I Thought My Dad was just another Nervous Patient.....Turns Out he was Fighting for His Life.

carla's clinical pearls general information pedriatic oral health Dec 06, 2021

My Dad came to visit me recently.  He hates the dentist.  And he hates to be reclined.

It’s almost a bit of an in-joke in our industry.  

Some of us have some hilarious passive aggressive comments ready to reply with when “Karen” complains she can’t breathe or feels dizzy when she lies back too far.

After all, it’s a genuine inconvenience to us clinicians who work in awkward positions all day to the get the job done.
But I wanted to share an “Aha!” moment I had last year.

And it happened to me with my Dad.

My father has always disliked the dentist, but I always put it down to a phobia.  Like a lot of patients, at 66 years old, he grew up in an era of dentistry that wasn’t as patient-centric as it is now.  In fact, it was often downright barbaric, especially for children in the 1950s and early 60s.

In the last few years, we’ve noticed that my Dad gets very tired and would often fall asleep while sitting up at family gatherings.

Dad was still working and a few years before, he had came home from work one evening, got out of the car and woke up in the garden….he was diagnosed with a heart condition.  

He also began to complain about his memory and was starting to notice himself forgetting things.

His GP and his heart specialist never once asked him about his sleep.

And I get it.  My dad is not a big guy.  At 74 kg and 170cm, he’s quite fit for an old bloke (soz Dad).   He’s active and when he’s not working, he builds and sells electronic drums online.
My Mum has always been a snorer with headaches on waking and extreme tiredness and I’d finally convinced her to have a sleep test – and yes – she had severe obstructive sleep apnoea.  So she had had nasal surgery and was using a sleep apnoea machine and was doing well.  
But could it be possible that my fit, healthy Dad who DIDN’T snore could have it too?
I finally convinced him to take the sleep test and turns out, he also has SEVERE obstructive sleep apnoea.
Now here are a few important things to understand about my dad:
1. He doesn’t have a thick neck and he’s not overweight
2. He has a broad palate and straight teeth with a history of cracking and breaking teeth and several root canal therapies
3. He is ¼ Chinese 
Did you know that people of Asian descent tend to have more severe obstructive sleep apnea than Caucasians of similar age and BMI?
The findings were the result of a joint study between University researchers in Australia and China published in the August issue of the journal SLEEP in 2010.
 A sample of 74 Caucasian patients from an Australian clinic and 76 Chinese patients from a clinic in Hong Kong underwent a sleep study and a series of physical and x-ray measures. 
OSA prevalence was similar for both populations, but Caucasians with OSA tended to be more overweight with a larger neck circumference. Chinese patients had smaller, more restrictive facial structures. When BMI measurements were similar the Chinese participants suffered from more frequent and severe breathing pauses during sleep.
My Dad’s longest breathing pause on his test was 170 seconds.  
His oxygen saturation dropped to 76% during the night which is determined to be not only severe, but life threatening.
So once the test results came back, I booked him straight in to be fitted for a CPAP machine.  I’m pleased to report that his sleep has improved significantly and he’s feeling much better.
But back to the dental chair….
At Dad’s appointment, I reclined him back.  Immediately he felt like he couldn’t breathe.   I sat him up slightly, made sure his head was above his chest and that seemed to help a lot
And this time, I took a closer look inside his mouth.
Turns out my Dad has a very deep sloping soft palate that covers the whole back of his throat and touches the back of his tongue. 
He has a wide arch but his mid face is fairly flat….in fact, it’s a family feature amongst the males on his side of our family.
And he struggles to breathe in a supine position.
In fact, if you think about it, add to that a whole lot of water and someone doing things in your mouth, it’s possible that it would induce actual panic…..?
It’s made me think – if I had been less dismissive of Dad’s phobia and been more aware of my training in sleep disordered breathing signs and symptoms, perhaps I would have picked up on Dad’s problems a long time ago.
So before you dismiss your patients who 
- don’t like to recline
- those with a significant gag reflex
- or those who feel panic at the dentist
Just dig a little deeper and ask a few more questions.
When a patient says that they can't recline all the way, instead of saying “well how do you sleep then?!” it should be a cue for us to genuinely as the question:
How ARE you actually sleeping? …..and question them about what the quality of that sleep is truly like.
Take a look at soft tissue in the reclined position:
- how much does that tongue fill the mouth?
- Is there much room at the back of the throat?
- is the patient able to nasal breath comfortably?
You could change someone’s life.
As for my Dad, it was right there in front of me along along…..
I just wish I had asked earlier.  
Carla xx

P.S. Click HERE to learn how to screen your patients for sleep/breathing problems in the dental chair.
Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea, Lee, et.al, Sleep 2010 Aug;33(8):1075-80.
 doi: 10.1093/sleep/33.8.1075.
Influence Of Neck Circumference & Bmi On Etiology Of Obstructive Sleep Apnea, Kaur, et. Al, Eurpean Journal Biomedical and Pharmaceutical Sciences, 2016, Volume 3, Issue 10.