Obstructive sleep apnea or OSA is the most common type of sleep apnea. Obstructive sleep apnea occurs when the soft tissue in the back of the throat and mouth falls back during sleep; seals the airway and the person stops breathing periodically.
Our body reacts to these stops in breathing by trying to rouse us. The heart rate increases followed by snorts, gasps, or choking sounds as a person’s body fights to resume breathing again. The patient wakes up in a panicked state.
- Heart Disease
- Morning Headaches
- Excessive daytime sleepiness
- Memory loss
At Apollo Dental, we coordinate with Sleep Medicine Physicians to coordinate a referral for Home Sleep Testing. Based on sleep apnea results of sleep study, we develop custom Oral Appliance Therapy for sleep apnea and snoring.
Obstructive Sleep Apnea Oral Appliance Therapy
Oral Appliances gently pull the lower jaw forward to open the airway. Dr. Ishita Seth can also help develop Pharyngeal training appliances to help perform targeted exercise and tone the muscles that maintain the airway function.
She will also manage the coordination of Oral Appliance Therapy with a Sleep Specialist for pre and post appliance analysis. Custom fitted oral appliances can be billed under most medical insurance plans (as opposed to dental insurance).
There are three stages of Sleep Apnea determined by the amount of Apnea events (breathing pauses):
- Mild OSA — 5-14 interruptions in breathing in an hour.
- Moderate OSA — 15-30 interruptions in breathing in an hour.
- Severe OSA — 30 or more interruptions in breathing in an hour.
For mild to moderate sleep apnea, a dental device is often the recommended therapy. For severe sleep apnea, CPAP is the option. Dental devices can also be worn in conjunction with a CPAP device to help lower high pressure needs.
To summarize, the following categories qualify for dental appliances:
- Patients with mild to moderate sleep apnea (not recommended for moderate to severe sleep apnea).
- Patients with primary snoring (in absence of sleep apnea).
- Patients who have tried and failed at CPAP therapy may qualify.
- Patients who were unsuccessful with or refused surgeries such as tonsillectomy, adenoidectomy, craniofacial operations, or tracheostomy.
- In combination with CPAP devices to help lower patient’s apnea/hypopnea index for more tolerable air pressure settings.
Once diagnosed with Obstructive Sleep Apnea, Dr. Ishita Seth will thoroughly examine your teeth and mouth to determine the obstructive sleep apnea device that is right for you. Dental impressions will be made to be sent to a laboratory to fabricate custom made oral appliances.
Once the oral appliance is being used on a regular basis, we can do a post appliance sleep study to evaluate the effectiveness. Many medical insurance policies offer to pay for some or all Oral Appliance Therapy.
There are two major categories of dental devices:
Mandibular advancement devices (MADs)
They fit into the mouth by snapping over the upper and lower dental arches and have metal hinges connect the two pieces – one fit the upper teeth/jaw and the lower fit the lower teeth/jaw.
They pull the lower jaw and tongue forward to open the airway. This prevents the throat muscles from collapsing back into the airways allowing for normal breathing during sleep.
Tongue retaining mouthpieces.
It has a small compartment that fits around the tongue using suction to keep it held forward and prevents the tongue collapse in the airway. This is used when jaw cannot be repositioned forward.
At Apollo Dental, Dr. Ishita Seth can also help develop pharyngeal training appliances to help perform targeted exercise and tone the muscles that maintain the airway function. We can also develop a DNA appliance for patients who have an underdeveloped upper airway and craniofacial bones. This helps prevent the collapse of smaller airways during sleep.
EMA is a thermoformed appliance to help open the bite and advance the lower jaw with interchangeable elastic straps to increase the airway space. It has a compact design.
- The thin maxillary and mandibular trays have a compact design with flexible straps.
- It has a metal free design. Non-restricted side-to-side (lateral) or front-to-back (protrusive) movements of the jaw are possible due to varying elastic bands.
- EMA does not interfere with breathing through the mouth, even in cases of congested nasal passages. It comes in 9 different lengths and 4 different strengths. The 36 different strap allows for comfortable repositioning and comfort.
- The patient can talk or even drink water while wearing it. They can even change the elastic straps themselves.
It is a mandibular repositioner used in earlier years for Orthodontic and TMJ therapy. Now, this modification is used for dental sleep appliances.
- It uses a telescopic sliding tube connection between the upper and lower retainer portions; also permits lateral and vertical movement while it maintains the mandible forward position. The upper and lower trays do not come apart.
- Materials include — dual laminate, acrylic with or without clasp appliance, or milled CAD/CAM. It allows 2-3 mm lateral movement and adjustable at ¼ mm increments.
- It is worn during sleep to increase the upper airway volume and reduce collapsibility.
- It utilizes a unique patented fin coupling component, maximizing patient comfort and compliance.
It utilizes 3D printing technology to treat sleep apnea and snoring. It has two splints and a retaining system. The upper and lower splints are for upper and lower teeth and the retaining system has a triangular shape with rods to move the lower jaw forward by pulling it in the front.
- It is made of a biocompatible material (type 12 polyamide), resistant to severe bruxism and the smallest device in the market.
- Due to its small size, it minimizes the bulk in the mouth. It has a plateau (occlusal contact) and band design option to maximize the comfort and retention.
- It uses the CAD/CAM technology and allows titration in 0.5 mm increments.
It is a custom two-piece appliance which snaps comfortably over the upper and lower teeth. It allows the patient to adjust to what extent the lower jaw is held forward so that it does not fall open during the night and cause the airway to collapse. It has a single point of central adjustment.
- Snap-Fit™ or Perfect-Fit™ trays; it comes as a fixed hinge with inseparable pivot.
- The triple layers tray with soft liner. It also comes with three hook sizes for better range of adjustment.
- 15mm protrusion range
- 10mm lateral excursion range
- Maximum lingual tongue space
- It is available in hard acrylic
The OASYS side hinges are set to hold the lower jaw forward, but also allows the patient to open or close the mouth. This allows side-to-side movement and helps open the airway in the back of the throat while pulling the tongue forward.
- It has a T-Hinge which is smaller in profile and allows for flexible placement even in shorter arch cases. This allows normal mouth opening and closing and 2-3 mm lateral movement.
- It allows advancement of 10mm and is designed for intra-oral activation. This allows maximum tongue space and freedom. It can be easily adjusted in the mouth.
- OASYS Hinge can pair with OASYS Oral Nasal Airway System, to include Nasal Dilators and Lingual Tongue Lifters.
It is the first system which helps address the resistance to breathing in the upper airway. It has a nasal dilator and a mandibular repositioner to help treat both and pharyngeal limitations responsible for snoring and sleep apnea.
It has an open anterior design for the treatment of mild to moderate obstructive sleep apnea. The open anterior concept contains no buccal or incisional coverage of the anterior teeth which leads to maximum patient comfort and natural tongue protrusion. These appliances also do not interfere with cosmetic work.
SomnoDent sleep apnea oral appliance is a premium, custom-fitted dental device developed for the treatment of snoring and obstructive sleep apnea.
A patient wears a SomnoDent while sleeping, the mandible (lower jaw) is pulled forward into a comfortable position and causes relaxation of the tissues at the back of the throat and ensuring the back of the tongue does not collapse and block your airway.
Somnomed has many oral devices and works to provide a treatment solution for each patient type.