Archive for August, 2016
Let’s Talk About Some Good News
Article for “Cranio UK” journal – June 2016 (British Society for the Study of Cranio-Mandibular Disorders)
For a considerable number of years dentistry has been sidelined from medicine and practitioners have focused almost exclusively on structures within the oral cavity. However there are some signs that this may be about to change. The subject of Obstructive Sleep Apnoea is now appearing regularly on conference programmes and special hospital clinics for sleep disorders are being set up and manned by dentists. One example is the Sleep Disorders Centre at Guy’s Hospital which provides mandibular-repositioning splints and is run by Professor Mark Woolford, director of Education at King’s Dental Institute.
Our patients will gain the most benefit when there is co-operation and understanding between all health workers and that includes Osteopaths, Chiropractors, Cranial and other complementary therapists.
The list of interdisciplinary societies is growing. I have listed a number of these on my blog roll on www.connectingheads.com eg: the Academy of Clinical Sleep Disorders Disciplines, the American Academy of Physiological Medicine & Dentistry, the Australian Academy of Dental Sleep Medicine, the International Academy of Biological Dentistry & Medicine. All these academies set out to provide a platform for interdisciplinary discussion with an holistic approach to treating patients. They seek to find the cause as opposed to only addressing the symptoms.
Last year I was invited by the Dean of King’s Dental Institute, Professor Dianne Rekow, to give a presentation to final year dental students at Guy’s Campus. The title was to be “Beyond BDS” and I chose the sub-title “Exploring the Wider Role of Dentistry”. Professor Woolford said that the students had “found it useful” and I was invited back this May. Again it was captured on video. I have already been given a date for 2017! I know that Professor Rekow has a special interest in integrating medicine & dentistry and I hope that will be reflected in the undergraduate curriculum at some time in the near future.
We should be encouraging young practitioners of all disciplines to enhance their knowledge in this wider field and not be intimidated by the so-called lack of Evidence Based Research.
The American Dental Association defines evidence based dentistry as:
“An approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences.”
This has been endorsed by Professor Kevin O’Brien in his blog of March 7, 2017 entitled “Evidence based orthodontics is not as straightforward as it seems…”. In his summary he states “My general feeling is that we should base our treatments on the evidence when it is there. When it is absent, we need to accept that our treatment is based mostly on clinical experience and other sources and we need to explain this to our patients. When we do this we are practising evidence-based orthodontics.”
The Role of Dentistry in Sleep Medicine
Article for “Cranio UK” journal – December 2015 (British Society for the Study of Cranio-Mandibular Disorders)
Patients have benefited greatly from the advances in cosmetic dentistry and implant surgery. So what’s next? In recent years there has been a growing interest in Sleep Dentistry and the role that dentists can have in improving the airway.
The spiralling increase in sleep disorders & associated problems has lead to a questioning of how these could be prevented and how best to treat established conditions. Nasal breathing has long been accepted as being far more efficient than mouth breathing. Functional orthodontists have, for many years, been aware of the useful role that they can play but this has not been accepted in more traditional circles. At the present time there is no robust data, however clinical experience does support changes in the airway.
The cause of malocclusion is, as yet, unknown and is almost certainly multi-factorial. Yet there are some factors which are common to most cases of crowding. These are a small maxilla and a retrognathic mandible. Developing the maxilla results in an improved nasal airway and correcting the mandible opens up the restricted pharyngeal airway.
At this point I would like to refer you to a video link on YouTube:
“Before and after IMDO jaw and facial distraction surgery explained.”
https://www.youtube.com/watch?v=tGbWQZ2W1vw
Dr Paul Coceancig, an oral surgeon in Sydney, has produced these 3D images which demonstrate graphically the changes that take place when this treatment is carried out. Functional orthodontists would prefer a slower method for developing the maxilla and employ functional appliances rather than surgery for mandibular correction. Nevertheless, the end goal is the same and results in these changes in airway and head posture.
So how could this knowledge alter what we, as dentists, do on a day to day basis. It is becoming evident that we need to be less tooth orientated and begin to look at our patients more holistically. We need to establish collaboration with other specialities, for example: paediatrics, ENT, Cranial Osteopaths and other body workers. We can give advice to mothers about the role of cranial osteopathy in the early years, the benefits of breast feeding, limiting pureed food, and monitoring breathing patterns in our young patients. The American Association of Sleep Medicine and the American Association of Dental Sleep Medicine have now issued a new guideline which supports increased teamwork between physicians and dentists to achieve optimal treatment for patients.
In most areas of dentistry and medicine once a problem has been diagnosed treatment is initiated. Not so in orthodontics –treatment is often delayed for several years. Traditionally, orthodontic treatment is initiated once most of the permanent teeth have erupted so that fixed appliances can be fitted. However, if patients are showing signs & symptoms earlier surely it would be better not to delay treatment. There are now a whole range of appliances that can be used as an alternative to fixed braces. For example, Myobrace trainers, the ALF (Advanced Lightwire Functional) and Biobloc (Orthotropics) can all be fitted at a younger age. Our challenge now is to inform the public about this new approach to treating malocclusion and airway/sleep disorders and to establish better collaboration with other disciplines.
See: https://www.linkedin.com/pulse/orthodontic-airway-roundtable-barry-raphael
Connecting Heads 