THE DENTAL HYGIENISTS ROLE IN SCREENING FOR OBSTRUCTIVE SLEEP APNEA

The most common type of sleep apnea, obstructive sleep apnea is characterized by partial or complete narrowing of the pharyngeal airway during sleep. It is defined as a condition in which there is a decrease of oxygen intake (hypopnea) or temporary cessation of breathing (apnea). This chronic, multifactorial and potentially life-threatening disorder is associated with a reduction in oxygen levels, increased carbon dioxide in the bloodstream, and numerous medical conditions.

Due to the frequency with which patients visit oral health care providers, dental teams are on the frontline of disease detection. Information obtained from the medical history, as well as the extraoral and intraoral examination, can reveal obstructive sleep apnea risk factors. Assessment can be used to establish a preliminary sleep apnea diagnosis, allowing referral to a medical specialist for definitive diagnosis.

Identifying the Signs of OSA Among Your Patients:

Although physicians are the only professionals licensed to diagnose OSA, dentists and dental hygienists can detect OSA risk through screening tools. Some of these tools are the Mallampati classification. The Mallampati classification is an evaluation predicting the ease of intubation and is higher in people who show severe degrees of OSA.

With the patient sitting upright, mouth open, and tongue protruded, the evaluator classifies the visibility of the posterior pharynx with aid of a light with a scale of I, II, III, and IV

Mallampati I: When we look inside, if we can see the bottom of the uvula, we score that as Mallampati I since the airway is very open.

Mallampati II: When we look inside, if the tongue is covering part of the uvula, we score that as Mallampati II since the airway is mostly open.

Mallampati III: When we look inside, if the tongue is covering most but not all of the uvula, we score that as Mallampati III since the airway is mostly closed.

Mallampati IV: When we look inside, if the tongue is covering all of the uvula, we score that as Mallampati IV since the airway is very closed.

STOP Questionnaire:

The STOP questionnaire is a concise and easy-to-use screening tool for OSA. It has been developed and validated in surgical patients at preoperative clinics. Combined with body mass index, age, neck size, and gender, it had a high sensitivity, especially for patients with moderate to severe OSA.

STOP-Bang Questionnaire

The STOP-Bang questionnaire is a series of eight questions with scores ranging from 0 to 8. If an individual answers yes to three or more items, then that patient is considered at high risk for OSA. Research indicates that a STOP-Bang score of 3 or greater reveals a high sensitivity for moderate-to-severe OSA along with an increase in specificity and predicted probability.

The Apnea Risk Evaluation System Questionnaire:

The Apnea Risk Evaluation System (ARES) is a portable monitor designed to record data for unattended diagnosis of obstructive sleep apnea (OSA) in the home.

Treatment Options for Obstructive Sleep Apnea:

Treatment of OSA includes lifestyle changes such as weight loss, upper airway surgery, continuous positive airway pressure (CPAP), and oral appliances.

While dentists and dental hygienists cannot diagnose OSA, they have the opportunity to play a crucial role in the detection, education, medical referral, and treatment in OSA. Dental hygienists can use screening tools, like the Mallampati classification, STOP questionnaire, and STOP-Bang questionnaire, to assist in the dental team in the detection of patients suffering with OSA.

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