**An interview with Dr. Samir Cáceres**
I am pleased to present the interview I did with Doctor Samir Cáceres, a dentist specializing in sleep medicine and a pioneer in managing mandibular advancement devices to manage apneas in Colombia. I am sure it will be of great interest to many of you, especially those looking for an alternative to apnea management with CPAP. So without further ado, here is the interview:
1. Doctor, first tell us a little about yourself, your training, and how you came to specialize in Dental Sleep Medicine.
My name is Carlos Samir Cáceres Jaramillo, I am a dentist graduated from the Santiago de Cali University. I came to sleep dental medicine through an uncle who is a dentist in the United States. He invited me to get to know this field where dentistry plays a vital role in diagnosing and treating snoring and obstructive sleep apnea. For this reason, I studied at the Somnomed Institute and, currently, I am a member of the Colombian Association of Sleep Medicine (ACMES).
2. What is dental sleep medicine?
According to the American Association of Dental Sleep Medicine, dental sleep medicine is defined as the area in charge of studying sleep disorders, their causes and consequences at the oral and maxillofacial level. In other words, we take care of assessing, diagnosing and treating the causes and effects that produce sleep disturbances, especially snoring and obstructive sleep apnea [1].
3. What sleep disorders do you treat in your dental practice?
In the dental office, we mainly treat snoring and obstructive sleep apnea. We carry out the diagnosis and treatment of these disorders utilizing mandibular advancement devices; all this is oriented under multidisciplinary work. We intervene with several health professionals (e.g. otorhinolaryngologists, pulmonologists, physiotherapists, somnologists, sleep nurses, psychologists, maxillofacial surgeons, speech therapists). We also assess other related conditions such as gastroesophageal reflux, orofacial pain and temporomandibular disorders.
4. Could you go a little deeper into how the mandibular devices can help with apnea and snoring?
In dentistry, the treatment for snoring and sleep apnea is carried out by adapting mandibular advancement devices, which dentists can only adopt with knowledge of dental sleep medicine.
a. How do mandibular advancement devices work exactly?
The devices bring the jaw and tongue forward, a position they maintain during sleep. This allows the airway to remain clear and for more air to pass through.
These devices are used exclusively by people while they sleep. All machines are custom designed for the patient.
b. Who can benefit from these devices?
Snoring patients and those with mild to moderate apneas. Also, it can be helpful in patients with severe apnea who cannot tolerate CPAP [2]. However, this requires a process of control and verification to guarantee the effectiveness of the treatment.
c. How long does the installation of these devices take?
First, an evaluation consultation is carried out. A comprehensive evaluation of the patient is made, including measurement of the body mass index, neck circumference measurement, dental assessment where oral structures are reviewed in-depth, and predictive test of apnea. All this allows us to observe which are the obstructive characteristics of the airway.
Second, a polysomnographic study is performed [3] (ideally), which confirms the presence of apneas. Finally, all this tells us if the patient is a candidate for a device. If it is, we proceed to take dental impressions and a bite record of the patient. Then, these are sent to the laboratory specialized in developing the device, adapted to the patient and installed. Once installed, follow-up appointments are made.
d. How long should the devices be used?
There is no specific time for device treatment since, being a multidisciplinary treatment, many factors must be considered before considering removing the devices. That is why it is essential to invite the patient to change many lifestyle habits that can help improve their physical condition and the severity of their apnea.
e. Do these devices help reduce or eliminate apnea?
That is the intention of the devices to eliminate or reduce obstructive apnea episodes to average values. However, its effectiveness can only be measured through a sleep study (polysomnography).
f. Once installed, what kind of care do these devices require?
The devices must be cared for as if they were a dental prosthesis. When the devices are delivered, the care instructions are given, mainly consisting of a simple wash in the morning, drying well, and storing them in a dry place.
5. What other specialists do you work with?
In treating obstructive sleep apnea, the treatment is multidisciplinary; we work hand in hand with other specialties such as otorhinolaryngology, pulmonology, physiotherapy, somnology, neurology, psychology, nursing maxillofacial surgery. That is, all areas are involved in the treatment of sleep disorders.
In particular, dentists are an essential component in diagnosing this disorder since obstructive sleep apnea is an under-diagnosed disease worldwide. By having direct contact with the oral cavity, we can close that gap and diagnose patients with this pathology.
We achieve this with the observation of the cavity and with a simple question to our patients, Do you snore ?. If the answer is positive, we can apply a predictive apnea test to determine our patient's risk and direct them to the appropriate treatment.
6. What complications does not treating sleep apnea bring?
Failure to treat obstructive sleep apnea brings complications such as the risk of stroke, diabetes mellitus, heart attack, atrial fibrillation, hypertension, memory loss and sexual impotence in men.
Additionally, people who suffer from this disorder tend to be irritable, tired, have poor work performance, and are at a very high risk of traffic accidents due to micro-sleep.
7. If someone wants to contact you, how can they contact you?
We are located in Cali and you can contact us by the following means:
Landline: (+57) 2-3936514.
WhatsApp: (+57) 316 5088689.
Address: Calle 5D 38ª-35 VIDA CENTRO PROFESIONAL (Building Of Colors) Torre 1 Consultorio 917;
Instagram: @dr.samircaceres and on
Facebook: Samir Caceres.
I hope you found this interview interesting. I find the practice of Dr. Cáceres exciting. In addition, I find it essential to be aware of treatment alternatives for people who suffer from apnea and find CPAP treatment difficult.
Finally, I am grateful to Doctor Cáceres for taking the time to allow me this s interview.
Sweet dreams!
Vocabulary
[1] – Obstructive Sleep Apnea: a condition in which breathing stops involuntarily for brief periods of time during sleep. Normally, air flows smoothly from the mouth and nose into the lungs at all times. Periods when breathing stops are called apnea or apneic episodes.
[2] – CPAP: Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The application of positive pressure may be intended to prevent upper airway collapse, as occurs in obstructive sleep apnea, or to reduce the work of breathing in conditions such as acute decompensated heart failure.
[3] – Polysomnography: also called a sleep study, is a comprehensive test used to diagnose sleep disorders. Polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study.