Bruxism, sleep apnea and airway

Obstructive sleep apnea (OSA) and sleep-disordered breathing are systemic conditions with serious downstream effects: hypertension, cardiovascular risk, cognitive decline, chronic fatigue, bruxism, temporomandibular pain, and in children, altered facial growth. Dentistry plays a central role in early diagnosis and in a meaningful share of treatment. At AS Odontología Digital in Vitacura, airway evaluation is part of every patient's clinical workup, and we treat with evidence-based oral appliances in coordination with pulmonology and sleep medicine when the case requires it.

The first step is recognizing signals most patients don't know are dentally relevant: habitual snoring, waking with choking sensation, daytime sleepiness despite adequate sleep, jaw pain on waking, morning headaches, nocturnal bruxism, dry mouth on rising, or reflux. In consultation we evaluate orofacial anatomy (Mallampati score, tongue position, tonsil size), breathing pattern, bruxism signs, and bite. When indicated, we refer for a sleep study (polysomnography) to confirm diagnosis and grade severity.

Our primary tool in dental sleep medicine is the mandibular advancement device (MAD), an intraoral appliance custom-fitted to advance the mandible slightly during sleep, opening the upper airway. Modern MADs are fabricated with intraoral scanning and digital design: precise fit, comfortable thermoplastic materials, titratable advancement mechanisms. Clinical evidence supports their use in mild to moderate apnea, in severe apnea patients who cannot tolerate CPAP, and as an adjunct in selected cases.

In severe apnea or with clear clinical indication, CPAP remains the gold standard. But CPAP adherence is notoriously low: many patients abandon it within months. That's where MAD becomes the most-used alternative, with significantly higher adherence rates and documented clinical efficacy. The decision between CPAP, MAD, or combined therapy is made clinically, considering the apnea-hypopnea index (AHI), individual anatomy, and patient preference.

Primary snoring without apnea is also treated with MAD when the patient's or partner's sleep quality is affected. While less serious than OSA, habitual snoring can be the first sign of an evolving respiratory disorder and always justifies a complete airway evaluation.

In pediatric dentistry, the dentist's role in airway is even more critical. A child who breathes through the mouth or snores chronically may be developing an altered facial pattern: narrow palate, crossbite, malposed tongue, retrognathia. Detecting it early enables intervention with maxillary expansion, functional orthopedics, and when appropriate, referral to ENT for adenoid or tonsillar hypertrophy. The window of opportunity is narrow: what can be corrected at age 6 to 9 is much harder to reverse in adolescence or adulthood.

Sleep bruxism and obstructive sleep apnea are clinically connected. Nocturnal masticatory muscle hyperactivity can be a response to microarousals caused by apneic episodes. So when we see severe bruxism, we evaluate the airway systematically. Treating bruxism alone with a conventional splint, without investigating the underlying cause, can leave the central problem unaddressed.

Our approach integrates dental sleep medicine with digital dentistry and sleep medicine itself. We use cone-beam CT (CBCT) for three-dimensional upper airway analysis, intraoral scanning for digital appliance design, and coordinated referral with pulmonologists and ENT specialists when the case demands a multidisciplinary approach. Airway evaluation is part of the academic standard we apply as NYU College of Dentistry faculty: a mouth cannot be understood without understanding breathing.