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Role of the Dentist in the management of
Snoring and
Mid to Moderate Sleep
Apnea.
Management of
snoring and "sleep disturbances" using dental appliances
is a growth industry. Appliances are simple to make, are
universally effective and non-invasive.
Dentists see more
patients more frequently than do most health care practitioners and
look in the mouth and down the throat of every patient they
see.
It is easy for a
dentist to observe tell tale signs of snoring/sleep apnea. Size of
the tongue, soft palate, u vulva, tonsils, tonsilar pillars,
anatomical obstructions. Also look for signs of chronic snoring;
presence of pharyngeal edema or abnormal redness.
An astute observer
may also notice behavior indicative of sleepiness or fatigue;
lethargy, yawning, sighing, slouching, drooping eyelids.
Asking the
patient very specific questions can also help to confirm
snoring/sleep apnea.
- Have you ever been told you
snore.
- Do you fall asleep at
meetings, watching TV, or reading.
- Do you feel tired when you
wake in the morning or have headaches.
- Do you feel tired and
listless during the day.
Depending on your assessment of the answers you
may decide to send the patient to see a Respiratory/Sleep
Specialist.
With Dental Oral Appliances being increasingly
accepted as an alternative to conventional therapies and CPAP. The
role of the Dentist as part of an overall multidicinplinary team is
also increasing.
What's needed
from the Dentist for the Dental Lab to custom make a comfortable
patient compliant MDSA® Adjustable Appliance.
Patient Impressions and Bite
Registration.
A protrusive registration, centre aligned with
5mm opening and notation of the approximate amount of advancement
where the registration was taken (eq 40% of full passive
protrusion). This will ensure the Lab can align the impressions and
overcome occlusions when the jaw is advanced.
Any commonly available
registration will do
When fitting the patient the Dentist
checks for patient comfort, trimming any problem areas and
initially setting the advancement at 60-70% of full
advancement.
The patient should be advised they
could experience transient discomforts for the first couple of
weeks, increased salivation etc. If they feel they are
uncomfortable with the fitting they should not hesitate to contact
the Dentist.
The patient should return at the end
of 2 weeks for follow up check and positioning of the advancement
etc.
Patient should then come back after
3 months and then on a regular 6 months for check up on alleviation
of symptoms and condition of patient teeth etc. It is common that
after 3-6months with relaxation of TMJ's the appliance may need to
be advanced slightly further.
In a small percentage of patients
occlusions have been reported as with change in bite and over
jet.
Patients should be made aware of
these possibilities at the time of first consultation and consent
forms signed.
Download a copy of the consent
form Consent Form PDF
It is the patients responsibility to
continually clean and inspect the appliance and if there is any
cracking or degradation return for repairs.
The MDSA is supplied with patient
instructions which they should be aware of and follow.
Your Laboratory
can also manufacture the MDSA® with posterior support.
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