I
n the last issue of Healthy Cells Magazine, I discussed snoring and sleep apnea and the pros and cons of wearing a CPAP machine or one of its varieties. Again, I want to emphasize that the CPAP is the best option for snoring/sleep apnea sufferers.
In review: Of the many patients who have had a sleep study, been diagnosed with snoring and/or sleep apnea, and have been prescribed a CPAP machine, many cannot tolerate the machine and don’t wear it. A large percentage of wearers stop doing so within three weeks of getting one. This is alarming since the symptoms of sleep apnea can be devastating, even leading to death.
An oral mouthpiece (appliance) offers a viable option to the CPAP, with several advantages. I want to emphasize that the CPAP works best, but if the patient is not going to wear it, there is hope with an oral appliance. An oral mouthpiece is intended to be worn during sleep and is designed to move and maintain the lower jaw (mandible) in a forward position. By maintaining the mandible forward, this opens up the airway and allows much more oxygen to flow into and out of the lungs during sleep. I discussed the advantages of an oral appliance in the previous articles on alternatives to CPAP.
There are some critical requirements that must be met prior to considering if a mouthpiece is your best option, after CPAP:
- You should have a sleep study done first and a discussion with your MD/DO/ENT/neurologist/respiratory specialist
- Not everyone needs a CPAP machine. The sleep specialist will often discuss and recommend a mouthpiece instead of a CPAP
- If you use a CPAP but want an alternative, lifestyle changes such as weight loss, diet, and other health factors need to be addressed
- Over-the-counter sleep mouthpieces with or without supervision are playing with fire. A non-custom made mouthpiece may not work properly and may cause TMJ/TMD symptoms that are permanent
- If you do not go to a general dentist or have dental treatment that has been put off, the treatment of both upper and lower arches (cavities, crowns, missing teeth, etc.) should be restored prior to mouthpiece impressions and construction. If you are fearful of starting or completing dental care, some area dentists, such as Dr. Matt Anderson, feature oral conscious sedation dentistry and comprehensive care to meet your needs comfortably.
- If you have a history of TMJ or are not sure, you should see a dentist who treats both TMJ and dental sleep medicine. Our office specializes in both.
So, after a consultation, a thorough history, and a discussion on financial/insurance policies, what are the next steps to getting the mouthpiece?
I will briefly list the steps involved, and will provide a much more thorough discussion and photos in the next article.
- Examine and chart the upper/lower teeth
- Take a panoramic x-ray, if your dental office has not provided one, to check the integrity and position of both jaw joints, the teeth and their root structures, and the bone support around the teeth
- Palpate (lightly apply pressure) to the facial muscles, neck muscles, and the jaw joints to check for painful trigger points
- Measure mouth vertical opening and lateral motion to check for jaw misalignment or “locking”
- Listen for jaw noises
- Take upper and lower impressions
- Obtain a specialized measured bite of the teeth, with the mandible forward to a predetermined distance (for opening the airway and providing the dental lab, which will construct the mouthpiece, with the proper distance to move the jaws forward
- Send to lab where the mouthpiece is constructed, and once appliance is ready; deliver to the patient, adjusting it if needed, and follow-up.
If you have any questions, or want to discover if you are a potential candidate for an oral sleep appliance, our office provides free consultations.
 |
| Jeffrey Bassman, DDS, PC |
Dr. Jeffrey Bassman has been practicing dentistry in the Quad Cities since 1977, and TMJ and dental sleep medicine since 1985. He limits his practice to only these two specialties. For more information or a FREE consultation, please contact Dr. Bassman at 563-391-1525, by email: jbassmantmj@earthlink.net or visit online: www.jbassmantmj.com.