Dental sleep medicine is an extension of general dentistry with a specific concentration on providing treatment for adult patients who have been diagnosed with sleep-disordered breathing, including obstructive sleep apnea (OSA), snoring and sleep-related bruxism.
Obstructive sleep apnea occurs when your muscles relax during sleep, allowing the soft tissue to collapse and block the airway. As a result, sleep apnea causes you to stop breathing up to hundreds of times a night for anywhere from a few seconds to more than a minute. Snoring, excessive daytime sleepiness, memory problems, irritability, fatigue and insomnia are all signs that you could be losing shut-eye to sleep apnea.
If left untreated, sleep apnea can be a potentially life threatening condition. It can increase the risk for other serious health problems such as high blood pressure, stroke, heart disease, diabetes, obesity, depression and impotence.
There are two types of Sleep Testing methods used by Physicians to diagnose Sleep Related Breathing Disorders(SBD).
PSG: This is nocturnal in lab sleep study. PSG consists of a simultaneous recording of multiple physiologic parameters related to sleep and wakefulness. PSG can directly monitor and quantify the number of respiratory events (i.e., obstructive, central, or complex) and the resultant hypoxemia and arousals (lack of oxygen, and resulting increase in wakefulness) related to the respiratory events.
HSAT: A portable monitoring at home sleep test, is a diagnostic test sleep professionals and doctors use to diagnose obstructive sleep apnea. WatchPAT is an innovative FDA-cleared wrist mounted home sleep apnea test device for the diagnosis of Sleep Breathing Disorders (SBD), which allows testing in the comfort of the patient’s own home.
WatchPAT has been clinically validated against the "Gold Standard", polysomnography (PSG), with a documented correlation of up to 90% to PSG.
Dr. Merchant and her team work with sleep physicians regarding which type of sleep testing will be appropriate for each patient. If a decision is made to use HSAT by our physician, our trained team members can get you set up with WatchPat One at your followup appointment.
The traditionally prescribed treatment for obstructive sleep apnea is continuous positive airway pressure (CPAP) therapy. It involves sleeping with a face mask connected by tubing to a constantly running machine. Although CPAP is effective, up to half of patients don’t adhere to the treatment.
Oral appliances effectively treat obstructive sleep apnea (OSA) and are recommended for patients diagnosed with OSA who prefer a therapy other than CPAP or are intolerant of CPAP.
Oral appliance therapy is an effective, non-invasive treatment option for snoring and obstructive sleep apnea that fits easily into your lifestyle. A dental oral appliance looks like a sports mouth guard and is worn only during sleep. It supports the jaw in a forward position to help maintain an open upper airway, preventing sleep apnea and snoring. Treating snoring or sleep apnea with oral appliance therapy can help you feel like a new person. You will find that your symptoms, and your quality of life, can improve dramatically when you remain committed to your treatment and use it nightly.
Once you have been diagnosed with obstructive sleep apnea by a sleep physician, a dentist experienced in dental sleep medicine can make a custom-fitted oral appliance using impressions and models of your teeth. Patients like it because it’s comfortable, easy to wear, quiet, portable, convenient for travel and easy to clean
Oral appliance therapy (OAT) is a proven treatment for mild to moderate obstructive sleep apnea (OSA). Studies have demonstrated that OAT effectively treats OSA through reduction in apnea-hypopnea index (AHI) and respiratory disturbance index in patients. Studies have demonstrated similar effectiveness between OAT and CPAP, even among patients with moderate-to-severe OSA. OAT provides the same short and long-term health benefits as CPAP.
▪ Reduced risk of cardiovascular mortality
▪ Reduction in blood pressure
▪ Improved sleep quality
▪ Reduced daytime sleepiness
▪ Reduced depression
▪ Improved driving performance
▪ Better quality of life
OAT is covered by most commercial insurance and Medicare. OAT is covered by medical insurance – not dental insurance. Qualified dentists have familiarity with medical insurance and the necessary documentation, pre-authorization and other requirements.
If you suspect you may have sleep apnea, we can recommend a sleep physician to help get you started on your path to treatment. Our office works with a board certified in Sleep Medicine . He has been in practice for over 20 years. If you have already been diagnosed with sleep apnea, we can fit you with an oral appliance. Our team at Arizona Sleep and Breathing is ready to answer your questions about obstructive sleep apnea, dental sleep medicine and oral appliance therapy.
Myofunctional therapy is an exercise training program for the muscles around your face, mouth, and tongue. These exercises are designed to improve issues with talking, eating, or breathing.myofunctional therapy may also be an effective treatment for sleep-disordered breathing.
Myofunctional therapy is an exercise program that helps treat orofacial myofunctional disorders (OMDs). OMDs are abnormal movement patterns of your face or mouth. They can be caused by:
▪ blocked nasal passages
▪ anything that causes a misplaced tongue position
▪ sucking and chewing habits past the age of 3
Myofunctional therapy uses neuromuscular re-education exercises to help normalize face and mouth structures. These exercises teach your muscles, nerves, and brain how to restore optimal movement. Specifically, they aim to improve:
▪ tongue position
▪ lip seal
▪ nasal breathing
Obstructive sleep apnea occurs when the muscles that support the soft tissue in your throat relax and close off your airway while you’re sleeping.
Myofunctional therapy aims to improve the function of muscles in the upper airway and help keep your airways open. It may also help reposition your tongue and improve nasal breathing to keep the airways clear.
Maxillary expansion does tend to open up circummaxillary sutures, circumzygomatic sutures, intermaxillary sutures and midpalatal sutures. Expansion also tends to happen more anteriorly than posteriorly. Amount of expansion depends on the treatment objective for the individual patient. Each patient presents with different malocclusion and will need a different amount of expansion.
Rapid palatal expansion (RPE) or Rapid Maxillary Expansion (RME) is an expansion technique where expansion of 0.5 mm to 1 mm is achieved each day until the posterior crossbite is relieved. The expander works by turning a key inside the center of the expander. The turn of this key will push the arms of the expander.
For stability purposes, the RPE usually remains in the patient's mouth anywhere between 3–6 months, but this time may vary between patients. This is often known as the "six month retention period" during which the bone fills the gap in the maxilla that was created by the expansion process. To prevent any type of relapse, a retainer is given to the patient to keep the teeth in proper alignment. RPE can be tooth supported, bone supported or both
Typically adults will need surgical intervention in order to open up maxillary sutures to get true expansion. Each patient presents with a different malocclusion and will need a different amount of expansion.Mini-implant assisted rapid palatal expansion (MARPE) involves the forces being applied directly to the maxillary bone instead of the teeth. This technique involves placing anywhere from 2–4 mini-implants in the palatal vault area of maxilla to anchor the RME appliance to the screws. The patient is then asked to turn the jackscrew with the rapid approach over the next two weeks.
This technique allows palatal expansion to be performed in young adults, in which the palatal suture is already fused, a result which was previously only achieved surgically. It has the advantage of being minimally invasive compared to SARPE and of achieving a greater degree of skeletal expansion compared to dentoalveolar expansion. In most adults, especially males a surgical assist may be recommended to achieve consistent outcomes, such as a typical SARPE procedure (now SAMARPE) or less invasive techniques. It has been demonstrated that both posterior expansion at the PNS, as well as expansion of the nasal aperture are critical in treating Obstructive sleep apnea.
▪ Trouble with pronunciation - Patients who have expanders may experience extra saliva and
lisps(pronouncing the letter s, t, and r blends becomes very difficult).
▪ Pain - Patients may experience pain and headaches while wearing palatal expanders and
when the screw is turned.
▪ Sores on tongue - This can happen due to contact with the expander's metal bars.
▪ Diastema - Space between upper front two teeth
▪ Fenestration of buccal bone
▪ Compression of periodontal ligament near posterior teeth
▪ Extrusion of posterior teeth
▪ Increased lingual bone thickness, decreased buccal bone thickness