InquiryDentist’s role in obstructive sleep apnea
Section snippets
Background
Obstructive sleep apnea (OSA) is characterized by repeated episodes of breathing cessation (apnea) or reduced airflow (hypopnea) during sleep. It reduces the patient’s quality of life and is detected most often through daytime sleepiness and snoring or witnessed apnea at night. Among the diagnostic tests for OSA are the Epworth Sleepiness Scale, endoscopy, laryngoscopy, pharyngometry, computed tomography (CT) evaluation, magnetic resonance imaging (MRI), cephalometry, MR fluoroscopy, acoustic
Diagnostic Considerations
Dentists and dental specialists are often called upon to diagnose OSA during their evaluation of the dental needs of patients. The pharynx and dentofacial structures lie close to each other. An anatomically narrowed airway is a pathophysiologic factor contributing to OSA. Dental practitioners may notice the symptoms of snoring and OSA during the course of obtaining a history and performing an oral examination. Once the dentist has made the diagnosis, it is often necessary to refer the patient
Use of Oral Appliances
Oral appliances (OA) are highly recommended for the treatment of OSA in patients who are intolerant of CPAP or who prefer alternate therapy. OAs increase upper airway size by positioning the mandible forward during sleep, which relieves snoring and OSA symptoms.
Mandibular advancement appliances may be monoblocs or biblocks. Both are well tolerated by patients, easy to use, noninvasive, removable, and have few side effects.
Tongue retention devices pull the tongue forward through the use of a
Other Treatments
Children with OSA tend to have a narrow maxilla, highly arched palate, and hypoplastic maxilla. Rapid maxillary expansion (RME) can be used to correct maxillary transverse deficiencies and posterior crossbites through orthodontic and orthopedic effects. RME treatment is well supported by the literature for the treatment of OSA in children.
RME plus a facemask can be useful for growing patients with OSA. It is applied to dental, skeletal, and soft tissues to change airway dimensions and relieve
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Kılınç DD, Didinen S: An algorithm of dental/dentofacial-based options for managing patients with obstructive sleep apnoea referred to a dentist/dental specialist by a physician. Br Dent J 221:37-40, 2016
Reprints available from DD Kılınç; e-mail: [email protected]