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Immunologic and Physiologic Effects of Dental Sleep Appliance Therapy

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Temporomandibular Joint and Airway Disorders

Abstract

Obstructive sleep apnea (OSA) is characterized by episodes of oropharyngeal obstruction due to repetitive collapse of the oropharyngeal tissues during sleep. OSA is associated with sleep fragmentation, hypoxemia, hypercapnia, marked swings in intrathoracic pressure, increased sympathetic activity, and cardiovascular complications.There are multiple medicalrisk factors for patients diagnosed with OSA and evidence showing improvement of health factors with the treatment of positive airway pressure (PAP) therapy.

 Multiple forces contribute to oropharyngeal collapse, including the elongation of the soft palate and uvula, loss of vertical dimension resulting in a shortening of the lower 1/3rd of the face, increase in tongue size due to fat deposition in the tongue, constriction of dental arches, negative transmural pressure gradient and tissue weight. The goal of this chapter is to show the correlation and improvements on immunologic and physiologic effects of dental sleep appliance therapy based on the improvements seen with PAP therapy.

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Abbreviations

AASM:

American Academy of Dental Sleep Medicine

AHI:

Apnea-hypopnea index

BMI:

Body mass index

CGRP:

Calcitonin gene-related peptide

CKD:

Chronic kidney disease

CPAP:

Continuous positive airway pressure

CPH:

Craniofacial Pain Handbook

CT:

Computerized tomography scan

GERD:

Gastroesophageal reflux disorder

GPT-9:

Glossary of Prosthodontic Terms Ninth Edition

HTR:

Hormone replacement therapy

IBS:

Irritable bowel syndrome

ICSD-3:

International Classification of Sleep Disorders Third Edition

LES:

Lower esophageal sphincter

MA:

Microarousals

MRI:

Magnetic resonance imaging

OAT:

Oral appliance therapy

ODI:

Oxygen desaturation index

ODS:

Obsessive daytime sleepiness

OFPG-4:

Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management, Fourth Edition

OSA:

Obstructive sleep apnea

PAP:

Positive airway pressure

PAS:

Posterior airway space

PGP 9.5:

Protein gene product 9.5

PM:

Portable monitors

PSG:

Polysomnogram

RAAS:

Renin angiotensin-aldosterone system

RDI:

Respiratory distress index

REM:

Rapid eye movement

RME:

Rapid maxillary expansion

RMMA:

Rhythmic masticatory muscle activity

RPS:

Retropharyngeal space

SB:

Sleep-related bruxism

SP:

Substance P

TAD:

Temporary anchorage device

TCR:

Trigemino-cardiac reflex

TMD:

Temporomandibular joint disorder

TST:

Total sleep time

TTH:

Tension-type headache

VDO:

Vertical dimension of occlusion

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Authors and Affiliations

  1. Center for TMJ & Sleep Therapy, 175 N. Pennsylvania Ave. #4, Glendora, 91741, CA, USA

    G. Gary Demerjian

  2. Smiles for Life Dental Group, Santa Clarita, CA, USA

    Pooja Goel

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  1. G. Gary Demerjian
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  2. Pooja Goel
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Correspondence to G. Gary Demerjian .

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Editors and Affiliations

  1. Center for TMJ & Sleep Therapy, Glendora, CA, USA

    G. Gary Demerjian

  2. Oral Biology and Medicine, UCLA School of Dentistry, Los Angeles, CA, USA

    André Barkhordarian

  3. CHS 63-090, UCLA School of Dentistry, Los Angeles, CA, USA

    Francesco Chiappelli

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Demerjian, G.G., Goel, P. (2018). Immunologic and Physiologic Effects of Dental Sleep Appliance Therapy. In: Demerjian, G., Barkhordarian, A., Chiappelli, F. (eds) Temporomandibular Joint and Airway Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-76367-5_8

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  • DOI: https://doi.org/10.1007/978-3-319-76367-5_8

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  • Online ISBN: 978-3-319-76367-5

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