Missing Teeth and Pediatric Sleep Apnea

Sometimes the problems we experience as adults, could have been avoided when we were younger. In order to continue to help our patients through all stages of their lives, we need to ensure they are receiving the best care possible as children. For instance, missing teeth in early childhood can result in abnormal facial morphology with a narrow upper airway[1]. As a result, this can leads to early dental extractions and the presence of obstructive sleep apnea (OSA).

The Study

In order to better understand this connection between dental extractions, abnormal facial morphology and sleep apnea, a study was conducted. The study reviewed clinical data, results of polysomnographic sleep studies, and orthodontic imaging studies of children with dental agenesis or early extraction of permanent teeth seen during the past five years. They compared their findings to those of age, gender, and body mass index.

The Results

As a result of the study, 31 children with dental agenesis and 11 children with early dental extractions had at least two permanent teeth missing. All children missing teeth had complaints and signs of OSA. There was a significant difference between the mean apnea-hypopnea indices in the three dental agenesis, dental extraction, and T&A studied groups. This was the mean abnormal AHI lowest in the pediatric dental agenesis group.In the children with missing teeth, aging was associated with the presence of a higher AHI.

The study showed that alveolar bone growth is dependent on the presence of the teeth that it supports. The dental agenesis in the studied children was not part of a syndrome. It was an isolated finding. In the children with permanent teeth missing due to congenital agenesis and/or permanent teeth extraction known to predispose the collapse of the upper airway during sleep, OSA was recognized at a later age.

Sleep disordered breathing may be left untreated for a prolonged period with progressive worsening of symptoms overtime. By providing proper care and treatment early on, we can prevent the development of OSA in those children.

Contact my office to learn more about sleep apnea and its role in children with missing teeth. It is our duty as dentists to provide the best care possible, and that means our children.

 

 

[1]  Guilleminault, C., Abad, V. C., Chiu, H. Y., Peters, B., & Quo, S. (2016). Missing teeth and pediatric obstructive sleep apnea. Sleep and Breathing,20(2), 561-568.

There’s a New Definition of Dental Sleep Medicine

Attention! Attention! There’s a new definition of Dental Sleep Medicine (DSM)–wait what? I know, I thought the same thing when I read this article. However, it did bring to mind some valuable information we can utilize from here on out for DSM. To begin with, dental sleep medicine is an extension of dentistry in which we an provide appropriate services for the treatment of sleep apnea. So, what is this new definition?

The New Definition

Dental Sleep Medicine’s new definition goes above and beyond sleep apnea. This new definition takes the role of sleep apnea treatment and takes it one step further by incorporating pain into the equation. DSM is the discipline concerned with the study of the oral and maxillofacial causes and consequences of sleep-related problems.

This helps to broaden the subject area to other problems in dentistry, such as orofacial or craniofacial pain, bruxism, and other areas. These disorders have been touched on as their own, but what about together?

Where to Begin

This “new” definition of dental sleep medicine can improve the services offered at your practice. To begin 2017 out on the right foot, I am excited to announce that on January 20-21 my first lecture will be “ABC – Airway, Bruxism & Craniofacial Pain”. This lecture will dive into this “new definition” of dental sleep medicine so you can continue to expand your dental practice services and expertise.

Take the next step in providing proper care to your patients and by educating yourself in the New Year. With the availability of the ABC lecture and others, I can work with you to continue your education.

Oral Appliance Study Displays Success

We never needed further proof of the success of oral appliance therapy, but it doesn’t hurt to hear more about it and reaffirm its input. In this recent study, we can see just how successful Narval appliances are in the treatment of sleep apnea. Let’s take a look…

The Background

In this study, mandibular repositioning devices (MRDs) are usually recommended as the first form of therapy for patients suffering from mild to moderate obstructive sleep apnea (OSA). Unfortunately, though, data on the long-term efficacy of MRDs hasn’t been readily available. This is not only true for patients with OSA who are noncompliant with CPAP, but also in those with more severe OSA.

To get a better understanding of the success of oral appliances, such as MRDs and the Narval appliance, the ORCADES study[1] aimed to determine the long-term efficiency and tolerability of two custom-made Narval MRDs for the treatment of OSA patients. The study was completed over a three to six month period of time.

Eligible patients suffering from OSA who also refused or were CPAP noncompliant, were studied. The outcomes were measured after gradual mandibular advancement titration, which included AHI, oxygen saturation, sleepiness, symptoms, quality of life, side effects and compliance. And, drumroll please! Here are the results…

The Results

Of a total of 369 patients involved in the study, overall MRD treatment was successful in approximately 76%. Additionally, complete response to treatment with MRDs was achieved in 64% of participants.

The study also treated severe OSA with MRDs, and about 60% of the participants were effectively treated with about 38% having completed symptoms resolution. As a result, the use of MRDs in the treatment of sleep apnea significantly decreased a person’s sleepiness, and eliminated symptoms while improving their quality of life. Treatment with MRDs were very well tolerated and compliance was at its highest rate.

Custom-made appliances, such as Narval MRDs, are effective forms of treatment for mild to severe OSA, as well as for patients who are CPAP noncompliant. Keep this study in mind when informing your patients of proper treatment options, as well as sharing with referring doctors.

 

 

 

 

[1]  Vecchierini, M. F., Attali, V., Collet, J. M., d’Ortho, M. P., El Chater, P., Kerbrat, J. B., … & Mullens, E. (2016). A custom-made mandibular repositioning device for obstructive sleep apnoea–hypopnoea syndrome: the ORCADES study. Sleep Medicine, 19, 131-140.

The Painful Truth About TMD and How to Help

As you already know, temporomandibular joint disorders (TMD) refer to a cluster of conditions that are often characterized by pain in the temporomandibular joint (TMJ) or its surrounding tissues. The surrounding tissues might include the neck, head and even shoulders. Conditions involving the TMJ are so common among the adult population that up to 75 percent show at least one sign of TMD upon examination. Let’s take a look at some of the instances in which TMD can cause further complications and how to educate your patients.

Further Complications

Evidence continues to be available about TMD and how it can be worsened by other conditions. Today, it has been shown that anxiety, stress, and other emotional disturbances may worsen TMD. Some of the common signs of TMD include:

  • Jaw pain
  • Limited or painful jaw movements
  • Headaches
  • Neck pain or stiffness
  • Clicking or grating within the joint
  • Inability to open mouth without pain

It has been shown that about 55 percent of patients with chronic headaches who were referred to a neurologist actually have signs of TMD. Without the education on TMD, signs and symptoms often go overlooked and no treatment can be found.

As a dentist, you can put an end to the misdiagnosis of TMD by completing further education. You can also educate your patients on self-care techniques and referral for non-invasive treatment should be considered [1].

Improvement with Treatment

Signs and symptoms of TMD improve over time with at-home care, and with oral appliance therapy from the dental office. Previous studies have even show that as many as 50% of patients improve in one year and 85% improve completely in three years. Encourage conservative treatment before any invasive options are considered. It is important to treat your patients properly without causing further complications.

Contact my office to learn more about TMD and available treatment options, as well as upcoming lectures for continuing your education.

 

 

 

 

1. Lindsay, J. (2016). TMJ Disorder-The Painful (but Helpful) Truth. Pain.