By: Dr. Steven Carstensen

You probably are reading biosignals and making health decisions every day. If you have a FitBit, an Apple Watch, an Oura Ring, a blood pressure cuff or a periodontal probe, you’re sampling biosignals to choose the next step. 

Technology isn’t just our laptops, our digital scanners or our 3D printers. We are in a period of explosive growth in how we can monitor the physiology of the body—what’s going wrong and how our treatments can put the person back to the right course.

As dentists, we are increasingly becoming part of primary care, asked to help manage chronic diseases such as sleep related breathing disorders and periodontal infections that challenge homeostasis. Nutrition choices and breathing function during growth years set people on a health trajectory that dentists can assess early. As we observe and measure growth and function, we can address problems early in life.

Enter biosignals technology. Can you recall when you first heard of the FitBit? The product came out in 2009—we’ve been watching our heart rates and counting our steps for over 15 years now, mostly with vague thoughts of losing weight or improving movement capacity. Worthy goals, but today’s devices provide more sophisticated insights into what’s happening to the wearer.

In September 2024, a ring a little bigger than a wedding band was FDA cleared to provide data sufficient to diagnose obstructive sleep apnea. A tagline the company uses is, “A clinical lab wrapped around your finger.” The list of digital biomarkers is long, the capability of its AI programming to provide insight into physiology is impressive. No longer does the person have to enter a specialized sleep lab, or position a dozen sensors around their whole body, to detect signals common to a disease that can be life-threatening.

Obstructive sleep apnea was discovered in hospitals, and first detailed in specialized labs by sleep doctor scientists who devised new ways to interpret biosignals such as heart rate, airflow, and brain waves to define a new disease. This model served medicine well during the formative years of sleep medicine, but the fact that even the most generous experts concede only about 20% of the people at risk are diagnosed, and the bottleneck is the testing systems, tells us new solutions are necessary. Stanford Sleep Center, the world’s first, was founded in 1970. Today, that center puts people in specialized beds, connects sensors to all parts of their bodies, and measures 20 or so biosignals to assess physiology.

Can a ring on a finger, or other devices with a few more touch points, provide the same data? Mostly the answer is yes, and sometimes the data supplied is even more precise. Certainly, the reports can be crafted to answer more specific questions for the individual patient.

How is this relevant for dentists? Especially those interested in providing sleep breathing therapy, perhaps with a mandibular advancement device? How about the patient in pain that the dentist prescribes an occlusal orthotic? When teeth are moved with clear aligners, does that preserve or improve autonomic system balance? Can leading a patient through a series of nasal breathing exercises improve their ability to resist periodontal disease? These are all questions able to be answered by today’s technology.

For example, mandibular advancement devices to manage an airway collapse during sleep. A patient arrives, diagnosis in hand, of an apnea-hypopnea index of breathing events that indicates treatment is needed. You read the sleep report and note the blood oxygen percentage falls to unhealthy levels, and there are enough arousals during the test night to provide explanations for the patient’s report of “poor quality sleep and excessive daytime sleepiness.” They want your help, and you’re trained to provide it.

The device fitting goes well; during the delivery appointment, the patient asks, “Dr., how will I know this is working?” This is one of the most common questions in all of health care; having a confident answer goes a long way towards acceptance and utilization of any treatment that demands patient cooperation. Many health concerns are silent – e.g., hypoxemia, and require objective measurement to check treatment progress. This is where today’s simplified technology becomes our partner. You can look at the data provided in the original diagnostic test. Are oxygen levels low? Could you suggest measuring overnight oximetry to see if your device therapy has improved that signal? Is sleep quality poor? There are several sensors available—rings, patches on the skin, one that mounts on the chin—that provide reports about sleep fragmentation.

Listening to your patient, examining the diagnostic data available to you, and applying your knowledge to address the specifics is the super power technology provides for dentists every day. It’s how we help physician colleagues manage chronic diseases. Precision medicine means the right treatment for the right patient at the right time. It’s primary care dentistry.

Dr. Steve Carstensen is a diplomate of the American Board of Dental Sleep Medicine and directs sleep education at the Pankey Institute. He volunteers as a Consultant to the ADA for sleep-related breathing disorders and is the Chief Dental Editor of Dental Sleep Practice Magazine. He is on the advisory boards of Respiva and Sharkbiit and is Clinical Education Director for Airway Technologies, Inc.