Dental sleep medicine standards for sleep-related breathing

Sleep-related breathing disorders are one of six classifications of sleep disorders identified in the International Classification of Sleep Disorders – Third Edition, the American Academy of Sleep Medicine’s clinical text for the diagnosis of sleep disorders, according to a recent article in the Journal of Dental Sleep Medicine.

The article states that obstructive sleep apnea (OSA) has an estimated prevalence of 12 percent, which includes both diagnosed and undiagnosed. There is also a lot of literature out there to support the use of oral appliances as an effective treatment of OSA in adults. However, limited evidence exists to suggest that mandibular advancement and maxillary expansion is an effective treatment modality for the management of pediatric OSA.

The American Academy of Dental Sleep Medicine understands there is inconsistent information about sleep medicine in U.S. schools. For this reason, they are looking to offer additional educational opportunities. This is to help improve dentists’ knowledge and experience in treating and managing OSA patients. However, there is still a lack of uniform standards for the practice of dental sleep medicine.

Current standards available

The AASM and AADSM released a clinical practice guideline for the treatment of OSA with oral appliances. The guideline was created to provide dentists with qualifications required or needed in the treatment and management of OSA.

It states that a dentist should have at least one of the following to treat sleep apnea patients:

  • Diplomate certification in dental sleep medicine by a nonprofit organization.
  • Designation as the dental director of a dental sleep medicine facility accredited by a nonprofit organization.
  • Obtain the designation of “qualified dentist.”

While completing continuing education in dental sleep medicine, dentists must also seek diplomate and/or dental director status.  The AADSM also commissioned a task force of experts to create a document defining the scope of a DSM practice.

The paper goes into clear set guidelines and standards for dentists. To learn more, check out the AADSM’s paper that sets clear guidelines for dentists.

What is the prevalence of general dentists who screen for OSA?

Now this is an interesting study that I know many of you will want to learn more about. While I was searching the internet for new studies and information on sleep apnea I found this study in the Journal of Dental Sleep Medicine. The researchers were looking to determine the prevalence of general dentists screening for obstructive sleep apnea (OSA).

One thousand general dentists across the U.S. received a brief 12-item questionnaire consisting of a demographic section and questions about OSA screening methods, parameters and preferences. Here is what researchers found.

General dentists screen for OSA

Out of 1,000 general dentists who received the questionnaire from researchers, only 71 responded. However, based on demographic results, those who did respond represent a broad range of general dentists practicing in the U.S.

Dentists were asked to select which screening modalities they use and to supply specific information to provide validity to their responses. Researchers found that 76 percent of general dentists who responded, reported that they screen for sleep apnea.

Dentists use more than one modality

Most of these dentists also use more than one modality when screening for sleep apnea in their patients.  The questionnaire found that 60 percent do not routinely screen more than 70 percent of their patients. And a total of 37 percent ranked themselves a three or less on a scale of one to five regarding their confidence in screening for sleep apnea (one being uncomfortable and five being confident).

To screen for OSA, 72 percent of dentists reported using a patient interview, 52 percent identified anatomical parameters and 39 percent used patient questionnaires. Of the dentists who screen for OSA, 41 percent stated that they have their patients perform an at-home sleep test. There were also 87 percent of dentists suspecting OSA who referred their patients to physicians for further evaluation.

Additionally, dentists with fewer than 30 years of experience were significantly more likely to screen for OSA (87 percent) than those with more than 30 years of experience (63 percent).

A majority of general dentists do screen for OSA in their patients. However, most lack the confidence in performing accurate routine screenings. They do so in fewer than 70 percent of their patients. If you are a general dentist, reach out for help. By completing education courses and attending upcoming lectures, you can better prepare for screening for sleep apnea.

Dr. Mayoor Patel receives the Haden-Stack Award 2018

Recently, at the 2018 American Academy of Craniofacial Pain (AACP) Annual Meeting in Kansas City, Mayoor Patel, DDS, MS, received the prestigious Haden-Stack Award.

 

The award is named after two major icons and pioneers of craniofacial pain and TMD dentistry, Dr. Jack Haden and Dr. Brendan Stack. The AACP created the Haden-Stack Award in 1998 to acknowledge those who have made significant contributions to the advancement of knowledge in the field of Craniofacial Pain and Temporomandibular Disorders.

Dr. Patel’s experience

Each year, Dr. Patel has dedicated as much of his time as possible to personally educating hundreds of dentists on TMD and craniofacial pain. And not only has he provided education to dentists, but he also mentored them. Through this he was able to help guide dentists in their journey into TMD, craniofacial pain and dental sleep medicine. He challenged them to become the best providers they possibly can be for their patients.

With his wealth of knowledge and easy-going teaching style, Dr. Patel maintains a unique ability to connect with people while also transferring knowledge in a very accessible way. It doesn’t matter what your personality type is, Dr. Patel connects with you and provides you with a learning experience that is unlike any other.

Going beyond just lecturing, Dr. Patel engages with other dentists throughout the process and asks the right questions to get his students to think and apply information to their own specific situation.

Dr. Patel also received over 15 credentials from major organizations related to orofacial pain or sleep apnea, which enables him to accurately and properly treat TMD, orofacial pain and sleep apnea in his dental office.

The next time you see Dr. Patel, make sure to congratulate him on this amazing accomplishment. Way to go, Dr. Patel!

Sleep apnea is linked to atrial fibrillation

As time goes on and more research is completed, we continue to find connections with various health conditions and sleep apnea. We, as dental sleep medicine specialists (or soon to be), need to continue to advance our knowledge on these connections to better improve our patients’ health and well-being.

A recent study published in HeartRhythm looked at poor sleep quality as a major risk factor for atrial fibrillation. Researchers of this study even found a link independent of sleep apnea. Atrial fibrillation (AF) is an irregular, rapid heart rate that might cause a variety of symptoms such as heart palpitations, fatigue and shortness of breath. AF can significantly reduce a person’s quality of life. It also is linked with stroke, dementia, heart attack, kidney disease and even death.

Sleep apnea is a risk factor

Obstructive sleep apnea is known as a risk factor for AF. However, the mechanism remains unclear. Episodes of abnormal breathing and apnea may cause cardiopulmonary stress, induce inflammation and contribute to cardiovascular disease. OSA also results in poor quality sleep. When a person suffers from poor quality sleep, they can experience altered sleep duration, efficiency and architecture. These all link to cardiovascular diseases.

Researchers looked at four different studies to determine if poor sleep was a risk factor for AF. They found that a subset of these individuals who had undergone formal sleep studies experienced less REM sleep. This predicted future AF. Through further outreach, researchers found that sleep quality is extremely important to cardiovascular health, specifically to AF.  Sleep disruption was consistently an important risk factor. The underlying mechanisms are still unknown, but this study is a good way to think about sleep and AF.