ACEs, Integrative Medicine, and the Mind Body Connection Why Dental Sleep Practitioners Must Take a Seat at This Table by Sunita Merriman, DDS
hat is spoken of as a clinical picture is not just a photograph of a sick man in bed; it is an impressionistic painting of the patient surrounded by his home, his work, his relations, his friends, his joys, sorrows, hopes and fears. Now all of this background of sickness which bears so strongly on the symptomatology is liable to be lost sight of in the hospital.”1
Patients enter dental sleep practices with issues that can complicate treatment and which may not be evident upon physical exam or radiograph. Emotional trauma may adversely impact sleep quality, treatment compliance, and overall health. Understanding how to identify these issues and associated comorbidities, discuss them with patients, refer to mental health professionals when appropriate, and recognize what impact they’re having on treatment outcomes is crucial to providing comprehensive integrative care.
Dental Sleep Practice subscribers can answer the CE questions online at dentalsleeppractice.com/ce-articles to earn 2 hours of CE from reading the article. Correctly answering the questions will exhibit the reader will: 1. Define Adverse Childhood Experiences (ACEs) 2. Understand the relationship between ACEs, sleep disordered breathing (SDB), and potential health outcomes 3. Recognize paths to broach mental health concerns with dental patients 4. Identify how depression and ACEs may affect SDB treatment acceptance or adherence 5. Possess the ability to incorporate an ACE screening protocol into the dental practice
38 DSP | Winter 2020
Although penned in 1927, if Dr. Francis W. Peabody sat at his desk today to review those words from his landmark article “The Care of The Patient,” it is very likely he would list “childhood history” to what he considered to be major components of an “impressionistic painting” of the clinical picture of a patient. In addition to the impact and consequences of sleep deficiency and sleep disorders on adults, Pediatric Sleep Disordered Breathing has captured our attention, and continues, rightfully so, to be the subject of multidisciplinary research. A Google search of Pediatric Sleep Disordered Breathing on any given day yields over 670,000 results. This bodes well for our society on many levels. But SDB can relate to childhood in a different way as we understand it.
Childhood Trauma or ACEs, Adverse Childhood Experiences
According to the Adverse Childhood Experiences (ACE) Study, ACE’s are potentially traumatic events that occur in childhood (017 years) which could include experiencing violence, abuse, or neglect, witnessing violence in the home or community or having