Research and Articles
Optimal Dental Therapy for OSA
September 2015 | Dentalcetoday.com
Optimal is a very different than acceptable, especially if you are the patient. This case study will highlight the need for a structural assessment of the 4 points of the airway prior to treatment utilizing CBCT (i-CAT). In additional, this case report will demonstrate how successful resolution of sever apnea with an oral appliance on a patient for whom continuous positive airway pressure (CPAP) had little effect on excessive fatigue until the nasal airway was addressed.
Research and Articles
CBCT in the evaluation of airway — minimizing orthodontic relapse
Dr. Steven Olmos Discusses the Four Points of Breathing Obstruction
For those of us who treat obstructive sleep apnea (OSA) or those who have tried but run into problems that make you want to throw up your hands, think about the four points of breathing obstruction. Each patient has a different set of obstructions, so decisions on how to choose between the hundreds of appliances to treat breathing disorders are based upon multiple points of obstruction. The best treatment may be combination therapy (hybrid): oral appliance therapy, nasal positive pressure, and nasal surgery. The optimal result is one in which the four points of obstruction are best managed. Triage of options is dependent on a good clinical exam of the tongue and its posture and cone beam computed tomography (CBCT).
Research and Articles
Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015
An American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine Clinical Practice Guideline
Kannan Ramar, MBBS, MD1; Leslie C. Dort, DDS2; Sheri G. Katz, DDS3; Christopher J. Lettieri, MD4; Christopher G. Harrod, MS5; Sherene M. Thomas, PhD5; Ronald D. Chervin, MD6
Introduction
Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring.
Methods
The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations.
Research and Articles
Dentistry’s New Direction – “The Starting Point”
by Steven Olmos, DDS, DABCP, DABCDSM, DABDSM, DAAPM, FAAOP, FAACP, FICCMO, FADI, FIAO
I am so excited to be a dentist in the year 2014. I started out way back in 1977 as a freshman at the University of Southern California dental school wanting to help people by relieving their pain and preventing them from having it. As my practice evolved from giving relief from dental, bony and soft tissue infections, inflammation and injuries to the relief of Craniofacial Pain and Sleep Breathing Disorders, I am impressed. I am impressed and proud that we have a profession that is so expansive in its’ ability to help people that we can limit our services to addressing medical conditions as a Dentist.
Orthopedic dysfunction of joints (TMD), chronic facial, mouth, and head pain as well as bstructive sleep breathing disorders, are all medical conditions. Sleep bruxism is identified as a medical movement disorder like PLMD (Periodic Limb Movement Disorder) in the category of a “Sleep Related Movement Disorders” by the International Classification of Sleep Disorders.
Research and Articles
Oral Health – Future of Dentistry (Part 3)
by Steven Olmos, DDS, DABCP, DABCDSM, DABDSM, DAAPM, FAAOP, FAACP, FICCMO, FADI, FIAO
We need to evaluate our system of treatment. A patient presents with worn dentition or complaints of muscle soreness. The dentist produces a nightguard without further in vestigation. The result is that the treatment helps the symptom of muscle soreness, makes it worse or has no effect. The dentist is unclear what to do.
Facial muscles are sore because of central nervous system stimulation. Jaw joints break down the result of continued nocturnal parafunctional activity. We bite harder at night due the result of proprioception ascending to the cerebellum and basal ganglia in stead of the cortex where we recognize how hard we are biting. In the daytime proprioception ascends to the cortex where we are conducted a study on one hundred adult bruxers and their relation ship to stress and anticipatory stress measured by EMG. They found: “No overall relationship was established between electromyographic measures and the personality variables nor between electromyographic measures and self-reported stress.”
Research and Articles
Use of a sibilant phoneme registration protocol to prevent upper airway collapse in patients with TMD
© Springer-Verlag 2007
Patients with temporomandibular dysfunction (TMD) require correction of mandibular position, but the ideal position for the mandible remains controversial. Miralles et al. [1] found the amount of freeway space (FS) required depended on the protocol used to measure it. For example, a significantly higher clinical FS value was found using a phonetic method than after swallowing or with the mandible in a relaxed postural position. A sibilant is the hissing or whistling sound heard in the formation of certain letters in speech, such as the letter “s.” A phoneme is the smallest unit of speech that defines one sound from another.
Thus, a sibilant phoneme registration (SPR) protocol is colloquially known as a ‘phonetic bite’. Patients with TMD secondary to temporomandibular joint (TMJ) inflammation (retrodiscitis), disc displacement, or disc dislocation require an antero-posterior (AP) correction inter alia.
Research and Articles
The Effect of Condyle Fossa Relationships on Head Posture
Steven R. Olmos, D.D.S.; Donna Kritz-Silverstein, Ph.D.; William Halligan, D.D.S.; Sarah T. Silverstein
Although it is commonly accepted that there is an interrelationship between the temporomandibular joint (TMJ) and head posture, few, if any, previous studies have quantified this effect. The purpose of this study is to quantify the effect of a change in the condyle fossa relationship of symptomatic temporomandibular joints on head posture. Charts of 51 patients (N=10 men and N=41 women) with symptomatic TMJ pathology were reviewed. The condyle fossa relationships were measured pre- and posttreatment using sagittal corrected hypocycloidal tomography. The amount of slant between the shoulder and external auditory meatus (EAM) was measured in pre- and posttreatment photographs as an indicator of forward head posture; less slant indicates better posture. Subjects ranged in age from 13-74 years (mean=43.1) and had been treated for an average of 5 months. Comparisons with pre-treatment measures showed that after treatment, the amount of retrodiskal space was significantly increased by an average of 1.67 mm on the left side (t=-10.11, p<0.0001) and 1.92 mm on the right (t=-9.62, p<0.0001). Comparisons also showed that after treatment, the amount of slant between the shoulder and EAM decreased by 4.43 inches on average which was also significant (t=13.08, p<0.0001). Improvement in the condyle fossa relationship was related to decreased forward head posture. This suggests that optimizing mandibular condyle position should be considered in the management of forward head posture (adaptive posture).
