Snoring Isn't Sexy [Insert City]
Snoring isn't sexy - Neither are cardiovascular disease, high blood pressure, diabetes, stroke, depression and even erectile dysfunction. Nor are the accidents caused by the drowsy driving related to sleep apnea. And now a new study has shown that loud snoring itself can have devastating consequences. An article published in March, 2008 stated that loud snorers had 40% greater odds of having hypertension, 34 % greater odds of having a heart attack and 67 % greater odds of having a stroke than people who did not snore.
It doesn't matter if you are a man or woman (although men do snore more), or young or old or thin or heavy, snoring and sleep apnea can affect everyone - even young children! Snoring can be a sign of obstructive sleep apnea. It's not just unsexy. It's unhealthy. But you're not alone, which is why we've created this resource.
Dentistry now plays a critical role in the recognition and management not only of snoring but also obstructive sleep apnea.
Snoring can be a hazard to your health, but it is treatable.
About Dr. [Insert Doctor's Name]
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Snoring
Snoring is the sound of obstructed breathing during sleep. Sometimes snoring can be harmless, but generally it is a danger sign that indicates a serious problem which progresses from upper airway resistance syndrome (UARS) to OSA.
SnoringSnoring occurs when the structures in the throat are large and the muscles relax enough during sleep to cause the airway to narrow and partially obstruct the flow of air. As air tries to pass through the partially collapsed airway, the throat structures vibrate causing the sound we know as snoring. Large tonsils, a long soft palate and uvula, certain jaw formations and excess fat deposits contribute to the collapsibility of the airway.
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea occurs when the airway completely collapses during sleep and airflowNormal Airway stops entirely. Since no air can be drawn into the lungs, the oxygen level in the blood drops which eventually signals the brain to partially awaken in order to stimulate the throat muscles to open and clear the obstruction. This usually happens with a loud gasp or choking sensation. Once the airway is open, breathing and sleep can resume. However, the relaxing Obstructed airwayinfluence of sleep affects the throat muscles as before and this process starts again and continues over and over all night. People with OSA experience disrupted sleep and periodic drops in oxygen levels each night. This is associated with cardiovascular disease and excessive daytime sleepiness. The condition known as upper airway resistance syndrome (UARS) lies midway between snoring and true OSA. People who suffer from UARS suffer many of the symptoms of OSA but do not really have OSA.
I Can't Wear my CPAP
Now there is an effective way to control snoring and obstructive sleep apnea without resorting to cumbersome CPAP devices. A small device, similar to an orthodontic appliance, can be an alternative to cumbersome CPAP machines and, in some cases, be the first choice for treatment of mild to moderate obstructive sleep apnea.
CPAP problems
Continuous Positive Airway Pressure (CPAP) is generally considered the mainstay of treatment for obstructive sleep apnea. However, in almost half of the cases where it is prescribed, it is poorly tolerated or simply rejected due to its cumbersome and intrusive nature.
Other objections include:
* Inconvenience
* Nasal Congestion
* Sinus Problems
* Skin Irritation
* Claustrophobia
* Mask Leaks
Overview of Oral Appliance Therapy
Oral appliances have been in use for over 20 years to effectively treat snoring and obstructive sleep apnea. Currently, over 40 different appliance designs are available to specially trained dentists for this use. Many scientific studies have been published that demonstrate the effectiveness of these appliances when utilized by trained and experienced sleep-disorders dentists.
Oral appliances are placed in the mouth much like an orthodontic retainer or an athletic mouth guard. They are utilized during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat so that the airway stays open during sleep. The appliances promote adequate air intake thereby helping to provide normal sleep for those who suffer from snoring and/or obstructive sleep apnea. Oral appliances can be used alone or in combination with CPAP or after surgery. Determination of proper therapy can only be made by joint consultation between your sleep-disorders dentist and your sleep physician.
Types of Oral appliances
Of the many appliances available today, each falls under one of two categories based on mode of action. The first and largest category is that of the “mandibular repositioning device”. By far the majority of all appliances in use today fall into this category. These devices serve by gently repositioning the lower jaw forward during sleep. The second category is that of the “tongue retaining device”. These appliances are seldom used but can be very effective for many people, especially those with few or no teeth or jaw joint problems. Tongue retaining devices function by protruding the tongue forward during sleep.
Appliances used in our office
- TAP -Thornton Adjustable Positioner
- PM Positioner
- Elastomeric
- TRD - Tongue Retaining Device
The TRD is lab constructed of a flexible polyvinyl material adapted to the general contours of the teeth and dental arches. It does not depend on teeth for retention. Rather, the tongue is held forward by the negative pressure created in the vacuum bulb on the front of the appliance.
The appliance is available in four tongue extensions and with or without air way tubes for patients with compromised airway patency. It is constructed in conjunction with the Kel Gauge (described in another section of this program.)
Since the mandible is not rigidly or firmly held by the appliance, freedom of movement is possible during use. This would seem to make the TRD a good choice for the edentulous patient, the patient with periodontal disease and the patient with temporomandibular joint dysfunction.
There is ample research available documenting the effectiveness for treatment of snoring and OSA in certain patients.
Hide TRD - Tongue Retaining Device - Somnomed
The SomnoMed MAS is a custom-made device, consisting of upper and lower dental plates with a unique patented fin-coupling component, which allows normal mouth opening and closing. If required, a part can be added to make the device adjustable. This feature provides incremental and adjustable levels of lower jaw advancement, which improves the effectiveness and comfort-level of treatment as the jaw is moved only as far as is required to alleviate snoring and reduce OSA. Key features and benefits of the device include: Permits normal mouth opening Allows speech and drinking Provides full lip-seal Easily adjustable Safe and effective Clinically proven Custom-fitted Additionally, the SomnoMed MAS is made from durable fade-proof acrylic that retains its shape and color for at least four-five years and is covered by a two year manufacturer's warranty.
FDA Approval received July 2005
Hide SomnoMed - EMA
The Elastic Mandibular Advancement (EMA®) appliance uses elastic force to advance the mandible. Hand plastic trays are pressure formed to the patient's models and utilize the undercut areas of the teeth for retention. This insures that there will be no movement of the patient's teeth. Bite planes are used to open the bite. Mandibular advancement is achieved with different length straps. The elastic pull can also be adjusted to suit the patient's musculature. The straps provide complete lateral movement.
The EMA® - Custom is available only to dental professionals
FDA Approval: Approved for both Snoring and OSA
Date of FDA Approval: Sept. 29, 1997
FDA Registration Number: K971794
Hide EMA
The Thornton Adjustable Positioner (TAP®) oral appliance is a mandibular advancement device composed of two separate arches (maxillary and mandibular) containing an advancing mechanism which permits unlimited advancement of the lower jaw. The arches are custom fit to a patient's models. The advancing mechanism is engaged and the screw mechanism in the upper tray is then turned to advance the mandible until the patient begins to feel any discomfort in the temporomandibular joint or in the facial muscles (maximum mechanical protrusion which is an average of 2.5mm beyond maximum protrusion). The advancing screw is then turned back until patient is comfortable. Hide It
The Adjustable PM Positioner™ utilizes materials and a design that minimize office chair-time and provide the patient control of adjusting the jaw position under the dentist’s supervision. Research studies have shown that this appliance is successful in treating 77% of patients with moderate obstructive sleep apnea. The appliance fits over all maxillary and mandibular teeth and is made of a special acrylic material (Bruxeze™) that softens in hot water to provide a combination of comfort, strength, and retention. This material has proven to be very durable. Expansion screws are located on the right and left buccal areas to allow maximum space for the tongue and easy anterior-posterior positioning of the mandible to achieve optimal effectiveness. This design permits ample lateral and protrusive movement to maintain jaw comfort.
The device uses a unique method of retention consisting of small projections of acrylic within the device that comfortably grip the undercut areas of two posterior teeth in each quadrant. Therefore, no metal clasps are necessary. Hide It
Constructed in a dental laboratory, it is made of a very pliable soft, custom-injected silicone and is tooth retained. There are no clasps or wires to adjust. The flexibility of the material lends itself to a high degree of patient comfort. The Elastomeric appliance is not protrusively adjustable. The vertical opening is 5 mm and the mandible is afforded some limited movement due to the high flexibility of the material.
Proven effective by the University of Kentucky Medical Center Sleep Apnea Laboratory. Recommended for partially edentulous patients and non-bruxers. Hide It
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