CEREC doctors.com - Q1 2017 - page 26

24 | CERECDOCTORS.COM | QUARTER 1 | 2017
systematic treatment planning, comprehensive exams (including an intentional evaluation of the TMJs and muscles
of mastication) and occlusion have been an overarching theme in my practice since around 2000. Bruxism, snoring, apnea and
gastro-esophageal reflux became an integral part of my practice somewhere around 2008 or 2009. Although the integration of
the two disciplines today might seem easy, logical and appropriate, early on, there was confusion.
CEREC Airway
Airway, Dentistry, Digital Imaging: Health
Now, as we enter 2017 and the evolution continues, some
aspects of these disciplines have become more clear and easy to
integrate, yet the addition of evaluating the airway in our profes-
sion continues to evolve quickly, resulting in some ambiguity in
diagnosis and treatment. Regardless, with current knowledge
and more accessible diagnostic tools at our disposal, we have the
ability to help all of our patients move toward health which makes
every day more fun, impactful and worth the transition for both
clinician and patient alike.
Historically, our profession has focused on the obese male
patient who reports poor sleep, daytime sleepiness, snoring and
has failed continuous positive airway pressure
(CPAP). It is not uncommon for this patient to
be irritable, depressed, anxious and have other
related comorbid conditions.
Typically, the patient has moderate to severe
apnea confirmed by a sleep study, and may benefit
from an oral appliance that facilitates protrusion
of the mandible to reduce obstructive airway
events while sleeping (Figs. 1-2).
The dental profession has proudly played a role in helping these
types of patients and, the more we learn, the more we can help
patients avoid the above scenario and move toward long-term
predictable health.
However, there is a category of patientswho do not fit the typical
profile above. Patients who are “pre-apneic” and still putting up a
great fight for air and oxygen. Patients who can be helped with
our improved screening and current knowledge.1 There are also
many children negatively affected by poor airway and oxygen
saturation, resulting in altered craniofacial development, as well
as systemic and neurocognitive development, and whose lives can
be significantly improved when identified and treated early.2
It is possible that both types of patients described above cannot
breathe through their nose. These patients are often referred to as
“obligatory mouth-breathers.” With advances in technology, we
have an opportunity to easily screen, identify and work on behalf
community has always known
that sleep patterns can be greatly
affected by good nasal func-
tion.3 Airflow receptors inside of
the nose play an integral role in
maintaining good muscle tone
in the oropharynx, facilitating
a patent airway4 (Fig. 3). It is
C A S E S T U D Y | | | B Y K E V I N K W I E C I E N , D . M . D . , M . S .
Fig. 1 (above):
Sleep Study
Reading
Fig. 2 (left): Sleep
Study Report
Fig. 3 (below):
Checking airflow
of these patients to help themmove toward long-term health.
The obligatory mouth breather is often one who simply cannot
breathe through the nose. By holding a finger on each nostril and
breathing in, we can hear, feel and see the lack of nasal patency —
maybe due to a history of trauma — resulting in a deviated septum.
Maybe there are other anatomical abnormalities, like nasal polyps
that the patient has not been aware of until this quick screening
helped identify them. Or, maybe there is simply chronic inflam-
mation in the air passage due to allergies, possibly exacerbated by
sleeping on a pillow covered with pet dander.
If the airway is opened, the body becomes grateful. The medical