GAP Magazine Clear Idea Volume 5

20 www.acasociety.com | info@acasociety.com A 2014 survey of Australian and New Zealand dental university programs revealed that most dental courses only taught about 4.5 hours of sleep medicine in a 5 year course. While the concept of sleep, airways and TMD may be intimidating to some dentists, screening and incorporating them into our everyday practice is very simple. We do not have to be experts in the field, nor do we have to have any interest in treating sleep, airway or TMD issues. However, being able to screen and identify signs/symptoms of possible sleep, airway and TMD issues is an important skill, especially if you’re performing orthodontics and/or aligners. Below are 4 simple signs/symptoms you can look for in your patients to screen for sleep, airway and TMD issues. 1. Nasal Breathing Is the patient breathing with their mouth open or closed? Humans should ideally breathe through the nose with the mouth closed. The nose is for breathing, the mouth is for eating and talking. I tell all my patients, if you’re a mouth breather, you’ll have to learn how to eat/ talk through your nose. Many patients with obstructive sleep apnea (OSA) are mouth breathers due to an obstruction somewhere in their airway. In children in particular, nasal breathing is very important as it also helps influence proper craniofacial growth. More importantly, if a child cannot breathe properly at night, this can lead to serious health issues due to oxygen deprivation (e.g. stunted growth, difficulty concentrating at school, ADHD). 2. Mouth Range Of Motion (ROM): 42-52mm Measuring how much the jaw can open/ close and move sideways and forwards is a simple indicator for any TMJ intra- articular (disc) issues or muscle issues. Our normal ROM should be between 42-52mm, 8-12mm laterally and 6-10mm protrusively. If you note any restriction in jaw movements, potentially the TMJ disc and/or muscles may be need further investigating. It is best to measure ROM using a Therabite (pictured top right) TMD and dental sleep medicine By Dr Damian Teo Damian Teo 3. Tonsils are beyond the pillars 0. Surgically removed tonsils 2. Tonsils hidden within tonsil pillars 3. Tonsils extending to the pillars Class I Uvula, fauces, soft palate, pillars visible Class II Uvula, soft palate, fauces visible Class III Base of uvula visible, soft palate Class IV Only hard palate visible 4. Tonsils extend to midline Continued page 22 tool is checking if the tongue (Mallampati Score) or tonsils (Tonsil Grading) are blocking the throat. Just ask your patient as they are designed to incorporate the TMJs synovial rotation and translator movements. However a ruler will also suffice. Finger measurements can also be used but are very arbitrary and highly inaccurate due to difference in finger sizes, and the smallest change in millimetre measurements can make a huge difference. 3. Throat Obstructions: Mallampati Score and Tonsil Grading Dentists are the gatekeepers of the airway. When we’re looking inside the mouth and doing our dental/perio charting, we’re already looking down the person’s airway. A very simple airway screening