What Your Mouth Can Tell You About Your Sleep with Dr. Mark Burhenne

The health of your gut is very important for your overall health. Your mouth is the first section of your gut and is therefore very important also. But the mouth doesn’t get the attention it deserves. Did you know that problems in the mouth can be an indicator that you have sleep apnea? Also that inflammation in the mouth can create inflammation throughout your entire body?  Today we speak with Dr. Mark Burhenne DDS to learn more about this often overlooked section of your gut.

Dr. R’s Fast Facts

  • The mouth can be viewed as the first section of the gut and is therefore very important for one’s health.
  • Unfortunately, oral health is rarely discussed or addressed in healthcare
  • The mouth can act as an early indicator for sleep apnea and other sleep impediments
  • Dr. Mark estimates that up to 30% of people have oral problems causing sleep impediments, and that only 10% get diagnosed
  • It can be hard to determine if one has an oral problem causing impaired sleep based upon symptoms, but some symptoms that may indicate a problem include:
    • Headaches, neck aches, teeth grinding, GERD/reflux, cavities, snoring, frequent waking, fatigue
  • Oral dysbiosis (imbalanced bacteria) and infections are very important and often overlooked
  • To evaluate if you have a problem with your oral health, you can:

If you need help with your gut health, click here.

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Topics:
Dr. Mark Burhenne DDS Bio … 1:24
Sleep, Mouth and Health … 2:45
Sleep Apnea and Your Mouth … 6:34
How Common is Sleep Apnea? … 10:22
Sleep Apnea Symptoms … 13:12
Gut and Oral Dysbiosis … 18:09
Sleep Assessment … 24:55
Dreams … 29:10
Surgery and Other Interventions … 30:48
Resources … 33:27

Download Episode  (Right click on link and ‘Save As’)


Links:

  1. For more on the important of sleep see our previous podcast: Sleep – Is Too Much Just as Bad as Not Enough?
  2. Dean Howell podcast
  3. American Academy of Dental Sleep Medicine
  4. The 8-Hour Sleep Paradox: How We Are Sleeping Our Way to Fatigue, Disease and Unhappiness by Dr. Mark Burhenne
  5. Ask the Dentist

What Your Mouth Can Tell You About Your Sleep with Dr. Mark Burhenne

Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. Today, we have Dr. Mark Burhenne, and we’re going to be talking about the connection between your mouth and sleep. And something I’ve been wanting to do for a while is bring on someone who can talk in a more expert way about the mouth because I look at the mouth like the first section of the gut. And if we have this kind of heavily-weighted philosophy on the importance of the gut, then the mouth being the first section of that would also be very important.

So, Mark, thanks so much for coming on the show today.

Dr. Mark Burhenne: Michael, thanks for having me. I’m very excited.

DrMR: Absolutely. I’m definitely looking forward to this conversation also.

Dr. Mark Burhenne DDS Bio

And I guess to kick us off, can you tell people a little bit about your background and how you got into looking into the mouth and everything there?

DrMB: Well, I’ve been practicing dentistry for almost 30 years. Dentistry was appealing to me a little bit after the fact. I certainly have the personality for it: a little OCD and tinkering and fixing things. There’s the mechanical aspect of it. But my father was a well-known physician, so I was always enamored with healthcare but couldn’t follow in his footsteps.

It kind of came as a surprise to me. I took a little personality test in college, tied into career choice kind of counseling, and dentistry was the number two choice. It just never occurred to me that that would be something I would want to do. And of course, since I learned more about it, it was a no-brainer. I was fascinated by it and have been ever since.

DrMR: And then the topic of sleep is one… I think most people probably have heard in some context how crucially important sleep is, right up there with other lifestyle interventions like stress management, exercise, and healthy diet. Definitely one of the fundamental pillars of health.

Sleep, Mouth and Health

And so, I’m curious to hear your expansion on the connection between your mouth, your teeth, and your sleep. So wherever you want to launch into this conversation, let’s go ahead.

DrMB: Yeah, so of course that came later in my career. It was after I realized I had sleep apnea. That was about 12 years ago, and of course there were other people close to me who had it. And it was unbeknownst to me, ironically, as a healthcare professional. And that’s, of course, the irony, that a lot of us don’t know what we have until we… More knowledge of course leads to a sicker patient. The more we know, the more we realize what we can diagnose.

So my wife and I both have sleep apnea. She has severe sleep apnea, and the book is centered around her story and my story a little bit. And it just occurred to me that the recognition of sleep disorder breathing, sleep apnea, UARS, all these things that are related to breathing and not breathing at night or poor breathing at night, leading to arousals and poor sleep — the recognition of that can happen and does happen decades earlier in the dental environment than it does in the medical environment.

And I think as soon as I came to that conclusion and saw that firsthand, that I could see it, screen for it — dentists are not allowed to diagnose sleep apnea or sleep disorder breathing, but we can certainly screen for it as we can for diabetes. But there are certain things in the mouth, and there are certain things about a relationship with our patients that are slightly different than perhaps a patient’s relationship with their primary care doctor that allow us to find it, screen for it, and identify it sooner. And we can certainly go over all those little details.

I think that’s what really fascinated me is I didn’t know I had sleep apnea until I got older, and then you think, “Well, I’m tired because I’m old or getting older,” and, of course, that’s not true. But I think the turning point was when my wife got the diagnosis for sleep apnea, and then of course I was looking for alternatives, learned more about it, and then realized, “Boy, this has been kind of sitting under our nose all this time, and if only we had recognized it sooner” — which we do now in the dental world — “it would be great.”

It’s a hot topic now in dentistry. A lot of dentists are rushing to this field because it’s something they can add to their regimen of what they can help patients with. And of course, that’s what we’re all about. We’re here to help. But, boy, if you can change someone’s life and prevent them from acquiring all the comorbidities or some of the comorbidities of sleep apnea later in life and catch them early, even as children, young children, infants, what a great service that is.

DrMR: That’s a terrific point, and I think many clinicians, probably like myself, struggle with knowing when the adequate time to recommend someone have an evaluation for sleep apnea is. Because there are so many symptoms that can be associated with sleep apnea that are non-specific, fatigue being one of the most notable. Fatigue, maybe headaches. That can be anything from hormone imbalances to even a gut problem.

And so, when is it the best time to make that referral for what can be a bit of a daunting study? Or even before that, you push someone down a road where they may have to go see a couple doctors and jump through some hoops even before they can get the actual sleep study, which is a bit of a commitment in and of itself. So I really like this from an angle of trying to have an early indicator of sleep apnea.

Sleep Apnea and Your Mouth

And I would definitely love to hear your expansion on what some of that looks like and some things that people might want to ask their dentist or even if people can look in their own mouths and try to get an early indication of if they might want to have a further evaluation.

DrMB: Right. So you’re absolutely right. How do you know whether to go down that road or not? And of course, it’s expensive. Insurance doesn’t always cover the sleep study, and a lot of people don’t want to have that diagnosis. So there’s a real stigma to getting that diagnosis. And that’s the key is that I can notice things as a dentist that perhaps a physician, an M.D., may not, and, hence, I can make that more definitive diagnosis. It’s not actually a diagnosis; it’s a screening.

But if I can make that and assure the patient that this is an issue, that your fatigue is perhaps related to some kind of sleep disorder breathing, then I think they’re more likely to go ahead and believe that to be true and move ahead. These are things like bruxism. Sleep bruxism is now the term. It used to just be bruxism, but we’ve divided it now into two, nighttime and daytime, categories.

There’s lingual erosions. That’s acid, GERD. Stomach acids in the mouth that are literally eating away at the inside of the teeth. There’s the shape of the tongue. There’s scalloping of the tongue, fissuring of the tongue. That’s a tongue that doesn’t have enough room in the mouth.

There are also things developmentally that we can see in children, like narrow arches, mouth-breathing. It’s how the child develops. Are they developing correctly? Are they developing into an adult with a small airway because of not enough breastfeeding or too much reliance on sippy cups or those pacifiers?

Again, everything I think I just mentioned is much different — or just a different perspective — from what a physician would be looking for and also what a patient would be looking for. How does a patient go in…? Let’s say, take a 35-year-old, and I’m thinking of one person specifically earlier this week whom I saw. How do you tell your doctor that you are tired, exhausted, not sleeping well? Most people don’t know what the definition of good sleep is, and to relay that information to a doctor, well, they may, as you said, assume something else like a gut microbiome issue. It could be hormonal. It could be meds. It could be so many other things.

So I think the dentist can narrow it down or exclude it as a potential diagnosis a lot quicker because of that unique knowledge about the mouth. I know I have a lot of physicians that I refer to and work with, a lot of ENTs, and it must be a term they use in medical school. They always refer to the mouth as the little black box.

As my world ends at the nasopharynx, maybe the velopharynx, their world begins. And it’s really that area, that airway, that kind of crossover area, where both of our worlds kind of collide, the medical and dental world. And actually, that’s the crux of the issue: We need to know what that airway is doing, what the muscles are doing at night when you’re approaching deep sleep.

DrMR: So it is kind of this transitional point that no one seems to really be focusing too keenly on. Maybe an ENT, but I understand what you’re saying. And I’d like to in a moment come back to what type of dentist or what resources people may have so they can try to find someone to, quite simply put, look in their mouth and tell them if they think that they’re at risk for this.

How Common is Sleep Apnea?

But before we do that, how common is sleep apnea? And are there any main symptoms that you would say if someone has X, Y, or Z, it’s a pretty strong red flag that they might want to get an evaluation?

DrMB: In my practice, I’ve literally taken a look and looked at the numbers, and I’m running at about 28%. I have a big cross section of ages and a lot of children, but I’m also looking at anything beyond just apnea and hypopneas. Anything that wakes you up and prevents you from achieving deep sleep. Because anything that’s related to airway issues, that could be upper airway resistance syndrome. It could be just a lot of RERAs. With a child, it could just be tonsils and adenoids that are blocking the airway. It could be severe allergies. But I would say at least 30%.

I know when I first got into sleep apnea they were saying it was 6%, and I think those numbers have been corrected. I think you’ll see 20%, and sometimes you’ll see 25%. It depends on who you’re talking to or what you’re reading. So it is prevalent, but I don’t think that’s really the issue. The issue is how many of those people have been diagnosed, and if they haven’t been diagnosed, of course, they haven’t been treated. And that number is probably close to 90%.

And these are people that are out there operating heavy machinery. They’re flying our planes and operating our trains. It could be your surgeon. It could be your dentist. It’s the person driving in the opposite direction around 2 o’clock in the afternoon, which is when most of these accidents occur.

So it affects us all, even though it’s a seemingly small percentage of the population. I wouldn’t call 20 or 30% small, but of those 20-30%, 90% don’t know they have it.

DrMR: Key point. Are there any strong indicators in terms of…? For example, I was just reading a study, actually a pretty fascinating study, unrelated, but on hypothyroidism. And this group of researchers did an excellent job of pinning down 13 symptoms that were most closely associated with hypothyroid. And they were actually even able to get a step further and say if someone has three or more of these symptoms present it is very suggestive of hypothyroid.

And so, there are a lot of symptoms, of course, that can present during hypothyroid, but they narrowed it down to a list of 13 that was somewhat consolidated. And then they even had some symptoms that were mostly suggestive.

Sleep Apnea Symptoms

Is there anything similar with sleep apnea or other sleep impediments?

DrMB: Well, it depends. It depends on how you look at it. I would say it’s a little bit less tangible because it covers a broader base. We’re talking about a hormonal issue, and you can get blood tests and things like that. But it happens that hypothyroidism is on my list, and I think it’s in my book. If I see hypothyroidism and a little adrenal gland insufficiency with some bruxism and some lingual erosions and daytime tiredness and all that, that to me is a sign that that patient has suffered from sleep apnea for quite a while. They wore out their adrenal glands, and now the thyroid is suffering because the thyroid tries to take over when the adrenal gland is down and out.

It’s difficult to say. I think the more subjective part of making that diagnosis or that screening is what the daytime symptoms are like. And that’s what I referred to earlier is my relationship with my patients as a dentist. I know them a little bit more intimately, perhaps, than a primary care physician does. People tend to stick with their dentist longer, and I see them two to four times a year. That’s just the nature of dental treatment.

And because of that, I can see that they’ve gained a little weight. I see small changes in their muscles of facial expression. I see more wear on their teeth. They may complain to me about some things. I’ll ask them how they are and they’ll say, “Well, I’ve been kind of tired lately. I’m taking naps more.” Of course, I’m very focused on sleep.

But I think because of that, and if you ask all the right questions — and again, I have long lists in the book for patients and also for healthcare providers to look at. You start checking off some of those things, like morning headaches for example. What does that mean to me? That means that patient may have been grinding all night. Maybe a neckache, a levator muscle or a trap muscle. Maybe they’re lifting their head off the pillow because they were suffocating. You push your head in a more forward position when you’re struggling for air.

These are subtle little things. If you start putting a lot of that stuff together, then you start getting a clearer picture. So I think it’s a little more of kind of a diagnostic art. You have to put a lot of things together. You have to know your patient well, and I would say half of it is concrete things like bruxism, abfractions, cracks in the teeth, excessive wear to the teeth.

Lingual erosions are very clearly GERD, and GERD is 53% associated with obstructive sleep apnea. And that’s on a temporal basis. In other words, it’s happening right at that moment. They’re able to do that in sleep studies. They can test the pH of the lower esophagus while you’re sleeping, and the patient will have an apnea and then the pH is dropping. The acids go up.

And then the other half of it is this kind of gray zone of, like, what are the daytime symptoms? We always talk about what’s going on at night, but if we talk about what’s going on during the day… Do you fall asleep in a car as the passenger? How quickly does that happen? A lot of people are very proud of how quickly they can sleep like in a plane. To me, I let them roll with that, and basically they’re talking to me about sleep latency. If they can fall asleep that quickly, I worry about that. I put that on my list of things to add to that assessment. Does this patient have sleep apnea? Do they need a PSG, a sleep study?

So that’s the other half of it, just listening to the patient. Do they have a gut microbiome issue? Do they have a dry mouth? Are they breathing through their mouth? Do they have a high caries rate? The pH in the mouth can change if you’re breathing through your mouth at night. You’re more likely to get cavities because the pH is dropping. There’s no buffering of the acids in the mouth with saliva.

So it’s a combination of many things, and it’s a long list. But you can — not shorten the list — but you can abbreviate things quickly as you find out what seems to lead to a correct diagnosis. And I would say most of time, the patient is surprised because they’re in denial. But when they do get their sleep study, they do come back with a diagnosis.

DrMR: And just to clarify for people, bruxism just means teeth grinding in case anyone wasn’t familiar with that symptom. I appreciate what you’re saying, which is that it’s not always something that has a clear symptom list associated with it. But a good clinician should be able to sniff that out. Totally agree.

Gut and Oral Dysbiosis

And you mentioned gut dysbiosis, and I also wanted to get your take on oral dysbiosis. This is something I’ve been keeping a closer eye on in the clinic again because me being somewhat of a gut specialist, I look at, again, the mouth as the first section of the gut. And I know there have been a number of studies. Probably the best linked condition with oral dysbiosis, at least from what I’ve seen, has been rheumatoid arthritis.

And certainly, from just a philosophic perspective, if we have dysbiotic bacteria in the mouth, they can leach their way down into the gut, cause immune activation, cause inflammation, cause problems. And so, it’s something that I keep an eye on. I make recommendations for patients who seem to have frank signs of oral dysbiosis, things like flossing, brushing your teeth, using oral rinses, following up with your dentist for any festering infections and what have you.

But I’m certainly not an expert in oral hygiene or oral dysbiosis, so I’m curious to get your take on if there are tests that people can do to have that evaluated, oral dysbiosis. And/or what kind of impact are you seeing from oral dysbiosis? And what would you offer people there?

DrMB: Michael, you’re way ahead of most practitioners. Again, it’s that black box that I hear often referred to. And, yes, of course, any dysbiosis and signs of that can be anything from bad breath, halitosis, gum disease, long in the tooth, as you may remember. You may not be old enough to understand what that term means, but recession, bleeding, blood on your floss or toothbrush, and classic periodontal disease.

I actually have a form that I share with all of my physicians. It’s a CRP referral form. Like a cardiologist who’s measuring CRP to see if their treatment is working in terms of heart disease with their patient, but what they may not realize is that the dysbiosis in the mouth is contributing to that CRP. And if he’s ignoring that and the levels aren’t dropping, well, then of course it’s going to be hard to treat your patient. So that’s a CRP form that I have on my website, and it’s being downloaded by many healthcare practitioners.

It’s a form that you would give to the patient, they would take to their dentist — hopefully, they have one — and that dentist would make an assessment and give you an idea of what that contribution is. What’s the weighting of that contribution to elevated CRP? And the oral systemic connection — it’s been long talked about — that is just coming into vogue now, and we realize how important it is, and it has to do with the oral microbiome and the gut microbiome. The ratio or the population of bugs that can go wrong between the gut and mouth is about a 50–60% overlap. And of course, the environment is a little different because it’s open to the outside environment. The pH is a little different. There’s little unique stuff going on.

But it’s essentially the same. It’s the beginning of the gut, and anything that happens in the mouth can affect the gut microbiome. But here’s the thing. Bacteremia, that’s bugs in the blood — typically, blood is sterile. But after a cleaning, for example — a dental cleaning — or even if you have a cavity… A cavity is essentially an infection of the underlying structure of the tooth, the dentin, which half of is calcified. The other half is collagen. That infection actually shows up in the blood.

So these are transient, typically, hopefully. And these bugs in the mouth get into the bloodstream, so there is that infection, metastatic kind of mechanism of, “What happens in the mouth happens in the body.” And that’s where we get into trouble. In the old days before antibiotics and modern medicine, a lot of people died because of an infection in the mouth. And of course, we don’t see that too often today, but there is a connection.

We’ve long known that the oral systemic connection basically — there’s a connection between the heart and the infections in the mouth, poor flora ratios between the anaerobes and the aerobes. That can all affect diabetes, insulin resistance. There are connections now to breast cancer, even Alzheimer’s. So it’s pretty important that any practitioner, whether it’s medical or dental, that we take seriously the infections in the mouth. Or if there’s a dysbiosis in the mouth, it has great ramifications throughout the body.

DrMR: Sure. I agree. Coming back to sleep for a second, I just want to point out to people in case people listening to this or reading this are newer to our audience, we did do a very comprehensive review of the literature on sleep. And I won’t go into detail on that now, but if you use the search box on our website and type in sleep, you should be able to find it. I’ll see if we can fish out the link and include it in the transcript also.

But if people wanted to get what I think is a pretty jaw-dropping affirmation of how massively impactful sleep is to overall health, then I would see that episode because it is very, very important. And I’m also wondering: Are there indicators that people should be on the lookout for that their teeth or their mouth might really be at play? You’ve hinted at a few of these, but are there any others that you think are important that indicate their sleep might be being interfered with by their mouth or their oral airway or what have you?

DrMB: Right. Well, there are no dental diseases that would affect sleep. These are only ramifications in the mouth that indicate that there is an interruption in sleep. It’s a sign or a symptom, I guess you could call it. If you had full-on gum disease, obviously, your CRP levels would be raised, elevated. There’d be some inflammation that could lead to RA, certainly, and other diseases. There are those connections. How that would affect sleep, I don’t know.

Sleep Assessment

DrMR: Maybe another way to come at this is, I know you discuss ways to test your sleep. So maybe people can look at their sleep as a reverse way of figuring this out. So do you have some sleep assessment tips for people that might tell them about that?

DrMB: Yeah, so that is kind of an important point that I try and drive home in the book. A lot of us are not having the right discussion. And I don’t think really anyone thinks about what is an ideal night of sleep. And so I go through these long lists of what to check off as being a good thing and a bad thing.

To sum it up, I think sleep should be amnesic. And maybe we remember that from childhood; maybe we don’t. But I think a lot of us are tossing and turning and we accept that to be normal. I always ask patients, if you have any recollection of anything that happens during the night, you checked your watch, you rolled over and adjusted your pillow, you heard your partner snoring, that means you were awake. Your sleep is fragmented.

The best night’s sleep is essentially you go to sleep, hopefully at the same time and you wake up at the same time, and it’s an amnesic effect. In other words, you only think 10 minutes have passed, and you’re in a little bit of disbelief that it’s been that long. It’s been 7 hours or 6 and a half hours.

There are certainly apps. Everyone is very enamored with these apps. I think a lot of them underreport, and it could be a little dangerous. There is one that I do like. It is one that listens to you. It’s a smartphone app that basically listens to you. If you’re snoring at night and moving around a lot, that is pretty clearly an indication that you’re not sleeping well. And that’s easy to do. You just have to sleep alone. It has to be a quiet room, and you have to have a smart phone or an iPad or something like that. These are free apps. They’re very inexpensive apps if they cost anything. And I use them to help calibrate my devices.

DrMR: What’s that app, Mark? Just out of curiosity.

DrMB: I think it’s called the Sleep Analyzer. Sleep Analyzer, and I think it’s only on the iPhone and iOS. In the book, I do mention an Android app. But since I’ve written a book, there are several other apps available now. And I’m working actually with a company on this. We’re looking for the $39.95 thing that you can slip onto your finger, sleep with it one night, and it tells you whether you have sleep apnea or not. And I think we’re getting close to something like that.

DrMR: That’d be great.

DrMB: That would be great. And practitioners could use it. But that’s almost a disposable price where people would pick that up. And I always argue in my book and on the air that everyone should be checking themselves for poor sleep. Again, 90% of us are undiagnosed, and this affects society in general if a lot of us are sleeping poorly.

So there are ways of knowing. Looking at your daytime symptoms: Are you tired? Do you fall asleep after lunch? Can you watch a movie start to finish? Can you pick up a book and read a few chapters without feeling sleepy? There’s an Epworth scale. There’s a test that physicians will give you. It’s a questionnaire with six or seven questions, and depending on how you rate on that, how you score on that.

So there are lots of little, kind of more subjective… What we don’t have is a blood test. That’s what everyone’s looking for: a little prick test or a blood test or a scan that could tell us we have a small airway and we’re not sleeping well. And that’s the problem. But the Sleep Analyzer is a good place to start. That tells you a lot.

I know it works. I have tested people who are wearing one of my oral appliances that have been verified by a sleep study where they have zero interruptions. And then we take out the appliance one night, and they’ll go from zero to five noises at night, i.e. snoring, to 500 to 1,000 noises at night. So we know it works. We know that is kind of an indirect methodology for knowing what are you doing at night.

DrMR: I really like the just like a simple reminder of your sleep should be amnesic.

Dreams

And it makes me wonder, how do dreams factor into that? I’ve heard differing things on dreams, and I can say my own experience. I don’t know if this is representative of most people or not.

But I tend to dream more so when, let’s say, I’m snoozing. I wake up, and I don’t have to get up for another 10 minutes or so, so I kind of roll back over. I have a short dream, and I wake up. And that’s the only really dreaming that I recall. And so, it makes me think that dreaming might be an indicator of short duration, non-deep sleep. But I’m absolutely speculating on that but wondering, how do dreams potentially interface with quality of sleep?

DrMB: That’s a very good question, and I don’t think we really — a lot of sleep professionals, the sleep researchers, they’ll tell you that dreaming is not necessarily an indication that if you remember your dreams and you wake up in the morning and then you say to yourself, “Well, I was dreaming. I must’ve been sleeping well.” They certainly don’t measure that directly. They do know when you’re in a REM state when they do the sleep study, the PSG.

But if you remember your dream and it’s early in the morning, I’m not so sure that’s important. Dreaming is, of course, very important. And it’s nice to be able to dream, but I would not use that as an indicator that you are sleeping well. I would be very wary of that.

DrMR: Ok. Well, I was speculating there. So I certainly don’t want to paint that picture as that being a tried and true indicator.

Surgery and Other Interventions

Something else I’d like to get your take on. We had a gentleman on the show, Dr. Dean Howell, a number of months ago. And he works with devices, or part of his work uses devices, that can open up the oral airway if it has been somewhat encroached, kind of like reverse braces almost. Is that something you have any thoughts on?

DrMB: Yeah. It’s always best to do this before we are fully developed, and in dental terms, in lower face development that’s usually by age 10, maybe age 12. Some start earlier of course. But absolutely. I’m not sure how effective it can be in adults, but right now we do something that’s pretty important and coming back into vogue, which is rapid maxillary expansion in dentistry. And that’s where we help the child, the young patient, develop properly.

There are a lot of epigenetic factors that prevent that in our modern diet and environment. And if we can intervene — I guess intervene is not the word, but if we can help and let that child reach their full genetic potential in terms of lower and forward face development, then there’s a better chance that that child will not have any sleep disorder breathing issues as an adult.

Yeah, there is something to be said for that. I’m just not familiar with it beyond the developmental stages. Although, I’ve heard about it, and if they have orthognathic surgery, we can take a 45-year-old… I think Carol Burnett is the poster-child for that. She was very retrognathic and had the surgery done. And I think it was a success. And her chin was a little lower and more forward, and chances are — it wasn’t mentioned back in those days — she’s sleeping better.

So there is a surgery where we break the upper and lower jaw, one or the other or both, and that can sometimes move the tongue forward and help the airway. It prevents the airway from collapsing. It depends on where the collapse is. But in terms of what your guest — and I did remember hearing that episode — I think that’s very viable. I think it’s all case selection and patient selection.

DrMR: Sure. Sure. Okay. So maybe now to transition us more in terms of what people can do. We’ve already skirted at some of these.

Resources

But how can people help themselves in this regard? And I know you’ve written a book. That might be a good resource. There also might be an organization that you can refer to if people were looking to try to find a dentist themselves, and they didn’t want to go with a book, they wanted to try to find a professional to guide them. What would you offer people in terms of actionables they can do to help get themselves better in this regard?

DrMB: Right. That’s a good question. The book is certainly focused on that. Here’s the problem, and I’ve mentioned it before. Sometimes going in to see your primary care physician — I see patients do that and they come away. And of course, if this patient’s thin and they have low blood pressure and they have none of the comorbidities of sleep apnea, they’re going to get turned away. And then they’ll think everything’s fine.

I think as a patient you have to educate yourself. You have to read books on the matter. You have to examine your family history, and you really have to ask, “Is that me? Am I tired for those reasons?” Once you get the diagnosis, then of course you’ve got choices with surgery. Dentists can make an oral appliance that helps support the airway. And of course, the gold standard is the CPAP, APAP, that continuous positive airway pressure. It’s a little device that keeps the airway open with positive pressure. It’s blowing air inside of you.

Again, a book like mine. There are several other books, of course. Read about what lack of sleep leads to and make the fair assessment. And a lot of us are not good at making fair assessments, especially when it comes to our own health, but I think that’s a good starting point. There is certainly enough information now on the web and in books and in media where we can pretty much make a self-assessment. And again, my book talks about how you make that self-assessment.

The other thing is of course, and I think this is a great way to go, and we’re training dentists now to do this, is go see your dentist. Ask your dentist these questions. And if the dentist isn’t trained in that manner, and not all of us are, then I would go to the AADSM website. That’s the American Academy of Dental Sleep Medicine. And of course, there you can just type in your zip code, and they will find you a dentist who is trained. And that’s actually sometimes the quickest way to get information and to get a diagnosis.

And again, I cannot make a referral directly to a sleep lab, but it helps a lot when you have one healthcare professional backing you up and giving you a list of symptoms and signs that this is enough to get a sleep study. I think there’s also a website out there called MySleepDentist.com. I hope I’m remembering that correctly, but that is the website that is associated with the AADSM. But I would start with the AADSM.com. That is a fantastic group of physicians and dentists that are kind of collaborating and making it easy to find out who has sleep apnea and who doesn’t.

DrMR: And tell us the name of your book again and where people can pick that up and where else they might be able to connect with you: a website, podcast, what have you.

DrMB: So Amazon is the best place to get it. You can get it for your Kindle. You can get a paperback printed up. It’s called The 8-Hour Sleep Paradox: How We Are Sleeping Our Way to Fatigue, Disease, and Unhappiness. It’s been out for a year. I get maybe a call once or twice a week from other healthcare professionals, certainly a lot of feedback from patients.

And again, it’s a very simple book. You can read it in about 3 or 4 hours, but this book can really open up a lot of worlds for you that you perhaps didn’t even think about. Like, why am I tired? And it can just answer a lot of questions quickly without having to go see someone and get the runaround and worry about whether insurance covers this or not.

My website is AskTheDentist.com. That talks about dysbiosis and the oral systemic connection. There’s a big focus on that, but also there’s a lot of information on sleep there as well, along with the standard, “What do I do if I need a root canal?” kind of stuff.

DrMR: Sure. Sure. Well, great. This has been a very enlightening call for me, and I absolutely think this is an important area but one that’s really underserved. So I’m excited to actually flip through your book and look more into that and have this as a resource for people. Because like I said a little while ago, this is something where I have my feelers out for it, but I’m not an expert in it. And I haven’t really known where to send someone to get expert advice in this area.

So I love it. I love what you’re doing, and I’m glad that you took the time to put together this information to help people who need it. Because, again, this is kind of like that black box area that isn’t maybe getting the attention that it deserves.

DrMB: Right. There’s a real need for it, and I’m glad it’s out there. It’s helping people. That’s the point, right?

DrMR: Absolutely. Well, Mark, again, thank you so much for your time. I’m sure people are going to love this conversation, and I guess we’ll hopefully stay in touch. And please let me know if there are any major breakthroughs in your field, and we’ll have you back on.

DrMB: Absolutely, Michael. Thanks for having me on the show. I enjoyed it.

DrMR: My pleasure.


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