Volume 7, Issue 2

SLEEP AND DENTISTRY - Dental Treatments for Sleep Disordered Breathing

For over twenty years Positive Airway Pressure therapy has been the gold standard treatment for Obstructive Sleep Apnea. Although modem CPAP machines are comfortable, quiet and compact, not everyone can tolerate the devices. What is the solution for those who cannot or will not use the therapy? Luckily, there ore alternative treatments.

One of the most common CPAP alternatives for sleep-disordered breathing is called a mandibular repositioning appliance [MRA), or oral appliance. These devices resemble orthodontic retainers and work by repositioning the lower jaw forward during sleep, thereby anchoring obstructive tissue out of the airway and preventing apneas. The devices usually have some sort of adjustment screw or tensioner that allows for minute advancements. A health professional preforms these advancements over time until the breathing is corrected. The devices have been shown to be effective in treating some forms of sleep disordered breathing such as snoring and mild to moderate apnea. Patients with severe sleep apnea might see a reduction in intensity of their apneas, but the problem is likely to remain. For this reason, an MRA is not recommended for severe sleep apnea.

You may have seen the commercials on television for so-coiled "boil and bite" mouth guards that help to treat snoring. These devices are generally not beneficial. To be truly effective, oral appliance therapy must be custom fit to each patient and a qualified dentist must supervise the advancement of the device. Advancing the jaw too far forward too quickly can lead to complications including temporomandibular joint (TMJ) pain.

It is also very important that there be an objective measurement of the treatment's efficacy after initiation. Patients may subjectively feel some relief after using an oral appliance, yet they can still hove significant sleep disruptions. An overnight sleep study should be performed to confirm or refute the efficacy of the oral device. 

When correctly fit and titrated, oral appliances may provide a convenient way of treating mild sleep disordered breathing. They can be also be used in conjunction with PAP therapy to allow for reduced pressures. Oregon Sleep Associates has longstanding relationships with several dental providers in the area who specialize in oral appliance therapy. If you are interested in an alternative to CPAP or ore seeking treatment for the first time, contact our sleep specialists for more information at 503-288-5201.


SLEEP DISORDERED BREATHING AND TMD

Obstructive Steep Apneo (0SA) has been linked to multiple conditions including hypertension, cardiovascular disease, and Type II Diabetes. New evidence shows a correlation between OSA and Temporomandibular Disorder. 

The temporomandibular joint is the "hinge" that connects the lower jaw to the temporal bone of the skull. This joint is flexible, allowing for yawning, chewing, and talking. Temporomandibular disorder (TMD) is a painful condition characterized by tenderness in the face, jaw, neck and shoulders. The pain is often present in or around the ears when chewing, speaking, or opening the mouth. The condition afflicts between 5-12% of the population and may become debilitating enough to warrant surgical intervention in some cases.

Researchers from multiple universities recently conducted a study using the 5-yeor Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) cohort study of over 2600 adults ages 18-44 with temporomandibular disorder. The researchers identified participants as having a high likelihood of having OSA if they reported a history of sleep apnea or had al least two of the following hallmarks of sleep apnea: loud snoring, daytime sleepiness, witnessed apneas, and hypertension.

The results suggest a strong correlation between sleep disordered breathing and TMD. "Men and women with two or more signs/symptoms of 0SA had a 73% greater incidence of first-onset TMD, in relative terms, than those with fewer signs/symptoms, independently of age, gender, race/ethnicity, obesity. smoking history, and autonomic parameters," the study authors explained. "The prospective cohort findings imply that OSA contributes to the onset of painful TMD symptoms."

If you experience jaw pain on a regular basis or have been diagnosed with TMD or TMJ problems, you may be at higher risk for having undiagnosed sleep apnea. Contact Oregon Sleep Associates at 503-288-5201 to schedule a consultation and get screened for the sleep disorder.


BRUXISM MAY BE RELATED TO COMMON SLEEP DISORDER

The dentist has been telling you for years. Maybe you even use a night guard to protect your pearly whites.But new research indicates that teeth grinding, or bruxism, may be a sign of something more dangerous to your health.

Bruxism occurs in approximately 8% of the US population and is not considered a life threatening condition. It can cause excessive wear on the enamel surfaces of the teeth and is usually diagnosed by dentists. Many times a simple nighttime retainer or oral appliance is all that is needed to correct the problem. But researchers recently uncovered a connection between Bruxism and Obstructive Sleep Apnea. They found that nearly 25% of people with Sleep Apnea also grind their teeth at night. The connection may come from the frequent nocturnal arousals associated with Sleep Apnea. "The ending of on apneic event may be accompanied by a number of mouth phenomena, such as snoring, gasps, mumbles, and teeth grinding," said Dr. Shyom Subramanian of Baylor College of Medicine. The researchers also found that teeth grinding is most prevalent in Caucasian males and may also be related to anxiety and heavy caffeine use.

While having bruxism doesn’t guarantee you have Obstructive Sleep Apnea. It may be prudent to watch for signs of the condition. Overly sensitive teeth, painful jaws, and inflammation in the mouth ore all symptoms of bruxism. At your next dental visit, ask your dentist to check for signs of teeth grinding. They can tell you if there is damage to the enamel of your teeth and the best method to prevent it. Then, visit a sleep specialist to make sure you don't have an underlying sleep disorder such as Sleep Apnea.

For more information on Sleep Apnea or to contact a sleep specialist, visit our website at www.OregonSleepAssociates.com.