Is There a Place for Teaching Obstructive Sleep Apnea and Snoring in the Predoctoral Dental Curriculum?

Abstract

The widespread prevalence of obstructive sleep apnea and apneic snoring is both alarming and well documented. Sleep disorders affect one out of ive Americans. Yet, during an attempt to study the prevalence of obstructive sleep apnea and snoring among patients at the University of Tennessee Health Science Center College of Dentistry, a search through the entire school's database for the terms "sleep apnea" and "snoring" found only ninety-two patients who admitted to snoring. Currently, the condition "sleep apnea" is not even on the school's list of health/medical questions. These igures not only are inconsistent with national statistics, but conirm that more needs to be done to make dental students aware of these disorders, include them in patient medical histories, and ultimately educate patients about therapies that can help. Considering the health concerns related to this sleep disorder, the economic impact of insomnia and daytime sleepiness, as well as the fact that the dentist is well poised to reduce symptoms and increase the quality of life among sufferers, mandibular advancement devices should become an educational standard in the predoctoral clinical curriculum of dental schools. Predoctoral clinical curricula need to relect this current health trend and train dentists to care for these patients comprehensively.

Obstructive sleep apnoea and the need for its introduction into dental curricula

“…The authors of this paper suggest that emphasis should be placed on an interprofessional model of collaborative practice with various health practitioners, as previously proposed . Therefore, dental institutions need to have access to qualified faculty who are knowledgeable in providing didactic and clinical material on this subject, in addition to having adequate clinical laboratories, courses and hands‐on experiences regarding OSA, otherwise preparing future dental practitioners will be incomplete .…”

“…Individuals often seek treatment for undiagnosed OSA due to snoring, which is often a major complaint originating from their sleep partner . Amongst those aforementioned characteristics, high body mass index (BMI) is most common , and due to the current obesity epidemic, both the prevalence and severity of SDB have been increasing (3%–9% females; 10%–17% males in ages 30–49 to 50–70 years of age) . In contrast, the prevalence of OSA in paediatric patients has been reported from 0–1% to 4–5.7% .…”

“…Orofacial and dental features associated with the presence of OSA are as follows: increased neck circumference (≥16 inch in females, ≥17 inch in males), body mass index >30 kg/m 2 , Mallampati score of 3–4 , retrognathic mandible, macroglossia , longer face height, scalloped tongue, tonsillar hypertrophy and decreased lateral peritonsillar space, elongated uvula, deep hard palate, nasal anomalies and excessive overjet . If a dental practitioner is not comfortable in following the appropriate information gathering procedures and examination, referral to a knowledgeable colleague may serve as a vital step in both assessing and management of OSA . Once a diagnosis is provided by a medical practitioner and if appropriate (mild‐to‐moderate OSA or CPAP intolerant), the patient may be managed by a knowledgeable dental practitioner who has specific education and training regarding OSA .…”

“…Dental practitioners may be reluctant to engage in management of OSA due to concerns of litigation and malpractice , as they report a lack of adequate training in the screening for OSA and its subsequent management in providing OAs . The training that is currently available is mainly derived from courses offered by OA manufacturers, scientific meetings and information garnered from the literature .…”

“…Considering that dental practitioners will have patients with OSA either knowingly or unknowingly, they should have appropriate background knowledge about OSA and related morbidities and be competent to screen for SBDs and OSA. Unfortunately, current dental curricula have failed to respond to this health trend and, at best, provide an introduction regarding OSA usually without an appropriate dental approach for these patients . It is prudent for dental institutions to be at the forefront of educating in this subject matter.…”