2017 AAO Annual Session - Oral Appliance Treatment: The Good, Bad and Ugly / Facial Skeletal Deficiencies and OSA: Insights on Prevention and Intervention / If They Snore, Do More / A 35-Year Perspective on Sleep Disorders

Oral Appliance Treatment: The Good, Bad and Ugly

Oral appliances are an accepted first line of treatment for a wide range of adults with obstructive sleep apnea. As specialists in dentofacial orthopaedics, orthodontists are ideally suited to deliver this increasingly popular OSA treatment modality and should be well aware of both the associated benefits and complications. This presentation will focus on the latest evidence regarding the effectiveness of oral appliance treatment of OSA, as well as review the management of the most common side effects.

Learning Objectives:

• Describe the effectiveness of oral appliance treatment of obstructive sleep apnea in adults.
• Recognize the side effects commonly associated with oral appliance treatment.
• Propose best practices in long-term patient management.

Facial Skeletal Deficiencies and OSA: Insights on Prevention and Intervention

Obstructive Sleep Apnea is a health and life threatening condition affecting adults and children. Current evidence suggests that certain types of craniofacial morphology such as maxillary and mandibular deficiencies predispose to OSA. Therefore, early orthopedic dento-skeletal maxillary and mandibular development may be critical treatment modality in resolving and preventing OSA. This lecture will discuss current evidence and future vision for orthodontic profession taking the lead in management of this serious medical condition.

Learning Objectives:

• Recognize types of craniofacial morphology predisposing to OSA with the aid of CBCT imaging.
• Recognize treatment and prevention modalities in addressing OSA in pediatric and adult patients.
• Discuss and analyze current literature on OSA.

If They Snore, Do More

Overnight polysomnolgaphy in a sleep laboratory remains the gold standard for diagnosis of sleep disordered breathing (SDB). However, the high cost and inconvenience of this test makes home monitoring an attractive alternative. This lecture will discuss the merits of home monitoring as well as the use of the Pediatric Sleep Questionaire to identify patients at risk for SDB in the orthodontic practice. And, importantly, what to do when you find them.

Learning Objectives:

• Analyze the differences between at-home monitoring and Overnight PSG.
• Define the score on the PSQ that puts a patient in the at-risk category.
• Evaluate the health consequences of SDB for teenagers.

A 35-Year Perspective on Sleep Disorders

Sleep apnea has been part of the human experience centuries before Charles Dickens’ ‘Pickwick Papers’ actually made it part of our culture in the 19th century. At that time, however, most of the focus was on one of the character’s obesity rather than the sleeping disorder associated with it. It wasn’t till the early ‘60s that the complexity and variability of expression associated with sleep disorders was more fully appreciated as the use of polysomnography made it possible to fully document apneas during sleep. Soon we were able to begin to effectively address the disorder’s etiologies thanks to the proliferation of Sleep Centers around the globe. As a result, all sorts of therapeutic approaches evolved ranging from drug & inhalation therapies, to various surgical and appliance methodologies/gizmologies. But how far have we progressed in effectively managing or eliminating this condition as now more reports document its worldwide impact. Its prevalence persists at ever-higher rates across a wider variety of ethnic groups, and even increasing in the pediatric population as well. What have we accomplished to date in sleep medicine? Why are matters apparently getting worse in this field? What is it that we are missing? Where should we better focus our efforts? This presentation will attempt to address these concerns by: reviewing the history of sleep-disorders and our accomplishments in managing them. It will focus on how we as healthcare providers can help our patients better manage their conditions beyond the mere use of intraoral appliances.

Learning Objectives:

• Discuss the historical & epidemiological ramifications associated with sleep-disordered breathing disorders.
• Identify the multivariate etiology behind sleep apnea and other sleep-disordered breathing conditions.
• Offer better options needed to help manage the care for sleep apnea and sleep-disordered breathing patients.