The blue ocean of dental sleep medicine

Dental sleep medicine is defined by the American Academy of Dental Sleep Medicine as an extension of general dentistry that focuses on the management of sleep disorder breathing in adults, including disorders such as snoring, obstructive sleep apnoea, and sleep related bruxism.

For Dr Kelvin Chye, CEO and founder of Asia Pacific Dental Holdings, dental sleep medicine provides the benefits of non-invasive, non-surgical and reversible forms of treatment, which first drove him to dwell deep in the field in 2017, by training with the American Academy of Dental Sleep Medicine.

dental sleep medicine Dr Kelvin Chye
Seeking to address the underlying conditions encountered by patients, Dr Chye decided to embark on the journey of dental sleep medicine

“I had set my mind to find out more about it at the time. As a general dentist then, I encountered patients who grind and break their teeth, fillings, crown, and issues with implant loosening; the patients will think that it is the fault of the dentist or quality of the materials,” said Dr Chye.

“Traditionally, we as dentists are trained to make a mouth guard to help protect the patient’s teeth. But a lot of patients in fact do suffer from a more serious underlying medical condition like sleep apnoea. I decided to dwell further to the root cause problem and learn about dental sleep medicine.”

The branch of dental sleep medicine represents one of four broader treatment strategies. Other strategies include lifestyle modification such as dieting and weight loss management, continuous positive airway pressure (CPAP) devices which pushes air through the obstruction that may be in the mouth, and surgeries such as skeletal surgery, soft tissue surgery, septoplasty, and hypoglossal nerve stimulation.

The principle of oral appliances in dental sleep medicine operates by stabilising the jaw in a slightly forward position. Because the tongue is attached to the jaw by the higher bone, the appliance helps to prevent the lateral collapse of the pharyngeal wall. This ensures that an airway is created and maintained for a patient to breathe without obstruction in their airways.

Using oral appliance therapy to treat patients with sleep disorders, dental sleep medicine serves three important functions according to Dr Chye. First, it helps to reduce a patient’s snoring. Second, it helps to improve the patient’s sleep apnoea condition. Third, it protects the patient’s dentition from the effects of teeth grinding during sleep.

INTERDISCIPLINARY MANAGEMENT

Within the past five years, Dr Chye has noted several developments which has raised the popularity of dental sleep medicine as a treatment method.

The advancement of digital dentistry has enabled shifts in workflows from physical impressions providing precise and customisable oral moulds in the creation of oral sleep appliances. Coupled with the improvements in printing materials, end products have greater qualities for durability and comfort. Dr Chye further noted that most reputable manufacturers are increasingly providing warranty periods for structural defects of an appliance.

Simultaneously, Dr Chye has witnessed a growing awareness and interest in the field. Through his personal practice and interactions, he seen different specialists such as orthodontics, prosthodontics, and oral maxillofacial surgeons, reporting a good experience when collaborating with Dr Chye to treat patients with sleep apnoea.

However, Dr Chye believes that education needs to focus on the multidisciplinary and interdisciplinary nature of dental sleep medicine to make the treatment practice more widespread. With a background in public health, Dr Chye is trying to marry the practice of public health and dental sleep medicine.

dental sleep medicine Dr Kelvin Chye
In addition to treating patients at his clinic, Dr Chye is active as a advocate of dental sleep medicine and connects with various associations in Asia to share its benefits

“In public health, there is a part that focuses on the management of non-communicable disease. Using this principle, we look at all the management strategies and risk factors related to sleep apnoea, and it is a multidisciplinary condition involving dentists, respiratory physicians, ENT surgeons, neurologists, and psychiatrists to help manage the patient,” said Dr Chye.

He added that dental sleep medicine also needs to be interdisciplinary as each patient is unique and the right solution may involve a combination therapy of CPAP, oral appliances, or surgery. Moreover, whatever measures are taken, lifestyle modification is still required to sustain the treatment outcome which involves changes to one’s lifestyle, diet, and activity levels.

Specifically, Dr Chye noted that there is potential for medical sleep professionals to collaborate with dentists to screen cases, referring to a policy statement adopted by FDI World Dental Federation in 2018 which highlighted the important role of dentists in prevention, early screening and treatment of young or adult patients with Sleep-related Breathing Disorders by establishing effective inter-professional collaboration with medical sleep doctors.

Moreover, Dr Chye believes that dentists are in a unique position to screen for symptoms of sleep apnoea because of the nature of their interactions. “Dentists see patients daily and from looking into the patient’s mouth, straight away there are many telltale signs whether a patient has sleep apnoea. For example, dentists can assess a patient’s melon party score by examining elongated uvulas and enlarged tonsil, the presence of tori, signs of bruxism due to sleep apnoea.”

Following the American Board of Dental Sleep Medicine standards and guidelines in his practice, Dr Chye follows up with a patient at the first, third, and sixth month intervals. Along the process, Dr Chye coordinates with other specialists to monitor patients through reports like sleep studies to assure them of their progress.

“For the past five years, I have been trying to build an ecosystem, identifying all the different stakeholders in this ecosystem and how to establish links with everyone so that we can have a more successful and effective management strategy for sleep apnoea patients,” Dr Chye said.

BLUE OCEANS

An important milestone in a positive direction for the field was the launch of the first Fellow of Dental Sleep Medicine (FDSM) programme in 2022 by the Australasia Sleep Association (ASA). The fellowship certifies the achievement of minimum clinical competencies in the practice of dental sleep medicine where Dr Chye was among one of the first dentist outside of Australia to be awarded the fellowship.

Dr Chye sees dental sleep medicine as a scarcely known yet exciting blue ocean in managing sleep disorders. To realise its potential, Dr Chye started Asia Pacific Dental Sleep Academy to provide training and education courses, and promote the benefits of the field among both consumers and practitioners.

To read the full article, click here or refer to Dental Asia May/June 2024 issue.