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News Bulletin : ADA News Bulletin December 2011
46 DECEMBER 20 11 The Oral Sleep Medicine Conference, held at the Sydney Convention Centre from 24 to 26 October 2011 in association with the Australasian Sleep Association, was a great success according to Andrew Gikas, Course Convener. The program attracted many dentists from all over Australia, New Zealand, Germany, and Hong Kong. Local and international speakers included sleep physicians, oral medicine specialists, an ENT surgeon, dentists and medical specialists. KEY PRESENTATIONS TREATMENT PROTOCOLS AND CHOOSING AN APPLIANCE Jonathan Parker has a specialty practice in dental sleep medicine in the United States and is a past President of the American Academy of Sleep Medicine. Dr Parker presented the results of his recent study which demonstrated a method of adjusting or titrating an oral appliance during a sleep study, which increased the success rate of treating patients with mild to moderate sleep apnoea from 70 per cent to 95 per cent. He discussed the importance of the dentist being able to choose from a range of evidence-based appliances rather than relying on one. The selection of an appropriate appliance depends on many factors such as the number of teeth, the relationship of the teeth and jaws, intra-oral space, presence of bruxism, degree of sleep apnoea and the degree of patient sensitivity to an intra-oral device. BRUXISM -- AETIOLOGY AND TREATMENT Donald Falace, Professor and Chief of the Division of Oral Diagnosis, Oral Medicine and Oral Radiology at the University of Kentucky in the United States, discussed the strong link of bruxism with sleep apnoea. Given that most people with sleep apnoea are not aware they have it, he emphasised the importance of medical practitioners screening sleep apnoea patients for bruxism, and dentists screening their bruxism patients for possible sleep apnoea. He cautioned that research has shown an occlusal splint for bruxism can worsen the degree of sleep apnoea and that a mandibular advancement splint was far superior to an occlusal splint in decreasing the degree of sleep bruxism. Professor Falace discussed the types of occlusal splints and expressed concern with the use of anterior splints given the potential for unwanted occlusal changes. He also cited research which demonstrated that a flat plane, full mouth occlusal splint was just as effective as one with cuspid and anterior guidance in treating bruxism and TMD. SNORING SO WHAT? John Wheatley, Professor of Medicine at the University of Sydney, presented his groundbreaking, published research which demonstrates that snoring alone, in the absence of sleep apnoea and hypoxia could be a major risk factor for stroke. His research demonstrated that heavy snorers had very high levels of carotid atherosclerosis. In fact, heavy snoring was by far the greatest risk factor for carotid atherosclerosis -- higher than smoking, hypertension and gender -- the traditional highest risk factors. He presented evidence that the transmission of vibration from snoring could be a major factor in causing endothelial dysfunction in the carotid artery -- which is in close proximity anatomically. Further research is required and if snoring is a cause of carotid vascular disease in heavy snorers this may have substantial public health implications for the prevention of stroke. PROBLEMS ASSOCIATED WITH THE UPPER AIRWAY Dr Weaver, Associate Professor of Otolaryngology and the Chief of Sleep Surgery at the University of Washington in Seattle, United States, discussed the anatomy, abnormalities and associated treatments with the upper airway. He discussed how these abnormalities can be a factor in the development of sleep apnoea and how these problems can be treated. He emphasised the importance of a patent nasal airway for breathing which can be as simple as using a nasal strip over the bridge of the nose, as well as the use of oral appliances and the CPAP machine. TEMPOROMANDIBULAR DISORDERS IN MAS (MANDIBULAR ADVANCEMENT SPLINTS) FOR SLEEP APNOEA -- DIAGNOSIS AND MANAGEMENT Ramesh Balasubramaniam is Clinical Associate Professor at the University of Western Australia and has an oral medicine specialist practice focusing on orofacial pain, oral diseases and dental sleep medicine. He presented the results of several studies and discussed the findings that many patients with TMD have untreated sleep apnoea. Added to the complexity of treatment is that untreated sleep apnoea results in increased levels of musculoskeletal pain, fatigue, lowered mood and a decrease in overall wellbeing. While up to 10 per cent of patients can get some initial TMD symptoms with the use of a MAS, long-term use does not cause any impairment of the TMJ. People with a pre-existing TMD prior to oral appliance therapy did not have a worsening of the disorder over time, and this does not need to preclude treatment. LATEST DEVELOPMENTS IN ORAL SLEEP MEDICINE Peter Cistulli, Professor of Respiratory Medicine and Head of Sleep Medicine at the University of Sydney, is regarded as a world authority on oral appliances and has published extensively in the field. He presented groundbreaking research which demonstrated that in a group of 108 patients with significant sleep apnoea, oral appliances were as effective a treatment as the CPAP machine. While CPAP was better in reducing the number of apnoeic events, the oral appliance was just as effective when assessing the results of the impact on blood pressure, quality-of-life and cognitive function. Compliance was significantly higher with the oral appliance, with participants using it for an average of two hours more than CPAP. Another recent study was presented in which 71 per cent of patients preferred the oral appliance as against 8.5 per cent preferring CPAP. This is the latest of many studies proving the effectiveness of oral appliances and the role dentists play in the management of snoring and sleep apnoea. Harry Ball For further information or if you are interested in joining a study group, please email the author at firstname.lastname@example.org 'DENTAL AS ANYTHING' Highlights from recent Conference
ADA News Bulletin November 2011
ADA News Bulletin February 2012