Oral Appliance therapy for OSA (Obstructive Sleep Apnea)
Obstructive Sleep Apnea (OSA) threatens the health and well-being of millions of Americans. Call Us Today! (425) 329-6497
We Are an Advanced State-Of-The-Art Facility Dedicated to TMJ & Sleep Apnea Treatments.
Dr. David Buck has had comprehensive training in dental sleep medicine. He and his team can work with you to manage the serious disease of sleep apnea.
Dr. Buck is also part of a collaborative team consisting of sleep physicians, sleep techs, sleep centers, ENT physicians and pulmonologists who all combine their expertise where needed to maximally manage obstructive sleep apnea and snoring.
Obstructive Sleep Apnea (OSA) threatens the health and well-being of millions of Americans. When breathing is obstructed during sleep, the amount of oxygen coming into the body is reduced, creating toxic health conditions. Sleep apnea sufferers labor to breath while sleeping and the body does not rest or sleep properly to refresh itself. This affects a person’s health, daily function, work performance, relationships and overall well-being. Sleep apnea is much more than annoying snoring. It is potentially life-threatening.
Dr Buck is one of only a few dentists in Washington state to use a “neuromuscular” based sleep appliance to create the most comfortable and maximally effective oral appliance designed for sleep breathing problems.
Three Types of Apnea
Sleep apnea is very common, as common as adult diabetes, according to the National Institutes of Health. Risk factors include being male, overweight, and over the age of forty. However, sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority of suffers remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant, and deadly consequences.
Sleep Appliance Adjustment Follow-Up
Making Room for The Tongue
Dr. Buck says “It’s like trying to park an SUV in a garage build for a compact car.” That is the way a person’s tongue can fit when a jaw is underdeveloped. So when a person reclines to sleep, the tongue easily falls back to obstruct the airway. When the tongue is properly positioned, there is no obstruction and the person can sleep with normal breathing.
The New MicrO2 Sleep Device
The new MicrO2 Sleep Device (Prosomnus, Sleep Technologies, Patent Pending) is designed to address many of the known opportunities for optimizing the performance of MADs. The MicrO2 is the first sleep device made from a control cured dental grade poly methyl methacrylate (PMMA) material. This material is less porous, allowing the MicrO2 device to be stronger and more biocompatible than MADs made from traditional, cold cured PMMA material. Because the device’s material is stronger, it can be made smaller and more comfortable than traditional MADs. The enhanced material strength also provides the dentist with more treatment flexibility when it comes to optimizing the vertical bite opening.
MicrO2 is also the first precision milled MAD. Precision milling, as opposed to manual fabrication, offers advantages with respect to accurately mirroring the patient’s dentition, delivering the prescription consistently, and making it easier to replace if a device is lost or damaged. The CAD/CAM process enables a new titration method utilizing precise combinations of upper and lower arches, each with different fin offsets, designed to achieve the doctor’s prescription. With enhanced retention made possible by precision milling, ball clasps are optional and the MicrO2 device also features a lingualess design that creates more room for the tongue.
Another noteworthy feature is the 90 degree dorsal fin angle. The 90 degree fin angle is designed to hold the jaw forward in the prescribed position even when the mouth opens during sleep.
Children and Breathing
New evidence clearly shows that certain facial types, such as retruded and narrowed jaws and long faces, can put a child at risk for developing chronic health problems known to be associated with compromised nasal breathing during both wakefulness and sleep.
It is therefore imperative that pediatric dentists, pediatricians and care givers recognize these early warning signs.
• Aggressive behavior
• Behavioral Inhibition
• Executive Dysfunction
• Rule Breaking
• Peer Problems
• Conduct Problems
Additional custom services provided by Dr. Buck at TMJ and Sleep Center of Seattle
A “chew toy” is a used to allow the patient in the morning to work to allow back teeth to fit together if it is difficult to do so after wearing the appliance through the night. This is worn for up to thirty minutes in the morning to allow muscles to accommodate to bring the teeth back together. This is a part of the comprehensive service Dr. Buck uses.
Dr. Buck may recommend a sleep physician to administer a take home sleep study to screen and make initial evaluation of sleep disordered breathing. Depending on the results, the sleep physician may advise the need for an overnight in lab study or may qualify the patient for oral appliance therapy.
Alternatively, if no PSG has been completed, Dr. Buck will require referral to a sleep center for completion of a PSG and physician interpretation before oral appliance therapy begins. It is critical to carefully and thoroughly manage this deadly disease with a team approach.
Sleep Apnea Treatment Sequence: Oral Sleep Appliance Therapy With Prior Diagnosis of OSA by Sleep MD
- The treatment process involves records, history and clinical exam along with dental impressions of the jaws. Dr. Buck will carefully take a calibrated bite to open the airway with instrumentation to start appliance therapy. If greater than 1 year since PSG, Dr. Buck will have the patient see a sleep physician to administer a baseline take home study prior to OAT (oral appliance therapy).
- Delivery of appliance with any adjustments for comfort and fit. Instructions for completion of adjunctive sleep logs, and specific instructions on patient guided titration.
- One month interval checks between months 2-5 for review of sleep logs, physical evaluation and check on appliance. Possible custom calibration of appliance for increased efficiency.
- At completion of titration phase (4-6 mos.), administration of ambulatory/take home sleep study to objectively measure appliance therapy results.
- Possible referral back to sleep physician or other medical professional for further management, or possible of co therapy to increase effective treatment results.
Sleep Apnea Treatment Sequence: Oral Sleep Appliance Therapy Without Prior Diagnosis of OSA
- Consultation and intake screening exam. Possible administration of take home/ambulatory sleep study. Results to be sent to sleep physician for interpretation.
- Referral for PSG and formal diagnosis from certified sleep center and physician (Dr. Buck will consult with sleep physician on course of therapy or therapies to best manage patient).
- If appropriate, records, impressions, and calibrated bite for fabrication of sleep appliance.
- Delivery of appliance with instructions.
Possible Course of Actions After Delivery of Appliance
- Referral back to sleep center for adjustment of CPAP and initiation of co-therapy.
- If Truly CPAP intolerant (presumes moderate to severe OSA) than sleep physician supported Oral Appliance Therapy with supervision to maximal improvement (MMI) in place of CPAP.
- If other nasal airway problems, referral to ENT physician for nasal patency treatment either before or during OAT treatment.
OAT Treatment Considerations
Oral appliance therapy (OSA) is very effective, safe and very well tolerated by patients. These appliances are medically tested and certified as effective in the management of mild to moderate OSA. It is critical to understand that “snoring” guards, or other over the counter devices, including snoring remedies are dangerous at best. The disease of OSA is not a social nuisance, but rather a deadly disease if not treated. By simply attempting to treat snoring, a patient may unintentionally worsen the condition, and hasten serious medical complications.
Dr. Buck also strongly believes that OAT is not intended to supersede or compete with proper management of OSA by CPAP. Some dental sleep treatments are marketed as replacing properly fitted and adjusted CPAP by qualified sleep physicians, this is not in the patient’s best interest.
Take home studies are a good baseline and tool for progress, should not be substituted for medically supervised PSG. Dr. Buck believes all suspect OSA should be diagnosed properly by physicians, and management should be a collaborative, team approach for the best results. Poorly-treated OSA, will still lead to very undesirable medical complications, or contribute to other deadly diseases such as diabetes, obesity, hypertension, stroke and cardiovascular disease.
OAT has few complications. These would include slight movement of teeth and opening of contacts (space between teeth); increase in untreated TMJ related pain such as headaches, jaw and tooth pain, joint pain; changes in bite making the bite not as uniform as before OAT. These are acceptable complications given the serious nature of untreated or poorly treated chronic OSA. Since Dr. Buck is a TMJ expert, he can assist in treating this condition, which commonly accompanies OSA. If TMJ problems were unrecognized before OSA treatment, OAT may unveil this and require subsequent management.
Testing and Follow Up
Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.