A rapidly increasing number of dentists are finding that incorporating the treatment of sleep disorders into their practice fits in with their goal of improving the overall health of their patients (see the article on dental sleep medicine by Dr. Suzanne Haley here). Oral appliance therapy is a well-established method for the treatment of snoring and obstructive sleep apnea (OSA) caused by a constricted or collapsed airway, which can be screened for in the dental office and diagnosed by a physician.1 By bringing the lower jaw or tongue forward to open the airway, dental sleep appliances have demonstrated improvement in various health outcome measures, such as daytime sleepiness and blood pressure.2 Many patients prefer mandibular repositioning therapy to continuous positive airway pressure (CPAP) therapy,3 and this patient preference provides an excellent opportunity for dentists to become involved in the rapidly growing field of sleep medicine.
Dental sleep appliances have demonstrated improvement in various health outcome measures, such as daytime sleepiness and blood pressure.
With a variety of dental sleep appliances offered by Glidewell Dental, doctors have many options for the minimally invasive treatment of OSA and snoring. For example, the Silent Nite® sl, EMA® and dreamTAP™ appliances (Glidewell Laboratories; Newport Beach, Calif.) are available to treat both snoring and OSA, while the aveoTSD® device (Glidewell Direct; Irvine, Calif.) is intended for snorers (Table 1). Although doctor preferences and patient needs dictate which appliance will be recommended, the Silent Nite sl is the No. 1 prescribed dental sleep appliance at Glidewell Laboratories due to its comfort, effectiveness and affordability (Table 2).
To select the correct appliance for each patient, Dr. Suzanne Haley, a recognized expert in sleep dentistry, suggests that doctors consider the following at the treatment appointment:
- Tongue space
- Airway opening
- Comfort of the appliance
- Durability of the appliance
- Ability of the appliance to keep the lips together
With many solutions for providing dental sleep therapy to patients, here are some key takeaways for each appliance:
- The Silent Nite sl appliance is used to treat snoring and mild or moderate sleep apnea. The device is made from a soft/hard frame that is durable, BPA-free and very comfortable for the patient. “The appliance is designed to position the mandible forward by using Side-Link connectors that are attached to both the upper and lower trays,” said Dr. Haley. “Silent Nite is perfect for snorers and mild sleep apnea; it’s not for heavy bruxers.”
- The EMA appliance is used to treat both snoring and mild or moderate sleep apnea. The appliance opens the patient’s bite and moves the mandible forward. “The elastic straps aid in keeping the mouth closed, advancing the mandible, and allowing lateral movement,” explained Dr. Haley. “The EMA allows tongue space and is not recommended for heavy bruxers.”
- The dreamTAP appliance is also used for the treatment of snoring and OSA, with a design that affords more tongue space for the patient. The device offers three hook sizes to increase the range of adjustment. “This appliance is perfect for snorers, as well as mild, moderate or severe OSA patients — particularly those who may be CPAP-intolerant,” said Dr. Haley. “It’s perfect for bruxers and grinders.”
- Finally, the aveoTSD tongue-stabilizing device is used to treat snoring. Available in three sizes, it gently suctions the patient’s tongue, preventing it from settling back into the throat and obstructing the airway. “This is a great appliance for snorers and patients in orthodontics,” said Dr. Haley. “No impressions are needed, and it’s delivered on the same day as the appointment. It’s perfect for snorers.”
Oral appliance therapy has inspired many dentists to offer a holistic approach to patient care. Whether the patient requires treatment for snoring or OSA, dentists are successfully implementing dental sleep medicine into their practices.