Tooth loss and sleep apnoea: should you sleep with your dentures in or out?

Obstructive sleep apnoea (OSA) is breathing stopping and starting during sleep because the airway in the throat repeatedly narrows and closes. The symptoms the NHS lists are breathing stopping and starting during sleep, gasping, snorting or choking noises, waking up often and loud snoring; and during the day, constant tiredness, difficulty concentrating, mood changes and headaches on waking. Its severity is measured with the apnoea-hypopnoea index (AHI): how many times per hour of sleep breathing stops or drops markedly. According to the NHS, an AHI of 5–14 counts as mild, 15–30 as moderate and over 30 as severe apnoea.

The teeth, the bone that holds them and the denture on top determine where the tongue and jaw sit inside the mouth. When the teeth have been lost and the denture is taken out, the lower jaw can rotate upwards and backwards during sleep, and the tongue may tend to fall back. In a study in which 48 people with no teeth had their sleep recorded over two nights (Bucca and colleagues, 2006), the air space at the back of the throat was measured on X-rays as narrowing when the dentures were removed. In the same people, the average AHI was 17.4 on the night without dentures and 11.0 on the night with them; the proportion with an AHI above 5 was 48 per cent with dentures and 71 per cent without.

A 2025 systematic review that examined the link between tooth loss and apnoea in 23 clinical studies says that all of the studies found this link, that the severity of apnoea was connected with the extent of tooth loss and the length of time spent without teeth, and that the average AHI in people with no teeth was found to be two to three times higher than in people with teeth. In the same sentence, the review notes that the statistical data for this comparison are scarce, and in its conclusion that the clinical data are limited and were collected with differing methods. These are observational studies: tooth loss and apnoea are seen together, but it has not been proven that tooth loss causes apnoea. Factors that increase both, such as age and weight, come together in the same people.

Studies do not agree on the effect of wearing the denture at night. In Bucca's study, apnoea decreased when people slept with their dentures. A randomised study in a sleep laboratory with 23 older apnoea patients with no teeth (Almeida and colleagues, 2012) found the opposite: the average AHI was 25.9 with dentures and 19.9 without; the difference was greater in those with mild apnoea (16.6 versus 8.9), and the increase was seen mostly when lying on the back. Of the 14 people who preferred to sleep with their dentures, 10 had a higher AHI with them.

In the largest study, 77 older people with no teeth and untreated apnoea slept for 30 nights with their dentures and 30 nights without (Emami and colleagues, 2021). The difference in AHI between the two periods was only 1.0 event per hour and was not significant. The number of breathing-related arousals, however, was on average 2.3 per hour higher with dentures; there was no difference in the questionnaires on daytime sleepiness and sleep quality. The authors interpreted the result as some support for the usual advice to remove dentures at night. A 2024 meta-analysis combining three such randomised trials with 123 participants also found no difference in AHI, sleep quality or daytime sleepiness between sleeping with and without dentures, and said the evidence was not enough to reach a conclusion.

One explanation for this mixed picture may be airway structure, which varies from person to person. An analysis using data from the Emami study found that those whose apnoea got worse when wearing the denture at night differed in certain airway measurements; but this model explained only a small part of the change in AHI. The practical conclusion is this: in one person a denture may reduce apnoea, in another it may increase it, and only a measurement made during sleep shows which. Deciding on the basis of your own observation or your partner's impression can be misleading.

The denture question has another side besides apnoea. The NHS says dentures should not be worn at night unless your dentist advises it, because food debris trapped under them increases the risk of gum infection and decay, and because there is a risk of the denture slipping into the throat during sleep. In a study in Japan in which 524 people aged 85 and over were followed for 3 years, the risk of hospital admission or death due to pneumonia was found to be about 2.4 times higher in those who slept with their dentures; these people had more plaque, fungus and gum inflammation on their tongue and dentures. This is also an observational finding, and in a very elderly group, but it shows that wearing dentures at night is not without cost.

Apnoea itself is also a disease that needs to be taken seriously. The NHS says untreated sleep apnoea increases the risk of high blood pressure, stroke, type 2 diabetes, heart disease, depression and road accidents caused by tiredness. Being overweight, a thick neck, older age, alcohol, smoking and sleeping on your back are also among the risk factors the NHS lists. So for a person with no teeth who snores, the real question is not only what the denture should do at night, but getting the apnoea diagnosed and treated with the right method.

The first list covers situations where the complaint can be explained by how the denture fits or by a problem inside the mouth; for these, see your dentist. If an item from the second list applies to you, dealing only with the denture is not enough; ask your GP (family doctor) for a sleep assessment.

The sequence first separates out an emergency, then moves on to diagnosis, and finally to the denture decision. Making the denture decision with the result of a sleep study is safer than making it by guesswork.

1. 1

   Separating out an emergency

   If a denture or part of one has slipped into your throat and you are having difficulty breathing, call 112. Apnoea itself is not an emergency, but if you nod off while driving during the day, do not get behind the wheel until a diagnosis has been made.

2. 2

   Recording the symptoms

   The NHS says apnoea is hard to recognise yourself and that it helps if someone watches you while you sleep. Have the snoring and pauses in breathing noted over a few nights, both when you sleep with your denture and without it; a sound recording on your phone can also be useful. This record does not make a diagnosis, but it is a good starting point to take to the doctor.

3. 3

   GP and sleep study

   According to the NHS, if your GP suspects apnoea they refer you to a sleep centre, and the test is often done at home with devices that record your breathing and heartbeat through the night. The test shows your AHI and the severity of the apnoea. Tell the doctor that you have no teeth and whether you sleep with or without your denture.

4. 4

   Discussing measurement with and without the denture

   Because in studies the denture's effect varied from person to person, some centres can make the recording both with and without the denture. Ask your sleep doctor whether this can be done for you; comparing two measurements is the most accurate way to make the denture decision.

5. 5

   Treating the apnoea

   The NHS says that in mild apnoea losing weight, sleeping on your side, cutting down on alcohol and not taking sleeping pills unless a doctor recommends them can be enough, while many people need a device called CPAP that pushes air through a mask. Other options include a mouth appliance that holds the lower jaw forward, surgery and a device that stimulates the nerve of the tongue.

6. 6

   Reviewing the denture

   If the denture is loose, worn or the bite height has dropped, the dentist may recommend relining or replacing it. This step does not treat the apnoea, but a well-fitting denture is also needed for an appliance used at night or a CPAP mask to fit.

7. 7

   A long-term dental plan

   If the denture keeps moving or an appliance has nothing to hold on to, implant-supported options may come up. This decision should be made jointly by your sleep doctor and the dentist planning your denture or implants; below we explain why the evidence is limited.

Treating apnoea is the sleep doctor's field; the dentist can be part of that treatment. For some of the options below the evidence is strong, while for others it rests only on case reports.

The following are common wrong decisions on this subject and what they cost.

Timings vary with the person and the treatment chosen. The flow below is a general framework; the plan of your sleep doctor and your dentist takes priority.

1. Referral and first appointment

   Go to your GP with your notes on the symptoms and, if possible, with the person who has seen you sleeping. Mention the medicines you take, your drinking and smoking habits, and whether you sleep with your denture.

2. The night of the sleep study

   The test is often done at home; sometimes you need to stay a night in a clinic. Ask your doctor before the test whether you should sleep with or without your denture. If only one measurement is to be made, sleep the way you always do; if two are possible, one can be made with the denture and one without.

3. Starting treatment

   If CPAP has been started, getting used to the mask can take time in the first weeks. The NHS says the device can feel strange at first but recommends using it every night. If an appliance is being considered, the fit of the denture is checked first.

4. Follow-up and re-measurement

   After an appliance or CPAP has been started, regular check-ups are needed to check its effect and monitor side effects. Re-assessing the apnoea when the denture is renewed or implants are placed also makes sense, because the structure inside the mouth changes.

We do not give a single figure, because managing apnoea in a patient with no teeth requires sleep medicine and dental treatment to be planned together, and the scope varies greatly from person to person. The main items that determine the scope:

Type of sleep study

There is a difference in scope between a test done at home and one done by staying a night in a sleep laboratory; two measurements, with and without the denture, may be needed.

Method of treating the apnoea

CPAP, a custom-made appliance and surgical options each require a different number of appointments and check-ups.

State of the denture

If the denture fits well, a check-up alone may be enough; if it is loose or worn, relining or replacement may be needed.

Whether implants are needed

If an appliance or denture does not hold, an implant-supported solution can be planned; the number of implants and the state of the bone determine the scope.