Wednesday, March 19, 2014

The Nexus Between Oral Appliance Therapy and Treating Certain Sleep Disorders

From time to time BRPT invites a "guest blogger" to contribute a short article in this space. The opinions, representations and statements made within a "guest" article are those of the author and should not be construed as statements made on behalf of BRPT.   Copyright remains with the author. 

By Victor Woodlief, DMD

When it comes to my work as a dentist, there are three things I’m really passionate about: the absolute need to treat each patient as an individual; the need for collaboration with other healthcare practitioners; and, keeping an open mind in this evolving health care arena.

In my practice, I’ve had the great pleasure of collaborating with terrific sleep medicine doctors and sleep technologists when it comes to treating mild to moderate obstructive sleep apnea (OSA). And we’ve really seen first-hand how oral appliances can be a very successful front-line treatment for snoring and OSA. The plastic device fits in the mouth during sleep like a sports mouth guard or orthodontic retainer, helping to prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake. And, oral appliances may be used alone or in combination with other treatments for sleep-related breathing disorders, such as weight management, surgery or CPAP.

An Overview Of The Important Steps To Take When Considering Oral Appliance Therapy
Oral appliance therapy involves the selection, fitting and use of a specially designed oral appliance that maintains an open, unobstructed airway in the throat when worn during sleep. In my experience, custom-made oral appliances are proven to be more effective than over-the-counter devices, which are not recommended as a screening tool or a therapeutic option.

Dentists with training in oral appliance therapy are familiar with the various designs of appliances and can help determine which is best suited for your patient’s specific needs. A board certified sleep medicine physician must first provide a diagnosis and recommend the most effective treatment approach. A dental sleep medicine specialist will then provide treatment and follow-up.

The initial evaluation phase of oral appliance therapy includes an examination and evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance, and the function.

Of course, ongoing care including short- and long-term follow-up, is an essential step in the treatment of snoring and OSA with oral appliance therapy. Follow-up care with a sleep study serves to assess the treatment of your patient’s sleep disorder, the condition of your patient’s appliance, and your patient’s physical response to the appliance making sure it’s comfortable and effective.

Advantages of Oral Appliance Therapy
I’ve seen many advantages to using oral appliances, the least of which is they are easy and comfortable to wear.  In fact, most patients find it only takes a couple of weeks to become acclimated to wearing the appliance. In addition, they’re small and convenient making them easy to carry when traveling – I have patients who don’t miss a beat when going camping or hunting! Lastly, treatment with oral appliances is reversible and non-invasive.

Understanding The Different Types Of Oral Appliances
With so many different oral appliances available, selection of a specific appliance may appear somewhat overwhelming. Oral appliances can be classified by mode of action or design variation. And, it helps to know that nearly all appliances fall into one of two categories: Mandibular Advancement Device (MAD) and Tongue Retaining Device (TRD).

Mandibular advancement devices reposition and maintain the lower jaw in a protruded position during sleep. The device serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid. The device also holds the lower jaw and other structures in a stable position to prevent the mouth from opening.

Tongue retaining devices hold the tongue in a forward position using a suction bulb. When the tongue is in a forward position, it serves to keep the back of the tongue from collapsing during sleep and obstructing the airway in the throat.

In short, there is a time and place for treating patients with sleep disorders using oral appliance therapy and in doing so I’ve seen terrific results and have very much enjoyed working with other health care practitioners. It’s exhilarating to be a part of a larger network that communicates, collaborates and comes together to provide high quality individual patient care.