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The role of dentists in management of snoring with oral appliances
From Volume 45, Issue 5, May 2018 | Pages 408-412
Article
A recent development in dentistry is the emergence of dental sleep medicine (DSM), which is a recognized branch of sleep medicine that deals with patients who have sleep-related breathing disorders. These can range from ‘simple’ snoring to obstructive sleep apnoea (OSA), which is characterized by repeated collapse of the pharyngeal airway during sleep. Whilst snoring is largely considered to be more of an anti-social problem, with resultant disturbed sleep for bed partners, there is evidence to suggest that this in turn could act as an independent risk factor for Type II diabetes and cardiovascular disease.1,2 OSA and the resultant impaired sleep is associated with a significant cardiovascular and metabolic comorbidity, impaired quality of life and increased risk of motor vehicle accidents.3,4
Dentists are beginning to take notice of their proactive role in this emerging area of special interest in managing patients who have sleep-disordered breathing. First line therapy for symptomatic OSA remains continuous positive airway pressure (CPAP), in view of its proven treatment effect.5 However, the limitations of this therapy relate to significant issues with tolerance, in particular adherence which remains highly variable and has been reported to range from 17−60% and, finally, in a small sample may not resolve the OSA.5,6 There is now an established evidence base for the management of OSA with custom-made, titratable, which permits incremental advancement (3rd generation7), mandibular advancement appliances (MAAs), provided by a dentist with special training.8It is worth remembering that dentists remain the only healthcare providers with both the knowledge and expertise to undertake MAA therapy.
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