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Dental Tribune United Kingdom

About the author Neel Kothari qualified as a dentist from Bristol University Dental School in 2005, and currently works in Saw- ston, Cambridge as a principal dentist at High Street Dental Practice. He has completed a year-long postgraduate certificate in implantology and is cur- rently undertaking the Diploma in Implantology at UCL’s Eastman Dental Institute. CPAP machine August 1-7, 201126 Clinical United Kingdom Edition page 25DTß breathing disorders and says: “We all know that a disturbed night’s sleep is very debilitating. The unfortunate patient may report poor sleep quality being continuously drowsy and tired and all of these symptoms should sound alarm bells to the den- tist. Guides to diagnosis include looking for factors that make the condition worse such as weight gain, lying on the back during sleep and the taking of muscle relaxants which includes alco- hol. Factors that give relief to the symptoms such as weight loss, avoidance of alcohol and postural changes in sleeping position will not only help in treatment but also support the diagnosis... A sleep study undertaken by the chest physicians is undoubt- edly the conclusive acid test.” Dr Ash’s management of ob- structive sleep apnoea consists of a multi-disciplinary team rang- ing from fields including chest medicine, ENT and Orthodon- tics or a dentist with appropri- ate training and skills. Several methods of treatment are avail- able, most importantly changes in life style, less alcohol, weight loss and increased exercise; how- ever Dr Ash believes that sur- gery, such as laser assisted uvu- lopalatoplasty should be the last resort, as it may lead to scarring, restricted space and is generally excruciatingly painful over the weeks in the recovery period. Dr Ash says: “We must be careful to ensure that dentists work with the medical physi- cians and within their limits, thus whilst dentists should screen pa- tients and ask two very simple questions, ie “ do you snore” and “do you feel sleepy and drowsy during the day” we are really not the best health care profes- sionals to actually diagnose sleep apnoea. Remember there is Ob- structive sleep apnoea and Cen- tral sleep apnoea and perhaps even other variants. If there is pa- thology causing an obstruction in the airway, dentists would not be best placed to diagnose this.” Of the non-surgical ap- proaches, the Continuous Posi- tive Air Pressure (CPAP) ap- pliances are the gold standard, normally prescribed by the chest physicians. These devices consist of a close fitting face mask cov- ering the mouth and nose, con- nected by a flexible hose to an air pump which delivers air under a set pressure. This device forces air through the restricted air- way during sleep. Whilst CPAP is effective, the discomfort and in- convenience it causes to the pa- tient mean that many find CPAP to be intolerable and prefer to suffer the consequences than wear the mask. The most effective alternative or complementary treatment to CPAP is treatment using man- dibular advancement dental ap- pliances. These appliances work by holding the jaw forward in the recovery position during sleep and it is here where dentists with appropriate training are ideally placed to assist our specialist colleagues in the management of these conditions. In the next article I will be looking in more detail about some of the options that are used to treat snoring, such as mandibular advance- ment splints, how they work and what options are currently on the market! DT