Sleep is taken for granted by those not affected by obstructive sleep apnea. Unfortunately for tens of millions of Americans, sleep is a nightly struggle which leaves its victims and their bed partners fatigued, stressed and much less healthy.
Untreated sleep apnea is one of the major public health issues we face as a nation. The emergence of dental sleep medicine as a safe and effective treatment brings hope for the millions of patients looking for alternatives to CPAP treatment. Dr. Nugent can help you get a good nights sleep.
American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine Clinical Guidelines:
Recommendation: Sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without OSA).
When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, AASM/AADSM suggests that a qualiﬁed dentist use a custom, titratable appliance over non-custom oral devices.
When Oral Appliance Therapy (OAT) is indicated, the sleep dentist should fabricate a mandibular advancement device (MAD) that is adapted for the patient’s unique occlusion, periodontal health and parafunctional habits such as bruxism and TMJ status. The ability to titrate the oral appliance is essential for proper airway management. Over the counter “Boil and Bite” solutions are contraindicated.
AASM/AADSM recommends that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with OSA who are intolerant of CPAP therapy or prefer alternate therapy.
Approximately 50% of patients using CPAP ultimately fail. Unless these CPAP failure patients seek treatment with Oral Appliance Therapy they will likely develop the common comorbidities and risk factors of untreated OSA.
The sleep physician should refer the CPAP patient to a sleep dentist with a prescription for a custom oral appliance, letter of medical necessity, and CPAP Intolerance afﬁdavit.
AASM/AADSM suggests that qualiﬁed sleep dentists provide oversight — rather than no follow-up—of oral appliance therapy in adult patients with OSA, to evaluate for dental related side effects or occlusal changes and reduce their incidence.
The sleep dentist should provide follow up observations of their patients using oral appliances. The most common side effects of OAT are TMJ and jaw discomfort, changes in occlusion and tooth mobility.
Once the oral appliance has been inserted and fully titrated to maximize the airway, the patient should be referred back to sleep physician for a sleep test to conﬁrm the efﬁcacy of the oral appliance.
AASM/AADSM suggests that sleep physicians and qualiﬁed dentists instruct adult patients treated with oral appliances for OSA to return for periodic ofﬁce visits— as opposed to no follow-up—with a qualiﬁed dentist and a sleep physician.
Thus, patients using oral appliance therapy (OAT) to manage their OSA should be instructed to have their oral appliance checked on a regular basis. This will conﬁrm patient compliance, appliance integrity and monitor common side effects of OAT including TMJ, Occlusal changes and tooth mobility
Dr. Nugent can work with your doctor and offers alternatives to your CPAP. If you can’t wear you CPAP call our office today at 832-487-0647. Visit us at 3421 Burke Rd #1, Pasadena, Texas 77504.