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Tuesday, December 1, 2015
doctor with patient

Make your Sleep Dentistry Practice More Successful

An overview of the steps taken with the patient to successfully identify, measure and fit an oral appliance to treat sleep apnea

Sleep apnea, a potentially fatal sleep disorder, has historically been treated with CPAP machines that can disrupt a patient’s nighttime routine. As technology and our understanding of the condition have improved, so too have the variety and effectiveness of alternative solutions. The most widely-prescribed alternatives are oral appliances for sleep apnea and snoring. These devices are often suitable for patients with mild to moderate sleep apnea, but can be used in patients with severe obstructive sleep apnea if the patient is deemed CPAP intolerant.

To make your sleep dentistry practice successful, it is known that medical insurance reimbursements and networking with physician are important. However, while those are important considerations, chair side practice management is also important. In this article, we explore the steps dentists need to take to select and fit a dental sleep apnea device while with their patient that will result in both an effective and comfortable solution. The steps assume that your patient has been referred to you by a sleep physician who has recommended they be fitted with a sleep apnea oral appliance. Dentists providing oral appliance therapy must have a written order from the patient’s physician on file before delivering the oral appliance to the patient. 

 

1. Select the Most Suitable Device for your Patient

Each patient will present a unique set of challenges that need to be considered when selecting the most appropriate sleep apnea oral appliance. There are numerous options available on the market all of which ought to be carefully considered. The first step you need to take is to have a discussion with your patient on their quality of life and quality of sleep and their concerns and needs toward treatment. 

Secondly, the size and shape of the patient’s mouth and tongue, in addition to conditions such as bruxism or Temporomandibular Joint Disorder (TMJ), will also guide your selection of the most appropriate oral appliance. A common issue with many sleep apnea patients is a larger-than-average or enlarged tongue. In these cases it’s important to find a device that offers reduced lingual coverage, maximizing the tongue space.

If your patient suffers from bruxism or TMJ disorder, you should prescribe a device that allows for more freedom of lateral movement. It is important to avoid a device that is going to hold the patient’s jaw in one position throughout the night.

Learn more:

  • See Whole You's Sleep Appliance Recommendations Table base on Patient's condition.
  • Read about treating sleep apnea with oral appliances here
  • The healthcare company Whole You, offers a number of sleep appliance solutions and its representatives will be happy to talk through solutions with you, learn more here or by calling 1-844-548-3385

 

2. Take Accurate Impressions and Bite Registration

To make a custom oral sleep appliance, upper and lower impressions of the patient’s teeth are needed. The impressions are a mold that can be made by generic trays and allow the sleep apnea device to be tailored to the patient’s specific needs.

Taking an accurate bite registration is key to the success of how well the device is going to treat the patient’s sleep apnea. It is crucial to get an optimal position for the jaw that enables the best opening of the airway.

There are a number of ways to take an accurate bite registration, one of the most popular is the Airway Metrics combined with an acoustic pharyngometer. This method reveals how certain anterior/vertical mandibular positions increase the airway. While there are other ways to take a bite registration, they don’t have as many options for vertical positions. 

Once your patient is correctly positioned, have him or her make a snoring sound. Then try a different size jig and have him or her make the sound again. Keep repeating this step with different positions, openings and protrusions of the lower jaw until you find what position is opening the airway the best and reducing the snore sound.

Learn more:

  • Visit the Airway Metrics website here

 

3. Fit the Sleep Appliance

Fitting the sleep appliance should only take approximately five minutes. After inserting the device into the patient’s mouth, you will need to check that the bite is correct and that the device fits over their teeth properly. Be sure to provide the patient with care instructions for the device and talk to them to ensure they feel comfortable with the device and understand how they need to use it.

A second follow-up visit is recommended two to three weeks after the initial fitting. During this appointment, you will be able to determine how successful the device is treating the sleep apnea. If the patient reports that they are sleeping better and the device is comfortable, then the device is working effectively.

Learn more:

The above steps give a broad overview of more successful practice from a chairside perspective. However, the key to successfully treating patients with oral appliances can only be achieved through further education. To this end the independent Sleep Group Solutions have regular Dental Sleep Seminars where you can learn more about expanding your practice into sleep dentistry.