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Articles
John C. Chao, D.D.S., F.A.G.D
Anxiety Management,
Behavior Science,
Faculty, USC School of Dentistry
Your Dentist Can Treat Snoring And Sleep Apnea
Snoring is common and often harmless, at least to the snorer. But it can be a warning sign of "obstructive sleep apnea (OSA), a serious medical condition that affects an estimated 18 million people in the United States, according to the American Academy of Sleep Medicine (ACSM). Dangers related to OSA include severe daytime sleepiness, an increased risk of high blood pressure, and higher rates of stroke and heart attack.
"Obstructive sleep apnea occurs when the tongue and soft tissues in the back of the throat collapse and block the airway during sleep, which produces pauses in breathing that prevent air from getting to the lungs," said Dr. Kent E. Moore, president of the Academy of Dental Sleep Medicine. "These pauses can occur a few times or several hundred times per night," Dr. Moore added.
Similar in appearance to an orthodontic retainer or a sportsguard, an "oral appliance" for the treatment of sleep apnea maintains an open airway in the throat by repositioning or stabilizing the lower jaw, tongue, soft palate or uvula. There are many kinds of oral appliances. One of the more commonly prescribed appliances is called the mandibular advancement device. While this appliance maintains the lower jaw in a more forward position, it still allows the jaw to have a large degree of range of motion. You can think of it as a nightguard that advances the lower jaw into a forward position.
Not every case of sleep apnea can be treated with oral appliances. The American Academy of Sleep Medicine recommends that mild and moderate cases of sleep apnea be treated with oral appliances when other methods such as CPAP (Continuous Positive Air Pressure) or surgery is inappropriate or not preferred. CPAP is a device that is attached to the mouth and/or nose that assists in unobstructed breathing through positive air pressure. For severe sleep apnea, the ACSM recommends that CPAP be the treatment of choice.
Diagnosis of sleep apnea is first established by the physician. This may involve a sleep test (polysomnograph) where the patient sleeps overnight in a sleep center. In cooperation with the physician, a trained dental specialist can prescribe and fit the appropriate oral appliance called for by the specific circumstances. ACSM states that appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint (TMJ, or jaw joint), dental occlusion and associated oral structures. A follow-up sleep test may be needed to verify that the oral appliance is effective. The patient is required to return for regular visits with the dentist for adjustment and maintenance of the appliance. In addition the TMJ and the occlusion (bite) need to be examined periodically to make sure no undesirable changes are occurring.
If only snoring is the concern, then the protocol is simplified. After ruling out abnormal conditions in your jaw joints, bite, teeth and gum condition, your dentist may fit you with the appropriate appliance. Many patients report better, deeper, restful sleep, less daytime fatigue, more energy and better emotional disposition.
See your physician if you suspect you have sleep apnea. See your dentist for an oral appliance for the treatment of sleep apnea, if CPAP or surgery is not preferred. If you do not have sleep apnea, but only a snoring syndrome, you can ask your dentist about a snore-treatment device.
