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“I’ve tried so many diets and none of them work”  How many times have you heard that? Have you said that?  NOW YOU MAY HAVE A SOLUTION.
Lack of sleep is causally connected to many physical problems. We know that from numerous reliable studies.
 Obstructive Sleep Apnea (OSA) is a major cause of sleep loss and one of the common symptoms of (OSA) is being overweight. Sleeping less than six hours, or more than nine hours a night appears to increase the likelihood of weight gain. So then, how does OSA effect weight gain?
There are three hormones that factor in the equation of lack of sleep contributing to weight gain.

1. Ghrelin: the Hunger Hormone

Lack of sleep increases ghrelin, and decreases leptin, both effects influencing increased hunger and obesity. Ghrelin is produced in the gastrointestinal tract and functions as neurotransmitter. When the circadian rhythm is interrupted by exposure to light at night, gherlin is released.

 2.  Leptin: the Anti-hunger Hormone.

Leptin is the satiety hormone that has opposite effects from ghrelin.  The receptor for leptin is found on the same cells in the brain as the receptor for ghrelin.

3. Melatonin

Melatonin maintains the body’s circadian rhythm by regulating the other hormones. The circadian rhythm is an internal 24-hour “clock” that plays a critical role in when we fall asleep and when we wake up. When it is dark, your body produces more melatonin. When it is light, the production of melatonin drops. Being exposed to bright lights in the evening, or too little light during the day, can disrupt the body’s normal melatonin cycles. For example, jet lag, shift work, and poor vision can disrupt melatonin cycles.
Melatonin supplements can be helpful for those who are sleep disadvantaged but adherence to directions is recommended.

melatonin 5-6-15

The Process

An inverse relationship between the hours of sleep and blood concentrations of ghrelin exists: as the hours of sleep increase, ghrelin levels trend lower and obesity is less likely.  Short sleep duration is associated with high levels of ghrelin and obesity.

When the stomach is empty, ghrelin is secreted. When we eat something the stomach is stretched and ghrelin secretion stops. Ghrelin acts to increase hunger and to increase gastric acid secretion and gastrointestinal motility to prepare the body for food intake.

What else does Ghrelin do to effect weight gain?

Beyond regulating hunger, ghrelin also plays a significant role in other systemic functions. Ghrelin influences body composition, it stimulates the release of growth hormone and regulates the distribution and rate of use of energy.

Conclusion

This is just another convincing reason to get adequate healthy sleep…. at the right time. 

Light is the circadian rhythm disrupter. Avoid light disturbances during sleep: have no lights in the bed room, pull the shades down to block any outside light, turn off the TV and computer. Blue light at the end of the spectrum is the most disruptive. When you are ready for sleep, wear an eye mask.

https://adental.files.wordpress.com/2015/06/counting-sheep-a.jpg

1. Mallampati Airway Exam

  

2. Scalloped tongue

During an apnic event the tongue will force itself forward to remove itself as an air-blocking barrier.  Repeated compressions like this, pushing against the teeth, will leave impressions in the lateral edges of the tongue. The patient subconsciously  tries to force the tongue to move forward from the air tract and forces it against the teeth.This sign is readily detectable. This is also called Crenulated Tongue.

This indicator is nearly infallible; it must be differentiated from a similar condition (sign) in  a thyroid disorder.
We are in an excellent position to screen for sleep apnea and to help identify our undiagnosed (and therefore, untreated) OSA patients.
How can you miss these clinical signs?
You…..
• have direct observational access to the physiological structures of your patients’ upper airways
• are already screening chair side for other health conditions that can be easily spotted during a dental visit
• may see these patients more frequently than primary care physicians will, and are nearly one quarter more likely to see a dentist than a physician over any given time period.

Your field of operations is right next to the opening of the airway.

                                  MALLAMPATI EXAM

The Mallampati Scale is a simple but effective test to assess your patient’s (or your own) airway .

The subject should be sitting or standing with their head on a 90 degree axis to the floor. They protrude their tongue (not necessary to say “ahh”) and with a direct light into the  mouth, look in and/ or take a picture.
 
Class III or IV conditions are certain candidates for further testing and possible therapy.
The tongue is the most common factor in Obstructive Sleep Apnea.
Now that you learned this you will probably be heading for a mirror. How did you rate?   
Tracie Harley, RDH was a Super Hygienist. She exuded a contagious passion for helping her patients, and everyone loved her. She was admired for her clinical skills and successful patient compliance. Tracie enjoyed working as an itinerant “temp” hygienist because it gave her the opportunity to meet new dental professionals and learn from them.
 
When COVID-19 set in and dental practices needed to shut down, (Periodontal disease was not classified as an “essential” medical service), Tracie had time to reflect on her future. Her love for dental hygiene was overshadowed by the fear of returning to a risky dangerous occupation. Her concern about contaminated aerosols and the intimate physical contact with unknown strangers made her re-think her future.
 
 
DISAPPOINTMENT IS A SMALL OBSTACLE ON THE ROAD TO SUCCESS
 
That’s when she made the painful decision to investigate other options. She wanted to stay in Dentistry. She spoke with her friend Susan who was working as a Dental Sleep Coordinator in a Sleep Practice. 
 
With the advice of her friend, Tracie took a Sleep Coordinator training course, got placement assistance, became situated in a high value private dental practice and quickly concentrated on screening patients for Sleep Breathing Disorders like Obstructive Sleep Apnea.
 
Within two months of making her decision she was helping the dentist treating patients, on average three each day, for sleep apnea. The average income for each case was $4000. This generated for the office $12,000 a week for three easy, relaxed, rewarding half days a week.  And Tracie‘s income for this was three times greater than before as a hygienist.
 
This may sound like “pie in the sky” but it is a conservative example. When you check around you will find examples like this being quietly conducted all throughout the nation.
 
The happy ending- Tracie stayed on 3 half days a week as the Sleep Coordinator. How is that for a ROI of 6 weeks’ training?
 
If you are interested in getting into this exciting, rewarding, life-saving Dental Sleep Medicine field you may contact me at cskdoc@aol.com for more information

Tracie Harley, RDH was a Super Hygienist. She exuded a contagious passion for helping her patients, and everyone loved her. She was admired for her clinical skills and successful patient compliance. Tracie enjoyed working as an itinerant “temp” hygienist because it gave her the opportunity to meet new dental professionals and learn from them.
When COVID-19 set in and dental practices needed to shut down, (Periodontal disease was not classified as an “essential” medical service), Tracie had time to reflect on her future. Her love for dental hygiene was overshadowed by the fear of returning to a risky dangerous occupation. Her concern about contaminated aerosols and the intimate physical contact with unknown strangers made her re-think her future.


That’s when she made the painful decision to investigate other options. She wanted to stay in Dentistry. She spoke with her friend Susan who was working as a Dental Sleep Coordinator in a Sleep Practice. 
With the advice of her friend, Tracie took a Sleep Coordinator training course, got placement assistance, became situated in a high value private dental practice and quickly concentrated on screening patients for Sleep Breathing Disorders like Obstructive Sleep Apnea.
Within two months of making her decision she was helping the dentist treating patients, on average three each day, for sleep apnea. The average income for each case was $4000. This generated for the office $12,000 a week for three easy, relaxed, rewarding half days a week.  And Tracie‘s income for this was three times greater than before as a hygienist.
This may sound like “pie in the sky” but it is a conservative example. When you check around you will find examples like this being quietly conducted all throughout the nation.


The happy ending- Tracie stayed on 3 half days a week as the Sleep Coordinator. How is that for a ROI of 6 weeks’ training?If you are interested in getting into this exciting, rewarding, life-saving Dental Sleep Medicine field you may contact me at cskdoc@aol.com for more information

SLEEP HARMONY trains energetic, caring people to become highly qualified Sleep Coordinators and assists them to be placed in dental offices where they will screen patients and assist dentists in the treatment of sleep apnea.

This year August 18th was the 100th anniversary of the passage of the 19th Amendment to the U.S. Constitution- heralded as the turning point for women’s voting rights in America.
Textbooks hail the amendment, ratified on August 18, 1920, under President Warren Harding, as a “milestone” guaranteeing voting rights to women.
In 1973, Congress designated August 26, the date the amendment was officially certified, as Women’s Equality Day — honoring, in the words of then-President Richard Nixon, “the first step toward full and equal participation of women in our Nation’s life.”  

The 19th Amendment reads: “the right of citizens of the United States to vote shall not be denied or abridged by the United States or by any state on account of sex.

We know that men are more at risk of developing obstructive sleep apnea. But for women who suffer from OSA the risk of developing cancer is more than your male counterparts, says a recent research published in the European Respiratory Journal. During the study the scientists collected data of 20,000 patients with OSA. It was found that a large per cent of these patients were later diagnosed with cancer.

Researchers analysed data based on age, gender, alcohol consumption, body mass index and smoking. Again, there was a strong association between sleep apnea and higher cancer prevalence. Additionally, the link was stronger in women than men.

How Sleep Apnea Influences Cancer

The studies show that people suffering from sleep-disordered breathing have an increased risk of developing cancer and are up to five times more likely to die from the disease.
Once again the culprit is HYPOXIA. The lack of oxygen (hypoxia) caused by untreated Obstructive Sleep Apnea (OSA) can be a catalyst for a process called neovascularization (the creation of new blood vessels), giving a blood supply that can encourage tumor growth.

Sleep apnea leads to neurochemical imbalances. When poor sleep is the result of any untreated sleep disorder, the neurochemical balance that a whole-body process like sleep requires is disrupted.

 Two of the key hormones that fall out of balance—cortisol and melatonin—are critical for maintaining a healthy immune system (cortisol) and for regulating the body’s circadian system (melatonin). In addition, this neurochemical balance can lead to body-wide (systemic) inflammation.

 

How does this relate to cancer?

  • Without a healthy immune system, the body can struggle to fight off the aggressive cellular behaviors that can lead to tumors.
  • With an imbalance in circadian rhythms as the result of decreased melatonin, the body produces higher amounts of other substances that are risk factors for cancer (for women, higher estrogen can lead to breast cancer, and for men, higher estrogen can lead to prostate, bowel, lung, and bladder cancer).
  • Systemic inflammation causes oxidative stress to the organs. Oxidation is a breakdown of tissues that is the consequence of long-term inflammation; oxidative stress refers to the damage that results from unchecked systemic inflammation, which makes it easier for cancer—an opportunistic disease—to establish itself wherever the body is most vulnerable.

Cancer cells thrive in a low oxygen environment. Hospitals will put a patient on oxygen if their O2 levels drop below 92. Untreated OSA can cause oxygen levels to drop anywhere from the 90’s, 80’s and even in the 50’s.

Sleep apnea causes sustained low blood oxygen. 

One of the biggest problems with sleep apnea is the way in which it deprives the body of necessary oxygen. Frequent apneas (pauses in breathing that last at least 10 seconds, but often last much longer) lead to nocturnal intermittent hypoxia. 

Conclusion

Detecting OSA and leading the way for treatment can add YEARS to a  patient’s lifespan while significantly improving quality of life. Both cancer and OSA have symptoms that can be easily recognized in the chair during a regular checkup. While checking the mouth for masses and swelling, you can also check on the Mallampati score  and be alert to possible concerns you may have. 

                  MALLAMPATI EXAM

 

 More case studies

A 2012 study identified a link between sleep and aggressive breast cancers.  Ref: American Cancer Society 

In 2013, Spanish researchers reported that people with severe sleep apnea had a 65 percent increased risk for cancer. They suggested the risk is associated with increased hypoxia, a condition where the body is deprived of oxygen.

Another study from the University of Wisconsin found people with sleep-disordered breathing are five times more likely to die from cancer than people without sleep apnea. Researchers from the American study admit the study is limited in that there are no studies to compare it with that look at cancer survival in people with sleep apnea.

One recent study reported in the Journal of Sleep Medicine shows moderate and severe cases of sleep apnea are associated with increased cancer risk. That study also showed an increased risk for all “all-cause mortality” and cancer mortality due to cancer. The 20-year study showed that people with moderate to severe cases of sleep apnea are two and a half times more likely to develop cancer and three times more likely to die from cancer. The authors noted these findings confirmed previous research conducted by American and Spanish researchers. 

Animal studies have also confirmed previous findings. One 2014 study  reported in the journal Cancer Research linked sleep apnea with aggressive cancer growth in mouse models. Mice with tumors were placed in low oxygen environments that mimic the effects of sleep apnea and tumor growth in the mice progressed rapidly.

  

Researchers have also suggested a correlation between sleep apnea and increased cancer risk of any kind.   Risk of some cancers may increase. One Cancer study of 1,240 participants who underwent colonoscopies found that those who slept fewer than six hours a night had a 50 percent spike in risk of colorectal adenomas, which can turn malignant over time.
 
Sources: 

American Sleep Apnea Association
Centers for Disease Control
Mayo Clinic
National Institutes of Health
National Sleep Foundation
The New York Times
Wisconsin Cohort Study
World Health Organization

START A CONVERSATION BY MAKING A COMMENT

Your experiences and your skills have made you UNIQUE and you have much to offer your colleagues. We learn from each other.

When you post a comment, your name, your photo, your headline are on display in the messaging string, staying top of mind with your network.
A comment will show your support to the colleague who posted the update in the first place and tightens the relationship between the author and you, building your relationships 1:1.
Algorithms within LinkedIn reward member activity and it’s anyone’s guess how it may boost your personal profile when writing a comment as opposed to a like.
If you’re a seeking a new position, your expertise is on display when you type a comment, demonstrating your value and depth of knowledge as a candidate to a recruiter who has stopped by to read your profile at a later time.
A “like” is shared to your entire network; however, your comment may start a conversation by sharing your expertise to your entire network.
Appreciation to D.B. Wenke
As a women in dentistry I am sure you wondered how your gender compares in statistics like age, income, hours worked, and more. Here are some interesting data followed by fascinating facts

How many dentists are there in the U.S. ?

As of 2019, there are 200,419 dentists working in dentistry (dentists using their dental degree in some fashion) in the U.S. 

Source: Supply of Dentists in the U.S.: 2001-2019

What is the dentist-to-population ratio in the United States?

As of 2019, there are 61.1 dentists working in dentistry per 100,000 U.S. population. Ratios vary by state.

Source: Supply of Dentists in the U.S.: 2001-2019 . 

How many dentists are female?

Among the 200,419 dentists working in dentistry as of 2019, 33.4% are female.

Source: Supply of Dentists in the U.S.: 2001-2019 (Tables in Excel). 

What percentage of dentists are specialists?

As of 2019, about one in five professionally active dentists (21.0%) reported that their practice, research, or administration area is an ADA-recognized specialty.

Source: Supply of Dentists in the U.S.: 2001-2019

Female dentists in the United States are younger than their male colleagues. According to the latest data available, 80 percent are age 44 or under, while more than 60 percent of male dentists are age 45 or older. Compared to their male colleagues, women are less likely to be in solo practices and more likely to be employees or independent contractors. Fifty-three percent of female dentists are solo practitioners compared to 75 percent of male dentists, and 29 percent of women are employees or independent contractors compared to 8 percent of men.4 While this discrepancy is in part a function of age differences, women tend to move more slowly into solo practice arrangements than men.

 Women are somewhat more likely than men to work part-time: 28 percent vs. 15 percent, and are less likely to work overtime: 16 percent vs. 30 percent. A recent study indicated that marital status does not appear to have an impact on work hours among female dentists. However, having children reduces women’s work hours by nearly one workday per week, on average.

Gender differences in income are frequent topics of discussion. According to an ADA survey, nearly two-thirds of female dentists believe that they earn less than their male counterparts, while nearly two-thirds of male dentists believe that there is no gender difference in dentists’ income levels. The existing data, however, indicates that the perceptions of female dentists are more accurate than those of their male colleagues.

A comparison of the average income of all female dentists with the average income of all male dentists is not a useful indicator of income inequality, because, as we have indicated, there are substantial gender differences in practice arrangements and experience among U.S. dentists. Still, when comparing the average net annual income of full-time male and female practitioners who have been out of dental school less than 10 years, women earned only 64 percent of what men earn. Additionally, among dentists in all age groups, women who were partners or who were in solo practice only earned 58 percent and 73 percent, respectively, of what men earned in the same practice arrangements. Women as employees only earned 47 percent of what men earn as dental practice employees. 

THE TREND

Women in the pipeline

The number of women in the pipeline for a career in dentistry has grown dramatically over the last 30 years. Enrollment of women in U.S. dental schools stands at 48 percent;  in 1970, only 1 percent of dental students were women. 

in an analysis of the first-year data, we found that students’ motives for attending dental school appeared to be organized into four distinct areas.   The first cluster focused on money issues, and reflected the importance of financial and job security aspects of a dental career to students.  The second cluster was a set of people-related motives. Students who gave high ratings to these motives thought that caring for and helping other people were important reasons for attending dental school.The third cluster centered on the notion of flexibility, and suggested that the freedom and flexibility that dentists have in scheduling their work relative to other professions, both health-care-related and otherwise, is important to dental students. The fourth cluster focused on business-related motives for becoming a dentist, and the degree to which students stressed self-employment and being one’s own boss as important reasons for pursuing a dental career.

Our data showed that both women and men found the financial aspects of a dental career equally important as a motive for attending dental school. The perceived flexibility of a dental career was also equally important to both men and women. On the other hand, male students rated business-related motives as being more important in their decision to pursue dental school than did female students. Conversely, female students rated caring or helping motives as more important than did their male counterparts.

When asked about their aspirations following dental school, significant gender differences among first-year students emerged. Despite the fact that first-year students are not likely to have a great deal of in-depth knowledge about dental specialties, with the exception of pediatric dentistry, women were less likely to aspire to postgraduate dental education than men. In fact, the most significant predictor of postgraduate educational aspirations among first-year students was gender. Furthermore, compared to men, women were less likely to see themselves in a solo practice following graduation and more likely to see themselves as an employee or associate in a dental practice.

 CONCLUSION

The trends show an ever improving picture in all categories for women in dentistry.