hygiene - the international C.E. magazine of dental hygiene

I 21hygiene 1_2012 C.E. article_ sleep apnea I There are other recommended treatments, some involving behavioral therapy, that patients may be less likely to comply with, such as “non-supine sleep, [avoiding] late evening [food] consumption, weight loss, abstaining from drinking alcoholic beverages and a lifetime of required nightly use of continuous compressed air delivered by a CPAP (continuous positive airway pressure) machine via a nasal mask”3 (Fig. 5). The CPAP machines work when there is a compli- ant patient. If the patient is not compliant, there are other oral-appliance therapies that may be used, but CPAP remains the “’gold standard’ treatment for sleep apnea [and] the objective success rate of any other treatment must be judged against it.”10 If a pa- tient chooses oral devices over a CPAP machine, the dentalteammayberesponsibleforthefabricationof the oral devices. _Surgical treatments Surgery is usually done in severe cases of OSAS or as an alternate or last-resort procedure. The main surgical treatments offered for OSAS often target the anatomical areas of the posterior airway where collapseissuspectedtooccur.Treatmentisdesigned to enlarge the posterior airway space, reduce airway collapsibility and, ideally, stabilize the airway for the long term. Surgery has the advantage of correcting anycraniofacialabnormalitiesthatmaybethecause of the OSAS and of removing the variable of patient compliance that is required with other long-term treatment strategies. Obstructive sleep apnea syndrome sometimes occurs in patients with a retrognathic positioning of themandible(Fig.6).Peoplewhohavearecedingchin related to a small lower jaw are more likely to snore because there is less room in the back of the throat for the soft tissues and tongue. This reduction in spacedecreasesthesizeoftheairpassageandcauses increased snoring. Some patients undergo “maxilla-mandibular ad- vancement surgery.”3 Oral and maxillofacial sur- geons engaging in corrective surgery communicate with the general dentist, because whenever an OSAS patient undergoes surgery, treatment plans need to be suspended in anticipation of changes to the patient’s occlusion. Hoffstein says, “Maxilla-man- dibular advancement (MMA) surgery, which is based on traditional orthognathic surgery techniques, has been proven effective for a range of OSAS disease.”10 Surgery allows the repositioning of the tongue. Ad- ditionally, de Almeida says, “These bone movements pull the base of the tongue forward and upward, thereby enlarging the posterior airway space, creat- ing more anterior space for the tongue. The bony segments are fixed rigidly with screws and plates to assist in healing and to resist the pull of soft tissue that may cause skeletal relapse.4 _Dental team’s role in identifying sleep apnea Obstructive sleep apnea requires appropriate diagnosis and treatment. Interdisciplinary commu- nication is paramount when cases are handled by a team methodology. The dentist should work closely with other health-care professionals. Referral of patients to a physician indicates the dentist’s desire tomakecertainthatthepatientreceivesthebestcare possible. Dental professionals are crucial advocates involved in the management of OSAS and should be aware of the complications that can be caused by the disorder. Asking questions about patients’ sleep habits can stimulate awareness for the general dentists and hygienist, enabling them to refer a patient to a physician who specializes in sleep disorders. Use of a standardized questionnaire similar to a medical history will ensure that every patient is screened for OSAS (see example in appendix). Identifying the underlying causes of OSAS and recommending an appropriate course of treatment can help patients maintain quality of life and reduce morbidity rates. Prinsell says, “This should be a working relationship between the medical community.”3 _Teamwork between dental and medical professions Patients with OSAS have a higher risk for hyper- tension, which can lead to other physical complica- tions. Dental professionals working with physicians should be familiar with the medications and appli- ances used for sleep apnea and the oral complica- Fig. 5_CPAP machine nosepiece. Adjustments need to be made to the CPAP nosepiece and mouthpiece. Mouthpiece can cause pressure and create lesions in the upper anterior gingival tissues. Fig. 5