Many patients that suffer from obstructive sleep apnea may not know that they have another health professional in their corner when it comes to achieving healthy sleep. Dental sleep medicine doctors are dentists that have extensive additional training and are affiliated with professional societies such as the American Academy of Dental Sleep Medicine. A dental sleep medicine doctor works in tandem with a patient’s physician to creating an individualized solution to mitigate sleep-related breathing disorders and reduce the associated health risks. Oral appliance therapy, with consistent use, can help patients significantly improve their sleep quality.
What is Dental Sleep Medicine?
According to the American Academy of Dental Sleep Medicine,
Dental Sleep Medicine is an up-and-coming discipline, as is reflected both nationally and internationally in the founding of professional scientific associations (e.g., European Academy of Dental Sleep Medicine – EADSM; American Academy of Dental Sleep Medicine – AADSM), the recent publication of specialized textbooks, and even a peer-reviewed scientific journal (the Journal of Dental Sleep Medicine). The AADSM came up with a definition of the discipline in 2008: ‘Dental Sleep Medicine focuses on the management of sleep-related breathing disorders (SBD), which includes snoring and obstructive sleep apnea (OSA), with oral appliance therapy (OAT) and upper airway surgery.1
In addition to sleep-related breathing disorders like snoring and sleep apnea, dental sleep medicine also deals with:
- Orofacial pain
- Oral dryness or hypersalivation
- Gastroesophageal reflux disorder (GERD)
- Jaw movement disorders, including dyskinesia, dystonia, and sleep bruxism
Understanding Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is caused by the repeated collapse of soft tissues in the upper airway and leads to interrupted sleep and poor sleep quality. During sleep, the muscle tone of the upper airway decreases causing the airway to constrict or collapse entirely. OSA can be diagnosed during a sleep study when patients have five or more partial obstructions (hypopneas) and/or complete obstructions (apneas) of the upper airway per hour of sleep.2
OSA has an estimated prevalence of 12% (includes both diagnosed and undiagnosed).3 Patients with sleep apnea are susceptible to:
- Cardiovascular disease
- Insulin resistance
- Neuro-cognitive dysfunction
- Drowsiness-related accidents
- Cardiovascular and metabolic morbidity and mortality
- Ischemic stroke (or acute stroke)4
Treating Obstructive Sleep Apnea
Treatment for obstructive sleep apnea depends on the severity of the patient’s symptoms, anatomical characteristics, and health status. OSA has several treatment options, including lifestyle changes for weight loss, continuous positive airway pressure (CPAP), an oral appliance (also known as a mandibular advancement device), or upper airway surgery.5
A CPAP machine is the most commonly prescribed device for treating sleep apnea and associated sleep-related breathing disorders, delivering a steady flow of pressurized air into a patient’s nose and mouth as they sleep. This keeps airways open and helps normalize breathing.6
CPAP can be very effective for treating sleep apnea, but there are drawbacks associated with the use of a CPAP machine, including discomfort and difficulty falling asleep, especially when the patient is just starting to use it.7 For patients with primary snoring, mild, moderate, and severe (that can not or will not tolerate CPAP) OSA, oral appliance therapy can be considered as an effective alternative to CPAP therapy 8
Oral Appliance Therapy as an Alternative to CPAP
Oral appliance therapy (OAT) is an effective, non-invasive treatment, especially for patients with mild to moderate apnea.9 Patients often prefer oral appliance therapy over CPAP because it’s comfortable, easy to wear, quiet, portable, convenient for travel, and easy to care for.10
An oral appliance fits like an orthodontic retainer. When worn while sleeping, it supports the jaw in a forward position to help maintain an open upper airway.11 The larger space is created by pulling the tongue base, epiglottis, and soft palate forward. Patients find an oral appliance easier to use and more comfortable to wear and are more likely to use it consistently, especially in the treatment of mild to moderate OSA.12
There is abundant literature to support the use of oral appliances as an effective treatment of OSA in adults.13 The American Academy of Dental Sleep Medicine confirms that:
[a] properly fitted oral appliance worn nightly will decrease the frequency and/or duration of apneas, hypopneas, respiratory effort-related arousals (RERAs) and/or snoring events. Oral appliances have been demonstrated to improve nocturnal oxygenation as well as the adverse health and social consequences of OSA and snoring. Oral appliances are indicated for patients with mild to moderate OSA and primary snoring. Oral appliances are accepted therapy for patients with severe OSA who do not respond to or are unable or unwilling to tolerate positive airway pressure (PAP) therapies. Although oral appliances are typically used as a stand-alone therapy, with some patients they may be prescribed as an adjunct to PAP therapy and/or other treatment modalities for the management of OSA.14
Can I Manage My Apnea With Over-the-Counter Solutions?
Snore-reducing devices are affordable and sometimes can work when set up appropriately. However, you are on your own when it comes to setting them up and using them. They are not custom made and if they don’t fit properly, snore-reducing devices can create side effects like jaw pain and changes in tooth position in fact they could actually make the breathing disorder worse. Using a snore-reducing device without a dentist’s supervision is risky, so let your dentist know if you are using one.
Also, if the snore-reducing device doesn’t work, be sure to tell your physician and explore other options to be sure that your snoring is properly treated.15 In some cases, weight loss, avoidance of alcohol and smoking, or changing to a side-sleeping position can help to reduce snoring. But if none of these are the root cause of the snoring, these adjustments won’t be enough.16 It’s best to work with a physician and a qualified dental sleep medicine doctor to determine the cause of your snoring or sleep apnea and to decide on a course of treatment with you.
Working With a Dental Sleep Medicine Doctor
Dental sleep medicine doctors work closely with physicians to treat snoring and sleep apnea. During your initial visit, your dental sleep medicine doctor will talk to you about the benefits of treatment, potential side effects, and the cost of therapy. Then your dentist will conduct a complete clinical evaluation that includes an examination of your teeth, jaw, tongue, and airway, and possibly a new X-ray of your mouth.17
Oral appliances for sleep apnea treatment are made from customized impressions of your teeth. Once your oral appliance is ready, you will return to your dentist’s office for a fitting so your dental sleep medicine doctor can adjust the appliance to maximize its comfort and effectiveness. You also will learn how to clean the oral appliance and maintain it.18
Your dental sleep medicine doctor will schedule follow-up visits to ensure the optimal fit of your oral appliance and determine the efficacy of the treatment and see if any adjustments are necessary.19 The American Academy of Dental sleep medicine recommends that:
[p]atients who utilize OAT should be evaluated by the qualified dentist every 6 months for the first year and at least annually thereafter. The annual recall examination should verify OA efficacy and occlusal stability, check the structural integrity of the OA, and ensure that there is maintenance of previously resolved symptoms such as snoring and daytime sleepiness. The qualified dentist should inquire about patient comfort and adherence to therapy and screen for possible side effects. If side effects are noted, their presence should be documented, as well as any management and manner of resolution. Should the annual assessment reveal symptoms of worsening OSA or the potential need for additional adjustments to the OA, then the qualified dentist shall communicate this and any other relevant subjective or objective findings to the patient’s physician.20
These routine follow-up visits are an important part of your long-term treatment success.
Obstructive Sleep Apnea Treatment at Amber Dental
At Amber Dental of Wheaton, Dr. Michael Koehne is proud to offer oral appliance therapy to treat sleep apnea as a part of his whole-health approach to dentistry. Contact the team at Amber Dental to set up an appointment for a dental cleaning, sleep apnea consultation, or any of your dentistry needs.