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An Interdisciplinary Approach to Treating a Chronic Sleep Condition Author- Jim Duffy

Interdisciplinary treatment planning is a concept that’s gaining relevance among oral health professionals. It’s one of the chief tenets of the popular Seattle Study Club, and many finding it extremely rewarding to work with a group of like-minded professionals when treating their patients. This evolving holistic approach to oral health is exemplified in the evolving role that the orthodontist can play in addressing sleep apnea.

The notion that people should see an orthodontist about the sleeping problems they or their children endure might come as a surprise to the general public, but more and more medical and orthodontic experts are pointing toward a future that heads in that direction.

Consider, for example, the most common type of sleep-disordered breathing, obsessive sleep apnea syndrome (OSAS). It’s quite common among both children and adults, though precisely how common can be difficult to say because the condition is significantly under-diagnosed.

A 2012 paper in the journal Pediatrics placed sleep apnea numbers among children within the broad range of 1 to 5 percent of the population. The nonprofit Sleep Foundation estimates that at least 18 million adults have OSAS.

The syndrome can affect patients in a range from mild to severe, with the more serious cases being quite dangerous to long-term health. Among children, OSAS has been linked with poor school performance, learning disabilities, behavior problems, and even some cardiac abnormalities. In adults, it can boost the risk of hypertension, cardiovascular disease, coronary artery disease, and insulin-dependent diabetes.

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Pediatric Sleep Disordered Breathing/Obstructive Sleep Apnea

Pediatric Sleep Disordered Breathing/Obstructive Sleep Apnea

Sleep-disordered breathing (SDB) is a general term for breathing difficulties occurring during sleep. SDB can range from frequent loud snoring to Obstructive Sleep Apnea (OSA) a condition involving repeated episodes of partial or complete blockage of the airway during sleep. When a child’s breathing is disrupted during sleep, the body perceives this as a choking phenomenon. The heart rate slows, blood pressure rises, the brain is aroused, and sleep is disrupted. Oxygen levels in the blood can also drop.

Approximately 10 percent of children snore regularly and about 2-4 % of the pediatric population has OSA.   Recent studies indicate that mild SDB or snoring may cause many of the same problems as OSA in children.


The most obvious symptom of sleep disordered breathing is loud snoring that is present on most nights. The snoring can be interrupted by complete blockage of breathing with gasping and snorting noises and associated with awakenings from sleep. Due to a lack of good quality sleep, a child with sleep disordered breathing may be irritable, sleepy during the day, or have difficulty concentrating in school. Busy or hyperactive behavior may also be observed. Bed-wetting is also frequently seen in children with sleep apnea.

A common physical cause of airway narrowing contributing to SDB is enlarged tonsils and adenoids.  Overweight children are at increased risk for SDB because fat deposits around the neck and throat can also narrow the airway. Children with abnormalities involving the lower jaw or tongue or neuromuscular deficits such or cerebral palsy have a higher risk of developing sleep disordered breathing.

Potential consequences of untreated pediatric sleep disordered breathing

  • •Social: Loud snoring can become a significant social problem if a child shares a room with siblings or at sleepovers and summer camp.
  • •Behavior and learning:  Children with SDB may become moody, inattentive, and disruptive both at home and at school.   Sleep disordered breathing can also be a contributing factor to attention deficit disorders in some children.
  • •Enuresis: SDB can cause increased nighttime urine production, which may lead to bedwetting.
  • •Growth:  Children with SDB may not produce enough growth hormone, resulting in abnormally slow growth and development.
  • •Obesity: SBD may cause the body to have increased resistance to insulin or daytime fatigue with decreases in physical activity.  These factors can contribute to obesity.
  • •Cardiovascular:   OSA can be associated with an increased risk of high blood pressure or other heart and lung problems.

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Dental Phobia-Treatment and Coping Methods

Communicating With Your Dentist

Talking with your dentist is the key to beating dental distress. Modern dentistry can be almost painless. Therefore, it’s worth taking the time to discuss your fears — and the potential treatment options — with your dentist.

You can feel more in control if you take part in decisions about your treatment. And that can help you to feel less anxious. Your dentist should discuss with you all the procedures you may need. You may be able to have several procedures done at one time or have a series of shorter appointments. Ask your dentist to describe the types of pain control available. Then decide which you feel will work best for you.

During the appointment, ask your dentist to explain what’s happening at every stage of the procedure. This may help to lower your anxiety. When you know what the dentist is about to do next, you can prepare yourself. You won’t be taken by surprise.

On the other hand, some people may feel less anxious if they don’t know what’s happening. If this is true for you, explain this to your dentist. He or she should be willing to adapt to your wishes whenever possible.

Another helpful technique is to agree on a hand signal you can use if you want everything to stop right away. This will give you a sense of control. It can help to lessen your anxiety. You don’t have to wait until you’re having pain to give the signal. You may ask the dentist to stop because you’d like to rinse your mouth or simply catch your breath, or just take a break for a few seconds.

You may feel embarrassed to discuss your fears. Remember that you are not alone. Fears are not uncommon. Once your dentist knows what the issues are, he or she will be better able to find workable solutions.

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Drowsy Driving ~ Raising awareness among health care communities and the public about the costs and dangers of obstructive sleep apnea when left untreated

Drowsy driving can be as dangerous as drunk driving. Drivers are 15 times more likely to be involved in a deadly motor vehicle accident when they have excessive daytime sleepiness, a common symptom of sleep apnea. Motor vehicle accidents due to drowsy driving account for $48 billion in medical costs each year. Current legislation recommends that commercial drivers get screened and treated for sleep apnea. However, many drivers do not know that they have sleep apnea. The American Academy of Sleep Medicine estimates that 18 million Americans have sleep apnea. 80 to 90 percent of cases remain undiagnosed and untreated. The Institute of Medicine reports 50 to 70 million Americans suffer from chronic sleep disorders, including sleep apnea. Help protect yourself, your loved ones and your fellow travelers.

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Imagine what it would be like if you suddenly lost one or two of your front teeth. Smiling, talking, eating—everything would suddenly be affected.

Mouthguards, also called mouth protectors, help cushion a blow to the face, minimizing the risk of broken teeth and injuries to your lips, tongue, face or jaw. They typically cover the upper teeth and are a great way to protect the soft tissues of your tongue, lips and cheek lining. Knowing how to prevent injuries like these is especially important if you participate in organized sports or other recreational activities.

When it comes to protecting your mouth, a mouthguard is an essential piece of athletic gear that should be part of your standard equipment from an early age. In fact, studies show that athletes are 60 times more likely to suffer harm to the teeth if they’re not wearing a mouthguard. While collision and contact sports, such as boxing, are higher-risk sports for the mouth, you can experience a dental injury in non-contact activities too, such as gymnastics and skating.


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Mouth care during chemotherapy

Some people having chemotherapy treatment find that their mouth gets very sore. This information gives some ideas about how you can look after your mouth before and during your chemotherapy treatment.

Chemotherapy drugs interfere with the way that cells of the body divide and reproduce. Both healthy cells and cancer cells are affected by chemotherapy drugs. Healthy cells can generally repair the damage caused by the chemotherapy, but cancer cells can’t and so they eventually die. When the healthy cells in the lining of the mouth are affected, this can lead to a number of side effects.

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Sleep Treatment Options For Those Who Can’t Tolerate CPAP


An acrylic oral devise can effectively treat obstructive sleep apnea without the discomfort or claustrophobic effects of the CPAP machine.

An estimated 18 million Americans suffer from obstructive sleep apnea (OSA), with many of those cases undiagnosed. OSA can come with serious side effects and consequences including fatigue, obesity, and an increased risk of heart attack, stroke and diabetes.

Continuous positive airway pressure, or CPAP, has been clinically proven to help. With CPAP, OSA sufferers wear a mask that delivers continuous air that keeps a patient’s throat muscles and air passages from collapsing, thus preventing the snoring and pauses in breathing associated with apnea. CPAP is one of the most effective sleep treatment options available. There’s just one problem however—some people can’t stand it.

One study estimates 30-50 percent of CPAP users don’t like the treatment; another survey discovered that about half of patients stop using the device within 1-3 weeks of it being prescribed. However, discomfort shouldn’t be a reason an OSA suffer doesn’t get help for his or her condition—the consequences are just too great. Other sleep treatment options are available for patients who dislike CPAP and should be explored.


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