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Journal of Dental Sleep Medicine Official Publication of the American Academy of Dental Sleep Medicine | ISSN 2333-9756 Journal of Dental Sleep Medicine Official Publication of the American Academy of Dental Sleep Medicine | www.jdsm.org Volume 3, Number 3 In This Issue July 10, 2016 Pages 77–106 A Little Knowledge Is a Dangerous Thing Dort Differences in Volume and Area of the Upper Airways in Children with OSA Compared to a Healthy Group Rossi, Rossi, Filho, Rossi, Chilvarquer, Fujita, Pignatari Correction of Severe Obstructive Sleep Apnea Syndrome with Interdisciplinary Medical and Dental Treatment Planning Yousefian Abstracts of the 25th Anniversary Meeting of the American Academy of Dental Sleep Medicine: Denver, CO, June 9–11, 2016 Official Publication of the American Academy of Dental Sleep Medicine Journal of Dental Sleep Medicine Volume 3, Number 3 | July 10, 2016 | Pages 77–106 Editor-in-Chief Editorial Board Leslie Dort, DDS Ghizlane Aarab, DDS, PhD Peter Cistulli, MD, PhD Deputy Editor Greg Essick, DDS, PhD Olivier Vanderveken, MD, PhD Bernard Fleury, MD Nelly Huynh, PhD Associate Editors Sam Kuna, MD Fernanda Almeida, DDS, PhD Chris Lettieri, MD Gilles Lavigne, DMD, PhD Frank Lobbezoo, DDS, PhD Rose Sheats, DMD Marie Marklund, DDS, PhD Jean-Francois Masse, DMD, MSc Executive Director Antonio Romero-Garcia, DDS, PhD Jerome A. Barrett Kate Sutherland, BSc(Hons), PhD Satoru Tsuiki, DDS, PhD Managing Editor Andrew Miller Journal of Dental Sleep Medicine (JDSM) (Online whole articles or any parts of works, figures or DISCLAIMER: The statements and opinions 2333-9756; Website: www.jdsm.org) is published tables published in JDSM must be obtained prior to contained in editorials and articles in this journal online quarterly on the 10th of January, April, publication. Permission for republication must be are solely those of the authors thereof and not of July and October by the American Academy of arranged through the Copyright Clearance Center, the American Academy of Dental Sleep Medicine, Dental Sleep Medicine, 2510 North Frontage Road, Inc., 222 Rosewood Drive, Danvers, MA 01923, or of its officers, regents, members or employees. Darien, IL 60561-1511, phone (630) 737-9705 and phone (978) 750-8400 or fax (978) 646-8600 or The Editor-in-Chief, the American Academy of fax (630) 737-9790. URL http://www.copyright.com. There are royalty Dental Sleep Medicine and its officers, regents, fees associated with such permissions. members and employees disclaim all responsibility ADVERTISING: Digital advertising is available on www.jdsm.org. Please contact the National Sales for any injury to persons or property resulting REPRINTS: For author reprints contact the Account Executive at [email protected] for from any ideas or products referred to in articles complete information. AADSM office. For commercial reprint orders contained in this journal. contact Cenveo Publisher Services, 4810 PERMISSION TO REPRODUCE: Written Williamsburg Road, #2, Hurlock, MD 21643 or © 2016 American Academy of Dental Sleep permission to reproduce, in print or electronically, [email protected]. Medicine Table of Contents Vol. 3, No. 3 EDITORIALS ABSTRACTS 79 93 A Little Knowledge Is a Dangerous Thing 25th Anniversary Meeting of the American Academy Leslie C. Dort of Dental Sleep Medicine: Denver, CO, June 9–11, 2016 ORIGINAL ARTICLES NEWS AND UPDATES 81 Differences in Volume and Area of the Upper 103 Airways in Children with OSA Compared to a AADSM News and Updates Healthy Group Leila Chahine, Don Farquhar, James Hogg, Sheri Katz, Rosa Carrieri Rossi, Nelson José Rossi, Katherine Phillips, Kevin Postol, Thomas Schell, Edson Illipront Filho, Nelson José Carrieri Rossi, Rose Sheats, AADSM Staff Israel Chilvarquer, Reginaldo Raimundo Fujita, Shirley Shizue Nagata Pignatari CASE REPORTS 89 Correction of Severe Obstructive Sleep Apnea Syndrome with Interdisciplinary Medical and Dental Treatment Planning Joseph Z. Yousefian Instructions to authors are available online at www.jdsm.org JDSM EDITORIALS http://dx.doi.org/10.15331/jdsm.5990 A Little Knowledge Is a Dangerous Thing Leslie C. Dort, DDS, Diplomate, ABDSM, Editor-in-Chief Journal of Dental Sleep Medicine Calgary, Alberta, Canada The new guidelines for the use of oral appliances in the treat- only severe OSA symptom-snoring. He may have sustained ment of obstructive sleep apnea discuss for the first time the irreversible end-organ damage as a result of years of inad- minimum required to be considered a “qualified dentist.” 1 equate treatment. There is a failure of the dentist to understand The “qualified dentist” designation is intended to be a the need for treatment outcome assessment and the lack of minimum standard. The “qualified dentist” definition also correlation between snoring control and apnea control. There limits the type of institution/educator that is considered is a failure to communicate with the physicians. This failure eligible to provide “qualified dentist” continuing education is very possibly due to poor education. The dentist who made credits. The expectation is that the education will adhere to the monobloc very likely didn’t understand the negative conse- the guidelines in the critical areas of diagnosis, treatment and quences of replacing CPAP with an inadequate OA. The “quali- outcome assessment. fied dentist” designation evolved with the goal of providing Recently, a patient whose management highlighted the need basic training in clinical care paths, physician-dentist commu- for “qualified dentists” presented to a clinic. nications system well as OA fabrication. His cardiologist referred him for “assessment of existing There are other gaps here as well. Where was the follow up oral appliance.” The patient was a 70 year old male, BMI = 36, of the CPAP provider, of the sleep physician and the primary neck circumference = 45 cm, currently treated for hyperten- care physician? sion and GERD and undergoing investigation for ischemic A qualified dentist providing OA therapy according to cardiac disease. He had reportedly gained 15 lbs in the past two the recent guidelines is a leading example of state-of-the-art years. He had a cleft palate repair as a child but had no present care. Let us hope for the benefit of patients that all health care limitations to eating, drinking or speaking due to the repair. providers involved in OSA therapy continue to improve basic The patient had been diagnosed with severe obstructive sleep standards of care. apnea (OSA) several years previously. His chief complaint had been snoring without daytime symptoms. He had been tolerant CITATION of CPAP. He had been using a chin strap with his CPAP. He developed tenderness in his TMJ’s and sought advice from his Dort LC. A little knowledge is a dangerous thing. Journal of family dentist. His dentist reportedly pronounced the CPAP Dental Sleep Medicine 2016;3(3):79. and chin strap responsible for the TMJ soreness and without consulting the sleep physician recommended discontinuation of CPAP and fabricated a custom-made, monobloc oral appli- REFERENCES ance (OA). The OA controlled snoring. The patient’s wife was 1. Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the satisfied and no further evaluation was conducted. treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. Journal of Dental Sleep Medicine The cardiologist now investigating the patient’s cardiac 2015;2:71–125. concerns ordered a home sleep test (HST) to assess treatment effectiveness. The patient’s only concern was an increase in disruptive snoring. His Epworth Sleepiness Scale (ESS) was SUBMISSION & CORRESPONDENCE 5/24 and his Calgary Sleep Apnea Quality of Life (SAQLI) was INFORMATION 5.40. An HST was conducted while wearing the monobloc Submitted for publication June, 2016 OA. The respiratory disturbance index (RDI) was 34 events/ Accepted for publication June, 2016 hour (patient slept primarily in the lateral position). The mean Address correspondence to: Leslie C. Dort, DDS, 1016-68th Ave SW, Suite 150, Calgary, AB T2V 4J2, Canada; Tel: (403) 202-4905; Fax: oxygen saturation was 86%. The lowest oxygen saturation (403)202-0266; Email: [email protected] recorded was 76%. The patient spent 92% of the recording time below an oxygen saturation of 90% and 12% of the time below 85% oxygen saturation. DISCLOSURE STATEMENT This patient has not been given quality treatment. He has Dr. Dort is Editor-in-Chief of Journal of Dental Sleep Medicine. been using an oral appliance that likely has only masked his Journal of Dental Sleep Medicine 79 Vol. 3, No. 3, 2016 JDSM ORIGINAL ARTICLES http://dx.doi.org/10.15331/jdsm.5992 Differences in Volume and Area of the Upper Airways in Children with OSA Compared to a Healthy Group Rosa Carrieri Rossi, DDS, PhD1; Nelson José Rossi, DDS, PhD2; Edson Illipront Filho, DDS, PhD3; Nelson José Carrieri Rossi, DDs, MS4; Israel Chilvarquer, DDS, PhD5; Reginaldo Raimundo Fujita6; Shirley Shizue Nagata Pignatari, MD, PhD6 1Division of Pediatric Otolaryngology, Department of Otolaryngology and Head and Neck Surgery, Federal University of Sao Paulo-UNIFESP Brasil; 2Postgraduate of Orthodontics ,Educational Association of Brazil-FUNORTE/SOEBRAS; 3Division of Radiology, Sao Paulo State University-USP; 4Postgraduate of Orthodontics, Educational Association of Brazil-FUNORTE/SOEBRAS; 5Division of Radiology, Sao Paulo State University-USP; 6Division of Pediatric Otolaryngology, Department of Otolaryngology and Head and Neck Surgery, Federal University of Sao Paulo-UNIFESP Brasil Study Objectives: The cause of obstructive sleep apnea in children is not fully known.
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