Uniquely positioned: Honoring the oath we took by screening for sleep-disordered breathing and airway health

Sleep disorders by the numbers

Sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA), is a major public health concern that affects both children and adults and is frequently underdiagnosed. The Children’s Airway First Foundation reports that an estimated 400 million children worldwide have compromised airways, including 11 million children under age 10 in the United States, yet about 95% are never diagnosed.

Children with SDB in the first five years of life have been shown to have about a 40% increased risk of needing special educational support by age 8.¹ In adults, recent estimates suggest that approximately 83.7 million US adults (about 32.4%) have OSA, affecting roughly 34% of men and 17% of women aged 30 to 70 years,² with nearly 80% of cases remaining undiagnosed.³

OSA is associated with significantly increased cardiovascular risk, including about a 140% higher risk of heart failure, 60% higher risk of stroke, and 30% higher risk of coronary heart disease.⁴

Dental hygienists are uniquely positioned to help screen for SBD

Identifying the contributing factors may help prevent SDB and lessen its impact on public health. Dental hygiene science provides the essential foundation for preventive dentistry and medicine, positioning dental hygienists to play a vital role in improving health outcomes.

As an integral part of preventive medicine, comprehensive preventive dentistry depends on the expertise of dental hygienists in prevention, education, and personalized patient care. Screening, one of the dental hygienist’s core strengths, serves as a cornerstone of preventive medicine by detecting diseases in their early, often asymptomatic stages.⁵

The oral cavity is the site of much infectious and inflammatory disease, which has been associated with systemic diseases such as diabetes, cardiovascular disease, and preterm low births.⁶ By focusing on preventing cavities, gum disease, and other oral health problems before they arise, a central responsibility of dental hygienists, they help promote overall oral and systemic health.⁷ Through their unique role in comprehensive preventive care and patient education, dental hygienists can also significantly promote orofacial health that is essential for healthy breathing by supporting the correction and restoration of oral and facial function, thereby enhancing overall well-being.⁸

Additional reading: Overlapping symptoms: Is it poor sleep or ADHD?

During the initial phase of a recall appointment, the dental hygienist can identify potential airway concerns and perform effective screening and timely referral. As dental hygienists carry out their vital responsibilities as primary providers of preventive oral health care, working to promote and improve the oral and airway health of individuals, families, and communities, it is important to reflect on the oath once taken upon graduating from dental hygiene school.

Let’s revisit.

The Dental Hygiene Oath

In my practice as a dental hygienist, I affirm my personal and professional commitment to improve the oral health of the public, to advance the art and science of dental hygiene, and to promote high standards of quality care. I pledge continually to improve my professional knowledge and skills, to render a full measure of service to each patient entrusted to my care, and to uphold the highest standards of professional competence and personal conduct in the interests of the dental hygiene profession and the public it serves.⁹

Patient well-being and ethical practice

The Dental Hygiene Oath is a pledge to improve public oral health, advance the profession, and provide high-quality care. It underscores the importance of continuous learning, dedicated patient service, and maintaining high standards of competence and ethical conduct for the benefit of both the public and the profession.

Rooted in core principles of patient well-being, honesty, and ethical practice, the oath was first formalized and adopted by the ADHA in 1948 and later modernized in 1979 to reflect evolving professional values and responsibilities.

By taking this oath, we pledge our personal and professional dedication to advancing public oral health through lifelong learning, enhanced competence, accountability, and a commitment to delivering comprehensive care to every patient. It stands as a reflection of our shared dedication to improving oral health, advancing dental hygiene science, providing exceptional care, and continually upholding the highest standards of knowledge and ethics.

What’s the call?

Oral health is a vital aspect of overall well-being

Oral health goes beyond the mere absence of disease to include the structural and functional integrity of the oral cavity, supporting healthy breathing and positively influencing sleep health. Growing evidence increasingly emphasizes the strong link between oral health, oral function, and a wide range of systemic conditions.

OSA is a public health concern that requires attention to enhance patient outcomes. All dental hygienists are very much aware of the burden of oral diseases. They are integral in detecting systemic diseases that manifest orally, such as diabetes and cardiovascular disease,¹⁰ and are uniquely positioned within the airway health movement to bridge the gap between dentistry and medicine, serving as catalysts for change within the health-care system.¹¹

Dental hygienists interact with their patients regularly, often multiple times a year, allowing them to observe and monitor subtle changes in airway, breathing, and sleep health over time. This ongoing relationship uniquely positions hygienists to recognize early indicators of airway dysfunction and assist patients in restoring optimal oral function and airway health. In children, early identification can help prevent long-term cognitive, behavioral, and physical challenges¹², while in adults, timely intervention and education can lower the risk of chronic health conditions and potentially save lives.¹³

Dental hygiene, oral health, and airway health

Dental hygiene is an evolving science and profession that contributes significantly to oral health, airway health, and overall well-being in both children and adults. By providing individual care and addressing the public burden of SDB, dental hygienists play a vital role in advancing community health. We uphold a pledge to protect patient welfare, advance the profession and integrate whole-body health into dental and preventive care. This commitment includes continuous learning and professional growth to maintain the highest standards of care. Screening for SDB across all age groups aligns with this professional oath, reflecting the hygienist’s responsibility to promote comprehensive health and well-being.

Identifying and addressing SDB is not only a clinical duty but also a moral and professional extension of this pledge. This practice is consistent with the ADA’s 2017 and 2019 resolutions¹⁴ encouraging dental professionals to screen for sleep-related breathing disorders (SRBDs). As integral members of the oral health-care team, we are uniquely positioned to recognize early indicators of SRBDs and contribute to prevention, early intervention, and improved patient outcomes.

Our profession is guided by core values of continual improvement, accountability, and sincere dedication to patient care. The professional pledge of dental hygiene emphasizes lifelong learning, ethical responsibility, and a holistic approach to health. Through education, collaboration, and prevention-focused care, hygienists help enhance patients’ quality of life and promote optimal health from childhood through adulthood.

Enter the New Year with purpose, answer the call to screen, and serve and save lives.

References

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8. Boggan N. The role of dental hygienists in identifying and treating airway dysfunction. January 7, 2025. https://www.rdhmag.com/pathology/orofacial-myofunctional-disorders/article/55253463/the-role-of-dental-hygienists-in-identifying-and-treating-airway-dysfunction
9. Furnari W. The dental hygiene oath or pledge. Access. July 2012:10.
10. Wilder RS, Bray KS, Mosca NG, Al‐Shammari KF. Improving interdisciplinary collaboration for oral-systemic health.J Dent Hyg. 2016;90(1):45-50.
11. Ahern J. Advancing oral health equity through medical-dental integration: dental hygienists as catalysts for change in an evolving health care system. J Dent Hyg. 2024;98(3):8-12.
12. Gupta S, Sharma R. Pediatric obstructive sleep apnea: diagnostic challenges and management strategies. Cureus. 2024;16(12):e75347. doi:10.7759/cureus.75347
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14. Policy statement on the role of dentistry in the treatment of sleep related breathing disorders (Trans.2017:269; 2019:270). American Dental Association. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/library/oral-health-topics/ada_2019_policy_role_of_dentistry_sleep_related_breathing_disorders.pdf