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Membersof theSingHealthGroupChangi GeneralHospital KK Womens andChildrens Hospital SingaporeGeneralHospitalNationalCancerCentre NationalDentalCentre Centre NatioanalHeartCentre SingaporeNationalEyeCentreSingHealthPolyclinics

Mimi Yow BDS, FDS, MSc, FAMSSenior Consultant, Dept of Orthodontics, National Dental Centre

Visiting Consultant, Singapore General HospitalClinical Assoc Professor, Faculty of Dentistry, National University of Singapore

Dental Sleep Breathing Strategies

Dr Mimi Yow, Senior Consultant, Department of Orthodontics

Membersof theSingHealthGroupChangi GeneralHospital KK Womens andChildrens Hospital SingaporeGeneralHospitalNationalCancerCentre NationalDentalCentre Centre NatioanalHeartCentre SingaporeNationalEyeCentreSingHealthPolyclinics

Mimi Yow BDS, FDS, MSc, FAMSSenior Consultant, Dept of Orthodontics, National Dental Centre

Visiting Consultant, Singapore General HospitalClinical Assoc Professor, Faculty of Dentistry, National University of Singapore

Dental Sleep Breathing Strategies

Dr Mimi Yow, Senior Consultant, Department of Orthodontics

CHILD AHI !1

AHI !5 AHI > 15 AHI !30

Non-sleepy snorer!Sleepy snorer!Sleep hypopnea!Mild OSA!Moderate OSA!Severe OSA

OSA CONTINUUM

American Academy of Sleep Medicine Task Force, 1999

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OSA Culprits Child Adult

Peak age 2-6 y 30-60 y

: 1:1 1:2

AHI !1 !5

Incidence

Gen population 1-3% 2-4%Habitual snorers 9% 10-40%

Morbidly obese 37-55% > 50%

BMI Fail to thrive !28 Asian

!98th % !30

Caucasian

Common causes Enlarged

Adenoids Obesity

Tonsils

Causes of OSA

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OSA Facies

Retrognathic mandible

(p

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Braces in Airway Management

How do they work?

How do they work?

Tongue and lower jaw move forward

Airway widens in AP dimension

Muscle activity increases

Palatoglossus

Palatopharyngeus

Levator veli palatiniTensor veli palatini

Genioglossus

Airway collapsibility reduced

Battagel et al., 1999Gale et al., 2000Ryan et al., 1999

Schmidt et al., 1991

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What is the evidence?Evidence

*Ferguson KA et al, 2006** Lim et al, 2009

Do they work?

Evidence

Success in 52% AHI 1-11%

< daytime sleepiness

Less effective in higher BMI

More effective in positional apnea

Better acceptance by patients

Not Recommended

Severe OSA (AHI>30)

Multiple levels of obstruction

Cannot protrude lower jaw

No teeth

Oral sepsis

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Short term side effects

Sore teeth, painful TMJ & stiff muscles

Dry mouth or drooling

Temporary bite changes

Long term side effects

Tooth decay

Gum disease

Tooth movement

Permanent bite changes

Mild facial changes

DAlmeida et al, 2006

Dental splints Evidence

No electricity needed

Small & portable

Less visible

Less cumbersome

Better quality of life

Recommendations

American Academy of Sleep Report, 2005

OA for mild to moderate OSA

Follow-up PSG for effectiveness

Life-long follow-up for:

OSA signs & symptoms

Patient compliance Appliance fit

Teeth, gums, jaw joints

Occlusion