- Email: [email protected]
Dentist’s role in obstructive sleep apnea
A sample of 10 ml of each washing was incubated at 36 C for 48 hours. Colony-forming units (CFU)/ml counts were obtained at each stage. A scanning electron microscope was used for surface examination. For the in vivo section of the study, 24 persons wearing complete dentures and no clear evidence of oral candidiasis participated. Before ultrasonic cleaning, the dentures’ entire surface was brushed with a cleaning brush and immersed in 200 ml PBS. Ultrasonic cleaning was done as for the in vitro study. Total CFU/ml count was determined for all Candida species. Results.—In vitro, a mean CFU/ml count revealed significant differences between the first two and the second two stages in both the CA and the CG groups. Ultrasonic cleaning for 15 minutes in these groups removed 85.6% of the cells between stages 1 and 2 and 97.2% of the cells between stages 3 and 4. The scanning electron microscope evaluation detected no biofilm formation in either group. The CA group demonstrated many yeast cells and some pseudohyphae clustered in grooves, pits, and pores on specimen surfaces. All the cells in the CG group were in yeast form and lodged tightly in grooves, pits, and pores. After 30 minutes of ultrasonic cleaning, the number of cells on specimen surfaces was noticeably reduced in both groups. In vivo, the mean CFU/ml count was significantly higher in stage 1 than in stage 2 and higher in stage 2 than in stage 3. Fifteen minutes of ultrasonic cleaning removed 88.4% of the cells.
Discussion.—Candida cells were reliably and simply removed from denture base by using ultrasonic cleaning.
Clinical Significance.—Not all patients who receive dentures and oral hygiene instructions return to the dentist having achieved satisfactory results in terms of cleaning their dentures. Denture wearers often have Candida cells present in their oral cavity, even if they don’t have symptoms of colonization. As more and more of the population age and develop systemic complications, there are concerns over the emergence of drug-resistant microorganisms because of antibiotic overprescription. Dentists must provide not only oral hygiene management, but also management of removable prostheses such as dentures, which can harbor infectious agents.
Kawaski K, Kamikawa Y, Sugihara K: In vitro and in vivo removal of oral Candida from the denture base. Gerodontology 33:247-252, 2016 Reprints available from Y Kamikawa, Dept of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Kagoshima Univ Graduate School of Medical and Dental Science, Sakuragaoka 8-35-1, Kagoshima 890-8544, Japan; fax: þ81-92-275-6238; e-mail: [email protected]
Sleep Apnea Dentist’s role in obstructive sleep apnea Background.—Obstructive sleep apnea (OSA) is characterized by repeated episodes of breathing cessation (apnea) or reduced airflow (hypopnea) during sleep. It reduces the patient’s quality of life and is detected most often through daytime sleepiness and snoring or witnessed apnea at night. Among the diagnostic tests for OSA are the Epworth Sleepiness Scale, endoscopy, laryngoscopy, pharyngometry, computed tomography (CT) evaluation, magnetic resonance imaging (MRI), cephalometry, MR fluoroscopy, acoustic reflection, manometry, and home monitoring. The gold standard for evaluation and diagnosis is supervised overnight polysomnography (PSG). Treatment options are behavioral modification, diet and medication, continuous positive airway pressure
108
Dental Abstracts
(CPAP), oral appliances, and surgery. Sometimes these methods can be combined. The dentist plays an important role in the diagnosis and management of OSA patients. Diagnostic Considerations.—Dentists and dental specialists are often called upon to diagnose OSA during their evaluation of the dental needs of patients. The pharynx and dentofacial structures lie close to each other. An anatomically narrowed airway is a pathophysiologic factor contributing to OSA. Dental practitioners may notice the symptoms of snoring and OSA during the course of obtaining a history and performing an oral examination. Once the dentist has made the diagnosis, it is often necessary to refer
the patient to his or her primary care medical physician for confirmation and further testing. The dentist then is often the one who carries out treatment. Use of Oral Appliances.—Oral appliances (OA) are highly recommended for the treatment of OSA in patients who are intolerant of CPAP or who prefer alternate therapy. OAs increase upper airway size by positioning the mandible forward during sleep, which relieves snoring and OSA symptoms. Mandibular advancement appliances may be monoblocs or biblocks. Both are well tolerated by patients, easy to use, noninvasive, removable, and have few side effects. Tongue retention devices pull the tongue forward through the use of a suction cup. The resulting airway relaxation reduces the number of OSA episodes that occur during sleep. Palatal lift appliances are removable devices that lift and stabilize the soft palate. This reduces vibration and snoring. The main side effects of the OSA appliances are TMJ pain, tooth pain, increased salivation, dry mouth, irritated gums, and altered occlusal relationships. About 25% of OSA patients cannot tolerate devices and will require other interventions. Other Treatments.—Children with OSA tend to have a narrow maxilla, highly arched palate, and hypoplastic maxilla. Rapid maxillary expansion (RME) can be used to correct maxillary transverse deficiencies and posterior crossbites through orthodontic and orthopedic effects. RME treatment is well supported by the literature for the treatment of OSA in children. RME plus a facemask can be useful for growing patients with OSA. It is applied to dental, skeletal, and soft tissues to change airway dimensions and relieve symptoms.
Surgery is also an option. Surgically assisted rapid maxillary expansion (SARME) is designed to expand the maxilla of adult patients with OSA. This will address the disordered breathing that is contributing to symptoms. Distraction osteogenesis is useful for the management of a hypoplastic mandible. It lengthens the retrognathic mandible and can also be used for patients with Pierre Robin sequence and Treacher Collins syndrome who suffer airway obstruction caused by mandibular retrognathia. Transverse mandibular distraction osteogenesis can be used to address transverse mandibular deficiency. Midfacial distraction osteogenesis (MFDO) corrects obstruction at the level of the nasopharynx and velopharynx. Maxillomandibular advancement (MMA) can be used for patients who cannot tolerate CPAP. This approach pulls the anterior pharyngeal tissues attached to the maxilla, mandible, and hyoid forward. As a result, the entire velooro-hypopharynx is enlarged. MMA is associated with success rates of over 90% in patients with OSA.
Clinical Significance.—Interventions for patients with OSA will vary depending on the site and severity of obstruction. In addition, some patients cannot tolerate certain interventions, so alternatives must be tried. The dental practitioner and physician can address these problems in a collaborative fashion.
Kılınc¸ DD, Didinen S: An algorithm of dental/dentofacial-based options for managing patients with obstructive sleep apnoea referred to a dentist/dental specialist by a physician. Br Dent J 221:37-40, 2016 Reprints available from DD Kılınc¸; e-mail: [email protected]
Effects of treatment on blood pressure Background.—Obstructive sleep apnea (OSA) is a chronic inflammatory disease characterized by repetitive blood oxygen desaturation, cortical micro-arousal, and negative thoracic pressure on the heart. An estimated 25 million adults in the United States suffer from OSA, with a higher prevalence among older adults. With the increased numbers of obese and older patients
worldwide, OSA’s prevalence is expected to rise. The most common treatments are continuous positive airway pressure (CPAP) as a first line of treatment, mandibular advancement splint (MAS), or surgery. Comparison of CPAP and MAS with respect to blood pressure reduction has recently been done in a systematic review and meta-analysis.
Volume 62
Issue 2
2017
109
Discussion.—Candida cells were reliably and simply removed from denture base by using ultrasonic cleaning.
Clinical Significance.—Not all patients who receive dentures and oral hygiene instructions return to the dentist having achieved satisfactory results in terms of cleaning their dentures. Denture wearers often have Candida cells present in their oral cavity, even if they don’t have symptoms of colonization. As more and more of the population age and develop systemic complications, there are concerns over the emergence of drug-resistant microorganisms because of antibiotic overprescription. Dentists must provide not only oral hygiene management, but also management of removable prostheses such as dentures, which can harbor infectious agents.
Kawaski K, Kamikawa Y, Sugihara K: In vitro and in vivo removal of oral Candida from the denture base. Gerodontology 33:247-252, 2016 Reprints available from Y Kamikawa, Dept of Maxillofacial Diagnostic and Surgical Science, Field of Oral and Maxillofacial Rehabilitation, Kagoshima Univ Graduate School of Medical and Dental Science, Sakuragaoka 8-35-1, Kagoshima 890-8544, Japan; fax: þ81-92-275-6238; e-mail: [email protected]
Sleep Apnea Dentist’s role in obstructive sleep apnea Background.—Obstructive sleep apnea (OSA) is characterized by repeated episodes of breathing cessation (apnea) or reduced airflow (hypopnea) during sleep. It reduces the patient’s quality of life and is detected most often through daytime sleepiness and snoring or witnessed apnea at night. Among the diagnostic tests for OSA are the Epworth Sleepiness Scale, endoscopy, laryngoscopy, pharyngometry, computed tomography (CT) evaluation, magnetic resonance imaging (MRI), cephalometry, MR fluoroscopy, acoustic reflection, manometry, and home monitoring. The gold standard for evaluation and diagnosis is supervised overnight polysomnography (PSG). Treatment options are behavioral modification, diet and medication, continuous positive airway pressure
108
Dental Abstracts
(CPAP), oral appliances, and surgery. Sometimes these methods can be combined. The dentist plays an important role in the diagnosis and management of OSA patients. Diagnostic Considerations.—Dentists and dental specialists are often called upon to diagnose OSA during their evaluation of the dental needs of patients. The pharynx and dentofacial structures lie close to each other. An anatomically narrowed airway is a pathophysiologic factor contributing to OSA. Dental practitioners may notice the symptoms of snoring and OSA during the course of obtaining a history and performing an oral examination. Once the dentist has made the diagnosis, it is often necessary to refer
the patient to his or her primary care medical physician for confirmation and further testing. The dentist then is often the one who carries out treatment. Use of Oral Appliances.—Oral appliances (OA) are highly recommended for the treatment of OSA in patients who are intolerant of CPAP or who prefer alternate therapy. OAs increase upper airway size by positioning the mandible forward during sleep, which relieves snoring and OSA symptoms. Mandibular advancement appliances may be monoblocs or biblocks. Both are well tolerated by patients, easy to use, noninvasive, removable, and have few side effects. Tongue retention devices pull the tongue forward through the use of a suction cup. The resulting airway relaxation reduces the number of OSA episodes that occur during sleep. Palatal lift appliances are removable devices that lift and stabilize the soft palate. This reduces vibration and snoring. The main side effects of the OSA appliances are TMJ pain, tooth pain, increased salivation, dry mouth, irritated gums, and altered occlusal relationships. About 25% of OSA patients cannot tolerate devices and will require other interventions. Other Treatments.—Children with OSA tend to have a narrow maxilla, highly arched palate, and hypoplastic maxilla. Rapid maxillary expansion (RME) can be used to correct maxillary transverse deficiencies and posterior crossbites through orthodontic and orthopedic effects. RME treatment is well supported by the literature for the treatment of OSA in children. RME plus a facemask can be useful for growing patients with OSA. It is applied to dental, skeletal, and soft tissues to change airway dimensions and relieve symptoms.
Surgery is also an option. Surgically assisted rapid maxillary expansion (SARME) is designed to expand the maxilla of adult patients with OSA. This will address the disordered breathing that is contributing to symptoms. Distraction osteogenesis is useful for the management of a hypoplastic mandible. It lengthens the retrognathic mandible and can also be used for patients with Pierre Robin sequence and Treacher Collins syndrome who suffer airway obstruction caused by mandibular retrognathia. Transverse mandibular distraction osteogenesis can be used to address transverse mandibular deficiency. Midfacial distraction osteogenesis (MFDO) corrects obstruction at the level of the nasopharynx and velopharynx. Maxillomandibular advancement (MMA) can be used for patients who cannot tolerate CPAP. This approach pulls the anterior pharyngeal tissues attached to the maxilla, mandible, and hyoid forward. As a result, the entire velooro-hypopharynx is enlarged. MMA is associated with success rates of over 90% in patients with OSA.
Clinical Significance.—Interventions for patients with OSA will vary depending on the site and severity of obstruction. In addition, some patients cannot tolerate certain interventions, so alternatives must be tried. The dental practitioner and physician can address these problems in a collaborative fashion.
Kılınc¸ DD, Didinen S: An algorithm of dental/dentofacial-based options for managing patients with obstructive sleep apnoea referred to a dentist/dental specialist by a physician. Br Dent J 221:37-40, 2016 Reprints available from DD Kılınc¸; e-mail: [email protected]
Effects of treatment on blood pressure Background.—Obstructive sleep apnea (OSA) is a chronic inflammatory disease characterized by repetitive blood oxygen desaturation, cortical micro-arousal, and negative thoracic pressure on the heart. An estimated 25 million adults in the United States suffer from OSA, with a higher prevalence among older adults. With the increased numbers of obese and older patients
worldwide, OSA’s prevalence is expected to rise. The most common treatments are continuous positive airway pressure (CPAP) as a first line of treatment, mandibular advancement splint (MAS), or surgery. Comparison of CPAP and MAS with respect to blood pressure reduction has recently been done in a systematic review and meta-analysis.
Volume 62
Issue 2
2017
109