- Email: [email protected]
Coaches' roles
Sleep Apnea General dentists treating nonapneic snoring Background.—Snoring is a significant problem both for the snorer and for the partner. Both suffer poor quality of sleep and reduced quality of life. In simple nonapneic snoring, loud snoring is present without any accompanying abnormal respiratory events, such as apnea or hypopnea. Various treatments have been used, including weight loss, alcohol restriction, sleep position training, oral appliances, nasal appliances, and pharyngeal surgery. Mandibular advancement appliances (MAAs) position the mandible so that the tongue and soft palate are drawn forward, maintaining the pharyngeal airway during sleep and reducing snoring. Good results have been achieved, but it can be difficult to get in to see an orthodontist or financially not feasible because third-party payers only cover severe apnea. General dental practitioners (GDPs) have expressed some interest in treating patients with simple nonapneic snoring after they are appropriately screened in a sleep clinic to ensure that obstructive sleep apnea is not present. The success of short-term GDP training to treat nonapneic snoring using a monobloc design MAA was investigated. Methods.—Fifteen GDPs underwent a 1-day training course for the treatment of nonapneic snoring. The course addressed theoretical and practical training in the use of MAA devices. The 60 subjects had nonapneic snoring and were treated in three hospital centers with a monobloc design MAA. The subjects’ sleeping partner completed a questionnaire before and after a 3-month period of treatment. Subjects were assessed for daytime sleepiness using the Epworth sleepiness scale (ESS) questionnaire before and after the treatment period. Subjects also completed an outcome questionnaire to determine if any side effects accompanied the MAA treatment. Results.—Eighty percent of the sleeping partners provided complete data and reported a 48% success rate for the MAA treatment. The GDPs experienced difficulties
obtaining a protrusive bite in 10% of patients, so that the appliance could not be fabricated. The main problems were as follows: (1) the bite was recorded with a large mandibular asymmetry but none was present and (2) the lack of definition made locating the casts impossible. The ESS results indicated a slight reduction in the median scores. Patients reported problems with inadvertently removing the appliance during the night, having a loose appliance, having the appliance crack, and gagging on the appliance, but the most frequently reported problem was pain in the teeth or gums, seen in 22% of cases. Discussion.—The 1-day training course was not sufficient to equip GDPs to effectively manage nonapneic snoring using a monobloc MAA. Either further training or selection of an appliance with a different design is needed.
Clinical Significance.—A total of 258 GDPs were invited to take part in this experiment, but only 15 were willing and able to take part, which may suggest that practitioners are either not interested or not willing or able to give up enough time for training. The 48% success rate indicates that 1 day of training does not qualify GDPs to effectively manage patients with nonapneic snoring. With more resources, more training, and appropriate remuneration, dentists may be able to expand their practice into this area.
Church SKJ, Littlewood SJ, Blance A, et al: Are general dental practitioners effective in the management of non-apnoeic snoring using mandibular advancement appliances? Br Dent J 206:E151E-15-7, 2009 Reprints available from SKJ Church, Manor Hosp, Moat Rd, Walsall, West Midlands, WS2 9PS United Kingdom; e-mail: [email protected]
Spit Tobacco Coaches’ roles Background.—A significant number of collegiate athletes use spit tobacco (ST). Despite a National Collegiate Athletic Association (NCAA) regulation banning the use of ST in practice and competition and the known health
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Dental Abstracts
hazards associated with ST, the use is widespread. Baseball players are more likely to use ST regularly, with an NCAA survey finding 42% of baseball players in college doing so. Coaches are in a position to influence their
Table 2.—Spit Tobacco Use in Respondents Spit tobacco use
Use by coach No Yes, but i have stopped Yes Tried to quit before No Yes, once Yes, several times Spit tobacco use starting age Jr. high school or before High school 18–19years old 19þyears old Primary reason for use Recreational/Social Stress relief Makes me feel good Primary reason to start use Other teammates/players Professional players Coach using spit tobacco Family members/friends Promotional ads Use in-season vs. off-season I don’t use in-season Less in-season No difference More in-season Do you use around players? No Yes Do you use at practices? No Yes, 1–2 times/week Yes, 3þ times/week Do you use at games? No Yes, 1–2 times/week Yes, 3þ times/week
n (%) [% of spit tobocco users]
390 (76.6) 21 (4.1) 94 (18.5) 23 (4.5) [24.4] 15 (2.9) [15.9] 56 (11) [59.6] 15 (2.9) [13] 36 (7.1) [31.3] 25 (4.9) [21.7] 39 (7.7) [33.9] 45 (8.8) [47.9] 24 (4.7) [25.5] 25 (4.9) [26.6] 65 (12.8) [65] 8 (1.6) [8] 1 (0.2) [1] 22 (4.3) [22] 4 (0.8) [4] 11 (2.2) [10.2] 12 (2.4) [11.2] 43 (8.4) [40.2] 41 (8.1) [38.3] 64 (12.6) [58.7] 45 (8.8) [41.3] 54 (10.6) [50] 28 (5.5) [25.9] 26 (5.1) [24.1] 72 (14.1) [66.7] 17 (3.3) [15.7] 19 (3.7) [17.6]
(Courtesy of Eaves T, Schmitz R, Siebel EJ: Prevalence of spit tobacco use and health effects awareness in baseball coaches. J Calif Dent Assoc 37:403-410, 2009.)
players concerning the use of ST, with the ability to take preventive steps, enforce rules against its use, and make referrals for treatment of addiction to ST. They are also role models for their players and can exert significant influence. However, coach-driven interventions are relatively few. The personal ST use among coaches may contribute to this paucity of active prevention efforts. The prevalence of ST use among coaches, factors that influence use, knowledge about ST’s health effects, and the role coaches play in interventions were investigated through a survey tool.
Table 5.—Spit Tobacco Intervention Roles Intervention roles
n (%)
Is spit tobacco use a problem with your athletes? No, it is not Yes, with some athletes Yes, with most athletes Should adolescent/college-age athletes use spit tobacco? No, they should not Yes, if they understand the risk Yes, they should be allowed no matter what Can adolescent users quit with intervention? No, it does not help Yes, but only if they want to quit Yes, intervention can help anyone Do coaches play a role in preventing spit tobacco use? No, we do not Yes, in a small way Yes, we can help prevent use Can coaches help athletes who want to stop use? No, they do now want our help Yes, in a small way Yes, they need our help to stop use
251 (49.3) 229 (45) 18 (3.5)
470 (92.3) 29 (5.7) 3 (0.6)
11 (2.2) 318 (62.5) 167 (32.8)
22 (4.3) 118 (23.2) 358 (70.3)
7 (1.4) 206 (40.5) 284 (55.8)
(Courtesy of Eaves T, Schmitz R, Siebel EJ: Prevalence of spit tobacco use and health effects awareness in baseball coaches. J Calif Dent Assoc 37:403-410, 2009.)
Methods.—The 509 participants were all affiliated with the American Baseball Coaches Association. Each completed a Web-based survey designed specifically to reveal the ST use patterns and contributing factors for baseball coaches. Results.—Over 99% of the respondents were men and 90.8% were Caucasian. All team levels were represented, although high school coaches were more likely to respond, as were head coaches compared to assistant coaches. The prevalence of ST use among baseball coaches was 18.5%, similar to the 16.4% prevalence among college athletes of all sports and less than that of collegiate baseball players (Table 2). The coaches seemed to be well educated about the harmful effects of STconsumption, with 97.2% knowing athletic performance was not helped, 95.1% knowing there were harmful effects, 96.1% aware addiction could occur, and 97.2% knowing that physical activity does not offset the negative aspects of ST use. Coaches were aware of connections between ST use and oral leukoplakia, oral cancer,
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2009
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tooth decay, gingival recession, and nicotine addiction. Fewer were aware of the systemic illnesses that are linked to ST, including stomach ulcers and cancer, hypertension, cardiovascular disease, delayed wound healing, and sexual impotence. Fewer than 50% of the coaches believed ST use was a problem among their athletes. Most (92.3%) felt that their athletes should not use ST because of the negative health effects. Just over half (55.8%) believed they were able to positively influence their athletes’ decisions and to provide assistance in stopping ST use once it had begun (55.8%), even if only in a small way (Table 5). Discussion.—The ST use among baseball coaches was lower than expected and lower than college baseball players’ use. The level of understanding of the negative aspects of STuse was high. In addition, coaches recognize the potential role they could play in an ST prevention effort and are willing to try to minimize the use among their athletes.
Clinical Significance.—Positive role models can be tremendously influential in the lives of high school and college students. These coaches demonstrate an understanding of the problem and a positive attitude toward the idea of keeping their athletes healthy. To support preventive efforts against ST use, coaches should be provided with intervention training or information about how to modify any current intervention techniques as needed.
Eaves T, Schmitz R, Siebel EJ: Prevalence of spit tobacco use and health effects awareness in baseball coaches. J Calif Dent Assoc 37:403-410, 2009 Reprints available from T Eaves, Human Performance and Leisure Studies, North Carolina A&T State Univ, 1201 E Market St, Greensboro, NC 27411
EXTRACTS SORRY MAKES IT BETTER When medical errors occur in the University of Michigan Health System, often the doctor will admit the mistake upfront and a lawyer may offer immediate compensation. Richard Boothman, a malpractice defense lawyer and the chief risk officer for the health system says the approach reflects common decency. It is also a wise business strategy. Malpractice claims against the University of Michigan system have fallen from 121 in 2001 to 61 in 2006, and open claims fell from 262 in 2001 to 83 in 2007. Time to process a claim is just 8 months rather than the previous 20 months. When officials learn of possible medical errors, often from the doctors themselves, they conduct a peer review to see what occurred and what needs to be done to prevent a repeat. Doctors and officials then meet with the patients and their families to explain why the choice was appropriate or to admit mistakes. Apologies and upfront compensation often dispel the anger of patients and families, so there are fewer lawsuits and litigation expenses. Most caregivers want to do this; the health system officials are there to reassure them that it’s all right. ‘‘Saying you’re sorry’’ has its skeptics. Patients’ rights to sue doctors and make records public helps reduce medical mistakes and improve care, according to Matthew Gaier, co-chairman of the medical malpractice committee of the New York State Trial Lawyers Association. In addition, doctors must be protected from their own honesty being used against them in court, perhaps through a shield law. [Saying ‘Sorry’ Pays Off for U of Michigan Doctors. Yahoo News, July 20, 2009.]
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Dental Abstracts
obtaining a protrusive bite in 10% of patients, so that the appliance could not be fabricated. The main problems were as follows: (1) the bite was recorded with a large mandibular asymmetry but none was present and (2) the lack of definition made locating the casts impossible. The ESS results indicated a slight reduction in the median scores. Patients reported problems with inadvertently removing the appliance during the night, having a loose appliance, having the appliance crack, and gagging on the appliance, but the most frequently reported problem was pain in the teeth or gums, seen in 22% of cases. Discussion.—The 1-day training course was not sufficient to equip GDPs to effectively manage nonapneic snoring using a monobloc MAA. Either further training or selection of an appliance with a different design is needed.
Clinical Significance.—A total of 258 GDPs were invited to take part in this experiment, but only 15 were willing and able to take part, which may suggest that practitioners are either not interested or not willing or able to give up enough time for training. The 48% success rate indicates that 1 day of training does not qualify GDPs to effectively manage patients with nonapneic snoring. With more resources, more training, and appropriate remuneration, dentists may be able to expand their practice into this area.
Church SKJ, Littlewood SJ, Blance A, et al: Are general dental practitioners effective in the management of non-apnoeic snoring using mandibular advancement appliances? Br Dent J 206:E151E-15-7, 2009 Reprints available from SKJ Church, Manor Hosp, Moat Rd, Walsall, West Midlands, WS2 9PS United Kingdom; e-mail: [email protected]
Spit Tobacco Coaches’ roles Background.—A significant number of collegiate athletes use spit tobacco (ST). Despite a National Collegiate Athletic Association (NCAA) regulation banning the use of ST in practice and competition and the known health
334
Dental Abstracts
hazards associated with ST, the use is widespread. Baseball players are more likely to use ST regularly, with an NCAA survey finding 42% of baseball players in college doing so. Coaches are in a position to influence their
Table 2.—Spit Tobacco Use in Respondents Spit tobacco use
Use by coach No Yes, but i have stopped Yes Tried to quit before No Yes, once Yes, several times Spit tobacco use starting age Jr. high school or before High school 18–19years old 19þyears old Primary reason for use Recreational/Social Stress relief Makes me feel good Primary reason to start use Other teammates/players Professional players Coach using spit tobacco Family members/friends Promotional ads Use in-season vs. off-season I don’t use in-season Less in-season No difference More in-season Do you use around players? No Yes Do you use at practices? No Yes, 1–2 times/week Yes, 3þ times/week Do you use at games? No Yes, 1–2 times/week Yes, 3þ times/week
n (%) [% of spit tobocco users]
390 (76.6) 21 (4.1) 94 (18.5) 23 (4.5) [24.4] 15 (2.9) [15.9] 56 (11) [59.6] 15 (2.9) [13] 36 (7.1) [31.3] 25 (4.9) [21.7] 39 (7.7) [33.9] 45 (8.8) [47.9] 24 (4.7) [25.5] 25 (4.9) [26.6] 65 (12.8) [65] 8 (1.6) [8] 1 (0.2) [1] 22 (4.3) [22] 4 (0.8) [4] 11 (2.2) [10.2] 12 (2.4) [11.2] 43 (8.4) [40.2] 41 (8.1) [38.3] 64 (12.6) [58.7] 45 (8.8) [41.3] 54 (10.6) [50] 28 (5.5) [25.9] 26 (5.1) [24.1] 72 (14.1) [66.7] 17 (3.3) [15.7] 19 (3.7) [17.6]
(Courtesy of Eaves T, Schmitz R, Siebel EJ: Prevalence of spit tobacco use and health effects awareness in baseball coaches. J Calif Dent Assoc 37:403-410, 2009.)
players concerning the use of ST, with the ability to take preventive steps, enforce rules against its use, and make referrals for treatment of addiction to ST. They are also role models for their players and can exert significant influence. However, coach-driven interventions are relatively few. The personal ST use among coaches may contribute to this paucity of active prevention efforts. The prevalence of ST use among coaches, factors that influence use, knowledge about ST’s health effects, and the role coaches play in interventions were investigated through a survey tool.
Table 5.—Spit Tobacco Intervention Roles Intervention roles
n (%)
Is spit tobacco use a problem with your athletes? No, it is not Yes, with some athletes Yes, with most athletes Should adolescent/college-age athletes use spit tobacco? No, they should not Yes, if they understand the risk Yes, they should be allowed no matter what Can adolescent users quit with intervention? No, it does not help Yes, but only if they want to quit Yes, intervention can help anyone Do coaches play a role in preventing spit tobacco use? No, we do not Yes, in a small way Yes, we can help prevent use Can coaches help athletes who want to stop use? No, they do now want our help Yes, in a small way Yes, they need our help to stop use
251 (49.3) 229 (45) 18 (3.5)
470 (92.3) 29 (5.7) 3 (0.6)
11 (2.2) 318 (62.5) 167 (32.8)
22 (4.3) 118 (23.2) 358 (70.3)
7 (1.4) 206 (40.5) 284 (55.8)
(Courtesy of Eaves T, Schmitz R, Siebel EJ: Prevalence of spit tobacco use and health effects awareness in baseball coaches. J Calif Dent Assoc 37:403-410, 2009.)
Methods.—The 509 participants were all affiliated with the American Baseball Coaches Association. Each completed a Web-based survey designed specifically to reveal the ST use patterns and contributing factors for baseball coaches. Results.—Over 99% of the respondents were men and 90.8% were Caucasian. All team levels were represented, although high school coaches were more likely to respond, as were head coaches compared to assistant coaches. The prevalence of ST use among baseball coaches was 18.5%, similar to the 16.4% prevalence among college athletes of all sports and less than that of collegiate baseball players (Table 2). The coaches seemed to be well educated about the harmful effects of STconsumption, with 97.2% knowing athletic performance was not helped, 95.1% knowing there were harmful effects, 96.1% aware addiction could occur, and 97.2% knowing that physical activity does not offset the negative aspects of ST use. Coaches were aware of connections between ST use and oral leukoplakia, oral cancer,
Volume 54
Issue 6
2009
335
tooth decay, gingival recession, and nicotine addiction. Fewer were aware of the systemic illnesses that are linked to ST, including stomach ulcers and cancer, hypertension, cardiovascular disease, delayed wound healing, and sexual impotence. Fewer than 50% of the coaches believed ST use was a problem among their athletes. Most (92.3%) felt that their athletes should not use ST because of the negative health effects. Just over half (55.8%) believed they were able to positively influence their athletes’ decisions and to provide assistance in stopping ST use once it had begun (55.8%), even if only in a small way (Table 5). Discussion.—The ST use among baseball coaches was lower than expected and lower than college baseball players’ use. The level of understanding of the negative aspects of STuse was high. In addition, coaches recognize the potential role they could play in an ST prevention effort and are willing to try to minimize the use among their athletes.
Clinical Significance.—Positive role models can be tremendously influential in the lives of high school and college students. These coaches demonstrate an understanding of the problem and a positive attitude toward the idea of keeping their athletes healthy. To support preventive efforts against ST use, coaches should be provided with intervention training or information about how to modify any current intervention techniques as needed.
Eaves T, Schmitz R, Siebel EJ: Prevalence of spit tobacco use and health effects awareness in baseball coaches. J Calif Dent Assoc 37:403-410, 2009 Reprints available from T Eaves, Human Performance and Leisure Studies, North Carolina A&T State Univ, 1201 E Market St, Greensboro, NC 27411
EXTRACTS SORRY MAKES IT BETTER When medical errors occur in the University of Michigan Health System, often the doctor will admit the mistake upfront and a lawyer may offer immediate compensation. Richard Boothman, a malpractice defense lawyer and the chief risk officer for the health system says the approach reflects common decency. It is also a wise business strategy. Malpractice claims against the University of Michigan system have fallen from 121 in 2001 to 61 in 2006, and open claims fell from 262 in 2001 to 83 in 2007. Time to process a claim is just 8 months rather than the previous 20 months. When officials learn of possible medical errors, often from the doctors themselves, they conduct a peer review to see what occurred and what needs to be done to prevent a repeat. Doctors and officials then meet with the patients and their families to explain why the choice was appropriate or to admit mistakes. Apologies and upfront compensation often dispel the anger of patients and families, so there are fewer lawsuits and litigation expenses. Most caregivers want to do this; the health system officials are there to reassure them that it’s all right. ‘‘Saying you’re sorry’’ has its skeptics. Patients’ rights to sue doctors and make records public helps reduce medical mistakes and improve care, according to Matthew Gaier, co-chairman of the medical malpractice committee of the New York State Trial Lawyers Association. In addition, doctors must be protected from their own honesty being used against them in court, perhaps through a shield law. [Saying ‘Sorry’ Pays Off for U of Michigan Doctors. Yahoo News, July 20, 2009.]
336
Dental Abstracts