How Dental Sleep Medicine Help Treat Sleep Apnea
Obstructive sleep apnea (OSA) is caused by a blockage in the upper respiratory tract—people affected by this experience irregular breathing patterns, snoring, and sudden arousal from their slumber. If left untreated, OSA can cause health problems like hypertension, diabetes, cognitive dysfunction, and other cardiovascular diseases.
Primary care doctors usually recommend using a continuous positive airway pressure (CPAP) machine to manage OSA. However, CPAP may not be suitable for all sleep apnea patients since it can cause dry mouth, skin irritation, and discomfort. Dental sleep medicine provides non-invasive alternatives to machine-assisted therapy with oral appliances. Those with a more severe kind of OSA can also opt for surgical procedures.
How Do Oral Appliances Work
With the recommendation of a sleep physician, patients with OSA can consult a qualified dentist and determine the most suitable oral appliance for their case. Those with mild to moderate obstruction in the upper airways can either use mandibular advancement devices (MADs) or tongue retaining devices (TRDs). These dental sleep appliances open up the blockage in the throat or nasal cavity with simple muscle manipulation so patients can breathe correctly during sleep.
Mandibular Advancement Devices
MADs are commonly custom-made for each individual and are made of a medical-grade acrylic or nylon material. They are placed over the upper and lower teeth, like a boxing mouthguard, to hold the jaw slightly open and reduce throat constriction. These oral appliances come in different configurations, mostly with adjustment mechanisms that allow for the best fit. Some examples of FDA approved MADs include:
- Clasp Retained Mandibular Positioner (CRMP)
This oral appliance has clasps that can clip on the teeth, to push the lower jaw forward. It is a single piece that you can customize by changing the vertical sizing. This design allows for a larger opening for breathing.
- Hilsen Adjustable Appliance
This dental device snugly attaches to the upper and lower front teeth. Its soft and pliable structure with no rigid frames or clamps makes it easy for the doctor and even the patient to move it around and make adjustments.
- Elastomeric Sleep Appliance
This device is solely made from a custom-formed soft silicone that cannot be manually adjusted after final fitting. Elastomeric sleep appliances keep the airway open 5mm wide and prevent the lower jaw from moving throughout the night. This appliance is recommended for OSA patients who use dentures.
Tongue Retaining Devices
TRDs create an opening in the upper airways for better breathing by holding the tongue in a particular position. These devices have a small pocket where the tongue goes in so it can be slightly flattened and moved forward out of the mouth. They are made from soft, pliable materials and can be pre-fabricated specifically for each patient. TRDs are commonly prescribed to people with dental conditions like sensitivity, loss of teeth, or limited jaw mobility because most versions attach to the tongue. Ask your dental sleep specialist for the following FDA-approved TRDs:
- Aveo Tongue Stabilizing Device (AveoTSD)
Like other oral appliances, the aveoTSD is made out of medical-grade soft silicone. It has a notch that holds the tongue outside the mouth with a gentle suction created by the vacuum in the gap. This prevents OSA and snoring by keeping the muscles of the tongue flat and forward so it wouldn’t sag behind the throat and block the airways. The aveoTSD does not require special fitting and can be user-adjusted with the boil and bite method.
- Nose Breathe for Heavy Snorer (NBHS)
This type of TRD holds the tongue towards the roof of the mouth using the natural pressure inside the oral cavity. It ensures the patient will breathe through the nose instead of the mouth, preventing muscles in the throat or tongue from spasms that block the airways. The NBHS is made from ethyl vinyl acetate (EVA), which provides a snug fit without putting pressure on the jaws.
When to Consider Surgical Treatment
Sleep apnea can become dangerous when the blockage gets too big, that it entirely prevents the patient from breathing. In cases like this, surgical treatment can be recommended by your primary care doctor and dental sleep specialist. Surgery procedures for severe OSA include:
- Mandibular Osteotomy With Genioglossus or Inferior Border Advancement,
- Uvulopalatopharyngoplasty (UPPP)
- Laser-Assisted Uvuloplasty (LAUP)
- Reduction Glossectomy
- Internal and External Nasal Reconstruction