Scientific Session

TDO User Meeting & Scientific Session

Fall 2019

Lavigne

Gilles Lavigne

Gilles Lavigne, DMD (U de Montreal, Canada), PhD (U of Toronto, Canada), and FRCD (Oral medicine, Georgetown U, USA), completed a postdoctoral training on the neurobiology of pain at NIH, Bethesda, USA. He received a Doctor honoris causa from the Faculty of Medicine and dentistry, Zenntrum für Zahnmedizin, University of Zurich, Switzerland. He is a Fellow of the American College of Dentists and Canadian Academy of Healthy Sciences. In June 2018, he became member of Order of Canada.
Currently, he holds a Canada Research Chair in Pain, Sleep & Trauma and has been Dean of the Faculty of Dental Medicine at the Université de Montréal, Canada (2008-2016).
He was President of the Canadian Sleep Society and President of the Canadian Pain Society. He is co-founder and past Director of the three research networks for Oral Health, Pain and Placebo Mechanisms under the Fonds de la Recherche en Sante du Quebec and the Canadian Institutes of Health Research (CIHR).
Gilles Lavigne is internationally recognize for his experimental and clinical research projects on sleep bruxism and the interactions between sleep, pain, and breathing disorders. He is also active in clinical teaching and services in these areas. He was editor or co-editor of few book including Sleep medicine for dentists in 2009, re-edition for 2019.

Lecture Topic:

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.
Clinicians will:
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.

Educational Objectives.
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.

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