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Role of the Dentist in the management of Snoring
and
Mild 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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