Dental Asia January/February 2019

Dental Managment
and size (Figs. 2-5). The mechanism
of action of a tongue retainer device
is the protraction of the tongue due
to a slight negative pressure in the
bulb compartment of the device. The
displacement of air is achieved once the
tongue is placed in this compartment. A
tongue retainer device is indicated for
patients with compromised dentition,
including insufficient teeth, or periodontal
disease (Fig. 6).
Dentist’s Role
Due to their prime position as examiners
of the oropharyngeal area, dental
professionals have been recognised
as being an important team player in the
screening and management of obstructive
sleep apnoea 12 . The assessment
of tongue size, soft palate, uvula,
maxillary and mandibular arches are
commonly included as part of screening
(Fig. 7). Dental sleep medicine is a field
in dentistry that has evolved rapidly
during the last few years thanks to the
advancement in research related to
the use and efficacy of oral appliance
therapy for the management of OSA.
Oral appliances hold the mandible in
a forward position to help maintain
Fig. 6 Fig. 7
a patent airway during sleep for
patients with obstructive sleep apnoea.
Oral appliance therapy is mainly indicated
for patients with mild to moderate OSA
and patients with severe OSA who cannot
tolerate PAP therapy or in conjunction
with PAP treatment. It is important
to distinguish and recognise which
patients would benefit from OA therapy
in order to provide a suitable treatment
option effectively 13 .
As the field of dental sleep medicine
continues to grow, it is essential
that dentists who use oral appliances
for obstructive sleep apnoea
also understand the management of side
effects, including occlusal symptoms
and temporomandibular disorders (TMD);
and comprehend the current standards
of dental sleep medicine practice
developed by the American Academy
of Dental Sleep Medicine (AADSM) 14 . DA
References:
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of Sleep Medicine, 2001.
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obstructive sleep apnea. J Prosthodont Res 2015;59:161-171.
3. Wright J, Johns R, Watt I, Melville A, Sheldon T. Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic
review of the research evidence. BMJ 1997;314:851-860.
4. Abramson Z, Susarla S, August M, Troulis M, Kaban L. Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea.
J Oral Maxillofac Surg 2010;68(2):354-62
5. Berger RM. Mandibular Retrognathia and sleep apnea. JAMA 1982;247(16):2234
6. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328(17):1230-
5 doi: 10.1056/NEJM199304293281704[published Online First: Epub Date]|.
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doi: 10.1093/aje/kws342[published Online First: Epub Date]|.
8. Tsara V, Amfilochiou A, Papagrigorakis MJ, Georgopoulos D, Liolios E. Guidelines for diagnosis and treatment of sleep-related breathing disorders in adults and children.
Definition and classification of sleep related breathing disorders in adults: different types and indications for sleep studies (Part 1). Hippokratia 2009;13:187-191.
9. Gjerde K, Lehmann S, Berge ME, Johansson AK, Johansson A. Oral appliance treatment in moderate and severe obstructive sleep apnoea patients non-adherent to
CPAP. J Oral Rehabil 2016;43:249-258.
10. Epstein LJ, Kristo D, Strollo PJ, Jr., Friedman N, Malhotra A, Patil SP et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep
apnea in adults. J Clin Sleep Med 2009;5:263-276.
11. Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J, Jr., et al. Practice parameters for the treatment of snoring and Obstructive Sleep Apnea
with oral appliances: an update for 2005. Sleep 2006;29(2):240-3.
12. Paskow H, Paskow S. Dentistry’s role in treating sleep apnea and snoring. N J Med 1991;88(11):815-7.
13. Sutherland K, Vanderveken OM, Tsuda H, et al. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med 2014;10(2):215-27 doi: 10.5664/
jcsm.3460[published Online First: Epub Date]|.
14. Levine M, Bennett K, Cantwell M, Postol K, Schwartz D. Dental sleep medicine standards for screening, treating, and managing adults with sleep-related breathing
disorders. J. Dent Sleep Med. 2018;5(3):61-68.
Dr. Leopoldo P. Correa is an associate professor and director of the Dental Sleep Medicine fellowship program at Tufts University Dental
School in Boston Massachusetts. He completed his certificate of achievement in Craniomandibular Disorders and obtained his Master of
Science degree at Tufts University. He incorporated the teaching of dental sleep medicine into the pre- and post-graduate programs at
Tufts and developed various continuing education programs at the university including Dental Sleep Medicine Mini-Residency Program,
Dental Sleep Medicine Comprehensive Introduction, Paediatric Dental Sleep Medicine Interdisciplinary Course.
Dr. Correa is a Diplomate of the American Academy of Dental Sleep Medicine and visiting professor in different dental schools. He is an
active member of different professional associations. His passion for education allowed him to share and teach the Dental Sleep Medicine
Comprehensive Introduction program as a course director and on-site speaker in the USA, Europe, Latin America and Asia.
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