Susan M. Welch, DDS, with more than 18 years of clinical experience, became interested in disorders of the jaw and neck after battling her own temporomandibular joint dysfunction, commonly known as TMJ. In the process of research and study, Welch also learned more about sleep-disordered breathing (SDB), a group of physiopathological conditions characterized by abnormal respiratory patterns comprising upper airway obstruction and breathing cessations, known as apneas, of at least 10 seconds during sleep. SDB is characterized by disruptive snoring, excessive daytime sleepiness and inadequate oxygen in the blood.

Although a dentist cannot diagnose sleep apnea, Welch understands the importance of screening for the signs and symptoms of SDB, as well as educating patients about sleep architecture and in some cases, referring them to a physician for an assessment and diagnostic sleep study. Most people with SDB are overweight or obese, but the structure of the neck, throat and mouth can also predispose a person to the disorder. It often coexists with other respiratory, nervous, cardiovascular or endocrine conditions.

Factors that decrease upper airway size or openness during sleep can lead to intermittent obstruction during inhalation.

If the obstruction is sufficiently prolonged, blood oxygen levels drop and the individual arouses or awakens. Those arousals disrupt normal sleep architecture (the structure and pattern of sleep). The combination of disrupted sleep and decreased oxygenation often leads to more severe health concerns, including hypertension, arrhythmia, chronic pain, hormone imbalances, insomnia, depression, anxiety and death, according to Italian otolaryngology specialist Vittorio Rinaldi, M.D. Disturbed moods and reduced quality of life are another side effect. SDB can impair cognitive performance, leading to accidents and mistakes while driving or at work, according to studies published in the journals Chest and the New England Journal of Medicine.

Welch has recently taken more interest in forms of SDB that do not technically meet the definition of sleep apnea, such as upper airway resistance syndrome (UARS) and respiratory effort-related arousal (RERA) events, which cause severe fatigue. Although sleep apnea is much more common in men, UARS and RERA are equally common in women that may test negative for sleep apnea because they don’t have full apneic events, but do experience a resistance in airflow that can lead to disturbances in sleep cycles and create the symptomatology of obstructed sleep.

Patients with obstructive sleep apnea (OSA) can be treated with a continuous positive airway pressure (CPAP) device. Long-term treatment with CPAP reduces both mortality and the acute blood pressure elevation that occurs with SDB. However, the machine and facial mask aren’t comfortable for everyone.

“Many people continue to have issues that they are not able to solve with the CPAP, or they just don’t care for that type of apparatus and become non-compliant,” says Welch. “Then, the physician can refer the patient to me to make an oral appliance that brings the lower jaw forward; creating a muscular splint that brings the tongue forward. However, this too, can become uncomfortable, causing neck pain and stiffness,” notes Welch, adding that even oral appliances may fail certain patients because one solution does not fit all.

“This is where I begin to look more closely at the root of the problem, evaluating the head, neck and musculature factors; considering oral factors, the mouth, gag reflex, shape of the tongue and especially the jaw joint health,” advises Welch. “We examine [the patient] initially by manually evaluating the muscle health of the jaw, feeling around the jaw to study the jaw joint and looking at the jaw posture. We start a trial run with a temporary appliance before investing in a more permanent one. Then we continue to evaluate for comfort and compliance, as well as any changes in sleep patterns.”

Welch also consults with other members of the patient’s medical treatment team. “I actively seek and work with other medical and dental specialists to make sure patients are receiving the best care for their individual situation and to move them towards whole body health,” she explains.

“Part of what I am developing within my practice is a program towards overall wellness, beginning from the oral cavity standpoint, which is the beginning of the gastrointestinal tract and airway,” says Welch. “We help our patients learn how they can improve their health.”

Dr. Susan Welch is the owner of Wright Parkway Dental Center, located at 106 Wright Pkwy. SW, in Fort Walton Beach. For more information, call 850-243-1534 or visit WrightParkwayDentalCenter.com.

Lauressa Nelson is a contributing editor for Natural Awakenings magazines and a freelance writer who lives in Orlando, Florida. Connect at [email protected].