CEREC doctors.com - Q1 2017 - page 29

27
Upper Airway Resistance Syndrome (UARS), which has been
shown to be directly correlated to nasal issues.7 The same patient,
who is consistently fighting for air, will eventually have skeletal
changes, adapting to obtaining air orally, and eventually give up,
becoming apneic. The earlier we begin assessing nasal breathing
and evaluating nasal patency, the earlier we can have a positive
impact on skeletal growth, brain development, breathing habits
and health.
A simple way to evaluate the other end of the airway is using a
CBCT, which is becoming a more common diagnostic and evalu-
ative tool in dental practices. Even a 2-dimensional view of the
airway can be a valuable way to start the conversation with a
patient, when the problem is obvious (Figs. 4-5).
Even if we are only looking at the anterior-posterior aspect, it is
better than not looking at all. It may or may not be related to the
signs and symptoms that we see intraorally, and it may or may not
be related to sleep quality, apneas or hypopneas. But, then again,
the visualization of the airway on a 3-D scan may be indicative
of other issues. But, most certainly, it’s an opportunity to start a
discussion with the patient if airway issues are suspected.
is, however, another screening tool at our disposal — and if it
can help the practitioner and the patient better see the obvious,
why not use it?
Yet another advantage of the software is the ability to easily
compare the effect that mandibular position might have on the
volume of the airway (Fig. 10). To be very clear, the change is
definitely not indicative of any change that might take place with
respect to apneas, hypopneas, oxygen saturation or any other crit-
ical indicator of health or a healthy airway. A practitioner might
use it as a tool to evaluate possible airway improvement if consid-
ering mandibular advancement surgery. Minimally, it certainly is
an easyway to evaluate the lower section of the airway, a screening
tool for the benefit of the patient.
Certainly, there is a place in our profession to fabricate and
maintain mandibular advancement appliances to help improve
upper airway collapsibility under passive and active conditions.8
There is also a place to encourage and educate patients about
Buteyko mouth taping to re-train the body to breathe through the
nose.
Although the field continues to confuse us and cause some
ambiguity, it also allows us the opportunity to look at our patients
differently and more comprehensively.
Evaluating and discussing nasal patency and allergies, as well as
using our daily CBCT scans as a screening tool, are but a small part
of the bigger picture involving airway and helping our patients
achieve long-term predictable health.
For questions and more information, Dr. Kwiecien can be reached at
kkwiecien@speareducation.com.
REFERENCES
1 Prospective Randomized Study of Patients with Insomnia andMild Sleep Disordered
Breathing, Guilleminault C; Davis K; Huynh N, Stanford University SleepMedicine
Program, Stanford, CA, SLEEP, Vol.31, No. 11, 2008, 1527-33
2 Rees K, Kingshott RN, Wraith PK, Douglas NJ. Frequency and significance of increased
upper airway resistance during sleep. Am J Respir Crit CareMed. 2000;162:1210-1214.
3 CottleMH. Clinical benefits and disorders following nasal surgery. SouthMed J.
1968;61:1281-6.
4 White DP, Cadieux RJ, Lombard RM, Bixler EO, Kales A, Zwillich CW. The effects of
nasal anesthesia on breathing during sleep. AmRev Respir Dis. 1985;132:972-975.
5 FitzpatrickMF, McLeanH, Urton AM, Tan A, O’Donnell D, Driver HS. Effect of nasal
or oral breathing route on upper airway resistance during sleep. Eur Respir J.
2003;22:827-32.
6 de Godoy LB, Palombini LO, Martinho Haddad FL, Rapoport DM, de Aguiar Vidigal T,
Klichouvicz PC, Tufik S, Togeiro SM. New insights on the pathophysiology of
inspiratory flow limitation during sleep. Lung. 2015;193:387-92.
7 de Oliveira PW, Gregorio LL, Silva RS, Bittencourt LR, Tufik S, Gregório LC.
Orofacial-cervical alterations in individuals with upper airway resistance syndrome.
Braz J Otorhinolaryngol. 2015 Nov 6. pii: S1808-8694(15)00188-3.
8 Edwards BA1,2,3, Andara C2, Landry S2, Sands SA1,4, Joosten SA5,6, Owens RL1,7,
White DP1, Hamilton GS5,6, Wellman A1. Upper-Airway Collapsibility and Loop Gain
Predict the Response to Oral Appliance Therapy in Patients with Obstructive Sleep
Apnea. Am J Respir Crit CareMed. 2016 Dec 1;194(11):1413-1422.
Fig. 10: Volume of Airway Representation
In the dental world, the scan is not routinely taken with the
patient laying down in a supine position and asleep. No doubt if
they were, the appearance of the airway would likely be worse
with the patient laying down as the soft tissue collapses around
the airway. That is a starting place for a conversation. As the
software has evolved (SICAT Air is a perfect example), it allows
us to take a closer, 3-D look at the airway (Figs. 6-9). If we are
taking a scan on the patient for other restorative and diagnostic
needs, we might as well use the tools that we have to better
screen our patients. Certainly, the imaging is not diagnostic. It