Dentist and ENT physician collaboration is the best way to deal with several patient issues. This article gives a great testimony as to why we need dentists and ENT physicians in our lives, allowing you to envision us without them. It also discusses one of those instances in which a team approach using dentistry and otolaryngology provide for the best patient outcome.
Some of the most pervasive conditions faced by American people are poor sleep and snoring problems, with an estimated 90 million Americans suffering from them. As we all (or at least most of us) know, snoring and poor sleep promote several harmful long-term effects including (but not limited to) coronary heart disease, hypertension, stroke, and non-insulin-dependent diabetes, among others. Ironically, though, despite the extent of the problem, it has received very little attention from medical professionals, researchers and even the general public, with historically available treatments being home remedies (such as sewing a ball into the back of a nightshirt) or tedious treatments such as CPAP or surgery.
Thanks to recent advances in medical technology, however, it has now been known that chances of the condition getting treated can be considerably improved if an integrated team approach of medical professionals (physicians, dentists, nurses) can deliver coordinated care in a singular facility. One such collaboration is that of an otolaryngologist (ENT physician) and a dentist, who together with their skill, training, and expertise in the matter of airways, can successfully combat (or even eradicate) the problem of sleep disordered breathing.
Snoring and Sleep Apnea
Snoring is basically a noise that is caused by the vibration of the soft tissues of the upper part of the airway. The dysfunction of any one of over ten different anatomical areas can cause snoring, from a troubled soft palate, blocked nasal passages, misaligned tongue and/or jaw, and enlarged adenoids and tonsils, among others. There are other factors too that can cause snoring, which include (but are not limited to) poor social habits and lifestyle practices, genetics and body composition, level of fitness, and stress, among others.
Although snoring and sleep apnea are generally connected to each other, there are instances when that has not been the case. Nonetheless, snoring is a very troublesome condition that affects not only the sufferer, but also their partner (if they have any). In fact, it has been found that over one-fourth of the couples in the US sleep in separate bedrooms due snoring noises, with some partners having reported that the sound of snores were as loud as a commercial airplane engine!
As already mentioned, sleep apnea has several serious medical implications, which include (but are lot limited to) stroke, diabetes, and heart diseases. Moreover, a lesser amount of sleep would mean lower daily quality of life and lesser amount of oxygen being supplied to the organs.
The presence and degree of sleep apnea can be determined via a sleep study. Sleep apnea is generally one of the following types:
- Obstructive (treated by ENTs and dentists)
- Central (generally treated by neurologists); or
- Mixed (a combination of obstructive and central apnea)
The general treatment for treating Obstructive Sleep Apnea (OSA) is CPAP (continuous positive airway pressure). This entails providing the patient air via a mask or a nasal cannula when they sleep. Although very effective, CPAP is a rather difficult and very uncomfortable method for patients.
Thanks to recent advances in medical science, though, there are now several and non-invasive and minimally-invasive treatments that are safe, simple, and very effective. In order to be effective, however, these treatments should be treated by both ENT physicians as well as dentists.
First and foremost, the patient is evaluated by a board-certified otolaryngologist who specializes in anatomy of the upper-airway. Digital imaging technology is used to identify the anatomical areas that cause snoring, which is then are identified and shown to the patient.
Once this is done, a treatment plan is devised (chiefly by the dentist) and then explained to the patient in detail. Different problems have different treatments. For instance, a flaccid or long soft palate can be fixed with a Pillar procedure. Similarly, radiofrequency coblation is used to perform inferior turbinate reduction in patients whose breathing problems are caused by inferior nasal turbinates that are enlarged.
Many times, however, the procedures are performed in by a collaborating team of otolaryngologists and dentists. For instance, when the cause of the problem is the tongue/jaw relationship, is contributing to the problem, the patient is then seen by a dentist who focuses solely on treating snoring and obstructive sleep apnea.
Snoring (whether or not it is related to sleep apnea) can be treated by manipulating the airway, which in turn entails moving the mandible in an anterior manner in order to pull away the tongue from the pharyngeal wall. Once the hypopharynx’s size is measured and the TMJ is analyzed with the help of acoustic measurements, it is decided if an oral appliance is necessary. At this point, the dentist will recommend a custom appliance the patient that fits with his/her condition.
That does not end the process, however. The device will need constant monitoring, maintenance and adjustment, and that is impossible without the dentist, and more importantly the otolaryngologist. The patient will have to return to deliver the device from time-to-time, wherein adjustments will be made.
In order to achieve favorable, long-term results, there must be integrated team of specialists in place with the otolaryngologist and dentist at the helm of it. Both specialists must have great knowledge of the airway area and should be experienced in building removable oral appliances disorders.
With proper, coordinated care given by a collaborative team of specialist doctors and dentistry professional in an environment that is comfortable, safe and familiar, the patient will get a great amount of relief (if not complete freedom) from their condition, which in turn will help them sleep better, feel better, and live lives that are happier and healthier.