Snoring and sleep apnea

One of the more popular products in the lab is the Silent Nite appliance, which is used by dentists to stop snoring.

One of the more popular products in the lab is the Silent Nite appliance, which is used by dentists to stop snoring. Recently, I interviewed Dr. Michael Alvarez, who uses the Silent Nite. For Dr. Alvarez, who practices in Fremont, Calif., half of his general dental practice consists of sleep dentistry. He uses the appliance for those who snore, and as an introductory appliance on patients with sleep apnea. I spoke with Dr. Alvarez about sleep dentistry and the future of the field.

MD: I have been told the gold standard in treatment of sleep apnea is a CPAP (Continuous Positive Airway Pressure) machine. Can you talk about this machine?

MA: CPAPs are excellent, but they are best for people with severe sleep apnea. At its annual meeting last June, the American Academy of Sleep Medicine presented a position paper that said the first line of therapy for people with mild to moderate sleep apnea is an oral appliance, not a CPAP. The machine has lost its gold standard for those with mild to moderate sleep apnea.

MD: That’s huge.

MA: It’s so huge. We don’t have enough dentists. With this position paper, we don’t have enough dentists in the country to take care of these patients. So, the work you are doing is so important.

MD: Are there any good Web sites that might serve as a place for dentists to learn about dental sleep medicine?

MA: The American Academy of Sleep Medicine (www.aasmnet.org) and the Academy of Dental Sleep Medicine (www.dentalsleepmed.org) Web sites are excellent sources for dentists who want to get involved with this work. There is a protocol at the Academy of Dental Sleep Medicine in which board certification is needed. We work with the American Academy of Sleep Medicine. In turn, the academy acts as our advisors. So there is a whole avenue of experts in this field. Some dentists don’t want to get involved with all this. I think the best approach for them is to learn to not go into a lot of details, but rather to know that there are dentists they can refer to if they have a problem. It’s like trying to perform an endo, and you get stuck, so instead you send the patient to a specialist.

MD: How can treating something like sleep apnea improve the overall health of a patient?

MA: For people who have sleep apnea, there’s a direct link to cardiovascular problems such as heart attack and stroke. There is a greater mortality rate for anyone who has untreated sleep apnea, and a direct link to cardiovascular accident. This is already in the literature. It is nothing new.

MD: It’s amazing that this area of dentistry, which is unknown to so many dentists and still relatively young, seems to be one of the biggest areas that can affect the health of a patient and even be a life or death situation.

MA: In the future, for generations of patients who do not have many fillings and who have straight teeth because they have had ortho, dentistry is going to move to this type of work. This is already happening. The American Academy of Sleep Medicine has said that for people with mild to moderate sleep apnea, the first line of therapy is to see a dentist. While it will take time for this position paper to reach doctors and dentists, eventually this is going to happen.

MD: For people who have sleep apnea and deal with daytime sleepiness, what do they say after their conditions have improved significantly with an oral appliance?

MA: Well, it’s a complete shift. The quality of life for these people changes dramatically. People cannot thank me enough. I think it is one of the most rewarding fields in dentistry because we can help a person without picking up a drill to work on his or her teeth. It’s just a very satisfying feeling when people or their spouses come in, or they send candy or flowers, thanking me for helping them. Many of these are men who are such tough guys. They try to contain their excitement, but I know they are so happy.

MD: Dental journals often refer to growth centers. Do you think sleep dentistry is a great growth center for a general dental practice?

MA: Yes. In 10 years, I believe that it’s going to be one of the major growth centers because Baby Boomers will already have their veneers and crowns in place, and then dentists won’t know what to do.

MD: I imagine you enjoy deriving some 50 percent of your income without having to touch a handpiece or a drill.

MA: It’s pretty cool.

Dr. Michael DiTolla is the Director of Clinical Research and Education at Glidewell Laboratories in Newport Beach, Calif. He lectures nationwide on both restorative and cosmetic dentistry. He also teaches hands-on courses on digital photography and digital image-editing for the entire team. Dr. DiTolla has several clinical programs available on DVD through Glidewell. For more information on this article, or to receive a free copy of one of Dr. DiTolla’s clinical DVDs, e-mail him at mcditolla@mac.com.

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