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Dental Tribune United Kingdom Edition

S noring is a common problem. Loud and fre- quent snoring can be more than just a nuisance to sleep partners; it can disrupt whole households and has as- sociated inherent health risks. Snoring is also the primary symptom of Obstructive Sleep Apnoea (OSA), which is a seri- ous medical condition; 30-50 percent of asymptomatic snor- ers will have some degree of sleep apnoea. When OSA is also associated with excessive daytime sleepiness it is re- ferred to as Obstructive Sleep Apnoea Hypopnea Syndrome (OSAHS). Dentists are ideally placed to provide Mandibular Re- positioning Devices for the treatment of simple snoring and mild to moderate sleep apnoea, and many are becom- ing increasingly interested in treating snoring patients in general practice. However, they may be deterred by concerns over screening patients for OSA and complying with medico legal guidelines. Breaking into a new branch of dentistry, so closely allied to medical prac- tice, can be quite daunting and many practitioners are dis- suaded from providing such treatments. In the UK, we lag behind the US and most of Europe in the treatment of snoring and OSA with oral devices. To help encourage more effective treatments, it was felt that an association of all interested parties was required. Anyone connected with the provision of treatment to OSA patients would be welcome to join; be they dental surgeons, dental technicians, medical practi- tioners, respiratory nurses, ENT consultants or consultant respiratory physicians. To this end, a group of highly motivated dentists and technicians decided to act as a catalyst for the establish- ment of this British group and formed the British Society of Dental Sleep Medicine – BS- DSM (www.dentalsleepmed. org.uk and @BSDSM). The society encourages intercommunication and dis- semination of knowledge be- tween interested parties, with the ultimate aim of improving the treatment of patients with sleep disordered breathing (SDB), through the involve- ment of GDPs and the provi- sion of oral appliances. The BSDSM also works toward fa- cilitating a coordinated, syner- gistic approach with the medi- cal community for research, treatment, education and pro- fessional development. Patient selection One of the first problems faced in the treatment of snoring patients is selecting those pa- tients who are safe to treat. Whilst the diagnosis of OSA lies firmly within the remit of the consultant respiratory phy- sician, the dentist has a role in screening for and suspecting the presence of OSA. Dentists can provide MRDs to treat sim- ple snoring without referring the patient for specialist di- agnosis. However, the dental treatment of patients suffer- ing from OSA with MRDs can only be undertaken if the GDP is working as part of a multi- disciplinary team comprising a consultant respiratory phy- sician. Safe patient selection therefore, was a major issue. To address this issue, the BSDSM convened the Sleep Medicine Working Party, com- prising experienced GDPs working in the field of SDB, eminent ENT and respiratory physicians. Our aim was to produce a robust, easy to use screening protocol. This tool would allow GDPs to select those snoring patients deemed unlikely to suffer from signifi- cant OSA (who can be treated in practice without prior re- ferral for diagnosis) and those who would benefit from refer- ral for specialist diagnosis. This protocol (Ref 1) was presented to the British Tho- racic Society Sleep Advisory Group in 2007 who “accepted the principles and value of such an approach”. It has been accepted by Dental Pro- tection (UK) Ltd and the Den- tal Defence Union, and has also been incorporated into the Association of Respira- tory Physiology and Technol- ogy Sleep Apnoea Consortium (ARTP SAC) Standards of Care for Mandibular Reposition- ing Devices and Dental Sleep Medicine Services 2011. Dentist training The BSDSM provides regu- lar basic hands-on training courses as well as more ad- vanced training. Such cours- es cover an introduction into sleep and SDB, how oral de- vices work, patient assess- ment and screening, follow up requirements, device se- lection, practical aspects of appliance provision, use of home sleep monitoring de- vices and tips on how to intro- duce a successful dental sleep medicine service into your practice. A major advantage of our training courses is that the BSDSM is a non-profit making society which is totally inde- pendent of any commercial interests or bias. We are free to demonstrate many differ- ent devices and products from a range of providers. If our experience shows it works, we will share it with you. I firmly believe that there is no one perfect device that can be universally prescribed for every patient, so it is es- sential that GDPs are famil- The British Society of Dental Sleep Medicine Dr Roy Dookun discusses Sleep Apnoea and the BSDSM 0845 0715040 sirona.com info@sironadental.co.uk 1962 - the very latest in dental technology More than 50 years of knowledge and innovation. 2012 - the very latest in dental technology Sirona Orthophos XG Family • Proven, tested, reliable - the most sold OPG unit worldwide • Superior image quality through latest technology • Intuitive workflow with ease of handling Sirona Dental Systems, Lakeside House,1 Furzeground Way, Stockley Park, Heathrow, London UB11 1BD November 12 - 18, 2012United Kingdom Edition Snoring can be a health risk