Sleep Prosthodontics: A New Vision for Dentistry

the purpose of this article is to introduce a new term, sleep prosthodontics, to the dental community and to differentiate airway analytics from sleep dentistry. sleep dentistry may be thought of as the study of an oral appliance and its impact on the airway. sleep prosthodontics is the study of airway and its impact on the stomatognathic system. in other words, sleep dentistry addresses the how (ie, how does an appliance assist nocturnal breathing?), whereas sleep prosthodontics addresses the why (ie, why are patients developing malocclusions, creating myofacial pain symptoms, and wearing their dentition?) this article will focus on the impact of sleep disordered breathing on the growing child and the unique role dentistry plays in screening and treating these patients. S leep disordered breathing (sdB) encompasses a spectrum of dysfunctional sleep breathing, including occasional snoring, habitual snoring, upper airway resistance syndrome (UArs), sleep apnea, and hypoventilation. the medical community has traditionally focused on obstructive sleep apnea (OsA) and obesity hypoventilation syndrome. Unfortunately, many sleep-related breathing disorders, especially those predominately found in women Jeffrey S. rouSe, DDS Private Practice Prosthodontist San Antonio, Texas uArS and oSA: A Comparison Although many clinicians describe UArs and OsA as the same disease with a slight variance in severity, their pathophysiologies appear to be different.4 OsA is characterized by complete upper airway obstructions lasting longer than 10 seconds with an associated 4% oxygen desaturation. it is most commonly attributed to a hypotonia of the soft palate or base of tongue. Partial airway obstructions that lead to desaturation or brief awakenings from sleep are classified as hypopneas. Continued desaturations over time may cause excessive daytime sleepiness and hypertension. they have been correlated to endothelial dysfunction, myocardial infarction, and cerebrovascular accidents. the level of severity of OsA has been associated with an increased mortality.5,6 Anatomic irregularities or minor breathing impairments can create UArs.7 Patients with UArs may have a more collapsible airway because of abnormal inspiratory flow dynamics8 or increased collapsibility on expiration due to atypical anatomy.9 UArs patients have more sensitivity to restricted breathing or negative oropharyngeal pressure. the airway constriction is recognized and children, have been ignored because of the focus on OsA. snoring typically occurs when air passes between the tongue and soft palate, causing a vibration of the soft palate. A snoring sound may also be produced from the nose during inhalation. Children can produce the same loud snoring sound as an adult, but typically their snoring is more of an effortful breathing, making recognition and diagnosis more challenging in this population. the consequences of snoring can be serious. Habitual snoring, defined as three times per week or more, has been associated with hyperactive behavior in children as young as 3 years of age1 and poor academic performance.2 sleep fragmentation or disruption caused by snoring appears to play a role as important as hypoxia in causing dysfunction. Benign snoring in adults has been implicated in an increase risk of stroke.3 Peer Reviewed