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What are treatments

options?

What are treatment options?

The Continuous Positive Air Pressure (CPAP) device has long been considered the "gold standard" for treatment and management of OSA. The constant air pressure of the CPAP device maintains the patency of the airway, allowing for sufficient airflow to reach the lungs and replenish oxygen to the blood and vital organs. Unfortunately, due to a variety of reasons, patient compliance with CPAP therapy is only about 50%. Claustrophobia, allergic reaction, air leaks, discomfort and general inconvenience are just a few of the reasons cited by many patients who fail to use this life saving therapy.

 

There are a number of relatively invasive "surgical" remedies which attempt to alleviate air flow reduction and stoppages by removing anatomical interferences and maintaining or increasing airway diameter. In our view, these surgeries seem relatively extreme for the benefits gained.  One exception would be in the treatment of OSA in children, where surgical removal of enlarged tonsils and adenoids combined with palatal expansion can prove very beneficial.

 

A third very effective and non-invasive treatment is the use of dental (oral) devices that slightly reposition the lower jaw and tongue forward, increasing the cross sectional diameter of the airway and improving airflow to the lungs. These FDA approved Mandibular Advancement Devices (MADS) are similar in appearance to typical dental night guards. When properly designed, constructed, and accurately fitted to the patient's teeth, these devices can be very successful in the management of this deadly disease.

 

In the 2015 American Academy of Sleep Medicine Practice Parameters, it is a declared STANDARD that sleep physicians may  prescribe ORAL APPLIANCES for patients who snore and don't have OSA and for patients with OSA who are intolerant to CPAP therapy. GUIDELINES state that when an oral appliance therapy is prescribed by a sleep physician for an adult with OSA that a QUALIFIED DENTIST use custom designed, lab fabricated,  titratable appliances and provide oversight and follow up detect and manage any dental related side effects and ultimately determine the therapeutic effectiveness of the device.

 

How can dentists help?

In a number of ways, dentists are uniquely qualified to man the frontline in the battle against OSA.

 

  • In many instances, patients often see their dental professionals more often than their medical counterparts. Generally, at least twice a year, dentists have the opportunity to interact with, examine and evaluate their patients dental health and, to a significant degree, the overall physical health and well being. During the typical dental re-care visits, in addition to addressing all dental concerns, dentists routinely update medical histories, citing, evaluating and discussing any new or changing medical conditions and issues. Since nearly 90% of OSA conditions are undiagnosed, dentists have the best possible scenario to thoroughly screen their patients for this deadly condition.
  • Since the majority of causative factors of OSA are located in the oral cavity and upper airway, dentists are well qualified to evaluate this area to determine any anatomical conditions that increase the risk of OSA. This area of the body and most of the tissues that are problematic are centered perfectly in a dentist's  "wheel house" and area of expertise.
  • Since one of the more preferred treatment options for this condition is the fabrication of an oral device that minimally but precisely alters lower jaw and tongue position, who better to accomplish that task than a dentist specifically trained in dental sleep medicine treatment protocol ?