For years, as dentists, we manage dental consequences of sleep bruxism, patients with snoring and oral-dental pain in relation to poor sleep. In the late seventies, ‘sleep medicine’ emerged and since dentist use special designed oral appliance for snoring and sleep apnea. Clinicians rapidly faced the challenge of diagnosis and management of complex cases with concomitant sleep bruxism (SB)-tooth grinding, orofacial pain/TMD and insomnia.
In the present lecture, we will provide simple explanations on ‘why and how’ we sleep to improve our communications with patients and other health care providers. In the era of precision medicine, clinical successes requires i) ‘differential’ diagnosis skills with comprehensive assessment of risk factors, ii) multidisciplinary/’inter-sector’ health management strategies, iii) contribution of patient as a partner.
We also have to recognize that in most patients, SB and respiratory events (e.g., apnea) are not related. The ‘one size fits all’ paradigm is not ‘suitable’ in sleep medicine. Most SB patients’ are not sick; they need simple monitoring, advices or tooth protection. Pain patients do frequently have a poor sleep quality and present insomnia.
After a medical (apnea) and dental (bruxism, orofacial pain) diagnosis, the management (by sleep trained health doctors) include:
i) oral appliances (splint or mandibular advancement appliance) by dentists, ii) sleep hygiene advices by psychologist (cognitive behavioural therapies), iii) exercise by physical or ‘myo’ therapist, iv) prescription of CPAP, sleep positioning devices, oral appliance and/or medication to stabilize sleep or proton pump inhibitor (for GERD) by physicians.
1. Understand how we sleep (basic knowledge) to explain the ‘why’ of your treatment.
2. Be more comfortable to screen various concomitant sleep disorders.
3. Decrypt the overlap between sleep bruxism, sleep apnea and orofacial/TMD pain: a challenge.
4. Should be able to select the best management strategy: know when to refer, work in collaboration with psychologist, physical therapist, physicians (sleep, pediatric, ENT, etc)
5. Get a better vision of changes machine learning could have in dentistry.
By the completion of the day, ‘survivor’ participant should be able to:
1. Better understand sleep physiology
2. Screen for presence of various concomitant sleep disorders and other health issues.
3. Decide ‘when’ to refer to medicine or psychology.
4. Select best management, based on evidences, in a pragmatic and critical manner.
5. Be ready to attend hands course in dental sleep medicine with a broader understanding of dentist role.