Dental Therapy for Obstructive Sleep Apnea

ABSTRACT

This article reviews the history of dental therapy as it has led up to currently available options for the treatment of sleep-related breathing disorders with an emphasis on oral appliance therapy. Over the last 20 years and in particular the last 5 to 7 years the contribution as well as the effectiveness of oral appliances has impacted the treatment of sleep apnea and at the same time provides an alternative for many patients. The focus here is to examine oral appliances and the role they have as it may be delivered by the dentist with an interest as well as the expertise in dental sleep medicine.

KEYWORDS

Oral appliance(s) - mandibular repositioner(s) - tongue retaining device - functional appliance - obstructive sleep apnea syndrome - sleep-related breathing disorder(s)

REFERENCES

• 1 Graber T, Rakosi T, Petrovic A. Dentofacial Orthopedics with Functional Appliances. St. Louis, MO; CV Mosby 1985: 151
• 2 McNamara JA Naso-Respiratory Function and Craniofacial Growth. Center for Human Growth and Development, The University of Michigan, Monograph Number 9 Ann Arbor, MI; Michigan University Press 1979: 27-40
• 3 Cistulli P, Palmisano R, Poole M. Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion.  Sleep. 1998;  21 831-835
• 4 Cartwright R, Samelson C. The effects of a nonsurgical treatment for obstructive sleep apnea.  JAMA. 1982;  248 705-709
• 5 Bailey D R. Dental management of sleep disorders. Dentistry Today 2002 (Nov): 88-93
• 6 Friedlander A, Walker L, Friedlander I, Felsenfeld A. Diagnosing and comanaging patients with obstructive sleep apnea syndrome.  J Am Dent Assoc. 2000;  131 1178-1184
• 7 Center for Devices and Radiological Health, U.S. Food and Drug Administration . Class II Special Controls Guidance Document: Intraoral Devices for Snoring and/or Obstructive Sleep Apnea: Guidance for Industry and FDA.  Bulletin. November 12, 2002; 
• 8 White D et al.. Pharyngeal resistance in normal humans: influence of gender, age and obesity.  J Appl Physiol 1985. 58 365-371
• 9 Schwab R. Imaging for the snoring and sleep apnea patient. In: Attanasio R, Bailey D Sleep Disorders: Dentistry's Role. Dental Clinics of North America. Philadelphia; WB Saunders 2001: 759-796
• 10 George P. Selecting sleep-disordered-breathing appliances: biomechanical considerations.  J Am Dent Assoc. 2001;  132 339-347
• 11 Tsuiki S, Almeida F, Bhalla P, Lowe A, Fleetham J. Supine-dependent changes in upper airway size in awake obstructive sleep apnea patients.  Sleep Breath. 2003;  7 43-50
• 12 Frantz D. The difference between success and failure.  Sleep Review. 2001;  2 20-23
• 13 Ohayon M, Li K, Guilleminault C. Risk factors for sleep bruxism in the general population.  Chest. 2001;  119 53-61
• 14 Fransson A, Tegelberg A, Svenson B, Lennartsson B, Isacsson G. Influence of mandibular protruding device on airway passages and dentofacial characteristics in obstructive sleep apnea and snoring.  Am J Orthod Dentofacial Orthop. 2002;  122 371-379
• 15 Rose E, Staats R, Virchow C, Jonas I. Occlusal and skeletal effects of an oral appliance in the treatment of obstructive sleep apnea.  Chest. 2002;  122 871-877
• 16 Catlin G. The Breath of Life. New York; Wiley 1861
• 17 Schmidt-Nowara W. Recent developments in oral appliance therapy of sleep disordered breathing.  Sleep Breath. 1999;  3 103-106
• 18 Henke K, Frantz D, Kuna S. An oral elastic mandibular advancement device for obstructive sleep apnea.  Am J Respir Crit Care Med. 2000;  161 420-425
• 19 Menn S, Loube D, Morgan T, Mitler M, Berger J, Erman M. The mandibular repositioning device: role in the treatment of obstructive sleep apnea.  Sleep. 1996;  19 794-800
• 20 Marklund M, Sahlin C, Stenlund H, Persson M, Franklin K. Mandibular advancement device in patients with obstructive sleep apnea.  Chest. 2001;  120 162-169
• 21 Mehata M, Qian J, Petocz P, Darendeliler, Cistulli P. A randomized, controlled study of a mandibular advnacement splint for obstructive sleep apnea.  Am J Respir Crit Care Med. 2001;  163 1457-1461
• 22 Tan Y, L'estrange P, Luo Y et al.. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial.  Eur J Orthod. 2002;  24 239-249
• 23 Ferguson K, Ono T, Lowe A, Keenan S, Fleetham J. A randomized crossover study of an oral appliance vs nasdal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea.  Chest. 1996;  109 1269-1275
• 24 Clark G, Blumenfeld I, Yoffe N, Peled E, Lavie P. A crossover study of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea.  Chest. 1996;  109 1477-1483
• 25 Millaman R, Rosenberg C, Carlisle C, Kramer N, Kahn D, Bonitati A. The efficacy of oral appliances in the treatment of persistent sleep apnea after uvulopalatpharyngoplasty.  Chest. 1998;  113 992-996
• 26 Wilhelmsson B, Tegelberg A, Walker-Engstrom M et al.. A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea.  Acta Otolaryngol. 1999;  119 503-509
• 27 Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review.  Sleep. 1995;  18 501-510
• 28 Schnidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances.  Sleep. 1995;  18 511-513
• 29 Bucca C, Carossa S, Pivwtti S, Gai V, Rolla G, Preti G. Edentulism and worsening of obstructive sleep apnoea.  Lancet. 1999;  353 121
• 30 Travel J, Simons D. Myofascial Pain and Dysfunction The Trigger Point Manual. Baltimore; Williams and Wilkins 1983 183-281 and 305-320