Dr. Steven Olmos, Founder of TMJ Sleep & Therapy Centre, describes some topics regarding education in sleep-breathing disorders that will allow for more treatment possibilities for patients.
by Steven Olmos, DDS, Founder of TMJ Sleep & Therapy Centre
Awareness of sleep breathing disorders for adults and children will continue to grow. A recently completed research study validating a visual screening tool for pediatric OSA has been submitted to the Journal of Evidence-Based Dental Practice. Judith Owens, MD, MPH, of Boston Children’s Hospital was the principal investigator for this project which was funded by the American Academy of Craniofacial Pain (AACP) and the Board of Craniofacial Pain & Dental Sleep Medicine (ABCDSM). Adoption of this tool will ensure early treatment for children with OSA. The most common craniofacial features, in order: forward head posture, narrow vaulted palate, open bite, tongue thrust, tongue tie, and heart-shaped tongue.
Education for physicians and dentists will improve and become more comprehensive. Screening will be ubiquitous for all health care practitioners. Improved interpretation of sleep studies will allow the dentist to triage the specific phenotypic traits of OSA (PCrit, muscle responsiveness, loop gain, and arousal threshold). Lowering the cost of sleep studies by evaluation of other biomarkers such as fractional exhaled nitric oxide, which has been found to be correlated to OSA in snorers, with higher levels in uncontrolled asthma.1 In addition to lowering the cost of sleep studies will be the routine evaluation of jaw movements and giving a more accurate understanding of sleep bruxism. Mandibular jaw movement biosignal evaluation depicts the muscular trigeminal respiratory drive and is a highly effective tool for differentiating between central and obstructive sleep apnea episodes, including hypopneas. This provides clinicians valuable insights into wake/sleep states, arousals, and sleep stages.2
Oral appliances have been our entry to treating OSA. Their design and function have changed greatly. Appliances have changed from acrylic to more biofriendly materials such as 3D printed type 12 nylon or ethyl-methacrylate. Printed Hybrid appliances (Shirazi Hybrid/ Diamond Orthotic Lab) allows nasal delivery to address claustrophobia, and the absence of straps prevents aggravation of headaches and head pain. The frequency of use will increase to insure all patients have an optimal outcome.
The nose accounts for 50% of airway resistance so evaluating nasal function will increase in dental offices. Measuring volume and flow rate by utilizing rhinometry and rhinomanometry equipment will help to triage those patients needing nasal surgery or therapy for better treatment outcomes. Accounting for the starling resistor model of increased extra-luminar pressure of the pharyngeal airway (PCrit) with nasal obstruction or narrowing of the nasal valve is more precise medicine.
A reduction in morbidity of surgery for hypertrophied tonsils and adenoids, as well as pharyngeal soft tissue and tethered oral tissues, can be accomplished utilizing CO2 laser systems (Deka/BioResearch Inc). A study at the University of Manitoba Canada is headed by Enoch Ng, DDS. PhD utilizing CO2 lasers for tonsil reduction in children. Dentists of the future will take over this role routinely after FDA approval.
Orthopedic development techniques will be routine for properly trained dentists that are specific for pediatric OSA. The psychosocial pathology associated with OSA is less discussed. Untreated OSA impacts affective disorders such as depression and anxiety, and often leads to decline of cognitive functions or permanent brain damage.3 Attention-deficit/hyperactivity disorder (ADHD) is among the neurobehavioral sequelae associated with OSA. A study review found that children with OSA had a high rate of attentional deficits (95%), and up to 20-30% of children with ADHD had OSA.4 ADHD and Autism Spectrum Disorder (ASD) in children are highly comorbid with prevalence rates of ADHD in ASD being 39.4% ages (6-11) and 38% ages (12-17).5 Suicide is the second leading cause of death for 10 to 24-year-olds in the US. Individuals with neurodevelopmental disorders, including attention-deficit/hyperactivity disorder, learning disabilities, and autism spectrum disorder, are at higher risk for suicide attempts.6
For education and training in chronic pain and sleep breathing disorders, contact www.tmjtherapycentre.com.
Check out this special section on learning opportunities for education in sleep-breathing disorders. https://dentalsleeppractice.com/education-special-section/.
- Kiaer E, Ravn A, Jennum P, Pretorius C, et al. Fractional exhaled nitric oxide-a possible risk of obstructive sleep apnea in snorers. J Clin Sleep Med. 2024;20(1):85-92.
- Malhorta A, Martinot JB, Pepin JL. Insights on mandibular jaw movements during polysomnography in obstructive sleep apnea. J Clin Sleep Med. 2024;20(1):151-163.
- Vanek J, Prasko J, Genzor S, Ociskova M, et al. Obstructive sleep apnea, depression and cognitive impairment. Sleep Med. 2020 Aug:72:50-58.
- Ivanov I, Miraglia B, Prodanova D, Newcorn JH. Sleep disordered breathing and risk for ADHD: review of supportive evidence and proposed underlying mechanisms. J Atten Diord. 2024;28(5):686-698.
- Jones Piltz V, Halldner L, Markus J-F, Fridell A, et al. Symptom similarities and differences in social interaction between autistic children and adolescents with and without ADHD. Curr Psychol. 2024;43:3503-3513.
- Hua LL, Lee J, Rahmandar MH, Sigel EJ. Suicide and Suicide Risk in Adolescents. Pediatrics Jan 2024;153(1).