What Your Dentist Can See That Your Doctor Might Miss: Sleep Apnoea and Your Mouth

You are exhausted during the day. Your partner complains about your snoring. You wake up with headaches and a dry mouth. You have been told you are a light sleeper or that you seem to stop breathing briefly during the night.

If this sounds familiar, you may have obstructive sleep apnoea (OSA) — one of the most underdiagnosed medical conditions in South Africa. And increasingly, the dental surgery is where it is first identified.

At Smilez Dental Surgery, we have the training and tools to recognise the oral signs of sleep apnoea, and we want every patient to understand this connection — because OSA is not just a sleeping problem. Left untreated, it is a significant risk factor for hypertension, heart disease, stroke, and type 2 diabetes.

What Is Obstructive Sleep Apnoea?

OSA occurs when the soft tissues at the back of the throat — including the tongue, soft palate, and uvula — relax too much during sleep and partially or completely block the airway. Breathing stops repeatedly throughout the night, each pause (called an apnoea) lasting from a few seconds to over a minute.

Each time the airway is blocked, the brain detects the oxygen drop and partially wakes the sleeper to restore breathing. Most people with OSA have no memory of these micro-arousals — but they prevent deep, restorative sleep and leave the body under chronic physiological stress.

OSA affects an estimated 4 to 10 percent of South African adults, with men and people who are overweight or obese disproportionately affected. However, slim, young women also develop OSA — it is not only a condition of older, overweight men.

What We See in the Mouth

Several oral findings strongly suggest OSA and prompt us to raise the question with our patients:

Severe teeth grinding (bruxism) — particularly the type associated with a clenched, pushed-forward jaw — is strongly associated with OSA. The brain uses jaw repositioning as one of its strategies for maintaining airway patency during sleep.

Scalloped tongue edges — indentations along the sides of the tongue from where it presses against the teeth during sleep — suggest the tongue is falling back and partially obstructing the airway.

Mouth breathing signs include an extremely dry mouth on waking, cracked lips, and increased rates of tooth decay and gum disease (since saliva flow is reduced when breathing through the mouth).

Redness and irritation at the back of the throat, visible on oral examination, can suggest the tissue vibration and airway restriction associated with snoring and OSA.

Worn teeth from chronic bruxism — particularly on the biting surfaces of the front teeth — in a patient who snores is a significant combined finding.

The Dental Treatment for Mild to Moderate OSA

For patients with mild to moderate OSA, or for those with severe OSA who cannot tolerate CPAP (the standard medical treatment), a mandibular advancement device (MAD) — also called an oral sleep appliance — is a highly effective alternative.

A MAD is a custom-fitted oral appliance, similar in appearance to a sports mouth guard, that repositions the lower jaw slightly forward during sleep. This prevents the tongue and soft tissues from falling back and blocking the airway, maintaining an open passage for breathing.

Clinical evidence strongly supports MADs as an effective treatment for mild to moderate OSA, with many patients reporting equivalent or superior sleep quality compared to CPAP — and significantly better compliance because the device is comfortable and easy to use.

A MAD is made at the dental surgery following a proper assessment and, where appropriate, collaboration with a sleep physician who confirms the diagnosis and severity.

OSA, Teeth Grinding, and the Night Guard Question

This is an important nuance we want patients to understand: if teeth grinding (bruxism) is driven by OSA, a standard night guard — while protecting the teeth — does not address the underlying airway problem. In some cases, a traditional night guard can even worsen OSA by further restricting the already compromised airway.

This is why we always ask about sleep quality, snoring, and daytime fatigue during our assessment of teeth grinding patients. When OSA is suspected, we may recommend a proper sleep study before deciding on the most appropriate appliance.

The Broader Health Picture

OSA is estimated to double the risk of hypertension and significantly increase the risk of heart attack, stroke, and type 2 diabetes through the mechanisms of chronic sleep deprivation, intermittent oxygen drops, and the systemic inflammation it produces.

In South Africa, where cardiovascular disease and diabetes are leading causes of death, untreated sleep apnoea is a quietly devastating contributor to disease burden. Finding and treating it early — even through a dental consultation — can meaningfully change a patient's long-term health trajectory.

Should You Be Screened?

If you snore regularly, wake with headaches or a dry mouth, feel unrefreshed despite what seems like adequate sleep, or have been told you stop breathing during the night, please mention this at your next dental appointment. We can do a preliminary assessment, discuss your symptoms, and refer you appropriately for formal sleep testing if indicated.

Your dental surgery may not be the first place you expect to receive a potentially life-changing health insight — but increasingly, it is exactly where that happens.

Ready to take control of your oral health? Contact Smilez Dental Surgery today at 013 692 8249 or visit us at Tasbetpark Center, 8 Boekenout Street, Shop no.3, Witbank. We're your partner in building a healthier, happier smile.