The Role of The Dentist in the Interdisciplinary Approach of Obstructive Sleep Apnea Treatment.

Introduction: Healthy sleep is a synonymous term for the quality of life of the individual. Sleep disorders lead to socially significant diseases, which are a global epidemiological problem. In recent years, the role of the interdisciplinary teams of physicians and dentists has been highlighted in many clinical trials. Those trials involve patients with obstructive sleep apnea. Sleep disorders affect not only the quality of life, but also the physical, mental and emotional health of the individual.
Material and methods: During the last 14 years at the Faculty of Dental Medicine in Varna and the University Audio-Vestibular and Sleep Laboratory, a significant number of patients with obstructive sleep apnea and snoring have been examined, diagnosed and treated. These patients were examined by specialists in dentistry and otorhinolaryngology. Where comorbidity of the disease was found, consultations with pulmonologists, neurologists and other specialists were done. The interdisciplinary team has implemented the guidelines of the World Sleep Association, the American Academy of Sleep Medicine, and the American Academy of Dental Sleep Medicine. The diagnosis of obstructive sleep apnea of our patients was proven by a polygraph examination of their sleep at night.
Discussion: In order to put a correct diagnosis of the sleep disorder, patients should undergo a complete examination by otorhinolaryngologist, an endoscopic examination to determine the location of the obstruction in the upper respiratory tract, a dental examination, an imaging and a polygraph examination of sleep. Patients diagnosed with a mild obstructive sleep apnea case were offered a treatment with intraoral devices or a radiofrequency soft palate surgery with correction of nasal conchas and nasal septum, if necessary. The use of CPAP devices in moderate to severe obstructive sleep apnea does not preclude the use of intraoral devices.
Conclusion: Our experience during a large period of time has proven the need to establish an interdisciplinary approach to detect and treat sleep-disordered breathing. In the modern diagnosis and treatment of the stated disorders, and in particular, in obstructive sleep apnea and snoring, the role of the dentist is crucial.

Key words: obstructive sleep apnea, snoring, sleep medicine, intraoral devices, polygraphy, polysomnography

Assoc. Prof. Dr. Mario Milkov

Assoc. prof. Dr. Mario Petrov Milkov, MD, PhD is the Head of the Department of “Dental materials science and propaedeutics of prosthetic dental medicine” in the Faculty of Dental medicine in Medical University “Prof. Dr. Paraskev Stoyanov” – Varna since 2018. He works at the University Medical and Dental Center, in the Audio-Vestibular and Sleep Laboratory. He was born in 1968 in Varna and graduated“Medicine” from Medical University - Varna in 1995. Specialist in otorhinolaryngology from 2002. His PhD thesis is on the topic of Restoration of the auditory tract with Bulgarian prostheses for osiculoplasty. He created the first Bulgarian ossicular prosthesis from the Targis-Vectris material, which was patented in 2005. During his dissertation works, together with a multidisciplinary, international team, he conducted an analysis of biomaterials to create ossicular prostheses. Main professional and scientific interests are in the field of otology, neurotology, audio-vestibular medicine, biomaterials and bioengineering, creation of new prostheses for middle ear reconstruction, sleep medicine, hearing prevention in newborns and early childhood, screening for sleep disorders in professional drivers, biotolerance and biostability of materials. Implemented methodologies and innovations in practice - patent for ossicular prostheses and methods for their production.
Under his leadership (with his active participation) were established: Varna Association for Prevention of Hearing in Newborns - 2008, Bulgarian Association of Obstructive Sleep Apnea and Snoring - 2014, Black Sea International Otological and Neurotological Association - 2016, Bulgarian Academy of Sleep Medicine - 2018 and the International Bulletin of Otorhinolaryngology - 2004. He is a corresponding academic member of: Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, European Association of Otology and Neurotology (EAONO), Society for Biomaterials (SFB), European Association of Sleep Medicine (EASM), European Society of Pediatric Otorhinolaryngology (ESPO), European Sleep Research Society (ESRS), European Society for Biomaterials, International Pediatric Sleep Association (IPSA), Österreichische Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Politzer Society, Prospere Meniere Society, The Mediterranean Society of Otology and Audiology, World Association of Sleep Apnea (WASM), Bulgarian medical association (BMA), Bulgarian Society of Obstructive Sleep Apnea and Snoring (Honorary Chairman), Bulgarian Society of Otorhinolaryngology, Head and Neck Surgery, Bulgarian Rhinological Society (Vice-Chairman), Varna Association for the Prevention of Newborn Hearing (Chairman), National Bulgarian Surgery and Aesthetic Medicine, Pro Otology Association, Union of Inventors in Bulgaria, Balkan Otorhinolaryngological Association and its last secretary. Chairman of the Varna Association for the Prevention of Hearing in Newborns and Secretary for Bulgaria of the European Association of Otology and Neurootology EAO).
He has more than 150 scientific publications, has written two monographs and participated in four other textbooks, two of which in an international team: "All around the nose" 2020, "Prostheses for reconstruction of the auditory ossicles" in a team of scientists from Laval University in Canada He has participated in over 180 world, European, Balkan and national scientific symposia and congresses as a faculty member, chairman of meetings and round tables. He is the main organizer of the traditional multidisciplinary, international symposiums and conferences on Audio-vestibular and sleep medicine, as well as conferences dedicated to hearing screening in newborns and children in their early childhood. Famous scientists from over 45 countries took part in these scientific forums. For the first time in the country under the leadership of assoc. prof. Milkov World Sleep Day is organized in MU-Varna, and students are actively involved in the event, as well as in the organization of free preventive examinations of professional drivers of public transport in Varna. Participations in TV and radio programs for the prevention of sleep apnea in drivers in order to reduce mortality on the roads of Bulgaria. As Secretary of the Balkan Society of Otorhinolaryngology, assoc. prof. M. Milkov organized the 11th Balkan Congress, held at Golden Sands in 2018. Under his leadership, 2 dissertations of PhD students have been defended and three more PhD students are to finish their doctoral theses.
He has been the editor-in-chief of the journal International Bulletin of Otorhinolaryngology since 2004. Assoc. Prof. Mario Milkov is a member of the editorial board of five international medical journals in (USA, Russia, Romania, Turkey, Poland) and other Bulgarian medical journals. Winner of many awards as a physician and as a public figure. Participates as a reviewer in competitions for PhD students, senior assistants, associate professors and professors.