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Sleep disorders dentistry


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This presentation outlines sleep dentistry whiten the context of sleep medicine. Dr John Viviano DDS prepared this presentation to educate and encourage local dentists interested in the practice of …

This presentation outlines sleep dentistry whiten the context of sleep medicine. Dr John Viviano DDS prepared this presentation to educate and encourage local dentists interested in the practice of Sleep Disorders Dentistry

Published in: Health & Medicine, Business

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  • 1. What is… Sleep Disorders Dentistry John Viviano BSc DDS D ABDSM
  • 2. Sleep Disorders Dentistry… … the treatment of “Sleep Disordered Breathing” Eg. Snoring, Sleep Apnea, UARS Sleep Disordered Breathing is... STILL often ignored by Primary Medical Care Associated with Major Health Consequences Dentists are... ideally positioned to screen / refer / treat these disorders
  • 3. Yearly Cost to Society (USA): Approaching $200 Billion Sleep Disorders Dentistry…
  • 4. Sleep Disorders Dentistry…
  • 5. Sleep Apnea found in…Sleep Apnea found in… … 4% of men and 2% of Women (Age 40) … Increases with each decade of life … Higher in certain high risk groups …78% of Long Distance Truck Drivers …Highest on-the-job mortality of all professions Snoring found in…Snoring found in… … 40% of men and 20% of women … Increases with each decade Sleep Disorders Dentistry…
  • 6. With “Sleep Disordered Breathing”… The airway narrows or collapses Interfering with breathing during sleep Occurs at various levels of the airway Net Result… Snoring  Soft Tissue Vibration  Soft Palate, Uvula, Tongue, Airway Walls etc Sleep Apnea  Airway Narrows or Collapses may have Blood O2 Desaturation UARS  Airway Narrows: extra effort required to breathe causing arousals from sleep . Sleep Disorders Dentistry…
  • 7. Why me… Narrowing of the upper air-passages Reduced airway muscle tone Nasal obstruction Obesity Drugs Alcohol Fatigue Smoking Heredity Sleep Disorders Dentistry…
  • 8. Important Terminology Apnea: Breathing stops for 10 seconds or longer  Hypopnea: 50% in airflow and⇓ 4% in blood O⇓ 2  RERA: Respiratory Effort Related Arousal  Apnea Index (AI)  Number of Apneas / hour of sleep  Apnea Hypopnea Index (AHI)  Number of Apneas + Hypopneas / hour of sleep  Respiratory Disturbance Index (RDI)  Number of Apnea + Hypopneas + RERAs / hour of sleep Sleep Disorders Dentistry…
  • 9. Spectrum of Disease & Recommended Therapy as per American Academy of Sleep Medicine Sleep 2006 Snoring UARS (Sleepy Snorer) Mild Sleep Apnea (5-15 Events/hour) Moderate Sleep Apnea (15-30 Events/hour) Severe Sleep Apnea (Over 30 Events/hour) Sleep Disorders Dentistry…
  • 10.  Typical Screening Questions…  How Restful or Restless is your Sleep?  How often do you Awaken during your Sleep Period?  Witnessed Apneas?  Witnessed Snoring?  Do you Awaken Tired?  Daytime Fatigue?  Do you have Morning Headaches . Sleep Disorders Dentistry…
  • 11. Epworth Sleepiness Scale Score over 10 suggests a Sleep Disorder Sleep Disorders Dentistry…
  • 12.  Only a Physician can Diagnose these disorders…  Usually after having a Sleep Study…  Provides Objective Measurement of…  Apnea  Snoring  Blood Oxygen  Arousals from sleep  Breathing Patterns  …and much more . Sleep Disorders Dentistry…
  • 13.  Literature Validated Therapies AASM Sleep 2006  Lifestyle Choices  Positional Therapy  Surgery  nCpap  Airway Orthotics . Sleep Disorders Dentistry…
  • 14.  Lifestyle Choices…  Reduce Weight  Increase Physical Fitness  Avoid Alcohol & CNS Depressant Medications  Avoid Smoking . Sleep Disorders Dentistry…
  • 15. Positional Therapy… For some, Apnea is worse when sleeping on back; gravity makes it more likely for the tongue to fall back into airway and tissues to collapse and block the airway. Sew Tennis Ball into the back of your PJ’s. So every time you try to sleep on your back, your reduced comfort level will encourage you to role to your side . Sleep Disorders Dentistry…
  • 16. Surgery: most common are Palatal Surgeries or variations there of… Sleep Disorders Dentistry…
  • 17. Uvulopalatopharyngoplasty (UPPP or UP3) • UPPP involves the removal of the tonsils, followed by removal of the anterior surface of the soft palate and uvula, folding of the uvula toward the soft palate and suturing it together as demonstrated in the figures. In the US, UPPP is the most commonly performed procedure for obstructive sleep apnea, with approximately 33,000 procedures per year. The surgery is more successful in patients who are not obese, and there is a limited role in morbidly obese (>40 kg/m2). • Success; 25-50% for OSA, 75% for Snoring Sleep Disorders Dentistry…
  • 18. Laser Assisted Uvulopalatoplasty (LAUP) ◦Success; Not for Apnea, 50% for Snoring ◦Relapse a problem, Apnea may Worsen Sleep Disorders Dentistry…
  • 19. nCPAP: Pumps air into nose under pressure to expand collapsed airway  Overall, 65% compliance after 6 months  Average 3-4 nights a week, 3-4 hours a night  Compliance lower if <30 events per hour (Mild to Moderate Sleep Apnea)  Almost %100 Effective in Eliminating Apnea  BUT: when compliance is considered “Adjusted nCPAP effectiveness” is 50% Eur Respir J 2000;16(5):921-7 . . Sleep Disorders Dentistry…
  • 20. nCPAP Prescribed Most Often Sleep Disorders Dentistry…
  • 21. The Airway Orthotic Solution Sleep Disorders Dentistry…
  • 22. Mandibular Advancement Devices Most Effective Airway Orthotics Some Examples… Sleep Disorders Dentistry… Dorsal Herbst EMA Example of Orthotic in Mouth SUAD Narval Example of Orthotic in Hand Tap Silencer
  • 23. Sleep Disorders Dentistry… Airway Blockage Without Orthotic Airway Splinted Open With Orthotic
  • 24. Airway Without Airway Orthotic Airway With Airway Orthotic Airway Orthotic increases Airway SizeAirway Orthotic increases Airway Size Making the Airway Less CollapsibleMaking the Airway Less Collapsible See MRI Images Below Showing Increase in Airway SizeSee MRI Images Below Showing Increase in Airway Size . Increase Occurs with Mandibular AdvancementIncrease Occurs with Mandibular Advancement Sleep Disorders Dentistry…
  • 25. SIDE EFFECTS: Mostly Short lived and Upfront Mostly due to resisting the new jaw position during sleep Once jaw resistance stops – the discomforts stop Excessive Salivation lasts for approximately 2 Weeks Long Term Wear is Associated with Bite Changes This same side effect occurs with long term nCPAP wear No permanent cases of TMJ have been reported Sleep Disorders Dentistry…
  • 26. Airway Orthotics… the Facts… Airway Orthotics are considered First Line Therapy for the management of Snoring, Mild & Moderate Sleep Apnea. Sleep 2006:29:2 256 patient study – 90% patient compliance after 2 ½ years of wear. CRANIO 2000:18:2 Ten out of eleven prefer an Airway Orthotic over nCPAP for their long term treatment. Thorax 1997, 52:362-368 Sleep Disorders Dentistry… Know the Facts Before You Decide Which Therapy is For You
  • 27. The Dentist, Physician and Sleep Specialist workThe Dentist, Physician and Sleep Specialist work together in the treatment of Snoring and Sleep apnea.together in the treatment of Snoring and Sleep apnea. Communication is Key to Optimum TreatmentCommunication is Key to Optimum Treatment. Sleep Disorders Dentistry…
  • 28. Thank You & Sweet Dreams