai.
‘However, in milder cases, the condition can be treated by a dentist using a mandibular repositioning device (MRD), a mouth guard which is worn when sleeping and works by holding the lower jaw and tongue forward at night, opening the airway.’
MRDs are available on the NHS only if CPAP treatment is unsuitable, and can cost up to £2,000.
Wearing them for long periods can cause side-effects including tooth movement and jaw pain, but according to a study of 369 patients with OSA who wore them while sleeping for six months, published in the journal Sleep Medicine in 2016, they can make a difference. Overall, in 76 per cent of cases symptoms such as daytime sleepiness and morning headaches improved.
Even in severe cases, treatment was successful in about 60 per cent of cases, and only eight per cent of patients stopped using the device because of side-effects. Drop out from CPAP devices is up to 50 per cent. Dr Desai says all patients complaining of tiredness who are snorers should be assessed for a sleep disorder.
Sleep on it: Headaches first thing in the morning can be caused by teeth grinding at night, which affects up to a third of people
‘Doctors and dentists need to work together to get these patients properly diagnosed so they can be treated,’ she says.
Another area of sleep medicine where dentists may be able to help is snoring. In these cases a mouth guard my help.
The downside is there are only a handful of dentists specialising in sleep medicine (they are listed on the British Society of Dental Sleep Medicine website (bsdsm.org.uk) and they are all private. Prices start from £150 per appointment.
But it’s not just sleep. Dentists say there are many other health complaints linked to dental problems where they can help.
Headaches first thing in the morning can be caused by teeth grinding at night, which affects up to a third of people, according to Dr Mayoor Patel, a dentist in Atlanta, Georgia, who specialises in treating migraine, sleep problems and mouth and face pain.
‘As the jaw grinds the teeth together, it not only ruins the teeth but causes injury to the temporomandibular joint (connecting the jawbone to the skull),’ explains Dr Patel, who will also address next week’s conference. ‘This can result in temporomandibular joint dysfunction (TMD) — pain, inflammation and stiffness in the jaw joint and the surrounding muscles.
Overusing these muscles by teeth grinding can also irritate and activate the trigeminal nerve (responsible for sensation in the face, biting and chewing) which can trigger headaches. Between 30 and 50 per cent of adults who grind their teeth complain of a headache in the morning or during the day. ‘Exactly the same mechanism can also result in ear pain, ringing in the ears or a feeling of fullness in the ear.’ Up to three-quarters of people with TMD get headaches, according to a study published in the journal Pain and Research Management last year, compared with 45 per cent generally.
Managing the grinding — using mouth guards and muscle relaxants to take pressure off the teeth and jaw — along with the nerve pain it can cause, can get rid of these headaches, says Dr Patel.
‘These patients typically go to a GP for the headaches and try a series of medications. When they fail, other causes should be explored. We find them further down the line when they are eventually referred to the dentist and diagnosed with TMD,’ he adds.
‘Many doctors don’t consider the jaw as the source of the problem because this area of medicine is not part of their training, so they don’t know what to look for.’
The British Dental Association (BDA), which represents 35,000 dentists, says it is already on the frontline for identifying conditions such as oral cancer, checking for signs of the disease as a routine part of dental appointments.
However, the BDA would welcome a more ‘joined-up system’ with doctors. ‘Dentists see their patients twice a year — more frequently than many GPs,’ says Dr Desai. ‘We are making progress — but there is a lot more to be done to ensure patients get the treatment that they need.’
Yet GPs are cautious of welcoming any move to expand the role of dentists. ‘Dentists are highly competent health professionals, but they are not GPs, and sleep problems can be indicative of a range of more serious conditions that a GP will be able to fully assess and diagnose,’ says Professor Helen Stokes-Lampard, chair of the Royal College of GPs.
She adds: ‘Treatment such as mouth guards might be helpful for short-term sleep issues, but GPs can take a holistic view of a patient’s health and wellbeing, and dentists must not be seen, or used, as a substitute.’