Obstructive Sleep Apnea - The Dental & Maxillofacial Management

OBSTRUCTIVE SLEEP APNEA - THE DENTAL & MAXILLOFACIAL MANAGEMENT

Obstructive Sleep Apnea (OSA) is due to the blockage and/or collapse of the airway during sleep. There are many different causes of OSA. Please see a doctor trained in sleep medicine or a sleep team in a hospital to determine the cause or causes and severity of your condition. The treatment options are based on the diagnosis.

Dental Splints
Oral Appliance (OA) Therapy for lower jaw advancement

Different types of dental splints are available to treat mild to moderate obstructive sleep apnea (OSA). It looks similar to a sports mouthguard and is worn over the upper and lower teeth during sleep. It is suitable for patients with mild to moderate OSA, with a mainly tongue level obstruction. The patient's gums and teeth must be healthy and table in order for the dental splint to anchor well and push the lower jaw forward.

OA positions the lower jaw forward to open up the airway at the back of the tongue. Adjustments may be necessary in the first few months and the OA may need to be replaced after an average of 5 years.

Patients find it more convenient and easier to cope with OSA treatment using the OA compared with the CPAP breathing machine. However, OA therapy is less effective compared with the CPAP therapy. The common side effects with OA are:

Painful jaw muscles, dry lips, tooth discomfort, and drooling. These side effects are mild but they deter nearly half of all patients from using the OA in the long term.

With long-term use, there will be a permanent change in the positions of the teeth and jaws. The lower jaw protrudes by a couple of millimeters, and the upper and lower front teeth tip inwards and forwards, respectively. There are mild changes to the bite.

In some patients, OA therapy may not be effective and patients should be monitored with sleep studies before and after OA Therapy.

Tooth decay and gum diesease due to poor oral hygience may cause loss of teeth during OA use.

Dental checkups every 6 months are necessary.

Depensing of the type of OA, the cost varies from $600 - $1,200. The fees for consultation and investigation are not included as they are different for individual patients.

Surgical Options
Surgery is sometimes recommended for severe cases of obstructive apnea. It is the next option for patients with moderate to severe OSA who turn down CPAP therapy after finding it difficult to use the CPAP machine. Patients must be medically fit to undergo surgery.

All cases for surgery are examined thoroughly in order to customize the treatment plan. Soft and hard tissue surgery are planned to cater to the needs of each patient. In many instances, the multidisciplinary approach is taken and a team of surgeons is brought in for combined surgery. Sometimes, it may be necessary to stage surgical treatment into separate surgeries done at different times.

Oral and maxillofacial surgeons carry out jaw surgery. The otolaryngology (ear, nose and throat) surgeons carry out surgeries to the nose, palate and throat.

Types of Hard Tissue Surgery
Genioglossus advancement surgery is surgery at the chin. This pulls the tongue muscle forward and creates a larger airway between the back of the tongue and the throat. The tongue is also less likely to fall backwards, resulting in easier breathing during sleep.

Maxillomandibular advancement (MMA) is a more invasive surgical procedure that brings forward both the upper and lower jaws. This pulls on the soft tissues attached to the jaw bones, tightening up the lax tissue at the back of the nose, mouth and voice box. The airway also becomes bigger. The procedure is done using well-established orthognathic (jaw) surgery techniques. Long-term studies have shown a 90% success rate with this procedure.