Awareness Characteristics Series (Part 1): Steps 7–5 — The Doctor’s Responsibility
Patients often come into a dental office not realizing how a dentist could possibly help with their sleep issues. They may think of sleep apnea or poor sleep as strictly a medical concern, not connected to oral health. That’s why it’s important to guide patients through a structured awareness journey.
In this first part of our series, we’ll focus on Steps 7–5 (Ruin, Effect, Fear of Worsening) — the stages that are the doctor’s responsibility. These steps are about uncovering what the patient doesn’t know, showing them what you see, and helping them understand why it matters.
Step 7: Ruin — Understanding the Problem
Why it matters:
Patients cannot move forward if they don’t first understand what’s wrong. “Ruin” begins by pointing out the signs we can see as dentists — the dental clues that may be linked to airway and sleep disorders.
Dental Clues You Can Show in the Mouth:
• Excessive tooth wear or cracks from bruxism (grinding)
• TMD symptoms such as jaw clicking, popping, or pain
• A high-vaulted palate that reduces tongue space
• Narrow dental arches or crowded teeth
By showing patients these visible clues during their exam, you connect their dental health directly to possible sleep and airway issues.
Screening Next Step:
Once you point out these clues, explain the importance of screening with VivoScore. This at-home sleep test allows patients to see how their airway is affecting their sleep quality and health.
Provider Script:
“I’m noticing some dental signs that often point to sleep or airway issues. For example, your teeth show wear from grinding, and your palate looks quite narrow. These can be indicators that your airway may be restricted at night.
The best way to know if this is affecting your sleep is through a simple at-home screening called VivoScore. You wear a small ring on your finger for a couple of nights, and it measures how well you’re breathing and sleeping. This helps us confirm if what we see in your mouth is linked to your sleep issues. From there, we’ll know the right next steps for your care.”
Step 6: Effect — What the Problem is Causing
Why it matters:
Once patients understand what the problem is, they need to connect it to what the problem is doing. This step helps them recognize that it’s not just about snoring or fatigue — there are broader health implications.
Reviewing the Sleep Screening:
If a screening has been completed and reviewed by a sleep physician:
• Walk the patient through what the diagnosis means (mild, moderate, or severe OSA).
• Highlight concerns such as the Apnea-Hypopnea Index (AHI), oxygen desaturations, or time spent at low oxygen levels.
• Keep your explanation simple and patient-friendly.
How to explain OSA severity:
• Mild OSA (AHI 5–15): “You stop breathing 5–15 times an hour. Even this can affect your health and energy.”
• Moderate OSA (AHI 15–30): “You stop breathing 15–30 times an hour. At this level, the strain on your body is significant.”
• Severe OSA (AHI 30+): “This means more than 30 breathing disruptions every hour — almost once every two minutes.”
Medical Clues to Share
• High blood pressure
• Type 2 diabetes
• Increased risk of stroke or heart disease
• Daytime fatigue, poor focus, or depression
Dental Clues You Can Reinforce:
• Bruxism and cracked/worn teeth
• TMD pain and dysfunction
• High-vaulted palate and narrow dental arches
What to show:
• Their actual sleep test results
• Patient education videos (English or Spanish)
• Intraoral photos or CBCT scans
• Journal highlights on OSA comorbidities
Step 5: Fear of Worsening — What Happens If We Do Nothing
Why it matters:
Awareness peaks when patients realize their condition won’t stay the same — it may worsen without treatment. This is where urgency is created.
What to say:
• “If we don’t treat this, your symptoms will likely continue or get worse, and the risks to your health will increase.”
• “Untreated sleep apnea raises your risk for atrial fibrillation, heart disease, memory loss, and even dementia.”
• “Every night of poor sleep chips away at your health and energy levels.”
• After patients acknowledge the risks, you can add: “I’m sure you don’t want this to happen.”
What to show:
• Side-by-side images of healthy vs. untreated airway
• Sleep study reports showing oxygen desaturation
• Simple health risk progression charts
• Clips from Matthew Walker’s Why We Sleep that highlight cognitive decline and cardiovascular risks from poor sleep
Why These Steps Are the Doctor’s Responsibility
Steps 7–5 are about uncovering what patients cannot see or explain for themselves. The doctor must:
• Identify dental and airway clues
• Provide screening and review results
• Explain risks in clear, relatable terms
• Create urgency by showing what happens if nothing is done
Without the doctor leading here, patients may never connect their dental health to their airway or sleep health.
This is Part 1 of our Awareness Characteristics Series. In this post, we explored Steps 7–5: Ruin, Effect, and Fear of Worsening — the stages that are the doctor’s responsibility. Join us next week for Part 2, where we’ll cover Steps 4 and 3: Need for Change and Demand for Improvement. These steps shift the focus to the patient’s responsibility — how they take ownership of the problem and express a desire for improvement.
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