Australian dental journal最新文献

In dental sleep medicine several sleep disorders commonly coexist with pain, contributing to complex clinical presentations which might affect the provision of appropriate and timely treatment. There are associations between sleep disorders and pain in general, as well as with specific orofacial pain conditions. As many as five of six patients with orofacial pain can present with sleep problems. The comorbidity of orofacial pain and sleep disorders overlays a complex web of altered neurobiological mechanisms that predispose to the chronification of orofacial pain. This review discusses the relationship between orofacial pain and sleep disorders and highlights their interactions and the neurobiological mechanisms underlying those relationships.

Objective: The aim of this study was to assess the effect of RME on upper airway structure and its relationship to improvements in sleep disordered breathing.

Methods: The study was carried out in 23 children with malocclusion and OSA. Clinical assessment visits, daytime sleepiness questionnaire, polysomnography and orthognatodontic examination were performed before (T0) and 4 (T1) and 12 (T2) months after RME. CB CT scans with 2D and 3D reconstructions were performed before (T0) and 12 after months (T2) RME. The relationship between airway changes and improvements in sleep disordered breathing were evaluated.

Results: In all cases, opening of the mid-palatal suture was successfully achieved. Volume of the total upper airways, nasal cavity, nasopharynx and oropharynx increased significantly as well as the nasal osseous width. The increase in posterior suture, pterygoid process, maxillary, nasal cross-sectional width were significantly correlated with total upper airway volume, nasal cavity volume, nasopharyngeal airway volume, and oropharyngeal airway volume. The improvement in AHI was correlated with the increase in total upper airway volume at 12 months.

Conclusion: The study provides important details about the effect of RME on upper airway structure, including an enlarged posterior suture, pterygoid process, maxillary width and nasal cross-sectional width and enlarged airway volume.

Sleep Medicine has evolved into a highly multidisciplinary field over the last few decades, involving respiratory physicians, neurologists, cardiologists, ENT surgeons, psychiatrists and psychologists to name a few. It is within this highly multidisciplinary context that we have seen an increasing role for dentists in the recognition, diagnosis and management of select sleep disturbances and disorders. Over the last couple of decades, this growing role for dentists has seen the informal emergence of a new interdisciplinary field of Dental Sleep Medicine-a field that bridges medicine and dentistry as it pertains to the diagnosis and management of sleep disorders. This article describes this new field in terms of its history, the evolving scope of practice for dentists, the implications for education and training, and the importance of multidisciplinary care that optimises outcomes for patients.

Background: This study aimed to evaluate the current status of dental sleep medicine education across dental schools in Australia and New Zealand and gain further insights into the educational background of dentists who have sat the Australasian Sleep Association Fellow of Dental Sleep Medicine examination in 2023.

Methods: Online surveys were carried out, and descriptive statistics were used to analyse data.

Results: All dental schools responded to the survey. Seventy per cent of the schools included dental sleep medicine as part of their curriculum, with an average total teaching time of 2.6 h. Dentists who sat the Fellow of dental sleep medicine examination spent on average 87 h preparing for the examination. All dental schools included discussion on pathophysiology of obstructive sleep apnoea and oral appliance therapy, but did not adequately discuss advanced sleep medicine topics, clinical aspects in treatment planning or contemporary dental sleep medicine topics, whereas dentists that completed the Fellow of dental sleep medicine examination gained knowledge in all aspects of the field.

Conclusion: Findings from the study reveal that dental schools across Australia and New Zealand are not delivering adequate levels of education in dental sleep medicine, and hence the current dental sleep medicine curriculum needs to be reviewed and improved.

Both periodontal diseases (PDs) and obstructive sleep apnoea (OSA) are highly prevalent disorders with global impact, associated with a large burden at individual patient and health system levels. These disorders often co-exist, but there is growing evidence that the association between the disorders goes beyond an overlap between two highly prevalent diseases that have shared risk factors. Evidence suggests a potential causal relationship, although further research is required to verify this. Regardless of any causal relationship, the co-existence of these disorders is important to recognize since they may act in combination to heighten health risks, particularly cardiovascular risk. Thus, dentists have an important role in screening for OSA in patients presenting with PDs, and similarly, they need to evaluate periodontal health in patients requiring treatment for OSA. Here we provide a narrative review of the association between PDs and OSA to raise awareness among clinicians and promote multidisciplinary collaborations that aim at an evidence-based and effective management of such patients.

Objective: Sleep bruxism (SB) and obstructive sleep apnoea (OSA) seem to be mutually associated. This study investigates the relationship between current SB and OSA-related symptoms and the difference in OSA-related symptoms between groups based on a history of SB.

Methods: An online survey was drafted to report the presence of SB and OSA in sample of 243 individuals (M = 129;F = 114;mean(SD)age = 42.4 ± 14.4 years). The Subject-Based Assessment strategy recommended in the 'Standardized Tool for the Assessment of Bruxism' (STAB) was adopted to assess SB. To evaluate OSA-related symptoms, Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaires were adopted. Correlations between current SB and OSA-related symptoms were evaluated by Spearman test. ESS and STOP-BANG scores were compared by Mann-Whitney U test in individuals with and a without positive SB history.

Results: Current SB and SB history were reported by 45.7% and 39.1% of the sample, respectively. 73.7%, 21% and 5.3% of the responders showed a low, intermediate and high risk of OSA, respectively. Neither significant correlations between current SB and OSA nor significant differences between SB groups emerged.

Conclusions: This study did neither find any significant correlation between self-report of current SB and OSA nor significant differences in ESS and STOP-BANG scores between groups based on SB history.

The clinical spectrum of sleep-disordered breathing comprises a range of diverse conditions including obstructive sleep apnoea, central sleep apnoea and sleep-related hypoventilation syndromes. These distinct conditions have specific diagnostic features and are managed differently from one another. Therefore, it is useful for dental practitioners to have a working knowledge of sleep-disordered breathing beyond that of uncomplicated obstructive sleep apnoea (OSA). This review paper summarizes the diagnosis and management of commonly encountered clinical sleep-disordered breathing syndromes, with a particular focus on management from a dental perspective.

Failure of upper airway muscles to develop efficient dilating forces plays a key role in the occurrence of obstructive sleep apnoea in given patients. Thus, myofunctional therapy has been developed to improve the activity/efficacy of the upper airway (UA) dilator muscles, reduce its fatigability and improve mechanical performance. Various programmes, differing in the types of daytime exercises to be completed, as well as in their duration and intensity, have been evaluated. Meta-analysis confirmed the efficacy of myofunctional therapy, with mean apnoea hypopnoea index (AHI) scores decreasing from 28.0 ± 16.2/h to 18.6 ± 13.1/h, and lowest oxygen saturation (LSAT) values improving from 83.2% ± 6.1% to 85.1% ± 7.0%. In children, MT and nasal washing may result in little to no difference in AHI. Integrating oropharyngeal exercises with the use of a smartphone application to complete and record exercise performances represents an innovative turn in the development of ambulatory MT programmes. Since adherence to therapy is a weakness in conventional OSA strategies such as CPAP, this approach to MT is promising, as evidenced by a 90% mean adherence to it after 3 months of using a smart application. There is further need to determine the most effective combination of exercise algorithms and identify the target population most likely to benefit from MT in outpatient training programmes.

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.