Membership Matters - December 2017 - 24

SLEEP

By Mark T. Murphy,
DDS, FAGD

Airway Trumps Occlusion,
Periodontics, Decay
and Everything
YOU WILL SURVIVE ONLY UP TO
3 MINUTES without air but much longer with
a poor bite, attachment loss and decay. In
fact, humans can live quite well without teeth.
Our profession has evolved from the court
day extraction mill that drove Dr. L.D. Pankey
from New Castle, Kentucky, to Coral Gables,
Florida, in search of a way to save teeth.
Gradually, the understanding of periodontics
refocused our attention from drill and fill to
the bone and gums surrounding the teeth.
Then force management weighed in (pun
intentional) as occlusion took center stage.
Now it is the airway's turn to breathe fresh
ideas and screening protocols into our
daily regimen. Obstructive sleep apnea is
a major health concern and has several
life-shortening co-morbidities that cannot be
ignored (Figure 1).
The American College of Prosthodontics'
recent white paper suggests that making
a bite splint or night guard in the patient's

Diseases Associated with OSA
Hypertension
Atrial Fibrillation

35%
% with OSA

49%

Pacemakers
Diabetes

59%
72%

Congestive Heart Failure

76%

Obesity

77%

Drug Resistant Hypertension
Night Time Heart Attacks
Figure 1. Diseases associated with obstructive sleep apnea.
24

Membership Matters

83%
91%

usual bite or centric relation without
evaluating the airway is harmful to a
significant percentage of the population
of TMD and bruxism patients. That is true
because opening the vertical dimension
of occlusion in that mandibular position
would close the airway. A patient with a
compromised airway would require an
appliance that is down and forward from
maximum intercuspation or centric relation.
The ADA last fall had a resolution before
the House of Delegates stating that all
dentists should be screening for airway
issues in their patients. We should embrace
screening for airway issues for those in our
care. Treating them is of course optional
like other procedures that we opt in or out
of. Not every dentist does extractions,
periodontics, treats TMD or endodontics, but
we all must evaluate and refer if we choose
not to become adept at those disciplines.
The same is true for dental sleep medicine.
Screening is a must; treating is optional.
It is estimated that 20 percent to
25 percent of your patient population has
some level of sleep disordered breathing or
obstructive sleep apnea. If you have the ADA
average 1,600 active patients, you would
have approximately 400 such patients in
your care. According to multiple sources,
85 percent of obstructive sleep apnea
patients remain undiagnosed. That math
indicates the average practice has about 340
undiagnosed patients. Treating these patients
in maximum intercuspation or centric relation
(splints or restoratively) without putting their
airway first could have dire consequences on
their systemic health. It is imperative that we
take a proactive role and at least screen for
and refer these patients rather than wait for
litigation to drive change.
Often change does not become broadly
accepted until the winds of lawsuits and
settlements blow free. Until the courts
Oregon Dental Association



Table of Contents for the Digital Edition of Membership Matters - December 2017

From the Editor
New Members, Board Highlights
Events and Education
ODA Member Benefit of the Month: UPS
Compliance Corner: Requesting Patient Records
Advocacy in Action: Oregon Action for Dental Health — Listening and Learning
Through the Loupes: Peer Review Council Spotlight
Dr. Rickland Asai Sees Oregon as a National Leader
OHSU Considering Changes to Curriculum Based on Shifts in Dentistry
High School Programs Attract Next Generation of Oral Health Professionals
Airway Trumps Occlusion, Periodontics, Decay and Everything
Dental Foundation of Oregon: The Tooth Taxi Visits the Community Transitional School
Index of Advertisers
Membership Matters - December 2017 - intro
Membership Matters - December 2017 - cover1
Membership Matters - December 2017 - cover2
Membership Matters - December 2017 - 3
Membership Matters - December 2017 - 4
Membership Matters - December 2017 - From the Editor
Membership Matters - December 2017 - New Members, Board Highlights
Membership Matters - December 2017 - 7
Membership Matters - December 2017 - 8
Membership Matters - December 2017 - 9
Membership Matters - December 2017 - 10
Membership Matters - December 2017 - Events and Education
Membership Matters - December 2017 - 12
Membership Matters - December 2017 - ODA Member Benefit of the Month: UPS
Membership Matters - December 2017 - Compliance Corner: Requesting Patient Records
Membership Matters - December 2017 - Advocacy in Action: Oregon Action for Dental Health — Listening and Learning
Membership Matters - December 2017 - 16
Membership Matters - December 2017 - Through the Loupes: Peer Review Council Spotlight
Membership Matters - December 2017 - 18
Membership Matters - December 2017 - Dr. Rickland Asai Sees Oregon as a National Leader
Membership Matters - December 2017 - OHSU Considering Changes to Curriculum Based on Shifts in Dentistry
Membership Matters - December 2017 - 21
Membership Matters - December 2017 - 22
Membership Matters - December 2017 - High School Programs Attract Next Generation of Oral Health Professionals
Membership Matters - December 2017 - Airway Trumps Occlusion, Periodontics, Decay and Everything
Membership Matters - December 2017 - 25
Membership Matters - December 2017 - Dental Foundation of Oregon: The Tooth Taxi Visits the Community Transitional School
Membership Matters - December 2017 - 27
Membership Matters - December 2017 - 28
Membership Matters - December 2017 - 29
Membership Matters - December 2017 - Index of Advertisers
Membership Matters - December 2017 - cover3
Membership Matters - December 2017 - cover4
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