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4 Dental Tribune Middle East & Africa Edition | September - October 2013eVents Snoring And Sleep Apnoea – A Role For The Dentist S leep apnoea has been known, and reasonably well under- stood, by the medical profes- sion for a considerable time. Indeed, there are accurate descrip- tions of sufferers in some of Charles Dickens’ work. However, the disease process was not understood during the Victorian period and it wasn’t until the 1980s that technology was developed to help treat the problem. The last decade in particular has seen far greater understanding of the dis- order and the introduction of simple, cost-effective solutions that deliver real benefits for patients. Sleep-related breathing disorders are caused by varying degrees of collaps- ibility of the pharyngeal airway and range from simple palatal snoring to obstructive sleep apnoea. Simple snoring (affecting up to 45% of the adult population) is itself a health hazard. It has been shown to lead to poor memory, excessive daytime sleepiness, inability to concentrate, and reduction in overall performance due to the resultant sleep disturbanc- es. With Obstructive Sleep Apnoea (OSA) there is a much greater degree of collapse of the pharyngeal airway, causing obstruction, which leads to pauses in breathing (‘apnoea’) or epi- sodes of abnormally shallow breath- ing (‘hypopnoea’). The hypoxia and hypercapnia resulting from these ap- noeic and hypopnoeic events wakes the sufferer in order to re-establish patency and normal ventilation. Snoring is present in nearly all OSA patients and is classically very loud and intermittent. The snoring may be accompanied by gasping and some patients may wake with the feeling they are choking or gagging. Most problematic of all for sufferers is ex- cessive daytime sleepiness as a result of the hypoxia and poor quality sleep arising from the multiple arousals from sleep. Left untreated, OSA is also thought to place patients at increased risk of hypertension, coronary artery disease, heart failure, cerebrovascular disease and sudden death. Dr. Ama Johal, Consultant and Sen- ior Lecturer at Barts and the London Queen Mary’s School of Medicine and Dentistry and a leading expert in the field of sleep-related breathing disorders, said: “There is ever increas- ing awareness of sleep-related breath- ing disorders and the role mandibular advancement splints play in treating them. CPAP – continuous positive airway pressure – remains the gold standard treatment for severe cases of OSA. However, mandibular advance- ment splints, provided by a patient’s dentist, can offer a much simpler and more comfortable solution which can effectively treat many cases of mild and moderate OSA and eliminate snoring. There are a number of appli- ance designs on the market but not all have the same evidence base behind them.” With an increasing awareness of the problem there has been an increase in demand for the provision of man- dibular advancement splints to treat these conditions, the demand coming both directly from patients attending dental practices and also on referral from medical colleagues. Nicolas Bell, Managing Director of training company CPD Dubai agrees. “We are aware of the increas- ing demand from dentists to be able to provide mandibular advancement splints to treat a range of sleep-related breathing disorders. These disorders can have a profound effect on suffer- ers, their partners and those around them and we think this can be both a professionally and commercially satisfying area for dentists to get in- volved with. We have invited Dr. Ama Johal to come and speak on the topic to increase understanding amongst dentists in the regions and improve their ability to safely assess and treat patients using mandibular advance- ment splints.” The treatment of snoring and sleep apnoea using mandibular advance- ment splints is a rapidly expanding market both in Europe and North America, but despite large numbers of sufferers in the region, there are relatively few dental practitioners in the Middle East who can provide ef- fective appliances. Samer Sabbagh, Managing Director of Qualident Dental Laboratory, said: “We view mandibular advancement splints as a core product we need to be able to provide to practices across the UAE and beyond. We have been working with a UK company called S4S to un- dertake the required training to fab- ricate the Sleepwell appliance which is by far the most clinically proven and effective design. The Sleepwell is a soft, slim-line, two-piece appliance that unlike many similar appliances allows full lateral movement with the degree of advancement being fully adjustable. We are also looking to support local dentists with marketing and education materials for patients”. by dr. danielle stephenson ________________________ ‘Snoring and Sleep Apnoea – A Role for the Dentist’ will take place on October 12th at The Address Hotel, Dubai Marina. Please visit www.cpd-dubai.com for more information and to make your booking. Fig.1: CPAP machine Fig.3, 4, 5: The ‘Sleepwell’ mandibular advancement splint. Fig.2: With appliance Contact Information Information on CPD Dubai, licence renewal requirements and upcoming courses can be found at: www.cpd-dubai.com