Identifying specific oral markers during your dental patient exams can help dentists note elevated risks of obstructive sleep apnea (OSA). One of these red flags is the presence of a scalloped tongue.
The scalloped edges may be due in part to swelling, such as in cases of thyroid problems, hypothyroidism, or even dehydration. However, it is vital to note that the overall presence and severity of a scalloped tongue shows a direct correlation with specific types of airway problems. (1) More specifically, it is an easily identified sign of sleep pathology that can be noted during a routine dental checkup.
Other Markers to be Aware Of
Aside from a scalloped tongue, other examples and signs to look for include a neck circumference over 17cm, weight gain, gastroesophageal reflux, hypertension, complaints of a sore throat, or bruxism (due to the body’s struggle to increase oxygenation.) (2)
When an enlarged tongue is evident, the excessive tissues can play a part in blocking the upper portion of the airway when at rest. During sleep, forceful pressure of the tongue against the teeth, or anterior movement (to subconsciously open the airway) along with possible bruxism habits, lead to the indentations along the tongue’s margins. (3)
Next Steps in Patient Treatment
Although many people with snoring or obstructive sleep apnea (OSA) never exhibit signs of tongue scalloping or thyroid problems, dentists should still assess the margins of the tongue routinely to screen for such conditions. If scalloping is noted, ask the patient about their snoring history or any problems they have noticed in regard to their sleeping habits.
Rather than dismissing the scalloping as “something the patient has always had” or walking away convinced that the patient has “nothing that is bothering them,” the dental professional owes it to his or her patient to bring such situations to their attention.
Upon noting such markers, when appropriate, a take home sleep study or referral to the physician (such as when hypothyroidism is suspected) will generally be the next step. Should the physician diagnose obstructive sleep apnea (OSA) based on the sleep study, Continuous Open Airway Therapy (COAT) with the help of a SomnoDent mandibular advancement device can help.
Choosing the Best Oral Sleep Appliance
Understanding the anatomical characteristics that are contributing to your patient’s sleeping disorder is the first step in identifying the proper type of oral appliance necessary. SomnoMed has a variety of oral appliances for sleep apnea and fixed mechanical hinge devices to choose from, including a morning repositioner for next-day recovery.
Because of the lack of space due to an enlarged tongue, only specific oral device models are recommended like the SomnoDent Herbst Advance, SomnoDent SUAD or the SomnoDent SUAD Ultra – these models are Herbst designs and are recommended to allow the patient to have more tongue space. Other oral appliance models may not be as accommodating for limited space.
The next time you see tongue scalloping during a periodic or comprehensive exam, talk to your patient about their sleep history.
1.https://www.researchgate.net/publication/7408923_The_Association_of_Tongue_Scalloping_With_Obstructive_Sleep_Apnea_and_Related_Sleep_Pathology (this is an older reference, so if you feel it’s better, we can take it out)