World Sleep Day: Fascinating and complex world of dental sleep medicine

Today, on World Sleep Day, which aims to raise awareness of sleep as a human privilege often compromised by the habits of modern life, we take a look at the field of medicine dental sleep.

This article originally appeared in the March 2022 edition of the ADA Newsletter

An oral health issue keeps coming up in the news; Obstructive sleep apnea (OSA) affects up to half of men and a quarter of women over the age of 50. Even below this age, it is a widespread and well-documented condition among Australians.

The problem goes so much deeper than having a dry mouth and drowsiness; more than a fifth of road accidents are attributed to fatigue, and these accidents are statistically more likely to have a fatal outcome. In fact, OSA is “associated with a 2.4 times greater risk of motor vehicle crashes, which has been compared to driving over the blood alcohol limit,” as ABC News recently quoted. by Professor Lynne Bilston, Principal Investigator at Neuroscience Research. Australia.

Although it is often viewed by the public as a respiratory problem, the many ways the dental profession can be involved in the diagnosis and treatment of OSA and other sleep-related disorders are growing and changing at a rapid pace. healthy. This emerging field is attracting more and more interest from practitioners and researchers in the field of dental health, highlighting a growing need for more formalized learning and qualifications in this “crossover” field between dental care and sleep therapy.

Indeed, until recently, there were conflicting terms to describe this field. However, says Dr. Andrew Gikas, a general dentist with a particular interest in sleep medicine, experts are gradually coming to a consensus.

“The terminology for the field is unclear, but the consensus of those involved around the world is that it is ‘dental sleep medicine,’ or DSM,” he says. “’Sleep medicine’ is the term our medical colleagues use to describe their field, so it makes sense that we refer to ‘dental sleep medicine’; it is also sometimes incorrectly called sleep dentistry, which of course relates to sedation or GA dentistry.

Dr. Gikas is also one of the presenters of the latest DSM-related webinar on the ADA’s CPD portal and explains why he is so involved in this area. “We can make a significant difference in people’s lives by doing fairly simple dentistry,” he says. “From the first time you see one of your restorations fail, I think all dentists are fascinated by what our patients can do to their teeth while they sleep.

“My personal interest was sparked in the late 90s by a patient who asked me for help with his snoring. At the time, there was little CPD, or even much research on snoring therapy oral appliances for sleep-disordered breathing Over the last two decades the science has grown tremendously and Australia is also one of the world leaders in sleep research It is rewarding to be involved to help patients sleep better, help colleagues learn about the DSM, and volunteer in the association and research space.

From taking interest to “private interest”

Finding pathways accessible to dental practitioners who wish to achieve a minimum level of competence is currently very topical.

“Common pathways to gain knowledge of DSM include the University of WA Postgraduate Certificate in DSM, University of Sydney Masters in Sleep Medicine, private CPD course providers, or one can take on solid reading at their own pace,” says Dr Gikas, who is also involved with the Australasian Sleep Association (ASA).

Indeed, the ADA’s CPD material provides a solid foundation on which to pursue further studies, now that the ASA has recently launched a Dental Sleep Medicine Fellowship Program (FDSM), designed to help patients and referring physicians to identify dentists who have achieved minimum clinical skills.

“The scholarship is an important step in allowing dentists who have training and experience in the field to take an exam, show some cases and be awarded a recognized scholarship that will let the sleep community know which dentist refer,” says Dr. Gikas. “Having someone to refer complex cases to might be something the profession lacks because we don’t have specialists in dental sleep medicine.”

Marcia Balzer, CEO of ASA, has often commented on the power of multidisciplinary collaboration. “It’s really exciting to be able to offer this new certification program starting in 2022,” she says. “It was created by dentists with the help of sleep experts from different disciplines, because we know that better sleep for patients often involves the work of an entire team.

“ADA members are welcome to check out our Learning Center and on-demand dental sleep medicine learning resources. Simply visit and click on the Learning Center tab. You’ll need to create an account to access it, but you don’t need to be an ASA member.

The ENT point of view

Dr Lyndon Chan is the co-presenter of a new DPC webinar on sleep disordered breathing and has a particular interest in sleep surgery, having completed numerous fellowships in sleep surgery and rhinology in Australia and the United States. ‘foreigner.

(Check out the range of dental sleep medicine articles on the ADA’s CPD Portal, available to all members.)

His approach in the webinar focused on the latest publications on soft tissue surgery and hypoglossal nerve stimulators. “The place of soft tissue surgery is increasingly cemented with numerous RCTs and large population studies showing long-term durable results,” he says, “and should always be considered if unsuccessful or rejection of conservative treatments.

“The hypoglossal nerve stimulator will soon be available in Australia, and it’s the most exciting development in sleep surgery for a long time with good long-term results – but there won’t be a silver bullet for OSA because treatment is so individualized, everyone has a different physiological and anatomical phenotype.

Studies cited by Dr. Chan in the webinar list anatomical phenotypes to note as including tongue, tonsils, lingual tonsils, skeletal structure, position of the palate, epiglottis, length of airway, and body type. palate or pharyngeal collapse – indeed, the breadth of listed phenotypes highlights its call for highly individualized care.

“Individualized care is the way of the future, and to do that, the best multidisciplinary approach is the best way forward for optimal care,” he said. “Combination therapy may be a more effective treatment, particularly sleep surgery and mandibular advancement splints, but more research is needed in this area.”

Drs Chan and Gikas agree that a multifaceted sleep clinic scenario would be ideal for patients with sleep disorders of this type, as well as more learning content in postgraduate studies. “There is little dental sleep medicine content in the current curriculum of overcrowded dental schools.

I would like to see more sleep clinics in tertiary hospitals include DSM services, which would allow the public better access and rotations of students to these clinics,” says Dr Gikas. “Setting up DSM clinics in public hospital sleep clinics might be something we need to actively encourage and lobby for.”

Indeed, in the ADA CPD webinar, Dr. Chan cites his ideal “dream” clinic as comprising nine different specialists, ranging from dental/oral and maxillofacial practitioners, sleep doctors and ENT surgeons to specialists more complementary: dieticians, bariatric surgeons, exercise physiologists and Suite. “Multidisciplinary clinics probably have better outcomes, especially when ENT and dental surgery can work together,” he says.

OSA: what to watch out for

Some patients may be more susceptible to sleep disordered breathing or obstructive sleep apnea. Lifestyle indicators such as higher body weight, smoking, drinking more alcohol, patients with nasal congestion, or even those with larger than average necks.

Signs that may indicate further investigation to identify sleep apnea or other sleep-related disorders may include:

– dry mouth or headache, especially just after waking up;

– flattened teeth, broken dental work, bites on the cheeks or other signs of bruxism;

– Pain or TMJ disorder;

– brain fog, drowsiness or excessive tiredness or memory problems; and or

– Abnormally sized throat or mouth tissue, identified by manual examination or head and neck x-ray.

After listing them, Dr. Chan points out in the latest CPD webinar that BMI (body mass index) is not a limiting factor in all cases, and that a dentist should look for much more than just “big tonsils”.

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