dentistry's role in sleep medicine
In the mid 1990’s, the medical and dental scientific literature documented the role of oral appliance therapy for Obstructive Sleep Apnea. The American Academy of Sleep Medicine (AASM), in 1995, endorsed the use of oral appliances in dentistry as one of three modalities for the treatment of OSA (the others being CPAP and surgery).
The latest revision of oral appliance protocol, written and accepted by the AASM and Academy of Dental Sleep Medicine (ADSM), was published in 2006. The basic premise is that CPAP therapy is the gold standard, however in mild to moderate sleep apnea, dental devices can be quite successful and should be an option presented to patients for treatment. For patients who snore and do not have apnea, oral appliance therapy is the treatment of choice.
For those diagnosed with severe apnea who are unable to tolerate CPAP therapy, an oral appliance may be very helpful in lowering their occurrences of apnea and raising their level of oxygenation.
Since the diagnosis of snoring and obstructive sleep apnea is out of the realm of dental licensure, I will need you or a sleep physician to make the initial diagnosis and confirmn it with a polysomnogram.
The protocol also recommends a follow-up study by the referring physician to evaluate treatment success .
our office's role
As a dental practitioner trained in the treatment of sleep disordered breathing, I am available to work with you and your patients who snore or who have obstructive sleep apnea.
It will be necessary for me to contact you for every patient you refer to gather the necessary information about their medical history. I would also be interested in any concerns you might have about a mandibular and maxillary oral appliance, worn during sleep.
During my evaluation preliminary to appliance fabrication, if I see any need for dental treatment, I will send the patient back to their dentist of record for treatment. I will also need to contact their dentist about the oral condition, including the health of the teeth and surrounding periodontium, the health and history of the temporomandibular joint, and any planned restorations.
The dental treatment for obstructive sleep apnea is maxillary and mandibular appliances which reposition the mandible forward and hold it there during sleep to keep the pharynx open. It is imperative that the teeth, restorations, and periodontium be healthy before appliances are made and worn.
Your patient will be fully informed about the potential side effects of appliance therapy including sore teeth and muscles of the temporomandibular joints, movement of teeth, loosening of restorations, and periodontal concerns. These problems are usually short term and are treatable. I would appreciate your help in closely monitoring these potential side effects with referral back to me should it be necessary. I plan annual reviews of treatment to address any potential problems.
Please don't hesitate to call me about any concerns for your patients or questions about oral appliance therapy for snoring and obstructive sleep apnea.