Australian dental journal最新文献

Obstructive Sleep Apnoea (OSA) is a common heterogenous sleep disorder that is associated with a wide range of comorbidities and consequences, including the development of neurocognitive and cardiometabolic disorders. The heterogeneity of OSA necessitates a precision medicine approach to accurately diagnose this condition and to effectively manage patients. One of the primary models of precision medicine is described by the P4 approach of predicting those who are susceptible to disease, preventing the occurrence of disease, personalizing treatment, and encouraging patients to participate in their individual healthcare journey. Recent advances in oral appliance therapy and OSA monitoring techniques have fostered an exciting opportunity for enhanced collaboration between dentists and sleep physicians to optimize OSA precision medicine care. This review aims to discuss the sources of heterogeneity among OSA patients, provide an overview of the growing applications of oral appliance therapy and tailored monitoring programs for OSA that are shifting treatment to a more personalized and participatory model of care, and outline the pivotal role of dentists in managing patients with OSA.

Defined as an elevated frequency of obstructive respiratory events in sleep, obstructive sleep apnoea (OSA) is driven by a combination of four pathophysiologic mechanisms: elevated upper airway collapsibility, unstable ventilatory control, impaired upper airway dilator muscle responsiveness and decreased arousal threshold. Established therapies such as continuous positive airway pressure (CPAP) and oral appliance therapy (OAT) work chiefly through targeting elevated collapsibility, which affects the majority of OSA patients. However, many patients respond poorly or do not tolerate these 'anatomic' therapies. The emerging field of 'precision sleep medicine' seeks to determine if novel treatment approaches specifically targeting the other, 'non-anatomic' mechanisms will improve treatment efficacy and acceptance. In this review, we consider the concepts underlying each pathophysiologic mechanism, the predisposing factors, and the potential implications for established and future OSA treatments.

The purpose of the present manuscript is to provide an overview for researchers and clinicians summarizing the knowledge concerning the relationship between some of the main sleep-related conditions of dental interest: sleep bruxism (SB), obstructive sleep apnoea (OSA) and gastroesophageal reflux disease (GERD). Starting with the discussion of the evolving current knowledge on SB, the interconnections are discussed. Most of the available literature focused on the possible relationship between OSA and SB, but a clear pathophysiological connection or temporal relationship has not been identified. Despite the paucity of data on the possible commonalities, SB, OSA and GERD constitute a complex network of conditions that may affect the clinical and research dental practice, and they are rarely found in isolation. In this scenario, the key role of dental practitioners as sentinel in the case of these sleep-related conditions is important, thanks to their ability and the knowledge to identify signs, symptoms and risk factors that are signs of ongoing sleep-related conditions. Thus, dental practitioners are recommended to view bruxism as a potential gateway to medicine.

Sleep bruxism is a masticatory muscle activity that occurs during sleep and presents as rhythmic or non-rhythmic activities commonly seen in healthy individuals but might also represent movement or sleep disorders. Given that the clinical presentations of sleep bruxism are relevant to dentistry, the early detection of sleep bruxism is of particular interest to dentists. However, the gold standard for sleep bruxism diagnosis involves polysomnography with audio-visual recording - a resource intensive and mostly inaccessible diagnostic method. As such, ambulatory devices to detect sleep bruxism have the potential to address the limitations of polysomnography. This review of the literature was carried out up until December 2024 on commercially available ambulatory devices in detecting sleep bruxism. Select ambulatory devices appear promising as a preliminary screening tool for sleep bruxism both in clinical practice and for domestic use.

Obstructive sleep apnoea (OSA) is a disorder associated with multiple cardiovascular, metabolic and neurocognitive comorbidities which impact the health and quality of life of patients. Dentists trained in dental sleep medicine have a significant role as part of a collaborative multidisciplinary team led by specialist sleep physicians in the overall management of OSA. Based on the recommendations of the medical team and the patient's preference, dentists have a pertinent role in the provision of oral appliance (OA) therapy for OSA. This narrative review provides a practical guide for OA therapy for snoring and OSA.

Impacted mandibular canines often result in a variety of clinical dilemmas. Orthodontic disimpaction of severely displaced mandibular canines may be extremely challenging and associated with significant patient discomfort and a high risk of iatrogenic damage. This case report demonstrates the interdisciplinary management of a horizontally impacted permanent mandibular canine, utilising a combination of three-dimensional radiology, biomodel fabrication and subsequent endodontic treatment. © 2024 Australian Dental Association.

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M Foster: Writing – review and editing. J Patel: Writing – review and editing. B Turlach: Writing – review and editing. R Anthonappa: Writing – review and editing.