Want better sleep? See a dental practitioner!Uncategorised
Posted by: The Probe 5th August 2020
It seems that a feature of modern life is not enough sleep – or at least, not getting the much-quoted optimum amount of eight hours, every night. But what counts as “enough” is different for everyone. The odd bad night’s sleep, or even a few, are also normal.
The problem is when bad sleep is ongoing. During preventive-maintenance dental appointments, sleep quality should be considered when speaking to your patients. As well as affecting physical and mental function, poor sleep can have oral health implications and certain oral health conditions will inhibit a good night’s sleep. A 2019 study showed oral-health indicators of poor sleep include “gingivitis, high caries risk, poor plaque control and poor saliva control”.[i] Talking with your patient about their sleep will build a picture of their overall health and wellbeing, aiding you to offer quality, tailored care. By understanding more about each patient as an individual, you will find the right solutions and approaches to support them for years to come.
Why can’t I sleep?
If a patient reports a chronic sleep problem, further investigation will be required. If they are regularly drinking too much alcohol or caffeine, or they smoke, these behaviours can affect quality and quantity of sleep. We must assume that people know smoking is one of the worst things they can do for their health, so a compassionate ear is needed, and a discussion of what cessation support could work for them. Alcohol and caffeine, along with nicotine, are stimulants and therefore sleep-disruptors. The diuretic effects of too much caffeine and alcoholic drinks can also lead to an uncomfortable dry mouth and halitosis. As with smoking, if you have a patient who is addicted to alcohol, they will need support that incorporates other healthcare teams and professionals.
Stress is probably the number-one for a poor night’s sleep. Long-term stress and anxiety, which may lead to depression if unchecked, must be managed. A solution, or at least effective coping strategies are most likely to be found when, as before, several healthcare professionals integrate. Stress isn’t always chronic and a certain situation or set of events can cause temporary sleeplessness, sending an individual to despair while the phase lasts. In April, when the UK was just a few weeks into lockdown to control the spread of Covid-19, a survey from the Institute for Employment Studies (IES) found that 64 per cent of its respondents reported a loss of sleep due to worry.[ii] As well as the concern for our loved ones and general uncertainty, the majority of us lost our routines too, and the re-adjustment to the new “normal” disrupted sleep patterns.
A good routine for winding down is key to sleep hygiene (the practices and habits needed to achieve quality sleep). Other elements include avoiding stimulants at the end of the day (as above), patients can do this by turning off phones/tablets/laptops at least an hour before they turn in and don’t watch the news either! A set bedtime helps, as does a comfortable bed in a dark, quiet room that is not too hot or cold. Getting lots of natural daylight and exercise during the day is also essential. As well as improving sleep, the vitamin D and physical activity will boost immunity.
If it is a dental health related reason for poor sleep, you are best placed to investigate. Obstructive sleep apnoea is now being recognised in children, as well as adults.[iii] Also night-time bruxism and clenching, which as well as leading to pain in the jaw, headache, earache, tooth wear, can also cause mobility and exacerbate periodontal conditions. Bruxists are also sleepier during the day, according to another study.[iv] Other oral health related factors for poor sleep include “missing teeth or complete edentulism”, which can “cause the tongue to fall back into the airway” and disrupt the sleep cycle.[v] Other research has indicated how “stage‐grade of periodontitis was associated with short sleep duration, low‐sleep quality, and low oral health‒related quality of life”.[vi]
A well-rested patient will be motivated to practise good behaviours and be more receptive to advice. That’s why regular preventive appointments are so important, alongside a good cleaning routine using high-quality products (they could try TANDEX brushes and adjuncts).
We all suffer short periods of poor sleep, which do not disrupt our health and wellbeing in the long-term. But when lack of sleep and wakefulness is ongoing, it must be addressed. Oral health practitioners are perfectly placed to discuss the relationship between sleep, oral and general good health and give practice, effective suggestions about how to improve all three.
[i] Schroeder K, Gurenlian JR. Recognizing Poor Sleep Quality Factors During Oral Health Evaluations. Clinical Medicine & Research. 2019 Jun 1;17(1-2):20-8.
[ii] IES Working at Home Wellbeing Study. Interim Findings published April 2020. Link: https://www.employment-studies.co.uk/resource/ies-working-home-wellbeing-survey
[iii] Clinical Medicine & Research. 2019 Jun 1;17(1-2):20-8.
[iv] Câmara-Souza MB, de Figueredo OM, Garcia RC. Association of sleep bruxism with oral health-related quality of life and sleep quality. Clinical Oral Investigations. 2019 Jan 29;23 (1):245-51.
[v] Clinical Medicine & Research. 2019 Jun 1;17(1-2):20-8.
[vi] Karaaslan F, Dikilitaş A. The association between stage‐grade of periodontitis and sleep quality and oral health‒related quality of life. Journal of Periodontology. 2019 Oct;90 (10):1133-41.
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