Dental college helps patients in search of slumber

Dr. Reynaldo Todescan is serious about sleep.

In fact, when the associate professor of restorative dentistry became director of the College of Dentistry’s dental sleep medicine clinic in 2014, he asked if he could experience an overnight sleep study at the Misericordia Health Centre.

That meant voluntarily hitting the pillow with electrodes stuck to his scalp, face, chest and legs, a tube invading his nose, and various other wires monitoring his system.

“I thought I should see what it’s like for patients,” says the affable Brazilian-born dentist, who practised and taught in Toronto for more than 30 years before joining the U of M faculty six years ago.

One of the key problems diagnosed by sleep studies is obstructive sleep apnea (OSA). The breathing disorder is characterized by loud snoring, frequent waking with a choking sensation, and excessive daytime sleepiness. Left untreated, OSA can lead to serious health problems, such as cardiovascular disease.

“The role of the dentist is becoming quite important in identifying patients at risk for OSA,” says Todescan, head of the college’s division of temporomandibular disorders (TMD), orofacial pain and sleep apnea.

“General dentists should know what questions to ask about symptoms like snoring. They should be aware of apnea risk factors, such as obesity, large neck size and gastroesophageal reflux disease. Our curriculum is ensuring that students have that knowledge.”

Today and Saturday, Todescan is assisting as the college’s continuing professional development program delivers its first master class in dental management of snoring and OSA for Manitoba dentists. Experts from the U.S.-based Sleep Group Solutions are giving the course.

The U of M is an educational leader in the field. Todescan believes the College of Dentistry clinic, which opened in 2012, is the only one for sleep breathing disorders at a Canadian dental college.

He supervises third- and fourth-year students as they rotate through the busy Wednesday-morning clinic, seeing patients who have been medically diagnosed with sleep apnea. The clinic is a model for interprofessional collaboration and learning, a strategic priority of the Rady Faculty of Health Sciences. Since last year, physician sleep fellows from the Misericordia have been coming to the clinic to work with Todescan and the students.

The gold standard for OSA treatment is a continuous positive airway pressure (CPAP) machine to keep the patient’s airway open during sleep. However, Todescan says, many people can’t tolerate the bedside machine because they find the mask and tubing too uncomfortable.

That’s where dentists come in. They can custom-fabricate a mandibular advancement device (MAD) – a kind of mouth guard to be worn at night.

“The idea is to bring the jaw slightly forward to open the airway,” Todescan says. “From the literature, it’s very effective for snoring, and for mild to moderate apnea. It’s not really indicated for severe apnea, but patients who are unable to use the CPAP can try it.”

Todescan has seen life-changing improvement in some patients with a MAD. Unfortunately, the appliances can be expensive and, unlike the CPAP, are currently not covered by Manitoba Health. Private benefit plans vary in their coverage.

For Todescan, the bottom line is that dentists need to do detective work when it comes to patients’ sleep. Nighttime bruxism (grinding), for example, needs more attention than the automatic fabrication of a night guard to protect teeth.

“We now call it ‘sleep bruxism,’ because we know it’s a sleep disorder,” he says. “Before you prescribe a night guard, you should look at the breathing aspect. You have to look carefully and see what’s going on.”

ALISON MAYES