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Beyond Oral Appliances - The Future of Sleep Medicine?

July 14, 2016

futureSleepMedicineAbout a decade ago, Dave Singh, DDSc, PhD, DMD, discovered that midfacial surgery in teenagers increased the volume of the upper airway. The discovery came during NIH-funded research at the Center for Craniofacial Disorders, University of Puerto Rico, ultimately prompting Singh to search for ways to repeat the finding non-surgically in adults.

“It’s called pneumopedics and craniofacial epigenetics,” explains Singh, now chairman and CEO of BioModeling Solutions Inc, Beaverton, Oregon. “Put simply, it means that it’s possible to remodel the upper airway non-surgically. This procedure relies on an epigenetic response, which means you harness a patient’s own genetic potential for correction.”

In this way, he says, the facial bone volume increases, the upper airway volume increases, and the clinical effects include improved facial appearance and tooth alignment. “But perhaps most importantly,” says Singh, “we have found an elimination of the signs and symptoms of obstructive sleep apnea [OSA]—even with no device in the patient’s mouth while asleep.”

Empirical studies are underway that will attempt to show the underlying mechanism of the clinical correction in mild, moderate, and even severe cases of OSA. Singh reports that “future studies will likely focus on molecular biology and the cellular response, molecular genetics, and neural pathways; in collaboration with various university hospitals in the United States.”

Singh’s work is predicated on his belief that mandibular advancement in isolation is not a comprehensive solution for OSA. “In the short term, it can have benefits, but that protocol would not be optimal for a patient with a Class III malocclusion whose mandible is already protruded,” he says. “Since long term benefits of mandibular advancement in isolation are less clear, my concept is to wean patients off a device and avoid life-long appliance therapy per se.”

With many patients still told that their best option for OSA is a “CPAP mask for life,” Singh agrees with colleagues that more education is needed to inform the general public about feasible alternatives, which are usually covered through regular medical insurance.

At this point, predictions about the vast numbers of undiagnosed OSA sufferers are on track, and that means opportunity for dental sleep professionals, as well as clinicians who are exploring novel solutions such as pneumopedics and craniofacial epigenetics.

“The good news is that OSA is a condition that we can manage, potentially cure, and most likely prevent—especially if we start screening early in children,” says Singh, a member of the World Association of Sleep Medicine, the American Sleep and Breathing Academy, and the American Academy of Dental Sleep Medicine. “To me, this is a golden age of dentistry where our profession is making tangible contributions to the overall health of Americans.

“Once dental sleep medicine becomes a recognized specialty, and we are currently working on curriculum development with a leading Medical university-hospital on this—then I think more (and younger) dentists will consider a professional future in dental sleep medicine and Pneumopedics.”


About Dave Singh, DDSc, PhD, DMD

Professor Singh is a US citizen who was born, educated, and trained in England, UK. He is currently CEO and chairman of BioModeling Solutions Inc, Beaverton, Oregon. He is also a Member of the World Association of Sleep Medicine, the American Sleep and Breathing Academy, and the American Academy of Dental Sleep Medicine. In addition, he is an Academic Fellow of the World Federation of Orthodontists and a Fellow/Senior Instructor of the International Association for Orthodontics where he was awarded prizes in 2005, 2013 and 2014.

Previously, he was a visiting professor in Orthodontics (University of Michigan, USA; University of Hawaii, USA; University of Airlangga, Indonesia and University Sains Malaysia); associate professor at the Center for Craniofacial Disorders, University of Puerto Rico, USA; and assistant professor at the University of Saskatoon, Canada, as well as director of Continuing Education for the SMILE Foundation, USA. Holding three doctorates, Singh has some 200 published works in peer-reviewed medical, dental, and orthodontic literature, and is author of a book entitled Epigenetic Orthodontics in Adults. Singh has lectured nationally and internationally in North America, Europe, Asia, Africa and Australia, and holds several US and international patents

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