ortho - the international C.E. magazine of orthodontics

22 I I technique_ sleep apnea roofofthemouththatcanhelpincreasethewidthof the maxilla. As the roof of the mouth is also the floor of the nasal passage, RME helps to increase space in thepatient’sairway,allowingmoreairintothethroat and lungs. RMEcanbeusedinpatientsasyoungasage3,but it’s most often employed between the ages of 4 and 10. The key question is whether the child will sit still long enough for both the placement of the brace in the orthodontist’s office and for adjustments to the brace that will be made at home by parents. XuconcludeshispaperinJSMDentistrybysaying, “Pediatric dentists and orthodontists who perform a comprehensivehead-neckexamareinauniqueposi- tiontoidentifyyoungpatientswithincreasedriskfor OSAS.” He predicts a greater role going forward for dentists and orthodontists on the treatment side of things as well. _The orthodontist and adult OSAS Formaldiagnosisofsleepapneaismadebyasleep specialistafteranovernightpolysomnographyexam. OnceadultOSASisidentified,firststepstendtobeof the common sense variety — weight loss for obese patients, as well as changes in sleeping habits. Many patientsdobetteriftheysleeponthesideratherthan on the back. Another popular treatment, continuous positive airway pressure (CPAP), involves sleeping with a breathing mask that’s attached to a machine that helps generate more air pressure in the throat. CPAP is highly effective when used properly, but patient compliance is a big problem. Many people find the device so uncomfortable they simply stop using it. At this point, various surgical interventions may comeintoplay,includingtonsillectomyandadenoid- ectomy, cranofacial operations or tracheostomy. These can be successful on occasion, but they are far from sure-fire and lasting solutions in all cases. Here is where the orthodontist comes in. Various types of oral appliances offer partial relief to OSAS patients, especially in cases that fall in the mild to moderate range. The American Academy of Sleep Medicinerecommendstwodifferenttypesofdevices — tongue-retaining appliances that hold the tongue in a forward position and mandibular-repositioning appliances that keep the lower jaw in a protruded position while sleeping. California-based orthodontist Robert G. Keim discussed the difference such devices can make in a 2011 article in the Journal of Clinical Orthodontics: “Even a few millimeters of mandibular advancement during sleep may be enough … to produce relatively normal breathing patterns,” he wrote. Keimalsonotedthatsleepapneaisnowreceiving significant attention in both dental and orthodontic graduate schools — a sure sign that the trend of increased orthodontic involvement in OSAS is likely to continue._ ortho1_2014 ‘Even a few millimeters of mandibular advancement during sleep may be enough … to produce relatively normal breathing patterns.’ — California-based orthodontist Robert G. Keim

ortho - the international C.E. magazine of orthodontics

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