Connecting Heads

The Role of Dentistry in Sleep Medicine

August 27, 2016 at 9:25 am Leave a comment

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

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