The link between sleep apnoea, oral health and dental implant treatment

Sleep apnoea can affect oral health by causing a dry mouth, gum inflammation and changes to the jaw, and it can impact the planning and outcomes of dental treatments, including implants.

Sleep apnoea is a disorder characterised by repeated pauses in breathing during sleep. These episodes reduce the level of oxygen in the blood and affect the quality of sleep.

Types of sleep apnoea

There are three main forms:

• obstructive sleep apnoea (OSA) – the most common;
• central sleep apnoea;
• mixed sleep apnoea, which combines features of the other two.

In most cases, dentists see patients with obstructive sleep apnoea, caused by the partial or complete collapse of the upper airways.

Signs that may indicate the presence of apnoea include:

• loud and persistent snoring;
• breathing pauses observed by a partner;
• a feeling of suffocation during sleep;
• restless sleep;
• excessive tiredness during the day;
• difficulty concentrating;
• morning headaches;
• dry mouth upon waking. 

Sleep apnoea can affect oral health through excessive mouth breathing, dry mouth and gum inflammation, increasing the risk of tooth decay, periodontal disease, halitosis and bruxism.

Numerous studies have shown that patients with obstructive sleep apnoea have a higher incidence of oral problems compared with the general population.

Xerostomia (dry mouth)

Nocturnal mouth breathing reduces the amount of saliva in the oral cavity.

Saliva plays a vital role in:

• neutralising acids;
• protecting tooth enamel;
• controlling oral bacteria.

When saliva production is insufficient, the risk of tooth decay and gum inflammation increases.

Halitosis

A dry mouth encourages the growth of bacteria that produce volatile sulphur compounds, which are responsible for bad breath.

Gingivitis and periodontal disease

Chronic inflammation associated with apnoea may contribute to the worsening of periodontal disease. Research suggests a bidirectional relationship between obstructive apnoea and gum disease.

Tooth erosion

Patients who frequently breathe through their mouths may experience changes in their oral environment that promote tooth wear and sensitivity.

Bruxism

Nocturnal bruxism is common in patients with sleep apnoea and can lead to:

• tooth cracks;
• accelerated wear;
• fractures of dental restorations;
• excessive stress on dental implants. 

Facial structure and the development of the jaws directly influence airway patency.

• Tongue position: A low tongue position can contribute to a narrowing of the airway and the occurrence of episodes of obstruction during sleep.
• Narrowing of the airways: Narrow jaws or underdevelopment of certain facial structures can reduce the space available for airflow.
• Facial development: Specialists in dentistry and sleep medicine frequently observe that certain patterns of craniofacial development are associated with a higher risk of obstructive sleep apnoea. 

Sleep apnoea can indirectly affect the success of dental implants through increased systemic inflammation, slower healing and the presence of nocturnal bruxism.

Following implant placement, the body must undergo the process of osseointegration, i.e. the integration of the implant into the bone.

Patients with severe, uncontrolled apnoea may experience:

• an increased inflammatory response;
• slower tissue healing;
• a higher risk of complications associated with other systemic conditions.

Nocturnal bruxism

Bruxism is one of the most significant concerns in patients with dental implants.

The excessive forces generated during sleep can affect:

• dental implants;
• prosthetic crowns;
• support structures.

In such cases, the dentist may recommend the use of a protective mouthguard and close monitoring of occlusal function. 

Yes. The presence of sleep apnoea is not a contraindication for dental implant treatment.

Most patients with sleep apnoea can benefit from dental implants, provided they undergo a full medical and dental assessment.

The treatment plan may require additional measures to manage risk factors, including the management of bruxism and periodontal disease.

As part of the pre-implantation assessment, the doctor may review:

• your full medical history;
• whether you have been diagnosed with sleep apnoea;
• whether you suffer from bruxism;
• the health of the gums and bone;
• sleep quality;
• treatments undertaken for sleep apnoea.

In some cases, it may be advisable to consult a specialist in sleep medicine or an ENT specialist. 

The modern approach to treating patients with sleep apnoea involves collaboration between several medical specialities.

Treatment of sleep apnoea

Depending on the severity of the condition, treatment options may include:

• CPAP devices;
• oral devices to advance the lower jaw;
• ENT treatments;
• weight management;
• lifestyle changes.

Dental treatment

Dental treatment may include:

• management of periodontal disease;
• treatment for bruxism;
• prosthetic restorations;
• dental implants;
• monitoring of occlusal and articulatory function.

Through collaboration between the dentist, the ENT specialist and the sleep medicine specialist, the patient can benefit from a comprehensive and personalised approach.