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DR. MANISH SHAH
- Masters in Sleep Medicine
- General Medical Practitioner
- General, Implant and Cosmetic Dentist
- Certified in TMJ & Craniofacial Pain Management
After graduating from a degree in Dentistry with honours in 1998 (University of Sydney), Dr Manish went on to complete a degree in Medicine in 2005 (University of Sydney).
With a special interest in craniofacial pain and sleep disorders, Dr Manish has also competed a Masters in Medicine in Sleep Medicine (University of Sydney).
As a medical doctor and a dentist he has dedicated himself to providing wholistic care for all his patients.
Dr Manish has over 15 years experience in comprehensive restorative and cosmetic dentistry.
DR. Kenneth Lee
Dr Kenneth Lee received his Bachelor of Dental Surgery from the University of Sydney.
He is a practicing general dentist, principal of Today’s Dental for over 35 years and runs a multi-location group practice in Sydney, Australia. He has a keen interest in general practitioner orthodontics and oral implantology and has been practising both for over 30 years.
Dr Lee is Chair of Dental Science and Professor of post-graduate studies at Universitat Jaume I, and received his fellowship of the International College of Dentists, Pierre Fauchard Academy, American College of Dentists, and International Academy of Dento-Facial Esthetics.
- Chair of Dental Science, Post Graduate Studies, University of Jaume I Castellon
- Chair of the Division of TMD, Dental AI Association (DAIA)
- Professor and Head of Dentofacial Orthopaedics and Orthodontics Post-graduate Studies, University of Jaume I Castellon
- Professor of Dental Implantology Post-graduate Studies, University of Jaume I Castellon
- Editor in Chief, Journal of Stomatology Edu
- B.D.S (Syd Uni)
- Grad. Dip of Health Sc. (Uni. W. Syd)
- Grad Dip Clin Dent (Orth) (Uni. Of Bolton)
- MSc in Oral Implantology (Frankfurt University)
- MDSc in Orthodontics & Dentofacial Orthopedics, magna cum laude (UJI, Castellon)
- Fellow International College of Dentists
- Fellow Pierre Fauchard Academy
- Fellow American College of Dentists
- Diplomate International Board of Orthodontics
- Fellow, Diplomate and Master Senior Instructor of International Association for Orthodontics (USA), International Board of Orthodontics Certified
- Chair of Education for International Association of Orthodontics (2019-2022)
- President of International Association of Orthodontics (2015/2016)
- Fellow of American Association for Functional Orthodontics (USA)
- Fellow American Academy of Craniofacial Pain
- Fellow of International Academy of Dento-Facial Esthetics (IADFE)
- Fellow and Diplomate of International Congress of Oral Implantologists (USA)
- Fellow, Diplomate, and International Board Member of the World Academy of Ultrasonic Piezo Surgery
- Fellow, Mastership and Diplomate of International Dental Implant Association
- President of International Dental Implant Association Australia
- International Ambassador and Editorial Board Member of American Academy of Oral Surgery
A/ PROFESSOR
narinder singh
Dr Narinder Singh is an ENT Specialist Surgeon, Clinical Associate Professor of Surgery at The University of Sydney (Australia’s oldest and largest medical school) and Chief of Otolaryngology, Head & Neck Surgery at Westmead Hospital, Sydney (Australia’s largest hospital campus).
Dr Singh is a Rhinologist, specialising exclusively in disorders of the nose and sinuses, including nasal obstruction, surgery for snoring/ OSA, complex and extended endoscopic sinus procedures, anterior skull base surgery and rhinoplasty (functional and aesthetic).
Dr Singh has a special interest in the role of nasal obstruction in the pathogenesis of dental and maxillo-facial disorders and is the “go-to” ENT surgeon for dentists, orthodontists and Maxillo-facial surgeons across Sydney and NSW.
Rochelle McPherson
Rochelle is one of Australia’s leading practitioners of Orofacial Myology. Her expertise are highly sought after in the industry, and she regularly conducts training and mentoring for other practitioners in this field both nationally and internationally.
Rochelle runs a private, orofacial myology practice in Sydney, OM Health, bringing a unique, holistic approach to patient care. She incorporates a team approach with other health professionals to assist in a greater level of health and well-being. Rochelle treats children of all ages through to adults. Her special interests include, Orofacial Growth and Development, Orofacial Pain and Sleep Disordered Breathing.
Rochelle is a lecturer at the Australian Academy of Orofacial Myology. She is committed to advancing Orofacial Myofunctional Therapy in Australia through best practice and continuing education.
Dr. Dimitrios Jim
Papadopoulos
Dr Papadopoulos is one of Australia’s leading sleep medicine physicians and is widely known for his work with sleep studies in children, and in particular children with AD/HD special needs, orthodontic problems, gastro-intestinal issues and need for CPAP therapy.
Dr Papadopoulos was admitted to FRACP in General Paediatrics in 2002.
In 2003 he became the first prospectively accredited Level 2 Paediatric sleep physician in Australasia (highest possible level).
He then established the Paediatric Sleep Unit at St George Private Hospital.
This continues to be the only Private Hospital Paediatric Sleep Unit in NSW to offer ASA/NATA accredited Paediatric Sleep Laboratory services including diagnostic studies and CPAP. Our first-in-Sydney ASA / NATA accreditation for these services, including a commendation for our CPAP service, makes us unique amongst paediatric sleep laboratories in Sydney.
MODULE 1
- Understand normal sleep
- Understand stages of sleep (old and new nomenclature)
Understand the NORMAL patterns of sleep and the distribution of sleep stages across the night.
- Recognise the stages of sleep on a sleep study
Understand the relationship between
REM sleep & Pain- Discuss factors that modify sleep stage distribution
- Why do we need sleep
o Daytime sleepiness/alertness
o Acute and chronic sleep deprivation
- Understand the prevalence of sleep issues in the society
- Understand abnormal sleep
o What does it look like on a sleep study?
- Understand the definitions of apnoea, hypopnea, central apnoea
- Understand Arousal Index, AHI, RERA, RDI. When are each used? What are the relationships between them?
Understand the definition of Obstructive Sleep Apnoea (OSA)
Understand what is upper airway resistance syndrome
Understand what defines Upper Airway Resistance Syndrome (UARS)
- Understand tiredness and its multiple differential diagnoses
- Understand the concept of snoring – is it really important to treat?
- Understand the anatomy and physiology of the upper airways?
Understand the major causes of Sleep Disordered Breathing (SDB)?
- Understand the major causes of Sleep Disordered Breathing (SDB)?
o What causes the narrowing of the airways and what should we do about them?
o Is nasal breathing important? What should we do with people who breathe through their mouth?
- Understand the medical and dental effects of sleep disordered breathing
LEVEL 1
- Understand bruxism as a movement disorder
- Understand other movement disorders and their relationship to REM sleep and sleep breathing issues.
- Understand how to treat bruxism. Should you treat bruxism with splints? And what about botox?
- Understand the potential relationship between nutritional deficiencies, gut microbiome, REM sleep and bruxism
- Understand the concept of headaches and REM sleep
- Understand the relationship between bruxism and TMD
- Understand various questionaries used in sleep.
- Understand how to screen patients with 3 questions
Understand how to examine patients with sleep disorders
Understand how to identify these patients by just looking at them, without them opening their mouths.
Understand what to look for extra-orally and intra-orally
Understand how do you assess nutritional status with a physical exam and history
Understand snoring and sleep apnoea in children
Understand the approach to manage sleep breathing issues in a child
MODULE 2
Understand different types of sleep studies
Understand how we do sleep studies
Understand how to interpret sleep studies
o What results are we looking for? What do they all mean?
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Understand the role of radiographs, including OPG, Lat Ceph, CBCT
Understand the role of blood tests
- How to interpret results
- Understand the causes of tiredness
- Understand the basis of chronic disease
- Understand the role of Magnesium in sleep
- Understand the role of serotonin and melatonin in sleep
Understand the concept of Methylation and how B12 and Folate also plays a role in sleep
- Understand the concept of stress and cortisol, and how it effects sleep
Understand the relationship of parasympathetic system and sleep, and the role of acetylcholine, vitamin B5 and vitamin D
- Understand the role the gut plays in sleep.
- Understand the relationship of sleep, nutrition and headaches.
LEVEL 1
- Do we need to treat all patients with OSA?
- What are the treatment options for managing OSA?
- Does weight really play a role?
- How does surgery play a role and when does it play a role?
- What about CPAP? Is it superior? Or can MAS do just fine?
- What happens if my patient has been treated for OSA and sleep study shows they are fine, but they are still tired all the time?
- Do lasers really work for snoring and sleep apnoea?
- How do I nutritionally supplement? Are there any recommended doses and what time should they be taken?
- Are there any interaction of nutritional supplements with regular medications?
- How do we do a MAS?
o What bite do I take?
o But others are taking a bite differently. What is the difference?
o What if the patient is not getting better?
- Understand how to take bites for mandibular advancement splints.
- Understand how to send to lab and what to ask for
MODULE 3
Disordered sleep is prevalent, affecting 30% of children. Disordered sleep affects mood, behaviour and cognition and has an adverse impact on the family. Adverse intellectual impacts may be irreversible.
Snoring, even if non-vibratory (heavy breathing) can indicate the presence of underlying Obstructive Sleep Apnoea (OSA), Allergic Rhinitis, Gastro-oesophageal Reflux Disease and/or structural anomalies. These are also important contributors to adverse dentofacial outcomes.
We all know that snoring even without OSA can have adverse neurocognitive and dentofacial consequences. Around 10% of children snore, only 3% of children have OSA. What’s going on with the other 7% of snorers with sleep difficulties?
We will try and explore snoring and sleep difficulties in children from a new perspective and establish a background knowledge base from which we can start to tackle real world clinical conundrums in paediatric sleep.
- Understand the health burden of snoring and sleep difficulties in children
- Understand the symptoms, signs and tests which help us evaluate snoring and sleep difficulties in children
- Understand the importance of a multidisciplinary approach to the diagnosis and management of snoring and sleep difficulties in children
- Understand the differential diagnosis of snoring and sleep difficulties in children
This interactive discussion will build on the background knowledge base of my morning presentation.
A brief screening history mnemonic will be suggested, the essential elements of the physical examination and brief case histories together with digital sleep study data including video will be presented.
Hopefully this will illustrate a practical approach to the clinical conundrums faced in the real world by health professionals interested in paediatric sleep disorders.
- Learn a quick practical way to ask parents about sleep difficulties in children and the essentials of the physical examination relevant to sleep disorders.
- Learn about how we should approach the many and varied presentations of snoring and sleep difficulties in children
- Learn how sleep studies help in the diagnosis and management of various paediatric sleep disorders
Understand more about how a sleep paediatrician, ENT surgeon, paediatric gastroenterologist, dentist, orthodontist, paediatric dentist, orofacial myologist, speech therapist, educator, occupational therapist work together to address sleep disorders in children
- Understand the importance of treatment of the facial muscles as adjunctive therapy of OSA
Understand there is more to OSA when treating sleep
Understand there are sleep issues other than OSA, and what to questions to ask
Understand the importance of Oral Myology Therapy (OMT) post surgery
Understand how OMT improves CPAP and Mandibular Advancement Splint (MAS) treatment
- Understand OM therapy techniques to introduce to your patient care – practical
LEVEL 1
- Understand that nasal obstruction in adults is common
- Recognise that most patients with nasal obstruction don’t realise they are obstructed
- The key questions that reveal unrecognised obstruction
- The main causes of obstruction (anatomical and mucosal)
- How to manage nasal obstruction (investigations and treatment)
- Live demonstration of nasal endoscopy for a volunteer
- Surgical videos
- Understand that nasal obstruction in children is very common
- Signs and symptoms of nasal obstruction in children
- The 4 key causes of obstruction in children (very different to adults)
- Allergic rhinitis in a nutshell
- How to manage nasal obstruction in kids (investigations and treatment)
- Surgical videos
- Understand that there are validated evidence-based alternatives to CPAP
- Identify the key sites of anatomical obstruction
- Drug Induced Sleep Endoscopy (DISE) – a revolution in diagnosis
- A deep dive into each surgical option – details, pros and cons
- An algorithmic approach to management
MODULE 4
- The impact and burden of orofacial pain
- Pain, a multi-dimensional experience
- Multiple sources of orofacial pain
- Common findings of TMD
- Screening for common risk factors and findings
- Impact of TMDs
- Impaired Jaw Function
- Vicious cycle of chronic pain
- Psychosocial components of TMD
- Normal TMJ anatomy
- Functional anatomy of the TMJ
- Blood supply of the TMJ
- Innervation of the TMJ
- TMJ musculature and associated head & neck muscles
- Muscle pathology
- TMJ pathology
- Aetiological theories of TMD
- Pathophysiology of pain
- From nociception to pain behaviour
- Referred pain
- Contributors and factors to TMD
LEVEL 1
- What is bruxism? What causes bruxism?
- Is bruxism pathological?
- What happens when you inhibit bruxism?
- Understanding the role of bruxism in the nervous system
- Sleep bruxism
- Key elements of the chief complaint
- Comprehensive history for orofacial pain
- Psychological and sleep screening
- Occlusal analysis
- Muscle assessment
- TMJ evaluation
- Ear, nose, and throat
- Diagnostic imaging for TMD
- TMJ abnormalities
- Arthritic conditions of the TMJ
- Internal derangement of the TMJ
- Traumatic lesions
- Degenerative joint disease
- Rheumatoid arthritis
- TMD therapies
- What occlusion should we use?
- The objective of splint therapy for managing TMD
- Palliative splint
- Splints for intracapsular disorders: daytime and night-time
- Splint features and design
- Phonetic bite
MODULE 5
- Revisit the goal of splint therapy and management of TMD
- Understand the treatment sequence of TMD using conservative splint therapy
- Maintenance phase of TMD patients using splints
- Understanding head pain
- Understanding neck pain
- Local muscle soreness
- Myofascial pain
- Pain modulation therapies
- Hysical therapy
LEVEL 1
MODULE 6
- Understanding autologous blood concentrates
- Application of ABCs and regenerative medicine in TMDs
- Maximising the patient’s potential for healing and repair
LEVEL 1
- Understand the relationship between chronic pain and sleep disturbances
- Stress factors affecting sleep
- Relationship between TMD and sleep-disturbed breathing
- Poor sleep exacerbates chronic pain, chronic pain exacerbates poor sleep
- Effects of pain conditions on normal sleep patterns
- Healthy sleep is analgesic
- The impact of pain on sleep stages
- Pharmacological management
- The role of vitamin D
- Behavioural management of chronic pain and sleep issues
- Treatment of orofacial pain disorders
- The effect of sleep treatments on pain
- Effect of CPAP on pain, pain sensitivity, and oxidative stress
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