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Did you know an estimated 85-90% of OSA cases go undiagnosed? As prosthodontists, we have the power to spot signs others might miss. Here's what to look for...


Your OSA Screening Checklist


  • Oropharyngeal Structures: High arched palate, enlarged tonsils, elongated uvula, large tongue. [1,2,3] Assess for tori mandibularis and a narrowed lateral pharyngeal wall. [4]

  • Mallampati Score: This classification of soft palate and uvula position predicts OSA severity. [4,5]

  • Maxillary Constriction: Look for a narrow maxilla with a deep palatal vault. [5]

  • Mandibular Position: Evaluate for retrognathia, a risk factor for OSA. [1]

  • Breathing Patterns: Note signs of mouth breathing, suggesting airway difficulties. [3]


Beyond the Obvious

  • Bruxism (teeth grinding): May be the body repositioning the jaw for better airflow.

  • Scalloped Tongue: Indentations suggest pressure due to constricted space.

  • TMJ Issues: Ask about pain, clicking, or limited jaw movement.


If You See This, Then...

  • If You See This: Scalloped tongue, retrognathia Then: Consider adding a validated OSA screening questionnaire (STOP-BANG, etc.) to your intake forms.

  • If You See This: Enlarged tonsils, high Mallampati score Then: Refer to a sleep physician for further evaluation.


Special Considerations for Children

Keep OSA in mind with pediatric patients too. Look for signs of mouth breathing, hyponasal speech, and craniofacial abnormalities constricting the upper airway. [6,8] Early intervention may be life-changing for these children. [7]



By incorporating these simple observations into your exams, you become a frontline defender against the hidden risks of OSA.


References

  1. Lavigne, G., Lavigne, G., Babiloni, A., Babiloni, A., Beetz, G., Fabbro, C., Sutherland, K., Huynh, N., & Cistulli, P. (2019). Critical Issues in Dental and Medical Management of Obstructive Sleep Apnea. Journal of Dental Research, 99, 26 - 35. https://doi.org/10.1177/0022034519885644.

  2. Schellenberg, J., Maislin, G., & Schwab, R. (2000). Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures.. American journal of respiratory and critical care medicine, 162 2 Pt 1, 740-8 . https://doi.org/10.1164/AJRCCM.162.2.9908123.

  3. Petrou-Amerikanou, C., Belazi, M., Daskalopoulou, E., Vlachoyiannis, E., Daniilidou, N., & Papanayiotou, P. (2005). Oral findings in patients with obstructive sleep apnea syndrome.. Quintessence international, 36 4, 293-8 .

  4. Ruangsri, S., Jorns, T., Puasiri, S., Luecha, T., Chaithap, C., & Sawanyawisuth, K. (2016). Which oropharyngeal factors are significant risk factors for obstructive sleep apnea? An age-matched study and dentist perspectives. Nature and Science of Sleep, 8, 215 - 219. https://doi.org/10.2147/NSS.S96450.

  5. Ashraf, A., Menon, I., Gupta, R., Arora, V., Ahsan, I., & Das, D. (2022). Oral findings as predictors of obstructive sleep apnea- A case-control study. Journal of Family Medicine and Primary Care, 11, 5263 - 5267. https://doi.org/10.4103/jfmpc.jfmpc_582_21.

  6. Drogomyretska, M., & Gergel, I. (2023). Results of dental examination of children with obstructive sleep apnea syndrome. SUCHASNA STOMATOLOHIYA. https://doi.org/10.33295/1992-576x-2023-4-54.

  7. Toshniwal, N., Mani, S., Mote, N., & Nalkar, A. (2021). Obstructive Sleep Apnoea in Orthodontics - A Review. Journal of Evolution of Medical and Dental Sciences. https://doi.org/10.14260/jemds/2021/620.

  8. Kawashima, S., Niikuni, N., Lo, C., Kohno, M., Nakajima, I., & Akasaka, M. (1999). Clinical findings in Japanese children with obstructive sleep apnea syndrome: focus on dental findings.. Journal of oral science, 41 3, 99-103 . https://doi.org/10.2334/JOSNUSD.41.99.

  9. Aurora, R., Casey, K., Kristo, D., Auerbach, S., Bista, S., Chowdhuri, S., Karippot, A., Karippot, A., Lamm, C., Ramar, K., Zak, R., Morgenthaler, T., & Tracy, S. (2010). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults.. Sleep, 33 10, 1408-13 . https://doi.org/10.1093/SLEEP/33.10.1408.

  10. Villa, M., Bernkopf, E., Pagani, J., Broia, V., Montesano, M., & Ronchetti, R. (2002). Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion.. American journal of respiratory and critical care medicine, 165 1, 123-7 . https://doi.org/10.1164/AJRCCM.165.1.2011031.

Obstructive sleep apnea (OSA) is a common yet serious condition where breathing repeatedly stops and starts during sleep. [1] As prosthodontists, we have a unique role in identifying and managing OSA, especially with oral appliance therapy for select patients.


Why Prosthodontists Should Care about OSA

Our in-depth understanding of oral structures places us at the forefront of recognizing OSA risk factors. OSA has far-reaching health consequences beyond just disruptive sleep – it's been linked to cardiovascular disease, hypertension, daytime sleepiness, and accidents. [2, 4, 5] By contributing to OSA care, we improve not only our patients' sleep, but their overall health and well-being.


Treatment and Diagnosis of OSA

While continuous positive airway pressure (CPAP) remains the gold-standard treatment for moderate to severe OSA, oral appliance therapy (OAT) is a valid option for mild to moderate cases or patients who cannot tolerate CPAP. [2, 4, 5] As prosthodontists, we're experts in custom-fitting and managing these appliances.

Confirming an OSA diagnosis typically involves overnight polysomnography (sleep study), with home testing as an alternative in certain cases. [4, 5] While screening questionnaires exist, it's important to remember they have limitations and shouldn't replace formal diagnosis. [5]


Collaboration is Key

Prosthodontists don't treat OSA in isolation. Successful patient outcomes often rely on referring to sleep physicians and working as part of a multidisciplinary team.


The Bottom Line

By understanding OSA, its health risks, and treatment options, prosthodontists can significantly improve patient care. Oral appliance therapy is a valuable tool in our arsenal, and collaboration with other healthcare providers leads to the best results for our patients.


References

  1. Mohan, S., Gowda, E., & Banari, A. (2015). Obstructive sleep apnea (OSA): A prosthodontic perspective.. Medical journal, Armed Forces India, 71 Suppl 2, S395-9 . https://doi.org/10.1016/j.mjafi.2013.09.007.

  2. Jordan, A., McSharry, D., & Malhotra, A. (2014). Adult obstructive sleep apnoea. The Lancet, 383, 736-747. https://doi.org/10.1016/S0140-6736(13)60734-5.

  3. Chander, N. (2020). Sleep apnea and prosthodontic implications. The Journal of the Indian Prosthodontic Society, 20, 335 - 337. https://doi.org/10.4103/jips.jips_323_20.

  4. Kabir, A., Ifteqar, S., & Bhat, A. (2013). Obstructive Sleep Apnea in Adults. Hospital Practice, 41, 57 - 65. https://doi.org/10.3810/hp.2013.10.1081.

  5. Semelka, M., Wilson, J., & Floyd, R. (2016). Diagnosis and Treatment of Obstructive Sleep Apnea in Adults.. American family physician, 94 5, 355-60 . https://doi.org/10.1037/e676562012-001.

Introduction

Welcome to ProsthoInsights' Journal Round Up Series, where we explore the latest advances in prosthodontics. In this edition, we take a look at the September 2023 issue of the Journal of Prosthodontics, one of the leading journals in the field.

This issue is packed with exciting research, from new techniques for improving the wear resistance of denture teeth to the use of digital workflows to create more accurate and efficient restorations. We also explore the latest findings on implant placement, occlusal schemes, and denture adhesives.

Whether you're a practicing prosthodontist or a student of the field, this issue is essential reading. So sit back, relax, and let us take you on a journey through the latest advances in prosthodontics.


Brief Overview - Journal of Prosthetic Dentistry: September 2023 Edition:

  • Volume and Issue: Volume 130, Issue 3.

  • Page Range: Pages 273-416.

  • Cover Art: Immerse yourself in the tranquil "Evening glow at Horseshoe Bend, AZ," captured in the cover art.

  • About the Cover Artist: Dr. Kyung Chul Oh, a prosthodontics expert with a PhD in Dental Science from Yonsei University Graduate School. An assistant professor at Yonsei University College of Dentistry, specializing in digital dentistry and dental implantology.

  • Publisher: Published monthly by Elsevier, Inc., at 230 Park Avenue, Suite 800, New York, NY 10169-0901, USA.

  • ISSN: 0022-3913

Total Number of Articles: 20

Distribution of Articles by Category:

🔹Clinical Innovations in Prosthodontics: 4 articles

🔹Systematic Reviews in Prosthodontics: 6 articles

🔹Educational and Research Advances: 5 articles

🔹Technological Advancements: 5 articles


Article Overview of Journal of Prosthetic Dentistry: September 2023 Edition:






Section 1: Clinical Innovations in Prosthodontics

The field of prosthodontics is constantly evolving, with new techniques and technologies being developed all the time. These innovations are designed to improve the quality of care for patients, making it possible to restore smiles and improve function in ways that were not possible before.


Subsection 1.1: Enhancing Denture Wear Resistance

Lee et al. evaluated the use of zirconia crowns to enhance the wear resistance of dentures. They found that zirconia crowns were significantly more resistant to wear than conventional acrylic resin crowns. This is because zirconia is a strong and durable material that is less likely to fracture or chip.

The findings of this study suggest that zirconia crowns may be a good option for patients who are looking for dentures that will last longer. Zirconia crowns are also more esthetically pleasing than acrylic resin crowns, making them a good choice for patients who want dentures that look natural.


Subsection 1.2: Digital Techniques for Restoration

Lin et al. have published a comprehensive article that provides a state-of-the-art overview of the use of digital techniques for custom post-and-core restorations. They discuss the advantages of digital techniques, such as their accuracy, efficiency, and reproducibility. They also provide a detailed overview of the different steps involved in the digital workflow for custom post-and-core restorations.

The work of Lin et al. demonstrates the potential of digital techniques to improve the quality of custom post-and-core restorations. These techniques can help to ensure that restorations are fabricated accurately and precisely, which can lead to improved patient outcomes.


Subsection 1.3: Complete Denture Workflow

Kamalakidis and Pissiotis have developed a novel complete denture workflow that integrates polished surface registration. This innovation has the potential to improve the stability and retention of complete dentures, leading to improved patient comfort and function.

The polished surface registration technique involves scanning the patient's oral cavity with a high-resolution scanner. The scan data is then used to create a virtual model of the patient's mouth. This virtual model can then be used to fabricate a denture that is perfectly adapted to the patient's anatomy.

The complete denture workflow developed by Kamalakidis and Pissiotis is a promising new approach to fabricating dentures. It has the potential to improve the comfort and function of dentures for patients.


Subsection 1.4: Fully Digital Workflow for Dentures

Wang et al. have presented a fully digital workflow for treatment dentures that promises high precision with minimal effort. This approach has the potential to revolutionize the way dentures are fabricated and delivered to patients.

The fully digital workflow starts with a digital scan of the patient's mouth. The scan data is then used to create a virtual model of the patient's mouth. This virtual model can then be used to design and fabricate the denture using a 3D printer.

The fully digital workflow eliminates the need for traditional methods, such as hand carving and casting. This can save time and money, and it can also improve the accuracy of the denture fabrication process.

The fully digital workflow for dentures developed by Wang et al. is still in its early stages of development, but it has the potential to revolutionize the way dentures are fabricated. It could make dentures more accurate, efficient, and affordable.


Section 2: Systematic Reviews in Prosthodontics