Dental sleep medicine is an area of dental practice that manages sleep-related breathing disorders using custom-designed oral appliances. This field requires collaboration between dentists and physicians to address health issues that occur during sleep. It provides an alternative for managing conditions that are anatomical in nature, utilizing a dentist’s expertise in the structure of the jaw and oral cavity.
Conditions Treated with Dental Sleep Medicine
The primary condition addressed by dental sleep medicine is obstructive sleep apnea (OSA), a disorder characterized by repeated blockages of the upper airway during sleep. These blockages occur when the muscles in the back of the throat relax excessively, allowing soft tissues to collapse and obstruct airflow. Anatomical features such as a small or recessed lower jaw, a large tongue, or excess tissue in the soft palate can contribute to this collapse. When airflow is restricted, it can lead to pauses in breathing and drops in blood oxygen levels.
A related condition treated is snoring, which is the sound created by the vibration of these same soft tissues as air struggles to pass through a narrowed airway. While snoring can occur independently, it is often a symptom of OSA. The positioning of the jaw and tongue directly impacts the dimensions of the pharyngeal airway, and modifying this position can alleviate the obstruction.
Oral Appliance Therapy
The main treatment provided within dental sleep medicine is oral appliance therapy (OAT). This therapy involves a patient wearing a custom-fabricated device in their mouth during sleep, similar in appearance to a sports mouthguard or an orthodontic retainer. These appliances are non-invasive and work by repositioning oral structures to maintain an open airway.
There are two principal types of oral appliances used. The most common is the Mandibular Advancement Device (MAD), which fits over both the upper and lower teeth. MADs are connected by a mechanism that holds the lower jaw, or mandible, in a slightly forward position. This forward repositioning tightens the soft tissues at the back of the throat and pulls the tongue forward, increasing the airway space and preventing it from collapsing.
A second, less common type is the Tongue Retaining Device (TRD). Instead of moving the jaw, a TRD directly holds the tongue in a forward position using a soft plastic suction bulb. The tongue rests within this compartment, preventing it from falling back into the throat during sleep. This type of device can be an option for patients who may not be suitable for a MAD due to dental health reasons.
The Patient Treatment Process
Receiving oral appliance therapy begins with a medical diagnosis. A patient must first be evaluated by a sleep physician, who will order a sleep study, known as a polysomnogram, to confirm the presence and severity of a sleep-related breathing disorder.
Once a diagnosis like obstructive sleep apnea is confirmed, the physician may refer the patient to a dentist trained in dental sleep medicine. The dentist will conduct a comprehensive evaluation of the patient’s teeth, gums, jaw, and airway to determine if they are a suitable candidate for OAT.
If the patient is eligible, the dentist will take accurate impressions or digital scans of their teeth. These models are sent to a specialized dental laboratory where the custom oral appliance is fabricated, a process that takes a few weeks.
Upon completion, the patient returns for a fitting appointment. The dentist will deliver the appliance, making initial adjustments for a secure and comfortable fit. Patients are given instructions on how to wear, adjust, and care for the device. Follow-up appointments are scheduled to monitor progress and make further adjustments.
Candidacy for Treatment
Candidacy for oral appliance therapy depends on the specific sleep disorder, its severity, and the patient’s oral health. OAT is most frequently recommended for individuals diagnosed with mild to moderate obstructive sleep apnea. It is also considered a primary treatment alternative for patients who have tried and are unable to tolerate Continuous Positive Airway Pressure (CPAP) therapy, regardless of the severity of their OSA.
Individuals with severe OSA may not achieve adequate results with an oral appliance alone and might require other interventions. Patients must have a sufficient number of healthy teeth to provide a stable anchor for the device to be effective.
Contraindications for a mandibular advancement device include active periodontal disease, significant tooth mobility, or an insufficient number of teeth. Individuals with active or severe temporomandibular joint (TMJ) disorders may not be suitable, as the appliance could potentially worsen their symptoms.