Member spotlight: get to know Dr Andrew Gikas

This article was first published in News Bulletin, February 2023.
 

Your clinic helps patients with snoring, apnoea and other sleep-related issues. Tell us about setting this up?

The Dental Unit at the Alfred has a long and valued history in providing specialised dental treatment for patients who have other complex medical conditions, such as people with HIV, haemophilia or those who have had an organ transplant.

Over the last decade there has been steadily increasing demand from the hospital’s Respiratory and Sleep Unit to refer patients who might be suited for oral appliance therapy for their diagnosed sleep disordered breathing and to integrate dentistry into the multidisciplinary sleep team.

My role initially was in an honorary capacity to support and provide oral appliances for patients that would otherwise be unable to afford and oral appliance option in private practice. Over a couple of years we were able to build a case for funding by conducting a clinical audit and highlighting the clinical, teaching and research benefits of the service.

We currently have the hospital’s Respiratory/Sleep Registrars, postgrad Oral Medicine and Special Needs and DDS3 students rotating through the clinic so there is a strong focus on teaching and with a couple of research proposals going through ethics now I hope to build on Melbourne’s strong medical sleep medicine research by offering oral appliance options for some projects.
 

What are some highlights during your period of service as Federal Executive Councillor here at the ADA?

The immediate standout for me is the people involved in the ADA. A great association only thrives because people want to be involved, from a member who has valid input into a submission to those that volunteer their time to sit on committees. The quality and volunteer capacity of our profession and the ADA membership is indeed impressive and one that we should be proud of. As a Federal Councillor my role is ultimately to serve the membership and I take the role seriously.
 

You have a continuing interest in education and training; will you be taking part in the upcoming World Dental Congress this year?

I am taking part in a Symposium on Dental Sleep Medicine which will aim to cover a wide range of topics from bruxism and obstructive sleep apnoea to the current understanding and evidence around patient phenotyping, imaging and long-term outcomes including oral appliance side effects. My presentation will focus on the current appliance options for patients diagnosed with obstructive sleep apnoea.
 

What kind of new developments in the area of sleep medicine and oral health are you seeing now – and in the future?

The growth of wearable technologies, artificial intelligence and simple sensors that link up to your smartphone will be a game changer for screening and diagnostics. At last year’s Australasian Sleep Association (ASA)’s Annual Scientific Sleep Meeting, ‘Sleep Down Under’ we were introduced to some of the research from Prof. Jean-Louis Pepin and his group from Grenoble in France. They have done quite a bit of work on mandibular moments during sleep and how it can be used as a surrogate marker for sleep staging and respiratory effort. On first impressions it looks like we may have the first real bruxism sensor that can be used clinically to pick up and quantify nocturnal bruxism events plus more. The future is indeed exciting!
 

How does your interest in sleep medicine impact on your everyday practice as a general dentist?

My passion for the field of Dental Sleep Medicine was originally sparked because of my own poor sleep history. I honestly don’t believe I attended any 8am lectures in final year and when I heard, in the late 1990s, that dentistry could be involved in sleep treatments, I was right onto the CPD, the evidence and the growing body of research.

With referrals from sleep medicine specialists, I have been fortunate to gain the experience of running a part-time oral appliance clinic out of my private practice for more than 20 years. In a busy general practice, it can be challenging to fit in new patients but I have left aside appointment slots for new sleep patients throughout the week. Of course, this therapy is ongoing, so I do have a regular cohort of long-term patients that come in for ongoing review, maintenance, repeat sleep-study treatment needs and, of course, new devices.
 

You have been involved in clinical instructing for nearly five years, through the Melbourne Dental Clinic. What are your observations on dental training these days?

At Melbourne, the first observation is that dental students are older than they were. They do have a degree behind them before they enter dental school and indeed a wealth of education and learning that could propel them on several different career paths. As a result, I think they are possibly motivated slightly differently. From a learning and training perspective, not much has fundamentally changed, they still need to get their hands wet, and dentistry is a career of lifelong learning. My advice to new graduates is to seek out mentors and role models – and it doesn’t need to be formal. There is so much you can learn from talking to colleagues, so get out there and meet other dentists at every opportunity.
 

If you could give our readers one takeaway thought, what would it be?

Every dentist will be in contact with patients who are either in treatment or seeking treatment for sleep disorders. It is our role to help educate them, encourage them and, of course, highlight the impact of their choices on their dental and oral health. So at a minimum, each of us should have a basic understanding of oral appliance therapy and dental sleep medicine.

For those that want to be more involved, the ASA has set up a fellowship in dental sleep medicine, which is becoming the minimum standard that the medical community expects dentists to have attained to be involved in the field.