Instructor Spotlight : Mr . John Nadeau The Evolution of Dental Sleep Medicine
Instructor Spotlight : Mr . John Nadeau The Evolution of Dental Sleep Medicine
The dental sleep medicine landscape is rapidly evolving : The old protocols no longer apply and barricades to entry and success are disappearing .
The definition of dental sleep medicine , by the American Academy of Dental Sleep Medicine , is that dental sleep medicine is an area of practice that focuses on the management of sleep-related breathing disorders , including snoring and obstructive sleep apnea through the use of oral appliance therapy and upper airway surgery ..
I ' ve been actively involved in this field for many years and have been privileged to witness an incredible transformation in awareness , standard protocols , and technology integration . Dentists need only visit one of our Dental Sleep Medicine continuing education courses to see the first big change . Years ago , options for even learning about dental sleep were few and far between ; now , last year alone we hosted more than 80 training seminars and hundreds of in-office trainings . Now , instead of taking the course because it sounded like an interesting topic , dentists are learning more because patients are coming in and requesting treatment for sleep apnea . The awareness continues to grow every day .
Historic roadblocks also are coming down . It was not long ago that the only protocol to follow involved dentists sending their patient to a sleep lab or a hospital for diagnosis . This posed a problem for many " sleep dentists ," as patients frequently refused to follow through with this referral . Additionally , those who did go to the lab frequently ended up being put on continuous positive airway pressure ( CPAP ), leaving few , if any , patients for the dentist to treat with oral appliances .
Today , these patients are not completely in the hands of a sleep lab . Many dentists are taking advantage of home sleep testing technology and vast networks of board-certified sleep physicians who are able to provide interpretation and diagnosis . Patients with mild or moderate sleep apnea end up with an effective oral appliance therapy very quickly , while those with severe obstructive sleep apnea ( OSA ) are sent to local specialists for more detailed evaluation . This results in more optimal treatment being delivered faster and at a lower cost to the patient than the historical model . For the dentist , this means no more losing control of a case or having a patient who would have otherwise been a great candidate for oral appliance therapy be offered CPAP instead .
The dental sleep evolution also includes the clinical aspects of dental sleep medicine . Where there were once only a few FDA-cleared devices to treat apnea , there are now many dozens , each with their own pros and cons . Bite registration techniques and technology have evolved as well . Gone are the days of using a George Gauge and having the patient advance an arbitrary 50 % to 70 % protrusive and just guessing at appliance position .
Now dentists have the ability to measure the effect of both protrusive and vertical change on the airway using Eccovision airway acoustics to determine optimal therapeutic position . Being able to see patients who will , and will not , respond well to treatment ahead of time has drastically increased case acceptance and clinical success rates with oral appliance therapy while cutting down on appliance titration time .
These changes have helped position dentists as an integral part of a complete medical protocol for the diagnosis and management of sleep-related breathing disorders . I am pleased dentists are no longer practicing a " blind leading the blind " protocol of guessing bite position and then delivering an appliance that may or may not help without any objective way to measure .
One thing that is guaranteed to change is the number of people with sleep apnea . Current research points to increasing obesity rates in the U . S ., continuing their climb until they reach a peak in 2030 at a nationwide average of more than 44 %. The number of people with OSA will continue to increase right along with it . When teaching about dental sleep medicine every single weekend , we say , " The time has never been better to get involved ," and , unfortunately , that statement will also continue to be true as more and more people experience the debilitating consequences of untreated OSA .
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