03 2012 sleep apnea quebec


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A small lecture on the potential correlation between sleep apnea and TMJ dysfunction

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03 2012 sleep apnea quebec

  1. 1. “Diagnosis and treatment of sleepapnea in dentistry: the relationship with the TMJ dysfunction” A dentist’s perspective Dr Jean-Marc Retrouvey Director of the Division of Orthodontics McGill University
  2. 2. Objectives of the Presentation• Discuss the dental therapeutic approaches for TMJ dysfunction and Sleep Apnea from a dental perspective• Describe the different oral appliances used in the treatment of these conditions• Discuss the possible correlations between sleep apnea, TMJ disorders and bruxism
  3. 3. 1. Obstructive Sleep Apnea? 27 % of Snoring patients may exhibit snoring Upper Airway UARS Resistance Syndrome 4% OSA Obstructive Sleep Apnea 2-3%Snoring and obstructive sleep apneaBy David N. F. Fairbanks, Samuel A. Mickelson, B. Tucker Woodson, p 243
  4. 4. Most common contributing factors of OSA1. Environment 1. Diet = Obesity 2. Allergies2. Genetics 1. Skeletal malocclusions3. Combination http://www.saberycuidar.or http://www.crystalinks.com/overweight g/allergies-in-children.html kids.html
  5. 5. Correlation between Obesity and OSA Fairly direct correlation has been established between obesity and OSA in children* and teens** *The Correlation Among Obesity, Apnea-Hypopnea Index, and Tonsil Size in Children* Yuen-yu Lam, FHKAM(Paed), et al. Chest 2006: 1751-1756 **Obesity increases the risk for persisting obstructive sleep apnea after treatment in children Louise M. O’Brien et al . International Journal of Pediatric Otorhinolaryngology (2006) 70, 1555—1560
  6. 6. Dentist’s approach of OSA Dental AppliancesMandibular advancement devices (MADs) – Bring mandible forward to open airway – Basically same type of appliances as the mandibular protractors used for growth modifications – Over 75 types of appliances are described in the literature.
  7. 7. Clear Way Appliance: Dr Lowe UBC
  8. 8. CAD-CAM Manufactured ApplianceSlide from Dr Arcache
  9. 9. 2.TMJ dysfunction and the dental profession approach
  10. 10. Temporo-Mandibular Dysfunction? Myofascial 3 to 6% pains (10%) Intra- Painfull capsular 5 to 8% or not problems Type? bruxism 5 to 95%! Transient Snoring and obstructive sleep apnea By David N. F. Fairbanks, Samuel A. Mickelson, B. Tucker Woodson, p 243
  11. 11. Myofascial pain: Flat Occlusal Splint• Reported to be efficient to relieve myo-fascial pains – Variable response probably caused by poor differential diagnosis• Multiple designs – None seems to be consistently better than others Same design is also used in nocturnal bruxers
  12. 12. Disk Displacement:Mandibular Advancement Splints « Disk recapture »
  13. 13. What about OSA and bruxism?Sleep apnea (i.e., cessation of breathing in sleepwith hypoxemia and risk ofhypertension, daytime sleepiness) is a healthhazard found twice as often in the generalpopulation reporting tooth-grinding than in thenormal population (Krieger, 2000; Ohayon etal., 2001). Quantitative Polygraphic Controlled Study on Efficacy and Safety of Oral Splint Devices in Tooth-grinding Subjects C. Dubé, P.H. Rompré, C. Manzini, F. Guitard, P. de Grandmont and G.J. Lavigne J DENT RES 2004 83: 398
  14. 14. ‘’The use an occlusal splint in an OSA patient maytrigger more episodes of bruxism in 50% of cases’’ (Gagnon et al, Int J Prostho 2004)
  15. 15. More TMJ dysfunction in OSA patients? No difference in dysfunction between ‘’normal ‘’ population and OSA population
  16. 16. Contraindications to MADs in OSA Patients• Active TMJ dysfunction is a contraindication to the use mandibular advancement devices• 6 mm of protrusive movement is the minimum to consider a MAD
  17. 17. Association or correlation?
  18. 18. Herbst type MAD
  19. 19. Study of MAD use24 patients 12 drop out 3 for TMJ pain reasons ( no exact diagnosis given)
  20. 20. Picture from Dr Arcache
  21. 21. Interesting case of interdisciplinarytreatment of an UARS-TMJ patient
  22. 22. 17 year old female patient• Presents with severe malocclusion and temporo-mandibular pains and clicking in both joints – Physiotherapy helps alleviate pain but does not eliminate it
  23. 23. Treatment optionsContinue physiotherapyOrthodontics-orthognathic surgeryPhysiotherapy after surgeryPotential for occlusal splint after surgery
  24. 24. Pre Orthodontics-Orthognathic surgery 2004
  25. 25. 2009
  26. 26. Orthodontic preparation
  27. 27. Maxillo-Mandibular Advancement (MMA)
  28. 28. Post SurgeryPatient reports an improvement in her sleep apnea (subjective as no somnographyis available)Significant improvement in TMJ symptoms and mandibular excursions.Has stopped physiotherapy for now but advised to return if symptoms reappear.No occlusal splint worn at night.
  29. 29. OSA is a potentially life threatening medical condition TMJ dysfunctions can dramatically affect quality of life (non lethal)Cranio-mandibular disorders (OSA included) will benefit from interdisciplinary care jean-marc.retrouvey@mcgill.ca