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The role of orthodontist in sleep disorders

Abstract

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial closure of the upper airway during sleep leading to sleep fragmentation and oxygen desaturation. This sleep-related breathing disorder is associated with daytime sleepiness, impaired quality of life, poor work performance, neurocognitive decline, increased risk of motor vehicle accidents and, in the long term, an increased risk of cardio-vascular disease and mortality. Nasal continuous positive airway pressure (nCPAP) maintains a positive pressure in the upper airway through a nose mask worn during sleep and is currently the most effective treatment option for OSA patients. Nevertheless, adherence to this therapy is low. The availability of alternative treatment options is therefore of the utmost importance. Mandibular advancement devices (MADs), which hold the mandible forward with the aim of preventing collapse of the upper airway during sleep provide a less invasive, more comfortable, and less costly treatment alternative for patients with mild to moderate OSA who do not tolerate, do not respond to, or are not appropriate candidates for treatment with nCPAP. Forward repositioning of the mandible increases the upper airway volume, widens the lateral dimension of the velopharynx, it stretches tongue muscles counteracting tongue’s retrolapse during sleep, and it moves the hyoid bone anteriorly and stabilizes epiglottis and soft palate preventing the posterior rotation of the jaw. The therapy with a mandibular advancement device (MAD) represents a treatment option to obtain this anterior jaw repositioning. The obstructive sleep apnea (OSA) can be diagnosed also in children. Obstructive sleep apnea in children is associated with a series of daytime and nighttime symptoms, such as daytime sleepiness, morning headaches, snoring, laboured breathing, restless sleep and nocturnal enuresis. Craniofacial anomalies have often been associated with OSA in children. The most common reported are retrognathism and maxillary contraction usually associated with unilateral or bilateral cross bite and open bite. The potential benefit of orthodontic approach in children with OSA and malocclusion is described.


Dr.in Ambrosina MICHELOTTI BDS, DDS, Orth spec, Associate Professor

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Prof.in Ambrosina Michelotti graduated in Dentistry (DDS) in 1984. In 1991 she’s got the degree of specialist in Orthodontics and since then she has been teaching in pregraduate and postgraduate courses in Orthodontics and TMD at the University of Naples Federico II. Since 2001 she is associate professor in Clinical Gnathology. She is director of the post-graduated program in Orthodontics and responsible of the Master course on “Orofacial pain and Temporomandibular Disorders” at the University of Naples Federico II. Her clinical interests are limited exclusively to the treatment of temporomandibular disorders and to the orthodontic practice. She has authored or co-authored more than 130 papers published in Italian and international journals. She also gave numerous lectures at international congresses. Her research interests are mainly focused on the basic physiology of the jaw muscles, on the etiology, diagnosis and management of temporomandibular disorders and on the relationship between the jaw musculature and orthodontics.

She was the president of the European Academy of Craniomandibular Disorders (2010), President of the Neuroscience group of IADR (2011); President of SIDA (società italiana di disfunzioni ed algie temporomandibolari; 2012-2013); President of the RDC/TMD Consortium at the International Association od Dental Research (2013-2014), Associate Editor of the European Journal of Oral Science, Associate Editor of the Journal of Oral Rehabilitation, member of the Editorial Board of the European Journal of Orthodontics and referee of several national and international journals.