All about obstructive sleep apnea

Oct. 1, 2008
Do you ever wonder why your dental patients, in ever-increasing numbers, are asking you for help with their snoring?

by Rob Veis, DDS

For more on this topic, go to and search using the following key words: TMJ, obstructive sleep apnea, sleep appliances, Dr. Rob Veis.

Do you ever wonder why your dental patients, in ever-increasing numbers, are asking you for help with their snoring? In today's information age, you can't read a paper, listen to the radio, or watch television without hearing something about the latest device, herbal medicine, nasal strip, surgical technique, or dental appliance being used to treat snoring.

Around 10 percent of adults snore. For most of those afflicted, snoring has no serious medical consequences. But for an estimated one percent, habitual snoring is the first indication of the potentially life-threatening disorder called obstructive sleep apnea (OSA).

Estimates reveal that sleep disorders are indirectly responsible for more than $41 billion lost each year in job productivity, $17 to $27 billion in motor vehicle accidents, $7 billion in work-related accidents, and $2 to $4 billion a year in home and public mishaps. Clearly there is a problem, a nationwide problem demanding immediate and qualified attention.

At the most recent ATPA (Appliance Therapy Practitioners Association) symposium, it became evident, based on attendance at the sleep apnea sessions and frequent interactions with symposium attendees, that interest is high, the buzz is on, and the potential for exploration, innovation, and professional growth in this burgeoning concern are profound.

Sleep disorders: Who you gonna call?

Until recently, sleep disorders, their diagnosis and treatment have fallen under the jurisdiction of physicians. The sad fact is that the majority of physicians received less than one hour of training in sleep medicine as part of their medical education.

On average, during the course of four years of medical school, a mere two hours is devoted to teaching medical students about sleep and sleep disorders.

The medical community typically treats snoring and sleep apnea with the continuous positive airway pressure (CPAP) therapy mask, which has a rejection rate of 50% to 80%. Clearly, there's room for improvement. It's becoming increasingly evident that today's dental practitioner can play a significant role in successfully recognizing and treating snoring and sleep apnea.

New directions

Numerous appliances are now available and viable for treating snoring and OSA, with many more innovations and breakthroughs expected. To reduce snoring and ensure normal daily function, oxygen should be available and excessive daytime sleepiness should be eliminated. Appliances are also appropriate for patients who cannot tolerate CPAP or are unwilling or unable to endure surgery.

Most recently, Dr. Brian Keropian's Full Breath Solution emerged to challenge the usual suspects. Used in conjunction with an accredited sleep study or the FDA-approved home sleep study and pharyngometer, it is designed to gently keep the mouth open and the air passage free to provide just the right amount of tongue restriction and eliminate any jaw pain or TMJ problems.

It has enjoyed phenomenal success, attaining a therapeutic drop in the Apnea Hypopnea Index (which measures the number of times per hour that the tongue blocks the airway for at least 10 seconds).

Sleep appliances: a growing concern

Sleep appliances can provide up to three therapeutic functions. They can reposition the soft palate, bring the tongue forward, or lift the hyoid bone. In repositioning, they act to stabilize the tissues, which prevents airway collapse. Appliances also seem to increase muscle tone.

Appliance designs vary according to desired method of retention, type of material used, method and ease of adjustment, level of vertical control provided, differences in mandibular movement, and whether or not the appliance is fabricated in a lab or office. Concerns factored into design selection include: 1) TMJ health 2) periodontal structures, and 3) number and relative overall health of teeth.

Sleep disorder therapy is no longer an ill-served adjunct of the medical GP. Sleep appliances are, in every sense of the word, a going concern, a technological tsunami building in size and momentum as we speak. Dentists are at the forefront of this new wave, and rightfully so. Not only does it represent a golden opportunity to embrace the new technology and techniques, it provides dentists with a positively platinum opportunity to grow their practices.

Dr. Rob Veis is chief executive officer of The Appliance Therapy Group® (ATG), comprised of Space Maintainers, Inc.®, Success Essentials®, Second Opinion® The Smile Foundation®, and The Appliance Therapy Practioners Association®. For more information, visit or call (800) 423-3270.

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