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

22 I I C.E. article_ sleep apnea tions that can result from the different treatments. Treatment for sleep apnea and snoring can help patientsgettheresttheyneedtoreducethemedical complicationsandimprovetheirfunctionduringthe day. The dental team will be involved in monitoring anyocclusalchangesthatresultfrommouthdevices used in the sleep-disorder therapy. When working with patients who have been prescribed an oral appliance, the dental hygienist needstorecommendmandatorydentalvisitsaspart of the treatment plan to keep a record of changes that might occur in the occlusal bite or to stay ahead of other dental problems that can occur because of use of the appliance. Magliocca and Helman say, “In additiontothepatient’smedicalhistory,thedentist’s clinical examination findings influence treatment planning.” It is also important to be aware that patients may be taking medication that creates xerostomic effects.7 Kalan and Kenyon say, “There are, also, certain types of CPAP delivery that may add to the patient’s complaints of xerostomia.”11 Medications may sometimes be used to treat depression experi- enced by some patients with OSAS. These medica- tions may contribute to causing the oral cavity to be dry. Patients also might begin to neglect daily oral hygiene. Dentists and hygienists should recommend and prescribe artificial saliva products and regular fluoride applications for patients with xerostomia who are using the CPAP devices. While the incidence of caries has not been reviewed in the OSAS popula- tion, it would seem especially prudent to educate patients with xerostomia about avoiding cariogenic foods and beverages.7 Dental professionals need to be aware of the impact certain surgery procedures within the oral cavity can have on patients who are using a CPAP machine. For example, Kapur says, “Reflecting a mu- coperiosteal flap to accomplish surgical extractions or other procedures may preclude the patient from usingCPAPforonetotwoeveningstoavoidthepos- sibleriskofdevelopingsubcutaneousemphysema.”12 Because occlusal changes can occur with OSAS therapy, communication between the patient, den- tist, hygienist and the physician who prescribed the oral appliance is essential. Some patients may not noticeormaynotbeaffectedbychangesintheiroc- clusion while using an oral appliance, but problems may still exist. Robertson et al. suggest “keeping the patient’s bite opening to a minimum when fabricat- ing an appliance to reduce the impact on the occlu- sion.”13 When restorative work is be done on OSAS patients, such as crowns or fillings, adjustments to theexistingappliance—orfittingofanewappliance — may be needed. The process of adjusting or creat- ing a new appliance needs to be done with the oral surgeon or physician who prescribed the oral device. The prevalence of OSAS may be higher than estimated, and medical and dental health-care professionals can “offer these patients the full range of available treatment options to defeat this often fatal illness.”6 Adding sleep-related questions to the written or oral medical history and consideration of bothorofacialandphysicalfindingsmayresultinthe detection of a sleep disorder.8,14,15 Dental hygienists can ask questions, such as: “How many pillows do you sleep with? Does your spouse complain that you snore? Are you grinding or clenching? Do you wake up with headaches in the morning? Do you wake up with a dry mouth?” The routine oral assessment that hygienists provide can aide in recognizing condi- tions pertaining to OSAS. Hygienists can facilitate the management of the patient with sleep apnea by recommending oral care products to reduce xeros- tomia and to reduce inflammation of gingiva for sleep apnea patients who snore. Dental health-care professionalsshouldreferpatientstophysicianswho manage OSAS patients on a regular basis. Dental hygienists see patients frequently and often on a routine bases, so they are often the first to observe variations in the oral cavity. Cooperation betweenhygienistsanddentistsandmedicalhealth- care professionals who treat patients with OSAS createsanadvantagetothepatientforoverallhealth care. Treatmentplansforpatientswithsleepapneaand sleep disorders, along with the associated medica- tionsbeingusedbysuchpatients,shouldbeincluded inthemedicalhistoryinthepatient’scharts.Thiswill ensurethedentalteamisawareofanychangesinthe oralcavityandismonitoringforpotentialconditions associatedwithmedicationsbeingusedtotreatsleep disorders._ hygiene 1_2012 Fig. 6 Fig. 6_Retrognathic or receding jaw. (Photo/Provided by Oral Facial Reconstruction and Implant Center of Florida, www.oralfacial.com/ doctors-luis-cardenas.php)