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Treating OSA and Chronic Facial Pain (TMD)

(Keeping It Simple)

GENERAL DENTISTRY

Steven R. Olmos, DDS

In the previous three-part series of articles “The Future of Dentistry” (March, August and 100th anniversary issue 2011), I discussed the relationships between Obstructed Sleep Apnea (OSA), chronic pain, headaches, TMD and bruxism.

Dentists and dental auxiliaries have the opportunity to evaluate the oral airway on every visit. It is likely that every third adult that you or your hygienist sees today will have a Sleep Disordered Breathing (SDB) condition1 and or jaw/facial pain disorder2 that you could treat.

The problem is the voluminous amount of material and techniques necessary to treat these disorders and the lack of education.

In my experience the answers to treating these disorders comes down to three things:

• Controlling inflammation
• Controlling mandibular para-function
• Maintaining an airway

Trauma is the origin of osteoarthritic changes to a joint and facial muscle pain. Pain has it’s origin in the cascading inflammatory process of free radical
generation, mast cell release, serotonin modulated release of inf lammatory neurotransmitters (Substance P and Calcitonin Gene Related Peptide (CGRP), bradykinins, etc.) that plastically change the nervous system.

Micro-trauma of maintaining an airway and clenching the result of chronic pain are frequently the source of this free radical generation and the reason why patients fail to heal from macro-trauma injuries to the face and jaw.

Breathing is the brains highest priority to protect the survival of the human organism. The human body can withstand amazingly long periods without food and water but only minutes without oxygen.

Dentistry has long understood the importance of the first two of these directives but not with the understanding of how it affects breathing. Nightguards can increase the number of apnea (cessation of breathing) and hypopnea (a reduction of blood oxygen concentration by 3-4%) events.34
This results in an increase of comorbid medical conditions (hypertension, cardiovascular disease, diabetes).

The University of Tennessee College of Dentistry has postgraduate courses in the screening and treatment of OSA and how the dentist can assist in the treatment of SDB. Please learn how to avoid aggravating your patients existing medical conditions.

The future is now.

Dr. Steven R. Olmos, DABCP, DAAPM, DABDSM, DACSDD, FAAOP, FAACP, FICCMO, FADI, FIAO, Adjunct Professor, University of Tennessee, Memphis College of Dentistry.

Oral Health welcomes this original article.

References
1. Sleep Breath. April 9, 2008, Prevalence of probable obstructive sleep apnea risk and severity in a population of dental patients, Levendowski DJ, Morgan T et al.
2. J. Okeson, Management of Temporomandibular Disorders and Occlusion, 6th Edition, Mosby.
3. International Journal of Prosthodontics 2004, Gagnon et al.