Cranio Critiques: Sleep Medicine for Dentists: A Practical Overview

Editorial:

Sleep Medicine for Dentists:

A Practical Overview

Edited by LaVigne, G.L.,

Cistulli, P.A., Smith, M.T.

Quintessence Publishing Co., Inc.

210 pp., $68.00

ISBN 978-0-86715-487-0

This is a very difficult review to write. I was really looking forward to reading this book. I do not know Michael Smith. I regard Peter Cistulli as an icon in sleep dentistry. I do know and respect him as a researcher, clinician, and teacher. I have heard Gilles Lavigne deliver numerous excellent lectures, read his research articles, and have the highest respect for his intellect and contributions to sleep dentistry. That said, this book seriously failed to meet my expectations. The information presented is cursory. The reproductions of patient imaging are flat out poor. The discussions of sleep bruxism and snoring are inadequate. There is virtually nothing on appliance therapy or selection. They did not cover the biophysiology of Mandibular Advancement Devices (MADs), what they do, or how they work. A discussion of the biophysics of MADs is not part of the text. Any dentist who has attended one meeting of the American Academy of Craniofacial Pain focused on sleep medicine or an annual meeting of the American Academy of Dental Sleep Medicine already has a mastery of the items presented in this book. It is not a dentist’s substitute for “Principles and Practice of Sleep Medicine” by Kryger, Roth, and Dement, my concept of gold standard text. This book may be considered an extremely shallow very condensed version. I have gotten handouts from John Remmers’ courses that explain the pathophysiology better.

There is no mention of a protocol for dental treatment of sleep disordered breathing. How to make a better sleep appliance or the success criteria of good appliances are not covered topics. The chapter on sleep bruxism appears to be written by academics not clinicians. The book is loaded with epidemiologic data but very little clinical data. There is no discussion on respiratory physiology—hypoxia or hypercarboxia, and their consequences. The book completely ignores pediatric sleep apnea. Kids have this problem too, and the dental therapy is completely different than that for adults. The severity of apnea (the Apnea-Hypoxia Index) is based on an arbitrary definition. Too many pathophysiologic criteria are defined arbitrarily and not based on science. The example that screams out is the fact that the severity of the AHI is defined solely by the number of apneic events per hour. An apneic event is defined as 80-100% of reduction of air flow for at least 10 seconds with breathing effort. It makes sense to me that an apneic event of 30 to 60 seconds is more serious than an event of 10 seconds but this information is not factored into consideration of severity. Desaturations are defined arbitrarily as a three or four percent drop in blood oxygen. Drops of five to six percent are not considered more severe using conventional definitions.

Problematic matters such as these are not even addressed in the text. I cannot recommend this textbook as a good gift item for diplomates to give referring dentists in their area in order to heighten their awareness of sleep-disordered breathing, because it does not teach them enough to treat it. I do not recommend it as an essential component of the reference library of any dentist experienced in treating sleep-disordered breathing with oral appliances. 

Allen J. Moses, D.D.S.

Chicago, Illinois

ajmosesdds@sbcglobal.net