Why cosmetic dentist Rhonda Kalasho screens patients for sleep apnea at TruGLO Modern Dental.

By Alyx Arnett

Patients walk into Rhonda Kalasho’s cosmetic dental practice with dreams of the perfect smile, but Kalasho frequently spots a problem that could sabotage that quest: teeth grinding

Her expert eye discerns the subtle cues of flattened teeth indicative of nocturnal grinding (bruxism) and sometimes other physical markers, such as large neck circumferences and scalloped tongues, that point to obstructed airways during sleep, alerting her of the need to refer these smile-seeking patients to a sleep specialist.

Nocturnal bruxism and its link to snoring and sleep apnea is often overlooked by patients themselves, but it has become apparent to Kalasho, DDS, CEO of TruGLO Modern Dental, with locations in Beverly Hills, Hollywood, and Calabasas, Calif. Such damage signifies deeper health concerns that, if left untreated, could undermine the very foundation needed for the aesthetic enhancements her cosmetic dentistry patients desire. 

Rhonda Kalasho, DDS, CEO of TruGLO Modern Dental, consults with a patient.

“Sleep apnea patients have very worn down dentition, meaning their back teeth are so worn down that sometimes you can see the inside of the tooth,” she says. 

Bruxism poses a significant challenge for placing veneers or crowns. Capable of exerting up to 250 pounds of pressure,1 such grinding can easily damage or even break dental restorations. “We cannot cosmetically rehabilitate your mouth if you have this problem,” she says. So Kalasho adopts a holistic approach by integrating oral appliance therapy into cosmetic treatment plans and referring patients to sleep specialists, aiming to not only safeguard the dental work but also enhance the patient’s overall well-being. 

Kalasho’s Approach to Dental Wellness

After graduating from UCLA School of Dentistry, Kalasho further honed her expertise through a residency at the University of California San Diego/VA San Diego hospital system. Kalasho went on to work for several practices, from San Diego to Orange County, before becoming CEO of TruGLO in March 2018. Within a few years, TruGLO expanded to three locations.

Kalasho hopes to continue opening TruGLO locations, all while balancing her role as a wife and mother to two young children, ages 1 and 2. “It’s very busy,” she says. 

Since becoming CEO at TruGLO Modern Dental in 2018, Rhonda Kalasho has expanded the practice to three offices across Southern California and aims for further growth.

From TruGLO’s start, Kalasho incorporated dental sleep medicine. Because patients typically come to her for cosmetic work, they’re often surprised when she points out that their teeth show signs of bruxism, which commonly co-occurs with sleep apnea.2 “They have no idea that they do this,” she says. “They’re like, ‘What do you mean my front teeth are broken because I snore?’ It’s very misunderstood.” 

She adds, “When you are not getting enough oxygen, your body is in constant stress. So grinding is usually a parafunction habit that human beings have when they’re stressed.” 

Kalasho will have the patients download a snore monitoring app, typically SnoreLabs or Sleep Cycle – Sleep Tracker, to record their snoring. “I want to see if they are snoring and how many times in a night they’re snoring, what percentage of the night they’re snoring, if they go quiet or just snore,” she says. When the recording shows pauses of quiet, Kalasho sometimes fears that is a sign the patient has stopped breathing. “Those patients are highly recommended to enroll in a sleep study to be diagnosed with sleep apnea,” she says. 

For patients who are returned for simple snoring or because they can’t tolerate CPAP, TruGLO prefers Glidewell’s Silent Nite oral appliance, which has demonstrated efficacy in improving and preventing the effects of snoring and mild to moderate sleep apnea.2 

By subtly advancing the lower jaw, the Silent Nite device addresses the challenges faced by individuals with sleep apnea, whose airway muscles and ligaments are prone to collapse during sleep. “This innovative tool not only alleviates snoring but also addresses the underlying causes of sleep apnea,” says Kalasho.

Fitting Patients With Oral Appliances

TruGLO’s offices incorporate dental technologies, including 5D intraoral scanners and 3D printers, to fit and create oral appliances for patients. The scanners create digital impressions of the patient’s entire mouth, about a 15-minute process, and are used to 3D print the oral appliance. Kalasho also uses cone beam computed tomography in her evaluation. 

Once the patient has an oral appliance for snoring or sleep apnea, Kalasho can perform cosmetic dental procedures without risking damage. Kalasho’s approach is for patients to use the oral appliance before and with their temporary dental work, and upon completing their treatment, they are refit for a device that fits over the permanent work.

Rhonda Kalasho uses 5D intraoral scanners and 3D printers to fit and create oral appliances for patients.

Patients have seen significant benefits from using the oral appliance, according to Kalasho. Recently, a patient’s wife came into the office to bring the staff flowers for fixing her husband’s snoring, Kalasho says. The woman was also fitted for an oral appliance because “now that the man’s not snoring, he’s saying she’s snoring,” Kalasho says. (The SnoreLab app had picked up two snorers during the male patient’s recording.) 

Kalasho has also benefited personally. Her husband was a snorer. She laughs, “I’m such a light sleeper, and I would look at him like, ‘What is going on?’” She found relief for them both by fitting him with a complete set of veneers and an oral appliance. “He sleeps beautifully now. And so do I,” she says. 

Her Instagram page, which boasts 26,000 followers, showcases numerous before and after photos and videos of veneer patients, many of whom also use mandibular advancement devices. “A lot of people are very surprised by how they work, and they like it a lot,” she says.  

Still, she doesn’t romanticize the devices. “There are people who want to throw it out the window, right?” she says. Some patients initially find the appliance uncomfortable and may need time to adjust. She suggests over-the-counter pain medication for the initial nights of discomfort if the jaw’s forward position is an issue.

For those who stick with it, Kalasho says the benefits far exceed the initial discomfort. “I always tell people that after three nights or a week, you’re OK with it,” she says. “You also notice your breathing is better, and the person next to you is happier.” 

A Necessary Approach for Cosmetic Dentistry 

Oral and maxillofacial surgeon David Salehani, DDS, MD, who practices in West Hollywood, Calif, says that integrating dental sleep medicine into cosmetic dentistry is important to the patient’s health and to protect the work.  

He notes that while this integration is more typical in general dentistry, its adoption in cosmetic dentistry is rising. This trend is fueled by an increasing awareness of the underlying causes leading to patients damaging their veneers.

Before and after photos show a patient who is being treated with an oral appliance and had cosmetic veneers placed. The before photo shows damage caused by nocturnal grinding and snoring, says Kalasho.

“The dentists look into what happened. Was it grinding? Why are they grinding? And then they do sleep studies, and they find out that it was the sleep apnea that caused it,” he says.

Salehani has given sleep apnea lectures to his referring doctors since around 2007. “So you know dentists know about it, but does everybody bring it into the practice for cosmetic dentistry? Not everybody does it, but they’re realizing they need to,” he says.  

Salehani has been working with Kalasho for several years, as she refers patients to him. He commends her personally and professionally. “She’s very well-trained. She’s very good in business. She’s one of those women who do everything, and she’s very in-tune with what she does,” he says. 

References

  1. Teeth grinding. Hennessy BJ. Merck Manual Consumer Version. 2024 Jan.Available at https://www.merckmanuals.com/home/mouth-and-dental-disorders/symptoms-of-oral-and-dental-disorders/teeth-grinding.
  2. Martynowicz H, Gac P, Brzecka A, et al. The relationship between sleep bruxism and obstructive sleep apnea based on polysomnographic findings. J Clin Med. 2019 Oct 11;8(10):1653. 

Featured photo: (Left to right) Yalda Rostamnezhad, DDS; Rhonda Kalasho, DDS, CEO of TruGLO Modern Dental; Mary-Ann Khamis, DDS; and Michele Ginsberg, DDS.

Photos courtesy of Rhonda Kalasho