What is the dentist’s role in sleep disordered breathing: A review – 3

Continuing on – the studies showed the need for an organised approach to the OSA endemic.

Overall 1,432 studies were found in the six databases searched. In the second phase, 231 studies were evaluated by reading their full text. Eight­een studies matched the inclusion criteria. The experts, for a total of 22 included studies, included four studies.

The selected studies were published between 1999 and 2019. Recommendations made by the studies included in this systematic review were for the dentists’ clinical practice in patients with OSA, SDB or snoring.

Most of the included studies were based on or were the guideline itself from an accredited dental or med­ical association as follows: American Association of Ortho­dontics, American Academy of Dental Sleep Medicine, and American Academy of Sleep Medicine

Studies’ recommendations that ALL dentists should screen for potential patients with SDB/OSA.

Screening could include questionnaires, such as the validated tool for OSA risk assessment STOP-Bang questionnaire, the Epworth Sleepiness Scale, Friedman Tongue Classification System, Kushida Index, or Berlin Questionnaire for Sleep Apnea; evaluation of neck size and body mass index; modified Mallampati classification (throat size) to de­scribe the patency of oral airway.

Dentists should refer to the sleep physician or otolaryngologist when SDB/OSA is suspected.

Recommendations for OSA Management oral appliances.

Oral Appliance Therapy can be an effective therapy for OSA.

OAT is indicated for patients with mild to moderate OSA who prefer OAs to CPAP therapy or who do not re­spond to CPAP therapy or have contraindications for the use of CPAP therapy, although the sleep physicians are ‘re­sponsible’ for prescribing the most appropriate or accepta­ble treatment option.

OA can significantly decrease the AHI, respiratory disturbance index, and respiratory event index, inde­pendently of OSA severity.

Reduction in AHI before and after treatment with O.As versus CPAP has no statistically significant differ­ences

The sleep physician should prescribe OAT rather than no treatment for adult patients who request treatment of primary snoring and also for patients with OSA who do not tolerate CPAP therapy.

The sleep physician with sleep testing should do the evaluation of OA treatment efficacy so that a comparison from before and after can be compared.

Studies’ recommendations for the manage­ment/treatment of SDB by qualified dentists is that only qualified dentists should manage SDB/OSA and snoring screening and therapy.

When OAT is prescribed, the qualified dentist should use a custom, titratable appliance over non-custom oral devices.

The dentist should instruct patients with OA to re­turn for follow-up, and evaluate possible dental-related side effects such as occlusal (bite) changes and long-term ef­fects.

The dentist can acquire objective information with a portable monitor for purposes of titration only; the diag­nosis and follow-up assessment are the sleep physician’s role.

Studies’ recommendations for multidisciplinary ap­proach:

A physician or sleep physician should make the final diagnosis of SDB or OSA.

The sleep physician with sleep testing should do the evaluation of OA treatment efficacy.

The dentist must collaborate with the surgeon in case of maxillofacial surgery.

Orthodontic treatment.

Two orthodontic treatments in children may change airway dimension: rapid maxillary expansion in pa­tients with a constricted maxilla and mandibular advance­ment for class II malocclusion correction; however, the or­thodontic treatment in children in whom OSA is diagnosed should be planned based on the same principles for correc­tion of dental and skeletal malocclusion.

The management of OSA in children is different from that in adults, with tonsillectomy and adenoidectomy usually considered the first-line treatment.

Multidisciplinary teamwork is indispensa­ble. In my opinion this indicates the “range” over which the disease is found and managed is wide, consequently, a “cook-book” approach may not always be the best approach.

Patients may have the same disease but express it differently. We must not loose sight of the need to treat patients individually rather than en-masse simply because they have the same symptoms.

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