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by Patrick Tessier

Introduction

Here are some basic aspect of Dental Sleep Medicine. This viewpoint is from an industry participant, not a medical opinion.

    • Obstructive sleep apnea (OSA) is a huge health issue in North America and around the world

    • In the United States, it is reported that over 90 million of our friends and neighbors are afflicted with some level of sleep disordered breathing. Including 20-40 million with OSA.

    • If we deprive our bodies of oxygen and are are constantly waking up at night, bad things happen.

    • From daytime sleepiness to high blood pressure to diabetes, OSA is a gateway for all the bad things to creep into our lifes.

    • This short video clip is from our Australian friends and makes the point clearly.

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  1. Sleep disordered breathing (SDB) is the medical term that describes any issues with breathing while sleeping
    • Sleep disordered breathing (SDB) is the medical term that describes any issues with breathing while sleeping

    • There is one major measurement that helps define the range = AHI

    • The Apnea Hypopnea Index (AHI) is measured by how many times we have a reduction in airflow per hour.

      • Apnea Event = 80-100% reduction in airflow with stoppage of breathing for 10 seconds or more.

      • Hypopnea Event = 50-80% reduction of airflow with stoppage of breathing for 10 secs or more

    • Obstructive Sleep Apnea (OSA) is defined as a minimum of 5 AHI. Below that threshold is non-medical. Either snoring or upper airway resistance.

    • OSA is broken into three major catagories: Mild (5-15 AHI), Moderate (15-30) and Severe (>30).

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    • Anyone can screen for OSA, but remember only a Medical Physician can diagnose and prescribe treatment for this medical condition.

    • There are several ways to determine if someone needs to see a physician to determine if OSA is present.

      • Simple written quizzes - like the STOP-BANG test. This particular 8 question quiz has been correlated to OSA in a peer reviewed study.

      • Recording Pulse Oximeters: Not a diagnostic tool, but certainly highly correlated. These devices record your O2 level all night. If you are dropping below 90%, it's a strong indication to get checked.

      • Home Sleep Testing (HST) - These are sophisticated medical instruments that can be used diagnostically, when included with a more comprehensive physical exam. Wear this device in your own bed. Less expensive and more patient friendly than a PSG.

      • Polysomnograph testing (PSG) - This is the gold standard of testing for OSA and other sleep disorders. The patient spends the night in a laboratory and is monitored by a sleep technologist. By far, gives the most complete information for the diagnosing physician.

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    • Licensing Reality: Obstructive Sleep Apnea is a medical condition and can only be diagnosed by a medical physician.

      • Treatments can only be prescribed by a medical doctor

      • Dentists cannot diagnose or prescribe treatment.

      • In Dental Sleep Medicine, the Dentist is simply dispensing the prescribed treatment.

      • This doesn't prevent the Dentist from screening patients for evaluation or treating non-medical sleep disordered breathing

    • Cash Flow Reality: Insurance reimbursement for the prescribed treatment for OSA will only be from Medical Insurance.

      • No dental insurance reimburses for treatment of medical conditions.

      • Private Insurance and Medicare both have ample coverage for qualified (EO486) devices.

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    • Lifestyle Changes - The simplest treatments are the least expensive. Weight loss, stop smoking and avoiding alcohol or muscle relaxers before bed are all recommended.

    • Tighten up the Throat - There are several choices. How about playing the Didgeridoo? Or use an astringent to shrink the inflamed tissues? You can have a Dentist or Physician insert nylon rods at the back of the throat with the Pillar procedure. Or how about scarring the back of the throat with lasers or radio waves - Somnoplasty.

    • Breathe through the Nose - The literature is clear that if we breathe through the nose, rather than the mouth, it opens the airway. The tongue positions forward. Nasal Dilators are an inexpensive and effective treatment option. Chin Straps can actually work for some. Septoplasty surgery is effective way to clear out any blockages.

    • Don't sleep on the Back - Gravity works against us when we sleep on our back. The tongue drops back and fills the airway. This can be avoided several ways. Physical impediments like taping a tennis ball on a t-shirt or using a belt like the Zzoma work well. Electronic devices like the Night Shift or Night Balance are effective.

    • Open the Airway - The most patient friendly option are oral appliances. The best are custom made devices from the Dentist. The most popular Medical treatment is the famous CPAP. Literally blows the airway open with positive air pressure. The last resort options are surgical. UPPP or BiMax jaw surgery can be effective.

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    • For a long term treatment, an oral appliance is the best solution.

      • Easy to use with few side effects.

    • The literature shows that oral appliance therapy (OAT) matches CPAP in effectiveness for mild to moderate OSA.

    • The big difference is the patient compliance. CPAP checks in with about 40% compliance within 2 years. OAT is about 95%.

      • If the patient doesn't use the treatment, it can't help the condition.

    • As more folks realize that oral appliance therapy works, more patients can get treated. And the world will be a better place!

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Patrick Tessier

Member since: 08/09/2017

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