How Dentists Can Treat Sleep Breathing Disorders

A number of sleep-related breathing disorders like snoring and sleep apnea can be treated by your dentist in collaboration with specialists from other disciplines. The number of patients who regularly visit their dentists for diagnosis and treatment of sleep-related breathing disorders has been rising steadily.

The most common treatment for these conditions involves the use of the mandibular advancement orthosis (MAO) device, which provides excellent results and allows the patient to enjoy better sleep.

It is a simple and non-aggressive treatment option. Orthosis comes in two parts, one aligner rests on the upper jaw and the other on the lower jaw. It also incorporates a series of bars that connect two small apparatuses with each other. These features are designed to advance the lower jaw and open the upper airways for a better passage of air. It is a custom-made medical device and its operation is purely mechanical.

The MAO device, which was initially used in orthodontics is an effective and well-tolerated system. It corrects nocturnal pharyngeal collapse by keeping the mandible propulsed during sleep.

It allows precise and progressive advancement of the mandible until a position of comfort is reached, thus relieving apnea. The device is ideal for people with mild apnea. The apparatus of choice for severe apneic patients remains the continuous positive airway pressure (CPAP).

Multidisciplinary approach

The treatment of snoring and sleep apnea disorders is a multidisciplinary approach. It brings together pulmonologists, ENT specialists, cosmetic dentist, cardiologists, neurologists and sleep dentistry specialists, which helps improve patient outcomes. In cases handled by the dental surgeon, patients are referred by practitioners from other disciplines. In all cases, the dental surgeon is a key player in the management of sleep-disordered breathing (SDB).

Assessment

To diagnose sleep-disordered breathing, physicians typically take the following steps:

– Dental and joint assessment
– Medical questionnaire to check for a number of conditions, including snoring, quality sleep, hypertension, diabetes, bruxism
– Soft tissue examination (palate, tongue, tonsils, labial incompetence)
– Skeletal examination (ogival palate, endognathia, class II malocclusion)

Sleep recording is the exam used to determine the index hypopnoea apnea (IAH). It confirms the diagnosis of SOA or simple snoring and less than five apneas per hour of sleep. Different types of treatments are offered to the patient based on the severity of the condition.

The treatment options include continuous positive airway pressure (CPAP), mandibular advancement orthosis and tonsillar surgery or surgery of maxillomandibular advancement. The dental surgeon considers the possibility to set up an orthosis. This is determined by the value of dental anchorage, the periodontal quality and the prosthetic state. Orthotics may be indicated for the management of snoring.

Effectiveness of treatment

Orthoses are not as effective as CPAP machines, but require less adaptation and are useful for people with poor tolerance for wearing a CPAP. A MAO device does not replace a CPAP; it can serve as a supplement in the treatment of sleep apnea. It is important to note that sleep apnea can only be treated not cured.

The dentist or orthodontist determines if your dentition and occlusion warrant the use of a MAO. On the other hand, the sleep specialist (often a pulmonologist) is responsible for diagnosing sleep apnea and confirm that your case would benefit from the use of an advancement orthosis.

MAOs are also ideal when the person with OSA cannot use a CPAP. such as when traveling. Once orthosis has been used for a certain period, a polysomnography (sleep test) is conducted to check if the treatment is achieving the desired results.

Physicians can recommend different types of surgery to reduce snoring and apnea, but their effectiveness is relatively low and apneas tend to reappear some time after surgery. There is insufficient evidence that these interventions are recommended for people with mild to moderate sleep apnea. Surgery is not effective for all patients because it may improve or worsen the symptoms.

Documents required to benefit from health insurance cover various aspects, including sleep examination (polygraphy or polysomnography) and request for prior agreement issued by the sleep dentistry specialist.