Custom-made, Fully-adjustable Dental Splints for managing
Obstructive Sleep Apnoea (OSA) and Snoring
Why Dental SleepMed?
Individualized Dental Care
Obstructive Sleep Apnoea (OSA) is a very under-recognised condition and can carry significant health risks. Snoring, whilst not medically harmful, can significantly affect personal relationships.
At Dental SleepMed, we are dedicated to transforming the lives of individuals who suffer from either condition with Custom-made Fully-adjustable Dental Splits, where they are indicated.
As Snoring can occur with or without OSA, it is important to establish and understand which condition is present for each individual, as often they are treated and monitored differently.
We assist with the diagnostic process together with our Surgical, Sleep Physician and Sleep Clinic colleagues. Our aim is to find the best solution for every individual patient.
Obstructive Sleep Apnoea (OSA)
Loud snoring can disrupt restful sleep, but it can also indicate an underlying medical condition called Obstructive Sleep Apnoea (Apnea) or OSA.
What Is OSA? As we begin to drift off to sleep, the muscles of the throat mouth and tongue relax. As a result, the tongue drops back and in some individuals, the airway can partially, or even completely block. This can result in a choking pattern and in some instances, breathing can completely stop. This can lead to a condition called Obstructive Sleep Apnoea or OSA. When you cannot breathe properly, the body signals the brain to awaken so it can restore the oxygen levels and the normal respiratory function. Unfortunately, this can prevent the body from drifting into the restful REM (Rapid Eye Movement) sleep-state, which is critical in rejuvenating many bodily functions.
Though many people are unaware of these waking episodes throughout the night, they can occur dozens or even hundreds of times.
Reduced oxygen throughout the night negatively impacts on many of the body's systems, which can increase the risk of serious health issues such as:
• Obesity
• Hypertension
• Stroke
• Irregular heartbeat
• Heart failure
• Depression
• Headaches or migraines
• Chronic fatigue
• Anxiety
• Motor vehicle accidents
Signs and Symptoms of OSA
Because of the seriousness of OSA, recognizing the signs and symptoms is important. Some of these include:
• Daytime fatigue
• Inability to concentrate
• A sore throat on waking
• A partner noticing pausing in breathing
• Loud snoring
• Headaches on waking
• Feeling of choking during the night
• Weight gain
• Bruxism (teeth grinding)
Diagnosis
A Polysomnograph (PSG) Sleep Study tracks the quality of sleep by recording a number of parameters including brain function, oxygen levels, heart rate, air flow, chest and jaw muscle effort, snoring volume and eye (REM) and leg movement during sleep. Sleep studies are conducted either at a Sleep Clinic or with various home testing devices. Dr Andrew Findlay and his Dental, Surgical and Medical GP colleagues work together with the Respiratory Physicians and the technical team at University of Otago WellSleep Centre . Wellington's well-respected Sleep Organisation to assist patients in getting the most suitable treatment to optimise their sleep health and improve their normal bodily functions. The Respiratory Physicians will recommend appropriate treatment based on the severity of the individual's OSA and other medical and clinical factors.
Dental Assessment
Do You Suffer from OSA ?
If you recently received a diagnosis of OSA and a Dental Splint has been recommended, or your partner notices pauses in your breathing during sleep, or they complain of your loud snoring, we welcome you to contact our Wellington Dental Clinic to learn how we can help you enjoy a restful night’s sleep.
Initial Consultation Appointment
When we receive a patient enquiry or patient's Specialist Medical Referral about their Snoring or OSA, we arrange an initial Consultation Appointment to discuss in detail their individual problem. We review the medical information and undertake a thorough dental assessment, which usually includes a scan of the jaws, teeth, jaw joints and an examination of the teeth and mouth anatomy to determine if they are suitable for a successful splint therapy. For the referred Medically diagnosed patients, if a splint is indicated and they prefer to begin without delay, we can complete the documentation and begin the process of making the splint right-away.
For self-referred patients, who have not had formal Medical advice or a Sleep-test , it is very difficult to rule-out with 100% certainty the presence or absence of hidden OSA, even if their condition appears to be only "Simple Snoring". So if no stone is to be left unturned, we almost always recommend a referral to a Sleep Clinic for a medical opinion and appropriate testing so that a more formal diagnosis can be made.
It may well be that CPAP therapy is preferred over a dental splint.
Treatment
Sleep Therapy usually falls under the following categories:
· CPAP devices
· Dental Splints, including Mandibular Advancement Splints (MAS)
· Tongue (suction) retaining Devices (TRD)
· Surgical Intervention
· Certain Medications
· Lifestyle changes, including weight loss, avoiding sleeping on the back
Dental Splints
Oral Appliance Therapy for OSA
Studies show that well-designed Oral Appliances can often be a very effective, comfortable and convenient option in managing an individual's OSA. They can be a good alternative for those patients who find CPAP machines too intrusive or difficult to tolerate. At Dental SleepMed, we offer Custom-made, Fully-adjustable "Mandibular Advancement Splints" (MAS) which are known to be more effective than the more rudimentary, self-fitted "Boil-and-bite" devices available at retail outlets.
Mandibular Advancement Splint (MAS)
There are many splint designs world-wide and most work on the same principle of holding the lower jaw and tongue forward to open the airway and allow normal breathing to occour during sleep. This will improve the all-to-critical “REM” restorative sleep. We determine which splint is the most suitable, however we mostly provide splints from the Somnodent splint range. The many creditable studies give us confidence in their effectiveness and this has certainly been our experience in clinical practice. Patients often report that the appliances are comfortable, easy and discreet to use.
DentiTrac Compliance Recording
In some instances it is desirable to track the compliance of oral appliance therapy. A small DentiTrac sensor can be incorporated into the splint so it can capture data which helps follow the daily use of the splint and how its effectiveness could be refined. This information is stored securely in the Cloud.
Initial and Long-term Monitoring
Dental Side-effects
As part of our initial treatment consent process, we make you aware that, whilst dental splints can be very effective at managing OSA, this may not be the case for some individuals. There can be several reasons and combinations of reasons, why this might be the case. These have a recognised incidence and can include- but are not limited to- :
- Difficulty in tolerating the splint as an object in the mouth
- Known occurrences of unwanted dental side-effects such as : Jaw joint pain or clicking; tooth movements ; bite changes and changes in chewing function.
- the influence of life-style changes over time, including fluctuations in body weight and alcohol or sedative substances
- Development of other medical conditions and the use or changes in certain medications over time
- Adaptation and changes of the throat and tongue tissues.
- Advancing age
Research and studies are often conflicted over the incidence and significance of these occurrences, so we adopt a cautious approach and insist patients return for an initial follow-up appointment , to identify any concerns, give appropriate advice, test, refine and adjust the splint to optimise its effectiveness. We place great importance on the initial and on-going long-term assessments and this is so-much so, that we encourage patients to return for their first review by providing it at no cost. Further reviews are recommended, which would attract a fee and the regularity of these appointments would depend on the initial observations. Once the function of the splint is optimised and the pre-treatment symptoms have resolved (Snoring; daytime tiredness; witnessed pauses in the breathing by a bed-partner etc ), we make a considered decision whether the OSA has been successfully managed. Whilst in most cases this assessment is clinically adequate, it is a subjective assessment, so one cannot establish with 100% certainty that the OSA has truly been resolved. Depending on the OSA severity and the Medical recommendations, some patients are referred back to the Sleep Clinic to verify the effectiveness of the splint with repeat sleep-study tests and/or further advice.
Long-term Monitoring
As time passes, in some individuals their OSA or snoring conditions can tend to re-emerge despite splint adjustments and it is necessary to give consideration to other alternatives. Often we collaborate with a patient’s Dentist or Dental Hygienist to detect the need for a referral back to our dental clinic, or to the patient's GP, Sleep Physician or Surgeon.
Anti-Snoring Appliances
What if your partner reports loud snoring but you do not have OSA?
Most often snoring is just that and it does not carry any health risks. It can however, significantly affect personal relationships and this is the most common reason why patients seek our help. Some studies indicate however, that there is a 20% incidence of OSA with those that snore.
We need to make a considered decision if the snoring could be regarded as “Simple Snoring” or if there is a possibility of hidden OSA, in which case a referral for Medical advice and (usually) sleep testing, are appropriate before consideration is given to dental splint therapy. We use the same Dental Splint to alleviate or lessen your snoring so that you and your partner can comfortably sleep in the same room. This can improve personal relationships by eliminating the need for one partner to escape to the sofa midway through the night!