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Dental related sleep problems are a nightmare!

I am looking forward to joining the Somnomed Sleep Medicine course at the end of September where SomnoMed will be bringing together medical professionals with an interesting program for all sleep specialists. The course provides insights on the medical perspectives, hands on training on fitting of SomnoDent Oral Appliance Therapy and the ongoing management of patients diagnosed with Snoring and Obstructive Sleep Apnoea (OSA). I am really pleased to see that the course includes presentations by a Sleep Physician, Neurologist, Ear Nose and Throat Surgeons and an experienced BSDSM Dentist and it will be a chance to learn more about sleep disordered breathing from specialist doctors and how to fit oral appliances from an oral medicine specialist.

SomnoMed®, is a global leader in oral sleep appliance technology. The company’s competence in treating sleep apnoea, bruxism and snoring is based on the international SomnoMed® network of qualified dentists. Their common goal, like that of Granta Denta, is to treat patients successfully.  Thomas O’Connor and I will be talking about how we have integrated sleep appliance technology with our TMJ diagnostic tools into our successful practice in Cambridge, giving patients a holistic service.

Sleep issues are becoming a real hot topic.  On 2 September 2014, MPs held a debate in Westminster Hall on the treatment of obstructive sleep apnoea. The debate was led by the Labour MP for Bolton West, Julie Hilling. See the debate here or read the text version.

Disappointingly while the debate raised the profile of this very important public health issue there was no link to the role that dentists can play in diagnosing and treating these problems.  At Granta Dental the team have been trained by and are registered with the British Society of Dental Sleep Medicine. We are also a centre of excellence for diagnosis and treatment of Temporomandibular Joint Disorders.

For all of our patients we have meticulous analysis of the temporomandibular through the use of biometric equipment for measurement and recording, including:

  • Joint Vibration Analysis
  • Jaw Tracking
  • Electromyography

This allows for accurate and thorough TMJ analysis before, during and following treatment, and is essential in TMJ management for patients being treated with Mandibular Advancement Devices- or anti-snoring sleep aids as we are calling them here as more a accessible term for patients, to avoid unstable or traumatic repositioning. For patients who meet the criteria for in-house treatment, and for those referred to us for treatment by sleep physicians for a mandibular advancement device, we take:

  • a full set of biometric records
  • a full TMJ evaluation
  • a TMJ screening

The design details of the appliance will vary according to the patient, the TMJ function and the intraoral supporting tissues. All of our working impressions are taken in medical grade silicone to the same level of precision used for dental implants. We only use Mandibular Advancement devices which are titratable and evidence-based eg SomnoMed/SomnoDent, and ResMed Narval. The devices are custom designed by the dentist, and manufactured at approved laboratories. Full quality control is undertaken by the dentist before fitting, with patient instructions verbally and in writing, a complete storage and care kit for each appliance, and a follow-up to check for comfort and function. Titration and re-titration are carried out by the dentist, and a further home sleep study with the ResMed ApneaLink is carried out the measure the AHI and Risk Index.

Speakers in the debate, whilst not appreciating the role dentists can play in diagnosis and treatment, noted that the case studies demonstrate, OSA can have a huge impact on the quality of life of those who suffer from the condition and their families. OSA can contribute to other long-term health conditions, such as high blood pressure, stroke, diabetes and, critically, mental health issues.

MP Julie Hilling told MPs that she asked for the debate to coincide with the launch of the British Lung Foundation’s obstructive sleep apnoea health economics report, because an estimated 1.5 million people have the condition in the UK, yet only 330,000 people are currently diagnosed and treated. OSA affects people of all ages, including up to 4% of middle-aged men, 2% of middle-aged women and 20% of those aged over 70. Although not everyone with OSA is overweight, many are, and with an increasingly overweight and ageing population, it is anticipated that the rates of OSA will increase in the coming years.

Following the debate the British Society of Dental Sleep Medicine (BSDSM) announced that they will press for an Oral Device Health Technology Appraisal so that the efficacy of oral devices is confirmed, the role of oral devices in the treatment of OSA is clearly defined and that NHS funding will be made available for the correct provision of such devices by trained GDPs, somehting we at Granta Dental would support

Posted on 26 September 2014
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