Dental Sleep Medicine
This column will present the latest treatment techniques and case studies provided by dental professionals who work as part of the health care team using a multidisciplinary approach to the treatment of sleep disorders.
I received a phone call a few weeks ago from a very talented sleep technician/respiratory therapist; I had the pleasure of working with her at one of the sleep centers I am affiliated with. Unfortunately for us, she recently relocated to another part of the country and was calling for some advice. First, she wanted to know how she might interest the physicians in her area in including oral appliances as one of their treatment recommendations for treating sleep disordered breathing. And second, how she might locate a dentist trained in dental sleep medicine to become part of the treatment team.
Finding a dentist trained to work with sleep specialists was the easy part. I directed her to the Academy of Dental Sleep Medicines Web site (www.dentalsleepmed.org), which includes a Find A Dentist feature. Additionally, the site contains useful information that would address many of the questions her patients and colleagues might have regarding oral appliance therapy including a bibliography with the latest research findings from around the world.
Convincing her health care colleagues to include a dental component on the sleep disorder treatment team was a bit more challenging. I suggested she start by sharing her experiences working with me, which is why she had called me in the first place. I then reminded her that stabilizing the airway using mandibular advancement is not a new concept. We use it when we intubate patients and it is the cornerstone of cardiopulmonary resuscitationjaw down and forward, airway first. Oral appliances, in the simplest of terms, are mechanical devices that posture the jaw down and forward in an attempt to compensate for the loss of upper airway muscle tone that occurs with sleep, thereby decreasing its collapsibility. She thanked me for the suggestions and explanation, which gave her some tools to work with.
Dental sleep medicine is not just about oral appliances. Neither is it as simple as advancing the jaw forward as those of you learned who read the article by Don Franz, DDS, in the last issue of Sleep Review. There are many things a dentist can do to assist in managing patients with sleep disordered breathing. Dental surgeons can provide a host of surgical procedures that may benefit some patients. Additionally, for those patients particularly difficult to fit with continuous positive airway pressure (CPAP) masks, a dentist may help by fitting a custom mask or other respiratory interface. Oral appliances can also be used in conjunction with other treatment modalities such as surgery and/or CPAP.
There is no magic bullet or single treatment modality that works for everyone; therefore, we must tailor the treatment to the patients needs and desires. A dentist trained in the treatment of sleep disordered breathing can help.
Don A. Pantino, DDS, is president of the Academy of Dental Sleep Medicine (www.dentalsleepmed.org); is associate clinical professor at the State University School of Dentistry and Medicine at Stony Brook, NY; and is a member of Sleep Reviews Editorial Advisory Board.