Screen your orthodontic patients for TMD

There is a growing need for orthodontists to screen and evaluate their patients for temporomandibular dysfunction (TMD). It is even more important to discriminate between major and minor signs and symptoms of TMD if they are discovered during screening. If the patient has major TMD complications, the orthodontist will need to decide whether to take on the responsibility of management prior to initiating orthodontic treatment.

If you decide not to, then an appropriate referral will need to be made before orthodontic treatment is completed. And, similarly, orthodontists should also be ready to respond appropriately when a patient is referred specifically to the for the treatment of TMD.

The orthodontist’s role

When receiving referral from a dentist, it is important to maintain open communication with both the patient and the referring dentist. Remember to also follow current scientific concepts about TMD-orthodontic relationships.

If TMD signs and symptoms arise during orthodontic treatment, orthodontists must be cognizant of proper procedures. And because there is some potential for the development of TMD complications after orthodontic treatment, it is important for orthodontists to be prepared to react properly.

Just as dentists should complete continuing training, so should orthodontists. We owe it to our patients to provide the best care possible no matter what office they are visiting.

Patients with OSA experience reduced long-term cardiovascular morbidity, mortality

We have known that there is a link between sleep apnea and other health conditions, such as heart disease or diabetes. In another study, obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality.

This study looked at the effects of oral appliance therapy on a broad spectrum of cardiovascular outcomes. Researchers looked at various literature up to December 31, 2016. They found 25 relevant full-text articles with 16 considered methodologically sufficient.

What was found?

From the pooled data, it showed a significant reduction in daytime systolic and diastolic blood pressure compared to baseline. However, no significant reductions in heart rate, except for daytime heart rate when compared to inactive/placebo oral appliance therapy.

Compared to CPAP therapy, treatment was equally effective in reducing blood pressure. Another observational study showed that oral appliance therapy was as effective as CPAP in reducing cardiovascular death.

Through this we can determine that oral appliance therapy may lead to a reduction in long-term cardiovascular morbidity and mortality in OSA patients. However, further research will be needed to continue to advance this.

Minimizing mandibular advancement in oral appliance therapy

In a recent study from the journal Sleep Medicine researchers looked at the treatment of obstructive sleep apnea (OSA) with an oral appliance (OA). There is currently no gold standard method to fine-tune the mandibular advancement. This study was created to analyze the effect of gradual increment of mandibular advancement on the evolution of the apnea.

What were the results?

The researchers proposed the use of a multiparametric titration protocol to optimize the mandibular advancement. Thirty percent of the sample population exhibited the best results without any mandibular advancement and low frequency of side effects were observed. There were 36 patients involved in this study (22 were men) with a mean age of 57 years.

The mean mandibular advancement was between 1.7 and 1.5 mm achieving about 50 percent reduction in AHI in 72 percent of the patients. There were also 27 patients with an AHI of 10. Of the 21 patients with moderate to severe OSA, 17 had the highest decrease in the AHI in a mandibular advancement of about three millimeters.

Researchers found that monitoring the subjective symptoms of the patient and objective evolution in the AHI could minimize the mandibular advancement needed for proper treatment of OSA. What are some other ways to help improve oral appliance therapy results with our patients?

Why don’t more sleep physicians recommend oral appliances for OSA?

It’s an important question that many of us continue to wonder about – why aren’t more sleep physicians recommending oral appliances for sleep apnea? Well, to begin with, there appears to be a lack of data on the subject. While most dentists understand the importance of using oral appliances for the treatment of sleep apnea, physicians are still not in the know. So let’s get them some data.

What information is out there?

After doing a quick search through Google Scholar I found the following studies that showcase how effective oral appliances are for the treatment of sleep apnea in our patients:

Another reason is because they may not be comfortable with the process. If that is the case, then we must help them get more acquainted. This can be done by contacting their offices and educating them on the services we provide. Through proper education and understanding, you can help sleep physicians become better acquainted with oral appliance therapy as a successful alternative to the CPAP machine.

They are ignorant about topics they know little about, which is why it is important to educate them on oral appliances. Look up studies, attend classes and do what you can to provide the information they need to better understand this treatment alternative so we can all continue to help patients get a better night’s sleep.