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Home , Sleep hygiene, Somnology

The Dentists Role in Breathing Disorders

Kenneth A. Mogell, DMD, ABDSM April 8, 2017 www.fldsd.com [email protected]

By PresenterMedia.com

Technology in Dentistry

Technology for Screening for Sleep Breathing Disorders?

ShouldWhat should we have our arole role? be? THE NEED FOR EDUCATION ABOUT SBD’s

“Few health professionals receive adequate training in and .... At a minimum, medical students need basic training in sleep disorders, as do pharmacy, public health. DENTISTRY, and nursing students. This training should cover the public health burden of sleep loss and sleep disorders and the importance of diagnosis and treatment throughout the life span.”

Colten HR, and Altevogt BM, editors. Sleep disorders and : an unmet public health problem. Committee on Sleep Medicine and Research, Board on Health Sciences Policy; The National Academies Press: Washington, DC. 2006 American Dental Association (ADA) Proposed Policy Statement on the Role of Dentistry in the Treatment of Sleep-Related Breathing Disorders. March 2017

Some of the numbers…

•As many as 50% of adults snore

•1 in 15 Americans affected by OSA

•Less than 10% of OSA sufferers have been diagnosed

•Of those diagnosed, less than 25% have been successfully treated. Obesity is the dominant factor in 50% of cases Left Untreated

• High blood pressure • Heart Attacks • Stroke • Obesity • Diabetes • Heart Failure • Arrhythmias • Work Related or Driving Accidents

Heavy as a Cause of Carotid Artery Atherosclerosis Lee et al. Journal of Sleep Volume 31, Issue 09

Conclusions: Heavy snoring significantly increases the risk of carotid atherosclerosis

Obstructive

Must be diagnosed by a physician

With a …

POLYSOMNOGRAPH

APNEA

Abnormal pauses in breathing while asleep for at least 10 seconds or more! HYPOPNEA Your airway is partially blocked reducing airflow with at least a 3% drop in blood oxygen levels! Apnea + Hypopnea= AHI

Apnea Hypopnea Index

0-5 Nor mal 5-15 mild 15-30 moderate 30+ severe

MANAGING

CPAP Oral Appliances Surgery Sleep C PA P Continuous Positive Air Pressure

SURGICAL MANAGEMENT

Mandibular Advancement Devices DO THEY ACTUAL PERFORM AS DESIGNED?

306 patients with moderate to severe OSA completed the sequence of having a diagnostic PSG and a follow-up titration PSG to verify and maximize the efficacy of the MAD.

The average diagnostic PSG showed an AHI of 36.3/hour. The average AHI after appropriately titrating the device during the PSG was 10.7/hour Concer ns about using an Oral Appliance

Occlusal Changes Jaw Pain/Discomfort Tooth Pain/Discomfort Occlusal changes can occur with mandibular advancement devices

Most changes of a minor nature

Little concern to the patients

Routine regular dental reviews with ongoing treatment are advised Which Appliance Should I Use?

Where to begin? The 4 Questions •Do you snore?

•Do you have high blood pressure?

•Has anyone reported that you choke or gasp for air while sleeping?

•What is your neck size? men > 17 women > 15 ½ You WILL uncover severe apnea that is considered imminently life threatening.

Without treatment, these patients simply may not survive

How many of your patients have died of a heart attack or stroke?

What IF someone had identified their underlying sleep apnea condition? The number of undiagnosed patients with OSA is far too large of a public heath concern to not have dentists included in the overall health screening and treatment of these patients

Every practice here should immediately start screening your patients for signs and symptoms of OSA. www.fldsd.com [email protected]