In 2017, I obtained board certification in a small but growing field within dentistry: dental sleep medicine. No, it does not mean doing fillings and crowns on patients while they are asleep – that is more appropriately referred to as “sedation dentistry.” Dental sleep medicine is the treatment of Obstructive Sleep Apnea (OSA) with dental appliances that resemble a mouthguard or nightguard. One example is a Herbst appliance as pictured below on the left. It is an alternative treatment to a Positive Airway Pressure (PAP) machine pictured below on the right.
Obstructive sleep apnea (OSA) is a common disorder estimated to affect 9% to 38% of the overall population. Its prevalence is more common in middle and older age adults, particularly men, and those with associated disorders such as obesity, high blood pressure, and cardiovascular disease. It can manifest as daytime sleepiness or non-restful sleep, but it’s estimated that 80 to 90 percent of adults with OSA remain undiagnosed and may be unaware that they are affected. While the dental appliance is only used to treat adults, it is important to note that OSA can occur in any age group. Approximately 2% of children have OSA and it occurs most commonly in preschool ages, associated with enlarged tonsils and adenoids.
CPAP is the standard treatment for sleep apnea for adults. However, the American Academy of Dental Sleep Medicine estimates that up to 50 percent of sleep apnea patients do not comply with or tolerate PAP. Sleeping with a PAP machine, which includes a face mask, tubing and a constantly running motor, can be difficult, to say the least. In contrast to a PAP machine, oral appliances are a “mouth guard-like” device worn only during sleep to maintain an open, unobstructed airway. Patients like oral appliance therapy because it is comfortable, easy to wear, quiet, portable, and easy to care for.
The key is to successful sleep apnea management is working with patients and their sleep physicians as a team. The first visit with the patient is dedicated to a thorough interview to elicit a comprehensive medical and sleep history. Oftentimes, sleep apnea is a disorder that needs to be tackled from multiple angles. For example, an oral appliance can be used in conjunction with PAP to make PAP therapy more effective. Or, changes in sleep position through the use of positional trainers can make a difference in reducing the severity of sleep apnea. When it is determined that an oral appliance may be helpful, then an appliance is custom fitted to each patient. After the initial fitting, a series of follow-up appointments are needed to make any necessary adjustments to ensure an open airway and a more restful sleep. It is important that the patient return to their sleep physician for long term follow up and re-evaluation sleep studies as necessary.
The American Academy of Dental Sleep Medicine is the leading professional organization for dentists who treat snoring and obstructive sleep apnea with oral appliance therapy. Earning Diplomate status from the ABDSM is a unique honor that recognizes special competency in dental sleep medicine.
Dr. Sharon Jin
Prosthodontist, Bedford and Needham office