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Updates in Dental Sleep Medicine

12 Jun 2018

Highlights of the American Academy of Dental Sleep Medicine (AADSM) Annual Meeting, Baltimore, USA  2018

 

The annual three day meeting was held in Baltimore, June 2018, with over 1300 participants from 23 countries.

 

The AADSM is regarded as the world peak body in the field, and this year I was joined at the meeting by two other Australian dentists.

 

The following is a summary of the highlights of the meeting and the extensive trade show that demonstrated all the best available customised oral appliances.

 

Oral appliance versus CPAP

 

While CPAP compliance remains a significant problem, oral appliances are now established as the proven alternative in achieving successful outcomes. CPAP remains more efficacious in reducing the AHI, however many studies demonstrate that both treatments are similar in reducing snoring and symptoms such as tiredness.

 

CPAP use can be measured objectively, however now sensors can be embedded into oral appliances to objectively measure compliance. The two companies manufacturing compliance sensors were present at the meeting and their research indicates that the technology is accurate and difficult to tamper with. The studies corroborate that objective MAS use is very similar to previously reported subjective use and overall significantly higher than CPAP, averaging six hours per night.

 

CAD CAM / 3D Printing

 

CAD CAM manufacturing with milling and 3D printing is becoming the standard, with resultant super thin, yet strong appliances. Traditional hand made manufacture is being superseded as materials are becoming more flexible and soft with higher levels of comfort and compliance.

 

Effectiveness of oral appliances and managing side effects

 

Despite the claims of some oral appliance companies, it is generally regarded that the various designs of appliances have similar efficacy.  The main differences between the various appliances being the level of comfort, ease of use and side effect profile. It is interesting to note that the cost of the appliance does not often correlate with the effectiveness.

 

There was a special emphasis on managing side effects. This included a discussion of a recently published review listing all the potential side effects and their management, including reports from an expert panel. The consensus is that side effects are transient, minor and easily managed with established systems.

Download the Management of Side Effects of Oral Appliance Therapy for Sleep-Disordered Breathing here.

Temporomandibular (TMD) symptoms are an infrequent occurrence, are usually transient, and do not lead to any long term problems.

Methods were presented of achieving speedy resolution of TMD symptoms, often not requiring discontinuing use of the oral appliance.

Occlusal Changes

 

The chief side effect remains bite changes and it was interesting to note that the different designs of appliances, including ones with anterior hooks, or those with side connectors, had a differing potential to cause bite changes.

It was emphasised that this should be considered when choosing an appliance for a patient that is assessed to be vulnerable to these changes.  I was particularly interested in new methods and strategies for preventing bite changes and effectively dealing with ones that have occurred.  One such method was presented by Dr Jamison Spencer, a keynote presenter at this year's AADSM meeting.

 

 Click here to view Dr Spencer's method on youtube.

The importance of the nose

 

One of the most popular presentations was from a leading ear nose and throat surgeon, Professor Raj Dedhia, whose chief emphasis was on the nose and how the various forms of obstruction can lead to poorer outcomes in the effectiveness of oral appliances and CPAP.  He outlined how a dentist can do a simple exam to identify such patients plus simple methods of management and criteria for referral.

Combining treatments

 

There was discussion on the adjunctive treatments, which when used in combination with oral appliances, or CPAP, can often lead to better outcomes. Given that studies show that average CPAP use is around four hours per night it is desirable for patients to be able to use an oral appliance when not using CPAP.

There was an emphasis on the importance of physicians providing a diagnosis and directing the treatment, as well as the final assessment of effectiveness.  There are potential legal ramifications for dentists not involving medically trained practitioners as highlighted by Dr Ken Berley, a dentist practising in the field of dental sleep medicine and also a practising attorney. 

Download the Sleep Medicine Malpractice Negligent Failure to Refer document here.

The AADSM will be held in San Antonio Texas next year and we hope to have more Australians participate.

 


 

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